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Massive psychic trauma due to genocidal persecution leaves an indelible imprint upon the psyche. These effects, however, may be variable due to many factors, such as one’s age during the onset of the trauma, the nature of the trauma, its duration, post-liberation experiences, etc. While these effects persist throughout one’s life, this presentation will focus on the end of the life cycle when survivors, like everyone else, are faced with the prospect of infirmity, illness, dependence, loss of loved ones, helplessness and ultimately death. There may be an emergence, reemergence, intensification and/or transformation of Holocaust memory and symptoms as the sands of time in the hourglass of life are running out. This phenomenon appears to be on a continuum with the so-called deathbed confession and the doorknob phenomenon at the end of a therapy session. The extent to which Holocaust trauma is integrated as opposed to being walled off through repression or dissociation also influences this “hourglass effect.” Findings will be presented from the clinical situation, a semi-structured interviewing project with child survivors, survivors’ testimony, accounts in the literature and personal relationships.