For many of the holocaust survivors that I have seen in my clinical practice, the memories of the past are often something that plagues them as the present and the ability to recall new items is lost and all they have to dwell on is the past. I remember one patient, a Polish holocaust survivor whose family was endeavouring to find a live-in support person to look after their mother as part of their commitment to try to keep her at home rather than have her admitted to a long-term care facility for which she qualified. They were looking for someone who could speak to her in her early spoken languages as with the dementia taking its toll, her English which in any event had not been well developed gradually slipped away and she reverted to her mother tongue which was Yiddish with Polish being remembered, but not used often.
According to the daughter in the distant past they had a Polish speaking housekeeper for her mother with whom she got along with quite well and there were never any problems between the two. The daughter found a Polish speaking person to be a support worker/caregiver to live in the home with her mother as a Yiddish speaking caregiver could not be found and those from other backgrounds that they spoke to were not able to communicate adequately with the mother for a relationship to develop. The daughter was very pleased to interview someone who had the qualifications she was looking for as a care provider who also spoke Polish. To the shock and horror of the daughter within a few hours of the person beginning her first day on the job she called the daughter and said she was being screamed at and cursed by the mother and wanted to leave which she did as soon as the daughter arrived.
The mother was in tears and shaking as she explained to her daughter that she was exposed to an anti-Semite and was fearful whenever the caregiver opened her mouth and spoke to her in Polish. She kept reiterating the threat she felt from being in the presence of someone speaking Polish and was sure the person had the intent of hurting her. No amount of explanation by the daughter was sufficient to calm her mother and get her to understand that they were no longer in Poland and that this woman was not a threat—needless to say the Polish caregiver did not return and an English-speaking Filipino woman with lots of experience and a gentle disposition was found with whom the mother managed to communicate adequately for her needs to be met.
To summarise my point, in order to provide an appropriate and sensitive level of care, when dealing with those patients who suffer from dementia and who are holocaust survivors, treating physicians and caregivers must understand that although there are some similarities between Holocaust survivors and those suffering from PTSD, there are many differences that need to be recognized as well. A more robust understanding of and attention paid to the pre-holocaust experience must be included in the evaluation of behaviour so that appropriate steps can be taken to minimize negative and frightening associations with past experiences.
Dr. Michael Gordon is currently medical program director of Palliative Care at Baycrest, co-director of their ethics program and a professor of Medicine at the University of Toronto. He is a prolific writer with his latest book Late-Stage Dementia: Promoting Comfort, Compassion, and Care and previous two books being Moments that Matter: Cases in Ethical Eldercare followed shortly on his memoir: Brooklyn Beginnings-A Geriatrician’s Odyssey. For more information log on to www.drmichaelgordon.com