At large family gatherings, like the Passover Seder, people tend to sit in generations.
The elders are at the head of the table. Middle-aged people next, where they can stage manage the serving and clearing. Teenagers tend to sit where they can make a quick exit when the meal starts to drag, and young children and their parents are stuck at the end often on a card table recruited when everything else is full. I am now truly at the top of the Seder table. Except for my 98-year-old Auntie there are no survivors of my parents’ generation. The same is true of my medical elders. The men and women who shaped me as a physician are mostly gone.
In the past month two giants of Canadian medicine have passed away, Dr.Michael Klein and Dr. Apostolos Papageorgiou both of whom I am proud to call my teachers and mentors.
Today, though, I am going to talk about Dr. Papageorgiou. I first met Apo as a young and impressionable medical student, in my neonatal intensive care rotation. We would round for hours, stopping by each incubator. Apo would grill us asking a series of questions, a process that is now disparaged as “pimping.” In Apo’s case, however, it was true Socratic teaching. He would guide us through the case, getting us to understand what was happening by linking the clinical presentation to the underlying disease. “You know it.” He would say. “Just think pathophysiologically!” We would then repair to the break room to listen to each other’s presentations on common clinical problems in neonatology while drinking coffee flavoured with baby formula. He made us realize that we did understand, that we could reason things out, that there was a link between the tens of thousands of facts that we had ingested in our first two years of medical school and the living, breathing, incredibly tiny patients we were caring for.
Later when I returned as an intern, pregnant with my first child, between the 26th and 30th weeks of my pregnancy, he would offer me a rolling stool to sit on during rounds as I almost passed out from prolonged standing in the heat of the nursery. I would go from incubator to incubator, visualizing my baby in utero as I pumped miniature doses of caffeine into the fragile veins of the tiny translucent babies to help them breathe. “We’re both happier after our coffee break” I would whisper. It was then that I realized that every night at around 10 p.m. Dr. Papageorgiou would always call, “How are the babies?” he would ask in a gentle voice. “Are they all breathing? Are they sucking well?”
I realized that he could not go to bed without being sure that everything in the NICU was under control. He first noticed me when, on the advice of, Deanna the assistant head nurse, I told him that the tiny little 26-weeker I was caring for was looking “floppy.” After we diagnosed and treated his meningitis I knew he saw me as a good person and a good student. I remember a night we struggled for hours trying to save the lives of a pair of tiny twins, who were the exact gestational age of the baby in my belly. He was kind when I fell apart when the little boy twin died. He guided me in one of my first confrontations with the death of a child. The little girl twin survived and taking care of her in the NICU was a surreal experience. As we fought for her life through all the dangers and complications of extreme prematurity, I kept envisioning my own fetus growing safely, I hoped, in the much better incubator of my womb. Many years later, at my daughter’s high school graduation, I recognized the mother of those twins sitting behind me. Next to her was the healthy girl, with her mouth full of braces, who had been that tiny baby. I almost cried.
Later as staff, when there were cutbacks to the number of pediatric residents, the NICU hired members of our FMOB group to do night call. It was a scary but very lucrative gig. Every night at 10 o’clock Dr. Papageorgiou would call, still checking that all was well.
I still teach using his methods. I try to link clinical reasoning to pathophysiology, to have differential diagnosis come from understanding of first principles. I like to help the students and residents understand that they already know it. They just have to reach inside themselves to become their best selves as physicians.
I hope that as I carry the memory of Dr. Apostolos Papageorgiou inside me that I am passing his legacy down the generations.