The Black Keys, Skrillex share early Grammys lead

LOS ANGELES (AP) — Dan Auerbach of The Black Keys is not such a lonely boy after all.

The singer-guitarist took the early lead at the Grammy Awards, picking up three trophies and assisting with a fourth during the pre-telecast show. Auerbach won producer of the year alone and best rock song for "Lonely Boy" and rock album for "El Camino" with his bandmate Patrick Carney, joining electronic dance music innovator Skrillex atop the early leaderboard. He was also producer for another winner, Dr. John.

A slew of artists sit one back going into the main awards show Sunday night at the Staples Center, including Kanye West and Jay-Z, Gotye, former best new artist winner Esperanza Spalding, jazz man Chick Corea and Christian singer-songwriter Matt Redman.

Most of the attention has been on Frank Ocean going into the awards, but his fellow lead nominees got an early lead on the R&B singer during the pre-telecast show.

West and Jay-Z won best rap song and best rap performance for the song "... in Paris" from their "Watch the Throne" collaboration and lost a third for short form video for "No Church in The Wild," which featured Ocean. Ocean will be up for five awards later in the evening.

Other early winners included Rihanna, Beyonce, Taylor Swift and Mumford & Sons, one of six top nominees with six nods apiece. Ocean is up for the major awards best new artist, album of the year and record of the year when the show airs live on CBS at 8 p.m. EST from the Staples Center.

The Grammy pre-telecast awards show at the Nokia Theatre had 70 trophies up for grabs, including rock, pop, rap and country categories.

Skrillex won best dance recording for "Bangarang," featuring Sirah, best dance/electronica album for "Bangarang" and best remixed recording.

"Let's keep making music," he said. "... We're a big family. We're a big community. We support music and forward-thinking ideas here."

Gotye won best alternative album for "Making Mirrors" and best pop/duo performance for "Somebody That I Used To Know," featuring Kimbra.

Spalding had one of the most touching moments of the pre-telecast awards show, taking the stage with her longtime jazz teacher Thara Memory for their win in the best instrumental arrangement accompanying vocalist category. She also won for best jazz vocal album for her "Radio Music Society."

Corea, who competed against himself in two categories, won best improvised jazz solo for "Hot House" with Gary Burton and best instrumental composition for "Mozart Goes Dancing."

And Redman won best gospel/contemporary Christian music performance and best contemporary Christian music song (in a tie) for "10,000 Reasons (Bless The Lord)."

Other early winners included Rihanna, who won short form music video for "We Found Love" featuring Calvin Harris, and Swift won the Grammy for best song written for visual media for "Safe & Sound," her collaboration with The Civil Wars on "The Hunger Games" soundtrack. It was Swift's seventh Grammy and the third for Joy Williams and John Paul White of The Civil Wars.

"I think it's appropriate that Taylor thanks us because we've been carrying her for a while and it's getting really tiring," White joked.

Beyonce won for best traditional R&B performance, Mumford & Sons took their first Grammy, winning along with Old Crow Medicine Show and Edward Sharpe and the Magnetic Zeros for their long form video documentary "Big Easy Express."

Celebrities began rolling down the red carpet in the early afternoon, but it remained to be seen if any would try to skirt CBS's mandate that stars dress appropriately with butts, breasts and other sensitive areas covered adequately.

"I think it's just, you know, we should always stay classy and dress according to the event that's being held," Ashanti said on the red carpet. "So I don't think people should be limited so much and told what you can and cannot do. But, you know, you do have to have a certain class and prestige about yourself."

Celebrities also felt an increased Los Angeles Police Department presence in light of a manhunt involving an alleged cop killer. Police were everywhere, including atop the hotel across from the Staples Center.

Ocean might be riding a wave toward some of the night's biggest honors. He is still up for five awards going into the night along with fellow top nominee fun.

"It feels cool," Ocean said on the red carpet. "It's really bright, a lot of beautiful ladies walking around being fancy. I have to perform tonight so the wheels are constantly spinning. You can't really just sit in your seat and take it all in."

All the night's major awards are still to come. Jack White's "Blunderbuss" competes with fun.'s "Some Nights," Ocean's "channel ORANGE," Mumford's "Babel" and The Keys' "El Camino" for the night's top award, album of the year.

Gotye's "Somebody That I Used To Know," featuring Kimbra, Taylor Swift's "We Are Never Ever Getting Back Together" and Kelly Clarkson's "Stronger (What Doesn't Kill You)" join the fun., Ocean and Black Keys entries in record of the year.

Fun. and Clarkson also are nominated for song of the year along with Ed Sheeran's "The A Team," Carly Rae Jepsen's "Call Me Maybe" and Miguel's "Adorn."

And rounding out the major categories, fun., Ocean, Alabama Shakes, Hunter Hayes and The Lumineers are up for best new artist.

Swift will kick things off with a show-opening performance. Fun. and Ocean will take the stage. Others scheduled to perform include Justin Timberlake, Carrie Underwood, Clarkson, White and Juanes.

There will be no shortage of mashups the Grammys have become famous for, either. Elton John, Mavis Staples, Mumford, Brittany Howard, T Bone Burnett and Zac Brown are saluting the late Levon Helm, who won the Americana Grammy last year a few months before his death. The Keys will join Dr. John and the Preservation Hall Jazz Band on stage. Sting, Rihanna and Bruno Mars will perform together. Other team-ups include Miranda Lambert and Dierks Bentley, and Alicia Keys and Maroon 5.

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AP writers Nekesa Mumbi Moody and Beth Harris in Los Angeles contributed to this report.

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Online:

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For Families Struggling with Mental Illness, Carolyn Wolf Is a Guide in the Darkness

When a life starts to unravel, where do you turn for help?

Melissa Klump began to slip in the eighth grade. She couldn’t focus in class, and in a moment of despair she swallowed 60 ibuprofen tablets. She was smart, pretty and ill: depression, attention deficit disorder, obsessive-compulsive disorder, either bipolar disorder or borderline personality disorder.

In her 20s, after a more serious suicide attempt, her parents sent her to a residential psychiatric treatment center, and from there to another. It was the treatment of last resort. When she was discharged from the second center last August after slapping another resident, her mother, Elisa Klump, was beside herself.

“I was banging my head against the wall,” the mother said. “What do I do next?” She frantically called support groups, therapy programs, suicide prevention lines, anybody, running down a list of names in a directory of mental health resources. “Finally,” she said, “somebody told me, ‘The person you need to talk to is Carolyn Wolf.’ ”

That call, she said, changed her life and her daughter’s. “Carolyn has given me hope,” she said. “I didn’t know there were people like her out there.”

Carolyn Reinach Wolf is not a psychiatrist or a mental health professional, but a lawyer who has carved out what she says is a unique niche, working with families like the Klumps.

One in 17 American adults suffers from a severe mental illness, and the systems into which they are plunged — hospitals, insurance companies, courts, social services — can be fragmented and overwhelming for families to manage. The recent shootings in Newtown, Conn., and Aurora, Colo., have brought attention to the need for intervention to prevent such extreme acts of violence, which are rare. But for the great majority of families watching their loved ones suffer, and often suffering themselves, the struggle can be boundless, with little guidance along the way.

“If you Google ‘mental health lawyer,’ ” said Ms. Wolf, a partner with Abrams & Fensterman, “I’m kinda the only game in town.”

On a recent afternoon, she described in her Midtown office the range of her practice.

“We have been known to pull people out of crack dens,” she said. “I have chased people around hotels all over the city with the N.Y.P.D. and my team to get them to a hospital. I had a case years ago where the person was on his way back from Europe, and the family was very concerned that he was symptomatic. I had security people meet him at J.F.K.”

Many lawyers work with mentally ill people or their families, but Ron Honberg, the national director of policy and legal affairs for the National Alliance on Mental Illness, said he did not know of another lawyer who did what Ms. Wolf does: providing families with a team of psychiatrists, social workers, case managers, life coaches, security guards and others, and then coordinating their services. It can be a lifeline — for people who can afford it, Mr. Honberg said. “Otherwise, families have to do this on their own,” he said. “It’s a 24-hour, 7-day-a-week job, and for some families it never ends.”

Many of Ms. Wolf’s clients declined to be interviewed for this article, but the few who spoke offered an unusual window on the arcane twists and turns of the mental health care system, even for families with money. Their stories illustrate how fraught and sometimes blind such a journey can be.

One rainy morning last month, Lance Sheena, 29, sat with his mother in the spacious family room of her Long Island home. Mr. Sheena was puffy-eyed and sporadically inattentive; the previous night, at the group home where he has been living since late last summer, another resident had been screaming incoherently and was taken away by the police. His mother, Susan Sheena, eased delicately into the family story.

“I don’t talk to a lot of people because they don’t get it,” Ms. Sheena said. “They mean well, but they don’t get it unless they’ve been through a similar experience. And anytime something comes up, like the shooting in Newtown, right away it goes to the mentally ill. And you think, maybe we shouldn’t be so public about this, because people are going to be afraid of us and Lance. It’s a big concern.”

Her son cut her off. “Are you comparing me to the guy that shot those people?”

“No, I’m saying that anytime there’s a shooting, like in Aurora, that’s when these things come out in the news.”

“Did you really just compare me to that guy?”

“No, I didn’t compare you.”

“Then what did you say?”

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Samsung Challenges Apple’s Cool Factor

Apple, for the first time in years, is hearing footsteps.

The maker of iPhones, iPads and iPods has never faced a challenger able to make a truly popular and profitable smartphone or tablet — not Dell, not Hewlett-Packard, not Nokia, not BlackBerry — until Samsung Electronics.

The Korean manufacturer’s Galaxy S III smartphone is the first device to run neck and neck with Apple’s iPhone in sales. Armed with other Galaxy phones and tablets, Samsung has emerged as a potent challenger to Apple, the top consumer electronics maker. The two companies are the only ones turning profits in the highly competitive mobile phone industry, with Apple taking 72 percent of the earnings and Samsung the rest.

Yet these two rivals, who have battled in the marketplace and in the courts worldwide, could not be more different. Samsung Electronics, a major part of South Korea’s expansive Samsung Group, makes computer chips and flat-panel displays as well as a wide range of consumer products including refrigerators, washers and dryers, cameras, vacuum cleaners, PCs, printers and TVs.

Where Apple stakes its success on creating new markets and dominating them, as it did with the iPhone and iPad, Samsung invests heavily in studying existing markets and innovating inside them.

“We get most of our ideas from the market,” said Kim Hyun-suk, an executive vice president at Samsung, in a conversation about the future of mobile devices and television. “The market is a driver, so we don’t intend to drive the market in a certain direction,” he said.

That’s in stark contrast to the philosophy of Apple’s founder Steven P. Jobs, who rejected the notion of relying on market research. He memorably said that consumers don’t know what they want.

Nearly everything at Samsung, from the way it does research to its manufacturing, is unlike Apple. It taunts Apple in its cheeky advertisements while Apple stays above the fray.

And the Korean manufacturer may even be putting some pressure on Apple’s world-class designers. Before Apple released the iPhone 5, which had a larger screen than earlier models, Samsung had already been selling phones with even bigger displays, like the 5.3-inch screen Galaxy Note, a smartphone so wide that gadget blogs call it a phablet.

Samsung outspends Apple on research and development: $10.5 billion, or 5.7 percent of revenue, compared with $3.4 billion, or 2 percent. (Samsung Electronics is slightly bigger than Apple in terms of revenue — $183.5 billion compared with $156.5 billion — but Apple is larger in terms of stock market value.)

Samsung has 60,000 staff members working in 34 research centers across the globe, including, Russia, Britain, India, Japan, Israel, China and Silicon Valley. It polls consumers and buys third-party research reports, but it also embeds employees in countries to study trends or merely to find inspiration for ideas.

Designers of the Galaxy S III say they drew inspiration from trips to Cambodia and Helsinki, a Salvador Dalí art exhibit and even a balloon ride in an African forest. (It employs 1,000 designers with different backgrounds like psychology, sociology, economy management and engineering.)

“The research process is unimaginable,” said Donghoon Chang, an executive vice president of Samsung who leads the company’s design efforts. “We go through all avenues to make sure we read the trends correctly.” He said that when the company researches markets for any particular product, it is also looking at trends in fashion, automobiles and interior design.

Hangil Song, a Samsung product designer, described a visit to the Marina Bay Sands resort in Singapore, where he said he was amazed by the views of the sky, the cityscape and the water. He wanted to create an effect where water was overflowing from the screen. As a result, taps and swipes on the Galaxy S III’s phone screen create a unique ripple effect.

The genesis of the wide Galaxy Note phone reflects that same kind of consumer research. From focus groups and surveys, Samsung found that many respondents wanted a device that was good for handwriting, drawing and sharing notes. Asian-language speakers, in particular, found it easier to write characters on a device using a pen than typing. Those insights led to the Note, a smartphone that comes with a digital pen.

In courts, jury members have said some of Samsung’s research appears to comes closer to copying. Apple sued Samsung in Federal District Court last year for patent infringement and won a $1 billion judgment. One of the most explosive pieces of evidence was a detailed report breaking down each hardware and software feature of the iPhone and how each compared to Samsung phone features. Samsung is fighting the decision in court.

Roy Furchgott contributed reporting.

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Israeli Says Syria Twisted Comments by Rebel Supporter

BEIRUT, Lebanon — A public relations controversy erupted Saturday after a leading Israeli newspaper published comments from a brief interview with the leader of Syria’s main exile opposition group.

The news media outlets of the Syrian government, and its ally Hezbollah, the Lebanese militant group, reported that the opposition leader had declared that Israel had “nothing to fear” from a rebel-led Syrian government. Moreover, the reports said, the opposition was working with other countries to keep Syria’s chemical weapons away from Hezbollah, which he called a “son of the devil.”

But the opposition leader, Sheik Ahmad Moaz al-Khatib, never said any of that, according to the article in the Israeli newspaper, Yediot Aharonot, and its author, a prominent Israeli defense expert, Ronen Bergman.

Sheik Khatib was quoted in the article reiterating the opposition’s promise to keep Syria’s chemical arsenal out of “the hands of unauthorized elements,” and it was the international community, he said, not Israel, that had “nothing to fear.”

When Sheik Khatib realized that Mr. Bergman was an Israeli — after glancing at his business card — he abruptly ended the conversation, Mr. Bergman said in a Skype interview, repeating what he had written.

The original article was published only in Hebrew — and only in print — so it was the Arabic and English versions put out by the Syrian government and Hezbollah that raced around the Internet on Saturday, provoking outrage from government supporters and opponents at Sheik Khatib, who posted a message on his Facebook page denying that he had given the interview.

Yet the episode appeared to have been more than a simple misunderstanding. Syria’s conflict is not only a shooting war but also a propaganda war. Pro-government media apparently could not resist the chance to bolster their contention that the rebellion had been promoted by Israel and the West to punish Syria and its president, President Bashar al-Assad, for taking uncompromising positions against Israel.

“Unfortunately, the original text was less exciting,” Mr. Bergman said. “I would be happy if he would say something like, ‘Yes, we will make peace with Israel’ — then I would get the front page.” As it was, the article elicited little reaction in Israel.

But misrepresentation of the article suggested that it hit a nerve on one issue. An unnamed opposition member, not Sheik Khatib, called Hezbollah “sons of the devil,” according to Mr. Bergman, and said the rebel coalition was working with other countries to ensure that “not one piece of military equipment, not chemical weapons and not any other item, will pass into their hands.”

Syria is Hezbollah’s main conduit for arms, and Hezbollah has backed Mr. Assad’s bloody crackdown at great cost to its popularity in the wider Arab world.

Although Mr. Bergman said the opposition member was offering his own opinion and not presenting official policy, his comments bolstered the widely held view that a rebel-led government might halt the shipment of Iranian arms through Syria to Hezbollah. Hezbollah, a Shiite group and political party, is also concerned about the rise within the rebel movement of extremist Sunni jihadists who view Shiites as apostates.

The misleading reports appeared to be an attempt to further divide the opposition. Sheik Khatib found himself fending off critics from within the anti-Assad movement who objected to his even speaking with an Israeli reporter, though by all accounts he did not initially realize that Mr. Bergman was an Israeli.

It was the second time in a month that Sheik Khatib found himself on the defensive. He recently proposed talks with members of Mr. Assad’s government, but had not built political support for the proposal.

On Friday, Syria’s information minister, Omran al-Zoubi, gave the first official response to the proposal, saying that the government would negotiate with any opposition members who agreed to lay down their arms.

On Saturday, Mr. Assad named new cabinet ministers for oil, finance, social affairs, labor, housing, public works and agriculture, as Syria faces growing economic problems and shortages of electricity, fuel and bread.

Anne Barnard reported from Beirut, and Isabel Kershner from Jerusalem. Hania Mourtada contributed reporting from Beirut.

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Snoop Dogg blazes one during BMI songwriting panel

LOS ANGELES (AP) — Music fans who turned out to BMI's annual pre-Grammy Awards "How I Wrote That Song" discussion got a little more than they expected thanks to Snoop Dogg — a contact high.

The rapper smoked marijuana during Saturday's panel discussion, lighting up a large, Kush-filled blunt on stage at The Roxy. He briefly passed it off to B.o.B before methodically reducing it to ash over a 15-minute period. The panel also included Busta Rhymes and songwriters Luke Laird and Evan Bogart, all of whom abstained — at least on stage.

Fittingly, the conversation eventually turned to Snoop's groundbreaking work on "The Chronic."

Laird recalled growing up at the end of a dirt road 10 miles outside Conneaut Lake, a small town of 700 in rural Pennsylvania. Yet Snoop's work with Dr. Dre still infiltrated his world and that of all the other country kids around him.

"Let me just say, the album everyone was listening to was 'The Chronic,'" Laird said, noting how surreal it was to be sitting on stage with Snoop.

With acoustic guitar in hand, he played a bit of his Blake Shelton hit "Hillbilly Bone" in its original form: a rap song. The Nashville-based songwriter had everyone bobbing their heads to the beat.

"Now I feel like more than ever you see these influences crossing genres," Laird said.

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Follow AP Music Writer Chris Talbott at 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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Business Week in Pictures

Phil Libin, the chief executive of Evernote, during a staff meeting at Evernote’s headquarters in Redwood City, Calif. Evernote is among the privately held Silicon Valley start-ups that are worth more than $1 billion. An unprecedented number of high technology start-ups, easily 25 and possibly exceeding 40, have crossed that threshold. Many employees are quietly growing rich, or at least building a big cushion against a crash, as they sell shares to outside investors. Airbnb, Pinterest, SurveyMonkey and Spotify are among the better-known privately held companies that have reached $1 billion.

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California Police Officer Manhunt

Alex Gallardo/Reuters

A police cruiser in which an officer was shot in Corona, Calif.

BIG BEAR LAKE, Calif. — The search for the former Los Angeles police officer wanted in three killings continued throughout Friday here, even as a blizzard covered the mountains with a foot of snow. But as no new traces of the suspect were found, the authorities wondered if he had somehow slipped through their fingers.

Law enforcement agencies from across Southern California had been on a regionwide manhunt since early Thursday for Christopher J. Dorner, 33, a former Navy reservist sought in connection with the shooting deaths of three people and the attempted shootings of several police officials.

Over the course of the week, since the first killing on Sunday, Mr. Dorner had been spotted all over Southern California, from Riverside to San Diego. His trail seemed to lead here on Thursday when a burned-out pickup truck found at the base of the mountain was identified as belonging to Mr. Dorner. Law enforcement followed tracks from the car into the nearby woods. With only a few routes in and out of town, they were confident they had Mr. Dorner cornered.

More than 100 law enforcement officers have spent the last two days combing the area, going door to door overnight, taking special care to investigate remote cabins and other vacation homes whose owners were away, and scanning the area by helicopter.

But they have been unable to turn up any new clues, Sheriff John McMahon of San Bernardino County, said at a news conference on Friday.

“We searched all night; we did not discover any additional evidence,” Sheriff McMahon said on Friday morning. “We will continue searching until either we discover that he left the mountain, or we find him.”

“We don’t have any evidence to suggest that he is or is not here,” he added.

For the second day in a row, local schools were closed, keeping schoolchildren and their yellow buses off the mountain roads in the midst of the search.

Still, as the search continued without new evidence, and the ski resort reopened, life in the town began to return to normal. Skiers and snowboarders flocked to the mountain to take advantage of the fresh powder. And both local residents and visitors expressed growing skepticism that Mr. Dorner was — or ever had been — in town. Instead, many thought the pickup truck was a diversion.

Cindy Johnston was in the Big Bear Lake area, about 100 miles east of Los Angeles, to ski with her family. “We’re being a little bit more careful, but that’s about it,” Ms. Johnston said. “We’re keeping the kids closer together and not going out so much at night. I think he’d be stupid if he was here, and he doesn’t seem stupid. There are too many people looking for him.”

Yvette Blunt, a Big Bear Lake resident, did not think Mr. Dorner was in town anymore, either.

“He left the car here to attract everyone here,” Ms. Blunt, 66, said. “That way, he can go somewhere else.”

This article has been revised to reflect the following correction:

Correction: February 8, 2013

An earlier version of this article misspelled, in some instances, the surname of the former police officer who the authorities say has killed at least three people as part of a rampage aimed at police officers and their families. It is Christopher J. Dorner, not Dornan.

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NBC pulls 'Do No Harm' after 2 low-rated episodes

LOS ANGELES (AP) — NBC is pulling the drama series "Do No Harm" after two low-rated episodes.

The show is a take on the story of Dr. Jekyll and Mr. Hyde, and stars Steven Pasquale of "Rescue Me." He plays a respected neurosurgeon who turns into a dangerous alter ego each night. Other cast members include Alana De La Garza and Phylicia Rashad.

"Do No Harm" started with a historically small audience for a major network debut and then dropped further in its second Thursday airing.

NBC will replace "Do No Harm" with reruns of "Law & Order: Special Victims Unit" for the next two weeks.

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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 brown 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.

Friday Feb. 8 4:13 p.m. | Updated Thanks for all your responses. You can read about the winner at “Think Like a Doctor: A Confused and Terrified Patient Solved.”

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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.

Correction: The patient’s eyes were brown, not blue.

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