Stars salute MusiCares honoree Bruce Springsteen

LOS ANGELES (AP) — Be it concert or charity auction, Bruce Springsteen can bring any event to a crescendo.

Springsteen briefly took over auctioneering duties before being honored as MusiCares person of the year Friday night, exhorting the crowd to bid on a signed Fender electric guitar by amping up the deal. The 63-year-old rock 'n' roll star moved the bid north from $60,000 by offering a series of sweeteners.

"That's right, a one-hour guitar lesson with me," Springsteen shouted. "And a ride in my Harley Davidson sidecar. So dig in, one-percenters."

That moved the needle past $150,000. He added eight concert tickets and backstage passes with a bonus tour conducted by Springsteen himself. That pushed it to $200,000, but he wasn't done.

"And a lasagna made by my mother!" he shouted as an in-house camera at the Los Angeles Convention Center cut to his 87-year-old mother Adele Ann Springsteen.

And with an extra $250,000 in the musicians charity's coffers, Springsteen sat down and spent most of the evening in the unusual role of spectator as a string of stars that included Elton John, Neil Young, Sting, Kenny Chesney, John Legend, Faith Hill and Tim McGraw, Patti Smith, Jackson Browne took the stage two nights before the Grammy Awards.

"Here's a little secret about Bruce Springsteen: He loves this," host Jon Stewart joked. "There's nothing he'd rather do than come to Los Angeles, put on a suit ... and then have people talking about him like he's dead."

Alabama Shakes kicked things off with "Adam Raised A Cain" and over the course of the evening there were several interesting takes on Springsteen's voluminous 40-year catalog of hits. Natalie Manes, Ben Harper and Charlie Musselwhite played a stripped down "Atlantic City." Mavis Staples and Zac Brown put a gospel spin on "My City of Ruins." John added a funky backbeat to "Streets of Philadelphia." Kenny Chesney offered an acoustic version of "One Step Up."

Jim James and Tom Morello burned through a scorching version of "The Ghost of Tom Joad" that brought the crowd out of their seats as Morello finished the song with a fiery guitar solo. And Mumford & Sons took it the opposite way, playing a quiet, acoustic version of "I'm On Fire" in the round that had the crowd leaning in.

Legend offered a somber piano version of "Dancing in the Dark" and Young shut down the pre-Springsteen portion of the evening with a "Born in the USA" that included two sign-language interpreters dressed as cheerleaders signing along to the lyrics.

"John Legend made me sound like Gershwin," Springsteen said. "I love that. Neil Young made me sound like the Sex Pistols. I love that. What an evening."

Springsteen spoke of the "miracle of music," the importance of musicians in human culture and making sure everyone is cared for. And he joked that he somehow ended up being honored by MusiCares, a charity that offers financial assistance to musicians in need run by The Recording Academy, after his manager called up Grammys producer Ken Ehrlich to seek a performance slot on the show in a "mercenary publicity move."

In the end, though, he was moved by the evening.

"It's kind of a freaky experience, the whole thing," Springsteen said. "This is the huge Italian wedding Patti (Scialfa) and I never had. It's a huge Bar Mitzvah. I owe each and every one of you. You made me feel like the person of the year. Now give me that damn guitar."

He asked the several thousand attendees to move toward the stage — "Come on, it's only rock 'n' roll" — and kicked off his five-song set with his Grammy nominated song "We Take Care Of Our Own." At the end of the night he brought everyone on stage for "Glory Days."

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Online:

http://grammy.com

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

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In Nigeria, Polio Vaccine Workers Are Killed by Gunmen

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Aminu Abubakar contributed reported from Kano, Nigeria.

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Tesla's electric Model S is a truly competitive premium sedan

The Tesla Model S may be a silent car, but other automakers will no doubt hear it coming.

In its first crack at a premium sedan, the Silicon Valley electric-car maker has matched or beaten the likes of the Audi A7 or Mercedes-Benz CLS — products of a century of German engineering. Similarly packaged as a sleek four-door coupe, the Model S delivers the performance and polish implied by its $89,770 price.

All that's missing is the roar of internal combustion.

Ask the folks at Tesla Motors Inc. how they pulled this off and they'll say Tesla isn't a car company. It's a tech company, headquartered in a hive of innovation that helped lure the sharp minds who conceptualized the car from an outsider's perspective.

Founded in 2003, Tesla produced its first car in 2008, the two-seat Roadster. It sold about 2,400 of them before halting production last year.

The Model S represents Phase 2 of the Palo Alto company's outsized ambitions. Unlike the Roadster, which was built on the chassis of a Lotus sports car, Tesla built the Model S from scratch. It's a showpiece of the start-up's design prowess, targeting a demanding and well-heeled niche of customers.

The third and crucial phase — if the Model S can secure the company's survival a while longer — will be to create an affordable mass-market car. That's no small feat, given that the electric-car market, littered with past failures, accounts for just one-tenth of 1% of U.S. auto sales. (For all the accolades showered on Nissan's Leaf, the company has sold just 20,000 of the cars since 2010.)

The odds against Tesla will be easier to calculate soon, when the company details sales and earnings at a shareholder's meeting expected in late February. The most recent update came last fall, when Tesla cut its revenue forecast and scaled back 2012 Model S production plans from 5,000 to about half that number.

Just 253 of the sedans had been delivered at that point.

The lowered expectations raised concern that the company will need a new influx of cash this year. The cash that produced the Model S was gathered during the Roadster era. Tesla secured $465 million in U.S. Department of Energy loans and went public on the Nasdaq Stock Market. It also started collecting Model S deposits and sold minority stakes in the company to Toyota and Daimler, the parent of Mercedes-Benz.

Now it's up to the Model S to bring in more cash.

Nearly a week spent in the car's high-tech cockpit suggests that Tesla has a legitimate shot at making automotive history with truly competitive electric cars.

If Tesla is a technology company, the evidence starts with the car's innovative infotainment system. The 17-inch touch screen controls nearly everything — including navigation, stereo, climate control and driving settings. As clear and touch-sensitive as an Apple iPad, the huge screen can easily accommodate multiple functions at once.

You can view the Google Maps-based navigation on one half of the screen while fiddling with radio controls on the other. Or swap the two. Or close one of them and bring up a new function — say, the phone or the Internet browser. Or just expand one function to cover the whole screen.

Contrast that to a car company making technology: Ford has produced its Sync system about as long as Tesla has made cars, and yet Sync remains eons behind in sophistication and ease of use.

But the most impressive technology resides in the guts of the Model S. The car overflows with torque, that delicious byproduct of electric propulsion. Despite a portly curb weight — a comparable Audi A7 weighs about 400 pounds less — the S clears zero to 60 mph in a mere 5.6 seconds.

Our test car, rated at 362 horsepower and 325 pound-feet of torque, uses an 85-kilowatt-hour battery to power the rear wheels through an electric motor. The battery comes in the premium version of the Model S — the only one currently produced, with a base price of $81,820, including delivery, before any state or federal tax incentives. Additional options on our test car included the tech package, an upgraded sound system and air suspension.

Tesla has promised two less expensive versions of the car with smaller batteries, meaning decreased power and range.

Power in the premium Model S comes from roughly 1,000 pounds of lithium-ion cells — all integrated into the car's floor pan, an innovative setup giving the Model S a low center of gravity and a stiff chassis. The underside of the battery pack forms the underside of the car.

In eager driving, the S doesn't feel exactly light, but it carries its weight well, with no excessive body roll in turns. Drivers can use the touch screen to select one of three different steering modes, although the most aggressive 'sport' setting proved a little too firm in most driving situations.

The brakes on the Model S are plenty strong, and fortunately are not the regenerative variety you'll find on most gas-electric hybrids, which have a mushy, grabby feel.

Mash the go-pedal, and the Tesla plants you in your seat and rushes forward with eerily little feedback, save for the faint whir of the motor behind you. The addicting experience is not unlike being flung out of a giant sling-shot.

The trouble is that repeated demonstrations of the car's prodigious power utterly destroy its range. Tesla says this model will go 300 miles on a single charge. The EPA puts that number at 265 miles. Over four days of testing the car, we managed only about 160 miles in heavy-footed driving.

All Model S's will charge through a 120V or 240V outlet. Tesla says the former needs roughly 46 hours to recharge fully, while the latter needs eight to 10 hours. Buyers can reduce these times by adding a second on-board charger for $1,500 and buying a high-power wall connector for $1,200.

Tesla is also installing 100 of what it calls supercharging stations in the U.S. and Canada by year's end, including six already operating in California. They're free for Tesla owners, who can add half a charge in about half an hour.

There will be a lot more of those owners soon, the company says. Tesla has more than 13,000 fully refundable deposits and expects to deliver 20,000 of the cars this year. The only other morsel of intel on the company's finances came from Tesla Chief Executive Elon Musk, of PayPal fame, who cryptically tweeted in early December that the company was "narrowly cash-flow positive last week."

Established automakers should be paying attention, but they shouldn't be surprised. In a blog post dated August 2006, Musk laid out his three-step vision for Tesla. Step 1: Build a sports car. Then use that money to build an affordable car. Then, finally, use that money to build an even more affordable car.

Steps 1 and 2 are done, with mixed results. The Model S is hardly affordable, nor does it guarantee safe passage to Step 3. But strip away the financial drama, and all that's left is the best electric car ever made.

david.undercoffler@latimes.com

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Big Bear locked down amid manhunt

The bustling winter resort of Big Bear took on the appearance of a ghost town Thursday as surveillance aircraft buzzed overhead and police in tactical gear and carrying rifles patrolled mountain roads in convoys of SUVs, while others stood guard along major intersections.

Even before authorities had confirmed that the torched pickup truck discovered on a quiet forest road belonged to suspected gunman Christopher Dorner, 33, officials had ordered an emergency lockdown of local businesses, homes and the town's popular ski resorts. Parents were told to pick up their children from school, as rolling yellow buses might pose a target to an unpredictable fugitive on the run.

By nightfall, many residents had barricaded their doors as they prepared for a long, anxious evening.

PHOTOS: A tense manhunt amid tragic deaths

"We're all just stressed," said Andrea Burtons as she stocked up on provisions at a convenience store. "I have to go pick up my brother and get him home where we're safe."

Police ordered the lockdown about 9:30 a.m. as authorities throughout Southern California launched an immense manhunt for the former lawman, who is accused of killing three people as part of a long-standing grudge against the LAPD. Dorner is believed to have penned a long, angry manifesto on Facebook saying that he was unfairly fired from the force and was now seeking vengeance.

Forest lands surrounding Big Bear Lake are cross-hatched with fire roads and trails leading in all directions, and the snow-capped mountains can provide both cover and extreme challenges to a fugitive on foot. It was unclear whether Dorner was prepared for such rugged terrain.

Footprints were found leading from Dorner's burned pickup truck into the snow off Forest Road 2N10 and Club View Drive in Big Bear Lake.

San Bernardino County Sheriff John McMahon said that although authorities had deployed 125 officers for tracking and door-to-door searches, officers had to be mindful that the suspect may have set a trap.

"Certainly. There's always that concern and we're extremely careful and we're worried about this individual," McMahon said. "We're taking every precaution we can."

PHOTOS: A fugitive's life on Facebook

Big Bear has roughly 400 homes, but authorities guessed that only 40% are occupied year-round.

The search will probably play out with the backdrop of a winter storm that is expected to hit the area after midnight.

Up to 6 inches of snow could blanket local mountains, the National Weather Service said.

Gusts up to 50 mph could hit the region, said National Weather Service meteorologist Mark Moede, creating a wind-chill factor of 15 to 20 degrees.

Extra patrols were brought in to check vehicles coming and going from Big Bear, McMahon said, but no vehicles had been reported stolen.

"He could be anywhere at this point," McMahon said. When asked if the burned truck was a possible diversion, McMahon replied: "Anything's possible."

Dorner had no known connection to the area, authorities said.

Craig and Christine Winnegar, of Murrieta, found themselves caught up in the lockdown by accident. Craig brought his wife to Big Bear as a surprise to celebrate their 28th wedding anniversary. Their prearranged dinner was canceled when restaurant owners closed their doors out of fear.

"It's definitely scary," Christine Winnegar said.

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Alicia Keys, Bobby Brown perform at Will.i.am show

LOS ANGELES (AP) — Fergie may have been absent — but the Black Eyed Peas were joined by another female diva onstage: Alicia Keys.

Keys sang "Where Is the Love" with the pop-rap group at will.i.am's charity event Thursday night at The Avalon Hollywood in Los Angeles. British singer Estelle also sang Fergie's portion of "The Time (Dirty Bit)."

Will.i.am's TRANS4M benefit show — which assists his i.am.angel foundation — also featured Bobby Brown and Ludacris, who both earned roaring cheers from the crowd of several hundred.

Will.i.am. said at the end of the evening that he raised $3.3 million.

"We're having fun, but we're also collecting funds," he told the crowd.

Will.i.am introduced Grammy-winning Keys to the audience saying: "Are you ready for a strong woman?"

The R&B singer performed "Girl on Fire" and "Try Sleeping With a Broken Heart."

Brown sang his jams "Every Little Step" and "Tenderoni." He performed at the same event in 2011, as will.i.am and Taboo of the Peas worked as his background dancers. They did the same Thursday night.

He told will.i.am in between his set that he was proud of the musician and his charity work.

The Peas closed the night with the massive hit "I Gotta Feeling."

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Online:

http://iamangelfoundation.org .

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Follow Mesfin Fekadu on twitter.com/MusicMesfin

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The New Old Age Blog: The Executor's Assistant

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

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

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

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

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

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

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

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Apple weighs dividend boost, stock buyback to appease investors

SAN FRANCISCO — Apple Inc. is considering boosting dividends or buying back more stock in a move that could appease investors who have been stung by the sharp drop in the stock price.

The company revealed it is mulling over such actions after an influential shareholder sued the Cupertino, Calf., technology giant Thursday.

In a statement, Apple acknowledged that it had been in "active discussions about returning additional cash to shareholders" beyond the $45 billion in dividends and stock buybacks it announced last year.

As part of that review, the company said it would consider a proposal by Greenlight Capital to issue a new type of preferred stock to current shareholders.

"We will thoroughly evaluate Greenlight Capital's current proposal to issue some form of preferred stock," Apple said. "We welcome Greenlight's views and the views of all of our shareholders."

News that such plans were under consideration bolstered Apple's stock, which closed Thursday at $468.22, up $13.52, or 2.97%. In September, Apple shares reached a high of $702.10.

While Apple's statement seemed to somewhat quell investor worries, it is not expected to thwart a shareholder lawsuit filed by Greenlight. A dramatic showdown is still likely later this month at Apple's annual shareholder meeting scheduled for Feb. 27 in Cupertino.

On one side will be Greenlight, a hedge fund run by notable short seller David Einhorn. In a letter to Apple shareholders Thursday, Einhorn revealed that his firm had been pushing Apple for the last year to distribute a special class of stock to shareholders to enhance the value of their holdings.

In particular, Einhorn doesn't like a proposal placed by Apple on its annual proxy that would eliminate management's ability to issue the special class of stock without shareholder approval. Besides announcing a proxy challenge, Greenlight has filed suit in federal court in New York to block it.

"Like many other shareholders, Greenlight is dissatisfied with Apple's capital allocation strategy," Einhorn wrote. "The combination of Apple's low (and shrinking) price to earnings multiple and $137 billion (and growing) hoard of cash on the balance sheet supports Greenlight's contention that Apple has an obligation to examine all options to create and unlock additional value."

The revelation from Greenlight shed new light on a surprising announcement earlier this week that CalPERS, or the California Public Employees' Retirement System, had teamed up with Apple to support the tech giant's proposal. CalPERS has been a longtime critic of Apple's corporate governance practices but seemed to have been attracted by a provision in the proposal that called for majority election of directors.

But CalPERS said it does support the proposal to require shareholder approval on issuing preferred stock. Anne Simpson, CalPERS senior portfolio manager and director of corporate governance, confirmed the pension fund's backing of Apple's proposal in a statement Thursday: "CalPERS fully supports Apple's proposal to implement majority voting for the election of directors and to require shareholder approval for the issuance of blank check preferred stock."

Apple clarified that if its proposal passes, the company could still seek to issue the preferred shares that Greenlight has requested. The main difference would be that shareholders would have to approve such a move.

"These changes were recommended independently of Greenlight's proposal and would not preclude Apple from adopting their concept," Apple said in its statement. "Contrary to Greenlight's statements, adoption of Proposal #2 would not prevent the issuance of preferred stock," Apple said, referring to its proxy proposal.

chris.obrien@latimes.com

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3 officers shot, 1 fatally; ex-LAPD cop sought

A massive manhunt was underway Thursday morning for an ex-Los Angeles Police Department officer suspected of shooting three police officers early Thursday, one fatally. He is also a suspect in the shooting of a couple in Irvine over the weekend.

The suspect wrote an online manifesto threatening to harm police officials and their families. 

Photos: Memorial for slain basketball coach

The three shootings Thursday morning occurred in Riverside County.

One LAPD officer was grazed in the Corona area, law enforcement sources said.

Then sometime later, two Riverside Police Department officers were shot in Riverside. One of those officers died, sources said. That shooting occurred at Magnolia and Arlington avenues. The officers were taken to Riverside Community Hospital.

Officials warned that Christopher Jordan Dorner, 33. is armed and dangerous. Law enforcement sources said police have placed security at the homes of LAPD officials named in the manifesto and believe Dorner has numerous weapons.

Hundreds of officers were swarming around the Riverside shooting scene looking for the gunman.

The California Highway Patrol issued a "Blue Alert" to law enforcement:

*THE SUSPECT IS CONSIDERED ARMED AND EXTREMELY DANGEROUS*

A BLUE ALERT HAS BEEN ACTIVATED IN THE FOLLOWING COUNTIES: KERN, SANTA BARBARA, VENTURA, LOS ANGELES, SAN BERNARDINO, ORANGE, RIVERSIDE, SAN DIEGO, AND IMPERIAL.

ON FEBRUARY 7, 2013, AT APPROXIMATELY 0122 HOURS, THE SUSPECT WAS INVOLVED IN MULTIPLE SHOOTINGS WITH MULTIPLE AGENCIES IN THE RIVERSIDE CHP AREA.

THE SUSPECT IS CHRISTOPHER JORDAN DORNER, A 33 YEAR OLD, BLACK MALE, 6 FEET TALL, 270 POUNDS, WITH BLACK HAIR, BROWN EYES, WITH AN UNKNOWN CLOTHING DESCRIPTION.

THE SUSPECT WAS LAST SEEN DRIVING A 2005 BLUE OR GRAY NISSAN TITAN, WITH A CA LICENSE PLATE OF 8D83987 or 7X09131 - THE SUSPECT MAY BE SWTICHING BETWEEN THE TWO LICENSE PLATES.
THE VEHICLE ALSO HAS SKI RACKS ON ITS ROOF.

Irvine police Wednesday night named  Dorner as the suspect in the double slaying in the parking lot of an upscale Irvine apartment complex Sunday.

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

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

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

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

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

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

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Robin Roberts set to return to 'GMA' on Feb. 20

NEW YORK (AP) — ABC News says Robin Roberts will be back on the job at the "Good Morning America" anchor desk on Feb. 20. Her return will be five months to the day since her bone marrow transplant to treat a rare blood disorder.

Roberts has gotten the all-clear from her doctors, according to the announcement made Thursday on "GMA." She reached the critical 100-day benchmark in December.

In January, she began a series of dry runs at the "GMA" studio to re-acclimate herself to the work routine.

Her last day on "GMA" was Aug. 30 before she started her medical leave.

About a year ago, Roberts began feeling the symptoms of her illness, known as MDS.

She said in a statement: "What a difference a year makes."

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Online:

http://abcnews.go.com/

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

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

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

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

The Presenting Problem:

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

The Patient’s Story:

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

A Sister’s Visit:

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

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

His 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.

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

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