“Come back and visit me sometime,” he said as he waved at her. He and his nurse agreed she was an adorable child. He took his clown nose off after she left.
The doctor reported his findings to Cathy, which she relayed to Zoe and Austin as soon as Zoe and Jaime left his office. The only real news was about asparagus and eggplant. But he had confirmed how lethal honey and bees could be to Jaime. Cathy’s heart sank when she heard it, remembering what Paul had said about the honey allergy being so severe it was a loaded gun in Zoe’s hands, if she really was MBP. She could always claim afterward that she didn’t know there was honey in something Jaime ate, and it would be believable because so many commercial products had honey in them, even in small amounts. It posed a major threat to Jaime, especially in her mother’s hands. Austin realized it too.
* * *
—
When Dan Knoll came to Cathy’s office, he looked like a bull in a china shop as he sat perched on a couch next to the little chairs for children in her waiting room, and the low table with toys on it. The nurse led him to her office, after he heard a baby scream and a mother leave with a crying infant. The MMR shot, he assumed.
She stood up at her desk when he walked in, and extended a hand to shake his. She was startled by his size, he dwarfed her office the moment he walked in. He had a pleasant face and kind eyes, and there was nothing ominous about him. But he looked like he could take care of himself on a dark night, which was accurate. He was a black belt in karate, which his mentor thought would be good discipline for him. He still went to classes twice a week, to teach now, and sometimes he took some of the boys whose cases he handled with him. They were duly impressed. He was fast despite his size, and even more powerful than he looked. He let them try but none of them could get him to the ground. He always told them that you had to be smart and patient, not just strong, to get somewhere in life.
“Thank you for reporting the case, Doctor. Why did you wait until now? Did you ever suspect there might be child abuse involved here, in a classic sense?”
“Never,” she said honestly. “I know the parents. They are the most devoted parents in my practice, attentive, loving, responsible. Everybody loves them. I never thought of child abuse, and still don’t in the ‘classic sense.’ ”
“You don’t think the child’s protecting her parents?”
“Not at all. And I thought the accidents she’s sustained were just that, unlucky mishaps that could happen to any one-, two-, or three-year-old. Toddlers can get in a real mess sometimes and get badly injured.”
“It didn’t strike you as odd that she got injured so often?” There was accusation in his eyes, and Cathy looked regretful and shook her head.
“I don’t think I realized how long the list was on a day-to-day basis. I do triage. I deal with situations every day. I find solutions and fix them, and move on to the next one. I don’t keep a tally in my head. I realize now that I should have.”
“You’re not alone in that, Doctor. I was just asking.” He seemed to be gentle, and forgiving of her, but not Jaime’s parents. “When did you begin to suspect Munchausen by proxy?”
“I didn’t. There was an incident in Florida when they were on vacation, and Jaime was running on the wet surface next to the pool at their hotel. She slipped, fell into the deep end and nearly drowned, and cut her chin badly on the way into the pool. Her mother wasn’t watching her, and was talking to people with her back to the pool. Jaime’s father arrived on the scene in the nick of time, jumped in, and saved her.”
“No lifeguard?” He looked surprised.
“Apparently he was helping an elderly person and wasn’t watching either. That’s how tragedies happen. When they got back from Florida, Jaime’s father came to see me. His mother is a psychologist and had suspected MBP for some time but not told him until after the pool incident. He agrees with her, and wanted to know what I thought. It hadn’t occurred to me until then. I’ve never encountered it in my practice. I consulted a psychiatrist I know, and he concurred with the father and grandmother. He convinced me to report it to CPS. I felt disloyal doing it, but I felt I had to.”
“Disloyal to whom? Not the child.”
“No, I reported it to protect the child. I’m very fond of her mother. I always thought she was a good mother.”
“And now?” He looked at her directly and Cathy didn’t flinch.
“I think there’s a problem. A serious one, and they may be right. It breaks my heart to say it, but it sounds more than possible, even likely.” She tried to be as honest with him as she could be. She had made her report factual, but she was fleshing it out now.
“I agree with you,” he said simply. “Have there been any accidents or injuries since the pool incident?” he asked her.
“She got bitten in the face by a German shepherd ten days later, which required suturing by a plastic surgeon. Nothing since then, other than a severe allergic reaction to a substance she’d never eaten before. I think that was entirely innocent.”
He nodded. “It won’t be if there’s a repeat, however. What was it?”
“Honey.” He made a note on a pad.
“That’s dangerous because it’s so common.”
“I know,” she said sadly.
“Where do you see this going? Where would you like to see it go, for the child?” It was the toughest question of all and she hesitated, not sure what to say.
“I honestly don’t know. Jaime loves her mother. Everyone does. My nurses think she’s the best mother in our practice.”
“That’s not unusual in Munchausen by proxy, in fact, it’s typical,” he said coolly. “Most of them look like the best parents in the world. They’re cagey and cunning and smart, and you can’t always see how they do it, but the child gets hurt or dies. We have to avoid that outcome for Jaime.”
“That’s why I reported it. I don’t know what I’d like to see for them. I’ve been told counseling isn’t effective.”
“It runs deeper than that. A lot deeper. People with MBP are very sick. Ultimately, we’ll have to protect Jaime from her, if her father and grandmother’s suspicions are correct.” Cathy nodded.
“Zoe being removed from her life would be a tremendous loss to Jaime, and could mark her forever,” Cathy said sadly.
“So would getting killed by her mother,” he said bluntly. Cathy didn’t know what to answer. “The decision may happen by itself, if she steps too far over the line. She could wind up in prison, or give up custody of her own accord in lieu of prosecution. We just don’t want it to get out of hand. That’s our goal. We’re Jaime’s advocates, and I think you are too.” Cathy nodded, desolate for them all. What he outlined was so painful and so extreme, but he saw hard cases every day and made hard decisions for the well-being of children in jeopardy. It was just tragic that Jaime was one of them. Cathy had never expected that to happen when she’d met them.
He stood up then and thanked her for her time, and she handed him her card with her cellphone number on it. “Call me anytime. I want to help if I can.”
“Thank you.” He would have liked to call her for reasons beyond their investigation, but he would never do that. She was a beautiful woman, and a nice person, and shared his love of children. He hadn’t met anyone like her in a long time. “Honorable” was the word that came to mind, and she thought the same thing about him. She had been very impressed by how dignified the investigation was, as he conducted it. It wasn’t a witch hunt, it was a search for the truth for the benefit of the child.
It was six-thirty when he left. Her nurses had already gone home by then. He said he was going to interview the father and grandmother next, to get their impressions and hear why they thought Zoe was MBP. He was going to interview Fiona, Zoe herself, and all the physicians she’d consulted for Jaime, to get their views of the situation too. And there were a number of them. Cathy knew t
hat when he interviewed Zoe she would hit the roof. She was the director of a shelter for abused children, how could she be accused of abusing her own child? It might even cost her her job if it got out. But if their fears about her were true, it was right to question her. And if they were wrong, hopefully they would discover that too.
Before she left her office, Cathy knew what she had to do. Austin had no idea what was coming at him, that she had reported it to CPS, and she felt she owed him a warning now.
She called him in his office and hoped he was still there. He worked late frequently, and she was relieved when he picked up.
“Hi, how are you?” Cathy asked, sympathetic.
“Managing,” he said, sounding tired.
“I called you to make a confession.”
“That sounds interesting.” He smiled as he said it. She was a faithful friend and he was grateful for her wisdom, expertise, and support. They were lucky to have her as a doctor, and a friend.
“After the allergic reaction, I spoke to Paul Anders and he said I had no choice, and I agree with him. The honey allergy gives Zoe too dangerous a weapon to leave this dormant any longer. I called CPS on Monday and made a report. An investigator just came to see me in my office. I think you and your mother are next. They’re taking it seriously, but he was a smart, sensible guy, and he’s not going crazy with it. I was very impressed.”
“Thanks for the warning, Cathy. I understand. I think you did the right thing. I felt guilty for what I thought about the honey attack, but it doesn’t change the rest. I’m still on the fence, but leaning heavily toward MBP.” He sounded almost matter of fact about it, but she knew how profoundly upset he was. Their whole life was on the line, their marriage, and Jaime’s life, in an even more real sense. “When are they going to talk to Zoe? Do you know?”
“I don’t. I assume they would talk to her last, so as not to tip her off before that. But that’s just me talking. I don’t know how they work. It may not be as methodical as that.”
“She’ll go nuts.” Cathy agreed with that. “It strikes at everything she cares about, and how she wants to be perceived as the best mother in the world. Her ego is going to take a heavy hit,” and so was their marriage. Cathy had thought of that too, and so had he. “I guess we’ll just deal with it when it happens.”
“Anything you say is confidential, so you can be honest with him. You should be,” Cathy urged him.
“I intend to be. Now that it’s in their hands, we all have to be honest. Zoe too, if she’s capable of it, or willing to be.” It was a sad statement to make about his wife. “Thank you for telling me. I’ll expect to hear from him sometime soon.”
“His name is Dan Knoll. He just left my office before I called you.”
“Talk to you soon,” he said in a tired voice.
Her cellphone rang as soon as they hung up. It was Dan Knoll from CPS.
“I forgot to ask you one question. How solid do you think their marriage is? Is there trouble there?”
“There wasn’t when I met them, or until recently. I’m not sure now. They’re not splitting up or anything, but he was furious about the last couple of incidents, especially the one at the pool, and he blamed her for it. She doesn’t do well with that. I think things are chillier than they used to be, but he’s not threatening to leave her over it. I think he realizes that if she’s really MBP and she’s orchestrating these incidents, he can’t stay with her, and it’s going to hit their marriage like a bomb.”
“I just wondered. Thank you. Have a great night.”
“Thanks, Dan. I will. You too.” She liked his approach, and he smiled as he hung up.
Chapter 17
Dan Knoll interviewed Austin in his office two days later, and was candid with him. He got a clearer picture of Austin’s fears about his wife, but he told him that people with MBP were the cleverest child abusers in the world, and proving a solid case against them was damn near impossible in most instances.
“Have you thought of just divorcing her and suing for sole custody?”
“I don’t think I’d win that either. And I don’t want to. What if she didn’t manipulate these accidents, and she’s not guilty? She’s my wife and Jaime’s mother and I love her, even if I don’t trust her. Maybe she’s just not vigilant enough.” Dan thought Austin’s loyalty was misplaced but he didn’t say so. He felt sorry for him. The poor guy looked tortured about his child, and had dark circles under his eyes. He told Dan every single detail he could remember, and Dan thanked him and promised to be in touch.
The following day he went to see Constance Roberts, who was intelligent, clear, lucid, well-informed, and convincing. There was no doubt in Dan’s mind that Zoe had Munchausen by proxy by the time he had seen Cathy, Austin, and Connie, and he’d believed it from the beginning. But the question was how to prove it or catch her at it. She was too cunning to be obvious about it or get caught easily, like most people with MBP.
He decided to wait before interviewing Fiona, in case she said something to Zoe, and the following week, he met with all the physicians Jaime had seen in her lifetime. Austin had given him the list. The gastroenterologist for her apnea as a baby, the neurologist after the fall off the changing table, the ENT she had lied to, to get the ear tubes put in, and more recently the allergist, the orthopedic surgeon about possible scoliosis, both plastic surgeons, and the ER doctor and surgeon Zoe had tried to push into an appendectomy. Austin didn’t remember their names, but the hospital had a record of them, and both orthopedists who had set Jaime’s arm and wrist in casts. It was a long list, and by the end of it, Dan was more worried than before. The ones that alarmed him the most were the gastroenterologist she had asked about an abdominal feeding tube when Jaime was five weeks old, and the ENT she had lied to, to get ear tubes inserted surgically, claiming Jaime had recurring ear infections when she’d only had two. The back surgeon admitted that Zoe had inquired about steel rods in Jaime’s spine and claimed she suffered from severe backaches, which both Austin and Cathy said wasn’t true. But the back surgeon was no fool.
“She seemed neurotic to me, and very insistent. We get patients with mothers like that. They want surgery for their kids, they want to feel important. They lead boring lives, and they want something major to happen. I never touch them, unless the children genuinely have a severe problem. I either tell them it’s unnecessary, or refer them to someone else. No one needs patients like that. Guaranteed you’ll end up in a malpractice suit or wind up with a nut job on your hands. Plastic surgeons see a lot of them too. They’re lawsuits waiting to happen. In my line of work, most people beg to avoid surgery. With people like that, they want you to operate on them or their children. It’s crazy, but most of them stick out like a sore thumb. She’s supposed to come back in six months, which is just a stalling tactic. I plan to send her on her way then. I avoid patients like her like the plague.” Dan shared what the orthopedist had said with Cathy, and she sounded shocked that Zoe had asked for rods for Jaime and claimed she had backaches, which was a flat-out lie. But it all confirmed what they feared.
“The sad thing,” Dan told her, “is that less reputable doctors, or less alert ones, will perform surgeries they shouldn’t, that’s how a lot of these kids die, from surgical procedures they never needed. The doctors either believed the mothers who were lying, or didn’t know what they were doing. The worst case is a woman who talked a doctor into a gastric tube for her infant, and then moved all over the country and left it in. She used it to pour salt into her five-year-old’s abdomen and killed him. She’s serving life in prison, and her little boy is dead. We don’t want something like that to happen to Jaime.”
“Her father wouldn’t let it, and neither would I,” she said firmly to Dan. “He stepped in when she wanted an appendectomy for Jaime, and they called in a surgeon and he flatly refused after he saw a normal sonogram.”
Dan
saw Fiona and was cautious with her. He didn’t ask her any leading questions, or to confirm anything they were worried about. He said that the meeting was entirely confidential and he preferred she not tell her employers about it. All she said was that Zoe was a wonderful woman, an outstanding employer, and an adoring mother, and Austin was a kind, loving father, and he let it go at that. She was not going to tell him anything of value. And that afternoon, he showed up at Zoe’s office. Her assistant asked if he had an appointment, and he politely said he didn’t. But his sheer bulk and size were daunting, as well as the agency he worked for, and he handed her his card and asked if Mrs. Roberts would see him briefly. She took it in and handed it to Zoe, who was having an insanely busy day.
“Oh shit. I guess I have to see him. It must be about one of our custody cases. I don’t want to screw it up for them. I can skip lunch and give him half an hour. Send him in.”
She was wearing a white blouse with a red sweater over her shoulders, and black jeans. Her shining dark hair hung below her shoulders, and she smiled and stood up when he walked in. He was struck by how pretty she was, and how young and personable she looked. She instantly tried to put him at ease.
“Which of our cases are you here for?” she asked him pleasantly with a warm smile, and offered him coffee, which he declined. “I think we have half a dozen going at the moment.” He smiled back at her, but he was guarded and didn’t make the mistake of believing that they were friends.
The Dark Side Page 20