Infectious Diseases in Clinical Practice:
Reflections of an ID Specialist-Invited

The Lemonade Lady

Louie, Ted MD

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University of Medicine and Dentistry of New Jersey, New Brunswick, NJ.

Address correspondence and reprint requests to Ted Louie, MD, 579A Cranbury Road, East Brunswick, NJ 08816. E-mail: tedlouie@msn.com.

To me, she will always be Marie, the lemonade lady. In times of trouble and stress, she always says, "Make lemonade out of lemons." But come to think of it, she does not make me think only of lemons. Lemons and tempered steel would be a more accurate description. Her daughter characterizes Marie's personality with a slightly different metaphor, "She's stubborn as a mule." Well, stubborn is good. I always tell my patients that stubborn people live longer.

Marie comes to my office every 3 months. I go over the review of systems, and I already know what she will say. "I'm tired," she invariably says. "So tired." And, "My feet are numb." And "No energy." Not terribly uncommon complaints for a 76-year-old lady. But then she looks at me behind her brown-tinted glasses, her bearing proud and erect, well dressed as always. As is the case with many of my 76-year olds, she is vain and does not like to be seen using a walker. But something in that calm impassive face makes me think again of quiet heroism and perseverance in the face of overwhelming odds.

I write out her prescriptions. She has so many. The nurses at the assisted living residence want to dole out her medicines to her daily, but she is still as sharp in the mind as always. She knows her medicines better than they do. And despite her infirmities, she still complains that there are too many old people where she lives. They just sit there. Many of them "don't remember too good." I believe her. In spirit, she is probably the youngest of all.

I don't recall exactly how this came up, but one day, Marie volunteered that she was a Holocaust survivor. After the account she told me, I began to understand.

Marie was born in a pleasant middle-class neighborhood in Poland. Her family was Jewish and had been there for generations. Her father was a furniture maker, renowned for his artistic work. One of his crowning achievements was the elaborately carved doors he lovingly produced for his synagogue. But then, Hitler came to power, and eventually Poland was overrun by the Nazis. Marie's family was roughly uprooted and forced to live in a tiny apartment in the ghetto. As the war dragged on, they were constantly worried, for they had heard about the horrific concentration camps not too far away.

Finally, very late one night in 1943, the Germans came for her. Shaking her roughly out of bed, they forced her on her feet and out into the night, over the protests of her parents. She was eventually taken to the notorious work camp at Bergen-belsen in Germany. She was not yet 15 years old.

There, imprisoned behind bars, along with 500 other girls, most of school age, she was forced to work 12 hours a day, 7 days a week, on loud machines that processed flax. The work was extremely difficult. The girls spoke of their families and were terrified that their loved ones would be sent to the concentration camp at Auschwitz. In the beginning, she was allowed some mail from her family, and these letters were a great solace to her, for she knew that they were still safe. But then, one ominous day, no more letters came: none from her parents, none from her siblings. There would be no letters that month, that year, or forever thereafter. And the unthinkable silence that forever followed was nearly intolerable.

The girls had little to eat and subsisted on thin soup and, occasionally, a small bit of bread. The winters were particularly harsh, as the girls struggled to keep warm. Many fell ill and died. Those wretched souls who didn't die prayed for death, as each endless day brought no relief to their suffering.

At long last, the Allies broke through German lines. British soldiers came to the work camp, to see if there were any survivors to liberate. They came across a grim site: lifeless body after lifeless body, all young girls, dead of disease and starvation. Only a handful made it. Marie does not remember this, but she was told later on that the soldiers found her barely alive, filthy, in a coma, severely malnourished, and weighing only about 50 pounds.

Her body seemed broken, but only temporarily; she was taken to Sweden for medical treatment. There, in a converted school, she was nursed back to health. And her spirit, which may have ebbed during her years in the work camp, recovered remarkably. She met the man she would eventually marry in Sweden. In a remarkable change of fortune, the couple settled in New York. Marie's husband, an extremely artistic jewelry maker, made a good living. The two learned to love life again. And whenever there was a wedding or a party, the two could be seen dancing a passionate tango. After all, tango is about living on the edge, and the couple had certainly done that.

In the early 1980s, her husband became ill and received a transfusion. Some years later, he again fell sick and passed on. It was felt at the time that his smoking had been the major factor in his illness. Marie went on, as always, making lemonade out of lemons, for life does go on. But how many ordeals can one person tolerate, even if they are stubborn as a mule?

It is 2005, and she is in my office again. I start writing out her prescriptions. Clindamycin…pyrimethamine…she has so many. I continue. "Efavirenz…emtricitabine…" I ask her if she is taking her medications. Of course she is. She is meant to go on living. Her spirit may ebb but never quite gets snuffed out.

Now, I understand. When Marie first came to me, frail and debilitated, with a huge chart from a Florida hospital, I leafed through the chart. She had been sick for a long time with different unusual symptoms, until finally she developed a seizure and became critically ill. In the intensive care unit, much to their surprise, they eventually made the diagnosis of cerebral toxoplasmosis, and Marie's HIV test came back positive. Marie does not remember her hospitalization at all, she was too sick. But now, several years later, she is perhaps the healthiest 76-year old in her community.

You see, now I understand. I understand that this incredibly strong-minded woman, one of only a handful who was able to survive the hellish work camp at Bergen-belsen has so indomitable a spirit that, even in her 70s, she was not going to succumb to AIDS, which her husband presumably contracted from that hospital transfusion in New York City in the early 1980s. Marie and her husband had no other risk factors for HIV.

The daughter at first did not allow any of the physicians or nurses to divulge the diagnosis to her mother. When the mother got a little stronger and was able to move around a bit with her walker, the daughter decided that it was time to tell. Looking back, that was wise. In my experience, people who have been through the Holocaust are able to take news of any kind in stride.

The next time she comes for her visit, it will be summertime. I will ask the familiar review-of-system questions. By this time, she already knows what the questions will be, and I already know what the answers will be. I expect that her blood work will continue to be excellent. But I want to be ready for her next time. I will have to tell her what an inspiration she is to me.

I shall serve her lemonade.

© 2006 Lippincott Williams & Wilkins, Inc.