“Some mornings, she’s so weak,” the mother continues, “I have to help her chew. That’s a fact. That’s what that, that boob job did to her.”
“Okay. I think I understand,” I suck on the inside of my cheeks. There is not enough air in the room for the three of us. My mind is on the verge of exploding, not to make sense of what I have just witnessed—no, that’s the easy part. There is no medical disease that can fluctuate in severity so dramatically from stone cold normal to floppy premature infant from one day to the next. No, I am thinking about an exit strategy. I am absolutely certain that Hayden Morse and her mother will not be relieved that she doesn’t have lupus. Mrs. Morse’s lawyer will not be pleased that his client does not have lupus. And frankly, although there is absolutely no evidence that Mrs. Morse has lupus, I wish she did have lupus.
There’s treatment for lupus. With the proper medications, nearly all of my lupus patients are living well with their disease. Plus, I am a little scared of Mrs. Morse’s mother.
Alternatives
The diagnosis of Munchausen syndrome floats to mind. Patients with Munchausen syndrome consciously exaggerate or invent symptoms of a disease to gain attention from medical providers. But that doesn’t ring true. Mrs. Morse seems to honestly believe that her symptoms of fatigue and muscle pain and weakness could be related to her breast implants. Her past history of anxiety and depression could easily reemerge at a time of stress and uncertainty. There is nothing calculating about her.
On the other hand … I turn my attention to Mrs. Morse’s mother and consider Munchausen by proxy, the elaborate scheme by another (usually a mother of a child) to suggest or transfer symptoms of a disease onto the child. This possibility, that Mrs. Morse’s mother may be fueling Hayden’s decline in order to share in a huge settlement, is both unsettling and unprovable. As a non-psychiatrist, I am in uncharted territory.
So I prevaricate. I pick up Mrs. Morse’s chart and tell them, “This is a very complicated case. I need time to review the notes from the other consultants as well as the extensive labs your lawyer forwarded,” I pause. Okay, so far so good. “Early next week, I’ll get a letter out to your lawyer. I’ll be calling your primary care doctor and reviewing my thoughts on how you can begin to feel better. For now, I want you to continue on the same medications you’ve been on.”