The Curious Case of the Sweaty Nipples (Published in Boing Boing)

Since I'm a doctor, when I tell people that I wrote a book, they usually say, "oh, that's terrific, like, a textbook?" (assuredly relieved I won't ask them to buy it.) But, then I tell them, "no, actually, it's a mystery. It's called Little Black Lies, about a psychiatrist searching for the truth about her mother's death." Most people are a bit intrigued (or at least polite enough to humor me), and the question comes up. A neurologist writing a mystery — how does that happen?

Truthfully, the leap from neurologist to novelist isn't all that extreme.

As a doctor, I write stories all day. I see patients, distilling their lives into consults in a language rich with Latin and colorful syndromes. Patients are protagonists in their own novels, and with each patient visit, I write another chapter. They get married, divorced, have babies, switch gender, lose a hundred pounds, lives full of plot twists, romance, and intrigue. But, patients don't just come by to chat, they come for help. As soon as they step into the exam room, they are asking me to solve their problems - which makes me a mystery writer too.

Let me explain. Join me, for a day in the life of a neurologist.

It's 8:15 A.M. and we open our first chart.

The "chief complaint" (what brings the patient in) is written in capital letters at the top. "FALLING." Sometimes a chief complaint gives the whole story away, "head-ache," for instance, or "seizure." But falling is pretty vague - could be anything from Parkinson's disease to a sprained ankle. We knock on the door to see "Duncan," a sixteen-year-old male, on the examining table, anxious parents besides him.

Where do we begin? The first rule of seeing patients is: observe. How does our patient speak and move? How does he dress? In our case, Duncan is unkempt, his hair greasy. His voice is monotone, with minimal facial expression, also called a flat affect. On top of our scratch paper, we write: "depressed?"

But that's not why his parents brought him in. FALLING.

Now it's time for the story. Our chart may be thick with details, backstories and plot points: MRIs, CTs, EEGs, EKGs, EMGs and other acronyms a-plenty. But none of this matters without the patient's history, his story. We go with the usual opener. "How are you doing today?"

Not an auspicious start, but we push on. "I understand you've been falling?""I'm fine," he grumbles, not even looking up. "My parents are crazy."

"A little. Sometimes. It's not a big deal."

With supreme effort, we drag out the story that he fell a couple of times in gym, "when he and his friends were doing a prank." His parents say it's happening more than that. At first they thought it was a clumsy teenager thing. But the last time, Duncan was on the floor for ten minutes, completely unable to move.

"When did that happen?"

"Right after he stood up for his trumpet solo," the father answers.

Was he dizzy? Light-headed? Did he pass out?

No, no, and no. Duncan is very clear on this account. He "wilted" to the ground. He was not light-headed and didn't faint, the way he did once after his blood was drawn. This particular time, he could hear everything: the school nurse, the EMTs, but he still couldn't move. We add to the scratch pad: "seizure?"

"And," the mother adds, "he's been really tired."

New complaint. Falling and tired. "Is that so? How tired?"

"A little," Duncan admits.

The father steps in here. "Not just a little. He's falling asleep everywhere."

We probe further and find that the father is not exaggerating. Duncan falls asleep on the school bus, through his classes, at the dinner table, and even once while playing trumpet at band practice. He fell asleep at a heavy metal concert. He's not just a little tired, he's half-asleep.

"He's also having," the mother clears her throat, "hallucinations. We think."

Duncan reluctantly tells us about "shadows watching him and holding him down" when he falls asleep. Once he saw spiders dangling from the bedroom fan and tried to swipe them away, but he couldn't move. Oh, and one more thing, he's been getting head-aches lately. We scribble in "head-aches."

Next step: the physical exam. Performed and completely normal. We are now ready to pronounce the diagnosis, drum-roll please, when Duncan turns beet-red, and says, "oh, and my nipples have been kind of sweaty."

Wait a second, hold that. Let's rewind. Sweaty nipples?

We had just finished our jig-saw puzzle, and now we have one piece left with too many tabs. What do we do now? Let's take it step-by-step.

We have sleepiness, hallucinations, and falling. Slam-dunk diagnosis: narcolepsy with cataplexy. How did we get that? This degree of sleepiness is the hallmark of narcolepsy. Hallucinations (hypnagogic, or upon falling asleep, or hypnopompic, upon waking up - don't you love Latin?) are also common in narcolepsy, often paired with sleep paralysis, the sensation of being fully paralyzed while awake.

Then there's the reason Duncan came to see us in the first place, falling. But not just falling any old time, only in emotional situations. With laughter, or anxiety, such as playing a trumpet solo. Weakness in an emotional situation is called cataplexy. Remember those videos you saw in high school, of the dogs running to get their food then keeling right over? You got it, cataplectic dogs. And what could be more exciting than chow-time?

Narcolepsy with cataplexy is a fairly common disease, about 1/2000, the same rate as MS, and it often presents in teen-age years. No one really knows the cause, it's thought to be auto-immune, where the body fights against itself for unknown reasons, similar to diabetes or hypothyroidism. So we have our diagnosis, but what about those head-aches? And even more, what about those sweaty nipples?

Plot twist! We need to put our thinking caps back on. This mystery is not over. Duncan has narcolepsy with cataplexy. But, that's not all. He has secondary narcolepsy with cataplexy, meaning something else is causing it. In this case, the salient clue being his sweaty nipples. We suspect he may have a benign brain tumor.

Where did we come up with this one?

Well, Duncan is right, and he is wrong. His nipples are not sweating, they are lactating or producing milk, also known as galactorrhea. Yes, it is possible for a man to produce milk. Unusual, but not impossible. If the body is producing the wrong hormones and turning on the lactation glands, this can occur. Which is exactly what happens with an active pituitary adenoma, a benign tumor in the middle of the brain sending the pituitary gland into overdrive. Which can also, by the way, cause narcolepsy with cataplexy.

We do an MRI of the brain, and confirm it. Surgery is scheduled, tumor removed, and Duncan is cured. And, I get to write about that too.

s a writer, I love a good mystery. But as a doctor, I love a happy ending even more.

9 Tips to Deal With the Inevitable Success of Your First Novel

You've waited years for this. 

You've dreamt about it. Your novel prominently displayed on Barnes and Noble Nook wall, or front and center at your local indie. Five-star reviews from a million Amazon readers. A full-page NYT ad calling you the next Hemingway.         

After years of toiling at the pen (interspersed with frequent #amwriting tweets), finding an agent, scoring a book deal, posting the mandatory cover reveal, and counting the is finally here...the BIG PUB DAY!!! 
It's exhilarating, of course, but also a bit terrifying. 

Because you realize that soon, your life will be changing - drastically. Suddenly, you will be fielding phone calls from Ellen, negotiating million dollar movie deals, researching off-shore tax havens, and hanging out with James Patterson and the like. As a debut author myself, I have deeply considered (for hours, mainly in coffeehouses) both the perks and pitfalls of the massive, surefire success of the first novel. To be sure, the effect of overnight fame can be a bit overwhelming.
Thus, I offer some practical advice.
1) Buy some ear-plugs. The sold-out, raucous book-signing events can be quite loud, with the deafening noise of people screaming out your name. You may even want to book a baseline auditory assessment now, before any damage occurs. Amazon sells them in bulk, and for the fashionistas, they even come in pink.
2) Invest in body guards. Everyone will want a piece of you. People will leave desperate messages on your phone, slip notes with their hotel rooms onto the podium, and cross continents to stalk you. It's always wise to have a bodyguard on hand to deliver the crushing "thank you, but I'm not interested" message.
3) Take a writing break. Now is a good time to soak up praise and adulation. You might even want to consider obtaining a ghost-writer to lighten the load of all that tedious pen-to-paper. It's time to appreciate writing for what it is: a necessary evil on the way to exorbitant wealth and fame. 

4) Take an expensive vacation. You deserve it, and you can afford it! You might even want to plan it before your pub date...why not? Cabo San Lucas, Hawaii, your own Bahamian island? If it's good enough for Beyonce and President Clinton, it's good enough for you. 

5) Give to charity. Now that you have gobs of money, it's just a solid tax-planning strategy. Plus, it looks good.

6) Don't expect too much. You might not get the Pulitzer Prize for literature on your first try. (Well, okay, you might, but just don't expect it.)

7) Don't be afraid to be a little "obnoxious." Remember, you're the golden goose now. Agents, publishers, editors - they'll all be lining up to get a piece of the action. Without being downright unctuous, they should show you a certain degree of deference. At this point in your career, you certainly deserve it. 
8) Save tid-bits. Every item associated with you will have extra value now. A napkin you were going to throw out? A perfect sell on Ebay. A signed ARC? Might end up the winner at Sotheby's.

9) Remember the little people. Your parents, spouse, and children, for example. They knew you when you were a nobody - before your stratospheric rise to fame. They may not understand your greatness right now, but eventually they will. They also come in handy for photo ops and family-interest articles, so you should at least try to be nice to them.  

Of course, there's the minuscule, improbable chance that this won't happen to you. And If this is the case, don't despair. The truth is: you published a freaking novel! That, my friends, is an accomplishment. 

So, hold your head high, turn all your books face-forward in your local bookstore, and bask in your mother's praise. But don't rest on your laurels for too long - it's time to get started on your next novel! (Which of course, will be a smashing, life-altering success. See above nine tips to deal with this). 
In the meantime, buy my psychological thriller, LITTLE BLACK LIES. It came out on February 17th, while I was sunning in San Cabo. Follow me on twitter, or friend me. (You should really try to catch me now, before I'm mega-famous.) 

The Elusive Truth: Repressed Memories

Please see below  article in Criminal Element blog!

When Eileen looked into her daughter's blue eyes, she was struck by the resemblance to her childhood best friend, who'd been killed at eight years old. The case had never been solved. But at that moment, looking at her daughter, Eileen had a terrifying flashback of the murder in vivid detail. The screaming, the rape, the crushed skull...and the killer. Who, she remembered with sickening clarity, was her father. Over twenty years later, her father was found guilty of the murder based on these “repressed memories.” But, as psychologist Elizabeth Loftus asks in her article “Myth of the Repressed Memory,” were Eileen's memories actually real?

First, a primer on memory. We start forming memories around nine months old, when the frontal cortex develops. Like language, memory is housed in the brain, within the temporal lobes. We figured this out in 1953, when a well-meaning surgeon cut out the temporal lobes of “Patient H.M.” to stop his seizures. Luckily, his epilepsy was cured, but unluckily, he also suffered severe short-term memory loss. Not “where did I just put my phone?” memory loss; he was completely unable to create new memories. If a stranger rang his doorbell, H.M. would answer and have a polite conversation. If the stranger then shut the door and opened it ten seconds later, H.M. would answer and have a polite conversation all over again. And so on.

Over time, we've learned a great deal about the neurological aspects of memory, its origin in the hippocampus, and processing and storing in the surrounding cortex. Through MRI and PET studies, we can now pinpoint the exact areas of memory formation and retrieval. We now know a lot about how we create memories.

What we don't understand is how we lose them.

I'm not referring to dementia here or the loss of memory through neurofibrillary tangles, brain atrophy, or other neurological dysfunction. I'm talking about “memory repression,” losing memory due to an emotionally traumatic event, just as the prosecutors claimed that Eileen did. The prickly question of “blocking” or repressing memories is not just murky, it's downright controversial. Vitriolic debates about memory repression have raged on for years between neuroscientists and psychologists.

Freud started it. Most of us have learned about Freud and his theory of the conscious and subconscious. Freud also had theories about memory. He posited that humans repress unpleasant or negative thoughts into the subconscious, leaving only functional, more constructive thoughts in the conscious mind. Thus, if an event is too traumatic for the brain to process, the memory is blocked or pushed into the subconscious.

“Hogwash!” the neuroscientists say.

“Isn't!” the neuropsychologists yell back. And thus we have a stand-off.

The truth is: no one really knows. It is clear that survivors of sexual abuse and other severe trauma at a young age may not fully remember these events. They may recall them later in life as flashbacks, just as war veterans who suffer PTSD. Blocked childhood trauma is one of the pervasive theories behind dissociative identity disorder (formerly known as multiple personality disorder), where patients enter a fugue-like state and lose time, sometimes spent as an alternate personality.

In Little Black Lies, my psychological thriller, Dr. Zoe Goldman is a psychiatrist who is well-versed in Freud and the theories of memory. When Zoe was only four, her mother died in a house fire. She remembers only fragments of that fateful night, and like other PTSD patients, still suffers nightmares from it. Working with her psychiatrist—yes, a psychiatrist sees a psychiatrist—she tries to recover memories through hypnosis (a fairly debunked method at memory retrieval, and in fact one which Eileen may have utilized). To make matters worse, her adoptive mother is declining from dementia and cannot provide reliable memories to help her daughter.

Little Black Lies is a mystery about the mystery of memory, the perilous boundary between what our brain allows us to remember and what we cannot help but forget.