Peter Clement - Mortal Remains

Munchausen by proxy syndrome was among the darkest of mental illnesses. Named after a German baron in the eighteenth century who’d been notorious for constructing elaborate lies to scam money from unsuspecting victims, it designated a disorder far more fiendish than any con for money. Parents, usually mothers, would deliberately inflict illnesses on their children. The techniques varied, from rubbing the skin raw to simulate mysterious rashes, through feeding them purgatives and laxatives to create bizarre GI symptoms, to smothering. An offender would then present her child to unsuspecting doctors as a medical mystery, and play the role of an untiring, long-suffering parent who sacrificed all to care for her child, reaping the subsequent attention bound to be lavished on her.

The literature related how a few carried off the ruse so well they’d been awarded Mother of the Year citations before being found out. The worst of them ended up killing their offspring outright, casting themselves in the part of the ultimate victim – a grieving mother – guaranteeing showers of sympathy. Earl’s worst nightmare throughout a lifetime of practice, as it was for all physicians, had been that he would miss diagnosing one of these helpless children because a cunning parent outsmarted his clinical skills. Current estimates suggested 30 percent of the victims eventually perished, but the number could be much higher. Mortality statistics were hard to come by because some of the cases that ended in murder were misdiagnosed as crib deaths, and the children who managed to outgrow the clutches of their secret abusers as they became too old to fool might never be diagnosed.

Mark took a few seconds to reply. “You figure Samantha was… Jesus Christ, her own mother was deliberately making Kelly ill-”

“Whoa, Mark! Quit jumping to conclusions. No, I don’t think it was as full-blown as that. At least there’s no evidence of Samantha having gone as far as actually physically injuring Kelly. But there’s one feature of that syndrome that does remind me of Samantha – the concerned mother carting her daughter from doctor to doctor, all the time insisting the child is ill, and, if her manner then was what it is now, playing the part of a self-sacrificing woman to the hilt.”

“I never would have imagined anything like this.”

“Neither did I, the first time you showed the file to me. But seeing Samantha today on her own turf…” He quickly related the highlights of his visit. “… the narcissism, the sense that only her grief counts, her forever playing to an audience, the fact she’s even made a shrine to Kelly – it all fit together with a big clunk.”

Mark let out his breath in a long, mournful whistle.

“Even if Samantha wasn’t physically harming Kelly, and her particular game doesn’t have its own fancy diagnosis,” Earl continued, “years of telling her that she was sick, suffering from a mysterious, terrible ailment that the doctors could neither diagnose nor make better, would be devastating psychologically. She’d be left with problems of anxiety, self-esteem, image, trust – a host of difficulties…” That he could coolly paint such a troubled clinical picture of a woman he once loved brought him up short. “Well, you get the idea.”

“No wonder my father had to give her four years’ worth of psychological support therapy.” Mark’s voice sounded distant, as if he were thinking aloud.

Earl said nothing, thinking what a wounded soul she’d been, and he hadn’t realized it.

“A wretched childhood like that,” Mark continued, “and I never had a clue.”

“How could you, being just a boy? Hell, she never even mentioned a word of it to me.” Yet I should have known, he said to himself. “But from what her parents said today, or rather, what Samantha wanted to tell me but Walter made her clam up about, I think your father had confronted Samantha head-on about what was happening.”

“What do you mean?”

“You know how we often don’t write really legally sensitive stuff in our charts?”

“Of course.”

“He hadn’t put it in writing, but the way Samantha wailed to me about what terrible things he’d said to her, and how Walter went on about having nearly sued him over it, but then backed off, I figure your dad ultimately twigged to what really might have been going on – that’s probably when he wrote Mother? in the margin – and did a follow-up visit with good old Mom and Dad where he made some pretty strong insinuations about the harm Samantha had been doing. Maybe he even threatened to report her if he ever got a whiff of any more visits to doctors over ‘mysterious illnesses.’ Judging from the fact that there were no more surgical scars from dubious operations, the ultimatum seemed to have worked.”

“Son of a bitch.”

“And here’s something else. Read the letter Kelly wrote to your father again, especially the part that says, Regarding the other two matters, we must discuss those. Whatever I plan for myself, I can’t leave and let them go unresolved. ” Earl quoted it from memory. “One of the matters she intended to resolve might have been what her mother had done to her. That possibility gives credence to Braden Senior’s insinuations about Samantha.”

“That she might have killed Kelly?”

“We have to look at the possibility. Suppose on the day she intended to run off and start a new life, she finally confronted her mother. Samantha could have erupted in anger, shoved Kelly or struck her. The woman’s fuse is short. Very short. You’ve seen it. I saw it this morning. What if she accidentally killed Kelly?”

Mark said nothing.

“Hello?”

“Yeah, I’m here. It’s a thought, but something about it just doesn’t sit right.”

“What?”

“I don’t know. Something.”

“Something. That’s all you can say?”

“Let me think about it.”

“Okay, okay.” They exchanged a few more suggestions about how to proceed. When he got off the call, Earl felt impatient. He wanted to go home, return to the present, his present – Janet, Brendan, and ER – not poke around in a quarter-century-old muck of other people’s mistakes. It was all so dreary, and what difference did it really make? Kelly was so long gone.

The whole mess also reminded him how easily a life of promise and love could go wrong, perhaps the result of a single mistake or bad choice. Too often, innocence or guilt played no part. Some, like Kelly, flamed out. Others, like Chaz or the McShanes, let themselves sink inexorably into ruin.

No, he couldn’t pull out just yet and leave loose ends that one day might not only ensnare him but devastate Brendan and Janet as well.

He shivered. Christ it was cold. Either that, or he was coming down with something.

11:35 A.M.

Medical Records,

New York City Hospital

“Could I speak with you a moment, Lena?”

Lena Downie looked up from the log she’d been reviewing at one of the workstations and saw Dr. Melanie Collins standing at the counter. “Why, of course.” She walked over, holding out her hand in greeting. “What can I do for you?”

“Actually, we need to speak in private.”

“Oh!” She glanced over to where the frosted glass door with her name and title stood closed. “My own office is in use right now.” She leaned closer. “A confidential audit,” she whispered. “But we’ll use my secretary’s. She’ll be delighted to take a coffee break.”

Within a minute they were seated across a cluttered desk from each other. Lena glanced at the adjoining entrance to her own domain, making sure it was shut tight, thereby ensuring both rooms were completely soundproof. “Now what can I do for you?”