Memories of Pain Beyond the Power of Healing*

Bernard Lown, MD

Whenever I read of an Iraqi war veteran’s suicide or of a soldier afflicted with post-traumatic stress disorder, I feel a frisson of anguish. My emotional reaction may be due to the many Holocaust victims whom I have doctored. They have taught me that some remembrances of pain and savagery are so deep and tautly embedded that the passage of time can only dilute, not purge.

One memory that frequently surfaces and fills me with desolation does not concern a Holocaust victim. This singular memory I wish to extirpate, but it leaves me helpless. My tormentor is a small, elderly housewife who was never a victim of Auschwitz, Buchenwald or the other charnel places of horror that had pockmarked Europe. This event happened so long ago that I have forgotten much else of that time.

The event I am about to relate occurred 61 years ago. The place was the Montefiore Hospital in New York City, where I was a medical resident. The hospital was then the city’s leading institution for the treatment of chronic disease, with its mostly elderly patients suffering from multiple intractable problems. Jack K., the intern working at the time on my service, was heavyset, ponderous, uninterested, and invariably complaining of indigestion. More annoying was his contempt for these elderly patients. He was impatient to complete the “stinking” internship and get on with his life’s commitment to psychiatry.

That singular day, the medical service was inundated with numerous admissions. During evening rounds, Jack provided a brief overview of those who, as he put it, ” had checked into the house.” Among those admitted was a Jewish woman from the Bronx whom he identified as a “crock.”

“Why the ugly label?” I asked angrily.

“She complains of waves in her head,” was the derisive response.

“What sort of waves?”

“Ocean waves on a Pacific atoll,” was his matter-of-fact answer.

“You got to be kidding. How does an elderly Jewish housewife in the Bronx get to the Pacific?”

“I didn’t ask. She sounds like a turkey.”

I completely lost my cool, berating him with a series of unmentionable expletives. “And you are aiming to be a shrink? They should run you out of the psychiatric profession before you set foot in it.” I marched off to learn about the Pacific atoll.

Mrs. G., a slight, involuted, birdlike woman, sat beside her bed in the dark, staring listlessly at a dirty window facing a brick wall. A somber Chirico painting came to mind, every image recoiling unto itself, with the only meaningful link to life a distant train pulling away beyond the horizon. She seemed intent on capturing an elusive image. Gently I probed why she had come to the hospital.

“I can’t stand the rush of waves. Doctor, it is driving me crazy. Yes, I am going crazy. If only I had loved my boys as much as my husband, I would be spared this suffering.”

How to inquire without probing a scalpel into a festering wound? Slowly I teased out the strands of the following tale: Mrs. G. had three sons. After Pearl Harbor they all volunteered, one in each of the three military services. The parents, poor Bronx Jews, the husband disabled by a heart condition, she with hypertension, depended on their children, but they nonetheless welcomed with pride the knowledge that their boys, like other patriotic Americans, were in the war against that “Jew exterminator, Hitler.” One son was killed, and then another was killed. Her husband nearly lost his mind with grief. She went to the Red Cross to get the last remaining son, her youngest, out of the Marines. The lady at the Red Cross was moved to tears by her tale and promptly sent a telegram to Washington. She assured Mrs. G that her pride and joy would be returned safely home.

Mrs. G. was elated and could not wait to bring the happy tidings to her husband. She was certain that the good news would help overcome his deepening depression. Upon arriving home she found her husband slumped over dead, clutching in his hand a piece of paper. The paper was a telegram from the War Department expressing regret that their youngest son had died heroically storming a Pacific atoll.

As she related this tale, her voice was without inflection, in the deadly monotone of a dirge. There were no tears. This tragedy had long ago dried out all tears. She repeated over and over, “My husband loved the boys. But why do I remain alive?” She clutched her head to shut out the drumbeat of waves hurtling against a distant shore. She rocked her body as though she was cradling a child in her arms. “Doctor, help me die. Please, please quiet the waves!”

The next morning I waited impatiently for morning rounds with the wise physician in chief, Dr. Louis Leiter. I was distraught and anxious to unburden myself. Rounds were at the bedside. I presented the patient’s story in detail. Dr. Leiter, usually calm, shifted from one foot to the other. When I finished, he looked far away, his face puckered in a grimace as though straining desperately to control a sob. He turned abruptly away from the bed, without uttering a word, and rapidly walked out of the ward.

The Spanish poet and dramatist Federico Garcia Lorca, murdered by Franco, addressing similar unfathomable human pain, wrote in one of his plays, “A scream tiptoes in my heart.“

What is a doctor to do? What can a doctor do? Where can the balm be found to heal? Before the enormity of such pain, medical science appears helpless.

Dr. Marc Agronin, a geriatric psychiatrist who has treated many Holocaust victims, has written, “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.” (1)

Why do these tales need to be told? In whatever direction one looks in our troubled world, whether at Darfur or Gaza, Afghanistan or Guatemala, there is torment beyond human imagining. In listening, one remembers and one shares. The deeper purpose is not vicarious suffering, but action. Light a candle rather than merely deplore the darkness. The stains of injustice cannot be wiped away. Moral equilibrium demands that we engage, so that the future is not a replica of the past. Herein medicine has much to offer. Doctors have long ago concluded that a disease that cannot be cured must be prevented. (2)

The essential sickness afflicting the global order is war. The strong thereby exact tribute from the weak. Prodigious sums of money are diverted from human needs to killing, maiming and oppressing. The environment is degraded more by war than by any other human activity, hastening global warming and making the planet inhospitable to all life. What is proscribed in individual human behavior and severely punished is permitted for nation-states. The leading terrorists of our day are not Muslim suicide bombers but the nation-state. The outlawing of war is the foremost issue on the agenda confronting humankind. Only then will we prevent ocean waves on a distant atoll deranging the mind of a bereaved mother.

*Originally posted (29 March 2009) on ProCor (www.procor.org), a global communication network promoting cardiovascular health in developing countries. ProCor was founded by Dr. Lown in 1997 to encourage knowledge sharing among a global community about preventive strategies.

Bibliography

1.    Agronin M.E. From a place of fire and weeping, lessons on memory, aging and hope. New York Times,December 23, 2008.

2.    Lown B. Prescription for Survival: A Doctor’s Journey to End Nuclear Madness” Berrett-Koehler Publishers, San Francisco, 2008.

6 responses to “Memories of Pain Beyond the Power of Healing*

  1. Dear Bernard,

    My god, the misery and sorrow. But so moving and sublimely expressed.

    Thank you for sharing such a poignant memory.

    Warren

  2. What a poignant story!

  3. Norbert Magazanik MD

    Dear Dr Lown,
    I am also an old doctor (since 1954). Till 1990 I worked in Moscow as internist, then in Israel as a family doctor. Like you I had a privilege to meet at the beginning of my medical career a wonderful doctor who showed me the art of treating the patient as a human being. It has impressed me so that all my life I tried to follow his example. At the conclusion of my medical career I wrote for young doctors a small book “Medical Treatment and Psychology” which was published in Moscow in Russian in 2007. Only yesterday I discovered in Internet your book “The Lost Art of Healing” translated into a rather poor Russian and read it with great interest and pleasure. To my amazement not only our attitude is almost the same, but even some chapters are discussing identical topics! For example, there are in my book essays “The art of listening to the patient”, “To touch the patient by hand”, “The art of not doing harm to the patient”, “The doctor as a remedy”, “Sincerity and optimism”, “Pessimism as a risk factor” etc. Some of my colleagues hinted that my attitude is obsolete and provincial, so it is a great encouragement that such an eminent physician has the same views.
    It may be a chance coincidence but being still a young doctor beyond the Iron Curtain I succeeded to find in a medical library “Clinical Cardiology” by Levine. The author’s name was at that time unknown to me, but I liked the book immensely and even wrote for myself some extracts from it. Still later in 1960 0r 1962 I again discovered by accident in a library a small book “Digitalis Intoxication” by a certain Lown and Levine which seemed to me a real masterpiece and also made a deep impression on me…
    My heartiest greetings to you!
    Sincerely, Dr Norbert Magazanik MD, Ashdod, Israel.

  4. Bernard Lown, MD

    Thanks to Warren and Winslow for pithy but relevant words.
    Dr. Magazanik and I have had parallel lives. This is not at all surprising. I have long ago realized that I have more in common with Russian or Kenyan physicians than with American businessmen. After all as doctors we share an ancient tradition, the same vocabulary, the same training, the same scientific data base, the same methodology, the same commitments to heal. We have taken the same oath “to do no harm,” we read each others journals, we harbor the same principles and values. More profoundly, during our training we have been indoctrinated that differences between humans are not even skin deep.
    I was blessed early on to have Dr. Samuel A, Levine as teacher and mentor. He was an exemplary and unmatched clinician. He humbled as well as uplifted, and implanted a life enduring love for the art of medicine and a respect for the powers of science. I describe some of this in my book “The Lost Art of Healing.” (Just last month Marianna Vavilova from Moscow translated the book into first rate Russian) I ma impressed with the coincidence that as young doctor in the USSR you encountered Levine’s masterful “Clinical Heart Disease”. This book made a change in my medical goals when I made it into a veritable while still a medical student at Johns Hopkins in the early 1940’s.
    During my medical and antinuclear work I traveled about 30 times to the Soviet Union. Academician Eugene Chazov, fellow cardiologist, was my closest Russian friend. This is described in the recent published book “Prescription for Survival: A Doctor’s Journey to End Nuclear Madness.”
    I very much welcome your meaningful comments

  5. Norbert Magazanik MD

    Dear Dr Lown,
    I send to you my corollary to your excellent essay The Doctor as a Placebo. Indeed we had been moving on parallel paths while working in completely different conditions, as you have justly said!
    Sincerely, Norbert Magazanik M.D.

  6. May I comment on Dr Magazanik’s remarks.
    All my family and I had been his patients in Moscow till 1988, when we emigrated to the U.S.A.
    All (three) of us have been certain that he is THE BEST doctor we have met. Now, being 78, I remember and quote his remarks and advices to his American colleagues and, believe me, NOT all of them are businessmen. Some of them are not only brilliant doctors., but great men. Still, I shall not forget Dr Magazanik – never. He is an “embodiment” of human doctor helping humans humanly!
    God bless him!

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