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EmailMemory and Duty
Michael Gordon, MD, MSc, FRCPC
Vice President Medical Services and Head, Geriatrics and Internal Medicine
Baycrest Centre for Geriatric Care
Professor of Medicine, University of Toronto
Member, University of Toronto, Joint Centre for Bioethics
Reprinted from the October 20, 2001 issue of the Canadian Medical Association Journal
Memorial sculpture outside the former SS barracks in Terezin.
The medical students told me they couldn’t do a history on the elderly patient. She was a recent Russian immigrant and spoke no English. They had done the physical exam, but they knew the history was key to figuring out her problem. On a surmise, I spoke to her in Yiddish. She understood. And so I proceeded to take her history, using the basic Yiddish I had learned as a youngster from my grandmother.
She was from Lithuania, the birthplace of my grandparents. When I mentioned the village of Eishyshok, she said it still existed but had no more Jews. I knew this. The 3446 Jewish inhabitants of the village were executed by the Nazis on September 25 and 26, 1941.
I asked my students if they noticed anything that might help them assess this woman’s medical problems. No one had noted the faded blue number on her left forearm. When I pointed it out, only two of the six students could explain its meaning. They could also suggest diseases that might have been contracted during what had been, as we learned, a three-year interment in Auschwitz.
My first contact with concentration survivors occurred when I was seven years old. It was a summer evening; my grandmother, with whom my sister and I shared a bedroom in our small Brooklyn apartment, was singing Polish, Russian and Yiddish songs with a group of friends, all Jewish immigrants from Eastern Europe. They all had blue numbers on their forearms, the significance of which was not clear to me. I knew there had been a war, but I was innocent of the details. My grandmother was not a Holocaust survivor, having immigrated as a young girl to New York to escape the pogroms. She worked as a seamstress in sweatshops, educated herself and became a labour activist. That musical evening is my first recollection of meeting Holocaust survivors. I did not know then that, many years later, the Holocaust would become a core preoccupation of my work as a physician.
In 1967 I was interning in the department of obstetrics and gynecology at Rambam Hospital in Haifa, Israel. It was my second time in the department, having first visited as a medical student after my fourth year at the St. Andrew’s University in Scotland. I returned because of my previous experience under the wonderful tutelage of Aharon Peretz, the department head. I recall assisting him with gynecologic examinations performed on concentration camp survivors, in whom he confirmed an association between their medical conditions, such as infertility and chronic pelvic inflammatory disease and their previous interment. I recorded the findings on forms for Dr. Peretz to sign in support of claims for financial reparations from Germany. Although the women were grateful for Dr. Peretz’s assistance in obtaining reparations, for them their medical problems, especially infertility, clearly caused much grief and heartache as reflected by their emotional state when told that nothing could be done to rectify their medical condition At the time, I did not know that Peretz had been a key witness at the Adolf Eichmann’s trial in 1961. I found him to be a most sensitive, warm and caring physician with a passion to help his patients become mothers. His compassion was especially evident, by the way he related to those who were holocaust survivors.
As intense as this experience was, I did not anticipate that it would become a preface to my work at Toronto’s Baycrest Centre for Geriatric Care. The Baycrest Centre looks after one of the largest existing long-term care populations of Holocaust survivors in North America. For 25 years, part of my practice has been to observe the impact of the Holocaust on the health of my patients — and of their children. I offer the following vignettes.
One of our patients developed a dramatic case of tuberculous meningitis for which the primary contact had likely occurred in a concentration camp 30 years earlier. One of the clues to the diagnosis was the blue number tatooed on the patient’s forearm. The very positive tuberculin test on that same arm demanded that the medical staff acknowledge the legacy of that patient’s Holocaust experience.
The wife of another patient was distraught. Both she and her husband were survivors. They had raised a family in Canada, having both lost their first spouses and children. Now, at age 80, the husband was having spells of terror during which he shouted names from his past. He would keep his wife up at night, telling her that those who had perished were pursuing him. He lost weight and couldn’t sleep; his cognitive function was deteriorating. In alternating Yiddish and English, he told me about friends who had died. He felt that he should have died instead. He told me how a friend was taken away while he was out of the office; had he been there, he might have been taken instead, thereby sparing his friend. At the camp, the man working next to him was shot for failing to move rocks as fast as he did. These people were now speaking to him, asking why he had survived. Then there was the Polish-born patient with progressive Alzheimer’s disease who became very agitated when her caregiver left for personal reasons. The family hired a new caregiver who, luckily they thought, spoke Polish. The woman screamed that she did not want to speak Poish after what they did to her and her family. The children could not understand; years before, a series of Polish-speaking women and helped their mother with homemaking. The sudden change was a mystery. They kept trying to reason with her, but she became increasingly histrionic. She refused to stay in the house with the new caregiver and ran after her children when they tried to leave her there. Perhaps for this woman, as for many other survivors, Polish had become “the language of Hell.” Primo Levi recalled how, although German was the language of the oppressor, Polish was “the incomprehensible language that greeted us at the end of our journey [to Auschwitz].”(1) Memory has many layers, and not all of these were evident even to those who loved and tried to care for this woman.
Although many survivors’ responses to their Holocaust experience reflect unimaginable traumas, there are some whose strength and tenacity shine through dramatically. One 82-year-old patient had survived in the Hungarian woods for more than three years, hiding in the bush and in caves. He had heard about comrades who had been captured and summarily executed. He survived on berries, insects and the occasional small animal or bird. Of a large family, only he and a son (with whom he was reunited after the war) survived.
This patient suffered from progressively incapacitating angina, which responded initially to anti-anginal medications. Eventually, however, he became completely disabled. Catheterization revealed triple vessel disease. When the cardiac surgeon interviewed him he seemed very frail. He was discharged back to the Baycrest residence, where I saw him and explained the surgeon’s reasons for denying him surgery. I explained that he had a 30% change of not surviving the procedure, which the surgeon deemed to be too high a risk.