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Veteran obstetrician speaks a language of his own

THEO PANAYIDES meets a Nicosia gynaecologist who sees medicine as a Greek tragedy and philosophy as the basis of life

Doctors speak a language of their own, says Dr Sotos Demetriou – and proves it by speaking of super cubic catheters and tocolytic therapy, Bishop scores, ESR and vaginal swabs. Sotos is a gynaecologist and obstetrician, founder and managing director of the European Medical Clinic in Nicosia, and he’s been around. Just one of the hospitals where he’s worked over the years – Baragwanath Hospital, just outside Soweto in South Africa – had 100-140 deliveries a night, most of them examined and dilated (and sometimes delivered) by Sotos himself. He was there for four years, part of his decade (1978-88) in South Africa followed by 30 years in Cyprus. All told, the number of people whom he’s helped bring into this world runs into the hundreds of thousands.

“I remember, I put my arm up to here!” he recalls of one memorable birth, ‘here’ being up to the shoulder – and where he put it is exactly where you’d imagine he put it. “To take and deliver a retained second twin, which was transverse lie. The first twin came out, the second one didn’t want to”. ‘Transverse lie’ is more mysterious doctor-talk, meaning in a sideways position (as opposed to head-down); the second twin was comfily ensconced in its mother’s belly – and, as the hours passed, drastic action was called for. “I put my arm through an open cervix,” he explains, “up there – and when you put an arm inside the uterus, you don’t go for any other part except the toes. You check the feet. You never go for face, head [or] hands”. The trick is to take one foot, check to find the big toe, go next door to the other big toe, then grab with two fingers like a hook and pull, dragging out the recalcitrant twin.

Easy to imagine Sotos doing something so drastic. Easy to imagine him doing anything – because, despite his bespectacled look and halo of white hair, he comes across as a bit of a maverick. Another of his stories has to do with another mother of twins, a 40-year-old Spanish woman living in London who was absolutely desperate for kids; after years of trying, she finally managed to conceive – but the doctors in Britain ruptured the waters of one baby during amniocentesis, then (to “terminate the problem,” says Sotos scathingly) put pressure on the mother to abort. She was only about 16 weeks pregnant, and at a loss what to do – but Sotos, called on to advise by the woman’s sister-in-law in Cyprus, noted that her test results were good, and urged her to resist the doctors’ pressure and refuse to terminate. Easy to imagine the London doctors grumbling darkly about this Cypriot peasant sticking his nose in their business – but Sotos was vindicated when the woman gave birth to two healthy babies, including the one whose waters had been ruptured. “What is my price?” he says with feeling, using ‘price’ to mean something like ‘reward’. “You think it’s the money, Theo? This is my price!”

We speak in his office, with seven diplomas (from Greece and South Africa) on the wall and family photos on the shelf beside him. His eyes bulge behind thick glasses; the face seems to taper away at both ends, into a receding hairline and a long, rather droopy chin. He was born 65 years ago in Famagusta (he’s a Libra, so he’ll turn 65 in a couple of months), the youngest of four. His dad was a senior land surveyor and a man of few words, already in his 50s when Sotos was born, felled by a heart attack when the boy was 14; his mum – whose photo appears three times on the shelf above his desk – seems to have been a strong woman and a powerful presence in her son’s life, accompanying him to Athens (where he studied) and even, briefly, South Africa. Sotos himself has three children, in addition to the hundreds of thousands he’s helped deliver: a daughter and two stepsons, the latter two taken on after marrying their widowed mother in 1990.

He is, it must be said, an unusual person. The line about doctors speaking a language of their own applies doubly to him – as, for instance, when he talks of his wife Maria (to whom he’s devoted) and asserts, out of all possible compliments, that “I’ve never met anybody in my life who is so thoroughly clean”. Not just physically clean, of course, but pure of heart: “You cannot corrupt my wife!”. It’s a token of love – but still, an unusual thing to single out. (Maria is also “well-educated”, having studied at St Hilda’s in Oxford, and her two boys – now grown up – are also Oxbridge graduates; Sotos has a thing for good education.) He and his stepsons seem to have bonded quite smoothly – he explained straight away that he wasn’t there to replace their dad, merely to fill the gap left behind by his death – but some of his stories still give me pause, like the time when the older boy was missing his father and Sotos consoled him with the thought that at least he was lucky enough to have his mother, citing another boy in his class who’d lost both parents in a car accident! The sentiment, of course, is well-founded (always look at the glass as half-full), but it still seems a rather morbid way to cheer up a grieving seven-year-old. I suppose it worked at the time.

My impression, even in our brief acquaintance, is of a distinctive personality, sensitive to slights and utterly devoted to his work. The practice of medicine, for him, is a form of euphoria: “tension, tension, then release, like a Greek tragedy”. At the same time – and possibly related – he’s not easy-going, or necessarily a round peg in a round hole. He had a torrid time in Greece after his studies, partly because of the culture of negligence there (doctors “discussing politics and football”) but also because he’d made the mistake of correcting a senior consultant over an X-ray early in his tenure, “and ever since then, he didn’t like me at all”. Sotos isn’t the type to keep quiet: I see it even in our interview, when an assistant brings me a frappé and he points out that “there’s too much froth, you’ve shaken it too much!”. He’s not quite reprimanding her – he laughs as he says it – but he still points it out; the assistant smiles and departs, obviously used to his ways.

Even in South Africa, he was known for being demanding, getting upset if he felt the care was sub-standard. “They loved me, all those black patients there, they loved me a lot,” he says (he had white patients too, but he’s talking about Soweto), “though they couldn’t pronounce my name… They said, when they came to the hospital, ‘We want to be seen by this doctor – what’s his name? The one [who’s always] shouting too much!’.”

He shouted, but he also listened – and South Africa was the making of him as a doctor (and indeed a human being), says Sotos reverently, an intense youthful decade that taught him compassion and decency as well as the art of obstetrics. He lists some of his mentors, their names still fresh 30 years later. Professor Driscoll, who advocated patience and letting Nature take its course as far as possible. Professor Collet, who’d call Security if a patient tried to offer him money. Another, unnamed professor, who said the following: “You want to become a good doctor? Don’t look at your watch! Never! Don’t look at the dates. Don’t look if it’s Saturday or Sunday, you’re a doctor.” Above all there was Dr Bmbere – a black physician in apartheid-era South Africa – who asked Sotos to assist in a carcinoma operation on a black patient, and took the opportunity for a little human-rights lesson. “You were in Greece. The stomach in Greece, is it different from this one?” asked Dr Bmbere, pointing to the patient’s exposed organ, then did the same with the liver and the gall bladder. “So then why,” he asked, once Sotos had admitted that the organs looked identical, “should humans be treated differently, because of their race or nationality?”.

It’s a good lesson, though in fact one he already knew from his childhood in Famagusta. His family were religious, and widely assumed to be nationalistic – but he also recalls going to the hospital with his mum as a very young boy, and seeing both Greek and Turkish Cypriot mothers sitting on a bench with their newborns, distinguishable only by the colour of their headscarves. “And I remember one Greek mother, her baby crying a lot. Crying a lot, non-stop. The whole hospital [could hear], ‘waaah!’. And this Turkish Cypriot said” – he gestures with his hands – “‘Give it here’. She took it, gave it milk. Because the Greek Cypriot didn’t have milk. As soon as it got milk – it was hungry – the baby went quiet”. Sotos sits back, his point undeniable: “So tell me, after this big lesson, Theo: what’s the difference? What creates nationalities?”

History, I suggest.

“History,” he repeats. “Who writes the history? Humans. Humans! And let me tell you – human rights, justice, truth.” He shakes his head: “Don’t exist. We created these things… If we look inside ourselves, inside our country, then we solve these problems. But we don’t look”. People talk of ‘justice’, he says sadly, when it comes to the Cyprus problem: “I say ‘OK, go find your justice’. In theory! [But] we must compromise in life. We must learn to live next to each other. We must learn to respect each other.”

This is politics, of course, and whether you agree will depend on your own politics – but in fact Dr Sotos Demetriou isn’t political, the lessons he describes being merely an extension of his life experiences. He comes to this with a near-unique worldview: the worldview of someone who’s observed, hundreds of thousands of times, that we’re literally all the same – all of us born as helpless, undefined, morally identical babies. “You need philosophy. Philosophy is the basis of life,” he tells me, his own philosophy being perhaps a serene detachment from all things partisan and ideological.

Not that he’s ‘philosophical’ in the sense of relaxed, however; quite the opposite. He’s not – I repeat – easy-going, and I’m struck by how strongly he still feels the insults he suffered in Greece in the 70s at the hands of senior doctors (most of them probably dead by now): Dr Mendoulas, who tapped him with a steel rod when inexperienced Sotos couldn’t do a D&C womb cleaning, Dr Papademetriou who threw a box-file at him and “swore at me, with the worst words you can imagine, in front of the patients… I was so much insulted that day that I went home, and I wet pillows and pillows!”. And of course, like all Famagustans, he has bitter memories of 1974 – both the first invasion, when he served as a nurse and saw awful things (he recalls a lorry coming to the hospital gates piled high with corpses, and the driver being told to bury them all in a mass grave), and the betrayal of the second invasion when soldiers and police withdrew from Famagusta en masse, leaving the bemused Turkish troops to take over an abandoned city.

There’s so much else to talk about: more on South Africa, and the startling respect for medicine in a racist regime – but also, for instance, the recent rise in Caesareans over natural delivery (about 60 per cent of births in Cyprus are now C-sections, roughly twice as much as it should be), or the challenges faced by obstetricians in the age of IVF, and let’s not even start on abortion and ‘when does a foetus become a baby’. I don’t even really get to ask why he chose gynaecology in the first place – though I do repeat a friend’s feminist complaint that men shouldn’t be allowed to be gynaecologists, and get the kind of amused response you’d expect from a 65-year-old veteran: “Through the centuries, who loved most and sacrificed everything for women? The men! Go back to Helen of Troy, go back to history”.

“These days, it’s fashionable to say –” I begin, but he cuts me off.

“No, no. We don’t go with fashions. We go with feelings.”

In the end, maybe that’s the key to defining Sotos: a man of feelings more than ideas, a maverick who says what he feels, a sensitive soul who feels hurt (or love) to the point of seeming thin-skinned, a doctor whose devotion to the work goes beyond Hippocratic oaths to that feeling of euphoria which (he assures me) only doctors get to feel. Not that his feelings are so strong these days. Does he ever become truly angry, or upset? “When I was young,” he shrugs. “But now, I would say – like in the song ‘My Way’, ‘when tears subside’ – you know, ‘everything looks so amusing’.” Dr Demetriou smiles, his youthful tears mostly subsided. Bishop scores, vaginal swabs and a pinch of Frank Sinatra: truly a language of his own.

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