Friday, April 13, 2007
End-Of-Life Care of Holocaust Survivors
Day to Day, a radio program on NPR, had a good segment (4:47) on the difficulties and opoprtunities in caring for Holocaust survivors as they age. The primary focus was not end-of-life situations but it has implications for hospice & palliative medicine. The piece is a good example of how understanding and knowing the individual can really help give the best medical care. I have only cared for two holocaust patients (that I am aware of), but I did not encounter any of the issues brought up in the piece. Often a pleasant or at least neutral situation with patients near the end-of-life is when they 'see' or 'hear' people or re-experience memories from the past. For a holocaust survivor this may be much more difficult. April 16th is Yom Hashoah, also known as Holocaust Remembrance Day.
One highly reccommended book for the HPM practioner is Dr. Victor Frankl's book Man Search For Meaning. He was a holocaust survivor who was able to find meaning in life despite being in concentration camps.
6 Responses to “End-Of-Life Care of Holocaust Survivors”
April 16, 2007
Christian, thanks for bringing up an important aspect of hospice care. There are resources out there for Holocaust survivors who need hospice care. The National Institute for Jewish Hospice offers accreditation to hospice programs that specialize in caring for Jewish patients and their families. They have a website--I don't have the url handy, but it's easily googled. One very important aspect of NIJH training involves the emotional and spiritual care of Holocaust survivors. In addition to Holocaust survivors, Jewish patients might also have endured persecution from various governments in the world--i.e. Russia--that can also cause them additional pain at end of life. Our very large hospice has an entire program devoted to caring for Jewish members of our community, with specially trained volunteers, chaplains, social workers who speak Polish, Yiddish and Russian. Hospices who might not have the resources for such a program might consider teaming up with a local rabbi or cantor to assist Jewish patients.
Kate Maver
April 16, 2007
This is a good example of an often-overlooked but very important part of end-of-life care - understanding the life-defining experiences that clients have gone through, especially traumatic experiences or what I call "high-impact institutional experiences" - like military service or prison time. Working in New York City, we have immigrant clients from an almost overwhelming variety of backgrounds. Most immigrate for reasons of economic opportunity, but inquiry into the possibility of political / ethnic persecution is important and can open up a very rich area of exploration. Experience of holocaust survivorship is significant, both for the care of these people, and it also has lessons for the care of those who endured violent upheaval and persecution. There is much in common, and each has its specific implications for care.
April 16, 2007
This post touches on things near and dear to my heart--the issue of dementia and past trauma. I first came to think about this issue when, many years ago I heard a story about a nursing home in Chicago with many holocaust survivors. The staff was predominately non-Jewish and couldn't understand the residents "freaking out" when being told it was time to go to the showers, or were "smuggling" food from the dining room. This story concentrated on the issue of providing awareness to the staff for the history behind these behaviors, but it led me to think about the larger issue--as a person who has experienced major trauma develops cognitive deficits, their ability to control unwanted thoughts decreases, as well as their sense of time becomes confused. Besides the survivors of the holocaust precipitated by the Germans, there have been numerous genocides and other atrocities -- how can we care for these people at end of life? Life review is a common EOL act -- but when someone has spent most of their life trying to suppress/avoid thinking about major life events, what tools do we have to help these people?
On a personal note--where I work there is a gentleman who survived the Bataan death march. He has severe dementia, and it is clear, as he declines his episodes of agitation have become worse (and he was a boxer so this can have some pretty major impacts on staff). I have also had other vets who experienced major distress as they were dying, not only over what they saw or how they were treated, but what they did as soldiers. The problem is not going to go away.
March 27, 2011
This post touches on things near and dear to my heart--the issue of dementia and past trauma. I first came to think about this issue when, many years ago I heard a story about a nursing home in Chicago with many holocaust survivors. The staff was predominately non-Jewish and couldn't understand the residents "freaking out" when being told it was time to go to the showers, or were "smuggling" food from the dining room. This story concentrated on the issue of providing awareness to the staff for the history behind these behaviors, but it led me to think about the larger issue--as a person who has experienced major trauma develops cognitive deficits, their ability to control unwanted thoughts decreases, as well as their sense of time becomes confused. Besides the survivors of the holocaust precipitated by the Germans, there have been numerous genocides and other atrocities -- how can we care for these people at end of life? Life review is a common EOL act -- but when someone has spent most of their life trying to suppress/avoid thinking about major life events, what tools do we have to help these people?
On a personal note--where I work there is a gentleman who survived the Bataan death march. He has severe dementia, and it is clear, as he declines his episodes of agitation have become worse (and he was a boxer so this can have some pretty major impacts on staff). I have also had other vets who experienced major distress as they were dying, not only over what they saw or how they were treated, but what they did as soldiers. The problem is not going to go away.
March 27, 2011
This is a good example of an often-overlooked but very important part of end-of-life care - understanding the life-defining experiences that clients have gone through, especially traumatic experiences or what I call "high-impact institutional experiences" - like military service or prison time. Working in New York City, we have immigrant clients from an almost overwhelming variety of backgrounds. Most immigrate for reasons of economic opportunity, but inquiry into the possibility of political / ethnic persecution is important and can open up a very rich area of exploration. Experience of holocaust survivorship is significant, both for the care of these people, and it also has lessons for the care of those who endured violent upheaval and persecution. There is much in common, and each has its specific implications for care.
March 27, 2011
Christian, thanks for bringing up an important aspect of hospice care. There are resources out there for Holocaust survivors who need hospice care. The National Institute for Jewish Hospice offers accreditation to hospice programs that specialize in caring for Jewish patients and their families. They have a website--I don't have the url handy, but it's easily googled. One very important aspect of NIJH training involves the emotional and spiritual care of Holocaust survivors. In addition to Holocaust survivors, Jewish patients might also have endured persecution from various governments in the world--i.e. Russia--that can also cause them additional pain at end of life. Our very large hospice has an entire program devoted to caring for Jewish members of our community, with specially trained volunteers, chaplains, social workers who speak Polish, Yiddish and Russian. Hospices who might not have the resources for such a program might consider teaming up with a local rabbi or cantor to assist Jewish patients.
Kate Maver
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