'Is that all of it?'
'Un-uh. There were two other GI crises. At sixteen monthsfour days after an appointment with Tony in Gastro clinic-and a month and a half latet, following his final appointment with them.'
'Same symptoms?'
'Right. But both those times, mom actually brought in bloody diapers and we worked them over for every possible pathogen-I mean we're talking typhoid, cholera, tropical maladies that have never been seen on this continent. Some sort of environmental toxin-lead, heavy metals, you name it. But all we found was a little healthy blood.'
Are the parents in some sort of work that would expose the child to weird pollutants?'
'Hardly. She's a full-time mom and he's a college professor.'
'Biology?'
'Sociology. But before we get off on the family structure, there's more. Another type of crisis. Six weeks ago. Bye-bye gut, hello new organ system. Want to take a guess which one?'
I thought for a moment. 'Neurological?'
'Bingo.' She reached over and touched my arm. 'I feel so vindicated calling you in.'
'Seizures?'
'Middle of the night. Grand mal, according to the parents, right down to the frothing at the mouth. The E.E.G showed no abnormal wave
activity and the kid had all her reflexes, but we put her through a CAT scan, another spinal, and all the high- tech neuroradiology video games, on the chance she had some kind of brain tumor. That really scared me, Alex, because when I thought about it I realized a tumor could have caused everything that had been happening, right from the beginning. A growth impinging on different brain centers, causing different symptoms as it grew.'
She shook her head. 'Wouldn't that have been a happy situation? Me talking psychosomatic and there's an astrocytoma or something growing inside her? Thank God all her scans were totally clean.'
'Did she look post-seizural when you saw her in the E.R.?'
'In terms of being drowsy and listless, she did. But that's also consistent with a little kid being dragged to the hospital in the middle of the night and put through the wringer. Still, it scared me-that there could be something organic I was missing. I asked Neurology to follow up. They did for a month, found nothing, terminated. Two weeks later-two aiys ago-another seizure. And I really need your help, Alex. They're up in Five West, right now. And that's the whole kaboodle, history-wise. Ready to give me some wisdom now?'
I scanned my notes.
Recurrent, unexplained illnesses. Multiple hospitalizations.
Shifting organ systems.
Discrepancies between symptoms and lab tests.
Female child showing panic at being treated or handled.
Mother with a paramedical training.
Nice mother.
Nice mother who might just be a monster. Scripting, choreographing, and directing a Grand Guignol, and casting her own child as unwitting star.
Rare diagnosis, but the facts fit. Up until twenty years ago nobody had heard of it.
'Munchausen syndrome by proxy,' I said, putting my notes down. 'Sounds like a textbook case.'
Her eyes narrowed. 'Yes, it does. When you hear it all strung together like this. But when you're right in the middle of it...
