even now I can't be sure.'
'You're still considering something organic?'
'I have to until I can prove otherwise. There was another case-last year, over at County. T'enty-five consecutive admits for recurrent weird infections during a six-month period. Also a female child, attentive mother who looked too calm for the staff's peace of mind.
That baby was really going downhill and they were just about ready to call in the authorities when it turned out to be a rare immunodeficiency-three documented cases in the literature, special tests that had to be done at NIH. Moment I heard about it, I had Cassie tested for the same thing. Negative. But that doesn't mean there isn't some other factor I haven't caught. New stuff keeps popping up-I can barely keep up with the journals.'
She moved her spoon around in her coffee.
'Or maybe I'm just denying-trying to make myself feel better for not seeing the Munchausen thing sooner. Which is why I called you in-I need some direction, Alex. Tell me which way to go with this.'
I thought for a while.
Munchausen syndrome.
A.k.a.pseudologiafantastica.
A.k.a. factitious illness disorder.
An especially grotesque form of pathological lying, named after Baron von Munchausen, the world-class prevaricator.
Munchausen is hypochondriasis gone mad. Patients fabricating disease by mutilating and poisoning themselves, or just lying. Playing mind games with physicians and nurses-with the health-care system itself Adult Munchausen patients manage to get hospitalized repeatedly, medicated needlessly, even cut open on the operating table.
Pitiful, masochistic, and perplexing-a twist of the psyche that still defies comprehension.
But what we were considering here was beyond pity. It was an evil variant: Misnchaissen by proxy Parents- mothers, invariably faking illness in their own offspring. Using their children-especially daughters as crucibles for a hideous concoction of lies, pain, and disease.
I said, 'So much of it fits, Steph. Right from the beginning.
The apnea and passing out could be due to smothering those movement artifacts on the monitor could mean she was struggling.'
She winced. 'God, yes. I just did some reading, found a case in England where movement artifacts tipped them off to the baby being smothered.'
'Plus, with mom being a respiratory tech, breathing could be the first system she'd choose to mess with. What about the intestinal stuff?
Some kind of poisoning?'
'Most likely, but it's nothing the tox panel could come up with when they tested.'
'Maybe she used something short-acting.'
'Or an inert irritant that activated the bowel mechanically, but passed right through.'
And the seizures?'
'Same thing, I guess. I don't know, Alex. I really don't know.'
She squeezed my arm again. 'I've got no evidence at all and what ill'm wrong? I need you to be objective. Give Cassie's mom the benefit of the doubt-maybe I'm misjudging her. Try to get into her head.'
I promise a miracle, Steph.
'I know. But anything you can do will be helpful. Things could get really messy with this one.
'Did you tell the mother I'd be consulting?'
