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Authors: Maribeth Fischer

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When he turned to look at her, he was crying. “Jack having fun like any other child,” he said, “that's what I'm going to have to hold onto, and how dare you, how dare you try—” but he was sobbing then, and there was nothing to do but go to him and promise that it would be okay. She resented it, though; she resented a lot, she had realized these past few days, and she couldn't help but wonder how deeply he resented her too.

Eight

G
race stared at the row of black-and-white photographs of the four main bridges connecting Philadelphia to New Jersey that hung on the wall to her right. Bennett Marsh, the lawyer, sat across from them in a leather wing chair, a tall floor lamp just behind him.

Stephen filled Bennett in on what they knew: someone had called Child Protective Services last spring accusing Grace of making Jack sick—Munchausen Syndrome by Proxy. No one had informed Grace or Stephen of this. They had only discovered the accusation two days ago. Stephen's brother's girlfriend was a social worker who had happened upon the file with Grace's name.

The only sound in the dimly lit office was the scratch of Bennett's fountain pen across the legal pad. He asked basic questions: what they did for a living, where they worked, the names and ages of their kids, the name of Jack's illness, in what hospital he was being treated. “Have you ever had problems with Child Protective Services before?”

Grace glanced up. Never.

“Any arrests?”

She shook her head. Of course not. Her throat ached. She knew he had to ask. He was simply doing his job. Stephen squeezed her hand. Actually,
he'd
had a DUI when he was nineteen, he said. But that was twenty years ago.

“You'd be surprised what comes up in these files,” Bennett said.

 

Noah grinned. “With my luck, I'll have some bumbling Matlock-type lawyer.”

“And he'll wear those seersucker suits in the courtroom.” Grace was laughing. “
What?
Don't give me that look. Doesn't Matlock wear seersucker?”

“You actually
watch
that show?”

They were sitting on the beach talking about the Philadelphia lawyer who had been missing for months; the judge she'd been having an affair with was now being investigated. Noah had joked that if either of them ever met an unforseen death, the other would automatically be suspect.

“Neither of us would have alibis, of course.” Grace reached for a pretzel from the bag he held. “You'd have been out on your own trying to save a bird—or so you'd say.”

“You'd insist you were driving to the hospital and got stuck in traffic. They'd search your car, though, and find beach sand beneath the floor mats.”


And
in my hair.” She laughed. “
And
my shoes.
And
under my fingernails.” She folded her arms over her upraised knees and rested her head on them, watching him. His eyelashes were gold in the sunlight. “So what would the prosecution say my motivation was?”

“Oh, the usual. You discovered I was in love with another woman and became insanely jealous.” He grinned to show he was joking, but the words had sharp edges.

“Is that what you want?” she asked quietly. “For me to be jealous?”

He squinted at her as if he wasn't sure. “Yeah, sometimes,” he said.

“Are
you
?”

“Jealous of you and Stephen?”

She nodded.

“All the time.” He was staring towards the surf when he said this. She could no longer see his face.

 

Bennett looked up from the typed summary of Jack's medical record that Grace had handed him. “He's on
all
these medications? Every day?”

There were eleven: ACE inhibitors, calcium channel blockers, diuretics, dioxin, thyroid hormone, potassium tablets, coenzyme Q10, prednisone. And morphine.

“I see the morphine is as needed. Which means what? How often?”

“Every day.” Her voice cracked, though she'd joked about this too. My little druggie, our little addict. She swallowed hard. It's not that she thought it funny, that she didn't take it seriously. She joked because it was too devastating to face what Jack's dependence on morphine really meant.

“How do you determine ‘as needed'?”

“Jack isn't ever without morphine anymore. We'd have to gradually wean him at this point to cut back. If he's in pain, though, I'll up the dose.”

“And Jack can articulate when he's in pain?”

Grace glanced at Bennett helplessly. “He tells me his heart hurts.” Her voice quavered. “And there are signs. He gets irritable. He becomes cyanotic—blue—around the mouth. He self-protects, holds himself stiffly when I pick him up.” She spoke slowly, deliberately. She would not cry. She would not. Even though this man was looking at her and maybe wondering if she was capable of drugging her child with a narcotic. If he were a good lawyer, and he was, then he had to wonder, didn't he? She imagined Bennett knew already that there had to be reasons for this accusation, that nobody was as uncomplicated as they appeared. She imagined that he would somehow understand, forgive her for whatever she had done wrong, as if he were a priest, not a lawyer, as if it were in his power to absolve her.

She took a deep breath. “His heart rate goes up, his eyes become dilated.”

Bennett was writing everything down. “How long has he been on the morphine?”

“Since the summer.”

“So this wouldn't be connected to the accusation.” He made another note, then set the summary on his lap and removed his wire-rimmed glasses. “Your little boy's been through a lot,” he said quietly. “And you have as well.” He sighed. “Munchausen's is an insidious accusation. I'm sorry you're being put through this.” He leaned back, his fingers steepled before his face. He had beautiful eyes, she noticed. Very blue. And very kind, and again she had to steel herself against the rush of tears burning her eyes.

 

In 1962,
The Journal of the American Medical Association
published a landmark paper called “The Battered-child Syndrome.” A Colorado pediatrician, alarmed at the number of abused children he was seeing, had written physicians and district attorneys across the country, asking for their observations. He presented the findings at a conference conducted by the American Academy of Pediatrics: An estimated sixty thousand children were being abused in the United States. Worse, the abusers could be anywhere; and they could be anyone: your next-door neighbor, your lawyer or tax accountant, the head of the PTA. You never knew. No child was safe, not even from his own parents. As if to bear this out, calls reporting more and more cases began pouring in.

It was an easy cause to triumph: saving children. It was politically safe. Money flowed into social service agencies to set up hotlines, conduct more surveys and symposiums, establish child protection teams, and educate the public. Within five years every state in the nation had passed legislation mandating that physicians and nurses report to Child Protective Services any suspected cases of abuse. To not do so was to risk being prosecuted on both civil and criminal charges. It was the most quickly passed legislation in the history of the United States.

Child abuse became its own field of study. National and international conferences, academic journals, and a new group of experts became devoted to the subject. The definition of abuse broadened to include sexual abuse, psychological abuse, and abuse by neglect. “Child abuse is so prevalent that it is now an ‘American tradition,'” declared one politician. By 1990, it was considered a national emergency. But as the meaning of the term grew, it became more vague. None of the fifty states regarded spanking an abuse—a concession made to get the legislation passed to begin with. However, in Illinois, rapping a child on the knuckles with a fork constituted abuse while in Florida, it did not—unless bruises persisted for more than three days. Women were reported to Child Protective Services because their homes were in disrepair. A mother who could not afford to buy eyeglasses for her child was accused of neglect. The sixty thousand reported cases in 1962 rose to over three million by 1994, with nearly half a million children taken from their homes and placed into foster care each year.

Less well known was the fact that 65 percent of the reports alleging abuse were based on erroneous information. In one year, in the state of New York alone, 85,000 of the 456,000 calls to Child Protective Services were determined to be pranks, the majority of which had to be treated as genuine until proven otherwise. It didn't matter. What politician would dare suggest that funding be cut to Child Protective Services or that maybe every case
didn't
need to be investigated? “How dare a family complain about a little inconvenience when a child's life is at stake,” one politician responded to the criticism that too many of the accusations were false. “I'd rather see a family disrupted than a bunch of dead children.” As if to bear him out, the major newspapers were filled with stories of children who had slipped through the cracks.

Grace had read “The Battered-child Syndrome” in graduate school. Its main author, Henry Kempe, was regarded as a hero for his studies differentiating intended injuries and accidental ones. Jenn had seen real-life examples of this firsthand during her student rotation in the ER. She had told Grace of the little girl with the grid of a heating grate branded into the soles of her feet; had it been an accident, only one foot would have been burned before the child leaped off the vent. The toddler whose bottom was scalded from being submerged in hot water, the water line across his abdomen as straight as if it had been painted there. It meant he'd been held down so forcefully, he couldn't move. The burgundy U-shapes across a boy's back, the imprint of the looped belt recorded on his skin like fast-motion photography.

Until two nights ago when Stephen walked into their bedroom and told her of the accusation, Grace would have been the first one to say that it didn't matter how many false accusations there were if even
one
of these injuries could have been prevented.

 

“Can either of you recall any run-ins, however trivial, with any of Jack's doctors, nurses, even family members who perhaps don't understand his medical condition?”

Jack had been sick for over a year before they got a diagnosis, so yes, there had been run-ins with plenty of doctors and nurses and yes, even family members. “You know too much,” one gastroenterolgist had told her. “You're an epidemiologist, right? You're probably imagining every horrible disease—we all do it. Welcome to the club.”

“It's a phase. So he's a fussy eater,” another doctor told her. But it was more than fussy. He had been born full-term. He was healthy for the first two months. And then something happened. He was too tired to eat and even when he did, he wasn't gaining weight. Failure to thrive. Her mother once asked, “Do you think maybe he's picking up on
your
tension, honey?”

They'd done the tests. A sweat test for cystic fibrosis. A whole GI workup. Nothing. At seven months she'd called the doctor in tears when she couldn't get Jack to eat, and they'd scheduled a swallow test, thinking maybe there was some sort of blockage and of course, the day of the test, he seemed fine and took his bottle perfectly.

She'd find him asleep in the middle of his toys. His hands and feet were freezing, his nail beds bluish, his heart racing. “It's not normal,” she kept insisting. “I'm telling you something's wrong.” They discovered a Grade III diastolic murmur, but “lots of kids have ventricular gallops,” they told her. They sent him home with a Holter monitor. Eventually, the cardiologist stopped returning her calls, made no follow-up appointments. Grace had phoned in tears one afternoon, terrified after a morning of watching him struggle for breath.

“What exactly do you want Dr. Buford to do?” the receptionist asked her.

“I want him to care,” Grace said wearily.

Silence from the other end.

“Look, I understand that he's frustrated,” she tried again, but was interrupted.

“It sounds like
you're
the one who is frustrated, Mrs. Connolly; most parents would be thrilled to know that there's nothing wrong.”
Most parents.

She'd hung up. And that's when she started writing letters. She'd log onto Medline and HealthWeb and read about Beckwith-Widemann Syndrome or glycogen storage disease of the heart or dilated cardiomyopathy, and she'd write to the doctors who had authored those articles, enclosing a copy of Jack's medical history.
If you have any ideas that might help us find an answer,
she wrote. It felt as futile as putting a note in a bottle and tossing it to sea in the hopes that it might reach someone on the other side of the world. But a doctor from the Cleveland Clinic had responded. Another from Johns Hopkins. Anju Mehta from Children's in Philadelphia. John Bartholomew from the University of California, San Diego. He'd been the first, offering to fly Jack out to his clinic for testing, then abruptly changing his mind. Grace looked up, her neck warm. What was it he said to her? Something accusatory. Something about how eager
she
seemed to have Jack undergo tests. Sentences from the Munchausen by Proxy Web site flashed into her mind:
“Munchausen by Proxy is a career pursued by supposedly wonderful mothers who use their children as sacrifices to win the attention of the powerful doctors whom the mother worships as a god.”
Is that what John Bartholomew had thought? She
had
been so grateful when he first called. She couldn't stop thanking him.

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