by Peter Elkind
It was religion that had made the difference. “I’ve been given the time to sit down and understand the Lord. I couldn’t have made it without His peace and strength.” Genene had rediscovered the Lord but not yet determined His denomination. I asked about the Star of David she wore on a chain around her neck; it had replaced the cross she wore in Georgetown. “I’m leaning toward the Jewish religion,” she explained.
Within the prison’s chain-link boundaries, most of the inmates enjoyed a modicum of freedom. Rather than individual cells, the women lived in communal dormitories, forty-six prisoners to a room. They worked or attended classes during the day, had access to recreational facilities for four hours, and until at least 10:30 every night could come and go freely from a central dayroom equipped with a television. Genene, however, was living in voluntary isolation. Serious attacks upon inmates in the Mountain View Unit were virtually unknown. And despite her dramatic written remarks to Keith Martin, Genene acknowledged to me that no one in prison had raised a hand against her. Nonetheless, she had spent the last three months in solitary confinement—emerging only for showers and an hour of daily recreation—after telling the warden it was necessary to ensure her safety. Genene had spent much time before that on light-duty “medical assignment” for an assortment of ailments. Her health complaints permitted her to pull the relatively easy job of making the dolls about which she had written to Martin; in the prison system, they were called “Parole Pals.” Even as we talked, Genene coughed frequently. She said she was suffering from the flu.
I asked the obvious question she had raised: If you are innocent, why you?
Genene shook her head. “I’ve never answered that. I figure sooner or later the question will answer itself.” She was a good American, Genene declared. She always believed in the American way, in Truth and the System. Until the jury verdict in Georgetown. Now, she explained, she knew “the power of big money.”
“The story of my conviction is about big money. When the state has unlimited funds to do anything they want to do and get anyone they desire—to fly to Sweden, to put on the drama of the century—and the defendant, who is indigent, has nothing, absolutely nothing but the truth to throw up there, and yet it’s such a huge performance and staged so dramatically, the truth is just buried.”
Did she still believe she bore no personal responsibility for her fate—no blame for what had happened?
Genene’s jaw set and her voice cooled. I was seeing a flash of the nurse of old. “That’s not a belief,” she stated. “That’s a definite fact. I know I am responsible in a way for bringing it to the public viewpoint, but as far as being responsible for any death—no, I am not.”
I was searching for a stray remark, a contemplative pause, an instant of hesitation—anything—to suggest that, five years after the events, a shred of doubt, even remorse, had infected her conviction. Did she think she could be the victim of some disease of the mind, a psychosis that led her to harm children without her conscious knowledge?
“No, I don’t,” she replied immediately. “Not at all. I’ve had a lot of time to sit and think. I don’t have any doubts in my innocence…
“I know what the facts are and what the truth is,” said Genene. “Whether another human being alive knows is not important to me. That may sound cold, but I’m the one doing this time. I can look myself in the mirror. I believe in the Lord; I can look Him in the eye too. That’s all that’s important.” What an odd speech, I thought, from a woman who had gone to such extremes to proclaim her innocence to the world.
We talked for hours during my two trips to Gatesville—about Genene’s family and childhood, about her marriage and early career, and about the events that had put her behind bars. She informed me that except for normal teenage rebellion, she had gotten along splendidly with her mother. She said she had never felt any jealousy toward her older sister, Lisa. And she told me she had breezed cheerfully through Marshall High School, in a quiet and content adolescence. “I have nothing but beautiful memories of my childhood,” she insisted.
We moved on. Genene told me she rarely attended parties in high school and was never present at a single one where alcohol was consumed. She had not pressured her mother for permission to wed Jim DeLany just days after her father’s death. She said infidelity was not an issue in their marriage. It was untrue that she had boasted of shooting her brother-in-law in the groin. Keith Martin was not gay; he was the father of her child, and Genene had never told Kathy Holland anything to the contrary.
Although I had seen a copy, Genene insisted that she had never written a note to Pat Belko warning that she wouldn’t leave Medical Center Hospital “without a bang.” She denied ever owning a novel about a cult of murderous nurses called The Sisterhood, even though Dr. Marisol Montes had found a copy in the ICU with Genene’s name inside the cover. Genene acknowledged that after her arrest, she had consented to an examination by San Antonio psychiatrist Franklin Redmond. But she claimed she had done so at the request of the prosecution—not her own attorneys. She told me she had never sent a Christmas card to William Thornton with the message: “You and I know the truth.” Although it was reported in the press and her lawyers recalled is vividly, Genene denied claiming to anyone that she was pregnant while in jail. And she insisted that there had been no estrangement with her mother; Gladys Jones, said Genene, had visited her regularly in the Williamson County Jail.
By the end of our conversations, Genene had completed an account of her life that was astonishingly different from what I had gathered from dozens of those who had known her. It clashed with reality not merely on the basic issue of her guilt—of which I now felt certain—but on a thousand details, small and unimportant, except as they loomed in Genene’s image of herself. Genene was contradicting not only the sure recollections of others and a voluminous written record, but facts she had told me herself four years earlier. It was a measure of her sickness. She was rewriting the story of her life as if it were a work of fiction.
After my final visit with Genene, I returned to San Antonio and spoke to her sister. Lisa had recently had her own conversation with Genene. The talk had filled her with a similar sense of wonder. Genene had spoken idyllically about their family, about the perfect relationship she had enjoyed with Lisa and Gladys. Genene talked about how she had enlisted her mother to help plot her legal defense, how they had battled valiantly together to see that justice won out. “She had it like they worked hand in hand,” said Lisa. “This was not so. Both Mother and I, we would read the paper to find out what was going on. I don’t know why she was telling me these things. She was painting a picture of total harmony. It wasn’t that way.”
Genene was reinventing their family history, as if speaking to someone who did not know better. “I don’t know what has happened in her mind,” said Lisa. “She went into it so extensively. She’s changed everything all around.” Lisa had become accustomed to hearing Genene tell tall tales. Often they involved her career, about which Lisa knew nothing. But this was clearly different. Said Genene Jones’s sister: “She’s trying to make it a dream world.”
In 1951, a doctor in London published a brief article in The Lancet, England’s most prestigious medical journal, about a phenomenon he called “Munchausen’s Syndrome.” He named the condition for an eighteenth-century German baron named Karl Friedrich Hieronymus von Munchausen, who captivated dinner guests with fanciful tales of his heroic deeds. “Like the famous Baron von Munchausen,” wrote Dr. Richard Asher, “the persons affected have always traveled widely; and their stories, like those attributed to him, are both dramatic and untruthful.”
Asher explained: “The patient showing the syndrome is admitted to hospital with apparent acute illness supported by a plausible and dramatic history. Usually his story is largely made up of falsehoods; he is found to have attended, and deceived, an astounding number of other hospitals; and he nearly always discharges himself against advice, after quarreling violently with both doctors and nurses.<
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“…Usually the patient seems seriously ill and is admitted unless someone who has seen him before is there to expose his past.” Such patients demonstrate “an immediate history which is always acute and harrowing yet not entirely convincing—overwhelmingly severe abdominal pain of uncertain type, cataclysmic blood-loss unsupported by corresponding pallor, dramatic loss of consciousness and so forth.”
Asher identified three characteristic features: “the acute abdominal type…Some of these patients have been operated on so often that the development of genuine intestinal obstruction from adhesions may confuse the picture”; the “hemorrhagic type, who specialise in bleeding from lungs or stomach, or other blood-loss”; and “the neurological type, presenting with paroxysmal headache, loss of consciousness, or peculiar fits.
“The most remarkable feature of the syndrome is the apparent senselessness of it. Unlike the malingerer, who may gain a definite end, these patients often seem to gain nothing except the discomfiture of unnecessary investigations or operations. Their initial tolerance to the more brutish hospital measures is remarkable yet they commonly discharge themselves after a few days with operation wounds scarcely healed, or intravenous drips still running.
“Another feature is their intense desire to deceive everybody as much as possible. Many of their falsehoods seem to have little point. They lie for the sake of lying. They give false addresses, false names, and false occupations merely from a love of falsehood. Their effrontery is sometimes formidable, and they may appear many times at the same hospital, hoping to meet a new doctor upon whom to practise their deception.”
Among the possible motives, Asher cited:
“A desire to be the centre of interest and attention. They may be suffering in fact from the Walter Mitty syndrome, but instead of playing the dramatic part of the surgeon, they submit to the equally dramatic role of the patient.
“A grudge against doctors and hospitals, which is satisfied by frustrating or deceiving them.”
In addition, Asher concluded, “there probably exists some strange twist of personality.”
Twenty-six years later, another British physician, Dr. Roy Meadow, published an article in The Lancet on a variation of the phenomenon, which he labeled “Munchausen Syndrome by Proxy.” Meadow described mothers who put their children through needless medical procedures, often by falsely describing their symptoms or even by tampering with urine samples to provide false results. In two cases Meadow described, the mothers “had a history of falsifying their own medical records and treatment. Both had at times been labeled as hysterical personalities who also tended to be depressed.” Unlike parents who felt uncomfortable in a hospital with their child, these mothers “flourished there as if they belonged, and thrived on the attention that staff gave them.”
In 1982, Dr. Meadow described seventeen more cases of Munchausen by Proxy. These cases included mothers who deliberately caused their children to bleed or suffer seizures, often with critical results. The mothers invariably seemed to enjoy lingering in the hospital with their sick children and formed close relationships with junior doctors and other parents. Their methods, wrote Meadow, “combined cunning, dexterity, and, quite often, medical knowledge.” All the women he had studied were medically sophisticated, and “often the mothers had had previous nursing training.”
A 1985 article by Dr. Meadow warned physicians of the following signs of Munchausen by Proxy:
(1) Illness which is unexplained, prolonged, and so extraordinary that it prompts experienced colleagues to remark that they “have never seen anything like it before.”
(2) Symptoms and signs that are inappropriate or incongruous, or are present only when the mother is present.
(3) Treatments which are ineffective or poorly tolerated.
(4) Children who are alleged to be allergic to a great variety of foods and drugs.
(5) Mothers who are not as worried by the child’s illness as the nurses and doctors, mothers who are constantly with their ill child in hospital (not even leaving the ward for brief outings), and those who are happily at ease on the children’s ward and form unusually close relationships with the staff.
(6) Families in which sudden unexplained infant deaths have occurred, and families containing many members alleged to have different serious medical disorders.
Another 1985 journal article, published by British doctors A. R. Nichol and M. Eccles in Archives of Disease in Childhood, discussed the case of a mother who had been diagnosed as an example of Munchausen Syndrome by Proxy. Asked why she had fabricated her child’s illness, the woman summed up her reasons: “I liked the sympathy, I needed my daughter to be ill so that I was important. I felt I was somebody in the ward.” The woman added that she enjoyed spending time with the doctors who treated her children, and took pleasure in having outwitted them for so long.
In recent years, experts have applied the diagnosis of Munchausen Syndrome by Proxy to individuals who fabricate and induce medical problems in children under their care. Genene Jones fits the profile with extraordinary precision. Her sickness is not the result of a sudden psychotic break. It is the product of an entire lifetime—of impulses planted in an unhappy youth, nurtured in a troubled early adulthood, and tragically unleashed in the world of medicine.
Since childhood, Genene had always regarded herself as neglected, by family and peers alike. As an unattractive teenager, she developed the habit of telling lies to win attention. Instead of disappearing in adulthood, Genene’s “love of falsehood” ripened like a malignant tumor. With growing skill, she used lies to abet her pathologic need for attention—an impulse that became increasingly difficult to satisfy.
Genene seized on the device of exaggerating medical problems even before she entered medicine. In her hands, Keith Martin’s routine allergies became cause for a forecast of calamity; her son became the potential victim of a rare disease that made children go blind. But it was her employment as a nurse that provided the deadly combination of impulse and opportunity.
Genene was low on the totem pole, only an LVN. But in medicine, she quickly learned, a single event made everyone pay attention: the calling of a code. Genene came to know the glory of receiving credit for helping save a child’s life. She came to relish the excitement of a medical emergency. Those who saw Genene following codes found her sweaty and excited, in an almost sexual euphoria. “You tune people out,” she had told me. “It’s an incredible experience. Oh, shit, it’s frightening.”
At first, Genene merely insisted on being in the midst of codes that happened on their own—whether or not her patient was involved. An ICU nurse had described Genene’s determination to be in the center of the action: “If there was a crash in the unit, she’d climb over everyone to get there.” Then Genene manipulated Pat Belko and the young RNs on her shift to assign her the patients most likely to experience emergencies. At shift changes, Genene dramatically predicted that her patients would go sour.
After a lifetime of failure, in the pediatric ICU Genene belonged. Other nurses called her out to the ward to start IVs. The rookie RNs sought her help. Supervisors gave her praise. Genene made the unit her entire life; it seemed she hated to leave. Neglecting her own children, she worked countless overtime shifts, arriving early and leaving late. On one occasion, she was reprimanded for refusing to leave a child’s bedside at the end of a double shift. On another, she reappeared in the pediatric ICU drunk at 5 A.M. and began to tinker with a patient’s medical equipment. Only she could give the children proper care; they could not live without her. By 1981, work had become the foundation of Genene’s sense of worth—the single thing that fulfilled her need to be important.
But then residents began to ignore her; Genene was the nurse who cried wolf. And the new RNs started to assert themselves; they stopped taking orders from an LVN. So Genene began to take steps to force everyone to pay attention. Heparin and syringes disappeared from the pediatric ICU crash cart. She began to inject children with the blood-thinne
r and an assortment of other powerful drugs. Patients started to experience unexpected emergencies, incongruous problems that occurred only when she was present. Genene had launched the epidemic.
Had Genene stopped after leaving the pediatric ICU, she might never have been caught. Medical Center Hospital wasn’t going to tell anyone; “judicious silence” might have worked. But Genene couldn’t stop—couldn’t go back to being just an LVN in just another small-town clinic. A second epidemic hit Kerrville; this time, it was succinylcholine.
Like the women who harmed their own children, Genene appeared too devoted to her charges to harm them. When a baby died, her grief—the wailing, the singing, the cradling of the corpse—exceeded that of any mother. So devoted was Genene that she seemed to place herself above the parents. Of Chris Hogeda, Genene had said: “He was my baby.” And she had condemned Petti McClellan’s testimony as “an insult to Chelsea’s memory,” as though Genene were better suited to judge.
Genene’s personal medical history fit the Munchausen pattern as well: the repeated hospitalizations and emergency room visits, the dramatic attacks of abdominal pain and breathing problems, the vague complaints of muscle weakness—“always acute and harrowing yet not entirely convincing.” Genene subjected herself to “the more brutish hospital measures,” but doctors usually could determine no cause of her problem. Several had labeled her a hysterical personality.