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.

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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..

Chinese Hackers Infiltrate New York Times Computers

SAN FRANCISCO — For the last four months, Chinese hackers have persistently attacked The New York Times, infiltrating its computer systems and getting passwords for its reporters and other employees.

The New York Times published an article in October about the wealth of the family of China's prime minister, Wen Jiabao, in both English and Chinese.

After surreptitiously tracking the intruders to study their movements and help erect better defenses to block them, The Times and computer security experts have expelled the attackers and kept them from breaking back in.

The timing of the attacks coincided with the reporting for a Times investigation, published online on Oct. 25, that found that the relatives of Wen Jiabao, China’s prime minister, had accumulated a fortune worth several billion dollars through business dealings.

Security experts hired by The Times to detect and block the computer attacks gathered digital evidence that Chinese hackers, using methods that some consultants have associated with the Chinese military in the past, breached The Times’s network. They broke into the e-mail accounts of its Shanghai bureau chief, David Barboza, who wrote the reports on Mr. Wen’s relatives, and Jim Yardley, The Times’s South Asia bureau chief in India, who previously worked as bureau chief in Beijing.

“Computer security experts found no evidence that sensitive e-mails or files from the reporting of our articles about the Wen family were accessed, downloaded or copied,” said Jill Abramson, executive editor of The Times.

The hackers tried to cloak the source of the attacks on The Times by first penetrating computers at United States universities and routing the attacks through them, said computer security experts at Mandiant, the company hired by The Times. This matches the subterfuge used in many other attacks that Mandiant has tracked to China.

The attackers first installed malware — malicious software — that enabled them to gain entry to any computer on The Times’s network. The malware was identified by computer security experts as a specific strain associated with computer attacks originating in China. More evidence of the source, experts said, is that the attacks started from the same university computers used by the Chinese military to attack United States military contractors in the past.

Security experts found evidence that the hackers stole the corporate passwords for every Times employee and used those to gain access to the personal computers of 53 employees, most of them outside The Times’s newsroom. Experts found no evidence that the intruders used the passwords to seek information that was not related to the reporting on the Wen family.

No customer data was stolen from The Times, security experts said.

Asked about evidence that indicated the hacking originated in China, and possibly with the military, China’s Ministry of National Defense said, “Chinese laws prohibit any action including hacking that damages Internet security.” It added that “to accuse the Chinese military of launching cyberattacks without solid proof is unprofessional and baseless.”

The attacks appear to be part of a broader computer espionage campaign against American news media companies that have reported on Chinese leaders and corporations.

Last year, Bloomberg News was targeted by Chinese hackers, and some employees’ computers were infected, according to a person with knowledge of the company’s internal investigation, after Bloomberg published an article on June 29 about the wealth accumulated by relatives of Xi Jinping, China’s vice president at the time. Mr. Xi became general secretary of the Communist Party in November and is expected to become president in March. Ty Trippet, a spokesman for Bloomberg, confirmed that hackers had made attempts but said that “no computer systems or computers were compromised.”

Signs of a Campaign

The mounting number of attacks that have been traced back to China suggest that hackers there are behind a far-reaching spying campaign aimed at an expanding set of targets including corporations, government agencies, activist groups and media organizations inside the United States. The intelligence-gathering campaign, foreign policy experts and computer security researchers say, is as much about trying to control China’s public image, domestically and abroad, as it is about stealing trade secrets.

This article has been revised to reflect the following correction:

Correction: January 31, 2013

An earlier version of this article misstated the year that the United States and Israel were said to have started a cyberattack that caused damage at Iran’s main nuclear enrichment plant, and the article misstated the specific type of attack. The attack was a computer worm, not a virus, and it started around 2008, not 2012.

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U.N. Panel Says Israeli Settlement Policy Violates Law

GENEVA — Israel has used the expansion of Jewish settlements to pursue a creeping annexation of the occupied Palestinian territories and committed multiple violations of international law in its treatment of Palestinians, the United Nations Human Rights Council said in a report on Thursday that called for an immediate halt to all settlement activity.

Presenting its findings after a nearly six-month investigation, the panel of three women jurists led by a French judge, Christine Chanet, said Israel’s settlements had clearly violated the Geneva Conventions which prohibit a state from transferring its own civilian population into territory it has occupied.

Israel “must cease all settlement activities without preconditions” and begin the withdrawal of all settlers from the occupied territories, the jurists said their report, which is to be debated at the Human Rights Council in March.

The panel examined 67 submissions from academics, diplomats, Israeli civil society and Palestinians, Ms. Chanet said, but Israel refused to cooperate with the mission which was unable to visit the West Bank and instead went to the Jordanian capital, Amman, to hear testimony.

The Human Rights Council voted a year ago to investigate the impact of settlements on Palestinian rights, which prompted Israel to break off cooperation and castigate the panel as a political platform used “to bash and demonize Israel.” The report came two days after Israel boycotted the council’s review of Israel’s human rights record, becoming the first country to withhold cooperation from a process in which all 193 United Nations member states have previously engaged.

The United States also opposed creating the fact-finding mission on the grounds that “it does not advance the cause of peace and will distract the parties from efforts to resolve the issues that divide them.”

Washington has opposed Israel’s creation of further settlements and construction in East Jerusalem as “unhelpful” and an obstacle to a two-state solution of the Palestinian issue.

Reviewing Israel’s settlements policy since 1967, the panel said that Israel, with the full knowledge and compliance of successive governments, had established some 250 settlements in the West Bank and East Jerusalem since 1967 which now have an estimated 520,000 settlers and are growing much faster than the population of Israel. The result is “a mesh of construction and infrastructure leading to a creeping annexation that prevents the establishment of a contiguous and viable Palestinian state and undermines the right of the Palestinian people to self-determination,” the report said.

These actions fall under the jurisdiction of the International Criminal Court, the panel said, and if Palestine ratified the Rome Statute that created the court, Israel could be called to account for “gross violations of human rights law and serious violations of international humanitarian law,” the report said.

The settlements are maintained through “a system of total segregation” between the settlers, who enjoy a preferential legal status, and the rest of the population, the report said. It found Palestinian rights to freedom of movement, equality, due process of law and access to education, water, housing and natural resources “are being violated consistently and on a daily basis.”

The panel reported that violence and intimidation by “a small minority” of settlers continued with impunity and expressed grave concern at the high number of children who are detained. They were “invariably mistreated, denied due process and fair trial,” the report said and many were transferred to detention centers in Israel, also a violation of international law.

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DealBook: McClendon, Under Fire, to Retire at Chesapeake Energy

9:15 p.m. | Updated

HOUSTON — Aubrey K. McClendon, Chesapeake Energy’s daring and innovative co-founder, will step down as chief executive on April 1 after months of scrutiny over how he mixed his personal finances and those of the corporation.

Mr. McClendon’s retirement, announced by the company on Tuesday, comes as the national boom in natural gas drilling, which he helped set in motion, is fading, diminishing Chesapeake’s prospects.

Over the past decade, Mr. McClendon aggressively explored for gas and outbid competitors in one shale field after another. Not only did his small Oklahoma company become the nation’s second biggest gas producer after Exxon Mobil, but Mr. McClendon also assembled a trophy room of assets that included a piece of the Oklahoma Thunder basketball team, a winery and a $12 million collection of antique maps.

In the end, a downturn in natural gas prices, caused in large part by the industry’s exuberant drilling, dealt a huge blow to the company’s balance sheet and to Mr. McClendon’s personal fortune.

Mr. McClendon borrowed heavily — more than $800 million — to finance his participation in an unusual compensation plan that allowed him to invest alongside his company in every well it drilled, sharing both in profits and expenses. Last year, the Securities and Exchange Commission opened an inquiry into Mr. McClendon’s finances, and a shareholder rebellion led to his removal as chairman in June and a reshuffling of the board.

Chesapeake, which borrowed extensively to finance its expansion spree, has been forced to unload $12 billion in valuable oil and gas fields over the last year as it tried to pay off its crushing debts. Last September, the company still had $19 billion in debt, according to Philip Weiss, a senior oil company analyst at Argus.

“He really built this company from nothing and made it into something meaningful,” Mr. Weiss said, “but in the end, I think it’s the right thing for the company and its shareholders” for him to leave. “The company needs a financial guy to bring spending under control.”

Investors appeared to agree, sending Chesapeake’s shares up more than 10 percent in after-hours trading.

The roots of Mr. McClendon’s sudden departure lay partly in a shake-up of Chesapeake’s board last summer, in which the company replaced more than half of its directors. Four of those board members were nominated by two major investors, Southeastern Asset Management and the investor Carl C. Icahn; an independent chairman was also appointed.

In recent weeks, Chesapeake’s board concluded that the company’s stock was suffering from Mr. McClendon’s presence, according to a person briefed on the matter. Shares in the company have fallen 14 percent over the last 12 months.

“Aubrey and the board have agreed that the time has come for the company to select a new leader,” Chesapeake’s chairman, Archie W. Dunham, said in a statement.

The company said the board’s review of Mr. McClendon’s financial dealings “to date has not revealed improper conduct.”

Mr. McClendon, 53, agreed to retire from the company on April 1 and will continue serving as chief executive until a successor is appointed.

“I am extremely proud of what we have built over the last quarter of a century,” he said in a statement. “While I have certain philosophical differences with the new board, I look forward to working collaboratively with the company and the board to provide a smooth transition.”

When gas prices were still high four years ago, Chesapeake’s stock price soared, and Mr. McClendon had a net worth of more than $1 billion. He bought homes in Hawaii, Colorado and Bermuda.

But as the price of gas fell by more than two-thirds over the last few years, Chesapeake lost more than two-thirds of its value as well.

Pressure on Mr. McClendon began last April after news reports revealed that he had obtained personal loans using minority stakes in company-owned wells as collateral. Reuters reported that he had personally borrowed more than $1 billion from EIG Global Energy Partners, a firm that also invested in Chesapeake, raising questions over conflict of interest.

Mr. McClendon was a larger-than-life figure in an industry filled with them. His dealings stretched across the globe as he negotiated partnerships with the Norwegian oil company Statoil, China’s CNOOC and France’s Total, shepherding the foreign oil giants into joint ventures in shale fields around the country.

“It’s an end of an era,” said Fadel Gheit, a senior oil analyst at Oppenheimer. “He was a maverick in the true sense of the word, and he represented both the good and the bad in corporate America. He was the risk-taker, a true visionary, but obviously there were excesses.”

Mr. Icahn, now one of the company’s largest shareholders, was generous in his praise.

“Aubrey has every right to be proud of the company he has built, the world-class team of people at Chesapeake and the collection of assets he has assembled, which in my opinion are the best portfolio of energy assets in the country,” he said.

A version of this article appeared in print on 01/30/2013, on page B1 of the NewYork edition with the headline: Under Fire, Chesapeake Co-Founder Is to Depart.

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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.

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Canon Forecast Falls Short of Expectations

TOKYO — Canon expects a 26.6 percent increase in operating profit this year as it cuts costs and increases revenue — but the projection Wednesday still fell short of analysts’ expectations.

Canon, a camera and printer maker considered a leader in profitability in corporate Japan with its aggressive cost-cutting, is angling for a foothold in the growing market for mirrorless cameras with interchangeable lenses, where it faces stiff competition from Sony, Olympus and Nikon.

Canon’s operating profit for the three months that ended Dec. 31 fell 17.9 percent, to ¥77.7 billion, or $853 million, below the average estimate of ¥100.9 billion among seven analysts surveyed by Thomson Reuters I/B/E/S.

“Both its full-year earnings and forecast are below market consensus, so the results were seen as negative,” said Makoto Kikuchi, the chief executive of Myojo Asset Management. “Investors have bought Canon on overly high expectations that a weaker yen will lift its bottom line, but such excitement should recede.”

Demand for compact cameras is shrinking as consumers shift to smartphones, while stretched budgets among customers in Europe have eroded sales of Canon’s office printers. And the company, which derives 80 percent of its revenue from overseas, was badly hit by the firmness of the Japanese currency last year. Canon officials said Wednesday that economic recovery in India and China, as well as aggressive economic stimulus policies in Japan, were likely to support the company’s earnings.

The company set its exchange rate assumptions for the business year ending in December at ¥85 to the dollar and ¥115 to the euro, weaker than the average last year of ¥79.96 per dollar and ¥102.8 per euro.

As one of the first blue-chip Japanese companies to report quarterly results, Canon is often seen as a barometer for technology sector earnings.

The company forecast a full-year operating profit of ¥410 billion for the current year through December, compared with the average expectation of a ¥443.3 billion profit among 21 analysts, according to Thomson Reuters StarMine.

Canon’s shares have fallen about 1 percent since the start of last year, underperforming the Nikkei average’s gain of 31 percent. The shares slipped to a three-year low in July, when Canon cut its outlook on fears of shrinking demand in China.

The stock ended nearly 3 percent higher Wednesday before the earnings announcement.

Xerox, with which Canon competes for a share of the global printer market, overshot expectations with its quarterly earnings and maintained its full-year targets as it restructures parts of its business and commits to further cost cuts.

Nikon is due to report its results next Wednesday, with Sony following the next day.

 

 

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India Ink: No Knowledge of Pakistan Complaints, Indian Officials Say

Following the recent killings of Indian and Pakistani soldiers near the Kashmir border, a local newspaper reported classified United Nations documents show that the cycle of violence between troops of the two countries has continued despite the cease-fire in 2003.

The Hindu, a national English-language daily newspaper, said Wednesday that Pakistan has repeatedly complained to the United Nations Military Observer Group in India and Pakistan about the killings of at least 18 of its soldiers, including four beheadings, by Indian forces between 2000 and 2011. The United Nations group was set up in 1949 to monitor cease-fire violations between the two countries.

In the worst flare-up since the 2003 cease-fire, Indian and Pakistani troops exchanged gunfire near the Line of Control earlier this month, resulting in deaths on both sides. At the time, India accused Pakistan of beheading one of its soldiers, a charge Pakistan denies.

Among the complaints it filed, Pakistan alleged in 2003 that Indian forces decapitated one of its soldiers, the Hindu said.

The Hindu also reported that Pakistan also complained that Indian forces decapitated two civilians during a massacre in the village of Bandala in 1998, which claimed 22 civilian lives.

Sitanshu Kar, spokesman for the Indian Ministry of Defense, said that he had no knowledge of Pakistan’s complaints to the United Nations group, and that he had not been contacted for The Hindu article. “It’s the first time I’m hearing about this,” he said. “I have not seen any such document.”

Syed Akbaruddin, the spokesman for the India’s Ministry of External Affairs, said that India did not have any formal exchange with the United Nations Military Observer Group. “We feel that Unmogip has outlived its relevance,” he said. The country’s relationship with the organization ended after India and Pakistan entered the 1972 Simla Agreement, in which both countries said they would resolve their disputes bilaterally.

Mr. Akbaruddin added that Pakistan had not raised these complaints directly with India. “Frankly, this is not a discussion we have had diplomatically,” he said.

An official at the United Nations organization’s office in Srinagar refused to comment on the report, or whether such complaints by Pakistan had been received. Calls made to the group’s office in Delhi were not answered.

A spokesman for the Indian Army was not immediately available for comment.

Lt. Gen. Baljit Singh Jaswal, who from October 2009 to December 2010 led the Northern Command, which supervises troops in Jammu and Kashmir, said that India had engaged in no cross-border violations during that time.

General Jaswal, now retired, added that Pakistan had violated the cease-fire “numerous times” and that India had exchanged retaliatory fire.

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DealBook: Former Jefferies Trader Is Charged With Fraud

Federal prosecutors charged a former senior trader at the Jefferies Group on Monday with defrauding his clients — and the government — while selling them mortgage-backed securities after the financial crisis.

Jesse C. Litvak, the former Jefferies trader, is accused of generating more than $2 million in revenue for Jefferies by overcharging his customers through deceitful conduct. Those who are said to have been his victims include some of the world’s largest investment firms, including Soros Fund Management, Magnetar Capital, BlackRock and Wellington Management.

The government was also a victim in this case, prosecutors said, because Mr. Litvak’s clients were managing money that was part of the Treasury Asset Relief Program, or TARP, the $700 billion bailout fund. As part of a public-private investment program, the Treasury picked nine private firms to invest in toxic mortgage-backed securities and help remove them from the clogged balance sheets of the large banks.

While the alleged violations — cheating brokerage clients by misrepresenting the prices of securities — might typically prompt the loss of a job or civil lawsuits, such conduct rarely, if ever, rises to the level of a federal criminal prosecution.

The case demonstrates the aggressive prosecutorial stance of the special inspector general for TARP, or Sigtarp, which led the investigation. The office, now led by Christy Romero, has been responsible for criminal cases filed against 121 individuals.

“Illegally profiting from a federal program designed to assist our nation in recovering from one of our worst economic crises is reprehensible,” said David B. Fein, the United States attorney in Connecticut, whose office brought the charges. The Securities and Exchange Commission filed a parallel civil action in the case.

Federal agents arrested Mr. Litvak, 38, early Monday morning at his apartment on the Upper East Side of Manhattan. He made an appearance in Federal District Court in Bridgeport, Conn., and was released on $1 million bail. Mr. Litvak, who worked at RBS Greenwich Capital earlier in his career, joined Jefferies in 2008 and was fired in December 2011.

“Jesse Litvak did not cheat anyone out of a dime,” said Patrick J. Smith, Mr. Litvak’s lawyer at DLA Piper, in a statement. “In fact, most of these trades turned out to be hugely profitable. Jesse looks forward to the trial in this case so that his name can be cleared and he can get on with his career.”

While the market for mortgage-backed securities is complex and opaque, the charges against Mr. Litvak are rather simple. Prosecutors said that he deceived his customers about the prices of the securities that he sold to them. The indictment said that Mr. Litvak deployed the scheme in part to increase the size of his year-end bonus.

In some cases, they said, Mr. Litvak would lie about the price at which his firm had bought a security so he could resell it to another customer at a higher price and earn more money for the firm. In other instances, the government said, he created a fake seller to give the impression that he was arranging a trade between two customers, when in fact he was selling the security out of his firm’s inventory at a high price.

“The kind of false claims made by Litvak were unfit for a used-car lot, let alone a marketplace for mortgage-backed securities,” said George S. Canellos, the S.E.C.’s deputy director of enforcement.

Mr. Smith, the lawyer for Mr. Litvak, said that the trades were transactions between sophisticated market participants and that the profits that Jefferies earned on each trade were well within industry norms for the mortgage-backed securities market.

Mr. Litvak wants Jefferies to pay his legal fees related to the government’s investigation, and he has filed papers in the Delaware Court of Chancery demanding compensation from the bank. Jefferies has refused to reimburse him, arguing that it fired Mr. Litvak for cause. Richard Khaleel, a spokesman for Jefferies, declined to comment.

The case first showed up on the government’s radar after one of Mr. Litvak’s customers, AllianceBernstein, complained to Jefferies that the bank had overcharged it for mortgage-backed securities, according to people briefed on the case. According to records from the Financial Industry Regulatory Authority, or Finra, Jefferies settled the case with AllianceBernstein for $2.2 million.

Court papers depict Mr. Litvak as an exuberant salesman, frequently communicating with instant messages and peppering his communications with slang. When Mr. Litvak reported to a client, Wellington Management, about a sham purchase, he wrote “winner winner chicken dinner.” Another time, the complaint said, Mr. Litvak gave a customer a false report on the price of a security that he sold to a hedge fund, York Capital Management. “We are doneski gorgeous!” he wrote.

A version of this article appeared in print on 01/29/2013, on page B1 of the NewYork edition with the headline: Ex-Trader For Jefferies Is Charged With Fraud.

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