A writer and a doctor: what a physician’s account of Auschwitz can teach us about the ethics of story-telling in medicine

Christine Henneberg, MS
University of California, San Francisco, United States 

In writing this work I am not aiming for any literary success. When I lived through these horrors, which were beyond all imagining, I was not a writer but a doctor. Today, in telling about them, I write not as a reporter but as a doctor.1

The opening “declaration” of Dr. Miklos Nyiszli’s book, Auschwitz: A Doctor’s Eyewitness Account, is at once straightforward and troubling. Nyiszli immediately underscores a point that must be made clear in any firsthand account of the Holocaust: No part of this story has been imagined, made up, or exaggerated. The pages you are about to read contain facts, not fiction. Yet by highlighting the fact-fiction divide—by declaring himself “not a writer but a doctor” and thereby placing himself firmly on the side of fact—Nyiszli problematizes the very notion of the doctor who writes, the objective scientist who tells a subjective story.

Nyiszli’s declaration thus describes a conflict: As narrator, he simultaneously inhabits two apparently discordant roles, that of the objective physician, and that of the subjective story-teller. This conflict recurs throughout the book, played out in his own conflicting coping mechanisms of emotional detachment on the one hand and human connection on the other, sometimes purposeful forgetting, at other times deliberately remembering.

Similar conflicts face doctors all the time, not only in the setting of such murderous atrocities of the Nazi death camps. Ostensibly asked to be compassionate and humane, doctors are also inculcated into an ethic of detached objectivity.  Recently, such conflicts have been identified in the contemporary literature and used to argue for an approach known as Narrative Medicine, which is based on the crucial ethical and humanitarian function of stories and story-telling in medicine. Nyiszli’s narrative conflict—and its resolution—offer an example of how contemporary doctors might choose to engage more deeply with patients, their suffering, and their stories.

Choosing to remember, choosing to forget

I must begin with a brief story of my own: As a medical student, I used daily journal writing to cope with the emotional stress of caring for sick patients and witnessing their suffering. My long-standing writing practice allowed me to renew my energy and maintain my empathy for patients when I was physically and emotionally exhausted. But there was a curious pattern to this practice: during my most rigorous clerkships, when I was spending long hours at the hospital learning to care for the sickest patients, I would often stop writing for weeks on end, using the excuse of being “too tired” or “too busy” to write. Now I can see that I had purposely stopped writing in order to detach from my emotions and from the suffering of my patients. By not writing, I was able to maintain a certain emotional stamina—or numbness. Like Nyiszli, I was choosing to forget.

Choosing to forget: Nyiszli the doctor

… It was absolutely necessary to forget it if we wanted to keep from going mad. Darkness before and darkness behind…. My only desire was to forget everything, to think of nothing.2

The decision to forget is one that Dr. Nyiszli made repeatedly, and often deliberately, during his time at Auschwitz. One evening, after hearing a series of gunshots in an adjacent room and rushing in to find the bodies of seventy women shot in the head, he says, “I took note… but meditated no further; I was afraid of going mad.”3Although he would later develop other tools to disconnect from his daily experiences (among them sleeping pills and alcohol), here is a straightforward example of selective consciousness: he sees something atrocious, but with almost inhuman strength of will, he chooses not to think about it.

Later, Nyiszli is ordered to perform autopsies of several pairs of murdered twin siblings. It is an inarguably heart-wrenching assignment, yet without so much as a pause, he launches into an matter-of-fact description: “They delivered me four pairs from the Gypsy Camp; all four were under ten years old. I began the dissection… and recorded each phase of my work ….”4 In a description void of emotion, Nyiszli focuses exclusively on the minutiae of his medical responsibilities, clearly aligning his work as a physician with a self-enforced ethic of detachment and objectivity.

Much later, Nyiszli recalls another example of such self-enforced professional detachment—this time with some degree of introspection and inner conflict. After refusing to assist the suicide of a young prisoner, he later feels private remorse: “Now that I was no longer beside his bed, now that his face no longer called forth the doctor in me, the purely human side of my nature was forced to admit that… I should have ‘let him go his way,’ not in front of the cold steel barrel of a machine gun, but in [a] pleasant narcosis … where he was free from all moral and physical pain.”5 Here, Nyiszli consciously aligns his physician identity (“the doctor in me”) with detachment, and his “purely human side” with compassion and altruism. It is this human side that longs to free this fellow human being from not only physical but also “moral” pain.

Choosing to remember: Nyiszli the writer

I felt it my duty to my people and to the entire world to be able to give an accurate account of what I had seen….6

Nyiszli is clearly capable of detaching and forgetting, but he is simultaneously determined to remember, repeatedly referring to remembering as a duty external to and larger than himself.

On entering a crematorium for the first time after a mass killing, Nyiszli writes, “I had no reason to be here, and yet I had come down among the dead. I felt it my duty to my people and to the entire world to be able to give an accurate account of what I had seen if ever, by some miraculous whim of fate, I should escape.”7

Describing plans for escape among the Sonderkommando (literally “special forces”—Jewish prisoners forced to work in and around the gas chambers), he says, “It was our bounden duty to make certain that the world learned of the unimaginable cruelty…. It was imperative that a message addressed to the world leaves this place.”8

In this way, Nyiszli clearly sees himself as a messenger, who must tell the world of the horrors of Auschwitz. This is, of course, precisely what he accomplishes in his Eyewitness Account; the book itself becomes the realization of his duty.

In the final hours before the abandonment of Auschwitz, Nyiszli stands on the crematorium stairway, where millions had descended to their death: “Standing there alone, on the top step of this, their last brief voyage on earth, I felt it my duty to pause and think of them for a moment with heartfelt compassion, in the name of their relatives and friends who, perhaps happy and well, were still alive somewhere in the world.”9 In this exquisite moment of connection, humanity, and memory, by invoking the friends and relatives of the murdered victims of Auschwitz “alive somewhere in the world,” Nyiszli acknowledges the individual stories of each of the dead, which would have provided meaning and comfort to their loved ones—the stories that cannot be told and will never be heard. At this moment in his story, a dedicated act of remembrance is the best he can offer. Born purely of compassion, it is a crucial part of his duty to the world.

Finally, Nyiszli ends the book with the reunification of his family, a reunion that is, crucially, centered on story-telling: “We had much to do, much to relate, much to rebuild.”10 The same objective scientist who refused to meditate for even a moment on the horrors he witnessed, now acknowledges that the rebuilding of his family will arise from the relating—the re-telling, the remembering—of these horrors. In this closing paragraph, we see Nyiszli’s “purely human side” reemerge. We see that it is this side of him, the story-teller, that has kept him alive at Auschwitz and will now ensure the survival of his family.

The narrative conflict in contemporary medicine and medical training

The dire circumstances—“beyond all imagining”— in which Nyiszli found himself at Auschwitz create a dramatic case study by which to examine the problematic value of emotional detachment in the face of suffering. But this conflict is not confined to such horrible circumstances as those found in the Nazi death camps. Although nearly everything about his experience at Auschwitz lies far outside the realm of “typical” medicine, Nyiszli’s strategy of emotional detachment bears a remarkable resemblance to that of doctors today.

It has been widely observed in the contemporary literature that the medical profession—including the training process of medical school and residency—embodies a continual conflict between two opposing sets of values: On the one hand, the competent physician must embrace an ethic of scientific objectivity and detached concern, in order to prevent feelings from clouding judgment and to avoid emotional burnout. On the other hand, members of a healing profession should embody the values of empathy, altruism, and compassion, in order to best serve their patients.11

My experience of this conflict in medical school—when I found myself temporarily abandoning my writing practice in order to detach from my most troubling emotions—is just one example. Many studies describe the emotional distress, burnout, loss of empathy, and pervasive substance abuse that plague medical students and residents.12 In the name of scientific objectivity, an ethic of humanism and compassion is often lost to a destructive ethic of detachment.

Narrative medicine and the ethic of “compassionate solidarity”

In his 2009 article “Compassionate Solidarity,” physician-writer and ethicist Jack Coulehan defines suffering as “the experience of distress or disharmony caused by the loss, or threatened loss, of what we most cherish.” He continues, “Such losses may strip away the beliefs and symbols by which we construct a meaningful narrative of human life in general and our own in particular.”13 This broad but incisive definition would seem to encompass the senseless suffering inflicted on the victims at Auschwitz as well as the timeless suffering of the sick and dying. Whatever form it takes, Coulehan argues that physicians are ill-equipped to respond to suffering on an existential level, because they are trained according to the pedagogy of detached concern, which “devalues subjectivity, emotion, solidarity, and relationship as both irrelevant and harmful.”14

This is precisely the detachment we see in Nyiszli when he calmly declines to think about the seventy women shot in cold blood, or when he describes the dissection of murdered children with a detached, scientific precision. We see it in the distraught medical student who conveniently “forgets” to write about her sickest patients, or in the tragedy of a young resident who injects himself with Fentanyl to fall asleep at night.

Coulehan proposes an alternative model for the physician response to suffering, which he calls “compassionate solidarity.” It is a call for doctors to meet patients and their suffering on an existential level—treating their physical pain but acknowledging the psychological and emotional distress that accompanies illness and death, thereby helping patients to restore meaning to their lives. He argues that writing can help physicians “gain deeper understanding of suffering,” thus moving them closer to their patients and to the realm of “symbolic healing.”15

Narrative Medicine is one answer to this call for a more humanistic model of healing, a deeper and more compassionate response to suffering. Defined and pioneered by the physician Rita Charon at Columbia University, Narrative Medicine espouses “a practice informed by the theory and practice of reading, writing, telling and receiving stories.”16 It is a practice that “invites one to be moved by stories of illness,”17 an approach to doctoring and a response to suffering that draws from what Nyiszli calls the “human side.” At its essence, Narrative Medicine is the practice that Nyiszli’s book describes: a project of relating and rebuilding, of restoring the dismembered artifacts of suffering to form a unified whole.

Dr. Miklos Nyiszli’s Auschwitz, A Doctor’s Eyewitness Account, is a beautiful and disturbing example of the narrative conflict embodied by the physician-writer. He begins by declaring himself as someone who divines meaning from objective facts—“not a writer but a doctor.” Yet he concludes, perhaps despite himself, as one who makes meaning through story-telling, a witness to human suffering with a “message to the world” to share, and with the work of relating and rebuilding laid out before him.

Of the many lessons to be learned from Dr. Miklos Nyiszli’s account of the atrocities committed at Auschwitz, one in particular resonates with the call of the Narrative Medicine movement: Human beings seem to have the ability to choose how we respond to suffering. We can detach, distance ourselves, forget; or we can draw closer, engage, relate. For doctors, this choice determines whether we merely treat our patients’ tangible lesions and physical pain, or whether we can also respond to their suffering on a deeper level. To tell a story—whether it is one’s own, or the story of another—is a powerful way to respond to suffering, to draw closer to others, to be a true healer. This is the choice Miklos Nyiszli makes in telling his story of Auschwitz.

Notes

  1. Miklos Nyiszli, Auschwitz: A Doctor’s Eyewitness Account, trans. Tibere Kremer and Richard Seaver (New York: Arcade, 2011), 12.
  2. Nyiszli, 184.
  3. Nyiszli, 67.
  4. Nyiszli, 61.
  5. Nyiszli, 109.
  6. Nyiszli, 52.
  7. Nyiszli, 52.
  8. Nyiszli, 123.
  9. Nyiszli, 185.
  10. Nyiszli, 222.
  11. Coulehan and Williams, “Vanquishing Virtue”; Hafferty and Franks, “The Hidden Curriculum.”
  12. See Lisa M. Bellini, Michael Baime, and Judy A. Shea, “Variation of Mood and Empathy During Internship,” The Journal of the American Medical Association 287 (2002): 3143-3146; Chantal Brazeau et al., “Relationships Between Medical Student Burnout, Empathy, and Professionalization Climate,” Academic Medicine 85 (2010): 3-6; Daniel Chen et al., “Characterizing Changes in Student Empathy throughout Medical School,” Medical Teacher 34 (2012): 305-11; Liselotte N. Dyrbye et al., “Systematic Review of Depression, Anxiety and Other Indicators of Psychologic Distress among US and Canadian Medical Students,” Academic Medicine 81 (2006): 354-73; Matthew R. Thomas et al., “How Do Distress and Well-Being Relate to Medical Student Empathy? A Multicenter Study,” Journal of General Internal Medicine 22 (2007): 177-83; Reidar Tyssen, “Suicidal Ideation among Medical Students and Young Physicians: A Nationwide and Prospective Study of Prevalence and Predictors,” Journal of Affective Disorders 64 (2001): 69-79.
  13. Coulehan, “Compassionate Solidarity,” 600.
  14. Coulehan, “Compassionate Solidarity,” 600.
  15. Coulehan, “Compassionate Solidarity,” 601.
  16. Rita Charon, Narrative Medicine: Honoring the Stories of Illness (New York: Oxford University Press, 2006), 4.
  17. Patricia Stanley and Marsha Hurst, “Narrative Palliate Care: A Method for Building Empathy,” Journal of Social Work in End-of-Life & Palliative Care 7 (2011): 46.

 


CHRISTINE HENNEBERG is a fourth-year medical student at the University of California at San Francisco (UCSF-UC Berkeley Joint Medical Program), with a BA in English / Creative Writing from Pomona College and an MS in Health and Medical Sciences from UC Berkeley. She will begin her residency in Family Medicine in July 2013.