Further Confessions of a GP

‘Miss Blumenthal not been eating or drinking for last few days,’ she told me, reading from a scrap of paper she’d pulled out of the pocket of her tunic.

‘Anything else you can tell me?’

Carmela studied her scrap of paper for any further information but there was clearly none. ‘I’ve been off the last few days,’ she shrugged.

‘Best go and see her then, shall we?’

Carmela led me through a network of corridors and fire doors before we reached Miss Blumenthal’s room.

‘Hello Miss Blumenthal, I’m the doctor.’

Miss Blumenthal opened her eyes briefly and mumbled something in a foreign language.

‘She used to sometimes speak to us in English, but she doesn’t any more. She only speaks to us in Polish now.’

This wasn’t unusual in people with Alzheimer’s. Even if they are completely fluent in a second language, as they slip further into dementia, they almost always lapse into speaking only their mother tongue. Carmela was wrong about the language she was mumbling in, though.

‘She’s not speaking Polish, that’s Yiddish.’

Carmela looked at me oddly: ‘But is say on her record that she is Polish.’

‘She may well have been born in Poland, but she’s Jewish and the language she is speaking is Yiddish. It’s actually closer to German than Polish.’

Carmela nodded, but looked at me suspiciously, as if I was trying to play some sort of odd trick on her. I sat on Miss Blumenthal’s bed and held her hand. She opened her eyes and I smiled at her but her look remained completely vacant. She mumbled something, again in Yiddish. Yiddish was the first language of my great-grandparents. It was once the common language of Jews all over Eastern Europe, but has now pretty much completely died out. The only words of Yiddish I know are ‘shmuck’ and ‘chutzpah’, neither of which were likely to have any great value in the current situation.

I turned my attention back to Carmela. ‘So, Miss Blumenthal doesn’t communicate much these days, but what can she do when she is well?’

Carmela again looked at me as if I was asking some sort of trick question.

‘I’ve never met Miss Blumenthal before, so I need to know how she is normally,’ I explained patiently. ‘For example, a couple of weeks ago what could she do?’

I was met with further awkward silence, so I tried to clarify things further.

‘Could she walk and eat and go to the toilet by herself?’

‘Oh no, Doctor,’ Carmela replied, relieved that she had finally got to grips with my line of questioning. ‘She used to sit in lounge, but not any more.’

‘So she’s bed bound.’

‘Yes, Doctor.’

‘And she’s incontinent of urine and faeces.’

‘Yes, Doctor.’

‘And occasionally she mumbles away in her language but doesn’t seem to understand you?’

‘Yes, Doctor.’

‘And you have to spoon-feed her puréed meals?’

‘Yes, Doctor, but last few days she is refusing to eat or drink.’

Carmela was smiling now, relieved that we seemed to have at least partly bridged what had once appeared to be an impassable chasm in our ability to communicate.

‘Does she have any family?’

‘Nobody. There is a nephew in Canada but we haven’t heard from him in years.’

Miss Blumenthal closed her eyes again and lay passively as I examined her.

As I rolled up her sleeve to check her blood pressure, I saw a series of green numbers tattooed on the inside of her left forearm. I stopped cold. It was a concentration camp tattoo. I had only seen one once before, but it was unmistakable. She opened her eyes and caught me staring dumbstruck at her forearm, but there was still not the slightest glimmer of expression in her face. In the relative peace of her nursing home, I couldn’t possibly imagine what horrors she must have witnessed 70 or so years ago in a Nazi concentration camp.

I remember as a medical student speaking to another patient who survived a concentration camp. He described a Nazi doctor separating the new arrivals into those who looked well enough to work and those who looked too weak. He was only 15 years old at the time, but the doctor chose him to live and placed his parents and little sister in the line that went straight to the gas chambers. I spent many hours after that conversation wondering how any doctor goes from learning about saving lives to choosing which people live and which die in a death camp. Looking at Miss Blumenthal’s tattoo, I wondered if she had faced some such doctor all those years ago. Had that doctor looked her up and down and chosen her to live?

It was now my turn to make a decision about Miss Blumenthal’s future. It was a different time and place, but in some ways there were stark similarities in the decision-making process. I was a doctor deciding whether I believed Miss Blumenthal might be able to survive the next few months. I was having to try to place some sort of value on her life and then make a decision based on my conclusion. Unlike the Nazi doctor, I’d like to think that my decision was going to be based on compassion and kindness, but it was still a massive decision to make, the significance of which wasn’t lost on me.