Chocolate and Liquor

His life revolved around his family, his traditions and his wheelchair. As a young man in Russia, he lost one leg during the Siege of Leningrad. As an older man, he lost the other to severe blood-vessel disease. Now, as an immigrant who spoke no English, he was dependent on his daughter to push him from place to place and to explain all of the inscrutable American customs along the way. I think he found us all to be very amusing.

Like many other Russians of his generation, he loved his vodka, his cigarettes and his traditional foods. In the months before I met him, his voice had changed from a joyous baritone to a coarse whisper. The growing cancer had taken away his voice and was affecting his swallowing. His eyes betrayed the universal sense that the things he loved deeply might soon be taken from him.

His treatment was difficult; he was not well and the recommended surgery and radiation therapy initially made things worse. For the first several weeks, he could neither talk nor eat. His dependence on his family grew, and he became very discouraged.

Gradually, though, he recovered. He brightened visibly as his voice returned - not to the rich tones of his youth, but to the point where he could sing the old folk songs to his grandchildren. His swallowing and sense of taste improved. He was able to eat many of the foods he remembered from his mother's kitchen. Some of the touch points of his world had, at least in part, returned to him.

"You are doing very well," I would tell him at his follow-up visits. "I see nothing that worries me at all. The cancer is completely controlled." He eyes would move anxiously from my face to his daughter's, waiting for her to translate my words into his mother tongue.

"The doctor says everything is fine," she would say in Russian.

Sometimes, at this point in the encounter, he would smile broadly and reach into the bag he had kept poorly hidden by his side since rolling into the examining room. From within, he would pull a gift and press it into my hands with surprising force. "Spasiba!" he would exclaim. Thank you!

The first time this happened, I was very surprised. I looked at the gift, a small box of specialty chocolates and a bottle of liquor. "I can't accept this!" I protested. "Please! This is not necessary!"

The daughter intervened. "Doctor, this is my father's tradition! Good news is always celebrated with chocolate and alcohol. You have given us the best news possible today! My father wants to share his celebration with you. Please accept! He truly will not understand if you do not."

I sputtered briefly as I reflected on the situation. Celebrate good news with European chocolates and a pint of Goldschläger? What a concept! It didn't take long for things to come into focus. "Hmmm," I thought to myself. "This seems like a remarkably fine tradition!"

I opened the box of chocolates and offered them to the others in the room. "Spasiba!" I repeated back to him.

He did not bring gifts every visit, but often enough, to be sure. The colleagues with whom I shared the gifts jokingly wondered whether or not we might ask him to return more frequently for check-ups.

Several years have passed since he died of heart disease, but I clearly recall his delight and how he used gift-giving to keep one of his traditions alive in a land far from home. The gesture deeply ingrained both his image and his graciousness on me.

I have had several thousand patients pass through my practice over the years and, I admit, I remember some much better than others - some I do not remember at all. However, one of the most memorable was the wheelchair-bound Russian-speaking survivor of both war and cancer who celebrated good news with chocolate and a toast.

"Spasiba," I think again, and, sadly, "Dasvedanya."

Bruce H. Campbell, MD, FACS
Medical College of Wisconsin Professor of Otolaryngology and Communication Sciences and Chief, Division of Head and Neck Oncology

Dr. Campbell practices at the Froedtert & The Medical College of Wisconsin Otolaryngology and Communication Sciences Clinic, the Zablocki VA Medical Center, and the Surgicenter of Greater Milwaukee.

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.