Isaac was referred to this Christian hospital by the community health service, as he wanted to be at home during the progression of his bowel cancer.
He had received all the treatment offered in the local government hospital, and had been told there was nothing more to be done. He had severe pain which needed management, and this was our initial focus of care.
During the course of regular home visits, Sara began to talk of her childhood and of her years in Auschwitz as a child. She and Isaac were imprisoned when they were both 12 years old, and never knew what happened to their parents.
They were abandoned with hundreds of others to the horrors of the camp. She had on her wrist the tattoo with her number very clearly shown, and always covered it up carefully to keep it hidden.
Isaac’s last days
The time came when Isaac asked for admission to the palliative care ward in the Nazareth hospital, and although it was not spelt out, he knew, Sara knew, and I knew, that it was time for terminal care.
The week he was with us was very difficult. It was hard to completely manage his pain, and I think that he needed to have pain so that he could be more in charge of all that was happening. He would not eat, would not drink, and withdrew from contact with his family.
They wanted him to have an IV for hydration, and artificial feeding, and to be assured that all possible treatment was being offered. Isaac was ready to die and refused to consider IV fluids.
The family were distressed, and we spent a lot of time trying to explain to them that the prognosis could not be changed, that IV fluids would not alter the course of the disease, and that we were doing all we could to keep him comfortable.
Their persistence and anger continued, and eventually Isaac and Sara relented and said that the IV could be started; but this was on one condition – that if the IV failed there would be no attempt to continue.
It ‘tissued’ very quickly, the arm swelled, and the family was reminded of the promise to Isaac that there would be only one attempt to give him fluids.
The last days were peaceful, with all battles faced, and the time ahead was completely in accordance with Isaac’s wishes, and controlled by him. He died in the ward, with his family present, and Sara by his side.
I realised the depth of his emotional pain, as he needed to face his own death without someone else being in charge. He had seen too many deaths in the camps, carried out forcibly and deliberately, and needed to face his own death on his own terms. This meant that no extra medical intervention was to be considered.
This was the beginning of a personal relationship between Sara and me. Sara was very distressed by Isaac’s death, and welcomed regular visits from someone outside the family, someone who would listen to her story.
She told me that she had never spoken of her experiences during the war to anyone, and I was prepared to listen to whatever she had to tell me. Much, she did not share.
Her story started with her arriving in Auschwitz with a train full of children and no parents. It was towards the end of the war, and cremations were happening daily.
Sara remembered vividly the occasions when the camp dormitory was crowded with hundreds of children, most of them ill with cholera, and she told me of the many times she cradled the dying little ones in her arms.
Roll call was a daily occurrence, and the children who could, had to stand to line for hours on end, until this was finished to the satisfaction of their guards.
During our time together, we talked of the religion of the Jewish people, and she asked about my commitment to Christianity, and of my beliefs.
She was brought up in an orthodox family; her father was a rabbi, and she knew the depth of his faith. She shared with me her longing to be able to believe once more, but said she just could not, and envied that I could.
I asked, perhaps stupidly, if she knew when she stopped believing in God.
Her reply was instant: “Of course I do. It was when we were standing out in the snow for roll call; children were falling down, and the guards were hitting many of them. We had no shoes, I had only a light summer dress on, and I knew then that God could not be real. No God could watch what was happening and not act.
“Then when the war ceased, the British came to help us. We were to be taken on board a ship and sent to Haifa as Jewish immigrants. We were kept in a camp in Cyprus, still with barbed wire around it, and many restrictions and guards with rifles, but British this time.
“The camp was on the beach, but we were never allowed to go onto the sand or to swim in the sea. We had to wait for the British to transport us away from Europe, according to the quotas for the week.
“We were in sight of Haifa, on the ship we thought was taking us to freedom, when the captain told us we had to turn back because no more could be accepted, as the quota had been filled. So back to the camp in Cyprus we went.”
Sara and Isaac
Sara met Isaac during this time and they became good teenage friends, eventually married, and settled into kibbutz life in Israel to raise their children, trying to forget the past.
The Israeli government had offered counselling to all who had come to Israel, to help them adapt to their new lives.
Sara ignored this, as she just did not want to think of the past, nor to talk about it. But she talked with me about events she had never shared with anyone else, and I encouraged her to arrange for an appointment with a counsellor, even though it was many years since the war.
Eventually she agreed, and the appointment was made, with the condition that I would continue to visit her at home.
She told me she cried and cried like she had never cried before, and that she felt like a burden had been lifted from her head and moved to her shoulders.
But nothing changed in her life. She had a couple more appointments before telling the counsellor she would not come again.
Some words I have never forgotten, and these are ones I have shared many times:
“Nothing will take my memories away. But now, I can live with them more easily, it is just like having a handbag swinging from my arms, full of memories. They are part of me – of my life.”
For the same reason, she refused the offer to arrange for the removal of the tattooed number on her arm. In her eyes, it was part of her that would never, and should never go away, even if it was surgically removed.
Volunteering in the palliative care unit
We continued to be in touch regularly and she agreed to become our first volunteer in the palliative care unit.
Language was often difficult, particularly as immigrants were coming into Israel from many different European communities, and often, in the ward, we had no common language.
Jewish families always understood Yiddish, and this is where Sara’s help was invaluable. She would visit homes with me, interpret, and advise about actions which were culturally acceptable.
Some years later, Sara was diagnosed with gall bladder cancer and contacted me immediately, even though I had returned to Australia.
She did not want any active treatment, and needed help in convincing her family to abide by her wishes.
I had a phone call from her family telling me that Sara’s condition was deteriorating and that her last wish was to say goodbye.
By a miracle of timing, the phone call came just as we were leaving Australia for a visit to undertake medical work in Gaza, and the family offered to meet us at the airport in Tel Aviv, take us to visit her at home, and the next day, to drive us to the border crossing into Gaza.
During our four weeks in Gaza, Sara and I continued to talk to each other, and I was able to advise about symptom and pain management, as she was refusing contact with anyone else.
As soon as we left Gaza, we travelled back to her home, as it was clear that Sara’s time was short.
Our meeting was memorable, and one I have never forgotten.
Love shared made the parting bearable. We spent all night together, talking, reminiscing about life and its challenges and heartbreaks. There was no time to sleep! We had to say goodbye in the morning.
We hugged each other, said goodbye, and as I turned at the door, to look once more at my friend, she simply waved goodbye, and said so clearly:
“Beris, I love you,” and I was able to respond: “Sara, I love you.”
Four hours later she died, at peace and without pain.
Palliative care is about many things, but we never stop learning as we listen to the people and families in our care.
It was most important to be aware that Isaac needed to be totally in control of his dying, and would accept care – but not interference – in the management of his terminal illness. We all took too long to understand what was happening, how, and why.
Sara and Isaac both knew they needed help, but wanted to be in control of all that happened and of all decision making.
I have related many times the Sara’s words about the handbag!
*Names changed to protect anonimity