By MARC E. AGRONIN, M.D.
Published: December 22, 2008 New York Times

Place of fire,

place of weeping,

place of madness

— Zelda, "Place of Fire"

The forest still stands, but the people are gone. Only a stone
memorial guards their place, surrounded by tall grasses that hide bits
of ash and bone deep beneath their roots.

On this spot on Feb. 4, 1942, more than 920 Jewish men, women and
children from the town of Rakov in what is now Belarus were rounded up
by the Nazis and herded into the synagogue. Several shrieking children
were stabbed with bayonets and thrown over the heads of the weeping
Jews just before the doors and windows were sealed and the building
was doused with kerosene.

An unspeakable scene of wailing ensued as the once vibrant Jewish
community was annihilated in the fire. My patient, now 98, still weeps
when he describes witnessing this horror from a hidden perch in a
tree. He gasps audibly when he recalls watching his father being
pummeled by a Nazi soldier before he was thrust into the doomed crowd.

When this survivor first told me his story, I was speechless. He held
tight to my arm, and I imagined myself as the branches of the tree
that supported him during this trauma. I was now a witness.

As his psychiatrist I am obliged to ease his suffering, but no
medicine of mine can touch such a memory. I have tried hard to
understand how he and others managed to mentally survive such
traumatic experiences. These aging Holocaust survivors, in particular,
have taught me what I have come to call "lessons from fire."

Lesson 1 is the most difficult for a doctor. Sometimes the perpetual
sadness of many older survivors is not to be healed but shared. Over
time, as memories fade and the voices of lost loved ones grow quieter,
all that remains is a closely guarded sadness, persisting as a
substitute for the losses. Any attempt to ease this emotion may be a
threat to painful but beloved remnants of memory. What some survivors
seek is not medicine or therapy: it is the attentive presence of a
doctor and others to serve as the next generation of witnesses.

Lesson 2 brings a paradox. Surviving a grueling trauma does not
inoculate one against the stresses of aging. A patient once told me
that the small daily indignities she faced in the nursing home felt
worse than her experiences in a Siberian labor camp. I realized that
she could not bear feeling like a victim again, even in small measure.

Lesson 3 gives me hope. One patient, a survivor of Auschwitz, recently
lost her husband of 60 years. She came to me severely depressed, with
thoughts of suicide.

I asked her, "How did you have any hope in the camp, knowing that each
day could be your last?" She smiled briefly and told me a story (I
reconstruct her words from memory):

"My dear doctor, I believe in God, and he was with me in the camp. But
I also had several young women from my town with me in the barracks.

"When we had to stand at attention for hours, we stood together,
propping up one another when weak. When we dug ditches we did it
together, one holding and moving the arms and shovel for another who
didn't have strength that day. We were desperate, but never alone."

I referred her to a social club we created for older people with mild
memory problems, and one day I crept into the room during a discussion
group and hid behind a corner to listen.

One women spoke disparagingly of her memory. "I am losing my mind,"
she said. "It is so painful."

Then I heard my patient respond in a resolute voice: "You must have
hope. We are all in the same boat here, together."

As I listened I could feel tears welling in my eyes, but I kept myself
hidden, afraid to let the group see their doctor weeping. From my
hiding place I witnessed a beloved patient begin to heal herself.

These lessons from fire are not the only points of clinical knowledge
that one needs to work with aging victims of trauma, but they're a
good start. When facing the last generation of Holocaust survivors, I
offer my presence as a doctor and I feel strengthened by their words.

"Faith — I still have faith," I hear a survivor say. "Doctor, hope for
me!" another commands. These are the primal gifts of life that we
share.

Marc E. Agronin is a geriatric psychiatrist in Miami.