“For once she was right.”
“Not really, a reaction that severe is unusual. You see it in nut allergies and shellfish. Apparently, Jaime has a very severe allergy to honey. It’s good to know. I have no doubt about it, Austin. It was real this time. She couldn’t manipulate this unless she knew about the honey allergy in advance. Even victims of people with MBP have real accidents and illnesses sometimes. This wasn’t Zoe, I’d stake my license on it.”
“I thought she had poisoned her,” he said, still shaken by what he’d seen.
“We can run some tests, but I think the only chemicals we’ll find in her system are the meds they just gave her.”
“Will you run the tests?” he asked, and she nodded. He felt supremely guilty for what he had thought. But the truth was that he didn’t trust his wife, with good reason. But apparently, Zoe had nothing to do with what had just happened, which in some ways was a relief.
Cathy ordered the tests after they registered Jaime, and she explained to the attending physician that she wanted to be sure she hadn’t ingested any chemicals or medications at home when no one was looking, or if it was a straight allergic reaction. The attending said it was thorough of her, but they both agreed that it was probably entirely an anaphylactic reaction. Cathy wanted to be sure.
The tests came back a few hours later, and were clear. The only things in her system were the drugs they had given her at NYU. Austin looked at Cathy guiltily when she told him. He didn’t know what to think anymore. And the attending spelled it out clearly to them before they released her at six o’clock.
“She had a near fatal allergic reaction to something she ate at brunch today. Dr. Clark is going to send you to an allergist tomorrow so you can figure out what. Until then, she needs to stay away from what she ate, banana, oatmeal, honey. You’ll need to carry an EpiPen for her in the future. I’m giving you a prescription for one, the children’s dosage. You should have it with you for her at all times. Allergic reactions usually get worse every time. She started out with a bang here, the next time we may not get as lucky. Learn to use the EpiPen, you may have to in a hurry, and you don’t want to be fumbling with the instructions or trying to figure it out. You can get a practice model, and test it on an orange. She’s very lucky you called 911 so quickly. They saved her life, and so did you.” Zoe glowed when he said it, and Austin nodded. For once, it was true, and she hadn’t caused the problem in the first place. Her innocence in this case left him feeling grateful but confused. “Sometimes people become allergic to foods they had no allergy to before. That can change anytime, so you need to check out everything she ate. And if it’s honey she’s allergic to, you’ll need to be careful. There’s honey in baked goods and in many other foods. People use it to cook, even on vegetables sometimes. Read the labels on everything you suspect might have honey in it. It’ll spare you another episode like this.” They both nodded, shaken and impressed by what had happened. They left the hospital with Jaime a while later. She was groggy from the Benadryl they had given her. Cathy had prescribed a children’s dose for the next few days, until the allergens were truly out of her system. They were to start it after they saw the allergist the next day, so they didn’t confuse his tests. After that, Cathy said Jaime would sleep for the next few days from the antihistamine.
All three of them were subdued when they left the hospital. Jaime from the drugs, and Zoe and Austin from what had almost happened. Jaime had nearly died from a donut. It had been one of the most frightening moments of their lives as parents. They sat in the kitchen after they put Jaime to bed, and neither of them said a word. They were lost in their own thoughts, with the image of Jaime unconscious in the ambulance, dying, engraved forever on their minds.
* * *
—
Cathy called Paul Anders at home that night and told him what had happened, since he was following Jaime’s case. Talking to him was comforting. It was an unnerving case, with their worries about MBP.
“We ran some extra blood tests, and there was nothing in her system except what she ate and the meds they gave her in the ER. Austin was afraid Zoe had poisoned her, but she’s clean on this one without a doubt. It was a straight anaphylactic reaction. And I don’t think Zoe had anything to do with it. Jaime had never had honey before, because her mother thinks it’s dangerous, and has been diligent about avoiding it for her. It turns out that she was right, for Jaime anyway. I think Austin was shocked that it was a real accident this time, and nothing had been engineered. I have to admit, I’m relieved. She came very close to dying. I can’t even imagine what that would look like if her mother had killed her. None of us would ever have forgiven ourselves for not moving sooner. This was a freebie.”
“Don’t celebrate too soon,” he said in a serious voice.
“You think she did it?” Cathy was stunned. She couldn’t see how in the circumstances.
“No, I don’t. I agree with you. Victims of a Munchausen by proxy mother can have an innocent allergic reaction, or real unprovoked illness too. And I agree with your diagnosis and analysis of the situation on this one. But you’re overlooking something major.”
“What?” She couldn’t see what it might be.
“The bad news is that Zoe has just been handed a lethal weapon, a major vulnerability in Jaime. She nearly died from a honey glazed donut today. An allergy that severe is a loaded gun in her mother’s hands. It seems like there’s honey in damn near everything these days, bread, cookies, cakes, all kinds of prepared foods to varying degrees. We’re not talking about a rare poison. We’re talking about a common substance that’s harder to avoid than to find. Anytime Zoe wants to kill her daughter, all she has to do now is give her something with honey in it, and then claim she didn’t know, or lose her EpiPen, or God knows how she’d orchestrate it. Jaime has an Achilles’ heel now the size of Yankee Stadium, an allergy to a substance so benign that Zoe will almost certainly get off scot-free if she kills her, unless someone sees her pouring honey down Jaime’s throat with the kid tied to a chair.”
“Shit. I hadn’t thought of that. I was just so glad that it wasn’t her fault this time.”
“Don’t be fooled by her outward demeanor, Cathy. You know better than that,” he said wisely. “The evidence against her is already strong. It may not hold up in court, but we’re all convinced of the truth, and her innocence today in this one incident doesn’t change that. She’s guilty of all the rest, and we know it, almost for sure. But this allergic reaction today is what could kill Jaime. Her life is even more at risk from now on, because of a simple thing like a severe allergy to honey.”
“So what am I supposed to do now?” She sounded near tears, and she knew that what he said was true. What would be easier than killing someone with honey, and it wouldn’t take much, judging by today.
“I don’t think you have any choice anymore. I wouldn’t even ask Austin. You can’t. He’s probably as confused as you are. She’s his wife. But you’re their doctor, Jaime’s doctor. This is a tragedy waiting to happen. You have to report what you know from the past three and a half years to Child Protective Services now. Cathy, you have to. There’s no other choice. With the compounding element of a severe allergy which could kill her, to a substance so readily available, they have to open an investigation. I was willing for all of you to wait until now. I’m not anymore. The honey allergy could be a death sentence for Jaime in her mother’s hands. Write your report tonight, and call CPS tomorrow. You can’t wait any longer.”
Cathy was silent for a long moment as she thought about it, and much to her chagrin, she knew he was right. And just as Austin did, she felt like a traitor to her friend. She was going to write the report, and call Child Protective Services, as Paul said she should. But she wasn’t going to tell Austin yet. He didn’t need to know.
Chapter 16
Dan Knoll had come to work at Child Protective Services through a circ
uitous route. Homeless and abandoned on the streets of Chicago at seven, by parents he couldn’t even remember, a father who died in prison, a mother who dealt drugs until her boyfriend killed her, he had grown up in foster care. He had been shuffled from one family to the next, badly treated and sometimes beaten. He had never worked out at any of the families where he’d been sent by the state. They said he was difficult, noncompliant, surly, oppositional, but mostly he was scared. He was a big kid, tall with broad shoulders and red hair, six foot four at twelve, and six-six at fourteen, so no one had figured out that anger was his camouflage to keep people from seeing that he was afraid. His friends and enemies called him Big Red. A football coach at one of the schools he went to had taken him under his wing, gave him a job when he left foster care and let him live with him and his family, and trained him. By a series of fortuitous circumstances that seemed more like miracles when he looked back on them, he had gotten into professional football, thanks to Coach Fitzgerald, and played for the Detroit Lions for three years. He was an offensive lineman, and had a bright future until a game against the New England Patriots in Boston ended all of that for him. He destroyed his knee and no amount of surgery could put him back in NFL football.
He played around with drugs for a while, drank too much, spent his money, and felt sorry for himself until Pat Fitzgerald grabbed him by the scruff of the neck, brought him home, threatened to kick his ass, and told him he had two choices. He could either be a bum for the rest of his life and maybe wind up like his parents, or be a respectable human being and do some good in the world. He told him to clean up, get a job, figure out what he wanted to do now that he was an adult. He lived with Pat and his family, worked at a gas station, and at night studied to be a social worker. It took a long time, but he got the degree. He moved to New York, got a job with Child Protective Services at thirty, and he had been there for ten years, handling cases of kids who were just like him when he was their age. He liked working with the bad boys best. It was such a victory when he could do something for them to help turn them around. That was Pat’s legacy to him. Dan wanted to give back what he’d been given. He wasn’t married, but had had a series of long-term girlfriends. He was “serially monogamous,” as the term went, and unattached at the moment. He had a heavy caseload and the department was understaffed and overworked, and he was usually at his desk at night working till all hours, writing reports to catch up.
The ultimate punishments for him were teenage girls. They were much harder to figure out, bitchier and more vicious than boys the same age. But he took what was assigned to him. His boss was a sixty-year-old African American woman, Yvette, who was smarter than anyone he knew. Dan was in charge of investigations of children whom observers suspected were being abused. It was thankless work, but he liked it. He liked discovering the truth and saving a kid from bad people. He felt like Superman when he did.
“I’ve got a new case for you,” Yvette said as she came by his office on Tuesday morning and dropped the file on his desk. “Came in yesterday. The initial reporter is the child’s pediatrician.”
“Child abuse?” He hated child abusers with a passion and removed the victims from dangerous circumstances and bad parents whenever he could. He had saved a lot of lives by doing so.
“More or less,” Yvette said cryptically. “In a convoluted way, if what they say is true.” They both knew that, given the opportunity, most of the people they dealt with were liars. Yvette had been in the field for twenty years before they assigned her to run the office. She’d been Dan’s boss since he’d been there.
“What does that mean, ‘convoluted child abuse’? Is that like virtual child abuse? They do it online?”
“Don’t be a smartass, read the report. She called yesterday. It’s confidential as to who called it in. The report is very comprehensive.”
“Is it red flagged? I don’t have time to read it till later. I have to see three kids today, and talk to the neighbor of a kid who was being beaten every night until they called the cops. She’s in a shelter pending a custody hearing.” He dealt with the heavy-duty cases.
“There’s no flag on it yet, but you should read it. It’s unpredictable and could get hot fast.”
“Great.” Yvette went back to her office, and he attacked the stack of files on his desk. He had interviews to do on each of them. The days were never long enough for him and he often finished work at ten P.M. He had no one to go home to right now anyway, although he hoped that would change. He’d been alone for a year, which was a long time for him. He was a good-looking man and some women loved his “gentle giant” appeal. But he hadn’t met a woman who mattered to him, and seemed worth the effort, in a long time.
He made notes on three files, and the orange file Yvette had left with him kept gnawing at him, begging him to open it. He put the others aside, and opened the file. Cathy’s neat, concise report on her letterhead looked up at him. She had sent it in hard copy and email. Yvette had said she’d forward the email to him too. Her identity was confidential to anyone except the department, particularly to the parents.
Cathy had listed all the incidents chronologically, and they filled a whole page, much to his amazement. He scanned through them quickly, all events that could be accidental, or engineered by a clever abuser. She included a brief profile of both parents, and he whistled. They sounded fancy to him, and certainly educated. The mother ran a shelter he knew well, but that didn’t impress him. He’d had two supposedly respectable physicians with apartments on Park Avenue nearly beat their children to death and lose custody. Fancy meant nothing to him. People were people and some of them were very sick. Those were the ones he was looking for, to put them away, and rescue their kids.
Cathy had explained that both the father and the paternal grandmother suspected that the mother of the child in the report suffered from Munchausen by proxy, and were afraid she would continue to injure the child and put her at risk. She said that a psychiatrist she had consulted, who had not met the family or the child, agreed with them, based on the evidence, and had urged her to report the family and situation to CPS. He could read between the lines that she had done so reluctantly, but sincerely felt that the child was in danger. Her phone numbers and email address, and the address of her office were all included if they wished to interview her.
The report was respectful, smart, not hysterical, and as factual as it could be, based on assumptions and guesswork and hypotheses. But there was nothing hypothetical about the injuries the child had sustained. There were too many of them to be entirely accidental. Dan would have been suspicious immediately if someone at the hospital had brought it to his attention. Some medical workers did, but many didn’t. They were supposed to be mandated reporters, but most of the time they were too busy to add up the evidence. They tried to get doctors and nurses to always report suspected child abuse, and many people were afraid to or didn’t want to get involved. With a three-and-a-half-year-old in this case, Dan didn’t want to let it slide. A child that age couldn’t defend herself, particularly not against a clever mother who hid what she did. He wouldn’t have suggested Munchausen by proxy on his own, but he had read about it, and was fascinated by the disorder. It was his first case of its kind.
He picked up his cellphone and called Cathy’s office number. He gave the receptionist his name but not who he worked for, and Cathy was about to refuse the call when she suddenly wondered if it was someone from CPS being discreet. The woman she’d spoken to the day before had told her that an investigator would call her.
“Yes? Dr. Clark,” she said officially when she picked up.
“Hello, Doctor. I’m Dan Knoll, CPS. I think you know why I’m calling. I have to interview someone in your area early this afternoon. Could I have a few minutes of your time after that?”
“Of course.” She was impressed that he had called so quickly.
“It would usually take me a little longe
r to get to you, but the subject is young in this case. I don’t like to let those cases sit around. Thank you for reporting it. Interesting situation. Will five o’clock work for you?”
“That’s perfect. My last patient is just a measles, mumps, and rubella vaccine, so it should be quick.”
“I can wait,” he said in a smooth, even voice. She couldn’t tell how old he was, but he sounded intelligent, and interested. She could only imagine the shitstorm that would happen when he interviewed Zoe. She would go insane. The world’s #1 super-mom, interrogated by CPS.
* * *
—
When Zoe took Jaime to the allergist Cathy had recommended, he did a number of scratch tests on Jaime’s arms and back. They had to wait in a room for an hour, watching to see what would react to the substances they’d applied, and come up in red blotches and welts. He was an older man and was wonderful with Jaime. He spoke to her with a red clown nose on him the entire time and she couldn’t stop laughing, great big belly laughs, and he asked her innocently why she was laughing at him, and she pointed at the red nose. When he came back into the room for the second time to check on her, he wore a clown wig to go with it, and she laughed even harder, and Zoe laughed too. It was a blessed relief from the shock of Jaime nearly dying two days before. He made it an easy stress-free visit for them.
The result of his skin tests showed that she was allergic to asparagus and eggplant, which weren’t part of her diet. She’d never eaten either, they were easy to identify, they wouldn’t be a problem. She had minor allergies to some pollens, a slight allergy to dust, which he said everyone had. She was allergic to cats and not dogs. And Cathy had relayed her amoxicillin allergy to him. But her allergy to honey was off the charts. And she was as allergic to bees as she was to honey. Either of those allergies could prove fatal, and both were in the anaphylactic range. Her parents would have to carry a double EpiPen Jr for Jaime, and so did the nanny, in case she ever got stung by a bee, at the playground or elsewhere. All of the other allergies were to a lesser degree which might make her sneeze or give her a rash or hives. But bees or honey would close her throat or stop her heart, and adrenaline, steroids, and a powerful antihistamine had to be administered immediately. As the doctor at the hospital had said, the allergist told Zoe that honey was tricky because it was in so many packaged foods and couldn’t always be detected. She would have to ask the question or read the label every time. But other than that, he found Jaime sound, and she said goodbye to “Dr. Clown” when they left and blew him a kiss.
The Dark Side Page 19