Michelle Obama expected at Hadiya Pendleton funeral today









First lady Michelle Obama is expected to attend Hadiya Pendleton’s funeral this morning at Greater Harvest Baptist Church in the Washington Park neighborhood, about two miles from where the 15-year-old girl was gunned down last month.


Hadiya was a majorette for King College Prep's band and performed during President Barack Obama's inauguration festivities just days before she was slain, shot in the back while hanging out with friends at a North Kenwood neighborhood park.


The shooter was after someone else, police said. No one is in custody.








Michelle Obama's plan to come to the funeral puts Chicago solidly in the middle of a national debate over gun violence that has polarized Congress and forced President Obama to take his gun control initiatives on the road to garner more public support.


The first lady's visit is being seen not only as a gesture of condolence to the family but as part of an effort to draw attention and support for the president's gun initiatives.


Inside the church, Hadiya’s silver casket was placed in the front, surrounded by flowers, and two large hearts, one with her picture on it.


Behind the casket, a TV screen showed pictures of Pendleton with her family, from birth to her teenage years.


Guests who were invited by the family were given orange wristbands and were able to enter through a shorter security line. Classmates and friends of Pendleton were given green wristbands and allowed to enter through that same line.


As of 7 a.m. there were already about ten people lined up outside the church, 5141 S. State St.


A hearse arrived shortly before 8 a.m. with a police escort.


Uniformed Secret Service officers, before the arrival of the 15-year-old's body, were moving people through metal detectors, though the public won't be allowed in for about an hour. 

Media and a select few others are using a separate entrance, also manned by uniformed Secret Service officers. City and Secret Service officers' K-9 unit dogs sniffed through camera bags before camera crews were allowed inside. 


The church is surrounded by an iron fence and all of the openings -- a pedestrian gate in the front, front and side doors to the church, and a driveway to the north  -- are guarded by city police or men in white shirts, ties and long black coats.

The early arrivals were being held outside the gate while security officers move portable barriers toward the front entrance.


Chicago police vehicles - two wagons, a handful of squads and SUVs - were guarding the outside of the church. Two more vehicles were circling the block.


Chicago police staffing the event are wearing dress blues -- a blue overcoat with pockets that allow access to the duty belt, creased navy pants, and a hat.


To the south of the church is a child-parent center and behind it, a boarded up three-story brick apartment building.


chicagobreaking@tribune.com
Twitter: @chicagobreaking 





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Michael Costigan Lands two-Year, First-Look Deal at Sony Pictures






LOS ANGELES (TheWrap.com) – Sony Pictures Entertainment said Tuesday that it has entered into a two-year, exclusive first-look agreement with producer Michael Costigan and his company COTA Films.


The deal reunites Costigan with Sony Pictures, where he previously worked for nine years and served as a production executive. Costigan then served as president of Ridley and Tony Scott‘s Scott Free Productions from 2005 until 2012.






Doug Belgrad, president of Columbia Pictures, and Hannah Minghella, president of production for the studio, made the announcement jointly.


“We couldn’t be more excited to be back in business with Michael,” they said in a statement. “He has a great eye for material, strong director and talent relationships and has been making interesting, original movies during his years with Scott Free. Of course he remains a great friend and we’re thrilled to be professionally reunited.”


Costigan most recently produced “Stoker,” Park Chan Wook’s English-language debut starring Mia Wasikowska, Nicole Kidman and Matthew Goode, and “The East,” starring Brit Marling, Ellen Page and Alexander Skarsgard, and directed by Spirit Award nominee Zal Batmanglij. Both films premiered last week at Sundance to positive reviews and will be released later this spring.


Costigan also produced “Out of the Furnace,” directed by Scott Cooper (“Crazy Heart”) and starring Christian Bale, Casey Affleck and Woody Harrelson.


As executive vice president of production at Sony, he acquired and developed films including “Charlie’s Angels,” “Gattaca,” “The People Versus Larry Flynt,” “Girl Interrupted” and “Bottle Rocket.”


Under the Scott Free banner, Costigan executive produced “Prometheus,” “The Counselor,” “Robin Hood,” “Body of Lies,” and “American Gangster.” He also produced Mark and Jay Duplass’ “Cyrus” and “Welcome to the Rileys.”


Before joining Scott Free, Costigan executive produced Ang Lee’s “Brokeback Mountain.”


Joining Costigan is Ben Leclair, who most recently produced the “Upstream Color,” directed by Shane Carruth, which premiered at Sundance. He previously worked as VP, production for Mike White at Ripcord, where he was a producer of “Year of the Dog” and oversaw Jared Hess’ “Gentlemen Broncos.”


TV News Headlines – Yahoo! News





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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen





At least nine polio immunization workers were shot to death in northern Nigeria on Friday by gunmen who attacked two clinics, officials said.




The killings, with eerie echoes of attacks that killed nine female polio workers in Pakistan in December, represented another serious setback for the global effort to eradicate polio.


Most of the victims were women and were shot in the back of the head, local reports said.


A four-day vaccination drive had just ended in Kano State, where the killings took place, and the vaccinators were in a “mop-up” phase, looking for children who had been missed, said Sarah Crowe, a spokeswoman for the United Nations Children’s Fund, one of the agencies running the eradication campaign.


Dr. Mohammad Ali Pate, Nigeria’s minister of state for health, said in a telephone interview that it was not entirely clear whether the gunmen were specifically targeting polio workers or just attacking the health centers where vaccinators happened to be gathering early in the morning. “Health workers are soft targets,” he said.


No one immediately took responsibility, but suspicion fell on Boko Haram, a militant Islamist group that has attacked police stations, government offices and even a religious leader’s convoy.


Polio, which once paralyzed millions of children, is now down to fewer than 1,000 known cases around the world, and is endemic in only three countries: Nigeria, Pakistan and Afghanistan.


Since September — when a new polio operations center was opened in the capital and Nigeria’s president, Goodluck Jonathan, appointed a special adviser for polio — the country had been improving, said Dr. Bruce Aylward, chief of polio eradication for the World Health Organization. There have been no new cases since Dec. 3.


While vaccinators have not previously been killed in the country, there is a long history of Nigerian Muslims shunning the vaccine.


Ten years ago, immunization was suspended for 11 months as local governors waited for local scientists to investigate rumors that it caused AIDS or was a Western plot to sterilize Muslim girls. That hiatus let cases spread across Africa. The Nigerian strain of the virus even reached Saudi Arabia when a Nigerian child living in hills outside Mecca was paralyzed.


Heidi Larson, an anthropologist at the London School of Hygiene and Tropical Medicine who tracks vaccine issues, said the newest killings “are kind of mimicking what’s going on in Pakistan, and I feel it’s very much prompted by that.”


In a roundabout way, the C.I.A. has been blamed for the Pakistan killings. In its effort to track Osama bin Laden, the agency paid a Pakistani doctor to seek entry to Bin Laden’s compound on the pretext of vaccinating the children — presumably to get DNA samples as evidence that it was the right family. That enraged some Taliban factions in Pakistan, which outlawed vaccination in their areas and threatened vaccinators.


Nigerian police officials said the first shootings were of eight workers early in the morning at a clinic in the Tarauni neighborhood of Kano, the state capital; two or three died. A survivor said the two gunmen then set fire to a curtain, locked the doors and left.


“We summoned our courage and broke the door because we realized they wanted to burn us alive,” the survivor said from her bed at Aminu Kano Teaching Hospital.


About an hour later, six men on three-wheeled motorcycles stormed a clinic in the Haye neighborhood, a few miles away. They killed seven women waiting to collect vaccine.


Ten years ago, Dr. Larson said, she joined a door-to-door vaccination drive in northern Nigeria as a Unicef communications officer, “and even then we were trying to calm rumors that the C.I.A. was involved,” she said. The Iraq and Afghanistan wars had convinced poor Muslims in many countries that Americans hated them, and some believed the American-made vaccine was a plot by Western drug companies and intelligence agencies.


Since the vaccine ruse in Pakistan, she said, “Frankly, now, I can’t go to them and say, ‘The C.I.A. isn’t involved.’ ”


Dr. Pate said the attack would not stop the newly reinvigorated eradication drive, adding, “This isn’t going to deter us from getting everyone vaccinated to save the lives of our children.”


Aminu Abubakar contributed reported from Kano, Nigeria.



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Rosenthal: Chevrolet restores style to Impala name








Because a brand embedded in our subconsciousness can find a space in our garage, the Impala endures.


About 16 million Chevys named for an African antelope have hit the road since 1958. And even though the one you recently returned to the airport rental lot bore little resemblance the one whose "giddy-up" the Beach Boys sang of a half-century ago, General Motors is betting the bloodline still can claim hearts.


A revamped 10th-generation 2014 model is now on display at the just-opened 105th Chicago Auto Show as a prelude to its dealership debut in a few weeks, a bid to re-establish its good name.






"It's always been a great brand name," Russ Clark, director of Chevrolet marketing, said alongside one of the made-over Impalas on the Auto Show floor at McCormick Place. "In fact, when we did research on the name, we found Impala is one of the strongest in terms of consideration and favorable opinion of any name in the industry. A lot of that is heritage. A lot of it is the fact that people say, 'I know people who have had them, and everybody loved them.'"


The brand has been ubiquitous for decades, even if you don't remember the Beach Boys immortalizing the vintage growl of a "four-speed dual-quad Posi-Traction 409" or how Robert Blake's 1970s TV tough guy Baretta drove a rusted-out Impala from '66, the era when Chevrolet could move about 1 million Impala sedans and station wagons a year. My own first car was a four-door V-8 '72 Impala, a powerful and roomy hand-me-down whose weather-beaten body — like the brand's identity — clearly had seen better days by the late '70s and early '80s.


More recent Impalas have hardly been the stuff of song, and it's hard to imagine them inspiring nostalgia. They've been too dully utilitarian to be iconic.


Nonetheless, although sales have slowed, it has been the overall best-seller among big sedans. Three-quarters of those sales have been as fleet vehicles for corporate salespeople, government agencies and rental companies. That means the premium has been on space, reliability and keeping costs down rather than the kind of panache and extras that might foster pride of ownership.


The goal of this Impala overhaul in both four- and six-cylinder iterations — drafting on similar nameplate revivals for models such as Ford's Taurus, Dodge's Charger and Chrysler's 300 — is to flip that 75-25 ratio of fleet sales to retail on its head.


"It makes perfectly good sense on General Motors' part to finally put some style back in the Impala," auto industry analyst Art Spinella, president of CNW Research, explained. "If you have a great brand name, to almost toss it off, treat it as an orphan and send it off to the fleet sales department with bland styling and cheap interiors, that's a disgrace. What they've done is kind of salvage themselves with this.


"It's finally dawned on General Motors that you can sell a consumer car to fleets, but you can't sell a fleet car to consumers. You always keep fleet cars (looking) relatively obscure and you keep the price way down, and that's what General Motors had been doing for years to keep the (Impala sales) volume up. Now they're taking another look. I don't think they've necessarily gone far enough, but it's a step in the right direction."


To wander through the vast Auto Show, which runs through Feb. 18, is to be reminded of how deeply many of us connect to vehicles, starting as children playing with toy trucks and cars. There's a teenage rite of passage when car keys and a license expand the world. Certain makes and models mesh with what played on their radios, the places traveled in them, the stage of life they marked.


That emotional bond doesn't form so easily with a mere box with wheels.


"What was it that made us fall in love with cars in the first place?" Henrik Fisker, executive chairman and co-founder of high-end hybrid carmaker Fisker Automotive, asked the crowd at Thursday's Economic Club of Chicago luncheon. "It struck me that most of us, when we really start to get our heart pumping about cars, it's usually not the cars of today. It's usually the cars of the '50s and '60s."


Road salt, slush and rain were my old '72 Impala's kryptonite. In time, its front bench seat reclined like a La-Z-Boy whenever I hit the gas because the floor beneath had rusted through. Whatever my affection for the vehicle, I could see the road we were on — literally and figuratively — both looking ahead and glancing down.


Thirty years after I traded it in for a sporty red Pontiac with seats that reclined only how and when I wanted, I would not have expected my old flame to generate much heat.


Carmakers, like most marketers, know that even when a brand is disconnected from what it once represented, it still can resonate. The new Impala is neither the muscular car of old nor the generic conveyance of late. Yet Impala means something to would-be buyers, and good or bad, it gives them something to measure this latest version against.


"They have equity in the name and you never get rid of a brand that has a good reputation," Spinella said. "Some people will buy it because it's an Impala. Some people won't. But they'll look at it because it's an Impala and they remember the Impala. It's easier to reintroduce a name than to introduce a name nobody knows."


I can still remember driving around with my friends with no particular place to go, a song on the radio about a horse with no name. If there was a tune about a nameless car, I don't recall it.


philrosenthal@tribune.com


Twitter @phil_rosenthal






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Blizzard packing more than 2 feet of snow reaches East Coast









A powerful storm expected to bring driving winds and more than 2 feet of snow to the Northeast, along with the potential for coastal flooding, touched down early Friday morning, canceling thousands of flights in its wake.


Blizzard warnings were in effect from New Jersey through southern Maine, with Boston expected to bear the brunt of the massive storm that could set records. The day began with light snow and winds that were due to pick up with much heavier snowfall by afternoon.

Officials urged residents to stay home, rather than risk getting stuck in deep drifts or whiteout conditions.

Boston and surrounding communities said schools would be closed on Friday, and city and state officials told nonessential city workers to stay home. Businesses were urged to let staff work from home or shorten schedules.

"Accumulation is expected to be swift, heavy and dangerous," Massachusetts Governor Deval Patrick told reporters. "I am ordering all nonessential state workers to work from home (Friday). I am strongly urging private employers to take the same precautions." Officials across the region echoed his recommendations, telling residents to prepare for any power outages and consider checking on elderly or disabled neighbors who might need help.


In New York City, still not fully recovered from the effects of October's devastating Hurricane Sandy, officials said they had 1,800 Sanitation Department trucks equipped with snow plows ready to be deployed. In New Jersey, also hit hard by Sandy, state officials expected major coastal flooding, high winds, and possible blizzard conditions in the northeastern section of the state.








"This is a dangerous storm, and we ask motorists to be careful while driving. There is also the potential for downed trees and wires because of wind conditions," said Colonel Rick Fuentes, director of the New Jersey Office of Emergency Management. "(The) evening commute will be treacherous throughout much of New Jersey."

The National Weather Service, warning of a "major, maybe even historic, snowstorm," said Boston and much of New England could get up to three feet of snow on Friday and Saturday, its first heavy snowfall in two years. Winds could gust as high as 60 miles to 70 mph. If more than 18.2 inches of snow falls in Boston, it will rank among the city's 10 largest snowfalls. Boston's record snowfall, 27.6 inches, came in 2003.


Cities from Hartford, Connecticut, to Portland, Maine, were expected to see at least one foot of snow. Airlines have already canceled nearly 2,500 flights for Friday, according to website FlightAware.com, with the largest number of cancellations at airports in Newark, New Jersey; New York City; Chicago and Boston.


"This is really serious," said FOX CT meteorologist Joe Furey. "This is a storm that can cripple all of southern New England," Furey said. "A blizzard is not about the amounts of snow. A blizzard is about sustained winds or frequent gusts of 35 mph or higher over three hours or longer."


Boston's Logan International Airport warned that once the storm roars in, all flights would likely be grounded for 24 hours.

United Continental Holdings Inc, JetBlue Airways Corp and Delta Air Lines Inc all reported extensive cancellations.


ECHOES OF '78


For some in the Boston area, the forecast brought to mind memories of the blizzard of 1978, which dropped 27.1 inches, the second largest snowfall recorded in the city's history. That storm started out gently and intensified during the day, leaving many motorists stranded during the evening commute.

Dozens of deaths were reported in the region after that storm, many from people touching downed electric lines.

Officials warned of a high risk of extensive power outages across the region due to the combination of heavy snow and high winds. Residents were also at risk of losing heat at a time when temperatures would dip to 20 Fahrenheit (minus 7 Celsius).

Across the region, store shelves were picked clean of food and storm-related supplies such as shovels and salt as residents scrambled to prepare.

Some big employers said they were considering pleas by officials to let workers stay home, including State Street Corp, one of Boston's largest employers in the financial sector.


Reuters and the Hartford Courant





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The New Old Age: The Executor's Assistant

I’m serving as executor for my father’s estate, a role few of us are prepared for until we’re playing it, so I was grateful when the mail brought “The American Bar Association Guide to Wills and Estates” — the fourth edition of a handbook the A.B.A. began publishing in 1995.

This is a legal universe, I’m learning, in which every step — even with a small, simple estate that owes no taxes and includes no real estate or trusts — turns out to be at least 30 percent more complicated than expected.

If my dad had been wealthy or owned a business, or if we faced a challenge to his will, I would have turned the whole matter over to an estate lawyer by now. But even then, it would be helpful to know what the lawyer was talking about. The A.B.A. guide would help.

Written with surprising clarity (hey, they’re lawyers), it maps out all kinds of questions and decisions to consider and explains the many ways to leave property to one’s heirs. Updated from the third edition in 2009, the guide not only talks taxes and trusts, but also offers counsel for same-sex couples and unconventional families.

If you want to permit your second husband to live in the family home until he dies, but then guarantee that the house reverts to the children of your first marriage, the guide tells you how a “life estate” works. It explains what is taxable and what isn’t, and discusses how to choose executors and trustees. It lists lots of resources and concludes with an estate-planning checklist.

In general, the A.B.A. intends its guide for the person trying to put his or her affairs in order, more than for family members trying to figure out how to proceed after someone has died. But many of us will play both these parts at some point (and if you are already an executor, or have been, please tell us how that has gone, and mention your state). We’ll need this information.


Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

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McDonald's January sales down 1.9%









McDonald's January comparable sales fell 1.9 percent, due to weakness in the Europe and Asia, the company said Friday. 

The Oak Brook-based burger giant warned during its fourth-quarter earnings release that sales at restaurants open more than one year would be down. But analysts polled by Consensus Metrix had expected a decline of 1.1 percent.

Of greatest concern to Wall Street, same store sales in Europe declined to 2.1 percent. The company cited particular weakness in Germany and France despite solid growth in the U.K and Russia. Europe is the chain's largest market.

Comparable sales fell 9.5 percent in McDonald's Asia Pacific Middle East and Africa division, for which the chain cited weakness in Japan, and declines in China, attributable to a calendar shift in the Chinese New Year, and the ongoing fallout from a poultry crisis.

In the U.S., comparable sales rose 0.9 percent. McDonald's cited popularity of its core menu and moving the grilled onion and cheddar burger onto the Dollar Menu.

Total sales rose in January 0.3 percent, or 0.7 percent adjusted for the impact of currency.

While McDonald's expects sales to improve later this year, the worst isn't over. The company said it expects a 3 percent hit to February sales as a result of a shorter month in 2013.

"While January's results reflect today's challenging environment and difficult prior year comparisons, I am confident that our unwavering commitment to delivering an exceptional restaurant experience will enhance our brand's relevance and drive long-term results," McDonald's CEO Don Thompson said in a statement.

eyork@tribune.com | Twitter: @emilyyork

Reuters contributed to this report.

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Ex-L.A. police officer suspected in cop killing, other slayings

A manhunt is under way for a double murder suspect, himself a former LAPD officer, after three officers were shot overnight, one fatally.









A massive manhunt is under way for a double murder suspect in California, himself a former Los Angeles police officer, after three cops were shot overnight, one fatally.


The suspect was already wanted for allegedly killing the daughter of a former Los Angeles Police Department captain as well as the woman’s fiance in Irvine, Calif., over the weekend.


The three new shootings occurred in Riverside County, Calif. One LAPD officer was grazed east of Los Angeles, in the area of Magnolia and the 15 Freeway in Corona, law enforcement sources said. Then sometime later, two Riverside Police Department officers were shot in Riverside. One of those officers died, sources said.








Police have launched a manhunt for the suspect, Christopher Jordan Dorner, 33.


Police said they are searching for Dorner, whose last known address is in La Palma, and said he drives a blue 2005 Nissan Titan pickup with California license 7X03191. He is described as a 6-foot tall African American man weighing about 270 pounds, with black hair and brown eyes.


Anyone with information is asked to call a tip line at (714) 724-7192.Irvine police on Wednesday night named  Dorner as the suspect in the double slaying in the parking lot of an upscale Irvine apartment complex Sunday. Officials warned that Dorner is armed and dangerous. Law enforcement sources said police have placed security at the homes of LAPD officials named in the manifesto and believe Dorner has numerous weapons.


In the online postings, according to the Los Angeles Times, Dorner specifically named the father of Monica Quan, the Cal State Fullerton assistant basketball coach who was found dead Sunday, along with her fiance, Keith Lawrence.


Randy Quan, a retired LAPD captain, was involved in the review process that ultimately led to Dorner’s dismissal.


A former U.S. Navy reservist, Dorner was fired in 2009 for allegedly making false statements about his training officer.


Dorner said in his online postings that being a police officer had been his life’s ambition since he served in the Police Explorers program. Now that had been taken away from him, he said, and he suffered from severe depression and was filled with rage over the people who forced him from his job.


Dorner complained that Quan and others did not fairly represent him at the review hearing.


“Your lack of ethics and conspiring to wrong a just individual are over. Suppressing the truth will leave to deadly consequences for you and your family. There will be an element of surprise where you work, live, eat, and sleep,” he wrote, referring to Quan and several others.


“I never had the opportunity to have a family of my own, I'm terminating yours,” he added.


Quan apparently served as Dorner’s representative, according to the manifesto. Of Quan, Dorner wrote: “He doesn't work for you, your interest, or your name. He works for the department, period. His job is to protect the department from civil lawsuits being filed and their best interest which is the almighty dollar. His loyalty is to the department, not his client.”


In the document, he threatens violence against other police officers.


“The violence of action will be high.... I will bring unconventional and asymmetrical warfare to those in LAPD uniform whether on or off duty,” Dorner wrote.


In his manifesto, Dorner seemed to allude to the Irvine slaying.


“I know most of you who personally know me are in disbelief to hear from media reports that I am suspected of committing such horrendous murders and have taken drastic and shocking actions in the last couple of days,” he wrote.


“Unfortunately,” he added, “this is a necessary evil that I do not enjoy but must partake and complete for substantial change to occur within the LAPD and reclaim my name.”


Quan, 28, and Lawrence, 27, had recently become engaged and moved into the condominium complex near Concordia University, where they had played basketball and received their degrees, authorities said. Lawrence worked as a campus officer at USC.


Dorner’s LAPD case began when he lodged a complaint against his field training officer, Sgt. Teresa Evans. He accused her of kicking a suspect named Christopher Gettler. An LAPD Board of Rights found that the complaint was false and terminated his employment for making false statements. He appealed the action.


He testified that he graduated from the Police Academy in February 2006 and left for a 13-month military deployment in November 2006.


“This is my last resort,” he wrote. “The LAPD has suppressed the truth and it has now led to deadly consequences.”


Dorner said it was the LAPD’s fault that he lost his law enforcement and Navy careers, as well as his relationships with family and close friends. Dorner wrote that he began his law enforcement career in February 2005 and that it ended in January 2009. His Navy career began in April 2002 and ended this month.


“I lost everything,” he said, “because the LAPD took my name and knew I was innocent.”


Los Angeles Times and KTLA





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The Wanted take music to television with E! reality show






LOS ANGELES (Reuters) – After storming the U.S. pop charts with their infectious dance songs last year, British-Irish boy band The Wanted are set to invade television screens with a new reality show on the E! channel this summer, the network announced on Wednesday.


“The Wanted Life,” co-produced by Ryan Seacrest Productions, will follow the band members as they move into a house in the Hollywood Hills and work on their anticipated album, due for release later this year.






The Wanted – Max George, Siva Kaneswaran, Nathan Sykes, Tom Parker and Jay McGuiness – formed in 2009 in England, and was signed by Justin Bieber‘s manager Scooter Braun for its U.S. endeavors.


The five, aged 19 to 24, are known for their raucous behavior and are often pictured out drinking and partying with girls.


“We’ve always tried to show who we are. We haven’t hid much,” band member George said in an interview with E! Online.


“I don’t think there’s anything off limits to be honest … We’ll let everything be exposed,” Kaneswaran added.


The band have accumulated a strong following of fans on Twitter after hit singles such as “Glad You Came” and “Chasing the Sun” became radio and pop chart staples last year.


The band also opened for Bieber at various tour dates including his sold-out Madison Square Gardens gig in New York last December.


They will be embarking on their own headlining tour in the United States and Britain in the fall, with details to be released in summer.


George has also grabbed headlines for his friendship with troubled actress Lindsay Lohan, who has been traveling to the UK with the band in the last few months.


George did not say whether Lohan would appear on the show, which is set to premiere in June.


(Reporting by Piya Sinha-Roy; Editing by Eric Kelsey and Eric Walsh)


Music 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.


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.

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