Munchhausen Syndrome and Munchhausen Syndrome by Proxy

Well, perhaps no one really cared what Angela did to herself, but they should have cared when she became pregnant. It was her third pregnancy; her first two children had been taken away by social services sometime during her teen years. Now she was in her twenties and much more stable! It was true she didn't know exactly who the father was, but that wasn't all that unusual in this day and age. Mostly, the hospital staff was concerned that she keep her prenatal appointments. Angela was a top patient in this respect — she loved going to the hospital and getting all that attention. For once, she actually had some real symptoms and could milk those for all they were worth.

Once she was over morning sickness, though, the baby became a burden to her body and a cramp in her social life. Angela started getting annoyed with her condition. She started coming to the emergency room with symptoms of a problem pregnancy. She had excessive bleeding (at home, but the symptoms magically stopped while she was in the emergency room) and she had horrible cramping (which did continue in the emergency room, but were strangely never picked up on the monitor). When the staff couldn't find any problem, Angela would become extremely hostile and demand a caesarean section.

"GET THIS BABY OUT NOW!" she would scream. The mystified staff just shook their heads, labeled her an overly emotional pregnant woman, and told her to get dressed. She would curse her way out of the emergency room and return just a few days later with the same story. There is, of course, the old saying, "Try, try again, and eventually you will succeed." In this case, Angela certainly could be commended for her efforts because she eventually did succeed.

It was another early-morning visit. The complaints were severe cramping, bleeding, dizziness, weakness...a litany of pregnancy problems. Angela was placed on a fetal heart monitor. An ultrasound was done, and an anomaly was found. Something was wrong with the baby that might require an immediate c-section and special care. Angela's face lit up. However, as the shift ended, the surgeon came in and gave Angela the bad news.

"Angela, we see some abnormalities in testing the baby, and I am concerned that the baby could have a serious condition. However, if I do a c-section now, the chances of survival for the baby is limited and, therefore, it is really a toss-up situation. Because we cannot be absolutely sure that what we are seeing in these tests is proof the baby is in certain danger, I think it best to allow the pregnancy to continue. The baby will have a better chance of survival if we allow it to stay in your womb. We can do some more tests later, and if there is still an indication that baby is in trouble, we will do a c-section then, but right now it makes no sense."

Angela became very agitated at this decision.

"I WANT THE BABY OUT NOW! NOW!"

The doctor tried to repeat his reasoning, but Angela became more and more upset.

"NOW! DO THE C-SECTION NOW!"

The doctor tried to explain his reasoning again to me on the way out.

"It is ridiculous to do a c-section now. I don't even know if what we saw on this sonogram really means the baby has a life-threatening problem. It would be a crime to do a c-section at only six months on the basis of a suspicion." I don't know if the doctor ever figured out Angela was not at all concerned about the baby and only wanted the c-section for her own satisfaction. For that matter, perhaps, she wanted the baby to be ill or die. Perhaps, she had moved on to the next level of Munchausen's and now was adding Proxy to the label.

The shift changed at this point and a new surgeon came on. He was brought in to see Angela. She told him about the tests, saying that her baby had a dangerous condition and she wanted the c-section immediately to "save" the baby. The surgeon read the reports. Suddenly the nurse came back into the room and told Angela they were going to prep her for surgery.

I felt like someone had just pulled the rug out from under that baby. Angela practically clapped her hands as she went off to surgery. The baby was born blind and mentally retarded (although doctors did not see the problem in the ultrasound) and remained on a feeding tube for the rest of its short life of one and a half years. The little girl spent her whole existence at the Hospital for Sick Children. Angela's visits to the emergency room dropped dramatically. After all, she could now get all the attention she wanted over at the other facility.

I didn't see Angela again until after the baby died and she came into Washington Hospital Center for a pregnancy test. She got pregnant right after the baby died. In fact, she used the test to get sympathy, "My last period? Oh, that would be right after I lost my baby girl." The nurse felt very badly for Angela. This was only her second pregnancy (it helps to change hospitals; the new one won't know your history), so poor Angela had not only lost her baby but her only child.

Angela started showing up regularly again. She had the same problems as with her last pregnancy. Did this make the staff suspicious? No, they couldn't figure out what was wrong. For that matter, they saw she had a "problem" with her last pregnancy, which required an emergency c-section at six months to "save" the child. They were even more sympathetic than the first time around. By the time she was six months pregnant again, Angela was in almost daily, demanding a c-section. The nurses would come out of the room and tell me they felt really sorry for this poor concerned mother, who only wanted this baby to be spared the tragedy that befell her last baby. I wanted to scream. Finally, I broke those Rules of Ethics, scrawled "Munchausen's Syndrome by Proxy" on a piece of paper I tore off the fetal heart monitor and held it up like a banner in front of me.

Munchausen's Syndrome note

"Do you know what this is?" I yelled. The faces on the staff were blank. It was hopeless. Angela could hire medical hitmen to kill her children, and no one seemed to have a clue what was happening.

Luckily for this baby, no hitman got confusing test results. The baby was born at the regular time. Angela played the good mother. She even wanted to nurse the baby, she told the lactation consultant, and she paid close attention as the woman showed her how to hold the baby and get the nipple in its mouth. But when the consultant left and the door closed behind her, Angela pushed the baby away and dumped it in the crib.

"I HATE nursing!" she signed to me. Then she went on to whine that she didn't understand why her relatives were bringing all these presents for the baby and none for her. She clearly had no feeling for her child.

The months went on, and her child survived. She brought it in for its baby appointments and milked me for information about what a good mother does. If I told her to read books, play games, do puzzles and so on, you could be sure that when the doctor asked her how she was doing with the child, she would enthusiastically state, "I read books to her, and play games with her, and do puzzles with her!" The doctor praised her, and she got the reputation of being an excellent mother.

I ended my career as a medical sign-language interpreter at that point, so I never found out if Angela went on to abuse her child, or if she ended up killing her child. I wouldn't be surprised to hear that if the child met an unfortunate fate, Angela would still be out there bearing more children, and would be free to kill again.

Pat Brown, early