“What kind of dog was it? Did she say?” Austin sounded jangled and Cathy felt sorry for him. He had a lot to worry about.
“A German shepherd.”
“Oh my God, how can you let a three-and-a-half-year-old play with a dog that size? Did she get the owner’s name?”
“No, she didn’t,” Cathy said quietly. So they couldn’t corroborate the stories and see who was telling the truth, or even trace the dog and owner. Cathy had a sinking feeling that Jaime was being honest and Zoe was lying to her, which meant that she had encouraged Jaime to play with a dog that looked fierce and was on a leash. But even on a leash, a shepherd could be dangerous, and had been for her. Cathy didn’t like the story, and it made what Austin feared seem even more real.
As soon as she hung up, she called Paul Anders expecting to leave him a message, instead he picked up himself. He was between patients and was surprised to hear from her. They hadn’t spoken in about a year.
“I have a problem and I need some advice.” She got right to the point. They were both busy and her next patient was due in any minute, and his probably was too. “Can I come by and talk to you?”
“Is it serious? Are you in a rush?”
“Serious, yes. In a rush, not so sure. When do you have time?”
“Are you free tonight? I’m going to L.A. tomorrow for a psychiatric convention. I could do it after my last patient. Seven o’clock work for you?”
“Perfect.”
“Come to my office. We can have a glass of wine while we talk.”
“Sounds great. Thank you, Paul,” she said warmly, grateful for the quick response.
“Any time.” They had dated a few times, but she liked him better as a friend. He was smart and serious and direct to deal with. She knew she’d get the straight scoop from him about Munchausen by proxy and whether or not Zoe sounded like she fit the bill.
Her next patient was waiting for her by then, and she went to do a six-month checkup, and tried to put Austin, Zoe, and Jaime out of her mind for a few hours, at least until she met up with Paul that night. Until then, she had to be an efficient pediatrician and think about her other patients.
She hoped Jaime had done all right with Jane. She was in good hands.
She smiled at the young mother as she walked into the exam room and a six-month-old baby girl grinned at her, and reminded Cathy how much she loved her job. This was just what she needed today, she thought as she picked up the baby and smiled at the mom. Except for situations like Jaime’s, it was a happy line of work.
Chapter 14
Cathy’s last patient left at five-thirty, and she had an hour and a half to kill before she met with Paul Anders. She didn’t want to go to her apartment, and decided to stay at the office and read carefully through Jaime’s records, and see how they seemed objectively, knowing Austin’s concerns.
She started at the beginning, with all of Zoe’s nursing difficulties and fears about the baby, cracked nipples, Jaime falling asleep at the breast after a few minutes, her fear that Jaime wasn’t getting enough milk, that she was a picky eater, might have a gastric obstruction which she obviously didn’t, projectile vomiting which she didn’t have either, claims at every visit that she had colic, with no real evidence of it. The beginning hadn’t been smooth, but none of it was serious. They were nervous first-time parents. And then three weeks in, the apnea incident when Jaime had stopped breathing, an incident that had never been repeated. Zoe had insisted on seeing a pediatric gastroenterologist for testing, and he had found Jaime to be normal. She saw a note from the doctor then, which Cathy had forgotten in the meantime, that Zoe had inquired about a gastric tube, which he had told her was inappropriate and unnecessary. And all along Jaime was gaining weight, and seemed to be thriving in spite of her mother’s nervousness.
Then there was her first injury when she rolled off the changing table at four months. Nasty bump on the head, but no concussion. Zoe had insisted on seeing a neurologist. Everything else was normal. And then the broken arm and stitches in her lip when she fell down the stairs, and later a fall in the bathtub. Cathy had made a note in the chart that Zoe had a lot of theories about no feeding schedules, no bedtime, respecting the baby’s freedom, no gates when she started walking. They hadn’t been friends yet, but she remembered how much she liked Austin and Zoe, how earnest they were, and how devoted Zoe was to her baby.
There was a note in the chart that she sat up all night every night with the baby, holding her upright, to avoid another apnea incident. Their anxiety screamed off the chart, but so did Zoe’s dedication. And all the other incidents were listed as she flipped through the pages. The broken wrist when she fell off the big girl swing. The flu and reported febrile seizure at home, and they had admitted her to the hospital for a night, and the fever had gone down by morning. Both dislocated elbows. It was all there, and as Austin said, the list of her injuries was long.
What struck Cathy was that Jaime was a healthy child who bounced back from every injury and incident. There were many notes in the chart, a lot of them about minor injuries, and Zoe’s concerns about the baby. She had called in frequently about teething problems for the better part of a year. And the more recent incidents were all listed too. Cathy had forgotten how many there were, many more than she normally saw, but somehow she hadn’t strung them all together because she knew what good parents they were, and there had never been a question in her mind about child abuse. But looking at it now, she could see that Jaime had been injured too often, and if she hadn’t known the parents so well, she might have questioned it. What came across was that Jaime’s mother was neurotic and overanxious and constantly concerned about her daughter’s health.
She saw the results of the leukemia testing, which she had done just to indulge her. She and Zoe were good friends by then. Jaime had been in their office far more than most of their patients. Jaime had had the usual coughs and colds and flus during her first year of school, and also the ear infection that led to her getting ear tubes without consulting Cathy about it. She had a lengthy history for what was essentially a healthy child. She had nursed for fourteen months, and was allergic to amoxicillin, none of which was unusual. None of her illnesses were serious, but the list of physical injuries was more extreme. If anything, Zoe came across as overzealous in the chart, and Cathy had made a side note early on: “uber mom.” And they had had long discussions about whether or not vaccines were dangerous and caused autism, but Zoe had finally given in and Jaime was up to date on all her shots. Her conclusion when she finished reading Jaime’s records was that she was too close to Austin and Zoe to see it objectively. She made a copy of the file, and put it in an envelope for Paul. Then she walked the ten blocks to his office, and arrived right on time.
She pressed the buzzer, and he let her in. He looked like a professor or a shrink. He was wearing a tweed jacket, cowboy boots, and jeans. He wore his light brown hair longer than most of the men she knew, and he had a beard. She knew he was somewhere in his late forties but didn’t know exactly where. She followed him up the stairs to his office, and he opened the promised bottle of wine.
She took a seat in the comfortable chair across from his and he handed her the glass of wine, and she noticed a box of tissues on the table next to her. She handed him the manila envelope with Jaime’s chart in it.
“So what brings you here, my friend?” She saw him looking at her legs and pretended not to notice. She knew he had been divorced twice and was something of a ladies’ man, which was one of the things about him that had put her off, but she liked him as a friend, and respected him as a shrink. And she had the blond, blue-eyed, wholesome kind of girl-next-door looks that appealed to him, and a great figure. But she was there as a doctor, not a date.
“A three-and-a-half-year-old patient. I read her chart again before I came over, to see if anything stuck out, or I missed anything. She’s a bright, happy
, normal, active kid. She gets banged up a lot, and has had a lot of minor accidents. Nothing terrifying that suggested child abuse to me, and I know the parents. But she’s had her share of injuries, probably more than her share. Broken wrist, broken arm at a year old, stitches, a bump on the head but no concussion, ten days ago she slipped while running at a pool, cut her chin open, fell into the deep end, and went down like a rock. Her father noticed and got to her just in time. She had twelve stitches in her chin. Today, she got bitten in the face by a German shepherd. It’s a long list. One minor surgery for ear tubes, and almost an appendectomy. Her mother lost a sister to leukemia as a child, so she’s nervous. At her request, I tested my patient for leukemia, negative of course. Now she’s seeing an orthopedic surgeon, wondering if the child has scoliosis—she doesn’t.”
“Shit, it sounds like a lot to me. Stitches twice in ten days?” He looked skeptical.
“Two in a row is unusual, even for her.”
“So what are you trying to figure out. Child abuse?”
“No. More intricate than that. To cut to the chase, my patient’s father thinks his wife may have Munchausen by proxy. His mother suggested it, she’s a licensed, non-practicing psychologist.”
Paul rolled his eyes at that. “God save me from my non-practicing colleagues, who have too much time to think. It’s an interesting diagnosis, though. What do you think about it?”
“I have no idea. I’ve never dealt with it. That’s why I wanted to talk to you. And the child’s mother runs one of the most respected abused-children’s shelters in the city, and had two years of medical school. The parents are highly educated, intelligent, nice people, and they’re crazy about their child. But I have to admit, the kid has gotten hurt a lot. When I try to look at it objectively, I see it too.”
“And you don’t think she’s abusing the kid in a more traditional sense, and the child is protecting her, as most abused children do?”
“Definitely not,” Cathy said as she took a sip of the wine and set it down on the table next to her.
“Interesting case. I have dealt with Munchausen by proxy. It’s a bitch to prove. The people who have it are usually smart and educated, a lot of them have medical training, as the mother does in this case. They lie like dogs and they do it brilliantly, and it’s very hard to pin anything on them and prove it. It all looks accidental, except for the excessive surgeries. The mother may be moving into that phase, if she’s taking her to an orthopedic surgeon.
“The ignorant ones usually kill their kids in more obvious, clumsy ways and wind up in prison for murder. But the children of the smart ones die too, if they go too far. It’s all about the parent getting attention from having a sick kid, either sympathy or they play super-mom, and everyone talks about what great mothers they are, except that they’re either making the kid sick, or putting them in situations where they’ll get hurt. Off the top of my head, just from what you’ve told me, I think it’s a possibility. Is it a sure thing? It almost never is. And most typically, their victims are under six, because they can’t communicate what’s happening to them. They don’t understand it anyway, so they make lousy witnesses. What is unusual is that most of the fathers of these kids never speak up. They either don’t understand what’s going on, or they don’t want to make waves, so they just lie low and pretend they don’t see it. Your patient’s father is atypical.”
“He says he’s terrified for his child. He doesn’t trust his wife anymore. He says she lies to him.”
“If she has MBP, or factitious disorder imposed on another, you can be damn sure she does. And if you try to pin something on her, she’ll lie more. And everyone will say what a fantastic mother she is. They make sure that everyone knows that about them. They’re the best mothers in the world, except that they’re injuring or killing their kids.”
“Is that what they want? To kill the child?”
“I honestly don’t know. I think sometimes they just go too far, and become too dangerous and it gets out of hand, or maybe they just can’t stop. But some of the victims die, there’s no question of that.”
“How do you stop them? Therapy?”
He smiled wryly at that. “Thank you for your faith in my chosen field. No, therapy has no effect on them. They’re like pedophiles, you can’t stop them or cure them. You have to remove the child, in order to save its life, and their quality of life. You know what your role is in this, don’t you?”
“No, I don’t. That’s why I’m here.”
“If you really believe the mother has Munchausen by proxy, you have to report her to the authorities, in other words, Child Protective Services. It’s your responsibility. You have to write the report and turn her in. It’s confidential, of course, and if you don’t have an airtight case, she’ll wiggle out of it. Most of them do, with righteous indignation. If it keeps happening, they may be able to nail her eventually. But it’s not easy, so you have to be fairly sure.”
“And if I’m not?”
“Then you don’t have a case, and the kid keeps breaking bones and having unneeded surgeries, and hopefully grows up and gets away, or she dies. It’s been a fairly taboo subject for all these years. Essentially, these kids are child abuse victims, to an extreme degree, and it’s often done in a very sophisticated way, by a mother who everyone tells the authorities is a star. I’ve only had one patient who was an MBP victim as a child. He was in pretty bad shape mentally, and eventually committed suicide. It was a sad case. They go after the elderly too, their geriatric parents who can’t defend themselves. They die pretty quickly. Kids are sturdier and more resilient. It’s an ugly business. I hope for your patient’s sake that you’re wrong about this. But at least she has her father on her team. It sounds like he’s alert and watching what’s going on.”
“He is now. But he doesn’t know how to stop her and keep the child safe.”
“He can’t do either one. If she has MBP, he’s got to get the kid away from her, as soon as possible. Whatever he does, she’s going to keep creating situations where the child gets hurt, or sick.”
“My God, it’s awful.” Cathy looked upset, thinking of Jaime with the dog bite on her cheek. She’d had an email from Jane at the end of the day that everything had gone well, and they’d taken care of her chin too. She promised there would be no scar on her cheek, which was why Cathy had sent them there. She had total faith in Jane.
“I’ll look at her file tonight, before I leave for L.A. tomorrow, and I’ll call you in the morning before my flight. What you do after that is up to you. You may have to wait awhile and gather more evidence against her. But while you do, the child is at risk. And if this woman runs a child abuse shelter, you’re going to have a hell of a time nailing her. She’ll smell like a rose in court. What does her father do?”
“He’s a child advocacy lawyer, and he does a lot of pro bono work for her.”
“It’s too bad if this turns out to be true. They sound like good people.”
“They are, which makes this that much harder to believe.”
“Just know that if she has MBP, she’s not a good person, whatever she looks like, or whatever her reputation is. She could kill her kid.” He couldn’t have put it more bluntly, and Cathy was glad she had come to talk to him. He knew a lot about MBP and made the situation very clear. It was equally obvious that Cathy was in a terrible position, and had to report it if she believed it was true. She would have to do so for Jaime’s sake, which was her responsibility here, as Jaime’s primary physician, and a licensed doctor in the state of New York. “I’ll give you my honest opinion in the morning, as best I can. With MBP, you almost never know for sure, unless you find her with a knife in the kid’s back. But they’re a lot more subtle than that as a rule. You have to go with your gut. You read about these cases in the papers, but not very often.” They talked about his trip to L.A. after that, and her busy practice, and they promised t
o have dinner when he got back. It was eight-thirty when she finally left. He had given her a lot to think about. She didn’t call Austin that night. She had nothing to tell him yet, except the general information Paul had shared with her, but Austin already knew it from the book his mother had given him. And if she called him, Zoe would be there. Cathy had to wait to hear from Paul anyway.
* * *
—
Paul called her the next morning at eight A.M., from the airport, before his flight to L.A.
“I read the file last night. If you want my personal opinion, I think you have an almost classic case of Munchausen by proxy on your hands. She fits the bill in a number of ways, just judging by the child’s injuries, and the assortment of specialists she’s been to. But the evidence you’ve got is pretty benign in a practical sense. Falling down stairs as a toddler, resulting in a broken arm, slipping off a swing, broken wrist. Running at a pool and falling in, after she slices her chin open. Rolling off a changing table. She’s gotten injured, but it’s cleverly done. It’s a lot of what appears to be small stuff. It’s not so small if you look at the volume of it, but there’s no obvious violence. She hasn’t poisoned her, or pushed her down the stairs. She wasn’t even at home for the stair incident, but she set it up. She unscrewed and removed the gate Jaime’s father had installed. I don’t think he could win a case with what he has. Even Child Protective Services couldn’t pull it off. She’s too smart, and they might try to accuse the father, which would be worse. What if they gave custody to her? She’s the superstar mom in all this, whom everyone sees adoringly, according to what you told me last night.”
“What do you think we should do?”
“He may have to wait for more concrete proof. Jaime will inevitably get hurt again. And he’ll have to watch his wife like a hawk, while appearing not to. It’s not fair, but I think it may be too soon. And medically, you can keep an eye on her. Don’t let her go to some quack who’d operate on the kid.”
The Dark Side Page 17