Growth in Consumer Spending Slows

WASHINGTON — American consumers increased their spending in December at a slower pace, while their income grew by the largest amount in eight years, the Commerce Department said Thursday. Income surged because companies rushed to pay dividends and bonuses before tax increases.

The 0.2 percent rise in consumer spending last month was slightly slower than the 0.4 percent increase in November.

Income jumped 2.6 percent in December from November, the biggest gain since December 2004.

Economists expect consumer spending, which accounts for about 70 percent of economic activity, to slow this year. That’s because consumers are receiving less take-home pay starting this month.

Congress and the White House reached a deal on Jan. 1 to prevent income taxes from rising on all but the wealthiest Americans. But they allowed a temporary reduction in Social Security taxes to expire this year. That means a person earning $50,000 a year will have about $1,000 less to spend in 2013. A household with two high-paid workers will have up to $4,500 less.

The diminished pay could slow consumer spending and economic growth at a precarious moment.

The economy unexpectedly shrank in the October-December period at an annual rate of 0.1 percent, the government said Wednesday. The dip was a reminder of the economy’s vulnerability as automatic cuts in government spending loom.

Some analysts have estimated that the roughly $120 billion in higher Social Security taxes could subtract up to 0.7 percentage point from growth this year.

Separately, the Labor Department reported Thursday that the number of Americans seeking unemployment aid rose sharply last week but remained at a level consistent with moderate hiring.

Weekly applications for unemployment benefits leapt 38,000 to a seasonally adjusted 368,000, the government said. The increase comes after applications plummeted in the previous two weeks to five-year lows.

The volatility reflects the government’s difficulty adjusting the data to account for layoffs after the holiday shopping season. Job cuts typically increase in the second week in January as retailers dismiss temporary employees hired for the winter holidays. Layoffs then fall in the second half of the month.

The department attempts to adjust for such fluctuations but the January figures can still be volatile. The four-week average, a less volatile measure, ticked up to 352,000, just above a four-year low.

On Friday, the government is scheduled to issue its January jobs report. Analysts forecast that it will show employers added 155,000 jobs, the same as in December. The unemployment rate is expected to remain at 7.8 percent for the third straight month.

Read More..

Well: Waiting for Alzheimer's to Begin

My gray matter might be waning. Then again, it might not be. But I swear that I can feel memories — as I’m making them — slide off a neuron and into a tangle of plaque. I steel myself for those moments to come when I won’t remember what just went into my head.

I’m not losing track of my car keys, which is pretty standard in aging minds. Nor have I ever forgotten to turn off the oven after use, common in menopausal women. I can always find my car in the parking lot, although lots of “normal” folk can’t.

Rather, I suddenly can’t remember the name of someone with whom I’ve worked for years. I cover by saying “sir” or “madam” like the Southerner I am, even though I live in Vermont and grown people here don’t use such terms. Better to think I’m quirky than losing my faculties. Sometimes I’ll send myself an e-mail to-do reminder and then, seconds later, find myself thrilled to see a new entry pop into my inbox. Oops, it’s from me. Worse yet, a massage therapist kicked me out of her practice for missing three appointments. I didn’t recall making any of them. There must another Nancy.

Am I losing track of me?

Equally worrisome are the memories increasingly coming to the fore. Magically, these random recollections manage to circumnavigate my imagined build-up of beta-amyloid en route to delivering vivid images of my father’s first steps down his path of forgetting. He was the same age I am now, which is 46.

“How old are you?” I recall him asking me back then. Some years later, he began calling me every Dec. 28 to say, “Happy birthday,” instead of on the correct date, Dec. 27. The 28th had been his grandmother’s birthday.

The chasms were small at first. Explainable. Dismissible. When he crossed the street without looking both ways, we chalked it up to his well-cultivated, absent-minded professor persona. But the chasms grew into sinkholes, and eventually quicksand. When we took him to get new pants one day, he kept trying on the same ones he wore to the store.

“I like these slacks,” he’d say, over and over again, as he repeatedly pulled his pair up and down.

My dad died of Alzheimer’s last April at age 73 — the same age at which his father succumbed to the same disease. My dad ended up choosing neurology as his profession after witnessing the very beginning of his own dad’s forgetting.

Decades later, grandfather’s atrophied brain found its way into a jar on my father’s office desk. Was it meant to be an ever-present reminder of Alzheimer’s effect? Or was it a crystal ball sent to warn of genetic fate? My father the doctor never said, nor did he ever mention, that it was his father’s gray matter floating in that pool of formaldehyde.

Using the jarred brain as a teaching tool, my dad showed my 8-year-old self the difference between frontal and temporal lobes. He also pointed out how brains with Alzheimer’s disease become smaller, and how wide grooves develop in the cerebral cortex. But only after his death — and my mother’s confession about whose brain occupied that jar — did I figure out that my father was quite literally demonstrating how this disease runs through our heads.

Has my forgetting begun?

I called my dad’s neurologist. To find out if I was in the earliest stages of Alzheimer’s, he would have to look for proteins in my blood or spinal fluid and employ expensive neuroimaging tests. If he found any indication of onset, the only option would be experimental trials.

But documented confirmation of a diseased brain would break my still hopeful heart. I’d walk around with the scarlet letter “A” etched on the inside of my forehead — obstructing how I view every situation instead of the intermittent clouding I currently experience.

“You’re still grieving your father,” the doctor said at the end of our call. “Sadness and depression affect the memory, too. Let’s wait and see.”

It certainly didn’t help matters that two people at my father’s funeral made some insensitive remarks.

“Nancy, you must be scared to death.”

“Is it hard knowing the same thing probably will happen to you?”

Maybe the real question is what to do when the forgetting begins. My dad started taking 70 supplements a day in hopes of saving his mind. He begged me to kill him if he wound up like his father. He retired from his practice and spent all day in a chair doing puzzles. He stopped making new memories in an all-out effort to preserve the ones he already had.

Maybe his approach wasn’t the answer.

Just before his death — his brain a fraction of its former self — my father managed to offer up a final lesson. I was visiting him in the memory-care center when he got a strange look on his face. I figured it was gas. But then his eyes lit up and a big grin overtook him, and he looked right at me and said, “Funny how things turn out.”

An unforgettable moment?

I can only hope.

---

Nancy Stearns Bercaw is a writer in Vermont. Her book, “Brain in a Jar: A Daughter’s Journey Through Her Father’s Memory,” will be published in April 2013 by Broadstone.

Read More..

Well: Waiting for Alzheimer's to Begin

My gray matter might be waning. Then again, it might not be. But I swear that I can feel memories — as I’m making them — slide off a neuron and into a tangle of plaque. I steel myself for those moments to come when I won’t remember what just went into my head.

I’m not losing track of my car keys, which is pretty standard in aging minds. Nor have I ever forgotten to turn off the oven after use, common in menopausal women. I can always find my car in the parking lot, although lots of “normal” folk can’t.

Rather, I suddenly can’t remember the name of someone with whom I’ve worked for years. I cover by saying “sir” or “madam” like the Southerner I am, even though I live in Vermont and grown people here don’t use such terms. Better to think I’m quirky than losing my faculties. Sometimes I’ll send myself an e-mail to-do reminder and then, seconds later, find myself thrilled to see a new entry pop into my inbox. Oops, it’s from me. Worse yet, a massage therapist kicked me out of her practice for missing three appointments. I didn’t recall making any of them. There must another Nancy.

Am I losing track of me?

Equally worrisome are the memories increasingly coming to the fore. Magically, these random recollections manage to circumnavigate my imagined build-up of beta-amyloid en route to delivering vivid images of my father’s first steps down his path of forgetting. He was the same age I am now, which is 46.

“How old are you?” I recall him asking me back then. Some years later, he began calling me every Dec. 28 to say, “Happy birthday,” instead of on the correct date, Dec. 27. The 28th had been his grandmother’s birthday.

The chasms were small at first. Explainable. Dismissible. When he crossed the street without looking both ways, we chalked it up to his well-cultivated, absent-minded professor persona. But the chasms grew into sinkholes, and eventually quicksand. When we took him to get new pants one day, he kept trying on the same ones he wore to the store.

“I like these slacks,” he’d say, over and over again, as he repeatedly pulled his pair up and down.

My dad died of Alzheimer’s last April at age 73 — the same age at which his father succumbed to the same disease. My dad ended up choosing neurology as his profession after witnessing the very beginning of his own dad’s forgetting.

Decades later, grandfather’s atrophied brain found its way into a jar on my father’s office desk. Was it meant to be an ever-present reminder of Alzheimer’s effect? Or was it a crystal ball sent to warn of genetic fate? My father the doctor never said, nor did he ever mention, that it was his father’s gray matter floating in that pool of formaldehyde.

Using the jarred brain as a teaching tool, my dad showed my 8-year-old self the difference between frontal and temporal lobes. He also pointed out how brains with Alzheimer’s disease become smaller, and how wide grooves develop in the cerebral cortex. But only after his death — and my mother’s confession about whose brain occupied that jar — did I figure out that my father was quite literally demonstrating how this disease runs through our heads.

Has my forgetting begun?

I called my dad’s neurologist. To find out if I was in the earliest stages of Alzheimer’s, he would have to look for proteins in my blood or spinal fluid and employ expensive neuroimaging tests. If he found any indication of onset, the only option would be experimental trials.

But documented confirmation of a diseased brain would break my still hopeful heart. I’d walk around with the scarlet letter “A” etched on the inside of my forehead — obstructing how I view every situation instead of the intermittent clouding I currently experience.

“You’re still grieving your father,” the doctor said at the end of our call. “Sadness and depression affect the memory, too. Let’s wait and see.”

It certainly didn’t help matters that two people at my father’s funeral made some insensitive remarks.

“Nancy, you must be scared to death.”

“Is it hard knowing the same thing probably will happen to you?”

Maybe the real question is what to do when the forgetting begins. My dad started taking 70 supplements a day in hopes of saving his mind. He begged me to kill him if he wound up like his father. He retired from his practice and spent all day in a chair doing puzzles. He stopped making new memories in an all-out effort to preserve the ones he already had.

Maybe his approach wasn’t the answer.

Just before his death — his brain a fraction of its former self — my father managed to offer up a final lesson. I was visiting him in the memory-care center when he got a strange look on his face. I figured it was gas. But then his eyes lit up and a big grin overtook him, and he looked right at me and said, “Funny how things turn out.”

An unforgettable moment?

I can only hope.

---

Nancy Stearns Bercaw is a writer in Vermont. Her book, “Brain in a Jar: A Daughter’s Journey Through Her Father’s Memory,” will be published in April 2013 by Broadstone.

Read More..

Ericsson Sales Rise on Spending to Upgrade Mobile Networks

BERLIN — Ericsson, the world’s biggest maker of mobile network equipment, said on Thursday that its sales and profit grew faster than expected in the fourth quarter as phone operators in the United States and Canada spent heavily to upgrade wireless networks.

The company booked a net loss during the quarter as it wrote down the value of ST-Ericsson, an unprofitable smartphone component venture with the French chipmaker ST Microelectronics.

But investors apparently looked past that to focus on the underlying growth. Shares of Stockholm-based Ericsson rose almost 10 percent after the earnings report, which showed that demand from North America had helped lift Ericsson’s global sales of network equipment, the company’s main business, by 6 percent from a year earlier.

Ericsson’s sales of equipment, software and services in the three months through December rose 5 percent to 66.9 billion kronor, or $10.6 billion.

“This suggests the declining sales of network equipment we have seen for some time has finally begun to turn around,” said Hakan Wranne, an analyst at Swedbank in Stockholm.

In North America, Ericsson said sales of mobile broadband and other network gear to U.S. and Canadian operators surged 86 percent to 9.4 billion kronor in the quarter from a year earlier, without providing a comparative figure. Sales of equipment rose 10 percent in Western Europe, and 38 percent in India, part of an upswing in half of Ericsson’s global sales regions.

The increase followed four quarters of declining global network sales.

“We continue to believe the long-term fundamentals of this industry are attractive,” Hans Vestberg, the Ericsson chief executive, said. “I think it is clear that society will be using mobile broadband and the cloud much more than they are now.”

Ericsson said it took an 8.6 billion kronor charge against earnings in the period for ST-Ericsson, which is based in Geneva and has generated about $2.8 billion in losses since February 2009. The charge caused Ericsson to report a loss of 6.3 billion kronor for the fourth quarter.

Ericsson had warned investors of the charge on December 20.

ST-Ericsson employs 5,090 workers and makes processor modules and modems for some Samsung, Motorola and Sony smartphones.

Mr. Vestberg said he had no new information on the future of ST-Ericsson, which reported a $71 million loss in the quarter on unchanged sales of $358 million. Last month, ST Microelectronics announced plans to leave the venture and Ericsson said it had no intention of buying its partner’s stake.

“We continue to believe that the modern technology in this venture is of strategic importance to the industry,” Mr. Vestberg said. “We are now in a discussion among the shareholders about our options going forward. We don’t exclude anything at this point.”

Mr. Wranne, the Swedbank analyst, said he thought it was possible that Ericsson might simply resort to shutting down the joint venture sometime this year.

“Both parents have essentially turned their back on the company and what I think they have done is essentially killed it,” Mr. Wranne said. “At this point, it is not certain whether the venture will be operating six months from now.”

With the charge against earnings, Ericsson has written off the entire value of its investment in ST-Ericsson, said Jan Frykhammar, the Ericsson chief financial officer. The business began to deteriorate after Nokia, its biggest client, announced plans in 2011 to halt its Symbian smartphone line, which had used many ST-Ericsson components.

Ericsson’s main network equipment business, which made up 53 percent of its sales in the quarter, more than made up for the ST-Ericsson write-off. Sales of Ericsson’s equipment, software and services in North America rose 51 percent to 17 billion kronor.

Excluding the ST-Ericsson charges, Ericsson’s operating profit in the quarter rose by 17 percent to 4.8 billion kronor.

Sales in the quarter rose on an annual basis in all regions except Scandinavia, the Mediterranean region of southern Europe, China, the Middle East and Latin America.

The gains are a harbinger a new phase of purchasing by global phone operators, Mr. Vestberg said, as they compete to sell mobile broadband services to the rapidly expanding ranks of smartphone users. Ericsson expects the number of mobile broadband users around the world to rise 40 percent to 2.1 billion by the end of this year from 1.5 billion in 2012.

By the end of this year, three in 10 cellphone users around the world will be operating smartphones and subscribing to mobile broadband service, Ericsson predicted. Demand for fast wireless Internet will in turn lift demand for Ericsson’s networks, Mr. Vestberg said. In the last quarter, he said, 40 percent of all cellphones sold worldwide were smartphones.

Operators, recognizing the strong consumer interest in mobile broadband, are stepping up their orders for new data networks that can handle the heavy traffic demands on their grids. “Operators and customers are focusing now on mobile broadband,” Mr. Vestberg said. “We are clearly seeing a change in their behavior.”

Shares of Ericsson rose 9.8 percent, or 6.55 kronor, to 73.45 kronor in Stockholm.

Read More..

IHT Rendezvous: Europeans Dismantle People-Smuggling Ring

LONDON — European police said on Wednesday that they had dismantled a criminal network that smuggled illegal migrants into the European Union, arresting more than 100 suspects across the Continent, from France to the Balkans.

The network smuggled people principally from Afghanistan, Iraq, Pakistan, Syria and Turkey.

Europol, a joint law enforcement agency set up to fight serious crime in the 27-member Union, said 117 house searches had been carried out in operations in the early hours of Tuesday morning that involved more than 1,200 police officers.

The latest crackdown on people-smugglers highlighted a chronic problem for European authorities as would-be migrants, desperate to escape poverty and conflict in their home countries, put their fate in the hands of organized criminal gangs to take a well-worn route via Turkey and the Balkans.

Interpol says the traffic is a high-profit, low-risk enterprise for transnational criminal syndicates.

“People smuggling syndicates are drawn by the huge profits that can be made, while benefiting from weak legislation and the relatively low risk of detection, prosecution and arrest,” according to the international police organization.

The International Organization for Migration (I.O.M.) said in a 2011 report that the activity earns organized crime groups an estimated $3 to $10 billion a year worldwide.

Europol described this week’s action as one of the largest coordinated efforts against people smugglers at a European level. It was also the latest indication that countries are pooling resources to fight international organized crime gangs.

Police and migration experts say there is a difference between people-smuggling, in which would-be migrants voluntarily pay to illegally cross transnational borders, and people-trafficking, which involves the criminal exploitation of duped or unwilling victims.

“Smuggling implies the procurement of irregular entry into a state of which the individual is neither a citizen nor a permanent resident, for financial or material gain,” according to the I.O.M. “Trafficking, on the other hand, occurs for the purpose of exploitation, often involving forced labor and prostitution.”

However, that may turn out to be a fine distinction for would-be illegal migrants who face abuse at the hands of the crime gangs.

Europol said migrants were often smuggled in inhuman and dangerous conditions in small hidden compartments in the floor of buses or trucks, in freight trains or on boats.

Gangs operating on the so-called West Balkans smuggling route have proved to be innovative and flexible in the face of increased international cooperation to tackle the trade.

Greek police broke up a smuggling network in 2007 that was transporting Albanian migrants across a dangerous mountain route. The smugglers then switched to alternative routes via Croatia, Montenegro and Serbia to Italy, Hungary and Slovenia.

The main destinations of the illegal migrants are France, Britain, Spain, Italy and Belgium. The raids this week involved operations in France and Germany as well as eastern Europe and Turkey.

Europol reported 103 arrests and said cell phones, computers, cash and a semi-automatic rifle with a large amount of ammunition were among the items seized.

In November, British immigration officers arrested eight suspects in an alleged criminal network suspected of helping Iranian migrants reach Britain from mainland Europe. That followed a joint investigation with Spain’s Guardia Civil that led to 11 other arrests in Madrid and Alicante.

Although the illegal immigrants may be traveling willingly in the search of a better life, people-smuggling is not a victimless crime.

The I.O.M. said in its 2011 report: “Numerous other crimes are oftentimes linked to people smuggling – human trafficking, identity fraud, corruption and money laundering – creating shadow governance systems that undercut the rule of law.”

Read More..

U.S. Economy Unexpectedly Contracted in Fourth Quarter

The United States economy unexpectedly reversed course in the final quarter of 2012 and contracted at a 0.1 percent rate, its worst performance since the aftermath of the financial crisis in 2009.

The drop was driven by a plunge in military spending, as well as fewer exports and a steep slowdown in the buildup of inventories by businesses. Anxieties about the fiscal impasse in Washington also contributed to the slowdown.

While economists expected output to decline substantially from the 3.1 percent annual growth rate recorded in the third quarter, the negative number caught Wall Street off-guard. It was the weakest economic report since the second quarter of 2009.

“I’m a little surprised,” said Michael Feroli, chief United States economist at JPMorgan. “It grabs your attention when you have a negative number across everyone’s screens.”

Stocks were modestly higher in early trading on Wall Street, as some traders shrugged off the unexpected drop.

Mr. Feroli had been expecting growth to come in at 0.4 percent, which was well below the 1.1 percent consensus among economists on Wall Street. Still, Mr. Feroli said there were some hints the economy was performing slightly better than the headline number suggested.

The 22.2 percent drop in military spending – the sharpest quarterly drop in more than four decades – along with the drop in inventories and exports overwhelmed more positive indicators in the private sector, he said.

For example, final sales to private domestic purchasers, which strips out government spending as well as trade and inventories, rose by 2.8 percent. “Consumers and businesses kept spending at a pretty steady pace,” Mr. Feroli said. “There was a lot of noise that moved the headline around.”

For the entire year, the economy grew by 2.2 percent, a slight improvement from the 1.8 percent annual rate in 2011.

Still, with unemployment stubbornly high at 7.8 percent and growth expected to remain slow in the first quarter, the poor report Wednesday was likely to set off more finger-pointing in Washington.

The compromise between President Obama and Congress earlier this month allowed a temporary cut in Social Security taxes to expire, which is expected to crimp growth in the first quarter. The change will cost a worker earning $50,000 a year an extra $1,000 annually.

Indeed, a consumer confidence survey released Tuesday by the Conference Board showed a sharp downturn in January, which economists attributed in part to financial anxiety arising from the reduction in take-home pay.

The consensus estimate for early 2013 is currently calling for output to rise at an annual rate of 1.5 percent, but that number may come down in the wake of Wednesday’s report.

This was the Commerce Department’s first estimate of fourth-quarter growth; revisions are due in February and March, so the final figure could go up or down significantly.

Read More..

The New Old Age Blog: For Some Caregivers, the Trauma Lingers

Recently, I spoke at length to a physician who seems to have suffered a form of post-traumatic stress after her mother’s final illness.

There is little research on this topic, which suggests that it is overlooked or discounted. But several experts acknowledge that psychological trauma of this sort does exist.

Barry Jacobs, a clinical psychologist and author of “The Emotional Survival Guide for Caregivers” (The Guilford Press, 2006), often sees caregivers who struggle with intrusive thoughts and memories months and even years after a loved one has died.

“Many people find themselves unable to stop thinking about the suffering they witnessed, which is so powerfully seared into their brains that they cannot push it away,” Dr. Jacobs said.

Flashbacks are a symptom of post-traumatic stress disorder, along with feelings of numbness, anxiety, guilt, dread, depression, irritability, apathy, tension and more. Though one symptom or several do not prove that such a condition exists — that’s up to an expert to determine — these issues are a “very common problem for caregivers,” Dr. Jacobs said.

Dolores Gallagher-Thompson, a professor of psychiatry at the Stanford University School of Medicine who treats many caregivers, said there was little evidence that caregiving on its own caused post-traumatic stress. But if someone is vulnerable for another reason — perhaps a tragedy experienced earlier in life — this kind of response might be activated.

“When something happens that the individual perceives and reacts to as a tremendous stressor, that can intensify and bring back to the forefront of consciousness memories that were traumatic,” Dr. Gallagher-Thompson said. “It’s more an exacerbation of an already existing vulnerability.”

Dr. Judy Stone, the physician who was willing to share her mother’s end-of-life experience and her powerful reaction to it, fits that definition in spades.

Both of Dr. Stone’s Hungarian parents were Holocaust survivors: her mother, Magdus, called Maggie by family and friends, had been sent to Auschwitz; her father, Miki, to Dachau. The two married before World War II, after Maggie left her small village, moved to the city and became a corset maker in Miki’s shop.

Death cast a long shadow over the family. During the war, Maggie’s first baby died of exposure while she was confined for a time to the Debrecen ghetto. After the war, the family moved to the United States, where they worked to recover a sense of normalcy and Miki worked as a maker of orthopedic appliances. Then he died suddenly of a heart attack at the age of 50.

“None of us recovered from that,” said Dr. Stone, who traces her interest in medicine and her lifelong interest in fighting for social justice to her parents and trips she made with her father to visit his clients.

Decades passed, as Dr. Stone operated an infectious disease practice in Cumberland, Md., and raised her own family.

In her old age, Maggie, who her daughter describes as “tough, stubborn, strong,” developed macular degeneration, bad arthritis and emphysema — a result of a smoking habit she started just after the war and never gave up. Still, she lived alone, accepting no help until she reached the age of 92.

Then, in late 2007, respiratory failure set in, causing the old woman to be admitted to the hospital, then rehabilitation, then assisted living, then another hospital. Maggie had made her preferences absolutely clear to her daughter, who had medical power of attorney: doctors were to pursue every intervention needed to keep her alive.

Yet one doctor sent her from a rehabilitation center to the hospital during respiratory crisis with instructions that she was not to be resuscitated — despite her express wishes. Fortunately, the hospital called Dr. Stone and the order was reversed.

“You have to be ever vigilant,” Dr. Stone said when asked what advice she would give to families. “You can’t assume that anything, be it a D.N.R. or allergies or medication orders, have been communicated correctly.”

Other mistakes were made in various settings: There were times that Dr. Stone’s mother had not received necessary oxygen, was without an inhaler she needed for respiratory distress, was denied water or ice chips to moisten her mouth, or received an antibiotic that can cause hallucinations in older people, despite Dr. Stone’s request that this not happen. “People didn’t listen,” she said. “The lack of communication was horrible.”

It was a daily fight to protect her mother and make sure she got what she needed, and “frankly, if I hadn’t been a doctor, I think I would have been thrown out of there,” she said.

In the end, when it became clear that death was inevitable, Maggie finally agreed to be taken off a respirator. But rather than immediately arrange for palliative measures, doctors arranged for a brief trial to see if she could breathe on her own.

“They didn’t give her enough morphine to suppress her agony,” Dr. Stone recalled.

Five years have passed since her mother died, and “I still have nightmares about her being tortured,” the doctor said. “I’ve never been able to overcome the feeling that I failed her — I let her down. It wasn’t her dying that is so upsetting, it was how she died and the unnecessary suffering at the end.”

Dr. Stone had specialized in treating infectious diseases and often saw patients who were critically ill in intensive care. But after her mother died, “I just could not do it,” she said. “I couldn’t see people die. I couldn’t step foot in the I.C.U. for a long, long time.”

Today, she works part time seeing patients with infectious diseases on an as-needed basis in various places — a job she calls “rent a doc” — and blogs for Scientific American about medical ethics. “I tilt at windmills,” she said, describing her current occupations.

Most important to her is trying to change problems in the health system that failed her mother and failed her as well. But Dr. Stone has a sense of despair about that: it is too big an issue, too hard to tackle.

I’m grateful to her for sharing her story so that other caregivers who may have experienced overwhelming emotional reactions that feel like post-traumatic stress realize they are not alone.

It is important to note that both Dr. Jacobs and Dr. Gallagher-Thompson report successfully treating caregivers beset by overwhelming stress. It is hard work and it takes time, but they say recovery is possible. I’ll give a sense of treatment options they and others recommend in another post.

Read More..

The New Old Age Blog: For Some Caregivers, the Trauma Lingers

Recently, I spoke at length to a physician who seems to have suffered a form of post-traumatic stress after her mother’s final illness.

There is little research on this topic, which suggests that it is overlooked or discounted. But several experts acknowledge that psychological trauma of this sort does exist.

Barry Jacobs, a clinical psychologist and author of “The Emotional Survival Guide for Caregivers” (The Guilford Press, 2006), often sees caregivers who struggle with intrusive thoughts and memories months and even years after a loved one has died.

“Many people find themselves unable to stop thinking about the suffering they witnessed, which is so powerfully seared into their brains that they cannot push it away,” Dr. Jacobs said.

Flashbacks are a symptom of post-traumatic stress disorder, along with feelings of numbness, anxiety, guilt, dread, depression, irritability, apathy, tension and more. Though one symptom or several do not prove that such a condition exists — that’s up to an expert to determine — these issues are a “very common problem for caregivers,” Dr. Jacobs said.

Dolores Gallagher-Thompson, a professor of psychiatry at the Stanford University School of Medicine who treats many caregivers, said there was little evidence that caregiving on its own caused post-traumatic stress. But if someone is vulnerable for another reason — perhaps a tragedy experienced earlier in life — this kind of response might be activated.

“When something happens that the individual perceives and reacts to as a tremendous stressor, that can intensify and bring back to the forefront of consciousness memories that were traumatic,” Dr. Gallagher-Thompson said. “It’s more an exacerbation of an already existing vulnerability.”

Dr. Judy Stone, the physician who was willing to share her mother’s end-of-life experience and her powerful reaction to it, fits that definition in spades.

Both of Dr. Stone’s Hungarian parents were Holocaust survivors: her mother, Magdus, called Maggie by family and friends, had been sent to Auschwitz; her father, Miki, to Dachau. The two married before World War II, after Maggie left her small village, moved to the city and became a corset maker in Miki’s shop.

Death cast a long shadow over the family. During the war, Maggie’s first baby died of exposure while she was confined for a time to the Debrecen ghetto. After the war, the family moved to the United States, where they worked to recover a sense of normalcy and Miki worked as a maker of orthopedic appliances. Then he died suddenly of a heart attack at the age of 50.

“None of us recovered from that,” said Dr. Stone, who traces her interest in medicine and her lifelong interest in fighting for social justice to her parents and trips she made with her father to visit his clients.

Decades passed, as Dr. Stone operated an infectious disease practice in Cumberland, Md., and raised her own family.

In her old age, Maggie, who her daughter describes as “tough, stubborn, strong,” developed macular degeneration, bad arthritis and emphysema — a result of a smoking habit she started just after the war and never gave up. Still, she lived alone, accepting no help until she reached the age of 92.

Then, in late 2007, respiratory failure set in, causing the old woman to be admitted to the hospital, then rehabilitation, then assisted living, then another hospital. Maggie had made her preferences absolutely clear to her daughter, who had medical power of attorney: doctors were to pursue every intervention needed to keep her alive.

Yet one doctor sent her from a rehabilitation center to the hospital during respiratory crisis with instructions that she was not to be resuscitated — despite her express wishes. Fortunately, the hospital called Dr. Stone and the order was reversed.

“You have to be ever vigilant,” Dr. Stone said when asked what advice she would give to families. “You can’t assume that anything, be it a D.N.R. or allergies or medication orders, have been communicated correctly.”

Other mistakes were made in various settings: There were times that Dr. Stone’s mother had not received necessary oxygen, was without an inhaler she needed for respiratory distress, was denied water or ice chips to moisten her mouth, or received an antibiotic that can cause hallucinations in older people, despite Dr. Stone’s request that this not happen. “People didn’t listen,” she said. “The lack of communication was horrible.”

It was a daily fight to protect her mother and make sure she got what she needed, and “frankly, if I hadn’t been a doctor, I think I would have been thrown out of there,” she said.

In the end, when it became clear that death was inevitable, Maggie finally agreed to be taken off a respirator. But rather than immediately arrange for palliative measures, doctors arranged for a brief trial to see if she could breathe on her own.

“They didn’t give her enough morphine to suppress her agony,” Dr. Stone recalled.

Five years have passed since her mother died, and “I still have nightmares about her being tortured,” the doctor said. “I’ve never been able to overcome the feeling that I failed her — I let her down. It wasn’t her dying that is so upsetting, it was how she died and the unnecessary suffering at the end.”

Dr. Stone had specialized in treating infectious diseases and often saw patients who were critically ill in intensive care. But after her mother died, “I just could not do it,” she said. “I couldn’t see people die. I couldn’t step foot in the I.C.U. for a long, long time.”

Today, she works part time seeing patients with infectious diseases on an as-needed basis in various places — a job she calls “rent a doc” — and blogs for Scientific American about medical ethics. “I tilt at windmills,” she said, describing her current occupations.

Most important to her is trying to change problems in the health system that failed her mother and failed her as well. But Dr. Stone has a sense of despair about that: it is too big an issue, too hard to tackle.

I’m grateful to her for sharing her story so that other caregivers who may have experienced overwhelming emotional reactions that feel like post-traumatic stress realize they are not alone.

It is important to note that both Dr. Jacobs and Dr. Gallagher-Thompson report successfully treating caregivers beset by overwhelming stress. It is hard work and it takes time, but they say recovery is possible. I’ll give a sense of treatment options they and others recommend in another post.

Read More..

Gadgetwise Blog: Q&A: Tweeting in Public or Private

Can someone you block on Twitter still see your tweets?

Blocking another Twitter user prevents the person from following your account and automatically seeing your posts in his or her Twitter feed. Your tweets may still be visible, however, if you have not turned on certain privacy controls in your account’s settings.

Twitter allows you to have a public account, where anyone on the Web can see your posts on your Twitter profile page, or a protected account, where only the people you approve as followers can see your tweets. You can adjust this visibility on Twitter in your account’s settings, as explained in the site’s help guide.

Read More..

IHT Rendezvous: Mali's Culture War: The Fate of the Timbuktu Manuscripts

LONDON — Scholars are urgently trying to determine the fate of a treasure store of ancient manuscripts in the city of Timbuktu.

As French-led forces consolidated their hold on northern Mali, international scholars feared the worst: that retreating Islamic militants had torched the Ahmed Baba Institute, home to 30,000 priceless items of scholarship dating back to the 13th century.

But many volumes may have escaped destruction by being hidden from fundamentalist forces that seized the north last year. The militants launched a campaign to eradicate historic vestiges of a medieval Muslim civilization that they deemed un-Islamic.

South African researchers involved in a project to preserve the Timbuktu manuscripts have had word that most of the treasures survived in private libraries and secure locations.

Mohamed Mathee of the University of Johannesburg told eNews Channel Africa, “It seems most of the manuscripts are OK. These manuscripts are with families and are safe.”

National Geographic News quoted Sidi Ahmed, a reporter who fled Timbuktu during its occupation, as saying: “The people here have long memories. They are used to hiding their manuscripts. They go into the desert and bury them until it is safe.”

Whatever the fate of the city’s ancient texts, the French intervention came too late to save some of the city’s most valued monuments, including centuries-old shrines of Sufi saints demolished by the Islamists during their nine-month rule.

It was part of a culture war that they waged to impose Sharia law after their capture of the north. The strict Sunni Salafists reject the worship of saints that is part of the Shia and Sufi tradition.

When UNESCO, the United Nations’ cultural agency, placed Timbuktu on its list of endangered world heritage sites after the Islamist takeover, Oumar Ould Hamaha, a spokesman for the Ansar Dine militants, responded: “We are subject to religion and not to international opinion.”

Elsewhere in North Africa, militants have attacked Sufi shrines as well as remnants of the region’s pre-Islamic past.

Radical Islamists were blamed last October for the destruction of stone carvings in Morocco’s High Atlas Mountains that were more than 8,000 years old and depicted the sun as a pagan divinity.

Their destruction was reminiscent to that of the Buddhist statues of Bamiyan, which were dynamited out of existence in 2001 by the Afghan Taliban despite appeals from fellow Muslims.

Such seemingly wanton acts of religiously inspired vandalism are not, of course, confined to Islamic fundamentalists, as my colleague Barbara Crossette wrote at the time.

“Certainly it evoked the religious triumphalism that plagues a broad swath of the world, from China to the Balkans,” she wrote, “the destruction of centuries-old mosques by Hindus at Ayodhya or by Serbs in Bosnia, or the assaults on heritage that defy peace itself in Jerusalem.”

From the Crusades to the conquest of the Americas, a militant Catholic Church also displayed a predilection for eradicating the artifacts of pagans and religious rivals alike. In the 17th century English Civil War, iconoclastic Puritans hacked down the statues of churches and cathedrals.

Recent events in Mali have highlighted how today’s ideological wars are fought with more than just weapons.

The Timbuktu manuscripts, which include texts on religion, medicine and mathematics, had been treasured by local families but largely neglected by the outside world until the end of French colonial rule in 1960.

That changed dramatically in recent years as rival African powers sought to use culture in their campaigns for influence in the region.

As my colleague Lydia Polgreen wrote from Timbuktu in 2007, both South Africa and the Libya of Col. Muammar el-Qaddafi were involved in efforts to revive the fortunes of the ancient city and its artifacts.

The South African initiative involved building a new library for the Ahmed Baba Institute, while Libya planned to build a luxurious 100-room resort to hold academic and religious conferences.

Charities and governments from Europe, the United States and the Middle East also poured hundreds of thousands of dollars into transforming the city’s family libraries.

“Timbuktu’s new seekers have a variety of motives,” she wrote. “South Africa and Libya are vying for influence on the African stage, each promoting its vision of a resurgent Africa.”

Read More..