I went to her consult room. The Byron book was back on the shelf, its gilded spine conspicuous among the texts.
I thumbed through a recent copy of Pediatrics. Not long after, Stephanie came in, closed the door, and sank into her desk chair.
“So,” she said, “how’d it go?”
“Fine, outside of Ms. Bottomley’s continuing antagonism.”
“She get in the way?”
“No, just more of the same.” I told her about the scene with the nurse and Chip. “Trying to get on his good side but it probably backfired. He sees her as a shameless ass-kisser, though he does think she takes good care of Cassie. And his analysis of why she resents me is probably right-on: competing for the attentions of the VIP patient.”
“Attention seeking, huh? There’s a bit of Munchausen symptomology.”
“Yup. In addition, she did visit the home. But only a couple of times, a while back. So it still doesn’t seem likely she could have caused anything. But let’s keep our eyes on her.”
“I already started, Alex. Asked around about her. The nursing office thinks she’s tops. She gets consistently good ratings, no complaints. And as far as I can tell there’s been no unusual pattern of illness in any of her patients. But my offer’s still open — she causes too much hassle, she’s transferred.”
“Let me see if I can work things out with her. Cindy and Chip like her.”
“Even though she’s an ass-kisser.”
“Even though. Incidentally, he feels that way about the entire hospital. Doesn’t like getting special treatment.”
“In what way?”
“No specific complaints, and he made a point of saying he likes you. He’s just got a general concern that something could be missed because of who his father is. More than anything, he looks weary. They both do.”
“Aren’t we all,” she said. “So what’s your initial take on mama?”
“She wasn’t what I expected — neither of them was. They seem more health-food restaurant than country club. And they’re also different from each other. She’s very... I guess the best word for it is basic. Unsophisticated. Especially for a honcho’s daughter-in-law. I can see Chip growing up rich, but he’s not exactly corporate son.”
“The earring?”
“The earring, his choice of profession, his general demeanor. He talked about getting conformity shoved at him throughout childhood and rebelling. Maybe marrying Cindy was part of it. There’s a twelve-year difference between them. Was she his student?”
“Could be, I don’t know. Is that relevant in terms of Munchausen?”
“Not really. I’m just getting my feet wet. In terms of a Munchausen profile, it’s too early to tell much about her. She does toss some jargon into her speech and she’s highly identified with Cassie — feels the two of them have an almost telepathic link. The physical resemblance between them is strong — Cassie’s like a miniature of her. That could enhance the identification, I suppose.”
“Meaning if Cindy hates herself she could be projecting it on to Cassie?”
“It’s possible,” I said. “But I’m a long way off from interpretation. Did Chad also resemble her?”
“I saw him dead, Alex.” She covered her face, rubbed her eyes, looked up. “All I remember was that he was a pretty little boy. Gray, like one of those cherub statues you put in a garden. Tell the truth, I tried not to look at him.”
She picked up a demitasse cup, looked ready to throw it.
“God, what a nightmare. Carrying him down to the morgue. The staff elevator was jammed. I was just standing around, holding this bundle. Waiting. People passing right by me, gabbing — I wanted to scream. Finally I walked over to the public elevators, rode down with a bunch of other people. Patients, parents. Trying not to look at them. So they wouldn’t know what I was carrying.”
We sat for a while. Then she said, “Espresso,” leaned over toward the little black machine and turned it on. A red light glowed. “Loaded and ready to go Let’s caffeine our troubles away. Oh, let me give you those references.”
She took a piece of paper from the desk and handed it to me. List of ten articles.
“Thanks.”
“Notice anything else,” she said, “about Cindy?”
“No belle indifférence or dramatic attention seeking, so far. On the contrary, she seemed very low-key. Chip did mention that the aunt who raised her was a nurse, so we’ve got a possible early exposure to health-related issues, on top of her being a respiratory tech. But that’s really pretty thin, by itself. Her child-rearing skills seem good — exemplary, even.”
“What about the relationship with her husband? Pick up any stress there?”
“No. Have you?”
She shook her head. Smiled. “But I thought you guys had tricks.”
“Didn’t bring my bag this morning. Actually, they seem to get along pretty well.”
“One big happy family,” she said. “Have you ever seen a case like this before?”
“Never,” I said. “Munchausens avoid psychologists and psychiatrists like the plague because we’re proof no one’s taking their diseases seriously. The closest I’ve come are doctor-hoppers — parents convinced something’s wrong with their kids, running from specialist to specialist even though no one can find any real symptoms. When I was in practice I used to get referrals from doctors driven crazy by them. But I never treated them for long. When they showed up at all, they tended to be pretty hostile and almost always dropped out quickly.”
“Doctor-hoppers,” she said. “Never thought of them as mini-Munchausens.”
“Could be the same dynamic at a milder level. Obsession with health, seeking attention from authority figures while dancing around with them.”
“The waltz,” she said. “What about Cassie? How’s she functioning?”
“Exactly as you described — she freaked out when she saw me, but calmed down eventually.”
“Then you’re doing better than I am.”
“I don’t stick her with needles, Steph.”
She gave a sour smile. “Maybe I went into the wrong field. Anything else you can tell me about her?”
“No major pathology, maybe some minor language delay. If her speech doesn’t get better in the next six months, I’d have it checked out with a full psych battery, including neuropsych testing.”
She began ordering the piles on her desk. Swiveled and faced me.
“Six months,” she said. “If she’s still alive by then.”
6
The waiting room was hot with bodies and impatience. Several of the mothers flashed hopeful looks at Stephanie as she walked me out. She smiled, said, “Soon,” and ushered me into the hall.
A group of men — three white-coated doctors and one business suit in gray flannel — was heading our way. The lead white-coat noticed us and called out, “Dr. Eves!”
Stephanie grimaced. “Wonderful.”
She stopped and the men came abreast. The white-coats were all in their fifties and had the well-fed, well-shaven look of senior attending physicians with established practices.
Business-suit was younger — mid-thirties — and hefty. Six feet, 230 or so, big round shoulders padded with fat under a broad columnar head. He had short dishwater hair and bland features, except for a nose that had been broken and reset imperfectly. A wispy narrow mustache failed to give the face any depth. He looked like an ex-jock playing the corporate game. He stood behind the others, too far away for me to read his badge.
The lead doctor was also thickset, and very tall. He had wide razor-edge lips and thinning curly hair the color of silver plate that he wore longish and winged at the sides. A heavy, outthrusting chin gave his face the illusion of forward movement. His eyes were quick and brown, his skin pinkish and gleaming as if fresh from the sauna. The two doctors flanking him were medium-sized, gray-haired, and bespectacled. In one case, the hair was a toupee.