Monday, September 28, 2020

Collection Tragedies Manic-Depressive Suicide

We found them! We found them! There was great excitement in the police car as the news broke through the radio.

“Are they all right?” Mr. Tanner shouted from the back of the police car.

“Just checking. They are not moving….. Yes there is a pulse. Yes, older girl too. … mmmm mother. Yes! They are all alive. We are getting them on the helicopter.”

The high drama occurred on a Sussex beauty spot that is riddled with legend and stories of ghosts and the devil.

Chanctonbury Ring was a truly man-made landmark. In 1760, a crown of beech trees were planted on top by a young man named Charles Goring, who lived to eighty five and saw his trees grow to maturity.

Unfortunately it is also a spot where legend has it that you can trade your soul with the devil. Mr Tanner was a very successful businessman who ran a number of very successful stores in the south of England. I was called to see his eldest daughter Tara following a massive overdose of painkillers. She survived because she took Aspirin instead of Paracetamol. There was perhaps some advantage in not being streetwise, namely not knowing which drug to take. Or perhaps she did not really want to die. It was not easy to tell after the event, as there is always an emotional rebound after an act like that. The lack of a suicide note was a positive indication and in truth, young people often want to draw attention to something going terribly wrong by attempting suicide.

I realised straight away that this was different to the kind of overdoses that we saw two or three times a week on the wards. She had not been involved in drugs, alcohol or boyfriends. She was not really worried about her exams. She was not at the top but within the top few percentages. No. She said it was not her exams that worried her.

But she would not tell me what her fears were.

The meeting with both parents did not throw any light on the situation.

It was one of those meetings where you found yourself not being able to get anywhere inside the family. Everybody was well spoken, courteous and indeed unemotional. Mother was extremely pleasant and told her daughter that she would take her and the rest of the family on a Caribbean cruise after the exams. Tara was quite happy to stay on at the hospital despite mother’s request for her to be discharged.

After the meeting, one of the nurses whispered to me that she knew the mother as she had seen her before on the adult ward when she worked nights there. Our nurses often worked nights or weekends in order to earn extra money. She went on to tell me that she in fact tried to jump onto the rail track a little while back but was somehow stopped. She also told me that the father was a very successful and wealthy man. She wondered why Tara was not in a private hospital.

I arranged to see father. In a one-to-one situation, he was a good deal more lucid and forthcoming.

Tara’s mother came from a wealthy family and her own father was extremely successful. She was very pretty when he married her, although recently she had put on quite a bit of weight. She had a rather tragic family history. Her grandmother was in and out of a private psychiatric hospital where she eventually hanged herself. Her mother was diagnosed with manic-depressive disorder and killed herself by jumping onto a railway track. He felt that neither had the best treatment from the private hospitals.

His wife’s first breakdown was shortly after the second daughter’s birth. There was only a year’s difference between the girls. She did get into a short funny phase after Tara’s birth but she became pregnant again and the pregnancy seemed to settle her. He said it was not the blues but that she was more manic. She spent a lot of money on redecorating the whole house, decided she did not like the results and started all over again. Then she stopped sleeping at night. He realised that something was wrong and went to the doctor. She was admitted but was well after she was put on Lithium. She did well for quite a while and he thought his nightmares were at last over. She decided she was well enough and decided to try for boys. Unfortunately the next baby was still a girl, followed by another baby girl a year later. She was very upset and stopped her medication. Not long after that she vanished from home and was seen to be behaving strangely at the local railway station. She had seldom used the trains and when questioned by the railway police could not give a good answer. She was brought home and he took her to the hospital where she confessed that she was going to kill herself. She was put on some new medication that had just come onto the market and that seemed to have worked well, except that made her put on a lot of weight.

They always had a nanny since the eldest was born and with the arrival of the younger girls they increased the staff to two nannies and a house-keeper. He admitted he was wealthy but he did not want to use private healthcare because he felt his in-laws were badly treated. He thought his wife had been well cared for in the last ten years or so.

I am a traditionalist who believes that Lithium is still the drug of choice for Manic-Depressive Disorder. Tara’s mother was well for ten years. She was taking only Lithium and no other medication.

Father was now extremely worried that Tara either had the same condition or was heading that way. He said he would have no problem with any treatment that I cared to recommend. He also told me that both his older daughters had phenomenal mood swings at the best of times and if they wanted something done it had to be done “now”. He always thought that they were perhaps a bit spoiled and did not think much of it. They were both like their mother. He said he only mentioned to his wife that perhaps they could take the family on a Caribbean cruise and the next day she booked the cruise. Now he was wondering whether he might have to cancel it.

In the last three to four years it seemed to have become fashionable and even desirable for somebody to have Bipolar Disorder (Manic-Depressive Disorder).

There was a touch of glamour to Bipolar Disorder too, as so many historical figures and modern day celebrities had been diagnosed either contemporaneously or posthumously with Bipolar Disorder. A “coming out” of sorts. Many parents now are no longer satisfied with ADHD. They want Bipolar. It is helpful to de-stigmatise mental illness, but not so helpful that so many want to “catch” it.

These parents seem not to be aware that there is a serious downside to Bipolar Disorder: a very high mortality rate mainly from suicide.

Father however was right. Based on family history and current presentation, there was little doubt in my mind that Tara also suffered from Bipolar Disorder. Convincing the nursing staff was perhaps more difficult. Luckily the nurse that knew mother helped. Otherwise Tara would just have been branded a very spoiled child – spoiled seventeen year old and why, with such privilege, should she want to take her own life?

I started her on Lithium and within four weeks she was quite a different person. She had another four weeks before her first examination and we started trying her for some week-ends at home.

It was during one of these week-ends when mother asked Tara if she would go shopping with her. Tara declined as she was busy with her studies. Mother decided to take the younger two. For a long time father had not allowed mother to go out without one of the nannies. Somehow they were busy with other things and Tara was not really aware of the rule. Mother put the little ones in her new SUV.

When father came home, he threw a fit. Mother had been gone for three hours and was not answering her mobile. Tara told me that she realised later when mother said goodbye to her it was like a final farewell. She felt a bit strange but because of her exams she did not think twice about it.

They called the police and the Helicopter was summoned. Thanks to modern technology they were able to narrow the car down through the mobile phone signal transmission.

Mother had strapped the girls up, driven them up Chanctonbury Ring, attached a hose from the exhaust and put it through a narrow opening of one of the windows and left the car running. She left a suicide note saying she was a burden and caused Tara to be ill with her own Bipolar. Worst, she could not give her husband his heir. She took some gin and fell asleep at the back with the girls, who had probably been given drinks that were laced with gin as well.

Thank goodness for catalytic converters and mobile phones – they did not come to much harm.

Unfortunately, mother had to be admitted compulsorily to a secure mental hospital and it was likely she would be there for a long time. The cruise had to be cancelled.

Tara’s younger sister then took an overdose and she too was treated as a Bipolar Disorder patient. Tara managed to get the grades to get to the university she want.

I saw mother once walking in the garden of the secure wing of the hospital. She thanked me for all that I had done for her family.

What a tragedy. What a family tragedy!

Thursday, September 17, 2020

Thalidomide

On 24 September 1972, The Sunday Times carried an article entitled "Our Thalidomide Children: A Cause for National Shame" : this examined the settlement proposals then under consideration, describing them as "grotesquely out of proportion to the injuries suffered", criticised various aspects of English law on the recovery and assessment of damages in personal injury cases, complained of the delay that had elapsed since the births and appealed to Distillers to make a more generous offer. The article contained the following passage:

"... the thalidomide children shame Distillers ... there are times when to insist on the letter of the law is as exposed to criticism as infringement of another’s legal rights. The figure in the proposed settlement is to be £ 3.25 million, spread over 10 years. This does not shine as a beacon against pre-tax profits last year of £ 64.8 million and company assets worth £ 421 million. Without in any way surrendering on negligence, Distillers could and should think again."

A footnote to the article announced that "in a future article The Sunday Times would trace how the tragedy occurred". On 17 November 1972, the Divisional Court of the Queen’s Bench Division granted the Attorney-General’s application for an injunction restraining publication of this future article on the ground that it would constitute contempt of court (see paragraphs 17 to 35 below for a summary of the draft article and particulars of the contempt proceedings).

Luckily, the European Court eventually ruled for The Sunday Times :

“The newspaper then decided to fight the injunction on its investigation into the origins and testing of the drug. The case went right through the British legal system and up to the European Court of Human Rights, which decided that the injunction violated the right of ‘freedom of expression’. The full story of thalidomide could eventually be told in 1976, revealing that both Grünenthal (the maker) and Distillers had not met the basic testing requirements of the time.”

How strange for the “untouchable" British Courts.

But why did Distillers with such a big business in Whisky and Gin decided to go into Pharmacy, you may ask. Watching the Harold Evans’ film finally gave me a clue. It was all to do with Huxley and his Brave New World.

One member of the board volunteered that he had read Brave New World in which Aldous Huxley predicted that sedative pills would soon replace alcohol and religion as ‘the opiate of the masses’. The board of Distillers sat up and the rest is history, saddest history of modern Medicine.

Thalidomide & Morality.

A certain Australian doctor, Dr. McBride has often been quoted as being the first to report the abnormalities associated with thalidomide taking and its effect on foetal development. In fact his reputation rested on a short letter to the Lancet in the early 60s asking if anyone else had noticed the problems he had observed in the babies of mothers who'd taken thalidomide for their nausea during pregnancy.

This was the first published notification of concern but the reality was indeed that a midwife at his hospital, Crown Street Hospital— Sister Sparrow — had noticed a few babies being born with limb defects.

They were mostly, if not all, Dr McBride's patients and the only thing Sister Sparrow could put it down to was that Dr McBride had started prescribing thalidomide as an anti-nausea drug when the other obstetricians hadn't.

Dr. McBride did eventually got the Australian Order for this letter but was struck off the Medical Register for falsifying data on the research of another drug .

The link

Dr. Widukind Lenz of Germany has been credited with working out the link between Thalidomide and malformed extremities.

In one of his lectures, Lenz described dramatically how he was confronted with this event:

In June 1961, 1 was consulted by the parents of a child who had been born with short arms and only three fingers on each hand. Shortly before, I had received inquiries about two similar cases and had replied that I was not aware of this specific type of malformation syndrome, but it seemed most likely to me to be due to a new mutation of a dominant gene. Shortly thereafter, however, further similar cases were born and other doctors reported similar observations. Hence, it seemed more and more unlikely that these cases were all due to new mutations of a gene that previously mutated extremely rarely.

Lenz started to systematically and thoroughly ask the parents about details of the gestational history. On November 11, 1961, a date he remembered well, he first began to suspect that the sedative Contergan (thalidomide) could be the cause of this ‘new’ malformation syndrome. Three days later, his suspicion turned into certainty and he communicated these observations to the manufacturer — Grünenthal — and recommended withdrawal of the agent. Only two weeks later, the company withdrew the drug from the market.

Dr. Widukind Lenz’s father, Fritz A Lenz was a German geneticist, member of the Nazi Party and influential specialist in eugenics in Nazi Germany.

Research into this subject throws up surprises.

Non approval

America is amongst less than a handful of major countries that did not approve thalidomide. It may be surprising that the notable country that did not was East Germany.

In 1960, America had a stroke of luck. That was when the application to begin mass-marketing the drug thalidomide in the United States landed on the desk of Dr. Frances Oldham Kelsey, a reviewer at the Food and Drug Administration (FDA).

The application for New Drug Approval (NDA) was by drug manufacturer Richardson-Merrell’s NDA for Kevadon—the U.S. trade name for thalidomide—was only the second NDA Kelsey received, meaning she didn’t yet have a backlog of reviews to get through. For Kelsey and the other reviewers, thalidomide did not pass muster.

Before the days of the Internet: Kelsey read about a paper was published in the BMJ[1] on December 31, 1960 of 4 patients suffering from symptoms of peripheral neuritis. This raised an even bigger red flag for Kelsey: “the peripheral neuritis did not seem the sort of side effect that should come from a simple sleeping pill.” Not only were there pharmacological problems, but Kelsey found the clinical trials to be woefully insufficient in that the physician reports were too few and they were based largely on physician testimonials rather than sound scientific study. She rejected the application.

She asked for more information from Merrell, who responded with another application merely stating that thalidomide was at least safer than barbiturates. Kelsey then sent a letter directly to Merrell saying that she suspected they knew of the neurological toxicity that led to nerve inflammation but chose not to disclose it in their application. Merrell grew increasingly upset that Kelsey would not pass their drug, which had been used in over 40 other countries at this point.

If neurological toxicity developed in adults who took thalidomide, Kelsey wondered: What was happening to the foetus of a pregnant woman who took the drug? In her training she has studied what happened to drugs crossing the placenta barrier. Her concern hit on what would be the most dangerous effect of thalidomide in other countries.

The withdrawal

On November 15, 1961, Dr. Widukind Lenz[2] called Chemie Grünenthal to share his suspicions regarding the drug and the link to limb malformations in newborns. He spoke to Dr. Mückter, Grünenthal’s medical director, and urged him to take the drug off the market immediately. Lenz now had 14 cases of babies born with deformities which he strongly believed were directly connected to Thalidomide. Mückter vehemently refused to withdraw the drug. Luckily Lenz wouldn’t be put off and went public with his suspicions. It was only after the press got hold of the story that Grünenthal decided to withdraw the drug, on November 27, 1961. But by then over 10,000 infants all over the world were affected, and countless others died in-utero.

Despite this withdrawal, Merrell did not withdraw the application on their own until April of 1962. But by then the drug had already been distributed to “more than 1200 physicians, about 15,000-20,000 patients—of whom over 600 were pregnant,” according to Swan. In the U.S., 17 cases of congenital deformities were reported, but as Swan says via email, “that could have been thousands had the FDA not insisted on the evidence of safety required under the law (despite ongoing pressure from the drug’s sponsor).”

A darker past

It has since emerged that the “first” case of foetal defect was born on Christmas Day, 1956 to an employee of Grünenthal.

In the Auschwitz[3] files:

In November 1944, Fritz ter Meer, sent a memo to Karl Brandt, the SS General who ran Hitler’s euthanasia programme, explaining that a drug numbered 4589 (with the same chemical formula as Thalidomide) had “been tested and was ready for use.”

Correspondence was discovered that dealt with the sale of one hundred and fifty female prisoners for experimental purposes, “… With a view to the planned experiments with a new sleep-inducing drug we would appreciate it if you could place a number of prisoners at our disposal…”

There are hints that some Auschwitz prisoners made artificial limbs[4] for some of these deformed babies.

It is now widely believed that this preparation was the forerunner for the preparation that was to become known the world over as Thalidomide.

President Kennedy awarded Kelsey the President’s Award for Distinguished Federal Civilian Service, making her the second woman to receive such a high civilian honour.

In her memoir, Kelsey says that the honour did not belong just to her. “I thought that I was accepting the medal on behalf of a lot of different federal workers,” she writes. “This was really a team effort.” She was quickly promoted to chief of the investigational drug branch in 1963, and four years later, she became director of the Office of Scientific investigation—a position she held for 40 years until she retired at the age of 90. She lived until the age of 101, and passed away in 2015.

There is hope still.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2098660/

[2] http://thalidomidestory.com/story/other-notables/historical-figures/widukind-lenz/

[3] https://www.rms-consultancy.co.uk/personnel/thalidomide-detailed-history-and-timeline/

[4] https://blogs.scientificamerican.com/molecules-to-medicine/from-the-holocaust-to-thalidomide-a-nazi-legacy/

Collection: Tragedies

Colletion Tragedies

Sadness

And your experience makes you sad:

I had rather have a fool to make me merry

than experience to make me sad…..

As You Like It - Act II, Scene 7

William Shakespeare

With so many quotable quotes from As You Like It you may wonder why I would chose to pick this one.

Perhaps it is a warning to young doctors to enjoy the blessings of inexperience. Luckily for me sadness brought about by experience from my clinical work is mercifully little but I would be either dishonest or heartless to say that there has been none.

As You Like It happens to be one of the few popular plays of Shakespeare that are often performed in schools, maybe apart from Dreams, and for most it is basically a comedy with a happy ending.

My wife and I went to a recent production at BAM (Brooklyn Academy of Music) by none other than Peter Hall[1] with his daughter playing Rosalind – their New York debut. Few would imagine Sir Peter picking Brooklyn for his debut. In the end it was a great experience. The New York Times said that it was more reviving than spending a week in the Caribbean. Having been an accidental resident in the Caribbean for two years I would dispute the comparison but totally agreed with the sentiments expressed.

At the BAM, it was like walking into a renovation site and in many ways I hope they leave it that way as it was rather charming. It was a most fitting setting for Shakespeare. I accept that they have to make sure it is safe.

It was at the start of my psychiatric training in England when I asked one of my gurus about reading matter. Apart from Shakespeare, he recommended Ibsen. I have since read most of Ibsen's plays but I still come back to Shakespeare, who seemed to be able to pick up so many strands of human experience.

My ideal Shakespeare is indeed one that can be performed on a bed sheet with a few broomsticks for prop and without wanting to sound derogatory, I would say that this was exactly the approach adopted by this production.

Much was left to the imagination and it worked.

Mrs Coleman

Now and again in our work we get an indescribably sad case. Sometimes what started out as a rather straightforward case might begin to roll downhill so fast that we would be forever taking deep breaths thinking: can it get any worse? We would question if what we were doing was making any difference at all to what seemed like a predetermined course where no intervention would be able to make any impact on the final outcome.

One thing is for sure, real life is not like a play – you have only one chance to perform it and often not everything is clear.

Mrs Coleman came to see me about her daughter within months of my appointment as a consultant. With my new job came advantages and disadvantages. I used to be able to ask my seniors about cases, especially the difficult ones. Suddenly I am supposed to know it all. I used to have a big team working on a case, to the point that when the patient came to me there was hardly anything left for me to discover. Single-handed consultants are “on their own”. They are lucky to have a social worker and perhaps a psychologist. I had both but the psychologist was not really part of our team – she happened to be sharing the same building. She belonged to the old school, which meant she knew her field and she did not try to be a social worker or indeed a psychiatrist. For a while it became fashionable to blame everything on background and upbringing. Any disturbed child not performing well at school had nothing to do with teaching methods or intelligence but everything to do with social background. What were the implications for the social background of bright high achieving children?

There was some excitement in the clinic when it was known that a shepherd’s family had been referred.

Shepherds? "As You Like It" sprang into my mind.

We have lambs so we must have shepherds – so I thought. It is true that we seldom had referrals from the farming community. I can only remember one other case and that was when I was a trainee. Shepherds also conjure up scenes of nativity and there is a sort of biblical romantic feel to it.

What we did have was something quite different. As it was unfortunately the lambing season, the shepherd Mr Coleman, though making a valiant appearance, was as good as asleep during most of the session. Mrs Coleman talked through the session with her rather charming old Sussex accent.

Mrs Coleman at the time had two children but it was the older daughter Laura of nine with whom she was having trouble. Tom, some eighteen months younger, was a happy-go-lucky sort of boy. Laura had a whole range of behavioural problems. She had recently taken to soiling in her pants.

It was often our practice for the social worker to do a preliminary home visit, and my social worker told me that she was most impressed with their home when she visited. They lived in a tied cottage on the farm. The children’s grandfather was a shepherd and he had two sons, the older one working on the dairy side. There was also a daughter, the children’s aunt, and her husband was the local milkman. The aunt had children similar in age to Laura and Tom. She worked part time in the local greengrocer’s and between her and Laura’s mother they split the fetching from school and childcare. The aunt unfortunately was recently diagnosed with breast cancer and was having different kinds of treatment at the local hospital. Luckily her husband was a milkman and could take over the afternoon part of the childcare arrangement whenever necessary. Mrs Coleman took the children to school on the days when the aunt had to go to hospital.

The aunt was a strong lady, Mrs Coleman told me, and she was sure she would outlive her.

It was an old cottage they lived in and my social worker told me that Mrs Coleman kept the place clean and tidy. It was therefore most upsetting to her when her nine year old daughter started soiling herself.

It was mostly in the afternoon but not everyday.

As my social worker had just started her training at the Tavistock Clinic on child therapy it was a good chance for her to take the girl on for some individual therapy sessions. Like my old consultant did when I was in training, it was now my turn to see mother.

This seemed to be a simple enough family and I did wonder at the beginning if there was much to unfold.

I was proved wrong.

Within two to three weeks of Laura starting therapy, Tom the younger brother refused to go to school. It was natural for everybody to think that there was some jealousy involved. So I arranged for mother to bring him to see me. It was rather obvious from the start that he was not very bright and that his not going to school had little or nothing to do with Laura but more to do with the fact that he could not keep up with the work and was being teased at school very badly. He tried to hit back at one particular boy and was told off by one of the teachers on duty at play-time. He did not want to go back. I arranged for the psychologist to assess him.

Yes, he was functioning at a much younger age and yes, he needed to go to a special school. In those days it was called an ESN school – school for the Educationally Subnormal. The SSN school was for the Severely Subnormal. In the 90s, it was deemed more polite to call the subnormal children “special”.

Both schools were local and extremely well run. Tom was transferred and seemed to have settled down well there.

Not bad. I congratulated myself.

Laura was getting on well with her new therapist. She was attending without any problem and was doing nice drawings, according to my social worker.

Mrs Coleman was grateful that I sorted out her son. Tom, who had always been a Daddy’s boy, had upset father very much with his escapade but as he had now settled in his new school father was rather pleased. He in fact went to the same school so he made it a point to turn up to thank me once everything settled.

Mmmm, perhaps we are not escaping the genetics theory.

As a precaution, we also tested Laura but she turned out to be rather bright.

Genetics, you are wrong.

Not so, Mrs Colman must have thought. She was rather perturbed when I told her. She started crying and pleaded with me to keep the secret she was about to tell me.

Her husband was not Laura’s father.

Mrs Coleman had worked at the local butcher’s since she left school and he was always all over her. Before long he was having intercourse with her at the back of the shop. He always gave her extra for that part of the service and she was happy with the extra bit of money. The butcher’s wife had a stroke a few years back and had been bed ridden.

“It was not the money,” Mrs Coleman assured me. She did not want me to think of her as a slut.

None of the mothers I saw wanted me to think badly of them and it often took a while before they would reveal their secrets.

Mrs Coleman had also been seeing the shepherd but never gave him much thought as she felt he was rather stupid. The butcher was much brighter.

Then one day some accident happened and she found herself pregnant. But the butcher was not going to divorce his wife. She was the one with the money.

She decided that the next best thing was to let the shepherd sleep with her as long as he married her. He was so pleased with himself and they had a big white wedding in the local church.

So Laura was the butcher’s daughter and not her husband’s. Now that I had proved Laura was clever, she was afraid I might ask awkward questions although she doubted if her husband would ever really work it out for himself.

Once a parent realised that you had ways to get to the truth, they often started revealing things that you wished they never did.

The butcher had some idea that Laura was his and had been slipping even more extra money for mother to buy her things. He never had any other children.

I never broke my promise and to this day I do not think that her husband ever knew.

What was to unfold was what caused most sadness.

I attended some special seminar on sexual abuse and at the time some rather ugly looking anatomical dolls were produced for the sole purpose of diagnosing Sexual Abuse. They were anatomical in that a whole family set including parents and grandparents, children and adolescent all had what was described as anatomically correct parts - females with breasts, nipples, vagina and anus; and males with penis and anus; and all the orifices were so to speak fully functional. These dolls all had proper clothes on and yet all the clothes could come off.

The idea was that normal children played with them as normal dolls but abused children would perform with the anatomical parts.

I had a full set ordered, having spent sometime persuading the managers that others had labs and X-rays and so on, but these were the only tools we required for the specific job.

Laura was the first to discover them and before my social worker’s eyes one of the male figure’s penis was in the girl’s mouth. She told my social worker that was what Uncle Tom liked.

What followed were special “disclosure” interviews conducted under camera. Uncle Tom was the milkman. It happened to both girls. When the boys were in the kitchen playing computer games on the TV, slowly the girls were made to suck him. That was when Laura started soiling.

Mrs Coleman went berserk. Arrangements had to be made for alternative child care which really meant she had to cut short her hours at the butcher’s. Uncle Tom moved to his mother’s as a temporary measure pending Social Service investigation and Police enquiry.

Mrs Coleman could not sleep at night and called her GP. He asked her to pray with him as she had to be forgiving. She was so angry and when she was cleaning around the house she managed to get some caustic liquid all over herself and had to be admitted to hospital. She was also referred to the adult psychiatric department. She started attending an anger management group at the hospital. It was thought to be the best way to help her deal with recent events.

One day when I went in to work, my social worker was already there and in tears. Mrs Coleman had just taken a massive overdose of Paracetamol and her liver was thought to be too far gone to survive. She died a rather painful death and we were all deeply saddened.

Could we have done any better? Was the truth too much for Mrs Coleman to bear? Would she still be alive if we had not discovered the sex abuse? We would never know. We might have rescued Laura from sex abuse but now she had lost her mother. Mrs Coleman was right about one thing though, her sister-in-law did outlive her.

As Shakespeare said,

“….And your experience makes you sad….”

I wanted to hide the dolls.

Collection Tragedies

Manic-Depressive Suicide