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 IMG_5164Germany. 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 Nazi 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

A Birding Guide to “War and Peace”


To say that War and Peace by Leo Tolstoy is about a bunch of aristocratic Russians during Napoleon’s 1812 invasion is like saying that Games of Thrones is about politics. This is a grand, epic story. There’s war and peace, love and death and a cast of thousands. But wait, there’s more! Here are the reasons I love this book.

I want to tell you my favorite passage. It’s when Pierre, fat, clueless and near-sighted, decided that he wanted to see the battle of Borodino. Because he is socially prominent, he is allowed to wander around the battlefield while others dodge bullets and shoot cannonballs with purpose.

He finds himself on a fortification looking far off at the battle. “The officers said that Napoleon or Murat was there. And everybody looked eagerly at this bunch of horsemen. Pierre also looked, trying to guess which of those barely visible men was Napoleon. Finally, the horsemen rode down off the barrow and disappeared from sight.”

This passage excites me. I want to, and have, read it to perfect strangers. Nothing in my life has described how I feel when I’m bird watching as well as this. Like Pierre, I am very near-sighted. Also, at five feet, zero inches, many things, including branches and other people’s heads, block my view. So, I’ll be out with a group of birders. Someone will spot an interesting bird, which, I remind you, is much teensier than Napoleon. It might be an elf owl, a Colima warbler, even something as big as a zone-tailed hawk. They ooh and aah among themselves.

“See the white eyebrows and cinnamon at the edge of the facial disc?”

I am the one in pink on the left

“There a small rufous spot on the top of the head.”

“I can see the two white bars across the black tail.”

I can’t even see the bird, much less the markings. I try to walk around the edge of the group as there’s no hope of looking above anyone’s head. This makes their kindly attempts to describe the spot –“see where the two branches make a V?” — even less accurate because the angle is different now. Then, someone will chime in, “Oh, it flew.”

Of course, in a story as long as War and Peace, many events happen. The remarkable thing to me is that people’s feelings change dramatically, but not necessarily caused by the events. As an example, Natasha as a teenager, falls in love with Andrei. They become secretly engaged. She is then seduced by the villainous Anatole, almost despite herself. “As soon as Natasha saw him, she was seized by the same feeling as in the theater, of vain pleasure at being liked by him, and of fear because of the absence of moral barriers between them.”

When her plan to run away with him is foiled, “… she sobbed with that despair with which people weep only over a grief of which they feel themselves the cause.” Shortly afterward, she discovers that Anatole was already married. She becomes distraught with guilt and loses her will to live.

For months, doctors visit and give her all sorts of medicines, “pills, drops and powders.” Natasha is thin, pale, withdrawn. She doesn’t eat. She doesn’t sleep. Then Tolstoy writes, “despite the absence of her accustomed country life, youth had its way: Natasha’s grief began to be covered over by the impressions of ongoing life, it ceased to weigh with such tormenting pain on her heart, it began to become the past, and Natasha started to recover physically.” (The doctors, and the family, believe that the medicine finally kicked in.)

Something like this happened to me. During college, I had been dumped by a boy from Connecticut. It hurt to hear that word. “Christmas in Connecticut” was a movie I couldn’t bear to see listed on the TV Guide. This guy drove a Volvo. Every time I saw one on the road (thank goodness they were quite rare in those days), my grief renewed. Some months later, I was driving and realized that I wasn’t paying attention to the makes of cars any more.

This book makes me wonder if life isn’t more arbitrary than I think. Sometimes, things just change. Most books tend to ascribe cause and effect to what the characters do. I tend to see my life in those terms too. All the major characters, Natasha, Andrei, Pierre, Nikolai make sharp turns in their lives. Sometimes, there are reasons. Sometimes, not. For myself, it’s made me less judgmental of people who seem to make illogical decisions. I give myself more slack too. Consistency isn’t some moral prerogative, I tell myself.

Tolstoy spends an inordinate amount of time writing about his theory that history is caused by millions of individuals doing what moves them: survival, greed, glory, love. Yet, put all these people with free will together and you get a historical movement. OK, OK, I get it. Like the characters’ actions, events are not pre-determined. It’s the mass of little people who make history, not Napoleon or Tsar Alexander I or General Kutuzov. He hits you over the head with this one idea, like he’s trying to convince himself.

War and Peace tells a spellbinding story, unwinding over the breadth of Russia in a time of turmoil. It also expresses the inner workings, desires, hopes, thoughts and connivances of the myriad characters in the most charming and unexpected ways. You never know what people in it will do. At the same time, Tolstoy marvels at the mystery of how the collective actions of these same people can seemingly become a mass movement.

I think each reader will also have his or her own takeaways in charming and unexpected ways. It’s sort of like when you strap on your binoculars, stuff your field guide in your pocket and go bird watching. You never know what you’re going to get.

TELL ME: What actions or decisions have you made that, on the face of it, wasn’t logical?

Geezer Sex

IMG_5121“Couldn’t those stiletto heels really hurt someone?”

“Doesn’t it hurt her neck to lean so far back?”

“How is he balancing?”

Bill and I are watching a porno movie on our 52” Sony TV in our family room. I ask the questions in rapid succession, as if the subject matter was usual for us. Bill is silent, eyes straight ahead. I had asked him to do this because of what I had read in “Come As You Are” by sex educator Emily Nogaski, PhD.

The goal of this book is to promote greater sexual enjoyment for everyone. Everyone. Each person’s anatomy is slightly different, but all normal. Sexual responses differ greatly, but are all normal. This is important because our own comfort with, and lack of judgment about, our own body and feelings and sexuality puts us in the best place for enjoying sex.

Emily (I will call her that as her author picture shows her to be young enough to be my daughter) is director of Wellness Education and lecturer at Smith College. She posits that context is key. And for women, the most sex-positive context is “low stress, high affection, explicitly erotic.” (italics mine)

When I was young, sex was something you could do on the spur of the moment. Car, sofa, dorm bed, swimming pool –no problem. Other than birth control, there was no equipment involved. Now that husband Bill and I are old, it’s a different story. There are pills to take, hormonal creams to apply, a big bed and soft pillows to accommodate for the tight hip, the bum knee and the creaky neck, oils or gels or lotions, and a vibrator that’s has to be the right size, speed and texture. We need all sorts of help.

After reading this book, I sent hubby on a hunt for explicitly sexual materials. Last week, the package arrived. There were a couple of DVDs, some lotions and a free bonus vibrator. The movies lacked even a semblance of plot. The sex was hugely athletic but lacked verve.

Still, we were a bit aroused, due to a phenomenon Emily calls “non-concordance.” The body’s response to a sexual situation and the mind’s response do not necessarily correlate. And we went at it. The vibrator worked pretty well. As for me, the biggest turn-on was the fact that Bill had taken the time and trouble to find the DVDs. Context, you know.

In the afterglow, when, in the movies, the man and the woman are drawing deep drags on their cigarettes, Bill and I just lie content and relaxed. I turned to him with a wide smile and say what I’ve said for twenty-five years, “I’ve never had sex with someone as old as you before.” Bill, his voice slightly hoarse, replies, “Ditto.”

Tell me: What books have you found useful in teaching you about human sexuality? What books were worthless?

The Third Reading Group (or, How I Became a Blogger)

My mother called me a bookworm. She was rather proud of her knowledge of this idiom in a foreign language. She was oblivious to the “lack of social life” aspect that this word implied. She was not wrong. I was usually reading at the dining table, in the bathtub and under the covers. Not resourceful enough to commandeer a flashlight, I read by the dim, green light of a three-inch plastic “glow in the dark” statuette of the Virgin Mary. If my Mom had known, she would have bawled me out when I had to get glasses in fifth grade. And I didn’t have friends.

Now, heading into my 8th decade of life, I marvel at the intense relationship I have had, and continue to have, with books, stories, anything written. I have lived in so many families: the Marches, Atticus, Jem and Scout, the Joads, the Brunettis of Venice. I have been the smart girl who wins in the end: Lizzie Bennet, Lisbeth Salander and Daenerys. I’ve have wanted to win over totally inappropriate men: James Bond, Sherlock, T.E. Lawrence.

Books were comfort for a broken heart, temporary escape when life was too hard or too boring, explanations for how our society, and little me in it, got to be where we are, explorations of human endeavor throughout our history and instruction on what to do and how to be.

Am I a co-dependent? Wasn’t everyone in the ‘80s? I was first tickled, then in profound agreement when Daniel Goleman mentioned asking the Dalai Lama for marriage advice for his about-to-be married daughter. The answer was, “Low expectations.” So opposite our Western, Protestant, striving culture, yet so right. Every time I had a major romantic breakup, I re-read the Lord of the Rings trilogy to get out of myself. I read Han Su-yin and Adeline Yen Mah’s memoirs, Chinese women doctors like my mom and me.

I do not think that my situation and my feelings are unique. I am hoping that lots of people whose personal universes include the characters, situations, ideas and emotions found in books will become my readers. What is unusual is that I can pinpoint just exactly when in my life all this started. The following essay, “The Third Reading Group,” explains.

The Third Reading Group

“The third reading group stays,” Miss Meyer ordered, as the rest of the class jostled noisily out the door at the clang of the recess bell. Richard, with his gravity-defying blond thatch, Sharon of the sharp elbows, sweetly-dimpled Sylvia and I, an earnest girl with my “watermelon seed” (oval) Chinese face and black hair pulled back in braids, milled dispiritedly around our teacher.

LuhB - 41

Resigned to the whims of adults, the four of us third-graders at St. Joan of Arc Parish School, situated among the “scrubby Dutch” of South St. Louis, scooted metal and wood desks toward the front. “Open This is Our Town to page 42,” Miss Meyer instructed. We obeyed the skinny, bespectacled young woman who flashed overcrowded lower teeth when she talked. Her short brown hair sat in a tight perm. I was fascinated by the long downy hairs that lay flat along the outside of her arm near the elbow.

When my turn came to read aloud, I stared hard at each word. There were some easy ones, like “the” and “of” and “tree” and “road.” I had them memorized. I had tried to memorize every word from the previous lesson, but there were just too many. I stumbled, beginning “kitten” with “kay” for the initial letter, and then, “tee,” and then “ten” because I knew the number ten. “Kay-tee-TEN,” I said haltingly.

“KIT-ten,” Miss Meyer corrected. “KIT-ten,” I echoed. But the next unfamiliar word came out just as garbled. The process eluded me. Even words that I thought I’d memorized didn’t pan out. I had trouble separating words like “tried” and “tired” and “dairy” and “diary.” They looked so similar but sounded so different.

Struggling through my paragraph was excruciating, and that was just to get the pronunciation.   I couldn’t be worried about deciphering the meaning. To my great despair, I didn’t see how it would go any better the next time.

The other kids soldiered on with equally horrible results. After all, that was why we were in the third reading group. I don’t know if they were dyslexic, ADHD, malnourished as infants or any of the sociological or medical terms we now throw around. In 1955, we slow readers were just grouped together. I’m sure Miss Meyer, who would have preferred a cup of tea or a cigarette during recess rather than drilling the “dumb” kids, had had no training in teaching remedial reading. Now I appreciate her efforts, even though her idea that we re-read aloud what we had botched reading during class wasn’t exactly inspired.

My particular reading problem could be traced to my family’s arrival to St. Louis from Hong Kong three months prior to the start of third grade. Just my bad luck to immigrate at the exact age that schools start to teach reading! My younger sister coasted in the first grade, and even taught me the meaning of “teacher’s pet.”

All I knew to do at school was to draw on my previous experiences in Hong Kong. I memorized English words because the only way to learn written Chinese is to memorize each character. Even though the character, the written word, is the same all over China, each of the hundreds of dialects in China pronounces that written character differently. For example, the character 好 , meaning “good,” is pronounced how in Mandarin, haw in Shanghai, huh in Taiwanese and hoe in Cantonese. Each word is also assigned a tone, and the number and nature of the tones differ with each dialect. If you pronounce how (Mandarin) with a “rising” tone, say, instead of the “down and up” tone, you’ve said a different word entirely – oyster, written 蚝.

Nothing about the Chinese character tells you how it’s pronounced. You just have to know. To be able to read a newspaper, you have to have memorized in the neighborhood of 5000 characters. I think that I knew several hundred Chinese characters at the time I came to America. I turned my rote memorization efforts to English.

Miss Meyer seemed as limited in her teaching approach as I was in my learning approach. Reading out loud, or even being read to while following the text, are good ways to learn…assuming you have a command of the spoken language. This reality struck home when my son was learning to read. All he had to do was to sound out the word because he was already conversant in English.

In addition to my untenable notion of memorizing everything, my efforts were hampered by the only English I had learned in Hong Kong—the alphabet. No one ever explained phonics to me! It was many weeks, maybe months, before I put together for myself that when a word started with a letter, say, “B”, one doesn’t pronounce the name of the word “bee.” I kept trying to pronounce words I didn’t know by saying the letters’ names rather than their sounds. It was mental pandemonium. As near as I can reconstruct, “dragon” came out like “de-ar-gee-un.”

Another source of puzzlement was the seemingly random accentuation of the syllables within a word. In Chinese, one character corresponds to one sound. That’s it. My pronunciation of longer English words, like “pronunciation,” was haphazardly, and often erroneously, accented. Thank goodness it was years later that I became aware of such words as “object” and “produce” that are either verbs or nouns depending on the accent.

Getting D’s in reading-dependent courses, History, Geography, and of course, Reading, quarter after quarter, even into the fourth grade, was crushing. Despite handing in blank pages when I didn’t understand Miss Meyer’s instructions except for her firm “Hands down” when she tired of students’ questions, I managed to get good grades in Arithmetic, Spelling (all memorization!), and Religion, having made my First Communion when I was five. But I could see the writing, even if I couldn’t read it, on the wall. Reading was the key to mastery of much more than just English. Day in, day out, I fought to make sense of each word, each line, each paragraph. I would stare at the page until I fell asleep.

While studying one gloomy winter’s day in the fourth grade, my eyes slipped their narrow focus and took in a whole line. And it made sense! Holding my head still, I shifted my gaze to encompass the entire line of words beneath the one I had just read. I held my breath, but it was not a fluke. I understood that sentence too. My heart was pounding so fast that I could barely sit. But sit I did because I wanted to keep reading. I wanted to know the rest of the interesting story. I didn’t want to lose this newfound knack, the way a 3-D picture can so quickly morph back into just panels of pattern. I barely slept that night fearing I’d wake up in the morning and be my old self again.

But the next day and the next and forever after, I could read English. Maybe I had missed the forest for the trees by focusing word by word. I’m sure my seemingly pointless efforts throughout the year were important in some way, like a three-year old who never spoke until he burst forth in complete sentences, but the connection was not direct. When I studied Buddhism in college and came to the term satori, a word often translated as “instant enlightenment,” I immediately flashed back to the glorious moment I learned to read.

I cannot exaggerate the impact that that one event –making sense of words—has had on my life. Like the world switching from “black and white” to color when Dorothy opened the farmhouse door after landing in Oz. Or, like the scales falling from St. Paul’s eyes after he had been blinded on the road to Damascus.


My favorite analogy is from a book I read with my son when he was small: “Grover and the Everything in the Whole Wide World Museum.” Grover, the blue-furred Sesame Street puppet (no, not the Cookie Monster who is also furry and blue but much fatter), enters the “Everything in the Whole Wide World” museum. After going through the “Carrot Room,” where a lone carrot sits on a pedestal, and the “All the Vegetables in the Whole Wide World Besides Carrots Room,” he goes on to a dozen other rooms. The rooms are labeled with equally arbitrary classifications: the Small Hall (a freckle, a thumbtack, an eyelash, a grain of sand –you get the idea), the Tall Hall (a tree, a phone pole, a giraffe, and so on), the Long Thin Things You Can Write With Room, the halls of Very, Very Light Things and Very, Very Heavy Things, and the Things That Make You Fall Hall (roller skate, banana peels, ice, soap, an out-stretched foot).

After scouting out all the rooms, Grover realizes that he still hasn’t seen everything in the whole, wide world. Then he spots a huge, double-doored gate with a giant gold sign above it, reading, “EVERYTHING ELSE.”

The final page of the book shows Grover, arms raised in salute, joyfully running out that huge door to the outside. He greets the sun, which is throwing off giant rays. He heads towards a town with buildings. In the distance, mountains poke their snow-capped peaks above a blue lake. Lush bushes dotted with flowers border Grover’s path. Here was the “everything else.”

Finding the secret to reading, which opened the door to everything ever written, held that same sort of exhilaration for me. Like Grover, I found marvels at every turn.  At first, it was the great relief of finally being able to pull more than D’s in my history, geography and religion classes. But that was just the beginning of my exploration of other people’s thoughts, my connecting with other people’s feelings, my bedazzlement by other people’s imaginations and my discovery of their humanity. I had fallen in love – with reading, with books.

Tell me:  When did you fall in love with books?