For more than half a century, Rachel Kane kept the memories at bay.
There were her daughters to think of, twins born in a displaced persons camp in the aftermath of the second World War. Kane didn't want to burden them with tales of the Holocaust, of a husband shot to death by the Nazis, a baby who starved to death in the forest, an extended family wiped out in a mass execution.
She didn't explain the nightmares that woke her, screaming, in the long string of cramped apartments the family called home after resettling in Detroit and then Los Angeles.
Instead, the university-educated Hebrew teacher who spoke seven languages regaled her daughters with stories about her "beautiful life" before Hitler's armies stormed Poland, successfully locking the war years away until 1998.
That was when her second husband died. When she began to lose her battle with dementia. When she became convinced that the soldiers were coming for her, as they'd done so many years before.
Lying in her room at the Los Angeles Jewish Home for the Aging in Reseda, the elderly woman with the soft white hair and bright blue eyes "was seeing Nazis," recounted daughter Esther Kane Meyers. "She was hearing things. I came and sat with her every day. It was the most painful thing I'd ever seen. It was all happening, right there."
Watching 50 years of strength crumble under the weight of a long-buried trauma made Kane's family sad and angry. What they did not know at the time was that her experience was not uncommon among aging victims of Nazi brutality.
In recent years, a body of research has sprung from the lives of Holocaust survivors like Kane as caregivers and mental health professionals work to understand and alleviate the pain of old age and remembered trauma. But when she first began to relive her past, the territory was largely uncharted.
"There has never been a group of genocide survivors live to this age in history," said Paula David, editor of the manual "Caring for Aging Holocaust Survivors." Their experiences offer a rare window into the confluence of trauma and aging.
One clear lesson from this shrinking group, whose median age is more than 70, is that "resilience ages, too," David said, "and diminishes along with hearing and vision."
The Los Angeles Jewish Home for the Aging has the largest population of Holocaust survivors in the West, according to nursing home officials. There were 63 such patients at latest count, although that number could rise to nearly 90 when a new building opens later this summer.
Although every Holocaust survivor is different, Kane's end-of-life experiences are a good illustration of the kinds of things they can go through, said Chaya Berci, the Jewish Home's executive director of nursing.
As people age and their grasp on the present weakens, events from the distant past can seem as real as anything unfolding today. For those who lived through severe early trauma, the memories that come rushing back are often of their most harrowing experiences.
Mental health professionals debate whether the symptoms they see in some aging Holocaust survivors stem from classic trauma or other conditions, such as an incomplete mourning process, said Allen Glicksman, director of research at the Philadelphia Corp. for Aging, who has studied the experiences of Nazi victims in long-term care.
Psychologist Marla Martin met with Kane regularly over the course of nearly three years as the woman's depression and anxiety bloomed into a psychotic break fraught with paranoia and auditory hallucinations.
Even pleasant events sometimes took on dark overtones for Kane, as the voices in her head reminded her of all she had witnessed and lost.
In October 1998, Martin wrote in her case notes that Kane's "daughter Esther gave her two nice blankets, and this started a problem for her. She was feeling guilt because of the Holocaust and the voices telling her to share the blankets. How could she have two nice blankets?"
Martin has been treating Holocaust survivors at the Los Angeles Jewish Home for 15 years. By the time she started seeing Kane, she had already observed that a "sizable minority" of the strongest survivors dwelt daily on past horrors.
And a psychotic break like Kane's is "not unusual," she said. "People who have had really acute trauma can re-experience it, feel that they're there."
Kane's first husband was shot to death after Germany invaded Poland in September 1939. Pregnant and alone in an occupied city, she fled to her family's home in the small town of Byten. But the soldiers soon reached there, too, and forced Jews into a cramped ghetto.
After Kane gave birth, her father, a respected rabbi, begged her to leave. It was the only way, he told her, to avert disaster. So she took her infant daughter into the nearby forest and joined the resistance fighters.