“I can manage it,” she said quietly, “if it’s important to you.” She wanted to help him, and she respected them both.
“I think it is,” he said somberly. “Do you suppose you can get your nurses not to say I came in? I know how friendly Zoe is with them. She’s always taking them chocolates and gifts, or baking cookies for them.” Cathy knew it was true, and the nurses loved Zoe for it.
“I’ll handle it.” She was glad he had reminded her. She wouldn’t have thought of it, but he was right. Her nurses all thought Zoe walked on water and was a saint, the most devoted mother in their practice. They would have done anything for her, and would have mentioned it to her that Austin came in. She knew it would look strange when she asked them not to, but confidentiality required that they respect his wishes, and she would see to it that they did. “Do you want to come in at lunchtime? It’s the longest break I have in my schedule today, and it sounds like you want to talk sooner rather than later.”
“I do.” She was very fond of them both, and hoped that she could put his mind at ease. As far as she was concerned, Zoe was a good wife, a good mother, and a good friend. She wondered if they were having marital problems, although Zoe hadn’t mentioned it to her, and she thought she would have. Maybe over the incident in Florida. She could hear on the phone that Austin was upset, and Zoe had told her as much after the accident in Florida and the stitches in Jaime’s chin, which Cathy was sorry to hear about. But at least she hadn’t drowned and Austin had pulled her out of the pool in time.
He got right to the point when he came to see her. He walked past the nurses and went straight to her office since he knew where it was, and she waved him to a chair after he closed the door so no one would hear them. She had a sandwich on her desk.
“I’m sorry to interrupt your lunch,” he said, looking apologetic, “you can eat while we talk if you want.”
“I’m fine.” She smiled at him, half friend and half physician, and trying to be both. “What’s on your mind?”
Before he said anything, he handed her a list of all of Jaime’s injuries, the stitches, the broken arm, the broken wrist, the sprains, the dislocated elbows, the fall off the changing table. The list was long and Cathy read it carefully, and he startled her with what he said next.
“I’m not sure I know who I’m married to. And I’m not sure you do either. That’s a long list of injuries for a three-and-a-half-year-old, not to mention the illnesses, the mysterious febrile seizure, apnea, the unnecessary surgery for ear tubes, that she conned me into and lied about, both to me and the doctor. The appendectomy she insisted on, that thank God they didn’t do, and you saved the day when you figured out that Jaime had strep in her stomach lining. And now she’s chasing an orthopedic surgeon for scoliosis Jaime doesn’t have, and Zoe may want rods put in her spine.”
“Do you know that for a fact?” Cathy frowned as she asked him.
“Close enough. She’s seeing an orthopedic surgeon for scoliosis, and that’s what he does. I assume that’s what she has in mind.” She was moving into the big leagues now, surgeries instead of falls.
“He won’t do it to a patient who doesn’t need it, if he’s a reputable surgeon,” she said with conviction.
“For now. He told her to come back in six months. God knows what else she’ll come up with by then.”
“What are you saying to me, Austin? We both know she’s anxious, because she lost her sister to leukemia when they were both so young. It frightens her as a mom. I’m sure she’s afraid the same thing could happen to Jaime. She’s never said that to me exactly, but it’s a normal fear for a ten-year-old who lost her seven-year-old sister.”
“She’s not ten years old now, and yes, I think losing her sister affected her deeply. She went through years of neglect by her parents, who were too devastated to pay attention to her. In a sense, they abandoned her as a child. They admit it themselves. She grew up with no affection and no help. And now she wants attention by being super-mom, and she can only be that if Jaime is sick. Maybe that’s all she knows. I’ve been reading about Munchausen by proxy, and, Cathy, she’s a textbook case.”
At first she was too stunned to respond to him, but she could see that he was serious, and she felt she owed it to him to pay attention to what he had to say. He was a reasonable person, and she respected his concerns.
“I don’t know much about it, to be honest with you. I’m a pediatrician, not a shrink.” She picked up the list of Zoe’s injuries for a minute and stared at it, set it down on her desk, and looked at him. “I know the description generally, mothers who make their children sick, set them up in risky situations to get injured, exaggerate symptoms to physicians to make themselves more important, and even cause their children to have unnecessary surgeries.”
“Sometimes leading to death,” he said somberly. “The ear tubes weren’t serious, but Jaime had general anesthesia when she didn’t need to, she’d have survived an appendectomy, and now Zoe’s going to an orthopedic surgeon, and God knows what she’s telling him. She had Jaime see a neurologist when she got a bump on her head, a gastroenterologist for reflux while she was nursing, and Jaime wore a monitor for a year that drove us all insane. You add that to the accidents, and it’s quite a list, and every time, Zoe is the hero, Jaime’s savior, except that the only time Jaime gets injured is when she’s with her, or because of something Zoe did, like remove the gate I set up, so Jaime fell down the stairs and broke her arm the next day. She was with the nanny that time, but that was the only time. And she put every household poison we had in an unlocked cupboard under the sink, until my mother discovered it, and I put them up high where she couldn’t reach them. That doesn’t scare you, Cathy? It scares the shit out of me. Or it’s starting to.
“Something changed for me in Florida, when I saw her with her back to the pool, while Jaime damn near drowned. Everyone thinks she’s super-mom, and I did too. Now I think there’s something broken so deep inside of her that none of us can see it, but it’s there, like a devil hiding in the bushes, waiting to devour my little girl. I don’t trust Zoe anymore. She lies to me. And I’m afraid of what will happen to Jaime when she’s with her. Every time she takes her out now, I’m afraid Jaime will get hurt.” He looked imploringly at Cathy. “I don’t know what to do. How do I protect Jaime from her own mother? And do I need to? But, all of a sudden I don’t think Zoe is who we think she is. She lies to you too.”
Cathy was shocked into silence, and the worst part was that some of what he said made sense. Austin wasn’t crazy. He was a sensible, down-to-earth, intelligent person, and she knew he loved Zoe. But his fear for their daughter was clear and sounded rational in some ways.
“Wow, I don’t know what to think. Let me go through Jaime’s records and try to see them objectively. I want to talk to a psychiatrist I respect. I’ve never come across Munchausen by proxy in my practice. Probably not a lot of physicians have. I don’t think it’s impossible, I just want to get an objective opinion from a knowledgeable person to tell me if the puzzle pieces fit together here, or if it’s just a series of unfortunate coincidences that look bad but maybe you’re wrong. I hope to hell you are,” she said, looking emotional.
“I would love to be wrong,” he said to her as the intercom buzzed on her desk. She picked up the phone, answered it, looked serious for a minute, thanked one of her nurses for “warning” her, and looked at Austin when she hung up.
“You’ve got to go now. I’ll let you out the back door,” she said as she stood up, and seemed anxious and rushed. “Zoe is on her way over with Jaime. She got bitten in the face by a dog at the park.” Austin looked panicked when she said it, and he wanted to stay for Jaime if she was hurt, but he didn’t want Zoe to see him here. There was no way he could explain his visit to Cathy, and it would appear suspicious to her. She walked him to the back door of her office, and he followed her. He had parked around the corner, so
Zoe wouldn’t see his car now when she drove up. “I’ll call you after I talk to my psychiatrist friend. Don’t jump to any conclusions yet. Sometimes things sound worse than they really are. But I’ll admit, it doesn’t look great when you shine a light on it. I’ll let you know what he thinks. Do I have your permission to share my records with him?” she asked, and Austin nodded. “Now, go,” she said, holding the door open for him.
Austin thanked her, gave her a quick hug, and left, and worried about Jaime all the way back to his office. He noticed that Zoe hadn’t called him yet. He wondered when she would, so soon after the episode in Florida. It would be humiliating for her that Jaime had gotten hurt again, or maybe she was losing her grip. But she hadn’t been a hero when Jaime nearly drowned because her mother wasn’t watching her. Maybe she needed another injury to turn it around, so she could save Jaime this time or comfort her. If so, she was a very sick woman, maybe even sicker than he thought. He was grateful that Cathy had listened to him and seemed to take it seriously. Admittedly, the list of Jaime’s illnesses and injuries was hard to refute. He had been shocked by them too when he wrote them down.
He wondered what the psychiatrist she knew would tell Cathy. Munchausen by proxy, or factitious disorder imposed on another as it was also called, wasn’t something doctors, or even psychiatrists, ran into every day. He was impressed that his mother had spotted it so early, but she was a smart woman and still kept up on her psychology journals, and read voraciously. And he believed now that she was right. What he didn’t know was what to do about it, what to say to Zoe, and how to protect Jaime from getting injured again and again, or taken to doctors for illnesses she didn’t have. Zoe was reaching out past Cathy now to specialists, like the orthopedic surgeon she had taken Jaime to. The thought of Jaime needlessly having spinal surgery made him feel ill. Their situation was a nightmare, and he didn’t know how to wake up.
* * *
—
Cathy was having similar thoughts about everything Austin had said. She loved Zoe, and they had become close friends. She was a wonderful person and remarkable human being, with the work she did, and Cathy had no doubt that she loved Austin and Jaime, yet what Austin said seemed so valid. What if it was true? She didn’t know enough about the disorder to know what the remedies were or if it could be treated with therapy. But if what he said was accurate, Jaime wasn’t safe with her mother, and Cathy couldn’t let their friendship cloud her vision and fail to do what was right for the child. Munchausen by proxy was a form of child abuse, a virulent, insidious kind that was difficult to identify, and harder still to prove. Cathy knew that much about it from the literature she’d read, but she didn’t know a single physician who had ever run into it. She hoped Paul Anders had and could shed some light on it, and give her some direction. If Austin was right, they had challenging times ahead. It was all swirling around in her head like a tornado, as she waited for Zoe to show up with Jaime. She hoped the dog bite wasn’t bad. She was due to have the stitches in her chin taken out tomorrow. Cathy was going to do it for her, and now she had another injury, so soon after the last one, and also on her face.
The nurse at the front desk buzzed Cathy when they arrived, barely five minutes after Austin had left, and she hurried to the exam room where they were waiting. Jaime was clinging to her mother and looked traumatized, and she had Zoe put Jaime down on the exam table. She was shaking, and Cathy feared at first that the bite was deep, but on closer inspection it didn’t look quite so bad.
“Hi, Jaime,” Cathy said gently and rubbed her back for a minute, as Zoe looked devastated. It was hard to believe that her fear for her daughter wasn’t real. She looked almost as shaken up as Jaime. But Cathy had to focus on Jaime now. “You ran into a big scary dog, huh? Did he chase you and knock you down?”
Jaime shook her head. “No, he was on a leash,” she said clearly, as Zoe shook her head.
“No, he wasn’t, Jaime,” Zoe said firmly, “he was off the leash, the leash was in the man’s hand.” Jaime moved her head from side to side again, disagreeing with her mother.
“Mommy said I could play with him,” she volunteered.
“Jaime!” Zoe objected. “I told you to stay away from him.”
“What kind of dog was it?” Cathy asked them.
“A German shepherd,” Zoe responded.
“He looked like a wolf,” Jaime added. “And he had big teeth.” All the while they were talking, Cathy was eyeing the wound on her cheek. It wasn’t bleeding profusely as Zoe had said her chin had, but the bite was deeper than Cathy liked. She didn’t want it to leave a scar on her face. She’d been lucky not to lose an eye, or the dog could have killed her. She turned to Zoe then, trying not to think of everything Austin had told her. She didn’t want to make any judgments yet, she didn’t know enough and needed further information.
“I’m going to give Jaime a booster for her tetanus shot, just to be on the safe side. Did you get the name of the owner, in case we need to contact him?” Zoe looked blank for a minute and then embarrassed.
“I never thought of it. That was stupid of me, but all I wanted to do was rescue Jaime and get her out of there. The owner called off the dog pretty quickly when I was screaming at him.”
“He pulled him back on the leash,” Jaime added, and she seemed listless to Cathy.
“He wasn’t on a leash,” Zoe said forcefully again. “He pulled on his collar when I shouted at him.” Zoe was determined to be the hero of the piece, and Cathy felt a chill run up her spine. Her behavior matched what Austin had described, and suddenly she felt sick. Maybe she and Austin had both misjudged Zoe, and the ghosts of her past tragedies had wounded her more deeply than either of them had thought. It was the only explanation Cathy could think of for what Austin had proposed. And more than anything, she wanted none of it to be true. Could they have misjudged Zoe so severely? But what if they had? It couldn’t be.
“At least we know he had an owner, and he wasn’t a stray dog,” Cathy said as she took the tetanus booster out of a drawer, and Jaime cringed when she saw the shot. Zoe held her and it was quick, and afterward Cathy smiled at Jaime and told her how brave she was. “I’m going to send you to a very nice doctor, and I think you’re going to like her. She’s from Hawaii. I went to medical school with her, and she’s only a few blocks away.” She turned to Zoe then. “She needs a plastic surgeon. I don’t want to stitch her up and have it leave a scar. Since it’s on her face, I think it’s better. She can take the stitches out of Jaime’s chin while you’re there. One stop shopping.” She wrote down the address of Jane Yamaguchi in SoHo, and handed it to Zoe. “I’ll call her and tell her you’re on your way.” She kissed the top of Jaime’s head and hugged Zoe, and they left a few minutes later as all of Cathy’s nurses waved at them.
Cathy walked back to her office to call the plastic surgeon, told her what she knew about the dog bite, and said she’d given her a tetanus booster, to be on the safe side. But the dog appeared to be a pet, presumably was licensed, so hopefully rabies wasn’t a concern. And then she asked her to take some stitches out of Jaime’s chin.
“What is this kid, a prizefighter? She’s got stitches in her chin, and just got a dog bite on her cheek?”
“A run of bad luck,” Cathy explained to her. “She had a swimming pool accident in Florida ten days ago, and got bitten by a dog today.”
“Poor kid. How bad is it?”
“I think it looks worse than it is. But I’d rather have you do it, instead of me, since it’s on her face.”
“Happy to be of service. How’ve you been by the way? We should have dinner together one of these days.”
“I’d love it, call me.”
“I will. And thanks for the referral. I’m going to throw some business your way shortly too. I’m adopting a baby in Hawaii, using a surrogate. It’s due in two months. A little boy.” She sounded happy and excited and Cath
y was pleased for her. She had always wanted kids, even in medical school.
“Congratulations! That’s terrific!”
“Yes, it is. I decided to stop waiting for Mr. Right, and when the right guy comes along, he’ll love us both.”
“Good for you, Jane.”
“My parents are a little upset about it, traditional Hawaiians and very conservative, but they’ll get used to it. The sperm donor is Hawaiian, he’s an old friend, so they’ll relax about it eventually. I’m flying out to Honolulu for the birth. I’ll bring the baby in to see you as soon as we get back. It’ll be a big change in my life.” She sounded thrilled. They were all coming to their own conclusions about turning forty, but Cathy wasn’t ready for any major decisions yet.
She called Austin after she spoke to Jane, to tell him about Jaime. She wasn’t sure if Zoe had called him yet, and he sounded tense when he answered.
“I just saw Jaime, it’s not a deep bite, and I think it will stitch up cleanly. I sent them to a plastic surgeon, I’d feel better about having her do it, and I gave Jaime a tetanus booster. And the plastic surgeon is going to take out the stitches in her chin.”
“She’s been through the wars. Is she very upset?”
“She was at first. She’ll be okay.” She hesitated for a minute, and then decided to tell him the disturbing piece she had noticed when they were in her office. “I think I should tell you that Jaime says the dog was on a leash and Zoe said she could play with it, and then he snapped at her. Zoe says the dog was off leash and she told Jaime to stay away from him. We’ve got two very different stories. But there was an owner so he wasn’t a stray dog, which is good news. He’s probably had all his shots and is licensed. Let’s hope so.”
The Dark Side Page 16