On a busy clinic morning I enter the examining room to meet patient L. for his semi-annual cardiac visit. Eleven years earlier he had cardiac surgery involving replacement of his aortic valve. The valve had become heavily calcified and narrowed resulting in severe aortic stenosis, a condition that can be fatal. L., now 88, continues to lead an active, robust and appropriately vigorous life. In a few weeks he will leave to spend the winter in Florida. As usual, both he and his wife (who always accompanies him to his appointments) greet me with their signature warm and welcoming smiles. Throughout the time he has been my patient, L. has always exhibited an extraordinary sense of internal strength, positivity, and a very strong desire to live life to its fullest.
I proceed to ask him about any new symptoms. There are none. His physical examination and his electrocardiogram are fine. I find myself, as I have done many times before, unconsciously focusing on the numbers tattooed on his forearm, the unmistakable sign of a concentration camp survivor. A quick glance at his record leads me to believe, that he is about to experience a birthday. When I congratulate him he tells me he actually has three birthdays. Before I can respond, he elaborates.
The first of his three birthdays occurred when he emerged from his mother's womb. The second was the day, after several years of surviving concentration camps and labor camps, he was liberated by the Russian Army while on a Nazi forced march of the remaining inmates of the Auschwitz concentration camp in Poland to a distant site in Germany. His third birthday occurred three years later when he was finally permitted to immigrate to the United States. While I knew some details about his past life as a holocaust survivor, I was unaware of his three births and rebirths. He states that the latter two birthdays are the most relevant to him.
Following his arrival in the United States L. met his wife, who was also a Holocaust survivor. L. is now retired and he and his wife enjoy this current stage of life with what I suspect to be the same intensity of earlier years. They have a wonderful, loving and highly productive family of children and grandchildren whose accomplishments have benefitted our society by whatever metric employed. His visit concludes with an excellent medical report. We wish each other a pleasant winter, and they leave to make ready for their annual southern migration.
Before seeing my next patient, there are a few silent moments to reflect on L.'s moving description of three birthdays. His generation of holocaust survivors are now well into their ninth decade of life. Many of those still alive have significant illness and are far less robust than L. Many have led difficult and troubling lives trying to cope with the enormity of their past experiences. But as a group these individuals often provide magnificent examples of man's resilience and the ability to overcome the most horrible of horrors. Their inner strength helped them survive and then propelled them forward to build unconditionally wonderful and loving lives in new countries. While continuing to carry their scars and trauma, they adapted to new cultures, learned new languages and mastered new professions. They are treasures who in the future will no longer be present to remind us of both man's strength, as well as the ability of society and its individual members to do immeasurable harm. These survivors, as noted by the author, psychiatrist and holocaust survivor, Dr. Viktor Frankl, typify the importance of "striving to find a meaning in one's life", even in the face of the unimaginable. For many, this strategy kept them alive. I have personally lived with this world view: my father was a survivor of the horrific anti-Semitic pogroms occurring in Belarus during the years following World War I. Only the magnitude of the holocaust could dwarf the savagery of these earlier tragic times.
Orphaned at age 9, my father traveled with his two sisters across Europe and eventually to the United States where he built a productive, meaningful and unconditionally loving life. He continually set new goals that provided fresh meaning throughout his 92 years of life.
L's third birthday, the date of his arrival in the United States, also provides focus on the current "refugee"/"migrant" problem the world faces today. Images appear regularly in the media of families who risk their lives to cross borders on foot or brave the Mediterranean in rubber rafts to seek safety in Europe, far away from the genocidal threats posed in their native land. Images of truckloads of corpses killed in transit are shocking to even the most insensitive. To those who have faced genocide either directly or indirectly, the impact is overwhelming. Both L. and my father had to wait several years before they were allowed entry into the United States from Europe. They both suffered and experienced renewed danger and anxiety while waiting to emigrate. When they and their generations finally arrived in the United States they thrived. How can and should our society deal with today's "refugee" problem? I cannot begin to answer that question here. But we must be responsive. Closing borders or sending families back to an uncertain future in their endangered country of origin is not the answer. Our country has been and continues to be built with the hands, backs and minds of such brave, committed and productive individuals. There are many citizens such as L. who also celebrate multiple birthdays. Their birth and rebirth in new lands provide them and their children with ongoing opportunities to reshape their lives as well as reshape their environments. Much as in genetics, diversity results in fresh strength and robustness.
I will carry L.'s three birthday message with me for years to come.