Taking an elderly patient to the shower or very small room; putting him in one of two queues going right or left; exposing him to a siren, potent odor or strong light; waking him up early to take his temperature; or squeaky footsteps on a hard floor shouldn't upset him. But if the patient is a Holocaust survivor, the shower may remind him of the gas chamber; the queues recall the Nazi "selection"; the siren a Nazi search in the ghetto for Jews; and the early wakeup may trigger nightmares about being counted in a concentration camp. The average Holocaust survivor, having lost his family more than six decades ago, is lonely even when surrounded by children, grandchildren and great-grandchildren. And their feeling of loss is only intensified when they lose their health in old age. The need to treat survivors with special consideration and awareness of their unique needs was stressed at the recent Jerusalem launching of a new Hebrew-language guide aimed at making doctors, psychologists and other professionals more attuned to their needs. ESHEL, the organization owned by the Joint Distribution Committee and dedicated to improving the lives of the elderly in Israel, launched the 256-page guide called Hatipul Benitzolei Shoah Mizdaknim (Treatment of Ageing Holocaust Survivors). The original English-language volume issued a few years ago by the Baycrest Geriatric Health Care System in Toronto (www.baycrest.org) was prepared by a team of experts led by hospital social worker Paula David. The text will appear free in three months on an affiliated Web site, with Baycrest wanting to spread the word to everyone who has dealings with survivors. The new Hebrew edition was translated by Ehud Amir of Yad Vashem and edited by Dr. Natan Durst, Prof. Ariela Lowenstein, Batya Rappaport and Dr. Shmuel Reiss of the Technion-Israel Institute of Technology and produced by Tuvia Mendelson, director of ESHEL's publications department. The Jerusalem-based ESHEL organization hopes that the NIS 70 guide will reach a wide audience of doctors, nurses, social workers, caregivers and therapists, and that its advice will be used as a therapeutic tool. THE GUIDE comes just in time to help the 256,000 Israeli Holocaust survivors who are still alive, but whose numbers are being reduced by dozens per day (survivors in the Diaspora are estimated to number about three times that figure). Today, the Israeli survivors - out of some 600,000 who moved to Israel during the early years of the State - comprise 36% of all Israelis over 65. They are the last remnant of the Holocaust generation - and one day not too far in the future, the last one will have died. But finally, after many of them were unfairly treated with pity, dismay and even ridicule for being the lucky ones among Jews who allegedly went "like sheep to the slaughter," in the past year survivors have been given reason to hold their heads high. Public campaigns to make survivors' last years comfortable have led to higher allotments, Knesset discussions and even the establishment of a state investigation committee headed by a former Supreme Court justice on how they have been treated. At a five-hour conference in the capital's Beit Avi Hai auditorium, ESHEL director Prof. Yitzhak Brick, whose grandmother and other relatives were murdered by the Nazis, said that over a third of all elderly residents are Holocaust survivors. While the government has decided to spend billions of shekels on this unique group, "there is still a long way to go." Ze'ev Faktor, a frail survivor who is chairman of the Committee for the Welfare of Israel's Holocaust Survivors, said that as the Holocaust falls deeper into the past, the population's awareness of it has become "more confused," even though a state memorial day is held annually. "Every year there are people who don't stop what they're doing and get out of their cars when the one-minute siren is sounded. For us, maybe the wounds of the past seem healed on the surface, but our pain remains and is surging." When Faktor arrived in Israel during the early years of the State and was identified as a survivor, "people thought I was crazy when asked if specific people they knew were still alive, and I said few had made it. It took a long time before Israelis realized what had transpired. I don't know how many generations will pass before descendants live normally, without these fears, influences and wounds, which are still bleeding." Lowenstein, whose academic gerontology center is the only one in an Israeli university to teach about Holocaust trauma, said the Baycrest volume and its Hebrew translation are evidence-based manuals for professionals and paraprofessionals who work with survivors. As their parents were usually murdered, survivors who were children during the Holocaust have no models of being old. When they finish building their families and retire from their jobs, Holocaust memories they had nearly forgotten pop up again, she said. PAULA DAVID of Baycrest, who came from Canada specially for the event, said a growing number of survivors are coming to the geriatric hospital. "Sometimes they need unique care. We aren't experts; the survivors keep teaching us, as they are the real and only experts." She and her team contacted doctors, nurses, dentists and social workers for tips on how they relate to survivors and how they treat them differently from other old people. Their suggestions, and others, were studied and tested for usefulness. Now the challenge is what will be done with the guide." She recommended that survivors' relatives photocopy or print out pages and take them to their doctors, dentists and caregivers. The need to ask other people for help is hard on many survivors, added Durst. Reading the guide can help caregivers and medical professionals identify with the hurt of the people sitting opposite them. They must become aware, he said, of the associations they arouse when they do things that can arouse horrible memories. Specific cases of interactions between caregivers and survivors were described by Rappaport, A young foreign-born caregiver named Theresa who takes care of an 80-year-old woman discovers a number tattooed on the arm of her employer and gets an angry reaction. The Holocaust nursing student is now participating in a seminar for those who work with survivors. Another case, recalled Rappaport, was the daughter of a survivor named Mrs. Goldstein who needs surgery. Her daughter begs the hospital staff: "Don't let her suffer. She has suffered enough." The gerontology expert and member of the editing team added: "Survivors want to be in control, but they know they can't fight death." An old man with cancer who had to have a lung removed was especially fearful because he knew that the sick in labor and concentration camps would inevitably die, and only the physically strong survived. Now he was among the weak." Several years before the publication of the Hebrew guide, ESHEL launched special projects to help survivors and strengthen their connection with adolescents. Low-income pensioners, many from the former Soviet Union, are invited to clubs and day centers with a special "European atmosphere" that combines emotional treatment with social support. "Treatment is less threatening when you get a hot cup of coffee and are encouraged to dance," said ESHEL program director Maggie Gad. Subsidized dental care in a mobile unit has just begun, and a program to create films and albums telling the life stories of survivors is very popular. The latter program brings together high-school pupils and youth movement members who are visited at home and invited to gatherings where the adolescents act out the life stories and develop an emotional bond with the elderly. "The kids learn history from the survivors' stories, and they hold public trials with defendants, prosecutors and witnesses for "theaters of testimony." These process the old people's trauma." Rahel Cohen, a Hungarian-born survivor, stood on the stage at the conference to describe in a few minutes what she had gone through. The country was rampant with anti-Semitism and beatings in the Christian school where she was forced to learn. Her father was taken to a concentration camp in 1942, and she herself went to Auschwitz at the age of 13 and then to a weapons factory in Czechoslovakia. "We walked many kilometers each day, were given two slices of bread in the morning, and in the evening we were fed something that was called soup." She was liberated at the end of the war and came on aliya to Israel, where she was completely alone. But she learned Hebrew, married a survivor from Budapest and had four children. When her daughter read a book on a child in the Holocaust, Cohen screamed and insisted that she stop; in recent years, she has been able and even willing to talk about her experiences. A son died of cancer 16 years ago and her husband eight years ago, but instead of giving in to despondency, Cohen went out to help other elderly survivors. University of Haifa gerontologist Prof. Ya'acov Gindin, whose father made aliya from Pinsk in 1928 and was thus the only survivor of his family, once watched a TV documentary on the Holocaust and suddenly identified members of his immediate family being shot to death and falling into a recently dug trench. "I remember we had to be quiet at home every Holocaust Day." Unlike many doctors, he always gently asks elderly patients how they spent World War II. He advises his medical students to do the same in hospitals and clinics, even though it may make those in the waiting room impatient. He also noted that survivors who are about to die show much more strength facing the end than non-survivors. Numerous survivors bearing traumatic memories do not sleep well, Gindin added. "They shout" in their beds, but do well during the day. As a result of this symptom, many Israeli psychiatrists in the Sixties and Seventies gave them a mistaken diagnosis of "psychoneurosis" and prescribed pills some take today, even though they can be harmful in combination with other drugs," Gindin declared. Not all survivors should be regarded as unfortunates, said Ben-Gurion University historian Prof. Hanna Jablonka, who delivered a rather iconoclastic and very positive speech. "I generally regard survivors as normal people. I have met thousands who didn't need psychological treatment. I don't think there is such a thing as a Second Generation [who were deeply affected by their parents' suffering]," she said. "Most of the survivors were successfully rehabilitated," she said. "They built the country, and their absorption into Israeli society is a real success story. And many of the newcomers fought for Israel's independence even though they were alone and didn't know Hebrew. Of 4,200 soldiers who fell, 1,300 had been through the Holocaust, some of them the only remnants of their families. This was tragic, but it was a victory for them to settle in a country where the Jew was not a minority. Even in the war, they felt they had come home." Finally, better late then never, it is time to help them - with guidance from the ESHEL book - to live out their final years as pleasantly as possible.