For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness





When a life starts to unravel, where do you turn for help?




Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.


In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.


“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”


That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”


Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.


One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.


“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”


On a recent afternoon, she described in her Midtown office the range of her practice.


“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”


Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”


Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.


One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.


“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”


Her son cut her off. “Are you comparing me to the guy that shot those people?”


“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”


“Did you really just compare me to that guy?”


“No, I didn’t compare you.”


“Then what did you say?”


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Is Southwest Airlines losing the love?









Southwest Airlines' reputation as an industry maverick seems to be going the way of flight attendants in hot pants and $20 one-way fares.


The nation's largest domestic carrier just marked its 40th straight profitable year, an unmatched feat in a time of economic turbulence, fluctuating fuel prices and airline bankruptcies. It did so by undercutting the competition with no-frills flights and, in the process, building an army of budget-minded fans.


Now many of those longtime customers say the Dallas-based carrier that calls itself LUV airlines has been losing their love since it recently began to shift its focus away from low fares and friendly service toward swelling its bottom line.





Among the changes that critics say show Southwest's new profit-boosting attitude: It cut the legroom on many planes to fit more seats, retooled its frequent flier program to make passengers spend more money to collect points and adopted new fees to board early.


"Southwest used to be a great airline," said Lance Malkind, a semi-retired consulting actuary from Phoenix, who has been flying Southwest for 33 years. "The fares were reasonable, onboard service was excellent, and the frequent flier plan was simple and very good. Now the fares are no longer that good compared to other airlines, and the frequent flier plan has gone from being one of the best to one of the worst."


Southwest is still the country's only major airline to waive fees for the first two checked bags. It also ranks high in on-time performance. But even airline officials conceded that Southwest had to find new ways to make money to compete.


"Yes, we have to keep up with the times and, yes, we have to change," said Whitney Eichinger, a spokeswoman for the airline. "But the truth is that Southwest remains a maverick in the industry."


Many of the new fees adopted in the last couple of years are for optional services, such as early boarding and wireless Internet access, she said. But what has long been included in the price of the fare — two checked bags, snacks and drinks — remains free, Eichinger added.


"If we were charging for peanuts, that is something that our customers would find outrageous," she said.


Because Southwest has forgone millions of dollars in revenue from baggage fees, analysts say, it was no surprise that the airline would look for other ways to generate extra cash to offset rising labor and fuel costs.


"Southwest is in the middle between customers who are very sensitive to higher fares and investors, on the other hand, complaining that the airline is not doing enough," said Seth Kaplan, a managing partner at Airlines Weekly, a trade publication.


With the economy rebounding and demand for air travel still relatively strong, airline industry experts say now is the best time for Southwest to test new moneymaking ideas without risking the loss of too many loyal fans.


"I'm not surprised by this," said Betsy Snyder, an analyst with Standard & Poor's. "They want to increase their profits and this is the way to do it. They could lose passengers, but in some markets what's the option? Do other airlines offer anything better?"


Southwest was born in 1971, serving Dallas, Houston and San Antonio with three Boeing 737s — a plane that still represents nearly 90% of its fleet. It made its headquarters at Dallas' Love Field, which later earned it the stock symbol LUV.


The airline took to the air amid tough competition from now-defunct Braniff and Texas International and fought back by offering free bottles of liquor and half-price fares for overnight flights.


Almost from the beginning, Southwest has pushed its niche — low fares but no extra frills like seat assignments, in-flight meals or roomy first-class seats. The hot-pants uniforms worn by flight attendants in the 1970s were replaced with shorts and pants in the '80s.


Southwest enjoyed its best years in the late 1990s when it saved millions of dollars with fuel hedging contracts that enabled the airline to buy fuel at a fixed price to avoid the exposure of price fluctuations. But the hedging advantage ended around 2008 when fuel prices dropped.


As the Great Recession took hold, most other airlines added baggage fees to boost revenue. Southwest, instead, broke from the trend and adopted a "bags fly free" policy. JetBlue is the only other airline to waive fees for the first checked bag, but it doesn't for the second.


Southwest officials said the bags-fly-free policy is probably responsible for increasing Southwest's market share about 2% since 2008 and generates up to $1 billion annually.


To further expand its customer base, Southwest announced a $1.4-billion deal in 2010 to acquire Orlando, Fla.-based AirTran Airways.





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FBI: Elderly man robs Niles bank













Bank robbery suspect


Suspect in the robbery of a Niles bank.
(FBI / February 9, 2013)



























































A man the FBI said appeared to be in his 70s and walking with a cane robbed a bank this morning in north suburban Niles.


A man who is estimated to be in his 70s robbed the Harris Bank branch at 7077 W. Dempster St. at 9:45 a.m., according to FBI spokesman Joan Hyde.


The robber was wearing a brown coat and walked with a cane during the incident, she said.





He displayed a weapon during the robbery, but no one was hurt, according to Hyde.


Niles police were not available immediately. 


chicagobreaking@tribune.com







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Grammys pay tribute to Shankar, King, Temptations






LOS ANGELES (AP) — Ravi Shankar passed away in December before he could attend The Recording Academy‘s Special Merit Awards celebration where he was to receive a lifetime achievement award. But the 91-year-old sitar master, Indian music promoter and friend to The Beatles got the call a few days before he passed away, and that meant everything to his family.


“I was very excited to hear about the lifetime achievement award a week before my dad passed away, one day before he went into surgery,” Shankar’s daughter, Norah Jones, said in an email to the Associated Press a few hours before the ceremony. “He knew about it and was very happy, and also that he and my sister, Anoushka, were both nominated in the same category for a Grammy (this year) was a special thing as well. We all miss him and are very proud of him. I will forever be discovering and re-discovering his music from all walks of his long and amazing life.”






Jones and Anoushka Shankar‘s acceptance of their father’s award Saturday afternoon at the Wilshire Ebert Theatre in Los Angeles was one of many memorable moments in the ceremony honoring performers and non-performers alike.


The crowd made a happy birthday video for Carole King, saluted husband-and-wife songwriters Marilyn and Alan Bergman on their 55th anniversary, and swooned as Charlie Haden paid tribute to his wife and family.


Shankar, singer-songwriter King and jazz bassist Haden were honored with lifetime achievement awards along with classical pianist Glenn Gould, who made his final public performance in the same theatre, blues guitarist Lightnin’ Hopkins, The Temptations and pop singer Patti Page, who like Shankar passed away in the last two months.


Special merit awards also were handed out to non-performers. Chess Records founders Philip and Leonard Chess, husband-and-wife songwriters Marilyn and Alan Bergman, and former Capitol Records executive Alan Livingston won the Trustees Award given to non-performers. And MIDI developers Ikutaro Kakehashi and Dave Smith and ribbon microphone manufacturer Royer Labs won technical Grammys.


Haden noted the importance of his family in his acceptance speech.


“I thank my brother Jim for letting me listen to his jazz records,” Haden said. “I heard Charlie Parker and that changed my life forever.”


For King, it was James Taylor who sent her down a new path. She noted in her video message he forced her to get up and sing one of her own songs in concert when she really didn’t see herself as a performer: “I guess he was right.”


The Bergmans, who wrote “The Way We Were,” turned in a romantic acceptance speech, adding another special moment to a partnership that produced some of our most well-known songs.


“I just want to say this in public: I’m married to the most remarkable woman in the world,” Alan Bergman said.


“Oh, cut it out,” Marilyn Berman responded.


___


Follow AP Music Writer Chris Talbott at http://twitter.com/Chris_Talbott .


___


Online:


http://www.grammy.com


Entertainment News Headlines – Yahoo! News





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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness





When a life starts to unravel, where do you turn for help?




Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.


In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.


“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”


That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”


Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.


One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.


“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”


On a recent afternoon, she described in her Midtown office the range of her practice.


“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”


Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”


Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.


One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.


“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”


Her son cut her off. “Are you comparing me to the guy that shot those people?”


“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”


“Did you really just compare me to that guy?”


“No, I didn’t compare you.”


“Then what did you say?”


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The fine line between legitimate businesses and pyramid schemes









Controversy is again casting a shadow over the multilevel marketing industry, as nutritional supplement company Herbalife Inc., which has thousands of distributors in the Chicago region, has been publicly called a pyramid scheme by a prominent investor — an allegation the company vigorously denies.


Meanwhile, a different multilevel marketer, Fortune Hi-Tech Marketing, was shut down in recent weeks after a lawsuit was brought by regulators and several states, including Illinois, alleging the company scammed consumers out of $169 million. The scheme affected an estimated 100,000 Americans, including some in Chicago, where it targeted Spanish-speaking consumers, the Federal Trade Commission alleged.


Most people outside the industry might have only a vague notion about multilevel marketing, also called network marketing and direct selling. It often involves personal sales of cosmetics, wellness products or home decor items — or as critics flippantly call it, "pills, potions and lotions" — usually sold through product parties hosted by friends or relatives.





For sellers, the companies offer the appeal of starting a business on the cheap with little training, working from home and being their own boss, if only for part-time money. Some might recruit friends and family to become sellers, which augments their own commissions and gives them a shot at the six-figure compensation many such marketing companies tout but few distributors attain.


The largest multilevel marketing companies, often known as MLMs, are household names: Avon, Mary Kay, Pampered Chef and Amway. MLMs have annual sales of about $30 billion, with about 16 million people in the United States selling their products, according to the industry group Direct Selling Association, which represents these firms and others.


The recent controversies might raise the question: What's the difference between a legitimate multilevel marketing company and an illegal pyramid scheme, in which only people who get in first — at the top of the pyramid-like structure — make money and everyone else is a dupe?


The harshest critics maintain there is no difference, that there's no such thing as a legitimate MLM and that the industry's secrets stay safe because of a cultlike mentality and a blind eye of regulators.


Jon M. Taylor, who was once a seller for an MLM company, said he has studied the industry for 18 years and analyzed more than 500 MLM companies. He maintains the website MLM-thetruth.com and offers a free e-book there.


"I have not yet found a good MLM — a good MLM is an oxymoron," Taylor said.


He said all MLM companies have the same flaw: They depend on endless chains of recruiting new members.  "There is no more unfair and deceptive practice than multilevel marketing," Taylor said.


Tracy Coenen, a forensic accountant and fraud investigator with Sequence Inc. in Chicago and Milwaukee, is author of the Fraud Files Blog. She is also a critic.


"Multilevel marketing companies are pyramid schemes that the government allows to operate," said Coenen. "The only difference is that Herbalife, or any multilevel marketing company, has a tangible product that they use to make their pyramid appear legitimate."


The Direct Selling Association says MLMs are legitimate businesses, and that the group has about 200 members carefully screened by the organization to ensure they are not pyramid schemes and don't use deceptive practices.


The Federal Trade Commission agrees there are legitimate MLMs. The difference between a legitimate business and pyramid scheme comes down to products.


If the company and its distributors make money primarily from the sale of products to end-users (and not boxes of product accumulating in a distributor's garage), it's OK.


By contrast, a pyramid scheme compensates those at the top of the pyramid with participation fees paid by those recruited at the bottom. It eventually collapses when the scheme can't recruit more people.


But identifying a pyramid scheme can be difficult because MLMs typically have product sales, along with recruitment fees and recruitment incentives.


"It gets cloudy when you have a situation where you have fees being paid for both," said Monica Vaca, assistant director of the FTC's division of marketing practices. "It's very nuanced."


While prosecuting an MLM can seem somewhat of a judgment call, cases have a common factor: deceptive promises about how much money distributors will earn, Vaca said.


In the Fortune Hi-Tech Marketing case filed last month, C. Steven Baker, director of the FTC's Midwest region, said, "These defendants were promising people that if they worked hard they could make lots of money. But it was a rigged game, and the vast majority of people lost money."





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Blizzard hits Northeast closing roads, cancelling flights








A blizzard slammed into the northeastern United States on Friday, snarling traffic, disrupting thousands of flights and prompting five governors to declare states of emergency in the face of a fearsome snowstorm.

Massachusetts Governor Deval Patrick announced a ban on most car travel starting Friday afternoon, while in Connecticut Governor Dannel Malloy closed the state's highways to all but emergency vehicles.


Winds were blowing at 35 to 40 miles per hour (56 to 64 km per hour) by Friday afternoon and forecasters expected gusts up to 60 mph as the evening wore on.

The blizzard left about 10,000 customers along the East Coast without power, and almost 3,500 flights were canceled.

Forecasters warned that about 2 feet of snow would blanket most of the Boston area with some spots getting as much as 30 inches. New York was due to get about a foot in some areas, while heavy snowfall was also expected in Connecticut and Maine.

"We're seeing heavier snow overspread the region from south to north," said Lance Franck, a meteorologist with the National Weather Service in Taunton, Massachusetts, outside Boston. "As the snow picks up in intensity, we're expecting it to fall at a rate of upwards of two to three inches per hour."

Early Friday evening, officials warned that the storm was just ramping up to full strength, and that heavy snow and high winds would continue through midday on Saturday. The governors of Massachusetts, Rhode Island, Connecticut, New York and Maine declared states of emergency and issued bans on driving by early Friday afternoon.

In many cases, authorities ordered non-essential government workers to stay home, urged private employers to do the same, told people to prepare for power outages and encouraged them to check on elderly or disabled neighbors.

People appeared to take the warnings seriously. Traffic on streets and ridership on public transportation was significantly lighter than usual on Friday.

"This is a very large and powerful storm, however we are encouraged by the numbers of people who stayed home today," Boston Mayor Thomas Menino told reporters.

In New York City, Mayor Michael Bloomberg suggested the storm created an opportunity to relax and catch up on sleep.

Even so, the storm caused a few accidents, including a 19-vehicle pile-up outside Portland, Maine, that sent one person to the hospital.

In addition to Friday's cancellations, more than 1,200 flights scheduled for Saturday were scratched, according to the website FlightAware.com.

The storm also posed a risk of flooding at high tide to areas still recovering from Superstorm Sandy last October.

"Many of the same communities that were inundated by Hurricane Sandy's tidal surge just about 100 days ago are likely to see some moderate coastal flooding this evening," said Bloomberg.

Brick Township in New Jersey had crews out building up sand dunes and berms ahead of a forecast storm surge, said Mayor Stephen Acropolis.

Travel became more difficult as the day progressed.

Amtrak suspended railroad service between New York, Boston and points north on Friday afternoon.






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Humble Damon cheers Oscar hopeful, friend Ben Affleck






BERLIN (Reuters) – It seems that wherever Matt Damon goes to promote his movies he is asked about something else altogether – his old friend and collaborator Ben Affleck, whose Iranian hostage drama “Argo” is in the running for a Best Picture Oscar.


Damon shared a screenplay Academy Award with Affleck for the 1997 film “Good Will Hunting” and has gone on to become one of the biggest stars in Hollywood, with blockbusters including the “Ocean’s Eleven” and “Bourne Identity” series.






He was in Berlin on Friday for the festival premiere of “Promised Land”, a tale set in rural America that tackles the controversial gas extraction technique known as “fracking”.


At a news conference following the press screening, the 42-year-old did not have to wait long for a question about Affleck, and, once again, he lavished praise on an actor who he said had endured his share of tough times.


“His life is so interesting that I kind of never get tired of talking (about it),” Damon joked.


Of the critical acclaim and string of awards for “Argo,” he said: “I’m really happy for him. He certainly deserves it.”


“He’s worked so hard and he’s taken it on the chin for years from the press and just from everywhere. He was really in a rough spot 10 years ago,” Damon told reporters, referring to the ridicule Affleck suffered during his romance with Jennifer Lopez and their 2003 movie flop “Gigli.”


The actor recalled Affleck once telling him he was “in the worst place you could be career-wise: I sell magazines and I don’t sell movie tickets’.”


Damon singled out some “fantastic” performances by Affleck in recent years: “Hollywoodland,” “The Town” and “Argo” itself, the last two of which he also directed.


He would not, however, be drawn on the chances of “Argo” landing the big prize at the Oscars on February 24.


PROMISED LAND “BOMBS”


Less successful has been “Promised Land,” which Damon readily admitted had “bombed” in the United States. It opens across Europe in February, March and April.


According to Boxofficemojo.com, the movie earned just $ 7.6 million at the North American box office.


“I’m leery of becoming one of those people who lives so much in a bubble that I just think everything I do is great,” he said. “I try to be mindful of that and listen.


“I’ve had a lot of movies that … haven’t been well received by an audience and I’m realistic about that, but with this one I just really love it and a big part of my heart is in it and I don’t understand what I’m hearing back.”


He said it was possible that “Promised Land,” also starring Frances McDormand and directed by “Good Will Hunting” filmmaker Gus Van Sant, would be appreciated more in the future.


“I’ve had movies bomb worse than this one and then actually make their money back.”


“Promised Land” is one of 19 movies in the main competition at the Berlin film festival running from Thursday to February 17.


Also screening on Friday were Polish entry “In the Name of” and Austrian director Ulrich Seidl’s “Paradise: Hope,” the final part in a trilogy looking at the lives of a single family, in this case an overweight teenager sent to a diet camp.


(Reporting by Mike Collett-White, editing by Jill Serjeant and Doina Chiacu)


Movies News Headlines – Yahoo! News





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Well: Think Like a Doctor: A Confused and Terrified Patient

The Challenge: Can you solve the mystery of a middle-aged man recovering from a serious illness who suddenly becomes frightened and confused?

Every month the Diagnosis column of The New York Times Magazine asks Well readers to sift through a difficult case and solve a diagnostic riddle. Below you will find a summary of a case involving a 55-year-old man well on his way to recovering from a series of illnesses when he suddenly becomes confused and paranoid. I will provide you with the main medical notes, labs and imaging results available to the doctor who made the diagnosis.

The first reader to figure out this case will get a signed copy of my book, “Every Patient Tells a Story,” along with the satisfaction of knowing you solved a case of Sherlockian complexity. Good luck.

The Presenting Problem:

A 55-year-old man who is recovering from a devastating injury in a rehabilitation facility suddenly becomes confused, frightened and paranoid.

The Patient’s Story:

The patient, who was recovering from a terrible injury and was too weak to walk, had been found on the floor of his room at the extended care facility, raving that there were people out to get him. He was taken to the emergency room at the Waterbury Hospital in Connecticut, where he was diagnosed with a urinary tract infection and admitted to the hospital for treatment. Doctors thought his delirium was caused by the infection, but after 24 hours, despite receiving the appropriate antibiotics, the patient remained disoriented and frightened.

A Sister’s Visit:

The man’s sister came to visit him on his second day in the hospital. As she walked into the room she was immediately struck by her brother’s distress.

“Get me out of here!” the man shouted from his hospital bed. “They are coming to get me. I gotta get out of here!”

His brown eyes darted from side to side as if searching for his would-be attackers. His arms and legs shook with fear. He looked terrified.

For the past few months, the man had been in and out of the hospital, but he had been getting better — at least he had been improving the last time his sister saw him, the week before. She hurried into the bustling hallway and found a nurse. “What the hell is going on with my brother?” she demanded.

A Long Series of Illnesses:

Three months earlier, the patient had been admitted to that same hospital with delirium tremens. After years of alcohol abuse, he had suddenly stopped drinking a couple of days before, and his body was wracked by the sudden loss of the chemical he had become addicted to. He’d spent an entire week in the hospital but finally recovered. He was sent home, but he didn’t stay there for long.

The following week, when his sister hadn’t heard from him for a couple of days, she forced her way into his home. There she found him, unconscious, in the basement, at the bottom of his staircase. He had fallen, and it looked as if he may have been there for two, possibly three, days. He was close to death. Indeed, in the ambulance on the way to the hospital, his heart had stopped. Rapid action by the E.M.T.’s brought his heart back to life, and he made it to the hospital.

There the extent of the damage became clear. The man’s kidneys had stopped working, and his body chemistry was completely out of whack. He had a severe concussion. And he’d had a heart attack.

He remained in the intensive care unit for nearly three weeks, and in the hospital another two weeks. Even after these weeks of care and recovery, the toll of his injury was terrible. His kidneys were not working, so he required dialysis three times a week. He had needed a machine to help him breathe for so long that he now had to get oxygen through a hole that had been cut into his throat. His arms and legs were so weak that he could not even lift them, and because he was unable even to swallow, he had to be fed through a tube that went directly into his stomach.

Finally, after five weeks in the hospital, he was well enough to be moved to a short-term rehabilitation hospital to complete the long road to recovery. But he was still far from healthy. The laughing, swaggering, Harley-riding man his sister had known until that terrible fall seemed a distant memory, though she saw that he was slowly getting better. He had even started to smile and make jokes. He was confident, he had told her, that with a lot of hard work he could get back to normal. So was she; she knew he was tough.

Back to the Hospital:

The patient had been at the rehab facility for just over two weeks when the staff noticed a sudden change in him. He had stopped smiling and was no longer making jokes. Instead, he talked about people that no one else could see. And he was worried that they wanted to harm him. When he remained confused for a second day, they sent him to the emergency room.

You can see the records from that E.R. visit here.

The man told the E.R. doctor that he knew he was having hallucinations. He thought they had started when he had begun taking a pill to help him sleep a couple of days earlier. It seemed a reasonable explanation, since the medication was known to cause delirium in some people. The hospital psychiatrist took him off that medication and sent him back to rehab that evening with a different sleeping pill.

Back to the Hospital, Again:

Two days later, the patient was back in the emergency room. He was still seeing things that weren’t there, but now he was quite confused as well. He knew his name but couldn’t remember what day or month it was, or even what year. And he had no idea where he was, or where he had just come from.

When the medical team saw the patient after he had been admitted, he was unable to provide any useful medical history. His medical records outlined his earlier hospitalizations, and records from the nursing home filled in additional details. The patient had a history of high blood pressure, depression and alcoholism. He was on a long list of medications. And he had been confused for the past several days.

On examination, he had no fever, although a couple of hours earlier his temperature had been 100.0 degrees. His heart was racing, and his blood pressure was sky high. His arms and legs were weak and swollen. His legs were shaking, and his reflexes were very brisk. Indeed, when his ankle was flexed suddenly, it continued to jerk back and forth on its own three or four times before stopping, a phenomenon known as clonus.

His labs were unchanged from the previous visit except for his urine, which showed signs of a serious infection. A CT scan of the brain was unremarkable, as was a chest X-ray. He was started on an intravenous antibiotic to treat the infection. The thinking was that perhaps the infection was causing the patient’s confusion.

You can see the notes from that second hospital visit here.

His sister had come to visit him the next day, when he was as confused as he had ever been. He was now trembling all over and looked scared to death, terrified. He was certain he was being pursued.

That is when she confronted the nurse, demanding to know what was going on with her brother. The nurse didn’t know. No one did. His urinary tract infection was being treated with antibiotics, but he continued to have a rapid heart rate and elevated blood pressure, along with terrifying hallucinations.

Solving the Mystery:

Can you figure out why this man was so confused and tremulous? I have provided you with all the data available to the doctor who made the diagnosis. The case is not easy — that is why it is here. I’ll post the answer on Friday.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”


Rules and Regulations: Post your questions and diagnosis in the comments section below.. The correct answer will appear Friday on Well. The winner will be contacted. Reader comments may also appear in a coming issue of The New York Times Magazine.

Correction: The patient’s eyes were brown, not blue.

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S&C relay at center of Super Bowl outage









An electrical relay device supplied by Rogers Park's S&C Electric Co. was found to be at the center of the Super Bowl power outage in New Orleans, the company said Friday.

S&C Electric Co. said the outage, which lasted for more than 30 minutes at Sunday's game, happened when the demand for Superdome power exceeding a "trip setting" for its electrical relay.






But the device didn't malfunction, S&C said. Instead, it said it found in testing that system operators didn't account for the amount of power needed at the Superdome. S&C doesn't control the power settings on its equipment.

S&C wouldn't go into more details, but the power provider for Sunday's game was Entergy New Orleans, a unit of Entergy Corp.

In a statement, Entergy said the relay device had functioned properly at other high-profile sporting events, including the Sugar Bowl.

The relay was designed to prevent an outage if a cable connection to the stadium failed.

"S&C continues to work with all those involved to get the system back online, and our customers can continue to rely on the quality and performance of our products," Spokesman Michael Edmonds said in a statement.

S&C equipment is commonly used where high reliability is critical, he said, including data centers for United Parcel Service Inc., drug manufacturing centers and hospitals. The company also works with other stadiums throughout the U.S. and Canada.

Entergy said in a statement that the Superdome relay has been removed and replacement equipment is being examined.

That statement came before a special meeting of the New Orleans City Council's Utility Committee Friday morning to discuss the root cause of the outage.

Immediately after the game, Entergy indicated its equipment was functional and the problem must have come from the Superdome, but later said it was launching an investigation to determine the source of the problem.

"While some further analysis remains, we believe we have identified and remedied the cause of the power outage and regret the interruption that occurred during what was a showcase event for the city and state," Entergy New Orleans President and CEO Charles Rice said.

sbomkamp@tribune.com | Twitter: @SamWillTravel

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