First, Do No Harm

“We need you to pronounce someone,” said the voice over the phone. I was a third-year medical student on call overnight at St. Louis City Hospital. It was 1978 and I was 31 years old. I had only been out of the classroom for a few months and had never been asked to certify someone as dead before. I had been to two “codes” where the patients had “crashed” and lost vital signs and everyone rushed in to try to resuscitate them –to pump air into their lungs through a tube, to do chest compressions, to give them epinephrine, to shock them with the paddles. Someone with more training than I, usually a resident, would end the procedure when the EKG showed sustained non-activity. “Pronounce someone Dead?” I asked. The nurse gave a “what can you do with the medical students” sigh and said, “Yes.”

This patient must have been a “No Code” – Do not resuscitate. Her room was dark and deserted. A florescent tube stuttered at the head of the bed. She was an elderly woman whose long, gray braid had come loose. Only her right arm was outside of the sheet. She looked asleep.

I drew a deep breath. So, this is what a dead person looks like. But what if she’s not really dead? How can I be sure? I walked around the bed, searching for any movement. I stuck my silver tuning fork, used in neurological testing, in front of her mouth looking for condensation. I touched her arm; it wasn’t stone cold. I listened with the stethoscope. Heard nothing. Feeling remarkably foolish, I dragged the EKG machine from the hallway and ran a strip. Flatline.

I filled out the form at the nurses’ station, looked at my watch and wrote the time of death as 2:55am. Really, someone isn’t dead until I, a third-year medical student, say so? I had thought of my future job as a physician as one of helping patients solve medical problems, suggesting good health habits, and giving emotional support. I would avoid troublesome side effects and counsel the least invasive surgery. First, do no harm. I was learning everyday to distinguish “normal” from “abnormal.” I didn’t know until then that I had to learn how to be sure someone was dead.


Last summer I read Sarah Helms’ 2015 book Ravensbruck: Life and Death in Hitler’s Concentration Camp for Women in preparation for a visit to the camp itself in Germany. As I read, I remembered that night so long ago and the terror of being the one to pronounce that woman dead. Helms’ book educated me in even more terrifying ways. I never knew that the Nazis had insisted that only licensed doctors could pronounce and certify the deaths of the people they themselves had murdered. And doctors were often the ones to designate who was next to be killed.

I visited Ravensbruck in July 2017 with my husband and two long-time friends. The camp was situated in a beautiful rural area with trees and a lake. There were hardly any visitors about, and the whole complex was eerily quiet. It reminded me of the quietness of some Civil War battlefields I have visited. This was the sole women-only concentration camp in the Nazi’s empire. Even though the original prisoner’s barracks were gone, many structures from the camp remained. The barbed-wired walls, the crematorium, the SS men and female guards’ living quarters and the foundations of some other buildings gave a good idea of how things might have worked in this place.

Rusty remains of barbed and electrified wires along the walls
Long abandoned SS housing
Crematorium oven, one of three

We know that the Nazis began their murderous spree by killing people they considered physically and mentally defective. The idea of that is so repulsive to me that it had never occurred to me that they would use real doctors to certify who was “qualified” to be killed. Even the “Final Solution,” the evil blueprint for committing genocide on a mass scale, was partially conceived by a licensed psychiatrist.

Doctors were integrated into the grisly camp routine. Helms writes that, “One of the camp doctor’s duties was to rule on whether a prisoner sentenced to twenty-five lashes on the Bock [a sawhorse-like devise] was physically strong enough to survive.” At mass shootings, “A doctor had to be there because ‘one bullet doesn’t always kill the prisoner immediately and his duty was to certify death’.”

I was horrified by the role that doctors played in the entire Nazi death-dealing system. As a physician, I felt the weight of judgment against the medical profession and against me. And I wondered how I would have behaved had I been a doctor during the time that the Nazis were in power. As wartime living conditions worsened and as Hitler and his gang grew more insane with their demands for killing, the jobs of these physicians often spiraled down into condoning, authorizing and even committing murder.

At Ravensbruck there were doctors and nurses, most of them prisoners working under SS doctors, who, worked hard to relieve the suffering all around them. But their power was very limited. One doctor who helped a lot of people was Loulou Le Porz, a French prisoner doctor. She was able to do more good because, ironically, she worked in the “death block,” where the “neglect killings,” as the war trials called them, took place. She was there because the SS required a bonafide physician to sign the death notices. Decades later, being interviewed by the author, 93 year old Dr. Le Porz could still name each of the patients, their families and their diagnoses.

Even though this book overwhelms you with the pile-on of cruelty, pain and suffering, most of it systematic and intentional, I also marveled at the innumerable acts of kindness and bravery, the implacable resoluteness to resist to the Nazi prison system, and a determination to survive and to keep their humanity.

Helm tells of Himmler inspecting some Jehovah’s witnesses who had been locked into a punishment bunker. Helm writes, “Himmler and [camp commandant] Koegel peered into the darkness at a huddle of starving, freezing women crammed inside a wet, stinking cell. The women were praying….Now he spoke. ‘Don’t you see your God has left you? We can do with you whatever we like.” One of the Jehovah’s witnesses in the cell responded: ‘God will save us. And if he does not –we will not serve you.’”

Else Krug, a prostitute, not a political prisoner, defied Koegel who ordered her to flog some Jehovah’s witnesses. “‘No, Herr Camp Commandant,’ said Else. ‘I never beat a fellow prisoner.’” Even though this meant punishment for her.

And resistance, it seems, was everywhere. Polish victims of medical experiment exhaustively documented their torture. They smuggled this information out at great risk by writing on scraps of paper using invisible ink made of urine.

The workers at the sewing factory run by a tailor who regularly threw the machines at the seamstresses’ heads and kicked them with hobnail boots, committed acts of sabotage. Everyday, the tailor checked religiously that all the buttons were sewed on securely and the buttonholes over sewn correctly. However, he never checked that the buttons and their holes were aligned. (He was tried and executed for his crimes in the post-war trials.)

Despite the intentional degradation, the female prisoners of Ravensbruck tried to live like human beings. Women nursed the sick and injured with folk remedies. Poets wrote poems and read them aloud. Others spun stories of love, sex or tragedy. Still others lectured on their area of expertise: Romanticism, anthropology, literature, ethnology. Olga Benario, who is said to be the model of the statue overlooking the lake of a woman lifting another in her arms, drew maps of battlefront happenings from information in smuggled newspapers. Hannah Sturm, a carpenter, found a copy of War and Peace –probably meant to be used as toilet paper – and read it to her compatriots.   Work gangs sang songs, including Mozart, Brahms, Bruckner. Sculptors carved little objects on toothbrush handles. Sunday’s ration of a dollop of jam and a pat of margarine were saved up to make birthday cakes.

Most of these activities were punishable by whipping or the dark, cold and hunger of the punishment bunker or worse. And yet, they persisted — with courage and with humor. In a way, Sarah Helm’s research and writing of this story is also an act of courage as she raced the clock to talk to survivors, now in their 80s and 90s. On leaving the gates of Ravensbruck, we saw dozens of plaques and memorials put up on the outside of the concentration camp wall.

In memoriam — plaques and flowers

In a strange way, my faith in humanity and my optimism for the future – even given our own government’s unfair treatment of immigrants, poor people and people of color – were bolstered by this book and by my visit to Germany. What I learned was that from the beginning, there were thousands, tens of thousands, hundreds of thousands of people who resisted Fascism and Hitler all across Europe. (The original reason for the concentration camps was to imprison resisters.) And these resisters, which the book shows clearly, included women across age groups, across ethnic lines and including every educational background. And even when they had paid the price of their resistance, with imprisonment and torture, they persisted. Even in the nightmarish environment of the concentration camp, they “lived out” their resistance — with kindness to others, with making literature and art, and by remembering.

Tell me: What unjust systems have you resisted and what did you learn from your resistance?

Statues representing Ravensbruck prisoners

By Cathy Luh

I am a doctor, a writer and Grammy to Edin and Caleb. I live in St. Louis with husband Bill.

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