Ideally, all medical encounters, regardless of setting or complexity, begin with a history. Before any blood is drawn for laboratory testing, before a patient enters a body imaging scanner, even before examining the patient, a doctor or nurse reaches out a hand, introduces themself, and asks, “Good morning. Why are you here today? Please tell me your story.”
It seems simple. Ask a few questions, record the answers, job done, move on. But as all doctors know, getting a good history is a defining skill, something that blends medical acumen and astute intuition. When history taking is done properly, it distinguishes adequate physicians from those who are truly exemplary in their ability to diagnose and treat disease. What makes getting an accurate history so challenging?
This slim but beautiful book by Jane Ziegelman may help answer this question. At first glance, it seems like an unlikely point of departure for a discussion of medical humanities. This elegiac work of history describes the yizkor (memory) books, which were written by survivors of the Holocaust. Their goal was to compile a lasting remembrance of the shtetls (towns/villages) of Eastern Europe, a record of the places where they lived and people among whom they lived for decades before the start of World War II, and that had been totally annihilated by the murderous onslaught of the Nazis. Most of the communities were small, populated by poor artisans and farm laborers who struggled day-to-day to feed and clothe their families. Food was never plentiful and the weekday diet was dominated by potatoes in any shape and animal fat in any form. Rain and snow routinely turned the streets into an unpassable sea of mud. The village square was cluttered with animals, big and little. Only young boys received a regular education and even that was often given by underpaid and underappreciated old men who were just as likely to beat their students as to serve as role models of the good life. Jewish rituals and the holiday calendar served as a sturdy anchor for shtetl life and provided spiritual relief to the townspeople from the quotidian drudgery. In a word, life was hard – a continuous battle to survive the hostile forces of nature and the random antisemitic attacks of their neighbors.
Yet, the inhabitants of the shtetls that dotted the Eastern European landscape never despaired of life. It is true that escape to America, the goldineh medina (country of gold), the promised land, was a dream for many. At the start of the 20th century, thousands of shtetl Jews abandoned their hometowns and left their families behind to cross the Atlantic Ocean in hopes of achieving a more prosperous life. But most stayed put and were reconciled to their lives. The steadfastness of shtetl life has been recorded in Jewish history and literature. In the face of hardship on so many levels, these men and women maintained their families, jobs, and, most importantly, their human agency.
History is the record of many kinds of stories – of people, places, political movements, ideas, war and peace, companies, the natural world, and the creative arts. The trajectories and the lessons to be drawn from historical narratives are as varied as the subjects. The endings can be upbeat and inspiring, or they may culminate in demise and depression.
Ziegelman’s compilation of shtetl memory books are historical documents of loss. For the writers of these books, the Holocaust had utterly destroyed their world. Everything they knew and held dear was wiped out in a frenzy of hatred and violence. The yizkor books were an effort to bring those vanished worlds back to literary life, to recreate them in full. But pain for the victims who died, regret over decisions made, and nostalgia for a better time inevitably color these tragic tales of loss. Can the testimony of the surviving witnesses be trusted? Are the linguistic pictures they draw true to what life was really like in Luboml, Radin, Lodz, or Kobrin? Was the community ever as unified as described by the yizkor book authors? Were the squabbles quite so divisive? Did everyone really look so angelic as Sabbath arrived at twilight on Friday? Did people really sink up to their knees in the mid-December mud? We are inclined to believe the authors because we empathize with their suffering and loss. But if we are to learn from the past and prevent the destruction of future worlds, we need to be sure we have things right as we look in the rear-view mirror.
It is reading about this literature of loss that brings us back to the doctor or nurse who is encountering her patient for the first time. These patients – men, women, adolescents, and children — have to recount their stories and explain what it is that brought them to the office or clinic. They are also telling stories of loss – loss of vitality and energy, the ability to think clearly, to climb a flight of stairs without needing to stop to catch their breath, to love passionately, to party with friends and family. For patients, their histories are tales of the world that they have lived in and grown accustomed to but which suddenly seems on the verge of breakup. As we listen, we have to decide. Are they accurate? Are they exaggerating their problems to gain our attention or downplaying them to avoid our interventions? Is their memory dependable about timing, severity, and responses to treatment? How confident are we that we have elicited an accurate story?
The notion of illness as narrative is widely appreciated in the world of medicine. We are attuned to view our patients as participants in a larger more comprehensive social context in which their illness is but one feature in a multitextured milieu. The initial patient history is our first entry into that world. We should be fully aware that the stories that patients tell us at that initial visit are, like the yizkor books, tales of loss. Hopefully, the medical story will unfold over time. There is no telling at the start how the saga will play out and end. But it always starts as a tale of loss. Just as we aim to combine heartfelt sympathy and clear minded appreciation of the facts as we read the Holocaust survivors’ yizkor stories, we should make sure that, while we are emotionally engaged with their pain and suffering, we are attentive to the facts and nuances as patients first describe their loss of health that prompted them to seek our help in the first place. Getting their history right at the start is the first step to getting patients better.
Once there was a town: The memory books of a lost Jewish world
Jane Ziegelman
St. Martin’s Press, New York, 2026, pp.227
Web image by Medhum.org
