Abnormal Hand Movements

It’s time for another physical diagnosis discussion. Four weeks ago we talked about abnormal gait. Today let’s discuss abnormal movements of the hands, and let’s limit the discussion to tremor. There are other abnormal movements of the hands, but most of them will occur in people with severe neurological or metabolic disorders, and not in people who are out in public, committing crimes, or solving crimes, i.e. characters in your stories. There are also tics, habits, and “unusual” movements of the hands which are under voluntary control, and are therefore “normal.”

Hopefully this discussion will be of value with description, and being specific.

So, let’s get started. What is tremor? The medical definition is “rhythmic involuntary movements.” Note that it can involve other parts of the body besides the hands.

In practice, when a physician sees someone with “the shakes,” the first thing he/she will do is to differentiate between Parkinsonian tremor and Benign Familial Tremor. They are two different neurological disorders, with far different prognoses and treatment.

Parkinson Tremor

The Parkinsonian tremor has a regular rhythm of four to six cycles per second. It is best seen when the patient is moderately relaxed, and disappears during sleep and complete relaxation. It also decreases with voluntary movement. It has been called a “rest tremor.” It can affect the hands, the feet, and the mouth. It is most commonly seen in the hand, where the thumb beats rhythmically against the flexed fingers, thus called a “pill rolling tremor.”

The onset of the tremor is often asymmetric, affecting one limb more that the other. Other clues that this is Parkinson’s disease include slow movement, shuffling while walking, flat facial expression, and rigidity to flexion and extension of the affected limb. Parkinson’s disease is also associated with dementia.

Benign Familial Tremor (now coded as “essential tremor”)

I prefer the old name, because it is more descriptive of the cause and the prognosis. This is a very common condition, affecting about four percent of the population. It is often mild and goes undiagnosed. And there is often a family history of the same tremor.

The tremor is described as affecting the fingers, particularly in the outstretched hand. It can also cause rhythmic oscillations of the head (titubation, or “head bob”). The tremor is fine, rapid, and accentuated by activity or emotional stress. I like to call it a “vibratory” tremor. And, because it is worse with activity or trying to suppress it, it is also described as an “intentional” tremor. It is not associated with dementia. And, unlike Parkinson’s Disease, it may not progress.

Others

Other common conditions that may be associated with a similar tremor, and may actually be uncovered, otherwise asymptomatic, Benign Familial Tremor, are the following:

• Excessive thyroid – either hyperthyroidism or excessive thyroid replacement
• Excessive caffeine intake – we’ve all seen that one
• Sleep deprivation
• Decongestant use such as pseudoephedrine (Sudafed)
• Use of stimulant drugs – either for attention deficit or illicit drug use
• Anxiety
• And any combination of the above

So, now you are prepared to describe in detail the tremor of that suspect sitting across the interrogation table from you. If you get a chance, grab his wrist and see how smoothly his arm flexes and extends at the elbow. Make him reach for something and see if the tremor ceases or is accentuated. And if his tremor is bizarre, get a neurological consultation. If that doesn’t yield a diagnosis, call a psychiatrist.

Okay, it’s your turn: What memorable characters with a tremor have you read about in a novel, or seen in a movie? What characters have you created with a tremor? Or, if you prefer, what would be an ideal situation to display a character with tremor? And, hopefully, it’s not your hero trying to aim his gun.

By Elaine Viets

There’s another virus that’s hitting those of us who work from home – ransomware. The most common right now is called the Microsoft Attack. A warning pops up that you have a virus and there is an 800 number to call “Microsoft” to have it removed. My IT guy says Microsoft will never call, email, or send a pop-up about a virus. That’s malicious software holding your computer hostage until the ransom is paid. You’re locked out.

Ransomware attacks are epidemic. Two weeks ago, a woman in my (socially distanced) gym class had her computer locked by ransomware. She refused to pay the ransom. Instead, she paid her IT guy $600 to free her computer. Yep. The poor woman ponied up 600 bucks. My IT guy said $50-100 was overcharging. He could do the job in under an hour.
I didn’t have the heart to tell her it would have been cheaper if she’d backed up her data and gotten a new computer. Not to mention a new IT guy.
Last week, my husband Don was working at his computer when it was attacked by ransomware. His computer was locked. Don couldn’t finish his article and he was on deadline. A red warning message blared across his screen. There was also an 800 number that he could call for “help.”

We both knew how expensive that help would be.
Don waited about an hour, hoping the ransomware would disappear.
No such luck.
Don and I had no choice but to use our most extreme weapon: 131 C.
He called the 800 number on his screen and I got on the line to listen in. The man who answered sounded young – maybe in his twenties – and he spoke English with an Asian accent. He told Don his name – a decidedly WASPy one, something like John Clark. That’s what I’ll call him for this blog. The attacker also told Don he was working in Chicago. I doubt he was anywhere near the place.
John claimed he didn’t know how Don’s computer got locked up. He was simply here to help, and if Don would give him his credit card number and tell him exactly what was wrong, then John would fix Don’s computer. They went back and forth like this for at least a minute:
John would ask Don to tell him what was wrong. Don would demand John remove the ransomware. John would deny he was there for any reason but to help and if Don would give him his credit card information . . .
At that point, I joined the conversation. “This is Don’s attorney, Vera Ellis, calling on a recorded line. Mr. Clark, you are aware that this conversation is being recorded, right?”
“No reason to record,” John Clark said. “If you will tell me what is wrong, I can fix the computer.”
“I’m Don’s attorney,” I repeated. “I’m speaking on a recorded line. You are in violation of FCC regulation 131 C. Do you understand that, Mr. Clark?”
“If you will tell me what is wrong, I can fix the computer,” John Clark said. He continued to protest that he only wanted to help and would we tell him what was wrong. I talked over him and kept repeating: “No, Mr. Clark. I’m informing you again, you are in violation of section 131 C. Do you understand? That’s 131 C.”
Finally, the line went dead. Don turned off his computer.
Half an hour later, Don switched his computer back on. The ransomware was gone and his computer worked fine. He finished his article on time.

By the way, 131 C is the number of an apartment we lived in on Capitol Hill in Washington DC. We moved in on a muggy August Saturday, and the air-conditioning was broken. The apartment was at least a hundred degrees. We couldn’t open the windows, either. They were painted shut. And there were no fans.
I called the landlord, who told me he couldn’t get anyone there before Monday at the earliest. I suspected he didn’t want to pay the weekend repair rates. I wasn’t about to swelter in that apartment until Monday.
“You have to get someone here to fix the air-conditioning,” I told him in a firm voice. “Or you’re in violation of section 131 C of the housing code.”
After I hung up the phone, Don said, “Isn’t 131 C our apartment number?”
It was. But it was enough to produce an air-conditioning repairman at our apartment within two hours.
And so the legend of 131 C was born.

Some of these scammers hijack major cities and counties. County officials in LaPorte, Indiana paid a $132,000 ransom to hackers who took over some of the county’s computers. The hijackers demanded their payment in Bitcoin. Another city paid more than $9 million to update their old, outdated system, rather than give the ransomers the $76,000 they demanded in Bitcoin. (Ransomware thieves loved Bitcoin.)
The FBI recommends that you don’t pay the crooks who hold your computer for ransom. You can report malware, ransomware, phishing and other scams to the FBI by calling 1-800-CALL-FBI. Press 3 and you’ll be directed to a website to file a complaint.
The FBI does catch some of the critters crawling around on the web.
One Raymond Odigie Uadiale pleaded guilty to conspiracy to commit money laundering in connection with a ransomware called Reveton. The former Microsoft employee got 18 months in prison.
If you ask me, and anyone else who’s battled these scammers, Ray got off easy.

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Coming March 2, DEATH GRIP, my latest Angela Richman, Death Investigator mystery. Kirkus says, “Viets produces chills with a murder hunt turned on its head.” https://tinyurl.com/ya9q9tfm

By John Gilstrap

A trait common to Gilstrap men is that as we age, we get cranky. The madness of 2020 added fuel to my ever-smoldering fires, manifesting itself as a pervasive need to scream my frustrations into the night. NOTE: The night doesn’t care. I’m pretty sure it didn’t even hear me.

To be honest, the certain malady-that-shall-not-be-named played nicer with me and mine than it did with many, but it upended so much and introduced such angst that there were times when I didn’t know what to do with the stress. Alcohol and Netflix helped, but there are limits, you know?

I react to the news of the day, and those reactions sometimes make writing especially hard. In times of major stress and distraction, I have difficulty summoning the concentration necessary to write fiction. In the months following 9/11, I wondered if I’d ever be able to write a convincing scene again.

When the state and federal governments shuttered all of industry back in late February and early March of last year, people who trust me with information that I probably shouldn’t know shared with me the terrifying reality of what many intelligence professionals thought was going to happen. The United States came this close to a total collapse of our food distribution system.

We all saw how petty and feral our neighbors got over toilet paper and hand sanitizer. Imagine the consequences if no food made it to supermarket shelves and no drugs made it to the pharmacy–and that there was no immediate means to repair the system.

Yeah, that almost happened.

And it almost happened in the exact same sleeve of time when I was writing a book about the collapse of American civilization in the wake of an apocalyptic event. It felt a lot like writing about a house fire as flames were rolling over my head. Unnerving, to say the least.

I managed to finish that book, more or less on time. It’s called Crimson Phoenix, the first entry in a new thriller series, and I think it’s one of the best things I’ve ever written. It hits the shelves on February 23. A click on the pictures or on this link will take you to a full description of the novel, but very briefly:

A rapid-fire series of communication fumbles leads to World War III, which lasts all of eight hours. By the time it’s over, the Unites States is in ruins. Millions die, yet millions survive. With all the infrastructure gone, elected leaders are unable to communicate with people outside of the bunkers that protected official Washington. It falls to individual citizens to figure out a way to continue living.

It doesn’t take long for the weak to turn feral. In one corner of West Virginia, though, a single mom named Victoria Emerson turns out to be the leader that everyone’s been looking for. Here’s the thing, though: She doesn’t want to lead. In fact, she quit Congress that very day because the rules of the Annex—the bunker to which the House and Senate are evacuated to—would not allow her children to accompany her. All she wants is to protect her family from harm. But when a community of desperate refugees instinctively look to her for leadership, she cannot turn away.

In writing Crimson Phoenix, I came to realize something that I guess I always knew, but never gave a lot of thought to. I call it the Concentric Circle Theory. As a husband and a father, my job is to protect my family from harm, which puts me in direct conflict with other husbands and fathers (and mothers and wives) who feel the same duty. One of the things that make nightmare scenarios so nightmarish is that human beings can turn every bit as feral as any other animal. The strong will prey on the weak every bit as viciously and reliably as wolves will prey on smaller animals.

Sounds dark, doesn’t it? But that’s not the way it turned out.

By the time I finished writing Crimson Phoenix, I realized that rather than writing about disaster, what I really ended up writing about was hope. Even in the worst of times, there’s good to be found in people, and great leaders will help others find that good in themselves. Great leaders also understand that many of the trappings of “civilized society” are contrived in comfort, and become irrelevant once the balloon goes up. When people are pushed hard enough, violence is inevitable. It’s understandable and even forgivable. It falls to Victoria to recognize the times for what they are and to help people understand that for every evil and for every act of violence, there are at least equal elements of kindness. Sometimes, though, the kindest approach is to wreak violence on offenders.

This introspection on human nature led me to a much calmer mental state than I occupied before I wrote the story, though perhaps at the cost of an even deeper cynicism.

1. People are inherently good. A sense of justice and fair play is one of the elements that separates us from other roamers of the earth. Within our individual contexts, love, personal responsibility and acceptance by our peers is a driving force in our lives. We don’t want to let people down.
2. If pushed hard enough, even the most mild-mannered and peace loving among us is capable of extreme anti-social behavior. Whether the behavior manifests itself in multiple baskets filled with toilet paper and hand sanitizer or in shooting someone perceived as a threat in the front yard, I think the vast majority of perpetrators feel genuine remorse when the hot blood cools. While I feel no need to forgive their actions, I think I’m obligated to understand their motivations.
3. Each of us is wired to handle crises differently. My instinct is to evaluate, analyze and act on data that I have seen with my own eyes, or has been relayed to me by a source that has earned my trust. Others act on what they hear from politicians and television news reporters. My way is not right, theirs is not wrong.
4. When all is said and done, each of us is on our own to make the decisions that are right for us. This is where I found my peace. If others take foolish or destructive actions on behalf of themselves and their families, that is on them, not on me. I will share my thoughts when asked, and I accept the fact that so few people ever ask.

Overall, this is new territory for me. It’s rare that I learn valuable life lessons through the act of writing. I hope it’s not like this again anytime soon.

What say you, TKZ family? Have your writing adventures ever led you to significant self-discovery?

By PJ Parrish

I think we’re stepping back in time with today’s First Pager. Back to an era when men were right gees, women were dames, a gun was a gat, but cigar was always just a cigar. And the view of the world comes through the slats of Venetian blinds and a swirl of smoke. But whose view is it?

Fatal Infraction

Chapter 1 — Offensive Planning

THE BOSS’S OPEN HAND slammed against his desktop with an ear-splitting smack. Every ornament, pen, and even the desk phone jump and then rattled back into place. “Damn it all! I didn’t want it to come to this!”

The huge man standing on the other side of the desk remained unfazed. His pectoral muscles stretched at the fabric of his black t-shirt, thick forearms crossed across his chest, biceps bulging above the short sleeves. Maintaining a placid expression required more self-control than most of his duties, which tended toward knocking heads together. A protruding vein, just visible above his left ear throbbed with increasing frequency. He hoped the boss would not notice. Being cool under pressure was his identity.

The early evening sunlight filtering in through a gap in the Venetian blinds. A recently smoked cigar lingered in the air.

“We knew he was a wild card, boss.” Not a quiver from the big man’s arms as he spoke. His voice was even; detached.

“Yeah, I know. But I still feel like we could have handled it better.” He sighed as he spun in his leather chair and reached for a cut-glass tumbler sitting on a polished credenza next to a crystal decanter. He poured himself two fingers of The McCallan 12. His companion stood stoically as he savored a sip, then turned back around. “You don’t think there are any other options?”

The big man shrugged, “That’s not my call, sir.”

“It’s really a shame. He had potential. He could have made us a lot of money.”

“That’s why you picked him. But, like you said, we can’t tolerate his actions.”

The boss took a long draught, then set the glass down with a clink. “I know. The time is right. You take care of it.”

“I will.”

The man behind the desk leaned forward and reached for his telephone handset as the big man left. He mumbled to himself, “It’s a damned shame.”

___________________________

I’m just guessing here because the scene-setting is bare bones, but I think we’re in the era of the pebbled glass door. The tone of this opening suggests the bygone era of pulp novels — Venetian blinds, smoke, whiskey, a desk phone rather than iPhone.  The tone also comes from the clipped macho dialogue, the physical descriptions (bulging biceps, throbbing veins). If I’m wrong, then I think the writer has a problem going in.  We can’t really tell where we are in time or place. More on than in a moment.

But the main problem here is one of point of view. There isn’t one. Sure, you can make a case for omniscient but it’s not consistent. And as we’ve said here often, omniscient POV just doesn’t cut it in today’s crime fiction where readers are looking for intimacy and connection with characters.

First off, the set-up itself is interesting. Two mugs are talking about a deal that has apparently gone off the rails because somebody screwed up. Someone off-camera is in trouble. Trouble is good. But because of the point of view problem, we don’t really care. Not caring is bad.

We have a classic case of head-hopping here. It feels like we are in The Big Man’s POV because we get some thoughts and details filtered through his consciousness. But the POV is not solidly grounded because we have omniscient intrusion with details like a throbbing vein in his head, stretching pec muscles (which the Big Man cannot see). Then, in the last graph, we are yanked out of Big Man’s POV with this:

The man behind the desk leaned forward and reached for his telephone handset as the big man left. He mumbled to himself, “It’s a damned shame.”

Whose head are we in now? Marginally, The Boss’s. This just doesn’t work.

Establishing empathy, sympathy, or at least INTEREST IN THE ACTION is essential to any opening. Because we are not grounded in any character’s POV, we can’t bond. Because the set-up is so bare bones, we can’t care what happens next. This feeling is intensified by the writer not giving us any names. It’s coy, in my opinion, and serves no real purpose.

Whose story is this? That’s the big question here.

Now, here’s a caveat:  I could be wrong, but I don’t think the protagonist of this story is on stage yet. I have a feeling the writer is using the device of showing us the danger or villain before we meet the hero. The fixer Big Man (bad guy) is sent on a mission to track down and deal with the protagonist. Let’s call the protag Jack Evans. This structure could work. Given more details in this set-up, we might begin to wonder about Jack. All we are told is he did something wrong and he’s a “wild card.” Maybe we need to start worrying about Jack. We need a reason to turn the page.

I think this could be a good opening if the writer dropped in some more details. Big Man needs a name because I suspect he’s going to have more scenes and POVs and it’s going to get really tedious to keep him nameless. The man he will be hunting down needs a name here. What kind of business is this? Why withhold that info? At least give us a hint of that and what got screwed up. Also, WHO screwed up? The Boss at one point says, “I still feel like we could have handled it better.”  Yet Big Man is sent to go after Jack the wild card.

The dialogue is not working hard enough. The writer needs to pack more information into it.  Let me give you an example of how that could work.

“We knew he was a wild card, boss.” 

“Yeah, ex-cops always are.” He sighed and spun around in his chair to pick up the decanter on his credenza. He poured out two fingers of The McCallan 12 but didn’t take a drink. “Why do you think Jack turned on us?” he asked.

The Big Man didn’t answer. He knew Jack’s kid was really sick with leukemia and that Jack was desperate to get him to that big hospital up in Rochester. He needed money bad. Bad enough, maybe, to even cross The Boss. Note drops of backstory that tell us something about Jack and make us care. Note too that by not telling The Boss about this we are learning something about Big Man as well.

“I don’t know why he did it,” Big Man said. 

The Boss swung back toward him. “Jack Evans had potential. Could’ve made us a lot of money. Damn shame.” He finally took a drink of the whiskey then set the tumbler down. “You think there are any options?” he asked. 

The question sounded almost like a plea. The Big Man remembered that The Boss had taken to calling Jack Evans “son.” More backstory nugget that deepens the relationship and makes us wonder what’s the dynamic here.

“That’s not my call, sir.” Big Man said.

The Boss shook his head slowly. “I’ve put up with enough. It’s time,” he said quietly. “Take care of it.” 

Okay, I’m running long. Here’s a quick line edit to cover some other things.

FATAL INFRACTION I like the title!

Chapter 1 — Offensive Planning

The Boss’s open hand slammed against his desktop with an ear-splitting smack. Cleaner: The Boss slammed his hand down on the desktop. You get rid of the ugly ss possessive and it’s active and not passive. Don’t need ear-splitting smack because it’s not in anyone’s POV. Every ornament, pen, and even the desk phone jump and then rattled back into place. “Damn it all! I didn’t want it to come to this!”

The huge man standing on the other side of the desk remained unfazed. His pectoral muscles stretched at the fabric of his black t-shirt, thick forearms crossed across his chest, biceps bulging above the short sleeves. Omniscient POV…Big Man can’t describe himself. Maintaining a placid expression required more self-control than most of his duties, which tended toward knocking heads together. A protruding vein, just visible above his left ear throbbed with increasing frequency. Ditto POV but easily fixed with “He could feel a vein throbbing in his temple. He hoped the boss didn’t notice it. He hoped the boss would not notice. Being cool under pressure was his identity.

The early evening sunlight filtering in through a gap in the Venetian blinds. A recently smoked cigar lingered in the air. A nice description here but can you filter it thru Big Man’s consciousness? He squinted against the sunlight slanting through the Venetian blinds and resisted an urge to swat away the cigar smoke lingering in the air. SMOKE lingers in the air, not the cigar itself btw.

“We knew he was a wild card, boss.” Not a quiver from the big man’s arms as he spoke. His voice was even; detached. It was a struggle to keep his voice even and detached because he knew what was coming and he didn’t know if he could do it. Again, drop in some hints here of intrigue. These men are flesh and blood. Show us some emotion.

“Yeah, I know. But I still feel like we could have handled it better.” He sighed as he spun in his leather chair and reached for a cut-glass tumbler sitting on a polished credenza next to a crystal decanter. He poured himself two fingers of The McCallan 12. His companion stood stoically as he savored a sip, then turned back around. Again, he can’t tell “his companion” (odd phrase) is stoic because his back is turned. And Big Man would not think to himself “I’m standing here stoically. “You don’t think there are any other options?”

The big man shrugged, “That’s not my call, sir.”

“It’s really a shame. He had potential. He could have made us a lot of money.”

“That’s why you picked him. But, like you said, we can’t tolerate his actions.”

The boss took a long draught, then set the glass down with a clink. “I know. The time is right. You take care of it.”

“I will.”

The man behind the desk leaned forward and reached for his telephone handset as the big man left. He mumbled to himself, “It’s a damned shame.” Final POV issue here. You’ve switched to the Boss’s POV in mid-scene. I would end this scene with Big Man. He’s the bridge to what comes next — the hunt and chase to find Jack Evans. So you should end with him leaving and doing something outside. Which might give you the chance to tell us where we are. Also, the sentence construction itself is bulky — He leans forward, reaches for his phone AS the other guy leaves. Big Man leaves. Then you can move on.  But again, I would stay with Big Man — he’s potentially more interesting at this point because he’s OFF TO DO SOMETHING.

Remember: The last line of a chapter is as important as the first line because it is the bridge to the next chapter. Don’t give your exit line to someone who doesn’t matter to what comes next.

So, brave writer. My main two suggestions is that you chose a point of view and run with it. Make your men come alive. And although I recognize you’re going for a spare neo-noir style here, we still need a little more meat. Don’t be afraid to slow down and give us a dollop of backstory and more description. We need a sense of your setting here beyond the old tropes of a smoke-filled office (that’s been over-done). Maybe take the scene outside via Big Man and let him — and your scene — breathe a little more.

That’s it for today. Thanks to our writer for submitting their work. And I hope you find this and other comments helpful.