Alex, because when I thought about it I realized a tumor could have
caused everything that had been happening, right from the beginning. A
growth impinging on different brain centers, causing different symptoms
as it grew.”
She shook her head. “Wouldn’t that have been a happy situation? Me
talking psychosomatic and there’s an astrocytoma or something growing
inside her? Thank God all her scans were totally clean.”
“Did she look post-seizural when you saw her in the E.R.?”
“In terms of being drowsy and listless, she did. But that’s also
consistent with a little kid being dragged to the hospital in the
middle of the night and put through the wringer. Still, it scared
me-that there could be something organic I was missing. I asked
Neurology to follow up. They did for a month, found nothing,
terminated. Two weeks later-two aiys ago-another seizure. And I
really need your help, Alex. They’re up in Five West, right now. And
that’s the whole kaboodle, history-wise. Ready to give me some wisdom
now?”
I scanned my notes.
Recurrent, unexplained illnesses. Multiple hospitalizations.
Shifting organ systems.
Discrepancies between symptoms and lab tests.
Female child showing panic at being treated or handled.
Mother with a paramedical training.
Nice mother.
Nice mother who might just be a monster. Scripting, choreographing,
and directing a Grand Guignol, and casting her own child as unwitting
star.
Rare diagnosis, but the facts fit. Up until twenty years ago nobody
had heard of it.
“Munchausen syndrome by proxy,” I said, putting my notes down. “Sounds
like a textbook case.”
Her eyes narrowed. “Yes, it does. When you hear it all strung
together like this. But when you’re right in the middle of it. . .
even now I can’t be sure.”
“You’re still considering something organic?”
“I have to until I can prove otherwise. There was another case-last
year, over at County. T”enty-five consecutive admits for recurrent
weird infections during a six-month period. Also a female child,
attentive mother who looked too calm for the staff’s peace of mind.
That baby was really going downhill and they were just about ready to
call in the authorities when it turned out to be a rare
immunodeficiency-three documented cases in the literature, special
tests that had to be done at NIH. Moment I heard about it, I had
Cassie tested for the same thing. Negative. But that doesn’t mean
there isn’t some other factor I haven’t caught. New stuff keeps
popping up-I can barely keep up with the journals.”
She moved her spoon around in her coffee.
“Or maybe I’m just denying-trying to make myself feel better for not
seeing the Munchausen thing sooner. Which is why I called you in-I
need some direction, Alex. Tell me which way to go with this.”
I thought for a while.
Munchausen syndrome.
A.k.a.pseudologiafantastica.
A.k.a. factitious illness disorder.
An especially grotesque form of pathological lying, named after Baron
von Munchausen, the world-class prevaricator.
Munchausen is hypochondriasis gone mad. Patients fabricating disease
by mutilating and poisoning themselves, or just lying. Playing mind
games with physicians and nurses-with the health-care system itself
Adult Munchausen patients manage to get hospitalized repeatedly,
medicated needlessly, even cut open on the operating table.
Pitiful, masochistic, and perplexing-a twist of the psyche that still
defies comprehension.
But what we were considering here was beyond pity. It was an evil
variant: Misnchaissen by proxy Parents-mothers, invariably faking
illness in their own offspring. Using their children-especially
daughters as crucibles for a hideous concoction of lies, pain, and
disease.
I said, “So much of it fits, Steph. Right from the beginning.
The apnea and passing out could be due to smothering those movement
artifacts on the monitor could mean she was struggling.”
She winced. “God, yes. I just did some reading, found a case in
England where movement artifacts tipped them off to the baby being
smothered.”
“Plus, with mom being a respiratory tech, breathing could be the first
system she’d choose to mess with. What about the intestinal stuff?
Some kind of poisoning?”
“Most likely, but it’s nothing the tox panel could come up with when
they tested.”
“Maybe she used something short-acting.”
“Or an inert irritant that activated the bowel mechanically, but passed
right through.”