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EmailNazi-era Memory
Michael Gordon, MD, FRCPC
Vice President Medicine and Head, Geriatrics and Internal Medicine,
Baycrest Centre for Geriatric Care
Professor of Medicine
University of Toronto
As age-related dementia sets in for many who survived the Holocaust, a geriatrician finds that, for these patients, recollections of that period seem more current than yesterday
On the patient's left forearm, the pale blue Auschwitz number could still be seen. She would not agree to the pacemaker even though she had collapsed four times and her symptomatic sick-sinus syndrome was so easily treated. She had survived vivisection experiments during her concentration camp internment and refused any surgery. We appealed to her son. Although he agreed with the need for treatment, he did not want to go against his mother's wishes. "I survived the Holocaust, I will survive this," she said when asked why she would decline such a simple, safe and life-saving treatment. Some members of the health-care team felt strongly that we should heed her wishes, others felt that we must treat her.
Isn't it time to forget about the Holocaust? It was so many years ago. Is there anyone left to whom it really matters?
It is common to hear people make such comments. There have been recent special reparation payments agreed to by German companies involved in Nazi-period slave labour. Are the payments meaningful or symbolic and does it matter any more to those who live with the memories of slave labour, mass murder and concentration camps? All who survived the Holocaust were deeply scarred by it. All carry the profound trauma with them but have coped over the years in different ways. Some have never managed to escape the impact on their lives and their experience colours everything they do. In their later years the horror of their experience may begin to be incorporated into their daily travails.
Some years ago I was hospitalized in Toronto with a back condition. While waiting on a stretcher to be taken by the orderly to the therapeutic pool, I heard a patient in the next room screaming, "No, no!" The orderly asked him why he was shouting so much as he was just going to take him for a "shower." Every time the orderly repeated this phrase, the patient screamed out more frantically, "No, no!" The panic was palpable. I heard this on two occasions and could detect the patient's eastern European Yiddish accent. I suddenly realized that the patient was responding to the word "shower" in a way that reminded him of the past. He may have believed the "shower" offered by the orderly was the same as in the camps—it was used as a euphemism for the exterminating gas chambers. I told the nurse who informed the orderly and the word "bath" or "wash" was substituted for "shower." The screaming stopped.
With cognitive decline the success of memory suppression, which may have worked as a coping mechanism, begins to fail. One Polish-born patient with Alzheimer's disease was getting along fine with full-time help at home until the helper with whom she spoke English became ill. The family found a replacement, a lovely lady whose mother tongue was Polish, which they thought would be perfect as in the past their mother spoke Polish when necessary. She even once had a Polish-speaking housekeeper. Suddenly their mother was screaming and threatening to kill herself and wouldn't let the woman in the house. She told them: "Why should I speak Polish after all they did to me?" The children were baffled. They could not understand that the loss of the ability to deal with the present made the past feel immediate. The suppressed associations with the brutality she experienced in Poland became real when she heard Polish being spoken. Some patients draw on the strengths that originally helped them cope with their medical problems today. Years ago, I looked after a patient who survived in the woods of Czechoslovakia for almost four years during the Holocaust years. He once told me how he lived in caves and ate what he could find including insects, berries and small animals. He frequently hid in dangerous and precarious places when he heard soldiers on the lookout for fugitives. Occasionally he could hear someone being caught, often beaten or summarily shot. When liberated, he immigrated to Canada when he discovered the community he had come from no longer existed. The only surviving family member was his young daughter who had been kept in hiding by some non- Jewish neighbours and whom he found after the war. They came to Canada where he became a successful businessman.
He came to live in Baycrest Terrace, the residence at Baycrest Centre for Geriatric Care in Toronto. He had angina which became more symptomatic. He benefited from each new treatment that became available, such as calcium channel blockers. He was a model patient, using nitrates before activities and undertaking all his efforts in a carefully determined manner. Finally he reached the point where he was not controlled on maximal anti-anginal therapy and had angina at rest. Angiography revealed four-vessel disease. The cardiologist's letter to me, which said he was not suitable for surgery, estimated about a 25% chance of dying from the surgery.
I read the letter to the patient. He looked straight into my eyes and said, "Does a 25% chance of dying from the surgery mean I have a 75% chance of surviving the surgery?" I nodded. "Those are great odds," he said. "I hid in the woods of Czechoslovakia for four years and every day I had a 99% chance of dying, so I'll take those odds." I told him I would make another appointment for him to see the surgeon and that I would write a letter. I told him to dress the way he usually did, suit and tie, and tell her what he just told me. Two and a half weeks after his bypass and pacemaker insertion for post-operative heart block, he was back in the Terrace, without anginal symptoms.
Another recent experience confirmed for me that actions of survivors cannot be readily predicted. I began to see a man some years ago because his family thought he was acting in a peculiar manner. He and his wife were both survivors but hardly mentioned their suffering. Suddenly the father began to focus on his concentration camp experiences and started writing poems and stories in Yiddish, Polish and English and talking to everyone about what he had been through. His family was distraught and assumed he had "flipped." During my interview with him it was evident he was cognitively intact with no psychotic features. He had come to believe that in the few years left of his life the "world should know" that it was real and that no one should be allowed to deny it. This quest to tell became an obsession for him but was giving energy and new meaning to his life.
With his permission I explained to his children what I thought was going on and that they had to find a way to support his efforts. I explained to him that he had to respect their need to find ways to cope with this new aspect of his life. At every visit to my teaching clinic he brought in new stories and poems and finally his self-published autobiography. The postgraduate trainees in my clinic, most of whom were not Jewish, were mesmerized by him and told me they had never had a comparable clinical experience.
He had severe and incapacitating pain during walking which was diagnosed as spinal stenosis. When surgery was first suggested, his children characteristically expressed their opposition to it, in a way clearly reflecting their desire to "protect" him. Eventually the pain was unbearable and unrelieved by all medical interventions. He requested surgery.
He had an appointment with me about three weeks after the surgery. I happened to be in the corridor when he arrived, accompanied by his son, walking briskly, upright and without a cane. I could not believe it. He told me that he had his surgery, on the day before Passover. The day after surgery, he said he wanted to go home and it seemed that no one objected to that request. He said he was taking only acetaminophen once in a while for pain. As I spoke to him and commended him on his wonderful recovery he looked at me with a half smile: "You know, doctor," he said, "surviving a concentration camp is good training for any surgery." I could not find an answer.
Most clinicians have some patients with remarkable histories of trauma and courage from different eras and many parts of the world. For those who survived the Holocaust, there is a special meaning to their lives because so many lost most or all of their friends and families and are now aging. Illness and death often has a special and sometimes strongly symbolic meaning for this population and for their families: "After what they survived—this?" The first patient described above was evaluated psychiatrically and felt to be incapable of making an informed decision about the pacemaker because of her fixation on her Holocaust experience. Her son agreed to the pacemaker. She was scheduled for it to be inserted, but had a fatal cardiac arrest before it could be done. One could say her Holocaust experience proved fatal to her, 50 years after the fact.
VOLUME 36, NO. 38, November 14, 2000