Saturday, June 30, 2007

Tell Me Now How Do I Feel

"Can't you see that she's in a great deal of pain?" the woman yelled at me. I had just gotten report and I had walked into the room to do a routine morning assessment. The woman's daughter, a mildly developmentally challenged young woman maybe about twenty years old, sat on the bed eating pancakes and flipped the channel changer for the television.

"Hi," I said to the young woman, ignoring the brick out-house-shaped screaming harpie for a moment. The girl gave me a timid half-smile. "I'm your nurse for today. How're you doing this morning?"

"OK," she said, and then she asked me if she could have some more syrup and I said that I'd go get some.

"Anything else while I'm out and about?" I asked with all the chirpiness I could manage, and her mother blared "Yes. Just go get that pain shot and forget about the syrup."

The girl wilted.

In a moment I came back with a few packets of syrup and a handful of morphine. I asked the young lady how bad it hurt and she said that it didn't hurt at all.

Then the mother yelled at me again. "None of you people care. You just won't give her any pain medicine because she's, well; she's retarded."

Then I registered shock. The patient was obviously a fully competent young adult, perhaps with a learning disorder, but certainly nothing that would keep her out of Hollywood, nor Washington D.C., nor any productive and fruitful modern American life. She was okay. And that was part of this bizarre problem.

Munchausen by Proxy Syndrome.

The mother was teutonic of stature and in another setting could have easily carried off a costume that included hubcaps for breastplates. She was big, loud, and in my face. All within seconds of my entrance. And no wonder she was so fiercely protective. That was part of the profile.

"Munchausen by proxy syndrome (MBPS) is one of the most harmful forms of child abuse. It is also perplexing. MBPS involves an apparent deeply caring mother who repeatedly fabricates symptoms or provokes actual illnesses in her helpless infant or child. MBPS was first described in 1977 by Meadow; since then more than 200 MBPS related articles have appeared, the majority being case descriptions. Understanding the dynamics of this disorder is of utmost importance because growing evidence indicates that it is more common than previously believed and it is devastating if not fatal for the children and infants. It is also important to mention the effects MBPS has on others who become involved in this cases, particularly nurses and physicians."

This had been going on for decades for this patient. It explained why the poor young woman had undergone numerous exploratory abdominal surgeries and so many hospitalizations in her mere two decades springing the mortal coil. Damn. This person very likely underwent many surgeries just because her mother was a nutcase. No underlying illnesses had ever been determined.

I told the mother that if the patient refused the pain medicine then I could not ethically administer it, and she exploded in dramatic rage. Fake, I thought. Scripted. A load.

The patient herself maintained a neutral emotional distance from the fireworks and she concentrated instead on her meal and morning television news.

I knocked on my boss's office door and explained the situation to her, and she indicated that she was well-aware of it all because it had played out many times before.

Did I tell you that I was floating to that unit that morning, and did I mention that the other nurses were all familiar with this Grendel-mother, and that they figured new meat was better than old meat concerning the assignation of a nurse for them that day? Actually I didn't mind at all.

This was back when I was working in a community hospital. I was friendly with many of the doctors there. Small town, small hospital, all that stuff.

I did not want to see this young woman undergo yet another laparoscopy just because her bitch mother was a lunatic, so my boss called in the medical director. A meeting was arranged with the patient and her mother, the surgeon, the family doctor, the medical director, the director of nursing, and a few other administrators who felt a need to be there. What else was there to do?

Thank goodness they left me out of it, because I was at work, after all, and others needed my tending.

Later I heard that during the meeting the mother had decided to remove her daughter from our institution against medical advice and that they'd left. The bed remained empty until the end of my shift and when I got home I cooked and listened to Blue Monday. Loud.

"I thought I was mistaken
I thought I heard your words
Tell me how do I feel
Tell me now how do I feel"

Now every time I think of that song; every single day, several times a day, I see that young woman crumple in my mind's eye as an echo of her insane mother's voice rattles my frame.

Fucking MBPS. I think I was witness to a very bad example of it. But at least I sent it. Not that much good came of it.


may said...

wow. how awful for the patient. or, should't the real patient (mother) be admitted to behavioral?

Jen said...

slick blog. I happened upon it accidentally, but I am a nurse, and also work closely with a lady who may or may not suffer munchausen by proxy. It is a sad state, really. I appreciate falling into a thoughtful and well written blog. Thanks for that.