From the Wards
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For Pappou: A Reflection on Loss During the Clinical Years

It was just a week into our third-year rotations and my class was eagerly awaiting our Step 1 scores while adjusting to the beginnings of our clinical responsibilities. When the day came that our scores were to be released, I received a phone call from my aunt who told me that my Pappou (grandfather), who was in Greece on his yearly summer trip, had collapsed on his veranda and was en route to a local hospital. Immediately, hundreds of different diagnoses popped into my head as I worried about everything from his diabetes to the possibility of a stroke.

Later that evening, my aunt called back to update me about the situation. Physicians at the local hospital believed that my Pappou had a subarachnoid hemorrhage. But, because they didn’t have a CT machine at the hospital, they were going to send him to another local hospital to confirm the diagnosis. In the meanwhile, my father and uncle were booking tickets to try to get to Greece as soon as possible.

I anxiously awaited another phone call and, around 8:30 p.m., my aunt called back. She informed me that they had rushed my Pappou to Thessaloniki, the nearest large city, because the smaller hospitals were not equipped to handle a subarachnoid bleed. She then broke the news to me that he had passed away shortly after his arrival. She told me that my uncle had received a phone call from the hospital while he and my father were sitting on the tarmac awaiting takeoff.

There was a long pause and I held back my tears. My Pappou and I were very close. This was a surreal and wrenching moment. As we both cried for a few minutes, I got off the phone to answer a call from my mother who had called to bear the same bad news. Even the second time around it did not seem real. I then took on the responsibility of calling my younger sister to let her know. It was a day that I’ll never forget.

After experiencing alternating anger and sadness for about an hour, I quickly realized that this was just the beginning of what would be a long and difficult ordeal. I knew that it was going to be hard to get the body back to the United States, but that it would be even harder to afford the time off from my first clerkship to travel to Massachusetts to adequately mourn and be there with my family for the wake, the funeral and visitors.

I was correct in my thinking. It took us nearly 10 days to get my Pappou home, and I knew I couldn’t feasibly take more than a day or two off from the clerkship, so we scheduled the wake for a Friday and the funeral the next day. Being the first-born grandchild and the closest to my grandparents, I wrote a eulogy in honor of my Pappou that I shared during the traditional Greek fish dinner that followed the funeral.

Although my story is not a story of patient interaction, or of an experience on the wards, this whole experience exemplifies the intricate connection between our work and our lives. Those of us in the health care profession have entered into a field that requires us to make many sacrifices, whether it be late nights, weekends or holidays. Experiencing the loss of my Pappou, while learning to balance this magnitude of work, was a difficult task. I was not able to spend as much time with my family as I would have liked during these difficult times, but the responsibility we take on as young physicians is extensive. We are required to make these sacrifices to help improve and save the lives of others.

I can certainly say that I’ve seen myself grow as an individual and as a young physician over these past few months. My time management, leadership skills and even interpersonal relationships have blossomed with each history and physical. I am no longer lost and uncomfortable in my short white coat. Rather, I am able work my way into any health care team in a “well-oiled” manner. My clinical experiences have shown me what it is to take care of another human being while remaining a devoted family member and good friend to others. I wanted to share this story as a story of loss in medicine because familial losses are just as trying as the losses we experience in the clinic and because our struggles in dealing with such matters overlaps with our clinical duties.

The following is my eulogy to my Pappou. Although difficult to read again, I wanted to share it with the readers of in-Training in honor of the lessons he taught me and his undying pride and support of my medical career.

From July 23, 2012 – For Pappou (Panagiotis Meltsakos)

Before I share with all of you some of my thoughts, I’d like to share the words of a Ralph Waldo Emerson poem that I remembered reading in high school entitled “To laugh often and much.”

To laugh often and much;

to win the respect of the intelligent people

and the affection of children;

to earn the appreciation of honest critics

and endure the betrayal of false friends;

to appreciate beauty;

to find the best in others;

to leave the world a bit better

whether by a healthy child,

a garden patch, or a redeemed social condition;

 to know that one life has breathed easier because you lived here.

This is to have succeeded.

Why did I want to start with this poem? Well, written and spoken language remain inadequate to express the whirlpool of emotions that the human mind and soul may experience, but this poem at least serves as a starting point to discuss the magnitude of Pappou’s contributions to our lives. From the time I was very little, Pappou had always shown me how to succeed. Whether it was putting a smile on my face while playing with my sister and I during childhood or, more recently, the way he would sit me down over lunch to talk with me about my goals in life and the “paths that lay before me,” Pappou always wanted to instill within me the power to succeed.

Though his words, carefully chosen and perpetually succinct, offered great insight into his philosophies, it was Pappou’s presence that seemed to have the most profound effect on me. Pappou was the kind of person you could quietly sit next to on a veranda for hours and not speak a word with, but remain in a state of mutual understanding and appreciation for the world and the details that surround us that words cannot capture. I can recall many of these moments over my lifetime, but the most powerful moments come from the summer of 2005 that I spent with Yia Yia and Pappou in Greece. I often think back to those moments spent sitting out on the balcony in the afternoon, either before or after some mezedes, just looking down at the garden below and the river just beyond. I remember simply taking in the details, sights, sounds and smells and appreciating the comforting presence of Pappou next to me, while simultaneously chuckling in my head at Yia Yia yelling at us to get into the shade. I am grateful for the evenings spent with Pappou sipping Greek coffee or frappe at the “Pappoudes” Kaffenio (grandfather’s coffeehouse). Through his silent observation of the world around us during these moments, he taught me that we should not be alive, yet blind to the life we are living, but rather that we should celebrate life and appreciate the moments we can capture.

To me, this short time period marked the most personal growth that I’ve experienced in my life to this date. It was a period of time marking my growth from adolescence to young adulthood. I strengthened a relationship with my Yia Yia and Pappou that brought me closer to each of them than I could have possibly imagined. It was after this experience that I truly came to appreciate the etiology of the word “grandparents.” Our forefathers were wise in their careful selection of language, because grandparents are nothing but a second set of parents. They are there to help love you, nurture you, and to assist you in your development to the best of their ability. It’s unfortunate that, far too often in modern society, we forget this. Too many times we don’t appreciate the depth of love, knowledge, and experience that our elders offer. I am so grateful for having realized this in my youth and for making the most of my relationships.

Pappou’s careful observation of the world around him oftentimes went unnoticed. At Christmas or Pasxa (Easter), I would routinely glance over at Pappou, either sitting at the head of the table or by the arni (lamb), intently and proudly watching and listening. He would briefly offer his input in conversations and then return to that state of profound pride and observation. From the time I was about 14 years old, each year at Pasxa, it was almost an unsaid rule that I would help Pappou to cut the lamb and clean the souvles (kebab skewers) after. I loved these moments because, as we worked in unison, oftentimes after the others had brought the food inside, I was able to spend one on one time with Pappou, watching, learning, and listening in the same fashion he demonstrated by his careful enjoyment and observation of the world around him.

Pappou fostered and taught me much over the course of my life, and I’m so grateful for everything he has done for me. His passing marks one of the most difficult days of my life, because there was so much more that I was hoping to give back to him. I was looking forward to making him proud upon my medical school graduation, or sharing smiles with him on a wedding day, and even one day introducing a great-grandchild to him because I know these would be the most profound and valuable gifts I could offer for all of the knowledge, love, care and pride he’d shown to me throughout my life.

But we cannot dwell on what could be or the plans we intended on, for life is as much a mystery as death is. We must take solace in knowing that Pappou lived a long life full of love, care, pride, and happiness. I am forever grateful for making sure that I was never too “busy” for a phone call or lunch date. I am forever grateful for the kind of man I have become, in part due to the lessons of my Pappou.

Though Pappou may not be here with us in the physical realm, he is far from absent. He lives on in each and every one of us: in memory, in thought, in lessons and laughs. The greatest gift we can offer to Pappou is to celebrate his life and to try to embody his hard work, dedication, passion, love, kindness, and perpetual appreciation for the world around him each and everyday.

So as we weep and mourn the loss of a great man, I figured I’d part with a final quote by Washington Irving that is more than fitting at this point:

“There is sacredness in tears. They are not the mark of weakness, but of power. They speak more eloquently than ten thousand tongues. They are messengers of overwhelming grief … and unspeakable love.”

Chris Meltsakos Chris Meltsakos (2 Posts)

Contributing Writer Emeritus

New York Medical College

Born and raised in Massachusetts, Chris grew up loving sports and having a passion for knowledge. He recently graduated from Boston University with a BS in human physiology and is now a member of the Class of 2014 at New York Medical College. In addition to spending most of his free time at the gym, Chris enjoys writing and reflecting upon his experiences as a young medical professional as well as offering his insight and knowledge regarding sports medicine, athletics, and the principles of training.