Ah, the doctor’s letter. This would be the version of Mrs. Palin’s “medical records” that she promised during the campaign.

The letter is short, as was President Obama’s, but it was only released by the McCain campaign an hour or so before midnight on election eve, 2008. It also differed from Mr. Obama’s in that the bulk of it concentrated on the birth of Trig Palin. The Obama children, their births and health, were not mentioned in his letter.

Much has been written on several excellent blogs about Mrs. Palin’s letter. Cathy Baldwin-Johnson, who calls herself the Palin family physician, signed the letter. A PDF of the document archived with the Los Angeles Times can be found HERE.

And Regina at Palingates recent post on the matter can be found HERE.

Others have questioned everything about the letter, from the doctor’s signature, to the formatting, to the passive voice. I found the letter odd in several ways, not the least being the fact that the McCain campaign released it, purposefully of course, at a time when no reporter could scrutinize it or press for answers. 

Why was that, Steve Schmidt?

To sort out what others see as discrepancies, I asked the neonatologist, with whom I have been speaking on this blog, to offer his expert opinion.

LN:  So, does this letter state that Sarah Palin was pregnant and gave birth to Trig Palin in 2008?

DOC:  It does say that she was pregnant and delivered a baby with Down’s syndrome in 2008 at 35 weeks gestation. It’s very vague and doesn’t mention a birth date, but it does spend more time on this pregnancy than any of the others. Others have noticed that it leaves out her two miscarriages and gets the year of Piper’s birth wrong.

I’m most interested in the part that says that the diagnosis of Down’s syndrome was made early in the 2nd trimester and confirmed by amniocentesis. I find this point interesting, because most pro-life or highly religious parents who I work with decline amniocentesis. In fact, they often get offended when I ask them about the pre-natal genetic testing. I often hear “It’s god’s will and we’ll accept the baby that god gives us”.  Amniocentesis carries a 1-2% miscarriage risk, and even if positive for something serious, the parents aren’t going to terminate the pregnancy based on the information they receive. There’s a rule in medicine: “Don’t do a test if you aren’t going to do anything with the results” and it certainly applies here.

The generic nature of the narrative suggests to me that she could have easily been describing Bristol Palin’s pregnancy. Perhaps Bristol, without strongly held beliefs about abortion like her mother, wouldn’t have objected to an amniocentesis in the face of suspicion of Down’s syndrome.

LN:L What do you make of the fact that the baby’s specific birth DATE is missing?  Would you put a date in a letter if you were writing it? Is that important?

DOC: Dates are critical in neonatology as we deal in premature babies and want to know exactly how premature a baby is. The exact date of Trig’s birth is very important. If Trig was born 3 or 4 weeks earlier than otherwise claimed, Bristol could have been the mother of both babies. The letter does not give a specific date for Trig’s birthday and if the letter were written for the implicit purpose of confirming Trig’s parentage, a specific date would have been expected. On the other hand, in most medical records that I read, only the year is given, so I don’t want to read too much into this.

LN:  Is there anything out of the ordinary in the letter?

DOC: It says nothing out of the ordinary except that the doctor changed her status at the hospital on June 1, 2008 to "devote more time to my work in the area of child abuse evaluation and prevention". The timing is interesting. If CBJ was board certified in 1983 then that puts her age somewhere in the 50s assuming a normal career path. Most doctors don’t start cutting back their time until they reach their 60s. Also, how is this relevant to Sarah Palin’s health? Why include this in a letter about her?

LN:  Do you surmise from it that the doctor is telling the truth (passive voice and odd narrative not withstanding.)

DOC:  I'm actually not all that bothered by the use of passive voice in the letter. It's pretty typical of medical written communication. That's what they tell us to do in medical school. I think she's telling as much of the truth that she can except for Trig's pregnancy. I'd still like to know if she was Bristol's doctor too, but there’s no reason to put that in the letter.

LN:  So what do you mean except for Trig's pregnancy?  Doesn't she say that she was Mrs. Palin’s doctor during this pregnancy and that she followed routine prenatal care?  Tell me if there is a clue as to what's missing.

DOC:  I mean that she tried to include as much factual information in the letter as possible to give it credibility. From the letter, we are supposed to assume that she was Sarah Palin's doctor during Trig's "pregnancy". I don't see any clues to anything amiss in the letter. However, it would be simple for her to attribute the care of Bristol Palin's pregnancy with Trig to that of Sarah.

LN:  In other words, mix two cases or names:  Blend the daughter’s possible pregnancy chart and attribute it to the mother?

DOC: Yes, that’s exactly what I’m saying.

LN:  But isn’t that precisely what would be unethical, if not illegal?  Isn’t the entire point of a medical record to go on the record about that one patient?

DOC:  Yes, and that’s why I find the fact that she went off active status in June 2008 to be interesting. If she had continued on after that point, her medical records might have received extra scrutiny by the credentialing committee at the hospital that she didn’t want to deal with.

LN:  So herein lies the rub:  If a doctor fibs about a patient to the public, that’s one thing. But any record of that can be discovered by the State during an audit for credentialing. And that could jeopardize an entire facility. So, is it possible she bowed out of her role there in order to staunch any bleeding that could occur down the road for the hospital itself? No matter how entwined she was with them?

DOC: The state handles licensing and each hospital handles credentialing. The state usually doesn’t act against a practitioner unless there is a specific complaint or if standard requirements aren’t met. Hospital rules for credentialing vary, but most require renewal every 2-4 years and any concerns or complaints are evaluated by the credentialing committee. Obviously, the process for “active” staff is more robust than for “courtesy” staff. In this particular case, it wouldn’t surprise me if CBJ struck some kind of deal with the hospital that she would downgrade to courtesy staff and they wouldn’t push back with any kind of investigation. Hospital administrators hate controversy.

LN:  Would you write that letter if you were NOT that woman's doctor? (May not be illegal, but it's sure a lie or unethical.)

DOC:  No way! If I was given access to her medical record and wasn't her doctor, I would make it clear that I wasn’t her personal physician.

LN:  So either this truly is Mrs. Palin’s doctor writing the truth, or…tell us under what circumstances a doctor might do this? Have you ever known one to not tell the whole truth in a letter like this?

DOC: I think CBJ may have already been too deep in this mess to bail out. If she had lied about Trig’s mother, she would have to continue to support that lie to keep her professional status intact. I don’t know of any cases in my experience like this, but as I have mentioned before, it is very easy for a doctor to get caught between doing the right thing and doing what their patients ask them to do.

LN: One of the things people have criticized is that the letter does not state that Dr. Baldwin-Johnson delivered the baby Trig. I don't see any issue about naming who actually delivered the child. It could well have been the OB on call at that hour, especially if Dr. CBJ induced labor at 11:30pm. She might simply have gone home.

DOC:  Absolutely, the on-call doc for the practice handles the delivery. No one but the most important VIP gets a guarantee to have their doctor at their delivery. The only exception would be the rare case of a true solo-practitioner. I will say, however, that OBs (and Neonatologists) often do 24-hour shifts for continuity of care.

LN:  Well, for a little levity, allow me to say I am flattered. My OB put in a 12-hour day and stayed to deliver my son and I was little more than a TV reporter (34-years-old, prima gravida. Etc., etc, and yes, she and I could both say exactly where and when he was born without mixing up our stories!)

DOC: Well speaking of that kind of wording (prima gravida et al.), I wonder if the records from Bristol’s "2nd" pregnancy indicate anything about her past OB history. Did someone write anything in her chart like her being a G2 P0101, which is OB for "2 pregnancies, one living preterm birth"? HIPPA protected, for sure, but interesting. Maybe Bristol will some day run for political office and have her medical records disclosed.

We often have moms who come in and say its their first pregnancy, but when the OB examines them, it's clear that they have episotomy or perineal laceration scars. That could also be in the chart.

LN:  So you think this letter could have been referring to Bristol giving birth to Trig?

DOC:  The letter doesn’t answer that question directly, but it certainly doesn’t settle the issue either.

LN:  And that’s the key here, in my opinion. They release a letter at, literally, the eleventh hour, with all this wording in order to settle a controversy, and yet it does precisely the opposite:  It remains vague and scattered enough to ensure that the controversy continues.  Why is that?

DOC:  I’m not sure what the law says about this, but the purpose of a doctor’s letter is to attest that a candidate has no significant health problems that would prevent them from fulfilling the office that they aspire to. In this case, they had a dual purpose. One was the standard statement of good health. The second was to use this as an opportunity to support the vice presidential candidate’s claim that she was Trig’s mother. The fewer details that CBJ put in the letter, the fewer details she could potentially have to defend later if/when the medical records are examined. However, it’s more of a political question than a medical question. I’m sure the McCain/Palin people went over that letter with a fine-toothed comb before releasing it.

LN:  But this is all just speculation, because the truth is, we’ll never know, am I right? Especially with a famous patient.

DOC:  There is no obligation to release medical records for public examination. Eventually, they may leak out to the public, but I wouldn’t hold my breath. It’s no different for a famous patient. When doctors have a famous patient, the rules are very simple. If you say anything to anybody about their health information, even to your own friends and family, you can look for a new job. We once had a prominent football player's baby in our nursery. Some staff that weren't caring for the baby or mother opened up the mother’s electronic medical record out of curiosity and were promptly fired.

LN:  So, bottom line, if you were NOT Mrs. Palin’s doctor, you would not have written this letter? So, we have to assume that Cathy Baldwin-Johnson was on the up-and-up here.

DOC:  She says that SP was seen "as a patient in our clinic since 1991". I see no reason to doubt that.

LN:  Except that they shared a religious affiliation that oversaw the Board of the hospital. Long time followers of the story can add more detail to this, I am sure.

DOC:  Now that's scary. Especially since Sarah flew quite a long way to deliver at this specific little hospital. That's the part that makes the least sense in the whole story.

LN:  So, what, if anything, leaves any doubt or questions in your mind about this letter?

DOC:  It’s a rather bland, routine medical letter as it should be. I have no idea why the “FP” at the end of FAAFP is in different color. Not sure it means anything. The three things that strike me as unusual or suspicious are Dr. CBJ resigning from active status at the hospital shortly after Trig’s birth, the amniocentesis, and the fact that Trig’s birth date is not given.

LN:  Let’s talk soon about the photos of the alleged newborn Trig. I have some thoughts about them but more importantly I’d love it if you could offer your own perspective as someone who has specialized in the care of high-risk and medically fragile newborns and children.

DOC: I assume you’re talking about the photos of him being held by friends and family, looking chubby and pink? I don’t see any jaundice in those pictures, nor do I see the normal “plethora” (or ruddiness) that most babies have in the first day or two of life. He also looks too chubby for a newly born baby; at least a few weeks old, but definitely not a new 6lb, 35 weeker. That looks more like one of those babies they use on soap operas who is 1-2 months old playing a newborn.

LN:  Thank you, Doc! That comment alone should get everyone’s juices flowing. I’ll try to pull together the photos and we’ll dissect them. 

...to keep the conversation going!
Thanks to Prof. Brad Scharlott for providing us with this intriguing comparison.  A picture does indeed paint a thousand words. For the record I hate that tacky pink and red scarf and I wonder how much that diamond cost. That's all I have to add!

Speaking of intriguing....I am continually fascinated by the high number, the sheer volume, of visitors to this site who hail from Alaska:  Wasilla, Anchorage, and Juneau in particular, though other, smaller town-folk are stopping by as well. Be assured, you are not alone. 

And I am curious as to why. I mean, who are you people? And what have you got to share?

Years ago, I worked with a wonderful journalist who would, on occasion, stop by my office, lean against the door frame and ask, "So, you got anything for me?"  That was code for he had something big - sheer gossip, mind you - and that I'd better have something to cough up too if I wanted to hear his dirt.

I've got a few good things coming my/your way for this blog. But I am reminded of the two people from Wasilla who have weighed in on the various blogs over the years. One woman wrote convincingly about Mrs. Palin's alleged 5th pregnancy, how she was in denial, didn't want the baby, did her best to cover for it, and perhaps worse. People jumped all over her, but I found her to be believable.

But then there's the mom who supposedly knew Mrs. Palin when she had her too-bull-ligation after Piper. And boy, did she have "something good for us." 

Where are you ladies? I want you back. I want to hear more. I want all you Alaskans to tell us that you saw her pregnant, that you saw her no where near pregnant, that you know this, that, or the other thing. Just clue us in to life there and tell us why you think what you think. And perhaps allow commenters to ask you civil questions. Probe a little. I believe we can do that here. 

Speaking of probing, I will be busy for the next two days taking care of my 50-year-old colonoscopy screen!  I suspect it will be a lot like working up the Palin pregnancy story, only with serious drugs on board. So help yourself to an open thread here. I'll be sipping my Gatorade G2 and will check in throughout the day.  

Many thanks, Laura
At the outset of writing about the controversy surrounding Trig Palin’s birth, I said clearly that I could go either way on what to believe about this story.

On the one hand, I do see why some consider this to be possibly the greatest and most malevolent hoax in the history of American politics.

Yet, I remain intrigued by the odd, conflicting, indeed seemingly contrived anecdotes about what is now widely called The Wild Ride, Mrs. Palin’s allegedly reckless and lengthy return to Alaska while leaking amniotic fluid and suffering contractions unbeknownst to anyone around her in order to avoid delivering in Texas someone who might one day pick fish. 

Those who believe in the hoax theory argue that pictures tell nearly the entire story. That all one has to do is look at a few photos to determine that Mrs. Palin was not pregnant.

Me? I’m a skeptic. Or maybe I’m just stupid. Although with two degrees from Columbia University, for both of which I had to write a thesis (neither of which informs my thoughts or opinions today, even though I received A’s on them, Mrs. Palin), some might call me a notch above stupid.

Things need to be spelled out for me. I know there is someone out there who can explain away every single, niggling detail about this very strange birth story. But she doesn’t appear to want to do that.

So, I thought I’d start with the photos. And little did I know that Professor Brad Scharlott, whose paper on the Spiral Of Silence has got more people talking about this birth story than ever before, is actually a Photoshop expert.

Prof. Scharlott teaches both digital publishing and photojournalism at Northern Kentucky University.  And he said he’d be glad to talk me through a few of the more famous pictures.

BS: Thank you for that introduction, Laura, but let me qualify what you said. I have been teaching digital publishing since the late 1980s, and I’ve taught photojournalism for nearly a decade. So I’ve had to learn a lot about Photoshop and related programs in order to teach them to my students. I’m pretty good at “photoshopping” pictures, as that word is generally used – for example, I can put people’s heads on animals’ bodies, for laughs – but calling me an expert might be an overstatement. Still, I know enough to effectively teach digital photography and photo editing to college students.

Today I’d like to focus on a picture of Palin that appeared in the Anchorage Daily News on March 14, 2008. That was nine days after Palin announced that she was seven month pregnant, and four and half weeks before she allegedly gave birth to Trig on April 18. Here it is, as it appeared in the newspaper:
While Palin looks fairly trim in this photo, it’s hard to tell just how flat her stomach is, because the darkness of her outfit obscures details.

Here’s where an experienced digital photographer can help. It’s well-known among the pros that dark areas in a photograph can be lightened to show details that otherwise will not be apparent. Any photo-editing program can be used to adjust the brightness level of a photo like this; that includes the photo-editing programs that are bundled for free with most new computers. People reading this who want to experiment can copy the above picture to their own computer, open the picture in iPhoto (if you are using a Mac, as I am), then click on the “Edit” icon, bring up the “Adjust” panel, and finally pull the “Shadows” slider to the right. (If you don’t see the “Adjust” panel, drag a corner of the photo to make it bigger.) And while you are at it, you might also bump up the brightness and contrast sliders a bit, also.

What will your adjusted photo look like? Probably like this: 
Sarah’s flat stomach is now quite apparent. Notice that neither I, nor you, dear reader (if you followed along) moved a single pixel (a “pixel” is a dot in a digital picture). And I did not use Photoshop, so no one can accuse me, in any sense, of “photoshopping” the picture.

Let me address that term, by the way. When “photoshop” is used as a verb, generally it means to deceive by adding or subtracting or altering certain elements in a picture. But using Photoshop (or any other photo editing program) to simply lighten a photo is not deceptive. So be wary of what people really mean why they use the word “photoshopped.”

LN: Okay, Brad, I’m going to play devil’s advocate for a moment. Mrs. Palin looks to be leaning back in this photo, possibly because she’s chuckling about something funny the Lt. Governor said, or because of a text on her ubiquitous phone. But seriously, one could argue she is tilted back because of the weight and force of a baby belly. Couldn’t that explain her posture?

BS: I’m glad you asked that, Laura. The photographer who took this picture apparently used a zoom lens at a long setting, thus producing a photo distortion known as pin-cushioning. Look at woman to the right in the photo; you can see that her body is bowing slightly to the left with her head skewing a bit to the right corner. In the case of Palin, the bowing makes her appear to be leaning backwards.

To get a truer sense of what Palin would have looked like if you had viewed her in that scene with your own eyes, I am going to use the “Correct Camera Distortion” feature in Photoshop Elements (the cheaper, home version of Photoshop), and basically add a bit of “barreling” to counter the effect of the pincushion distortion: 
The result gives a truer sense of how those three people would have looked if viewed with your own eyes that day. And while Palin seems to be standing straighter, the alteration did not affect the flatness of her stomach, which I think tells the story.

So what do you think, Laura? Do you believe Palin can be seven months pregnant in this photo?

LN:  What a great question! I know I need to buckle down and not dither, and I know that this is about health care and job creation, there, also too. But I need to ask a man and I will get back to you (as someone might say).

Seriously, Brad, can’t someone say that any change in a digital picture makes it less authentic, less true?

BS: Well, digital pictures are sometimes not admissible in court (for example, if the original is unavailable) because they are so easily manipulated. So you need to feel confident that the source of a digital picture is trustworthy. This particular picture comes from a major newspaper, so there is no reason to believe it was deceptively altered before it was posted online or published in the paper.

But the answer to your question is an emphatic “no,” altering a digital picture, say, by lightening it, does not make it less “authentic” (whatever that might mean). That’s because all digital photographs have already been processed in various ways before you see them. A cheap point-and-shoot camera makes numerous decisions for the user, such as light level and sharpness. A pro photographer using the “RAW” files captured by her camera must make those decisions herself before generating the pictures. (Back in the old days of film, any print of a picture had to likewise be processed through multiple steps, all of which introduced alterations from the “original,” which was generally a negative.)

Lightening a picture that already has been generated does not affect its “truthfulness” – it just presents a different aspect of the visual truth. The second picture above shows more detail than the first picture, and that is truthful, because in fact a person viewing the scene would have seen those details, since the human eye is much more sensitive than a digital camera. And the third picture is just as truthful as the first (or even more so) because it removes distortion caused by optics – in particular, by a zoom lens; it’s showing the scene as it would have looked to the human eye.

So the question for readers is this: Can you imagine any way Palin in this photo might be seven months pregnant?

LN:  For my part, I covered up her head with a piece of paper and tried to look at the photo that way. And I must admit I see no pregnant stomach there. What do Mrs. Palin’s supporters say about this photo? How do they explain it? Because as I’ve said all along on this blog, I am wide open to having a conversation about this.

BS:  Palin supporters generally try to ignore or belittle photographic evidence. Julia O’Malley, on April 14, in an Anchorage Daily News article with the headline “Make. It. Stop.” wrote this about my research paper titled “Palin, the Press, and the Fake Pregnancy Rumor”: “I read Scharlott's piece. It contains lots of innuendo and some widely-circulated Photoshopped pictures. What is missing from his investigation: facts.”

Notice her use of “Photoshopped” – the implication is the photos are deceptive. But in the case of the above photo, what deception can she possibly be referring to? The picture comes from her own newspaper! If she wants, she can probably go straight to the photographer who took the picture and get a copy from his or her hard drive, just as it was downloaded from the photographer’s camera.

She wrote that my investigation lacks “facts.” (The paper has over 40 footnotes, so it’s brimming with verified, factual information.) But a photograph is also a “fact.” Can she look at the above picture and honestly say she thinks Palin might be seven months pregnant in it? In her article she wrote that Palin’s baby bump was obvious. What baby bump?

LN:  Allow me to interrupt here and say that “obvious” is the last word I would use about this photo. I don’t know what the truth is, but there is no “obvious” pregnancy here.

BS:  Exactly! In that same vein, I would like to invite Justin Elliot of Salon, who on April 22 wrote an article with the presumptuous headline “Trig Trutherism: The Definitive Debunker,” to exam the photographic evidence presented here. And after he examines it, I’d like to know if he still feels 100 percent sure Sarah Palin was in fact pregnant with Trig. If his answer is yes, then I’d like him to explain what he makes of this photograph.

I have a doctorate in mass communications from a top school in that field, the University of Wisconsin-Madison, which means I’m a trained researcher. My research has been published in numerous peer-reviewed academic journals. I teach a senior-level college class on research methods. I’m an empiricist. I believe truth can be discovered and verified. And this picture that we have just examined objectively exists, and its truth value can be assessed. Here’s my bottom line from my examination of the photo: I am at least 95 percent confident that Sarah Palin is not seven months pregnant in that photo.

However, I am not 100 confident. I have no medical training. I do not work with pregnant women as a matter of course in my job. There are many people who can offer a much more authoritative reading of that photo than I can, including you, Laura, who have written so eloquently about your own high-risk pregnancy and the months your child lived in a NICU.  So I am making a request, or rather several requests, of your readers:

1. Would those of you with medical training, especially if it involves working with pregnant women, let me know if you believe Sarah Palin might be seven months pregnant in the above photo? Please let me know your credentials and if I may quote you by name in a follow-up article. If you possess relevant photographic evidence, please send it.

2. Would those of you who have been pregnant at least five times let me know if you, in the seventh month of your fifth pregnancy, looked approximately as slender as Palin does in the above photo. If you could verify your stage of pregnancy (for example, with the date of the photo plus the date that you gave birth), that would be great. Let me know if I may quote you by name and print your picture in a follow-up article. Likewise, if a close relative of yours (your wife, sister, etc.) looked that slender in the seventh month of her fifth pregnancy, let me know and send a picture.

3. If you are a professional photographer who has worked with pregnant women, please share any relevant observations or photographs you might have.

Feel free to post your comments below and I will certainly read them here, and respond, on Laura’s blog. Or if you wish for more privacy concerning your name, etc., you might want to post anonymously below or email Laura on her Contact page. But send your comments plus personal information and/or pictures to me at brad.scharlott@gmail.com.

Thanks in advance for your help.  And Laura, it’s always fun talking with you about this story, journalist-to-journalist.

LN:  Thank you, Brad. And I know that we are going to analyze two more critical photos here on my blog. And I can’t wait to see what you’ve got!  

Home from the hospital, at last. My son, who is now 16, rides a BMX bike, and is taking 2 AP courses, here at 4 months.

The second of the two pediatric specialists I've been speaking with had this to say about Mrs. Palin's pregnancy:

I’ll start off by saying that most doctors are honest and try to follow all applicable rules and laws. Of course there are some bad eggs that will lie, cheat and steal but they are the exception.

As a doctor you are often caught between conflicting interests. On one hand you have sworn to “do no harm” via the Hippocratic Oath, thereby putting the patient first. On the other hand, you have to make a living, remain accountable to your practice or employer, and don’t forget the insurance company that pays the bills. I’ll start with a few real life examples to make the point.

Often, I’ll have a parent who asks me to keep their baby in the hospital an extra day or two because they aren’t able to take her home on a particular day. Sometimes it’s because they can’t get off from work, other times it’s because they’re moving. My rule is to look at each situation individually. If the parent has a solid reason for not taking their baby home on a particular day, and the baby could potentially be harmed by the discharge, I’ll put the reason in the note and generally, the insurance company will pay for the extra day. If the parent’s reason for delaying discharge is simply for their convenience, I warn them that the insurance company may deny the extra day and they could get the bill. I will not “fudge” my note.

Of course, there is a gray zone between a solid reason to delay discharge and a flimsy one. One time, I had a parent who was very scared to take her baby home. He was a tiny preemie and had been medically unstable for a long time and had finally straightened himself out. I warned the parents ahead of time that the discharge say was coming. On the discharge day, I called the mother and she said she couldn’t take her baby home. It turns out that she had called in the pest control folks and they would be fumigating her home that day. I’m sure that she purposely scheduled that appointment on the discharge day as a delaying tactic.

I called the case manager, the intermediary between the doctor and insurance company. She reads the charts every day and advises us on insurance issues. She said the extra day would be denied if I thought the baby was otherwise medically ready for discharge. I was between a rock and a hard place. However, this mother was very resourceful and she figured out how to assure that her baby wasn’t going home that day. She had delayed taking the baby’s prescriptions to the pharmacy and they wouldn’t be ready until the next day. I couldn’t send the baby home without his medications, so that settled it.

If I have a difficult parent who is demanding that I do something improper or unethical, and I realize I can’t solve the problem myself, I go straight to risk management. They contact a lawyer and advise me on how to proceed. They usually start by helping me with the language in my notes that explains the situation and would protect the hospital and myself from liability. If the situation escalates, I would let the lawyers handle all of the communication.

Ok, now lets move from reality to the wildly hypothetical. Let think about a big lie, like a fake pregnancy. They say if you drop a frog in boiling water it will jump out, but if you put one in warm water and turn up the heat, it will slowly get cooked. This probably isn't true, but does explain the two ways a big lie like this could proceed.

What if a patient asked their doctor to lie about their pregnancy? This is an easy one. No doctor who cared about their professional standing and their ability to practice medicine in the future would do this. No one who gave up at least 7 years of their life after college to become a doctor would willingly say yes. End of story.

However, let's say the doctor started by caring for a pregnant teenager. At first they were just asked to keep it quiet and not talk about the case with anyone. This is not unusual and is probably how it would start. At some point, however, what if the parent asked for a note from the doctor that the teenager needs to stay home from school for something other than pregnancy, such as mono? Now a line is being crossed, but it still is somewhat understandable and a doctor wanting to please their patient might do this, especially if they’ve known the family for a long time

What if the mother then asks that the name on the records be changed to her name? What if the teenager’s mother starts wearing a pillow under her shirt and claims she is pregnant? What if this mother is a prominent public figure? At this point the doctor is past the point of no return and probably feels like she has no choice but to follow through with the whole lie. Time to get a good lawyer and let them take care of the transition from doctor to defendant.


Quick Take Tuesday, a blog of tasteful, yet shameless, self-promotion involving an author or someone of equal social standing. I ask two questions, and then my guest turns the table and asks me two questions, as long as they don’t involve pounds or pant size.

Today’s guest is Jenny Hilborne, author of the breakout mystery, Madness and Murder  and mother-to-be of a second suspense book, No Alibi.

Q) Your story is set in San Francisco, which as we all know is the capital of madness, while Oakland holds on to the murder title. But you’re a blonde Brit from SoCal. And I’ll bet you’ve even got long legs and a perfect accent. Why write about Fog City?

A) 1 out of three ‘aint bad. I’m a dirty blonde (hey, not my words, that’s what my hairdresser calls it!), I only have long legs when I slip into my 4-inch heels, and my once English accent has taken on something of an odd transatlantic twang. I chose San Francisco for my novels after I stood at the Wharf on a visit and realized how easy it would be to dump a body into the Bay. Not only that, the public transit makes it so easy for a killer to move around. The place struck me as the perfect setting for Madness and Murder.

Q) We first got to know each other because I wrote a blog post once I figured out how to put badges on my website. I acted as if I’d earned a Nobel Prize. And you were just as thrilled as I was! But we also shared our sense of frustration. How do you feel about all this stuff we have to do as authors?

A) In a word: Overwhelmed. I’m a non-techy type trying my best to function in an ever-increasingly techy world. I create. I write stories to entertain. I don’t know about gadgets, buttons, badges, whistles and bells. Madness and Murder would wither and die if I didn’t market it, so I dived in with my eyes wide open. I can honestly say, my social media efforts have been entertaining and quite a learning curve. I mastered Twitter (it’s easy, and I like the fact there’re no games). Creating a website I left to the experts (I got as far as obtaining my Go Daddy domain and threw my hands in the air, baffled). Some of the sites I use - Kindleboards, yahoo groups – have lots of helpful people more than willing to share knowledge, so I’ve come a long way. If only I could keep up. Like my title…it’s utter madness and murder.


Q) Okay, your turn, Laura. As well as being an author, I know you’re an avid reader. I always see you Tweet about pieces you read on Scribd.com. Tell us why you love the site so much, how you stumbled across it, and how the site has helped you in your writing career?

A) I went into San Francisco one day to hear a panel discussion about getting your first book published. A beautiful young woman named Kathleen was talking about this thing called Scribd. It was a social media site and publishing platform. She told the audience that as an author, you had to “get vertical.”  I went home and told my husband and son that night that I had to “get vertical.” I had no idea what that meant. So I got on Facebook and read instructions and pressed a button and practically clapped when something uploaded. Then, I went onto Scribd and nearly panicked when I saw the feed. It was overwhelming. But a wonderful woman writer named Helen Winslow was on there with her beaming photo and her wonderful comments. So I learned from her how to comment and read and share. I uploaded many of my New York Times articles there and it’s since been like my online resume, or repository for much of my reporting work and essays.  As of now, I have more than 85,000 reads of my work. I have about 45,000 followers. I’ve met more wonderful writers than you can imagine. Scribd changed my life as a writer. I can’t say enough about the hip, young, energetic people who are making it all happen.

Q) You’re working on the Clari Drake mystery series and launching it this year. Who is Clari Drake? Is she based on anyone in particular? Tell us about her?

A) Ah Clari. Dear, sweet, feisty, inappropriate Clari!  She was once a hot-shot reporter who has found herself decades later with a family and a widening waist line. Okay, I’ll cop to that! But she became every woman I wish I could be, and in some ways, am. She loves her family, but she’s not afraid to rock the boat at her son’s school. She makes some huge mistakes and allows her unbridled frustration and ambition to jeopardize her son’s peaceful existence. In short, she’s a shit-disturber with a Weight Watchers card. And I can respect that. If you bite it, then you write it, is their mantra. And if Clari senses something isn’t right, she’s right on it. I love her!  And after being jerked around mercilessly by one of the biggest literary agents out there, I decided I’d had enough. I’m launching the book myself. It’s a fun read and I hope to learn from pros like you on how to let the world know that. Finding Clarity, here we come!


Thank you for joining me on Quick Take Tuesday, Jenny Hilborne, dirty-blonde, British author and leggy So Cal gal! Please come back and fill me up, so to speak, with some of your work for my Friday Feature!

Two minutes after my son was born. His own team works on him while my C-section continues off camera.

The high risk portion of my pregnancy lasted four months, during which my husband and I met many fetal/maternal specialists. Our son's life in the intensive care nursery lasted three months, during which we encountered every pediatric specialist known to mankind. It was our experience that medical people are precise, caring, cautious and meticulous. Our son's life was always in their hands. And we trusted them implicitly.  

People who ponder the Palin pregnancy story have often asked the general question, Do Doctors Lie?  I asked the two specialists who have weighed in on this blog before.  Here is the first doctor's reply. You are welcome to weigh in as well.

There are a lot of subtleties to this story. Usually when the patient/parent wants you to lie for them, it’s insurance fraud, either commercial or Medicaid. They might ask you to lie to get the insurance to cover something they otherwise wouldn’t.  That's not going to fly. It’s a huge legal risk and you wouldn't trust a parent that asked you to lie for them to keep quiet. Their very request makes them as untrustworthy as the doctor would be if he or she lied.

But doing something to help a patient without the patient actually know you're doing it? Probably happens, more in the heyday of managed care than now. Using words in an authorization request that you know will get something approved but aren’t necessarily “nothing but the truth” happens. But that is not the same thing as lying. It’s a way of assuring care for children.

Fudging records just doesn't work. Period. Too many people see them. Nurses, technicians, insurance companies. It’s too easy to get caught and doctors don't have the training to get away with it. Doctors aren’t trained in fraud.  With electronic medical records, it's now close to impossible. Because they all have audit trails so that changes are all recorded by what was changed and by whom. And any time someone logs into a record to view it, that is recorded as well. A hospital can tell who is viewing a famous patient’s record.

And even if someone “snooped” in to a famous person’s medical records, to release that information in any way is both illegal and punishable by law. It has happened multiple times.

I think the family practitioner had an attorney to keep the newspaper honest, both legally and as a witness. Perhaps she wasn’t worried about what she had to say, but she certainly would have been concerned about being misquoted.

No doctor is going to put him or her self in jeopardy for a patient that is likely to be under the microscope like Palin. Even if this whole birth thing happened before she was nationally or world famous. There are too many witnesses in a hospital.

Ask Michael Jackson's doc how he feels about cover-ups now. The truth tends to find a way out.

And as far as the idea that someone was stuffing a pillow under their clothes for a month-long public pregnancy and that a doctor would sign a letter stating she took care of this patient while pregnant, that is just not going to happen.  There is no penalty for the “patient” but the doc could lose their license.

I would still say her water broke and she went home to have the kid in relative privacy. In the end, “No harm, no foul”.  Her actions may have been risky or inadvisable, if in fact the story of leaking fluid is true. But would a doctor lie about it?  I don’t believe so.

By the way, anyone seen a long form on Palin?