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 20^th 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

“Once There Was a Town: The Memory Books of a Lost Jewish World” Book Launch

The collection opens with a poem, “Dedication” (p.1), dedicating the poems that follow to those “dear friends” who share, and so understand, the sufferings of ongoing illness. The implication is that healthy people cannot, yet, truly enter that world and, in fact, “fear” those who must live there. Yet Silver’s poems are a way into that universe. Tender and fierce, the poems in this collection seem to arise fully formed from the deepest part of Silver’s existence. The poems in section I present us with the harsh realities of illness and the anticipation of loss. In the acknowledgements, (p.72), the author notes that the poems in this section are “in honor of my sisters with inflammatory and advanced breast cancer.” In “Advent, First Frost,” she likens that “feathered prophecy” to “a bowl of frozen tears” (p.6) and in “Stage IV,” she writes that she is “taboo, now,” that she and others use words that once embarrassed them, “courage, prayer, miracle.” Even so, she is aware that “Our passports have been stamped– / our wrists and collar bones have been marked” (p.7). In a lovely prose poem on page 11, she writes in memory of her friend, Susan: “Ulysses will sail the storms till he dies. And so, my dear ones, will we” (p.11), combining, as she often does, the reality of approaching death with hope, dignity, and strength. In “Leaving the Hospital” (p.23) and “On a Line from Virginia Woolf’s Diary,” Silver celebrates the return, even if temporary, to life: “And the day takes my body back simply, / the way a mother dresses her child” (p.14). For me, the most moving poem in this section is the title poem, “I Watched You Disappear” (p. 22-23). It is a litany of regret, loss, anger, and pain, related not in poetic images but in plain and deeply human language: “I hate spring, its prettiness. / Your heart kept beating. Why didn’t it just stop?” 

Section II consists of seven, short one-stanza poems based on images from Grimms’ fairy tales. It seems that the first two lines of each poem serve as metaphorical statements about the realities of advanced breast cancer. “Owl Maiden” begins “No transformation’s instant. / Her hair fell out first, replaced by quills” (p.29). “Strawberries in Snow” begins “Belief comes easily to the ill. / Miracles fall from their lips like gems” (p.31). And “The Flowered Skull” offers these opening lines: “The magician finds them, young or old, / mothers, maidens–to him–no matter–” (p.34). The final poem in this section is a tale told to her son, Noah. In “The Hazel Tree,” Silver is the mother who “died and grew into a tree,” “each nut a word she’d grown to tell her son / now that her speaking human voice was gone” (p.35).  

In Section III, she turns, as she did in her first collection, to poems about her family. She visits again the (actual) doors of her life (“Doors” p.39), expresses regret at being impatient with her son, “Ubi Caritas Deus Ibi Est” (p.41), and in other poems examines moments of her family life, especially those shared with her son, father, sister, and husband. This section’s poems rarely mention illness, yet as they share family stories, they hint at the inevitability of loss. The final poem in this section, “Sea Glass,” ends with lines that could be applied as well to the way poems might be born from the wages of a life: “Something salvaged, sunlit, / gem-like. Something saved / from the grinding into grit” (p.55).  

Section IV, like section II, contains only seven poems, three of them commentaries on paintings and, through those commentaries, observations on illness and suffering as well. “Late Renoir” speaks of how the artist painted to “smudge away doubt” and to submerge “the mutilations of war, his dead wife, / the black he banished from his palette” (p.59). The long poem “Valentine Gode-Darel (1873-1915)” is a reflection on the five paintings by Ferdinand Hodler that captured his lover’s sickness, decline, and death (p.60). “Portraits in the Country,” (page 63), offers a glimpse into the poet’s resignation and acceptance of death, a mindset supported by her faith in both the human and the holy: “But I will not rush to put down my sash. / Instead, I will turn the leaf of my book. See with what gentle gravity God / lets it hover, in balance, then fall to its side.” The book’s last poem, “The Firebird,” suggests that words, especially poems, might hold truths that sound louder than the approach of death: “The bell ringing in your throat will drown / out the train’s slow grieving” (p.67). 

These poems are beautifully crafted, often primal, and they touch the deepest reaches of personal illness and the shadow of mortality. Readers who have breast cancer or who have family or friends living with breast cancer, might find these poems difficult to read–others under the same circumstances might find them difficult and yet, at the same time, essential. For me, dealing with the reality of an aggressive breast cancer afflicting someone I love, these poems provide a window into an experience I can only observe from a distance, even if that distance is only an embrace away. These poems provide a portal into the emotions, fears, regrets, and pleas that might be hiding behind a patient’s or a loved one’s exterior of cheerful optimism and determination. We can’t walk the path that a woman with advanced breast cancer is traveling. But these poems help us be companions on the way. 

Miscellaneous 
“Strawberries in Snow” was first published in the Bellevue Literary Review (V12N1).  

Publisher Louisiana State University Press 
Place Published Baton Rouge 
Edition 2014 
Page Count 73 

A previous version of this review was published in the NYU Literature, Arts, and Medicine Database .  
Web image created by Medhum.org

A MacArthur Fellow and author of several acclaimed novels, Antrim has previously published a memoir of his upbringing with his alcoholic mother. In this new memoir, flashbacks of childhood neglect and chaos are juxtaposed with the present day as he takes the reader through the acute phase of his illness: a lengthy hospitalization, a course of ECT, discharge from the hospital, rehospitalization, and eventual stabilization.  

The author considers his condition to be suicide, noting that “depression is a concavity, a sloping downward and a return. Suicide, in my experience, is not that. I believe that suicide is a natural history, a disease process, not an act or a choice, a decision or a wish…I will refer to suicide, not depression” (pp. 14-15).   

The book ends on a hopeful note. After several relationships that might be described as codependent, Antrim meets his current partner, whom he marries. He sees the roof of his building through his window and remembers a certain Friday in April but is comforted by the sound of his wife playing Chopin and Bach on the piano.  

This is an exceptionally brave book. Antrim does not attempt to whitewash his situation in any way. Surely it is humiliating for someone so successful to acknowledge he has been utterly debilitated. He loses track of time. He gains weight and cannot fit into his clothes. His new book is released, but he is in no condition to help promote it. At first, he objects to being called psychotic but eventually it comes as a relief to know he is understood. One Friday in April will be inspirational to others who have suffered to see how an accomplished person is reduced to being allowed to use his razor only under strict supervision.   

At times Antrim touches on the link between mental illness and creativity. If he had hoped the cathartic exercise of writing about his childhood would have stopped his illness he learns otherwise: “Writing had not stopped my dying. (p. 80)” At another point, his friends joke that his diagnosis “might enhance my literary reputation” (p. 115). Finally, in one of the more poignant episodes in the book, Antrim gets a call from the novelist David Foster Wallace and is encouraged to undergo ECT. He has an excellent response to that treatment, but later learns that Wallace has hanged himself.  

While a diagnosis of psychotic depression fits best with the range of symptoms the author manifests, his point about suicide as a distinct disorder is well taken. In fact, the most recent edition of the DSM (Diagnostic and Statistical Manual) took the major step of including Suicidal Behavior Disorder as a “condition for further study.” This corroborates the author’s experience and means that SBD might be included in a later edition. (see also https://www.frontiersin.org/articles/10.3389/fpsyt.2020.499980/full)   

Those who are looking for an exposé or critique of the mental health system will not find it here. Antrim credits his psychiatrists and the hospital with helping him get through an unbearable time. One Friday in April is a book that will give reassurance to people who have endured suicidal thoughts that if they persist they will get better.  

Publisher W.W. Norton & Company 
Place Published New York 
Edition 2021 
Page Count 141 

Web image from Wikicommons
An earlier version of this review was published in the NYU Literature, Arts and Medicine Database