‘Bloodless’ Lung Transplants for Jehovah’s Witnesses

Eric Kayne for The New York Times

SHARING HOME AND FAITH A Houston couple hosted Gene and Rebecca Tomczak, center, in October so she could get care nearby.

HOUSTON — Last April, after being told that only a transplant could save her from a fatal lung condition, Rebecca S. Tomczak began calling some of the top-ranked hospitals in the country.

She started with Emory University Hospital in Atlanta, just hours from her home near Augusta, Ga. Then she tried Duke and the University of Arkansas and Johns Hopkins. Each advised Ms. Tomczak, then 69, to look somewhere else.

The reason: Ms. Tomczak, who was baptized at age 12 as a Jehovah’s Witness, insisted for religious reasons that her transplant be performed without a blood transfusion. The Witnesses believe that Scripture prohibits the transfusion of blood, even one’s own, at the risk of forfeiting eternal life.

Given the complexities of lung transplantation, in which transfusions are routine, some doctors felt the procedure posed unacceptable dangers. Others could not get past the ethics of it all. With more than 1,600 desperately ill people waiting for a donated lung, was it appropriate to give one to a woman who might needlessly sacrifice her life and the organ along with it?

By the time Ms. Tomczak found Dr. Scott A. Scheinin at The Methodist Hospital in Houston last spring, he had long since made peace with such quandaries. Like a number of physicians, he had become persuaded by a growing body of research that transfusions often pose unnecessary risks and should be avoided when possible, even in complicated cases.

By cherry-picking patients with low odds of complications, Dr. Scheinin felt he could operate almost as safely without blood as with it. The way he saw it, patients declined lifesaving therapies all the time, for all manner of reasons, and it was not his place to deny care just because those reasons were sometimes religious or unconventional.

“At the end of the day,” he had resolved, “if you agree to take care of these patients, you agree to do it on their terms.”

Ms. Tomczak’s case — the 11th so-called bloodless lung transplant attempted at Methodist over three years — would become the latest test of an innovative approach that was developed to accommodate the unique beliefs of the world’s eight million Jehovah’s Witnesses but may soon become standard practice for all surgical patients.

Unlike other patients, Ms. Tomczak would have no backstop. Explicit in her understanding with Dr. Scheinin was that if something went terribly wrong, he would allow her to bleed to death. He had watched Witness patients die before, with a lifesaving elixir at hand.

Ms. Tomczak had dismissed the prospect of a transplant for most of the two years she had struggled with sarcoidosis, a progressive condition of unknown cause that leads to scarring in the lungs. The illness forced her to quit a part-time job with Nielsen, the market research firm.

Then in April, on a trip to the South Carolina coast, she found that she was too breathless to join her frolicking grandchildren on the beach. Tethered to an oxygen tank, she watched from the boardwalk, growing sad and angry and then determined to reclaim her health.

“I wanted to be around and be a part of their lives,” Ms. Tomczak recalled, dabbing at tears.

She knew there was danger in refusing to take blood. But she thought the greater peril would come from offending God.

“I know,” she said, “that if I did anything that violates Jehovah’s law, I would not make it into the new system, where he’s going to make earth into a paradise. I know there are risks. But I think I am covered.”

Cutting Risks, and Costs

The approach Dr. Scheinin would use — originally called “bloodless medicine” but later re-branded as “patient blood management” — has been around for decades. His mentor at Methodist, Dr. Denton A. Cooley, the renowned cardiac pioneer, performed heart surgery on hundreds of Witnesses starting in the late 1950s. The first bloodless lung transplant, at Johns Hopkins, was in 1996.

But nearly 17 years later, the degree of difficulty for such procedures remains so high that Dr. Scheinin and his team are among the very few willing to attempt them.

In 2009, after analyzing Methodist’s own data, Dr. Scheinin became convinced that if he selected patients carefully, he could perform lung transplants without transfusions. Hospital administrators resisted at first, knowing that even small numbers of deaths could bring scrutiny from federal regulators.

“My job is to push risk away,” said Dr. A. Osama Gaber, the hospital’s director of transplantation, “so I wasn’t really excited about it. But the numbers were very convincing.”

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ComEd chief hopes to spark positive change

Every organization has its low point. For Commonwealth Edison, it was in summer 2011 when a storm left more than 850,000 people without power, some for days.

Customers flocked to the phones for information and were shocked to find that they were not only in the dark, but in the dark ages. They waited on hold for hours, only to hear the same message every 45 minutes. They couldn't find out when their power would be restored, what had caused the outage or how many other people were affected.

Residents raged about ComEd on Facebook and Twitter and to mayors, state representatives, and fire and police departments. Dealing with wires that blocked roadways, nursing homes without power and angry residents with spoiled groceries, these public officials turned back to ComEd — only to receive misinformation or no information at all.

For soon-to-be-instated CEO Anne Pramaggiore, it was a blaring wake-up call: Customers hated the utility.

"We heard our customers loud and clear that summer," Pramaggiore said. "Everything else in the world is instantaneous, and they don't understand why they have to sit and wait without power or information."

Fast-forward to today, and customers can text, call, look online, use an iPhone or Android app or communicate with a ComEd representative on Twitter or Facebook. In less than a year, the company's smartphone app has generated more than 1 million transactions and 59,000 downloads.

"We're on a mission to improve service to our customers," said Pramaggiore, 54.

The good news is that the company has nowhere to go but up. Since 1999, ComEd has consistently ranked among the worst utilities in the Midwest for customer satisfaction in surveys conducted by The American Customer Satisfaction Index and J.D. Power and Associates.

Two months ago, the company had zero pending complaints for the first time in its history after working its way out of backlog in "the thousands," according to Miguel Ortega, director of customer technology and support for ComEd.

"Anne gets it," he said. "I've been around for quite a while. I've been through a lot of CEOs. She has made it a priority to put the customer in every aspect of our business, which is a huge cultural change."

The shift comes at a time when ComEd's parent company, Exelon Corp., is squeezing its three regulated utilities for revenue. The money Exelon receives for producing its mostly nuclear-powered electricity is not what it once was because of increased competition from natural gas and wind.

As a regulated utility that is paid by customers to deliver electricity regardless of which supplier they choose, ComEd is in a position to provide a steady, predictable stream of income to its parent if it can garner support from the General Assembly to pass legislation that will benefit its bottom line. But to get there, Pramaggiore must convince legislators — the same ones who have spent years fielding complaints from constituents about ComEd's abysmal service — that the company can change.

Legislation related to funding the so-called smart grid, passed into law in 2011 as part of the Energy Infrastructure Modernization Act, is making its way through Springfield and is worth about $1 billion to ComEd.

Within four years, Pramaggiore wants the utility that customers love to hate to be the utility that customers actually like, a plan she has spent countless hours communicating to every employee in the company.

"Whether you'll love your utility, I don't know. It's not the kind of business you ultimately love," said David Kolata, executive director of the Citizens Utility Board consumer advocacy group, a frequent opponent of ComEd. "We are encouraged and do think generally that her heart is in the right place. She does want to transform the company. Will that play out? It's too early to tell."

Inspires trust

While Pramaggiore's lawyerlike ability to boil down complex regulatory issues is impressive, her power lies in her charm. Gracious and savvy, she laughs easily and often, winning over opponents with humility and a down-to-earth speaking style that inspires trust.

Gloria Castillo, a personal friend of Pramaggiore and president of Chicago United, said her ability to listen is one of her greatest assets.

"Anne is really one of the highest-ranking women in energy anywhere in the country, but you never get the feeling that she thinks about herself in a way that's different," she said. "She's so striking. She has a unique ability to be so present in a conversation."

Indeed, Pramaggiore, a soccer mom who fits in at a Paul McCartney concert as easily as in a contentious hearing in Springfield, is disarming in her remarkable ability to appear unremarkable. She described her childhood in Dayton, Ohio, as a "quiet, suburban upbringing with good schools," with a father who was a civil engineer and a mom who was president of the local PTO.

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2 hurt, 19 arrested in melee near Ford City Mall

Two people suffered minor injuries and police arrested 19 teenagers during a disturbance involving crowds of young people Saturday at Ford City Mall on the Southwest Side, authorities said.

About 4:45 p.m., a large group of disruptive teens ran yelling through the mall, which is located at 7601 S. Cicero Ave., according to a mall official.

Officials closed the mall minutes later, but the chaotic scene continued outside, where police found between 100 and 200 people damaging vehicles in the shopping center's parking lot, according to a police report.

Two people were taken to hospitals, according to Chicago Fire Department Chief Joe Roccasalva, a department spokesman.

A CTA bus driver suffered minor injuries and was taken to Holy Cross Hospital, said Roccasalva, who added he did not know what happened to him.
 
A “kid’’ was also hurt, and that person was taken to Advocate Christ Medical Center in Oak Lawn, also in good condition, Roccasalva said.

About 50 police squad cars assigned to multiple South Side districts, including Chicago Lawn, Englewood and Deering, and a helicopter responded to the scene, police said.

Traffic came to a standstill as teenagers jumped on cars, both parked and moving, according to a police report obtained by the Tribune. Many of those involved ignored orders to disperse, and police arrested 19 people between the ages of 13 and 17, according to police.

One teenager was charged with battery, another was charged with criminal trespassing, and the 17 remaining teens were charged with mob action, Chicago Police Department News Affairs Officer Hector Alfaro said.

Officers did their best to control the disturbance, "trying to get everyone out of there safely," News Affairs Officer Veejay Zala said.

During the disturbance the CTA had to reroute the No. 79 buses, which travel on 79th Street, as well as other buses in the immediate area.

Earlier in the afternoon, members of the teen band Mindless Behavior had appeared at the mall food court from 2 p.m. to 4 p.m. to promote their new release, "All Around the World," said John Sarama, the mall's senior general manager.

The band's autograph signing drew approximately 1,000 parents and children, primarily mothers and girls between the ages of 6 and 13, Sarama said.

About 45 minutes after the band left, the chaos began, Sarama said.

"A group of older youths came into the mall with the intent of causing havoc and chaos and were running through the mall, screaming, yelling and so forth," he said.

Security staff contacted the police department, and mall officials closed the mall about 5 p.m., Sarama said.

The mall did not sustain any property damage apart from a single broken planter, and it will reopen Sunday at 11 a.m. as usual, Sarama said.

In the meantime, mall officials are at a loss as they try to understand what happened.

"Ford City is a family-oriented mall," he said. "We have not had an incident like this [in the past], and I’m still in a little bit of a state of shock actually.

"What would make these youths comes here to try and cause this kind of commotion and trouble?" he continued. "I don’t know. But they did have a plan in mind."

Tribune reporter Adam Sege contributed.

rsobol@tribune.com

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The Texas Tribune: Advocates Seek Mental Health Changes, Including Power to Detain

Matt Rainwaters for Texas Monthly

The Sherman grave of Andre Thomas’s victims.

SHERMAN — A worried call from his daughter’s boyfriend sent Paul Boren rushing to her apartment on the morning of March 27, 2004. He drove the eight blocks to her apartment, peering into his neighbors’ yards, searching for Andre Thomas, Laura Boren’s estranged husband.

Expanded coverage of Texas is produced by The Texas Tribune, a nonprofit news organization. To join the conversation about this article, go to texastribune.org.

For more articles on mental health and criminal justice in Texas, as well as a timeline of the Andre Thomas case: texastribune.org

Matt Rainwaters for Texas Monthly

Laura Boren

He drove past the brightly colored slides, swings and bouncy plastic animals in Fairview Park across the street from the apartment where Ms. Boren, 20, and her two children lived. He pulled into a parking spot below and immediately saw that her door was broken. As his heart raced, Mr. Boren, a white-haired giant of a man, bounded up the stairwell, calling out for his daughter.

He found her on the white carpet, smeared with blood, a gaping hole in her chest. Beside her left leg, a one-dollar bill was folded lengthwise, the radiating eye of the pyramid facing up. Mr. Boren knew she was gone.

In a panic, he rushed past the stuffed animals, dolls and plastic toys strewn along the hallway to the bedroom shared by his two grandchildren. The body of 13-month-old Leyha Hughes lay on the floor next to a blood-spattered doll nearly as big as she was.

Andre Boren, 4, lay on his back in his white children’s bed just above Leyha. He looked as if he could have been sleeping — a moment away from revealing the toothy grin that typically spread from one of his round cheeks to the other — except for the massive chest wound that matched the ones his father, Andre Thomas (the boy was also known as Andre Jr.), had inflicted on his mother and his half-sister as he tried to remove their hearts.

“You just can’t believe that it’s real,” said Sherry Boren, Laura Boren’s mother. “You’re hoping that it’s not, that it’s a dream or something, that you’re going to wake up at any minute.”

Mr. Thomas, who confessed to the murders of his wife, their son and her daughter by another man, was convicted in 2005 and sentenced to death at age 21. While awaiting trial in 2004, he gouged out one of his eyes, and in 2008 on death row, he removed the other and ate it.

At least twice in the three weeks before the crime, Mr. Thomas had sought mental health treatment, babbling illogically and threatening to commit suicide. On two occasions, staff members at the medical facilities were so worried that his psychosis made him a threat to himself or others that they sought emergency detention warrants for him.

Despite talk of suicide and bizarre biblical delusions, he was not detained for treatment. Mr. Thomas later told the police that he was convinced that Ms. Boren was the wicked Jezebel from the Bible, that his own son was the Antichrist and that Leyha was involved in an evil conspiracy with them.

He was on a mission from God, he said, to free their hearts of demons.

Hospitals do not have legal authority to detain people who voluntarily enter their facilities in search of mental health care but then decide to leave. It is one of many holes in the state’s nearly 30-year-old mental health code that advocates, police officers and judges say lawmakers need to fix. In a report last year, Texas Appleseed, a nonprofit advocacy organization, called on lawmakers to replace the existing code with one that reflects contemporary mental health needs.

“It was last fully revised in 1985, and clearly the mental health system has changed drastically since then,” said Susan Stone, a lawyer and psychiatrist who led the two-year Texas Appleseed project to study and recommend reforms to the code. Lawmakers have said that although the code may need to be revamped, it will not happen in this year’s legislative session. Such an undertaking requires legislative studies that have not been conducted. But advocates are urging legislators to make a few critical changes that they say could prevent tragedies, including giving hospitals the right to detain someone who is having a mental health crisis.

From the time Mr. Thomas was 10, he had told friends he heard demons in his head instructing him to do bad things. The cacophony drove him to attempt suicide repeatedly as an adolescent, according to court records. He drank and abused drugs to try to quiet the noise.

bgrissom@texastribune.org

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Promise, peril seen for crowd-funding investors

Crowd funding is widely seen as a revolutionary idea.

A 2012 federal law known as the JOBS Act opens the door to allowing small, privately owned businesses to market ownership stakes in their ventures to people over the Internet.

Companies will be able to sell up to $1 million in equity a year to ordinary investors without having to register the offering with the Securities and Exchange Commission or state regulators.

Before the average person can use crowd funding to stake a claim in a startup, the SEC still must draft rules that the Obama administration hopes will result in U.S. businesses growing and adding jobs. At the same time, the securities cop needs to include safeguards that protect less sophisticated individual investors drawn to inherently risky startups.

That's why equity crowd funding under JOBS, or Jumpstart our Business Startups, has some longtime regulators and securities lawyers squirming.

"It can be an invitation for fraudsters to steal money," Matthew Brown, a Katten Muchin Rosenman lawyer, said last month at a CFA Society of Chicago event at 1871, a center for digital startups in Chicago.

But Brown also noted that equity crowd funding also democratizes small-business financing, a process that historically has given access mostly to wealthier — or, as they're known in high-finance circles, "accredited" — investors.

"The world has changed dramatically, and who's to say who is smarter than anyone else?" Brown added.

Many existing crowd-funding platforms such as Kickstarter don't sell equity stakes in businesses to average investors. Rather, they give consumers the chance to donate money to an enterprise or to get an early or discounted crack at a new product. Since Kickstarter's launch in April 2009, more than $450 million has been pledged by more than 3 million people funding more than 35,000 projects, the New York-based company's website says.

Their acceptance suggests that consumers are willing to engage with companies on a deeper level. As such, enabling unaccredited consumers to invest in companies in small increments online has promise and could become part of the fundraising "ecosystem," says one Chicago entrepreneur.

Abe's Market, a Chicago-based e-commerce site selling natural and organic products from more than 1,000 suppliers, said it would consider crowd funding under the JOBS Act, saying it and its vendors have "die-hard fans" and "a core group of customers" who might like to invest in their vision.

Last month, Abe's raised $5 million from Carmel Ventures, Index Ventures, Beringea and Accel Partners, a Groupon backer. New backers include OurCrowd, a crowd-funding site for accredited investors.

"If you can get passionate people to invest in your business, you're not just gaining investors, you're gaining evangelists," Abe's Chief Executive Richard Demb said. "The challenge for any consumer brand is: How do you find not just customers, but the right customers who are going to tell their friends?"

But there would also be potential headaches for companies raising equity financing through crowd funding, he said.

"You have to make sure that expectations would be set fairly, that no one is putting their life savings into the investment, and that they don't also come back and become a challenge to manage as the business grows," Demb said. "You don't want someone who invested $250 to come back and say, 'I don't think we should expand to the West Coast.'"

Safeguards for average investors exist in the JOBS Act. They include capping nonaccredited individuals' crowd-funding investments at $2,000, or 5 percent of annual income or net worth of less than $100,000, whichever is greater.

Snapclass, launched a few weeks ago at 1871, provides software enabling businesses to provide training online. Co-founder Scott Mandel, who has financed the company himself, doesn't expect to take advantage of equity crowd funding in the future and instead would seek, say, venture capital funding.

"Not all checks are the same," said Mandel, previously a trader and professional poker player. "I'd want someone who could add more than just the cash, such as connections and experience and help with things that I'm not an expert in."

One of 1871's fastest-growing startups is MarkITx. It recently raised $1.2 million from wealthy individuals in its first fundraising round, has seven employees and is looking to add sales jobs. It's an online exchange for businesses wanting to buy and sell used information technology equipment, from iPads to Oracle servers.

"For us, it wouldn't be the sole way to raise money, but it definitely is a viable vehicle to look at raising money," MarkITx partner Marc Brooks said of equity crowd funding under the JOBS Act.

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Drew Peterson: 'I don't do well in incarceration'

With a 38-year sentence at age 59, Drew Peterson most likely will spend the rest of his life in prison.

The former Bolingbrook police officer acknowledged as much in a tearful, rage-filled monologue before his sentencing Thursday. Barring a successful appeal, Peterson will not be eligible for release until he's 93. But he estimated he would not make it that long because he has developed high cholesterol and has been twice diagnosed with skin cancer since his incarceration at the Will County Jail.

"I'm not looking for any sympathy, but anything you sentence me to, you're sentencing me to the Department of Corrections to die," Peterson told the court in a raised voice choked with emotion.

Peterson's new life will stand in stark contrast to the one he knew as a police sergeant, when he busied himself by riding motorcycles, flying airplanes and chasing younger women. But it won't be that different from the nearly four years he has spent in jail after being charged with killing his third wife, Kathleen Savio.

Peterson was transferred to the Stateville Correctional Center on Friday morning, less than 24 hours after receiving his sentence. He stayed there only a few hours before being sent to his new home at the Pontiac prison. He is in the maximum-security facility, which has a protective custody unit. The assignment was based on factors such as his conviction, length of sentence, program needs, and medical and mental health requirements, per Illinois Department of Correction protocol.

Officials have not said whether he has a cellmate or if he will be in solitary confinement as he had been during his jail stay.

As part of his daily routine there, he will remain in his cell for most of the day, though he will be allowed out for meals and showers. Most inmates also get about five hours of recreation time outside per week, Illinois Department of Corrections spokeswoman Stacey Solano said.

Peterson already seemed to be envisioning a dreary existence.

"I don't do well in incarceration," he said during his 40-minute courtroom soliloquy. "Due to the bad food and lack of exercise (in jail), I have high blood pressure, high cholesterol, borderline diabetes, a variety of skin issues, and I've had two bouts with skin cancer."

Prisoners can earn work privileges and be assigned menial jobs in the kitchen, laundry room or other areas of the detention center. The shifts, which are not daily, are at least four hours long, Solano said.

Though the Will County Jail has a similar jobs program, Peterson did not participate in it because he was kept separate from the rest of the jail population. The sheriff's department, which oversees the facility, kept him segregated there amid concerns that his high-profile case and law-enforcement background could make him a target of inmates looking to build tough-guy reputations.

As such, Peterson had been kept in the jail's medical unit since his May 2009 arrest. He spent most of his time in his cell, which was 8 feet wide by 5 feet deep. He was given an hour or two in an adjacent day room each day, but that's about it.

His attorney Joseph Lopez, however, said he does not believe such measures need to be taken in state prison. Though high-profile inmates often attract unwanted attention — Jeffrey Dahmer, for example, was slain in 1994 while serving multiple life terms — Lopez thinks Peterson can protect himself.

"He's got a black belt in karate. He knows how to defend himself," Lopez said. "He's a gregarious type of guy. I'm sure the inmates will love him once they get to know him."

Peterson did not seem as convinced on Thursday.

"Originally, I had some cute and funny things to end with," he said, "but in closing now it's time to sentence an innocent man to a life of hardship and abuse (in) prison, and I don't deserve this."

Illinois Department of Corrections officials would not say what safety precautions would be taken in their facilities, but Solano said such issues are considered during an inmate's initial evaluation.

"IDOC will continue to ensure proper placement of all offenders as the health, safety and security of inmates and staff remain the department's top priority," she said.

Peterson will be allowed visits in prison, with some facilities allowing up to five per month. He had similar privileges in jail, but few people had actually come to see him. A visitor's list released shortly before his murder trial included his brother, sister and a small number of friends. Only two of his six children — his sons Thomas and Kris with Savio — went to see him in jail.

His older son, Stephen, who is raising his father's two youngest children, had not visited in the three years leading up to the trial. However, the two communicate frequently via collect phone calls from the jail. Illinois prisoners also have regular telephone contact — as long as it's collect — with people on their approved contacts list, Solano said.

Peterson's attorneys informed him after court Thursday that he could be transferred to Stateville as early as Friday. Despite his rage-filled monologue in court, he seemed to take the prison transfer in stride.

"He's ready for it," Lopez said. "He says he wants a change of scenery."

And that's just fine with Savio's family.

"I think he should have gotten 60 (years) myself," her brother Henry Savio Jr. said. "But he is going to spend the rest of his life in jail so I'm OK with it. He deserves to die there."

sstclair@tribune.com

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Drone Pilots Found to Get Stress Disorders Much as Those in Combat Do

U.S. Air Force/Master Sgt. Steve Horton

Capt. Richard Koll, left, and Airman First Class Mike Eulo monitored a drone aircraft after launching it in Iraq.

The study affirms a growing body of research finding health hazards even for those piloting machines from bases far from actual combat zones.

“Though it might be thousands of miles from the battlefield, this work still involves tough stressors and has tough consequences for those crews,” said Peter W. Singer, a scholar at the Brookings Institution who has written extensively about drones. He was not involved in the new research.

That study, by the Armed Forces Health Surveillance Center, which analyzes health trends among military personnel, did not try to explain the sources of mental health problems among drone pilots.

But Air Force officials and independent experts have suggested several potential causes, among them witnessing combat violence on live video feeds, working in isolation or under inflexible shift hours, juggling the simultaneous demands of home life with combat operations and dealing with intense stress because of crew shortages.

“Remotely piloted aircraft pilots may stare at the same piece of ground for days,” said Jean Lin Otto, an epidemiologist who was a co-author of the study. “They witness the carnage. Manned aircraft pilots don’t do that. They get out of there as soon as possible.”

Dr. Otto said she had begun the study expecting that drone pilots would actually have a higher rate of mental health problems because of the unique pressures of their job.

Since 2008, the number of pilots of remotely piloted aircraft — the Air Force’s preferred term for drones — has grown fourfold, to nearly 1,300. The Air Force is now training more pilots for its drones than for its fighter jets and bombers combined. And by 2015, it expects to have more drone pilots than bomber pilots, although fighter pilots will remain a larger group.

Those figures do not include drones operated by the C.I.A. in counterterrorism operations over Pakistan, Yemen and other countries.

The Pentagon has begun taking steps to keep pace with the rapid expansion of drone operations. It recently created a new medal to honor troops involved in both drone warfare and cyberwarfare. And the Air Force has expanded access to chaplains and therapists for drone operators, said Col. William M. Tart, who commanded remotely piloted aircraft crews at Creech Air Force Base in Nevada.

The Air Force has also conducted research into the health issues of drone crew members. In a 2011 survey of nearly 840 drone operators, it found that 46 percent of Reaper and Predator pilots, and 48 percent of Global Hawk sensor operators, reported “high operational stress.” Those crews cited long hours and frequent shift changes as major causes.

That study found the stress among drone operators to be much higher than that reported by Air Force members in logistics or support jobs. But it did not compare the stress levels of the drone operators with those of traditional pilots.

The new study looked at the electronic health records of 709 drone pilots and 5,256 manned aircraft pilots between October 2003 and December 2011. Those records included information about clinical diagnoses by medical professionals and not just self-reported symptoms.

After analyzing diagnosis and treatment records, the researchers initially found that the drone pilots had higher incidence rates for 12 conditions, including anxiety disorder, depressive disorder, post-traumatic stress disorder, substance abuse and suicidal ideation.

But after the data were adjusted for age, number of deployments, time in service and history of previous mental health problems, the rates were similar, said Dr. Otto, who was scheduled to present her findings in Arizona on Saturday at a conference of the American College of Preventive Medicine.

The study also found that the incidence rates of mental heath problems among drone pilots spiked in 2009. Dr. Otto speculated that the increase might have been the result of intense pressure on pilots during the Iraq surge in the preceding years.

The study found that pilots of both manned and unmanned aircraft had lower rates of mental health problems than other Air Force personnel. But Dr. Otto conceded that her study might underestimate problems among both manned and unmanned aircraft pilots, who may feel pressure not to report mental health symptoms to doctors out of fears that they will be grounded.

She said she planned to conduct two follow-up studies: one that tries to compensate for possible underreporting of mental health problems by pilots and another that analyzes mental health issues among sensor operators, who control drone cameras while sitting next to the pilots.

“The increasing use of remotely piloted aircraft for war fighting as well as humanitarian relief should prompt increased surveillance,” she said.

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16 airport investors show interest in Midway

An international array of airport investors and operators have shown interest in developing bids to privatize Midway Airport, the city announced Friday evening.

Sixteen parties responded to the city's "request for qualifications" by a 4 p.m. deadline, indicating they had interest in leasing, operating and improving the Southwest Side airport, the nation's 26th busiest, with about 9 million passengers passing through annually.

"The response generated from the  ... process is encouraging and provides the city with a sense of the strong level of interest in a potential lease," said Lois Scott, the city's chief financial officer. "We must evaluate fully if this could be a win for Chicagoans."

The city and its advisers will review the responses to identify qualified potential bidders.

Of the 16, seven had both the operational and financial capabilities sought in the RFQ. The city identified them as:

-- ACO Investment Group, an investor and operator with global airport experience.

-- AMP Capital Investors Limited, a manager and investor in airports, including Melbourne Airport in Australia and Newcastle Airport, in Britain.

--  Corporacion America Group, an Argentina-based airport operator with 49 airports in seven countries.

-- Global Infrastructure Partners (GIP), which is the controlling investor and active manager of London City Airport, London Gatwick Airport and Edinburgh Airport.

--Great Lakes Airport Alliance, which is a partnership of Macquarie Infrastructure and Real Assets and Ferrovial. Its airport operations include London's Heathrow, Brussels Airport and Copenhagen Airport.

-- Incheon International Airport and Hastings Funds Management, which is the sole owner and operator of Incheon International Airport in South Korea and an investor with 16 airport-related investments.

--  Industry Funds Management and Manchester Airport Group, an investor with interests in 13 airports, including Melbourne Airport and Brisbane Airport, both in Australia, and operator of Manchester Airport and East Midlands Airport, in Britain.

If the city moves forward and seeks proposals, a privatization plan could be submitted to the City Council this summer.

This is the second time Chicago has looked at privatizing Midway. A 99-year lease that would have brought in $2.5 billion died in 2009 when the financial markets froze. That deal had drawn six serious bidders.

Mayor Rahm Emanuel has said any second attempt would have to provide city taxpayers with a better deal than the widely criticized 75-year agreement to privatize parking meter operations, carried out during former Mayor Richard Daley's administration. Proceeds from the earlier deal were used to plug operating deficits, and meter rates rose sharply.

This time, proposed leases must be less than 40 years, which locks in the city for a shorter period.

Rather than making only an upfront payment, the private operator also must share revenue with the city on an ongoing basis. Initial proceeds would be used to pay down debt issued since 1996 to rebuild the airport, the mayor's office said. There is about $1.4 billion in outstanding debt.

Longer term, cash flow would be directed to city infrastructure needs. The mayor has pledged proceeds would not be used to pay for city operations.

kbergen@tribune.com

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Snow turning to drizzle during morning commute - ice expected

CAPTIONS

Tears
A tear drops from the eye of DePaul University student Sam Henning as she is hit by a stiff breeze on West Wacker Drive. Tears protest eyes from drying out in cold, windy weather. (John J. Kim, Chicago Tribune /February 19, 2013)

Staff report

4:48 a.m. CST, February 22, 2013

About three inches of snow fell across the Chicago region, though the snow is expected to turn to freezing drizzle this morning, coating the area with ice.

The accumulation was more or less consistent across the area, from Rockford in north central Illinois east to Portage, Ind.

The weather caused between 20 and 30 spinouts on highways across the city and suburbs, according to state police, who described the conditions as "horrible." 

State Police are in a "snow plan" and aren't responding to accidents without injuries - those are supposed to be reported later.

"It will be tapering off from the south in the next couple hours, possibly some freezing drizzle across whole area," said Mark Ratzer, meteorologist for the National Weather Service. "We may end up coming in a little less."

The city of Chicago has sent 284 plows to work clearing main thoroughfares, according to the streets and sanitation department.

Temperatures today should peak around 34 degrees with winds gusting out of the east around 20 or 25 miles an hour.

"The wind should be diminishing today to around 10 miles an hour," said Ben Deubelbeiss, meteorologist for the National Weather Service.

Flurries could linger into the weekend with a chance for light snow on Saturday. Deubelbeiss said he didn't expect any significant weather Sunday. High temperatures both days should be around 30, with lows in the low 20s and high teens both mornings.

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chicagobreaking@tribune.com

Twitter: @ChicagoBreaking

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The New Old Age Blog: For Traumatized Caregivers, Therapy Helps

I recently wrote about caregivers who experienced symptoms of traumatic-like stress, and readers responded with heart-rending stories. Many described being haunted by distress long after a relative died.

Especially painful, readers said, was witnessing a loved one’s suffering and feeling helpless to do anything about it.

The therapists I spoke with said they often encountered symptoms among caregivers similar to those shown by people with post-traumatic stress — intrusive thoughts, disabling anxiety, hyper-vigilance, avoidance behaviors and more — even though research documenting this reaction is scarce. Improvement with treatment is possible, they say, although a sense of loss may never disappear completely.

I asked these professionals for stories about patients to illustrate the therapeutic process. Read them below and you’ll notice common themes. Recovery depends on unearthing the source of psychological distress and facing it directly rather than pushing it away. Learning new ways of thinking can change the tenor of caregiving, in real time or in retrospect, and help someone recover a sense of emotional balance.

Barry Jacobs, a clinical psychologist and author of “The Emotional Survival Guide for Caregivers” (Guilford Press, 2006), was careful to distinguish normal grief associated with caregiving from a traumatic-style response.

“Nightmares, lingering bereavement or the mild re-experiencing of events that doesn’t send a person into a panic every time is normal” and often resolves with time, he said.

Contrast that with one of his patients, a Greek-American woman who assisted her elderly parents daily until her father, a retired firefighter, went to the hospital for what doctors thought would be a minor procedure and died there of a heart attack in the middle of the night.

Every night afterward, at exactly 3 a.m., this patient awoke in a panic from a dream in which a phone was ringing. Unable to go back to sleep for hours, she agonized about her father dying alone at that hour.

The guilt was so overwhelming, the woman couldn’t bear to see her mother, talk with her sisters or concentrate at work or at home. Sleep deprived and troubled by anxiety, she went to see her doctor, who works in the same clinic as Dr. Jacobs and referred her to therapy.

The first thing Dr. Jacobs did was to “identify what happened to this patient as traumatic, and tell her acute anxiety was an understandable response.” Then he asked her to “grieve her father’s death” by reaching out to her siblings and her mother and openly expressing her sadness.

Dr. Jacobs also suggested that this patient set aside a time every day to think about her father — not just the end of his life, but also all the things she had loved about him and the good times they’d had together as a family.

Don’t expect your night time awakenings to go away immediately, the psychologist told his patient. Instead, plan for how you’re going to respond when these occur.

Seven months later, the patient reported her panic at a “3 or 4” level instead of a “10” (the highest possible number), Dr. Jacobs said.

“She’ll say, ‘oh, there’s the nightmare again,’ and she can now go back to sleep fairly quickly,” he continued. “Research about anxiety tells us that the more we face what we fear, the quicker we are to extinguish our fear response and the better able we are to tolerate it.”

Sara Qualls, a professor of psychology at the University of Colorado in Colorado Springs, said it’s natural for caregivers to be disgusted by some of what they have to do — toileting a loved one, for instance — and to be profoundly conflicted when they try to reconcile this feeling with a feeling of devotion. In some circumstances, traumatic-like responses can result.

Her work entails naming the emotion the caregiver is experiencing, letting the person know it’s normal, and trying to identify the trigger.

For instance, an older man may come in saying he’s failed his wife with dementia by not doing enough for her. Addressing this man’s guilt, Dr. Qualls may find that he can’t stand being exposed to urine or feces but has to help his wife go to the bathroom. Instead of facing his true feelings, he’s beating up on himself psychologically — a diversion.

Once a conflict of this kind is identified, Dr. Qualls said she can help a person deal with the trigger by using relaxation exercises and problem-solving techniques, or by arranging for someone else to do a task that he or she simply can’t tolerate.

Asked for an example, Dr. Qualls described a woman who traveled to another state to see her mother, only to find her in a profound disheveled, chaotic state. Her mother said that she didn’t want help, and her brother responded with disbelief. Soon, the woman’s blood pressure rose, and she began having nightmares.

In therapy, Dr. Qualls reassured the patient that her fear for her mother’s safety was reasonable and guided her toward practical solutions. Gradually, she was able to enlist her brother’s help and change her mother’s living situation, and her sense of isolation and helplessness dissipated.

“I think that a piece of the trauma reaction that is so devastating is the intense privacy of it,” Dr. Qualls said. “Our work helps people moderate their emotional reactivity through human contact, sharing and learning strategies to manage their responsiveness.”

Dolores Gallagher-Thompson, a professor of psychiatry at Stanford University School of Medicine in California, noted that stress can accumulate during caregiving and reach a tipping point where someone’s ability to cope is overwhelmed.

She tells of a vibrant, active woman in her 60s caring for an older husband who declined rapidly from dementia. “She’d get used to one set of losses, and then a new loss would occur,” Dr. Gallagher-Thompson said.

The tipping point came when the husband began running away from home and was picked up by the police several times. The woman dropped everything else and became vigilant, feeling as if she had to watch her husband day and night. Still, he would sneak away and became more and more difficult.

Both husband and wife had come from Jewish families caught up in the Holocaust during World War II, and the feeling of “complete and utter helplessness and hopelessness” that descended on this older woman was intolerable, Dr. Gallagher-Thompson said.

Therapy was targeted toward helping the patient articulate thoughts and feelings that weren’t immediately at the surface of her consciousness, like, for example, her terror at the prospect of abandonment. “I’d ask her ‘what are you afraid of? If you visualize your husband in a nursing home or assisted living, what do you see?’” Dr. Gallagher-Thompson said.

Then the conversation would turn to the choices the older woman had. Go and look at some long-term care places and see what you think, her psychologist suggested. You can decide how often you want to visit. “This isn’t an either-or — either you’re miserable 24/7 or you don’t love him,” she advised.

The older man went to assisted living, where he died not long afterward of pneumonia that wasn’t diagnosed right away. The wife fell into a depression, preoccupied with the thought that it was all her fault.

Another six months of therapy convinced her that she had done what she could for her husband. Today she works closely with her local Alzheimer’s Association chapter, “helping other caregivers learn how to deal with these kinds of issues in support groups,” Dr. Gallagher-Thompson said.

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