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 blue 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.

Read More..

DealBook: Ireland to Liquidate Anglo Irish Bank

LONDON – The Irish government passed emergency legislation on Thursday to liquidate Anglo Irish Bank, one of the country’s largest financial institutions.

The legislation, which was signed into law after an all-night parliamentary session, came after negotiations with the European Central Bank over swapping so-called promissory notes, which were used to bail out the Irish lender in 2009, for long-term government bonds.

The move is an effort to reduce Ireland’s debt repayments at a time when the country is still struggling under a cloud of austerity measures and meager economic growth.

The Irish Parliament rushed through the legislation to liquidate Anglo Irish, which was renamed Irish Bank Resolution Corporation after its failure and bailout, because details of the debt-restructuring plan leaked on Wednesday. Politicians had hoped to announce the deal after agreeing on new terms with the European Central Bank.

“I would have preferred to be introducing this bill in tandem with a finalized agreement with the European Central Bank,” the Irish finance minister, Michael Noonan, said in a statement.

The European Central Bank is considering the country’s latest proposals on Thursday, though European policy makers are concerned that a deal with Ireland could set a precedent for other indebted countries, like Spain, whose local banks also are facing mountains of debt.

As part of the deal to save Anglo Irish, Dublin injected more than 30 billion euros ($41 billion) into the local lender, of which around 28 billion euros is still outstanding.

The bailout has saddled the government with 3.1 billion euros in annual interest payments, or roughly the same amount Irish politicians have said they would cut in yearly government spending to reduce the country’s debt levels. The local government has been eager to reduce that multibillion-euro figure by swapping the high-interest debt into long-term government bonds that can be repaid over a longer period.

Ireland racked up huge debts in bailing out Anglo Irish and the rest of the country’s financial industry, eventually requiring a rescue package of 67.5 billion euros from the European Union and the International Monetary Fund in 2010. The authorities have demanded that Irish politicians slash government spending to reduce the country’s debt burden.

Confusion reigned on Thursday at Anglo Irish’s headquarters in Dublin, a day after employees were sent home early in preparation for the government-mandated liquidation.

Some staff members had returned to work, but the atmosphere remained tense, according to a person with direct knowledge of the matter, who spoke on condition of anonymity because he was not authorized to speak publicly.

“People have been told it’s business as usual, but it’s anything but that,” the person said.

The accounting firm KPMG has been appointed to oversee the liquidation.

Under the terms of the liquidation, Anglo Irish’s assets will be transferred to the National Asset Management Agency, the so-called bad bank set up by the government, or sold to outside investors.

Anglo Irish has been at the center of controversy since the beginning of the financial crisis. Three of its former executives, including its former chief executive, Sean FitzPatrick, are facing fraud charges in connection with loans that were improperly administered.

Read More..

Tunisian opposition leader Chokri Belaid shot dead outside home

The Unified Democratic Nationalist Party says Chokri Belaid was shot as he left his house in the capital Tunis. Witnesses say he was taken to a nearby clinic and died. (Hassene Dridi / Associated Press / December 29, 2010)

By Jeffrey Fleishman

February 6, 2013, 3:41 a.m.

CAIRO -- A leading opponent of Tunisia's Islamist-led government was assassinated in front of his home Wednesday, raising fears of sharpening political turmoil in the country that ignited the Arab Spring movement but remains starkly divided between liberals and Islamists.

Chokri Belaid, head of the Unified Democratic Nationalist Party, was shot on his way to work in the capital, Tunis, according to authorities. No one claimed immediate responsibility for the attack, but it comes as Tunisia faces a troubled economy and a restive transition to democracy after decades of dictatorship.  

"This is a criminal act, and act of terrorism not only against Belaid but against the whole of Tunisia," Prime Minister Hamadi Jebali told a radio station. Shortly after the killing, hundreds of protesters gathered outside the Interior Ministry.

An outspoken liberal with a bushy mustache, Belaid often criticized Nahda, the dominant moderate Islamist party for failing to unite the country's political factions. He had accused Ennahda of not clamping down on increasingly violent ultraconservative Salafis from attacking movie houses, art galleries and institutions they deem as against Islam.

Belaid's family told Tunisian media that he had received repeated death threats.

"Chokri Belaid was killed today by four bullets to the head and chest ... doctors told us that he has died. This is a sad day for Tunisia," Ziad Lakhader, a leader of the Popular Front, was quoted as saying to Reuters.

Tunisian President President Moncef Marzouki who was traveling in France said he would cancel a planned trip to Cairo on Thursday and return home.

ALSO:

Bulgarian probe links Hezbollah to Israeli tourist bus attack

Bangladesh war crimes court jails Islamic party leader for life

Ahmadinejad ally linked to human rights abuses arrested in Iran

jeffrey.fleishman@latimes.com

Read More..

Karen Russell's <em>Vampires in the Lemon Grove</em> Is a Darkly Surreal Treat

Karen Russell is one of America’s most lauded young writers. Her first novel, Swamplandia!, was a Pulitzer Prize finalist and has been optioned by HBO. Her fiction combines a literary sensibility with a generous helping of the weird and surreal, which has made her popular with both literary magazines and fantasy and science fiction fans. This cross-genre approach is one that she sees in the work of many of her favorite authors, such as Kelly Link.

“You’re going to sacrifice a mimetic representational realism to tell another kind of truth,” says Russell in this week’s episode of the Geek’s Guide to the Galaxy podcast. “It’s like an optical trick to let you see something … that you might not be aware of if you were reading about the same plot set in a mall in New Jersey.”

Her first collection, St. Lucy’s Home for Girls Raised by Wolves, dealt largely with adolescents coming of age in a whimsical version of Russell’s native south Florida. Her second collection, Vampires in the Lemon Grove, ventures farther afield, with one story set in an Italian resort town and another set during the Meiji Restoration in Japan. The tone of the second book is darker, with several of the tales veering into outright horror, but stories about Antarctic tailgaters or U.S. presidents reincarnated as farm animals continue to revel in a joyful absurdism.

“Sometimes I wish you could just write the parody of whatever you’re writing,” says Russell. “It would probably be better in some ways.”

Listen to our complete interview with Karen Russell in Episode 79 of Geek’s Guide to the Galaxy (above), in which she recalls her early days as a secret nerd, confesses to feeling like the Bernie Madoff of fiction, and reveals that she’s highly ticklish. Then stick around after the interview as guest geek Lynne M. Thomas joins hosts John Joseph Adams and David Barr Kirtley for a panel discussion on the weirdest stories ever.

Karen Russell on being a secret nerd:

“I was the kind of nerd that wasn’t even courageous. I couldn’t even courageously claim my identity as a nerd … I remember I loved this Stephen R. Donaldson book called The Mirror of Her Dreams. It’s a two-book series, and it’s about this woman who … uses mirrors to see other worlds, and then she can enter those other worlds, which is basically a lot like writing, so I had this very concrete way to think about art as creation … But I remember being so embarrassed — hot-in-the-face embarrassed — when somebody saw that I was reading that … In Miami there seemed to be a stigma just if you were reading generally — that was suspicious enough — but certain of those covers aren’t doing you any favors. You know, there’s a woman in front of a dragon on the cover of your book. I think that had certain connotations, at least in my Miami high school, that I was eager to avoid.”

Karen Russell on her short story “Reeling for the Empire”:

“There’s an argument that the birth of feminist consciousness in Japan begins at this moment, because these women bind together to revolt against these conditions. There are these factory protests — completely female factory protests — because these places were riddled with tuberculosis and they basically held the women hostage. They were essentially slaves, and they worked ten-hour days in many cases … It’s a real horror story, and I think that to do that conversion and make it about this monstrous metamorphosis, where these women become these hybridized animal/machines, I think that was a way for me to think through what that must have been like when production gets mechanized, and suddenly time ceases to function the way it did before, and the factory work day is in place, and these women’s bodies became cogs in the larger machine.”

Lynne M. Thomas on pushing the envelope:

“There’s a story that I bought from Rachel Swirsky that hasn’t come out yet where I’m basically going to have to put a trigger warning on it for every possible kind of trigger there is — a trigger warning is for stories with things like domestic violence or sexual assault where people who have been subject to those crimes in real life might have a PTSD sort of reaction. And with Rachel, I was having this conversation where I was saying I’ve never seen these three types of stories done successfully in a way that didn’t completely upset me in the wrong ways, and she was like, ‘Challenge accepted!’ And she wrote this story that … I can’t even … I read it and I was like, ‘This is the most amazing, disturbing thing that I have ever read,’ and I bought in on the spot. I couldn’t believe that she’d managed to take a whole bunch of things that are so collectively awful and turn them into art. It’s called ‘Abomination Rises on Filthy Wings.’ Yeah, it’s not messing around.”

John Joseph Adams on the editor’s responsibility:

“As an editor, it kind of feels like a betrayal of your readers a little bit if you publish something that you don’t fully understand yourself, because when you present it to them, they want to believe that it’s going to make some sense, if they’re a good enough reader, and as an editor I don’t feel that I can be like, ‘Well, I think I understand it, but not really, so let’s leave it out there for the readers.’ And so the M. Rickert story is really the only time I’ve ever made an exception to that rule, and only because I’m certain that it’s brilliant, and the whole point of it is to make you feel that sense of strangeness, and it definitely succeeds in that.”

Read More..

Ipswich Journal: Paul Mason Is One-Third the Man He Used to Be

Paul Nixon Photography

Paul Mason in 2012, two years after gastric bypass surgery stripped him of the unofficial title of “the world’s fattest man.”

IPSWICH, England — Who knows what the worst moment was for Paul Mason — there were so many awful milestones, as he grew fatter and fatter — but a good bet might be when he became too vast to leave his room. To get him to the hospital for a hernia operation, the local fire department had to knock down a wall and extricate him with a forklift.

That was nearly a decade ago, when Mr. Mason weighed about 980 pounds, and the spectacle made him the object of fascinated horror, a freak-show exhibit. The British news media, which likes a superlative, appointed him “the world’s fattest man.”

Now the narrative has shifted to one of redemption and second chances. Since a gastric bypass operation in 2010, Mr. Mason, 52 years old and 6-foot-4, has lost nearly two-thirds of his body weight, putting him at about 336 pounds — still obese, but within the realm of plausibility. He is talking about starting a jewelry business.

“My meals are a lot different now than they used to be,” Mr. Mason said during a recent interview in his one-story apartment in a cheerful public housing complex here. For one thing, he no longer eats around the clock. “Food is a necessity, but now I don’t let it control my life anymore,” he said.

But the road to a new life is uphill and paved with sharp objects. When he answered the door, Mr. Mason did not walk; he glided in an electric wheelchair.

And though Mr. Mason looks perfectly normal from the chest up, horrible vestiges of his past stick to him, literally, in the form of a huge mass of loose skin choking him like a straitjacket. Folds and folds of it encircle his torso and sit on his lap, like an unwanted package someone has set there; more folds encase his legs. All told, he reckons, the excess weighs more than 100 pounds.

As he waits to see if anyone will agree to perform the complex operation to remove the skin, Mr. Mason has plenty of time to ponder how he got to where he is. He was born in Ipswich and had a childhood marked by two things, he says: the verbal and physical abuse of his father, a military policeman turned security guard; and three years of sexual abuse, starting when he was 6, by a relative in her 20s who lived in the house and shared his bed. He told no one until decades later.

After he left school, Mr. Mason took a job as a postal worker and became engaged to a woman more than 20 years older than him. “I thought it would be for life, but she just turned around one day and said, ‘No, I don’t want to see you anymore — goodbye,’ ” he said.

His father died, and he returned home to care for his arthritic mother, who was in a wheelchair. “I still had all these things going around in my head from my childhood,” he said. “Food replaced the love I didn’t get from my parents.” When he left the Royal Mail in 1986, he said, he weighed 364 pounds.

Then things spun out of control. Mr. Mason tried to eat himself into oblivion. He spent every available penny of his and his mother’s social security checks on food. He stopped paying the mortgage. The bank repossessed their house, and the council found them a smaller place to live. All the while, he ate the way a locust eats — indiscriminately, voraciously, ingesting perhaps 20,000 calories a day. First he could no longer manage the stairs; then he could no longer get out of his room. He stayed in bed, on and off, for most of the last decade.

Social service workers did everything for him, including changing his incontinence pads. A network of local convenience stores and fast-food restaurants kept the food coming nonstop — burgers, french fries, fish and chips, even about $22 worth of chocolate bars a day.

“They didn’t deliver bags of crisps,” he said of potato chips. “They delivered cartons.”

His life became a cycle: eat, doze, eat, eat, eat. “You didn’t sleep a normal sleep,” he said. “You’d be awake most of the night eating and snacking. You totally forgot about everything else. You lose all your dignity, all your self-respect. It all goes, and all you focus on is getting your next fix.”

He added, “It was quite a lonely time, really.”

He got infections a lot and was transported to the hospital — first in a laundry van, then on the back of a truck and finally on the forklift. For 18 months after a hernia operation in 2003, he lived in the hospital and in an old people’s home — where he was not allowed to leave his room — while the local government found him a house that could accommodate all the special equipment he needed.

This article has been revised to reflect the following correction:

Correction: February 6, 2013

The headline on an earlier version of this article misstated Paul Mason’s current weight relative to what he weighed nearly a decade ago. He is now about one-third, not two-thirds, the weight he was then.

Read More..

DealBook: Debevoise & Plimpton Drops Trusts and Estates Practice

Last month, the nation’s leading trusts and estates lawyers convened at a Florida resort to discuss the latest in estate planning.

Between lectures and workshops, some of the lawyers exchanged whispers about an unsettling piece of gossip: Debevoise & Plimpton, the prominent white-shoe law firm, was eliminating its trusts and estates practice.

Debevoise’s decision surprised members of the trusts and estates bar. If an institution as prestigious and financially sound as Debevoise was abandoning its practice, were they vulnerable too?

The news also raised eyebrows across the legal industry because it seemed to run counter to Debevoise’s reputation for a strong partnership culture. At a time when many large law firms have discarded the traditional partnership model and embraced a more bottom-line approach, Debevoise has been seen as retaining an old-school ethos — a genteel law firm known for its camaraderie and decency.

“It saddens me to see a great law firm terminate its estates department,” said William D. Zabel, a partner at Schulte Roth & Zabel and one of the country’s leading trusts and estates lawyers. “Although I don’t know the reasons for this decision, it would seem to be a byproduct of the economics of our society, making the law into more of a business than a profession. That saddens me even more.”

In a statement, Michael W. Blair, Debevoise’s presiding partner, confirmed that it was jettisoning trusts and estates, and that the group’s eight lawyers — including Jonathan J. Rikoon, the partner in charge of the practice — were trying to find another home.

“Debevoise supports the group in this process and will work to ensure that in this transition the needs of the firm’s clients continue to be served,” he said.

New York-based Debevoise is the latest big corporate law firm to discontinue the practice. In 2011, Weil, Gotshal & Manges, a 1,200-lawyer firm, got out of trusts and estates, deciding it did not fit the firm’s business model. Another firm, Gibson Dunn & Crutcher, with 1,100 lawyers, ended its trusts and estates practice about a decade ago.

Corporate law firms once viewed trusts and estates as a small yet important practice that discreetly advised wealthy families. But drafting wills and trusts, and the legal matters that flow from that, is less lucrative than the primary revenue drivers at big law firms: multibillion-dollar corporate transactions and high-stakes litigation.

And there are problems with trusts and estates within a big law firm model. The practice, to use the law firm management parlance, is not as leverageable as other areas. Corporate and litigation partners generate big fees by assigning armies of junior lawyers to megamergers and complex lawsuits. By comparison, trusts and estates work requires far less manpower, which mean far less profit.

Another issue in sustaining these departments is that individual clients bristle at billable rates that now reach more than $1,000 an hour. While big corporations grudgingly pay those rates, wealthy families often resist them.

As a result of these dynamics, firms’ trusts and estates practices have remained small and, in many cases, decreased. At the same time, firms have aggressively built up their corporate and litigation practices across the globe. They have also embraced hot, moneymaking practice areas like patent law and white-collar criminal defense.

There are some counterexamples to this trend, however. In 2011, seven trusts and estates lawyers from Weil, led by Carlyn S. McCaffrey, moved to McDermott Will & Emery, a firm with about 65 trusts and estates lawyers, one of the larger such practices. Another firm committed to trusts and estates is Katten, which has more than 50 lawyers in the group.

Joshua S. Rubenstein, the head of Katten’s trusts and estates practice, said that his business went well beyond comforting bereaved spouses and children. A successful practice, he said, includes assignments like advising families in the sale of closely held companies, overseeing trust-related litigation or even assisting in the purchase of a yacht or private jet.

“If done right, a full-service, high-end trusts and estates practice can generate a lot of work for other areas of the firm,” Mr. Rubenstein said.

As large firms have de-emphasized their trusts and estates practices, boutiques have sprouted up. Sanford J. Schlesinger, a former partner at the New York corporate firm Kaye Scholer, left in 2004 along with several colleagues to set up an 11-lawyer shop, Schlesinger Gannon & Lazetera.

Mr. Schlesinger lamented the demise of the practice at big firms, and said he thought they were missing a business opportunity.

“Families are going to pass more wealth in the next 10 years than in the history of humankind, and someone is going to have to shepherd that wealth transfer,” he said. “These firms are making a shortsighted, profit-driven decision without a view of the long-term big picture.”

Debevoise, started in 1931 by two young patrician lawyers, Eli Whitney Debevoise and William E. Stevenson, does not see it that way. Three decades ago, the firm’s trusts and estates practice had six partners, including Barbara Paul Robinson, now retired and a former president of the New York City Bar Association, and Theodore A. Kurz, the former head of the department. Today, there is only one, Mr. Rikoon, 57, who declined to comment for this article.

The firm formed a committee to study its trusts and estates practice, which has advised families like the Lauders (cosmetics) and the Dolans (cable television), according to people with direct knowledge of the group. After concluding that the practice did not have enough business to expand, the committee recommended closing it down. The firm will continue to employ Mr. Rikoon and the seven other lawyers while they interview elsewhere, these people said.

One factor contributing to Debevoise’s move to discontinue the group, people say, is its unusual lock-step compensation system, which pays partners in a narrow range strictly according to seniority. That means that Mr. Rikoon is paid on par with a star deal maker from the same law school year, while bringing in less business. This created some discord in the partnership ranks. Debevoise’s profits per partner are $2.1 million, according to The American Lawyer magazine.

Debevoise, with 650 lawyers, recently made headlines away from trusts and estates. The firm advised a special committee of Dell’s board on the $24 billion leveraged buyout of the computer company. And President Obama nominated the Debevoise partner Mary Jo White to run the Securities and Exchange Commission.

Stephen J. Friedman, a onetime Debevoise partner who is now president of Pace University, said that he was unaware of the facts involved in his former firm’s decision to close the trusts and estates practice, but noted that organizations are often faced with business realities that require painful choices.

“It’s sometimes necessary to make a decision that’s in the best interest of the firm but can hurt individual partners and associates,” he said. “That’s not a happy experience, but it’s sometimes the right thing to do.”

Read More..

Friends, investigators seek answers in killing of O.C. couple

They met in college, two highly regarded basketball players who seemed to have the same winning touch on the court and off.

After blazing through high school and college with her outside shot, Monica Quan became the assistant women's basketball coach at Cal State Fullerton. Keith Lawrence, whose highlight shots are still there on his college website, became a campus officer at USC.

Now police in Irvine are scrambling for an explanation — and friends are looking for a way to express their shock — after Quan and Lawrence were found shot to death in their parked car on the top floor of a parking structure in an upscale, high-security condominium complex near UC Irvine.

The two had just announced their engagement and had recently moved into a condominium complex near Concordia University, where they played basketball and had gone on to earn their degrees.

Late Sunday, after a passerby noticed two people in the parked car, police said they found Lawrence slumped in the driver's side of his white Kia. Quan was next to him, also dead. The couple were shot multiple times, and authorities said they have tentatively ruled out the possibility of it being a murder-suicide or motivated by robbery. Nothing in the car, police said, seemed to be disturbed.

The couple's friends and family said they were shaken by the violent deaths of two people who seemed to have so much to offer.

Quan was a 2002 graduate of Walnut High School in the San Gabriel Valley, where she set school records for the most three-pointers in a season and a game. She played at Long Beach State and at Concordia, where she graduated in 2007. She went on to earn a master's degree before becoming the assistant coach at Fullerton.

Quan's father was the first Chinese American captain in the LAPD, and went on to become police chief at Cal Poly Pomona.

Quan was known for pulling students aside to offer encouragement, said Megan Richardson, a former player. Marcia Foster, the head basketball coach at Cal State Fullerton, described her assistant as a special person — "bright, passionate and empowering," she said.

Quan shared a love of basketball with her fiancee, Lawrence, whom she met at Concordia.

He too had been a standout basketball player, starting at Moorpark High, where he played point guard and shooting guard, said Tim Bednar, who coached Lawrence.

Bednar said that Lawrence, who came from a family of athletes, was talented, yet quiet and humble. After Lawrence graduated in 2003, he continued to participate in summer youth camps

When he returned for the camps, Bednar said, he was known as the "best basketball player that ever came through" the school.

"He was awesome with the kids," Bednar said. "They all wanted to be around Keith Lawrence."

Bednar heard from Lawrence when he needed a recommendation to become a police officer after graduating from the Ventura County Sheriff's Academy. In August, he was hired by USC's public safety department.

John Thomas, the executive director and chief of the department, said that Lawrence was an "honorable, compassionate and professional" member of the community.

"We are a better department and the USC campus community is a safer place as a result of his service," Thomas said in a statement.

On Monday night, Quan's friends gathered outside Walnut High School. One clutched a heart-shaped balloon, another carried a collage of her basketball playing days. Still another held a basketball.

Lawrence's friends and family put up a Facebook page. "RIP Keith Lawrence, you will be missed," it said simply. Within hours, 840 had left comments or indicated they "liked" it. Concordia put up a link to Lawrence's game-winning shot that carried the school into a post-season tournament.

Michelle Thibeault, 27, said in a Facebook message that she had known Quan for more than a decade. The two were on the same athletic teams and went to junior high and high school together. "Monica was loved by everyone," she said.

During a somber gathering at the Cal State Fullerton gymnasium Monday, Foster read a brief statement from Quan's brother Ryan.

"We just shared a moment of incredible joy on her recent engagement," he wrote, and then added: "A bright light was just put out."

nicole.santacruz@latimes.com

kate.mather@latimes.com

lauren.williams@latimes.com

Times staff writer John Canalis contributed to this report.

Read More..

Exploding the Phone: The Untold Story of the Teenagers and Outlaws Who Hacked Ma Bell

An excerpt from Exploding the Phone

by Phil Lapsley

“

Locke spent the next twenty-four hours in what felt like a scene from a 1940s detective movie: a barren room with nothing more than a wooden table, a chair for him, two chairs for his interrogators, and a bare lightbulb dangling from the ceiling. Sitting across from him, the FBI agent and the telephone security man worked hard to get him to confess to using the blue box.

Before smartphones and iPads, before the internet or the personal computer, a misfit group of technophiles, blind teenagers, hippies, and outlaws figured out how to hack the world’s largest machine: the telephone system. The following is an excerpt from the new book Exploding the Phone written by Philip D. Lapsley and published by Grove/Atlantic, which tells the story of the “phone phreaks.”

There it was again.

Jake Locke set down his cup and looked more closely at the classified ad. It was early afternoon on a clear spring day in Cambridge in 1967. Locke, an undergrad at Harvard University, had just gotten out of bed. A transplant from southern California, he didn’t quite fit in with Harvard’s button-down culture — another student had told him he looked like a “nerdy California surfer,” what with his black-framed eyeglasses, blond hair, blue eyes, and tall, slim build. Now in the midst of his sophomore slump, Locke found himself spending a lot of time sleeping late, cutting classes, and reading the newspaper to find interesting things to do. Pretty much anything seemed better than going to classes, in fact. (“John Locke” is a pseudonym).

It was a slow news day. The Crimson, Harvard’s student newspaper, didn’t have much in the way of interesting articles, so Locke once again found himself reading the classified ads over breakfast. He had become something of a connoisseur of these little bits of poetry — people selling cars, looking for roommates, even the occasional kooky personal ad probably intended as a joke between lovers—all expressed in a dozen or so words.

But this ad was different. It had been running for a while and it had started to bug him.

WANTED HARVARD MIT Fine Arts no. 13 notebook. (121 pages) & 40 page reply K.K. & C.R. plus 2,800; battery; m.f. El presidente no esta aqui asora, que lastima. B. David Box 11595 St. Louis, MO 63105.

Locke had seen similar classified ads from students who had lost their notes for one class or another and were panicking as exams rolled around. They often were placed in the Crimson in the hopes that some kind soul had found their notes and would return them. Fine Arts 13 was the introductory art appreciation class at Harvard, so that fit.

But nothing else about the ad made any sense. Fine Arts 13 wasn’t offered at MIT. And what was all the gibberish afterward? 2,800? Battery? M.f., K.K., C.R.? What was with the Spanish? And why was somebody in St. Louis, Missouri, running an ad in Cambridge, Massachusetts, looking for a notebook for a class at Harvard? Locke had watched the ad run every day for the past few weeks. Whoever they were, and whatever it was, they clearly wanted this notebook. Why were they so persistent?

One way to find out.

Locke looked around for a piece of paper and a pen. He wrote: “Dear B. David: I have your notebook. Let’s talk. Sincerely, Jake.”

He dropped the letter in the mail on his way into Harvard Square to find something interesting to do.

An envelope with a St. Louis, Missouri, postmark showed up in Locke’s mailbox a week later. Locke opened the envelope and read the single sheet of paper. Or rather, he tried to read it. It wasn’t in English. It seemed to be written in some sort of alien hieroglyphics. It was brief, only a paragraph or so long. The characters looked familiar somehow but not enough that he could decipher them.

Locke showed the letter to everyone he saw that day but nobody could read it. Later that evening, as Locke sat at the kitchen table in his dorm room and stared at the letter, trying to puzzle it out, one of his roommates came home. Shocked that Locke might actually be doing something that looked like homework, his roommate asked what he was working on. Locke passed the letter across the table and told him about it.

His roommate took one look and said, “It looks like Russian.”

Locke said, “That’s what I thought. But the characters don’t seem right.”

“Yeah. They’re not. In fact …” His roommate’s voice trailed off for a moment. “In fact, they’re mirror writing.”

“What?”

“You know, mirror writing. The letters are written backwards. See?”

Locke looked. Sure enough: backwards.

Locke and his roommate went to the mirror and transcribed the reversed lettering. It was Cyrillic — Russian letters. Fortunately, Locke’s roommate was taking a Russian class. They sat back down at the table and translated the letter.

“Dear Jake,” the letter read. “Thank you very much for your reply. However, I seriously doubt that you have what I need. I would strongly advise you to keep to yourself and not interfere. This is serious business and you could get into trouble.” Signed, B. David.

Locke sat back. Someone had put a cryptic ad in the newspaper. He’d responded. They sent him a letter. In mirror writing. In Russian. In 1967. During the cold war.

Spy ring.

It just didn’t get much cooler than this, Locke figured. Intriguing. Terrifying, even. And far, far better than going to class.

Pages: 1 2 3 4 5 6 View All

Read More..

The New Old Age Blog: In Blended Families, Responsibility Blurs

Every year, Fran McDowell waited for the summer week when she would sing in a choral festival in the North Carolina mountains, then spend a few days in a lakeside cabin with close women friends.

That getaway grew more complicated to arrange — but perhaps more necessary — after her husband, Herb Beadle, was diagnosed with Alzheimer’s disease. They had a “gloriously happy” marriage — her first, his second — for 11 years, and she was more than willing to care for him in sickness as in health. But he could no longer manage alone in their Atlanta home.

For a few years, other family members pitched in to allow Ms. McDowell her cherished vacation. Eventually, though, she had to ask her husband’s daughter, a medical professional in another state, to take him into her home for a week.

She said no, then yes. Then, the day before Ms. McDowell was to drive him there, her stepdaughter again refused, leaving no time for alternate arrangements. If this had been her biological child, “I would have said, ‘Come on, don’t do this to me,’” Ms. McDowell said. Instead, reluctant to make waves, she canceled her trip.

“I think confrontation is riskier for stepparents,” she told me. “I was the compliant one who would bite my tongue rather than say what I thought.”

Ms. McDowell never told her stepdaughter, or anyone in the family, how angry and disappointed she was, or how difficult it was becoming to care for their father, who died three years ago at 86. She told the members of her dementia caregivers support group instead.

It was that group’s leader, Moira Keller, who e-mailed me to suggest this topic. A clinical social worker with the Sixty Plus program at Piedmont Atlanta Hospital, she wrote that “one of the biggest challenges I have is blended families in later life.”

Though I’ve written about the way the 1970s’ spike in divorces could complicate caregiving for adult children — more households to sustain, more siblings to either help or hinder — I hadn’t considered the impact on the older people themselves.

But Ms. Keller seems to be onto something. “The generation most likely to have stepchildren” — the boomers — “don’t need much care yet,” said Merril Silverstein, a Syracuse University sociologist co-editing a coming issue of the Journal of Marriage and the Family on stepfamilies in later life. “The crunch will come in 10 or 20 years.”

Initially, many adult children whose divorced or widowed parents remarry seem delighted, Ms. Keller said when we spoke. “They’re thrilled that Mom or Dad isn’t alone,” she said. “It’s a wonderful thing — until somebody gets sick.”

Then, she has found, “it gets really blurry. Who’s going to do what?” Grown children don’t have much history with these new spouses; they often feel less responsibility to intervene or help out, and stepparents may be unwilling to ask. Perhaps it’s unclear whether children or new spouses have decision-making authority.

“Older couples in this situation fall through the cracks,” Ms. Keller said.

Research shows that the ties which lead adult children to become caregivers — depending on how much contact they have with parents, how nearby they live, how obligated they feel — are weaker in stepchildren, Dr. Silverstein said. Money sometimes enters the equation too, Ms. Keller added, if biological children resent a parent’s spending their presumed inheritance on care for an ailing stepparent.

Adela Betsill, another of Ms. Keller’s support group members, married her longtime partner five years ago — her second marriage, his third. She has since given up her interior design business to care for Robert who, at 72, has also developed Alzheimer’s disease. His two children have had little involvement — perhaps because she’s just 49 and presumed able to handle everything.

Thus, though Robert’s son works from an office in their home, if Ms. Betsill needed to go out and asked him to remind his father to eat lunch, “he might, or he might not,” she said. “I don’t think he realizes it’s a burden.” So she has not asked.

Would it be different if she were his biological mother and he saw her wearing out under the strain? She thinks so, but it’s hard to know. After all, biological families also experience plenty of conflict and avoidance as elders age.

Still, that sense of reciprocity we often hear from caregivers — she took care of me when I was young, so I need to help out now that she’s old — doesn’t apply in late-life stepfamilies. Ms. Betsill didn’t raise this man, or his half sister.

Older couples who marry or remarry often discuss their finances, Ms. Keller has found. (An elder attorney, Craig Reaves, discussed the legal consequences here.) But illness and dependence may prove even more difficult subjects to broach.

“If I could yell one thing from a mountaintop,” Ms. Keller said, “it’s to talk about this stuff, too. Who’s going to take care of you if you become sick? Talk about that while you’re still healthy.”

---

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

Read More..

DealBook: Liberty Global in Talks to Buy Virgin Media

6:59 a.m. | Updated

LONDON – Liberty Global, the international cable company owned by the American billionaire John C. Malone, is in discussions to buy the British cable company Virgin Media.

In a brief statement on Tuesday, Virgin Media said it was in talks with Liberty Global, which serves almost 20 million customers worldwide.

“Any such transaction would be subject to regulatory and other conditions,” Virgin Media said in a statement. Spokesmen for both Virgin Media and Liberty Global declined to comment further.

Shares in Virgin Media, which was formed through several mergers of small British cable companies and a cellphone company in the 2000s, rose more than 15 percent in morning trading in London on Tuesday.

The company’s current market capitalization stands at $10.4 billion. Including debt, Virgin Media’s enterprise value is around $19.4 billion, according to data from Thomson Reuters.

To secure a deal, analysts at Espirito Santo said Liberty Global may have to pay as much as $24 billion, though they questioned whether the international cable company could afford to fund the acquisition because of its existing high levels of debt.

The analysts added that it would be difficult for Liberty Global to make costs savings between its current European operations and those of Virgin Media.

“A bid from Liberty would not offer any in-market synergies but would add to the company’s scale on a European basis,” Espirito Santo analysts said in a note to investors on Tuesday.

Virgin Media’s share price has jumped almost 60 percent in the last 12 months, as more consumers sign up for so-called bundled services, including Internet and cellphone contracts.

The cable company, whose primary listing is on Nasdaq, is the second-largest pay-TV provider in Britain after BSkyB, which is partly owned by Rupert Murdoch‘s News Corporation.

The British billionaire Richard Branson, whose Virgin brand is now used for a variety of products and services, including airlines and banks, owns less than 3 percent of Virgin Media.

While the British cable operator has been picking up market share, the company currently has 4.9 million customers, or roughly half the number of subscribers as its larger rival, BskyB, according to filings from the companies.

A potential deal for Virgin Media would put Mr. Malone head-to-head with Mr. Murdoch, his longtime rival.

In 2008, the Liberty Group, which has operations in 13 countries, completed its purchase of a controlling stake in DirecTV, the satellite television provider, from News Corporation in a cash-and-equity deal worth roughly $11 billion.

The deal came after Mr. Malone’s purchase of a 16 percent stake in News Corporation, which he then traded for the satellite television operator, a number of regional sports networks and around $550 million cash.

Liberty Global has been expanding its presence in Europe and has operations from Ireland to Romania, though it failed last month in its bid to acquire the Belgian telecommunications company Telenet Group for $2.7 billion. Liberty Global currently owns a 58 percent stake in Telenet.

In August, Liberty Media, the media conglomerate also controlled by Mr. Malone, agreed to buy a stake in Barnes & Noble for $204 million, but declined to buy the bookseller outright.

The move disappointed some investors after Liberty had earlier offered to buy a 70 percent stake of Barnes & Noble for $17 a share if its chairman, Leonard S. Riggio, who owns around 30 percent of the company, agreed to the deal.

Read More..