Livestrong Tattoos as Reminder of Personal Connections, Not Tarnished Brand

As Jax Mariash went under the tattoo needle to have “Livestrong” emblazoned on her wrist in bold black letters, she did not think about Lance Armstrong or doping allegations, but rather the 10 people affected by cancer she wanted to commemorate in ink. It was Jan. 22, 2010, exactly a year since the disease had taken the life of her stepfather. After years of wearing yellow Livestrong wristbands, she wanted something permanent.

A lifelong runner, Mariash got the tattoo to mark her 10-10-10 goal to run the Chicago Marathon on Oct. 10, 2010, and fund-raising efforts for Livestrong. Less than three years later, antidoping officials laid out their case against Armstrong — a lengthy account of his practice of doping and bullying. He did not contest the charges and was barred for life from competing in Olympic sports.

“It’s heartbreaking,” Mariash, of Wilson, Wyo., said of the antidoping officials’ report, released in October, and Armstrong’s subsequent confession to Oprah Winfrey. “When I look at the tattoo now, I just think of living strong, and it’s more connected to the cancer fight and optimal health than Lance.”

Mariash is among those dealing with the fallout from Armstrong’s descent. She is not alone in having Livestrong permanently emblazoned on her skin.

Now the tattoos are a complicated, internationally recognized symbol of both an epic crusade against cancer and a cyclist who stood defiant in the face of accusations for years but ultimately admitted to lying.

The Internet abounds with epidermal reminders of the power of the Armstrong and Livestrong brands: the iconic yellow bracelet permanently wrapped around a wrist; block letters stretching along a rib cage; a heart on a foot bearing the word Livestrong; a mural on a back depicting Armstrong with the years of his now-stripped seven Tour de France victories and the phrase “ride with pride.”

While history has provided numerous examples of ill-fated tattoos to commemorate lovers, sports teams, gang membership and bands that break up, the Livestrong image is a complex one, said Michael Atkinson, a sociologist at the University of Toronto who has studied tattoos.

“People often regret the pop culture tattoos, the mass commodified tattoos,” said Atkinson, who has a Guns N’ Roses tattoo as a marker of his younger days. “A lot of people can’t divorce the movement from Lance Armstrong, and the Livestrong movement is a social movement. It’s very real and visceral and embodied in narrative survivorship. But we’re still not at a place where we look at a tattoo on the body and say that it’s a meaningful thing to someone.”

Geoff Livingston, a 40-year-old marketing professional in Washington, D.C., said that since Armstrong’s confession to Winfrey, he has received taunts on Twitter and inquiries at the gym regarding the yellow Livestrong armband tattoo that curls around his right bicep.

“People see it and go, ‘Wow,’ ” he said, “But I’m not going to get rid of it, and I’m not going to stop wearing short sleeves because of it. It’s about my family, not Lance Armstrong.”

Livingston got the tattoo in 2010 to commemorate his brother-in-law, who was told he had cancer and embarked on a fund-raising campaign for the charity. If he could raise $5,000, he agreed to get a tattoo. Within four days, the goal was exceeded, and Livingston went to a tattoo parlor to get his seventh tattoo.

“It’s actually grown in emotional significance for me,” Livingston said of the tattoo. “It brought me closer to my sister. It was a big statement of support.”

For Eddie Bonds, co-owner of Rabbit Bicycle in Hill City, S.D., getting a Livestrong tattoo was also a reflection of the growth of the sport of cycling. His wife, Joey, operates a tattoo parlor in front of their store, and in 2006 she designed a yellow Livestrong band that wraps around his right calf, topped off with a series of small cyclists.

“He kept breaking the Livestrong bands,” Joey Bonds said. “So it made more sense to tattoo it on him.”

“It’s about the cancer, not Lance,” Eddie Bonds said.

That was also the case for Jeremy Nienhouse, a 37-year old in Denver, Colo., who used a Livestrong tattoo to commemorate his own triumph over testicular cancer.

Given the diagnosis in 2004, Nienhouse had three rounds of chemotherapy, which ended on March 15, 2005, the date he had tattooed on his left arm the day after his five-year anniversary of being cancer free in 2010. It reads: “3-15-05” and “LIVESTRONG” on the image of a yellow band.

Nienhouse said he had heard about Livestrong and Armstrong’s own battle with the cancer around the time he learned he had cancer, which alerted him to the fact that even though he was young and healthy, he, too, could have cancer.

“On a personal level,” Nienhouse said, “he sounds like kind of a jerk. But if he hadn’t been in the public eye, I don’t know if I would have been diagnosed when I had been.”

Nienhouse said he had no plans to have the tattoo removed.

As for Mariash, she said she read every page of the antidoping officials’ report. She soon donated her Livestrong shirts, shorts and running gear. She watched Armstrong’s confession to Winfrey and wondered if his apology was an effort to reduce his ban from the sport or a genuine appeal to those who showed their support to him and now wear a visible sign of it.

“People called me ‘Miss Livestrong,’ ” Mariash said. “It was part of my identity.”

She also said she did not plan to have her tattoo removed.

“I wanted to show it’s forever,” she said. “Cancer isn’t something that just goes away from people. I wanted to show this is permanent and keep people remembering the fight.”

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Daley turns focus toward Gary

Richard M. Daley has kept a low profile since leaving office in 2011.

That doesn't mean he has lost interest in urban issues. The former mayor has turned his attention in a surprising direction, beyond Chicago's borders to one of the most intractable urban tragedies in America: the collapse of Gary, Ind.

"I always believe no part of America should be forgotten, and I think Gary has been forgotten," Daley said.

Daley is using his influence at the University of Chicago, where he is a distinguished senior fellow, to push a modest but growing amount of manpower toward Gary Mayor Karen Freeman-Wilson.

With guidance from Daley and Freeman-Wilson, University of Chicago graduate students are trying to figure out what to do with Gary's abandoned buildings and how to promote greater use of technology to help the city accomplish more with less, among other projects.

The hope is that the students will go on to help other cities after graduation. If successful, the U. of C.-Gary partnership could be replicated in other industrial towns grappling with decline.

Gary spans about 55 square miles, nearly a quarter of the size of Chicago. Yet the steel town's population has plummeted to an estimated 80,000, meaning the city has lost about half its people since 1960. The city's problems have mounted, including abandoned buildings and homes, sagging infrastructure and a declining budget to pay for services.

Outsiders have tried to fix Gary since at least the Lyndon B. Johnson administration. Freeman-Wilson, a former Indiana attorney general, judge and Harvard College and Harvard Law School graduate, has reinvigorated Gary's renewal efforts. And she's unafraid to ask for help.

Immediately after winning the 2011 Democratic primary, Freeman-Wilson called Daley for advice. They met, and Daley invited her to be the first guest speaker at his lecture series at the University of Chicago's Harris School of Public Policy, where Daley has a five-year appointment.

This quarter, 11 students from the university's public policy, business and social services schools are getting course credit for working on projects for Gary.

"It was Mayor Daley's idea," Freeman-Wilson said as she rode from a meeting on Chicago's West Side to Gary. "I had always envisioned getting the support and work from (University of Chicago Law School) alums, because there were issues around codes and things of that nature. It was not until the mayor came up with the idea of using students from the (Harris) School of Public Policy that I said, 'Oh yeah, that would work. That would work very well.'"

Daley does not teach a class at the University of Chicago. He runs an occasional lecture series.

Carol Brown, his last policy chief at City Hall, leads the program and the class, which is called the "Urban Revitalization Project: City of Gary, Ind." Grants from the Chicago-based Joyce and MacArthur foundations help pay administrative costs, including Brown's salary and that of a part-time assistant.

Last quarter's class was divided into three project teams. One team is cataloging Gary's abandoned buildings, which are magnets for crime and eyesores that further depress surrounding property values. Another is trying to recruit pro bono legal and consulting services for the city. And a third is trying to craft a strategy to clean up front stoops and empty lots one block at a time. This quarter's class also is tackling untapped funding opportunities and economic development.

Freeman-Wilson said a major benefit of the partnership is the fresh ideas from students "who aren't jaded by the limitations of government, whereas a 20-year employee might say, 'Oh, no, we can't do that in government because we don't have X, Y and Z.'"

Already their work has prompted more widespread use among Gary employees of a technology that stores and analyzes geographic data. City workers are now using the technology to map potholes, fallen tree limbs and illegal dump sites. That way work crews can be dispatched to neighborhoods where the problems are most severe.

"This partnership encourages urban planners to think broadly about regions instead of cities — greater Chicago instead of the city of Chicago," said Stephen Paul O'Hara, a historian at Xavier University who wrote a book about Gary.

The students operate as consultants. They gather best practices and ideas from cities around the country and then recommend a course of action. At the end of each 10-week quarter, students present their recommendations to Daley, Freeman-Wilson and their staffs. Their grades are based on those presentations and supporting reports.

"I will tell you, it never stops getting nerve-wracking," second-year graduate student Jocelyn Hare said of presenting to Daley. "But it gets easier."

Last spring, Hare, 32, responded to an email seeking student volunteers to conduct preliminary research to test the idea of a partnership. Hare then interned for the city of Gary during the summer. The Harris school paid her $15 an hour. She then enrolled in the first class in the fall and again this winter, when it was opened to graduate students outside of Harris for the first time.

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Obama addresses gun violence, economy in Chicago

At a school on Chicago's South Side, President Barack Obama discussed gun violence in America, and specifically Chicago.

President Barack Obama returned to Chicago for a few hours Friday to address the high-profile gun violence that continues to plague his hometown and suggested the solution is not only more gun laws, but community intervention and economic opportunity in impoverished neighborhoods.

The president didn't delve into his specific call for an assault weapons ban and other gun control measures, instead choosing to illustrate Chicago's plight by comparing it to the December elementary school massacre in Newtown, Conn., where 20 children and six adults were shot.

"There was something profound and uniquely heartbreaking and tragic, obviously, about a group of 6-year-olds being killed," Obama told an audience in the gymnasium of Hyde Park Academy High School, less than a mile from his home. "But last year, there were 443 murders with a firearm on the streets of this city, and 65 of those victims were 18 and under. So that's the equivalent of a Newtown every four months."

Obama was introduced by his former White House chief of staff, Mayor Rahm Emanuel, who has been struggling to get a grip on the violence that threatens to define his first term in office. Homicides and shootings both were up by double-digit percentages last year, and last month marked the city's most violent January since 2002.

The president's visit brought a national and international spotlight on Chicago's gun violence. Emanuel sought to make the case Chicago's struggles aren't particular to this city.

"Like every major city in the country, Chicago faces two critical challenges: the strength of our schools and the safety of our streets. Our streets will only be as safe as our schools are strong and our families are sound," Emanuel said.

But the president brought the violence issue back to the city's streets, talking about the impact the shooting death of 15-year-old Hadiya Pendleton has had on him and first lady Michelle Obama, who attended the band majorette's funeral last weekend. Hadiya was shot in Harsh Park in North Kenwood after returning from Chicago from inauguration weekend festivities.

The teen's mother, Cleopatra Cowley-Pendleton, joined the 700 or so students, politicians and religious leaders in the audience, sitting with a group of other mothers of slain children.

"We need to do whatever we can to make sure there is no easy access to guns by people who are not supposed to have them," she said.

The president, a former Illinois state senator, nodded to the difficulty in getting gun control legislation passed at the state level, while making the case for a vote on a federal gun control package. "The experience in gun ownership is different in urban areas than it is in rural areas, different from upstate and downstate Illinois," he said. "But these proposals deserve a vote in Congress. They deserve a vote."

But Obama also acknowledged that "no law or set of laws can prevent every senseless act of violence."

"When a child opens fire on another child, there's a hole in that child's heart that government can't fill — only community and parents and teachers and clergy can fill that hole," he said.

Part of the solution, the president said, is to improve the economy and build the middle class, themes from Tuesday's State of the Union address. Obama spent the remainder of his 25-minute speech here making the case for early childhood education, targeted development in blighted areas and better job opportunities as a way to strengthen families and ultimately deter people from violence.

"If a child grows up with parents who have work, and have some education, and can be role models, and can teach integrity and responsibility, and discipline and delayed gratification — all those things give a child the kind of foundation that allows them to say, 'my future, I can make it what I want,'" he said.

The Chicago speech was billed by the White House as one of several stops the president is making to press for the economic package outlined in his State of the Union speech. But the crowd was packed with gun control advocates.

The Rev. Michael Pfleger, a longtime supporter of stronger firearms laws, said Obama's appearance is not an embarrassment for Emanuel. "Nobody asked that when the president went to Tucson" after a gunman wounded then-U.S. Rep. Gabby Giffords and killed six others, Pfleger said.

Rather, Pfleger said he expects the president's speech will mark the beginning of a new federal focus on urban violence. "It's not to embarrass anybody, it's just to help us deal with an issue that needs White House administration, Justice Department, Education Department, all the way down to the parent on the street," Pfleger said.

"When he comes, his administration comes behind him," Pfleger said. "So all of a sudden, if coming out of this becomes not only the focus on urban America, this has not been done before," Pfleger said. "This is saying we're recognizing in America what we've been ignoring for a long time. The primary victim of violence in this country has been black and brown ... so now (Obama) is putting the attention on it."

Obama was scheduled to take the stage at 2:40 p.m., but didn't begin his speech till about 3:30 p.m. During the delay, federal charges were announced against former U.S. Rep. Jesse Jackson Jr. — a co-chairman of Obama's 2008 presidential campaign and an early key supporter of his 2004 U.S. Senate bid — and Jackson's wife, former 7th Ward Ald. Sandi Jackson.

Before taking the stage, Obama met for more than an hour with a group of students involved in a youth mentoring program at the school called Becoming A Man, run by Youth Guidance.

"He told us there are other ways to deal with anger than picking up a gun," said Trai Germain, 17, who added that anger is the primary reason for the violence. "They are angry because they are struggling every day and waking up and not having anything."

Devon Lowery, 18, a senior at the school, said he was unaware that Obama, like himself, was raised by a single mother and barely knew his father.

"I thought about my own father," Lowery said. "He left me when I was 5, and now he is trying to be back in my life. But it's too late. I'm grown now."

Tribune reporter Monique Garcia and Tribune Newspapers Washington correspondent Kathleen Hennessey contributed.

jebyrne@tribune.com dglanton@tribune.com

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Fat Dad: Baking for Love

Fat Dad

Dawn Lerman writes about growing up with a fat dad.

My grandmother Beauty always told me that the way to a man’s heart was through his stomach, and by the look of pure delight on my dad’s face when he ate a piece of warm, homemade chocolate cake, or bit into a just-baked crispy cookie, I grew to believe this was true. I had no doubt that when the time came, and I liked a boy, that a batch of my gooey, rich, chocolatey brownies would cast him under a magic spell, and we would live happily ever.

But when Hank Thomas walked into Miss Seawall’s ninth grade algebra class on a rainy, September day and smiled at me with his amazing grin, long brown hair, big green eyes and Jimi Hendrix T-shirt, I was completely unprepared for the avalanche of emotions that invaded every fiber of my being. Shivers, a pounding heart, and heat overcame me when he asked if I knew the value of 1,000 to the 25th power. The only answer I could think of, as I fumbled over my words, was “love me, love me,” but I managed to blurt out “1E+75.” I wanted to come across as smart and aloof, but every time he looked at me, I started stuttering and sweating as my face turned bright red. No one had ever looked at me like that: as if he knew me, as if he knew how lost I was and how badly I needed to be loved.

Hank, who was a year older than me, was very popular and accomplished. Unlike other boys who were popular for their looks or athletic skills, Hank was smart and talented. He played piano and guitar, and composed the most beautiful classical and rock concertos that left both teachers and students in awe.

Unlike Hank, I had not quite come into my own yet. I was shy, had raggedy messy hair that I tied back into braids, and my clothes were far from stylish. My mother and sister had been on the road touring for the past year with the Broadway show “Annie.” My sister had been cast as a principal orphan, and I stayed home with my dad to attend high school. My dad was always busy with work and martini dinners that lasted late into the night. I spent most of my evenings at home alone baking and making care packages for my sister instead of coercing my parents to buy me the latest selection of Gloria Vanderbilt jeans — the rich colored bluejeans with the swan stitched on the back pocket that you had to lie on your bed to zip up. It was the icon of cool for the popular and pretty girls. I was neither, but Hank picked me to be his math partner anyway.

With every equation we solved, my love for Hank became more desperate. After several months of exchanging smiles, I decided to make Hank a batch of my chocolate brownies for Valentine’s Day — the brownies that my dad said were like his own personal nirvana. My dad named them “closet” brownies, because when I was a little girl and used to make them for the family, he said that as soon as he smelled them coming out of the oven, he could imagine dashing away with them into the closet and devouring the whole batch.

After debating for hours if I should make the brownies with walnuts or chips, or fill the centers with peanut butter or caramel, I got to work. I had made brownies hundreds of times before, but this time felt different. With each ingredient I carefully stirred into the bowl, my heart began beating harder. I felt like I was going to burst from excitement. Surely, after Hank tasted these, he would love me as much as I loved him. I was not just making him brownies. I was showing him who I was, and what mattered to me. After the brownies cooled, I sprinkled them with a touch of powdered sugar and wrapped them with foil and red tissue paper. The next day I placed them in Hank’s locker, with a note saying, “Call me.”

After seven excruciating days with no call, some smiles and the usual small talk in math class, I conjured up the nerve to ask Hank if he liked my brownies.

“The brownies were from you?” he asked. “They were delicious.”

Then Hank invited me to a party at his house the following weekend. Without hesitation, I responded that I would love to come. I pleaded with my friend Sarah to accompany me.

As the day grew closer, I made my grandmother Beauty’s homemade fudge — the chocolate fudge she made for Papa the night before he proposed to her. Stirring the milk, butter and sugar together eased my nerves. I had never been to a high school party before, and I didn’t know what to expect. Sarah advised me to ditch the braids as she styled my hair, used a violet eyeliner and lent me her favorite V-neck sweater and a pair of her best Gloria Vanderbilt jeans.

When we walked in the door, fudge in hand, Hank was nowhere to be found. Thinking I had made a mistake for coming and getting ready to leave, I felt a hand on my back. It was Hank’s. He hugged me and told me he was glad I finally arrived. When Hank put his arm around me, nothing else existed. With a little help from Cupid or the magic of Beauty’s recipes, I found love.

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Fat Dad’s ‘Closet’ Brownies

These brownies are more like fudge than cake and contain a fraction of the flour found in traditional brownie recipes. My father called them “closet” brownies, because when he smelled them coming out of the oven he could imagine hiding in the closet to eat the whole batch. I baked them in the ninth grade for a boy that I had a crush on, and they were more effective than Cupid’s arrow at winning his heart.

6 tablespoons unsalted butter, plus extra for greasing the pan
8 ounces bittersweet chocolate, chopped, or semisweet chocolate chips
3/4 cup brown sugar
2 eggs at room temperature, beaten
1 teaspoon vanilla extract
1/4 cup flour
1/2 cup chopped walnuts (optional)
Fresh berries or powdered sugar for garnish (optional)

1. Preheat oven to 350 degrees.

2. Grease an 8-inch square baking dish.

3. In a double boiler, melt chocolate. Then add butter, melt and stir to blend. Remove from heat and pour into a mixing bowl. Stir in sugar, eggs and vanilla and mix well.

4. Add flour. Mix well until very smooth. Add chopped walnuts if desired. Pour batter into greased baking pan.

5. Bake for 35 minutes, or until set and barely firm in the middle. Allow to cool on a rack before removing from pan. Optional: garnish with powdered sugar, or berries, or both.

Yield: 16 brownies

---

Dawn Lerman is a New York-based health and nutrition consultant and founder of Magnificent Mommies, which provides school lectures, cooking classes and workshops. Her series on growing up with a fat father appears occasionally on Well.

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Billionaire Sears CEO reveals lower Gap stake

Sears CEO Edward Lampert has upped his stake in Gap Inc. (Spencer Platt / Getty Images)

By Corilyn Shropshire




Tribune reporter

5:20 p.m. CST, February 15, 2013

Sears Chairman and CEO Edward Lampert has reduced his stake in The Gap Inc., according to security filings.

Lampert shed roughly 4 percent of his shares in the San Francisco-based retailer by Dec. 31, 2012, according to documents filed Thursday with the Securities and Exchange Commission.  He currently holds 25.3 million shares, personally and through his investment groups, ESL Partners, RBS Partners, LP and ESL Investments.

In 2012, Lampert reported that he held a 9.3 percent stake or 45.2 million shares.

Lampert is the billionaire hedge fund manager who engineered the merger of Sears and Kmart in 2005.  Since then, Sears has struggled to maintain its place with years of declining sales and executive changeover.  The company has focused on building loyalty rewards program and online business which officials said grew by 20 percent last year. 

Shares of The Gap, which also operates brands Banana Republic, Old Navy, Piperlime and Athleta closed up nearly 5 percent at $32.87 on Friday, in part due to news about Lampert’s boosted interested in the retailer and on speculation that Uniqlo-owner and Japan-based Fast Retailing, Ltd.  is also interested in the retailer.

The Gap has been on an upswing beating analysts estimates with holiday and January sales.  The retailer said sales in stores open at least were up 8 percent to $1.13 billion in January. 

Lampert, who has several retail holdings including Columbus, Oh-based Big Lots Inc., also decreased his interest Fort Lauderdale-based AutoNation, Inc. by about $13.5 million to $34.5 million and purchased 844, 926 shares of Pleasanton, Calif-based Safeway Inc. 

crshropshire@tribune.com | Twitter: @corilyns

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Stricken cruise ship docks in Alabama

MOBILE, Alabama—

Reeking of raw sewage, a crippled cruise ship carrying more than 4,200 people docked at a port in Mobile, Alabama, on Thursday as passengers waved towels and flashlights to greet the end of a voyage some described as hellish.

Tugboats pulled the Carnival Triumph into port in a drama that played out live on U.S. cable news stations, creating another public relations nightmare for cruise giant Carnival Corp. Last year, its Costa Concordia luxury ship grounded off the coast of Italy, with 32 people killed.

Passengers lined the decks and cheered as the ship reached the dock.

Over the last four days, passengers described an overpowering stench on parts of the ship after an engine room fire knocked out power and plumbing across most of the 893-foot vessel and left it adrift in the Gulf of Mexico. The ship, which went into service in 1999, was on a four-day cruise and on its way back from a stop in Cozumel, Mexico.

After the mishap, toilets and drainpipes overflowed, soaking many cabins and interior passages in sewage and turning the vessel into what some have described as a giant Petri dish.

"The thing I'm looking forward to most is having a working toilet and not having to breathe in the smell of fecal matter," said Jacob Combs, an Austin, Texas-based sales executive with a healthcare and hospice company.

Combs, 30, who said he had been traveling with friends and family on the Triumph, had nothing but praise for its crew members, saying they had gone through "hell" cleaning up after some of the passengers on the sea cruise.

"Just imagine the filth," Combs told Reuters. "People were doing crazy things and going to the bathroom in sinks and showers. It was inhuman. The stewards would go in and clean it all up. They were constantly cleaning," he said.

Terry Thornton, a Carnival Cruise Lines senior vice president, told reporters in Mobile that additional provisions were laid in on Wednesday and the ship was now "in excellent shape."

Passenger Donna Gutzman said those aboard the ship were treated to steak and lobster for lunch on Thursday afternoon.

"Our basic needs are being met. For the most part, they are making us happy," Gutzman told CNN.

A senior Carnival official said it could take up to five hours to remove all the passengers from the ship, which has only one functioning elevator.

Carnival said it would greet the passengers with warm food, blankets and cell phones.

Once off the ship, many passengers still had a lengthy journey ahead. More than 100 buses were lined up waiting to drive some passengers the 490 miles back to Galveston, Texas, while other passengers had elected to stay overnight in hotels in Mobile before flying home, Carnival said.

Operated by Carnival Cruise Lines, the flagship brand of Carnival Corp, the ship left Galveston a week ago carrying 3,143 passengers and 1,086 crew. It was supposed to return there on Monday.

A Coast Guard cutter escorted the Triumph on its long voyage into port since Monday, and a Coast Guard helicopter ferried about 3,000 pounds of equipment including a generator to the stricken ship late on Wednesday.

Earlier in the week, some passengers reported on the poor conditions on the Triumph when they contacted relatives and media before their cell phone batteries died. They said people were getting sick and passengers had been told to use plastic "biohazard" bags as makeshift toilets.

Smoke from the engine fire was so thick that passengers on the lower decks in the rear of the ship had to be permanently evacuated and slept the rest of the voyage on the decks under sheets, passengers said.

'VERY CHALLENGING CIRCUMSTANCES'

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Doctor and Patient: Afraid to Speak Up to Medical Power

The slender, weather-beaten, elderly Polish immigrant had been diagnosed with lung cancer nearly a year earlier and was receiving chemotherapy as part of a clinical trial. I was a surgical consultant, called in to help control the fluid that kept accumulating in his lungs.

During one visit, he motioned for me to come closer. His voice was hoarse from a tumor that spread, and the constant hissing from his humidified oxygen mask meant I had to press my face nearly against his to understand his words.

“This is getting harder, doctor,” he rasped. “I’m not sure I’m up to anymore chemo.”

I was not the only doctor that he confided to. But what I quickly learned was that none of us was eager to broach the topic of stopping treatment with his primary cancer doctor.

That doctor was a rising superstar in the world of oncology, a brilliant physician-researcher who had helped discover treatments for other cancers and who had been recruited to lead our hospital’s then lackluster cancer center. Within a few months of the doctor’s arrival, the once sleepy department began offering a dazzling array of experimental drugs. Calls came in from outside doctors eager to send their patients in for treatment, and every patient who was seen was promptly enrolled in one of more than a dozen well-documented treatment protocols.

But now, no doctors felt comfortable suggesting anything but the most cutting-edge, aggressive treatments.

Even the No. 2 doctor in the cancer center, Robin to the chief’s cancer-battling Batman, was momentarily taken aback when I suggested we reconsider the patient’s chemotherapy plan. “I don’t want to tell him,” he said, eyes widening. He reeled off his chief’s vast accomplishments. “I mean, who am I to tell him what to do?”

We stood for a moment in silence before he pointed his index finger at me. “You tell him,” he said with a smile. “You tell him to consider stopping treatment.”

Memories of this conversation came flooding back last week when I read an essay on the problems posed by hierarchies within the medical profession.

For several decades, medical educators and sociologists have documented the existence of hierarchies and an intense awareness of rank among doctors. The bulk of studies have focused on medical education, a process often likened to military and religious training, with elder patriarchs imposing the hair shirt of shame on acolytes unable to incorporate a profession’s accepted values and behaviors. Aspiring doctors quickly learn whose opinions, experiences and voices count, and it is rarely their own. Ask a group of interns who’ve been on the wards for but a week, and they will quickly raise their hands up to the level of their heads to indicate their teachers’ status and importance, then lower them toward their feet to demonstrate their own.

It turns out that this keen awareness of ranking is not limited to students and interns. Other research has shown that fully trained physicians are acutely aware of a tacit professional hierarchy based on specialties, like primary care versus neurosurgery, or even on diseases different specialists might treat, like hemorrhoids and constipation versus heart attacks and certain cancers.

But while such professional preoccupation with privilege can make for interesting sociological fodder, the real issue, warns the author of a courageous essay published recently in The New England Journal of Medicine, is that such an overly developed sense of hierarchy comes at an unacceptable price: good patient care.

Dr. Ranjana Srivastava, a medical oncologist at the Monash Medical Centre in Melbourne, Australia, recalls a patient she helped to care for who died after an operation. Before the surgery, Dr. Srivastava had been hesitant to voice her concerns, assuming that the patient’s surgeon must be “unequivocally right, unassailable, or simply not worth antagonizing.” When she confesses her earlier uncertainty to the surgeon after the patient’s death, Dr. Srivastava learns that the surgeon had been just as loath to question her expertise and had assumed that her silence before the surgery meant she agreed with his plan to operate.

“Each of us was trying our best to help a patient, but we were also respecting the boundaries and hierarchy imposed by our professional culture,” Dr. Srivastava said. “The tragedy was that the patient died, when speaking up would have made all the difference.”

Compounding the problem is an increasing sense of self-doubt among many doctors. With rapid advances in treatment, there is often no single correct “answer” for a patient’s problem, and doctors, struggling to stay up-to-date in their own particular specialty niches, are more tentative about making suggestions that cross over to other doctors’ “turf.” Even as some clinicians attempt to compensate by organizing multidisciplinary meetings, inviting doctors from all specialties to discuss a patient’s therapeutic options, “there will inevitably be a hierarchy at those meetings of who is speaking,” Dr. Srivastava noted. “And it won’t always be the ones who know the most about the patient who will be taking the lead.”

It is the potentially disastrous repercussions for patients that make this overly developed awareness of rank and boundaries a critical issue in medicine. Recent efforts to raise safety standards and improve patient care have shown that teams are a critical ingredient for success. But simply organizing multidisciplinary lineups of clinicians isn’t enough. What is required are teams that recognize the importance of all voices and encourage active and open debate.

Since their patient’s death, Dr. Srivastava and the surgeon have worked together to discuss patient cases, articulate questions and describe their own uncertainties to each other and in patients’ notes. “We have tried to remain cognizant of the fact that we are susceptible to thinking about hierarchy,” Dr. Srivastava said. “We have tried to remember that sometimes, despite our best intentions, we do not speak up for our patients because we are fearful of the consequences.”

That was certainly true for my lung cancer patient. Like all the other doctors involved in his care, I hesitated to talk to the chief medical oncologist. I questioned my own credentials, my lack of expertise in this particular area of oncology and even my own clinical judgment. When the patient appeared to fare better, requiring less oxygen and joking and laughing more than I had ever seen in the past, I took his improvement to be yet another sign that my attempt to talk about holding back chemotherapy was surely some surgical folly.

But a couple of days later, the humidified oxygen mask came back on. And not long after that, the patient again asked for me to come close.

This time he said: “I’m tired. I want to stop the chemo.”

Just before he died, a little over a week later, he was off all treatment except for what might make him comfortable. He thanked me and the other doctors for our care, but really, we should have thanked him and apologized. Because he had pushed us out of our comfortable, well-delineated professional zones. He had prodded us to talk to one another. And he showed us how to work as a team in order to do, at last, what we should have done weeks earlier.

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Buffet, 3G to buy Heinz for $23B

Warren Buffett's Berkshire Hathaway and private equity firm 3G Capital will buy ketchup and baby food maker H.J. Heinz Co for $23.2 billion in cash, a deal that combines 3G's ambitions in the food industry with Buffett's hunt for growth.

Including debt assumption, Heinz valued the transaction, which it called the largest in its industry's history, at $28 billion. Berkshire and 3G will pay $72.50 per share, a 19 percent premium to the stock's previous all-time high. Heinz shares actually rose slightly above the offer price, although Buffett cautioned he had no intention of raising his bid.

Analysts said the deal could be the first step in a broader wave of mergers for the food and beverage industry.

"Maybe for the consumer staples group in general this may start some talk about consolidation. Even corporate entities are flush with cash, interest rates are low, it would seemingly make sense," Edward Jones analyst Jack Russo said.

Companies like General Mills and Campbell Soup - itself long seen as a potential Heinz merge partner - rose on the news.

BUFFETT HUNTING GROWTH

The surprise purchase satisfies, at least in part, Buffett's hunt for growth through acquisition. He was frustrated in 2012 by the collapse of at least two deals in excess of $20 billion and said he might have to do a $30 billion deal this year to help fuel Berkshire's growth engine. In this case, Berkshire is putting up about $12 billion to $13 billion cash, Buffett told CNBC, leaving it ample room for another major transaction.

Berkshire Hathaway already has a variety of food assets, including the Dairy Queen ice cream chain, chocolatier See's Candies and the food distributor McLane. Buffett, famed for a love of cheeseburgers, joked he was well acquainted with Heinz's products already and that this was "my kind of deal."

It does represent an unusual teaming of Berkshire with private equity, though; historically, Buffett's purchases have been outright his own. He and 3G founder Jorge Paulo Lemann have known each other for years, and Buffett said Lemann approached him with the Heinz idea in December. One Berkshire investor said he had mixed feelings about the deal because of the limited growth prospects domestically.

"We're a little hesitant on the staple companies because they don't have any leverage in the United States," said Bill Smead, chief investment officer of Smead Capital Management in Seattle. But at the same time, he said, Buffett was likely willing to accept a bond-like steady return even if it was not necessarily a "home run."

3G EXPANDS

For 3G, a little-known firm with Brazilian roots, the purchase is something of a natural complement to its investment in fast-food chain Burger King, which it acquired in late 2010 and in which it still holds a major stake. Lemann, a globe-trotting financier with Swiss roots, made his money in banking and gained notoriety for helping to pull together the deals that ultimately formed the beer brewing giant AB InBev.

3G's Alex Behring runs the fund out of New York. He appeared at a Pittsburgh news conference on Thursday with Heinz management to discuss the deal - and to reassure anxious local crowds that the company will remain based there and will continue to support local philanthropy.

But at the same time, Behring said it was too soon to talk about cost cuts at the company. Unlike Berkshire, which is a hands-off operator, 3G is known for aggressively controlling costs at its operations.

PITTSBURGH ROOTS Also to be determined is whether CEO Bill Johnson would stay on. Only the fifth chairman in the company's history, Johnson is widely credited with Heinz's recent strong growth.

"I am way too young to retire," he told the news conference, adding that discussions had not yet started with 3G over the details of Heinz's future management.

The company, known for its iconic ketchup bottles, Heinz 57 sauces as well as other brands including Ore-Ida frozen potatoes, has increased net sales for the last eight fiscal years in a row.

Heinz said the transaction would be financed with cash from Berkshire and 3G, debt rollover and debt financing from J.P. Morgan and Wells Fargo. Buffett told CNBC that Berkshire and 3G would be equal equity partners.

Heinz shares soared 19.9 percent, or $12.06, to $72.54 on the New York Stock Exchange. A week ago the stock hit a long-term high of $61 a share - near records it set in 1998 - having risen almost 5 percent this year and nearly 12 percent since the beginning of 2012.

The deal is also a potential boon for new U.S. Secretary of State John Kerry, whose wife Teresa is the widow of H.J. Heinz Co heir John Heinz.

Kerry's most recent financial disclosures from his time in the U.S. Senate show a position in Heinz shares of more than $1 million, although the precise size is unclear.

Centerview Partners and BofA Merrill Lynch were financial advisers to Heinz, with Davis Polk & Wardwell LLP the legal adviser. Moelis & Company was financial adviser to the transaction committee of Heinz's board and Wachtell, Lipton, Rosen & Katz served as its legal adviser. Lazard served as lead financial adviser. J.P. Morgan and Wells Fargo also served as financial advisers to the investment consortium. Kirkland & Ellis LLP was legal adviser to 3G Capital, and Munger, Tolles & Olson LLP was legal adviser to Berkshire Hathaway.

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Family: Hadiya Pendleton slaying suspect 'good kid'

The family of a reputed gang member charged with fatally shooting 15-year-old Hadiya Pendleton in a South Side park last month defended him Wednesday, saying he is a "good kid" who has made mistakes but would not commit such a senseless crime.

After a brief hearing in the case, an aunt and cousin of accused gunman Michael Ward told reporters that they hope the "truth will come out" about Ward, who they say has a young child of his own.

"He has made some mistakes in the past, and we are not disputing any of that," said his aunt, Janise Cooper, who denied Ward is a gang member. "But he is a loving son (and) father, and our family is torn apart, just like the young lady's family is torn apart."

Judge Donald Panarese Jr. scheduled a preliminary hearing March 1 for Ward, 18, and co-defendant Kenneth Williams, 20. Both were ordered held without bail Tuesday on charges of first-degree murder, attempted murder and aggravated battery with a firearm in the Jan. 29 attack that also left two teens wounded.

After the 30-second hearing at the Leighton Criminal Court Building, Ward turned and gave a little wave to his family seated in the front row of the courtroom gallery.

Ward's family had previously told his attorney that he was seeking a high school equivalency certificate at Malcolm X College. However, school officials said Wednesday they had no record of him taking any classes.

Cooper, 43, declined to say if she thought her nephew would be acquitted of the charges.

"I'm not going to say that. All I'm saying is that the truth will come out," she said. "Young people make mistakes. All you can do is get them back on the right path. ... They have to just get back up and get on the right track."

Ward's cousin, Eliel Brown, 20, echoed the praise about Ward, saying he has always known him as a "good kid."

"He's good at heart," Brown said. "He loves his family."

Williams' family has not spoken publicly. His lawyer, Matthew McQuaid, said Williams has no criminal record and graduated from King College Prep, the same selective-enrollment school Hadiya was attending when she was gunned down.

Authorities described Ward and Williams as reputed gang members out for revenge on a rival gang.

At the hearing Tuesday, prosecutors said Ward confessed to police that he and Williams were driving around when they passed Harsh Park and spotted Hadiya's group, relaxing after final exams and taking shelter from the rain under a canopy. After Williams handed him a gun, Ward crept up on the group and fired six shots, prosecutors said.

Hadiya, who had recently performed with her high school band at President Barack Obama's inauguration festivities, was fatally shot in the back, and two other students were wounded. The tragedy has focused national attention on Chicago's rampant gun violence.

Ward was convicted early last year of aggravated unlawful use of a weapon and was on probation at the time of the homicide, according to prosecutors.

jmeisner@tribune.com

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Well: Straining to Hear and Fend Off Dementia

At a party the other night, a fund-raiser for a literary magazine, I found myself in conversation with a well-known author whose work I greatly admire. I use the term “conversation” loosely. I couldn’t hear a word he said. But worse, the effort I was making to hear was using up so much brain power that I completely forgot the titles of his books.

A senior moment? Maybe. (I’m 65.) But for me, it’s complicated by the fact that I have severe hearing loss, only somewhat eased by a hearing aid and cochlear implant.

Dr. Frank Lin, an otolaryngologist and epidemiologist at Johns Hopkins School of Medicine, describes this phenomenon as “cognitive load.” Cognitive overload is the way it feels. Essentially, the brain is so preoccupied with translating the sounds into words that it seems to have no processing power left to search through the storerooms of memory for a response.

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Katherine Bouton speaks about her own experience with hearing loss.

A transcript of this interview can be found here.

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Over the past few years, Dr. Lin has delivered unwelcome news to those of us with hearing loss. His work looks “at the interface of hearing loss, gerontology and public health,” as he writes on his Web site. The most significant issue is the relation between hearing loss and dementia.

In a 2011 paper in The Archives of Neurology, Dr. Lin and colleagues found a strong association between the two. The researchers looked at 639 subjects, ranging in age at the beginning of the study from 36 to 90 (with the majority between 60 and 80). The subjects were part of the Baltimore Longitudinal Study of Aging. None had cognitive impairment at the beginning of the study, which followed subjects for 18 years; some had hearing loss.

“Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increased risk of developing dementia over the course of the study,” Dr. Lin wrote in an e-mail summarizing the results. The worse the hearing loss, the greater the risk of developing dementia. The correlation remained true even when age, diabetes and hypertension — other conditions associated with dementia — were ruled out.

In an interview, Dr. Lin discussed some possible explanations for the association. The first is social isolation, which may come with hearing loss, a known risk factor for dementia. Another possibility is cognitive load, and a third is some pathological process that causes both hearing loss and dementia.

In a study last month, Dr. Lin and colleagues looked at 1,984 older adults beginning in 1997-8, again using a well-established database. Their findings reinforced those of the 2011 study, but also found that those with hearing loss had a “30 to 40 percent faster rate of loss of thinking and memory abilities” over a six-year period compared with people with normal hearing. Again, the worse the hearing loss, the worse the rate of cognitive decline.

Both studies also found, somewhat surprisingly, that hearing aids were “not significantly associated with lower risk” for cognitive impairment. But self-reporting of hearing-aid use is unreliable, and Dr. Lin’s next study will focus specifically on the way hearing aids are used: for how long, how frequently, how well they have been fitted, what kind of counseling the user received, what other technologies they used to supplement hearing-aid use.

What about the notion of a common pathological process? In a recent paper in the journal Neurology, John Gallacher and colleagues at Cardiff University suggested the possibility of a genetic or environmental factor that could be causing both hearing loss and dementia — and perhaps not in that order. In a phenomenon called reverse causation, a degenerative pathology that leads to early dementia might prove to be a cause of hearing loss.

The work of John T. Cacioppo, director of the Social Neuroscience Laboratory at the University of Chicago, also offers a clue to a pathological link. His multidisciplinary studies on isolation have shown that perceived isolation, or loneliness, is “a more important predictor of a variety of adverse health outcomes than is objective social isolation.” Those with hearing loss, who may sit through a dinner party and not hear a word, frequently experience perceived isolation.

Other research, including the Framingham Heart Study, has found an association between hearing loss and another unexpected condition: cardiovascular disease. Again, the evidence suggests a common pathological cause. Dr. David R. Friedland, a professor of otolaryngology at the Medical College of Wisconsin in Milwaukee, hypothesized in a 2009 paper delivered at a conference that low-frequency loss could be an early indication that a patient has vascular problems: the inner ear is “so sensitive to blood flow” that any vascular abnormalities “could be noted earlier here than in other parts of the body.”

A common pathological cause might help explain why hearing aids do not seem to reduce the risk of dementia. But those of us with hearing loss hope that is not the case; common sense suggests that if you don’t have to work so hard to hear, you have greater cognitive power to listen and understand — and remember. And the sense of perceived isolation, another risk for dementia, is reduced.

A critical factor may be the way hearing aids are used. A user must practice to maximize their effectiveness and they may need reprogramming by an audiologist. Additional assistive technologies like looping and FM systems may also be required. And people with progressive hearing loss may need new aids every few years.

Increasingly, people buy hearing aids online or from big-box stores like Costco, making it hard for the user to follow up. In the first year I had hearing aids, I saw my audiologist initially every two weeks for reprocessing and then every three months.

In one study, Dr. Lin and his colleague Wade Chien found that only one in seven adults who could benefit from hearing aids used them. One deterrent is cost ($2,000 to $6,000 per ear), seldom covered by insurance. Another is the stigma of old age.

Hearing loss is a natural part of aging. But for most people with hearing loss, according to the National Institute on Deafness and Other Communication Disorders, the condition begins long before they get old. Almost two-thirds of men with hearing loss began to lose their hearing before age 44. My hearing loss began when I was 30.

Forty-eight million Americans suffer from some degree of hearing loss. If it can be proved in a clinical trial that hearing aids help delay or offset dementia, the benefits would be immeasurable.

“Could we do something to reduce cognitive decline and delay the onset of dementia?” he asked. “It’s hugely important, because by 2050, 1 in 30 Americans will have dementia.

“If we could delay the onset by even one year, the prevalence of dementia drops by 15 percent down the road. You’re talking about billions of dollars in health care savings.”

Should studies establish definitively that correcting hearing loss decreases the potential for early-onset dementia, we might finally overcome the stigma of hearing loss. Get your hearing tested, get it corrected, and enjoy a longer cognitively active life. Establishing the dangers of uncorrected hearing might even convince private insurers and Medicare that covering the cost of hearing aids is a small price to pay to offset the cost of dementia.

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Katherine Bouton is the author of the new book, “Shouting Won’t Help: Why I — and 50 Million Other Americans — Can’t Hear You,” from which this essay is adapted.

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This post has been revised to reflect the following correction:

Correction: February 14, 2013

An article on Tuesday about hearing loss and dementia misidentified the city in which the Medical College of Wisconsin is located. It is in Milwaukee, not in Madison.

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