A Mother's Trial (2 page)

“Mindy Phillips is a thirteen-month-old Korean child with congenital cytomegalovirus and intermittent cyanosis. She has been hospitalized several times during the last month with chronic diarrhea. So far we can find no cause for the cyanosis. EKG and cardiac exams are normal, and Dr. Tarnoff from Cardiology believes that her cyanotic condition is due to a peripheral vascular disorder.

“In spite of Mindy’s treatment with IV fluids and Cho-free formula plus polycose, she continues to have intermittent bouts of voluminous watery stools. In this she bears a quite striking resemblance to her sister, Tia, who at a similar age developed an intractable form of watery diarrhea with peculiar electrolyte abnormalities, including high serum sodium levels.

“As you will remember, after months of hospitalizations and repeated work-ups, tests, and procedures that yielded no real clue to her illness, Tia eventually died one year ago.

“I needn’t remind you that although both children were adopted and of Korean extraction, they are not related to each other. I consider this a critically important point because it rules out the hereditary factor.”

Sara looked around the conference table at the other pediatricians and paused.

“Are there any comments?” she asked.

2

Dr. Evelyn Callas sat squarely, leaning forward against a hand cupped under her firm chin as she listened to Sara’s presentation. Her apparent relaxation was just a pose. She was a bustling, vigorous woman who thrived on work. At forty-eight, she had been in practice as a pediatrician for over twenty years and on the staff of Kaiser for nineteen, and had just been appointed Chief of Pediatrics. Sometimes it was hard for her to believe that she had climbed that high.

Evelyn Ridenauer boasted descent from rough country stock. Reared in rural Sonoma County, north of San Francisco, she had attended the fifteen-student, one-room Ridenauer School taught by a single teacher, her mother. Her father, a small farmer all his life, was head of the school board. Her family had always specialized in overcoming difficulties. In 1853, her great-grandfather had taken up a land site in Sonoma County that Evelyn remembered and often described as rather scenic but totally useless. He had added to his problems by sympathizing with the Unionists in a Confederate county, but the Ridenauers survived, and if they hadn’t prospered, at least they had endured.

She had to manage without much money. But the Ridenauers did provide their only daughter with a modicum of ambition, an inheritance of extraordinary energy, and a considerable portion of intelligence. After an undergraduate career at nearby Santa Rosa Junior College, followed by a year at USC, Evelyn decided to apply to Southern Cal’s medical school. It was 1951, and the Korean war veterans were descending in droves upon every medical school. There was a quota for women at USC and for this Evelyn considered herself lucky. Otherwise, she sometimes thought, they would not have taken any women. As it was, out of their class of seventy they accepted four women. Evelyn Ridenauer was one.

In the next four years she completed medical school—graduating near the top of her class—married one of those Korean veterans and produced a son. She had always known she wanted to be a pediatrician, preferring to deal with acutely ill patients she could see, treat, and send home well, rather than with the chronically ill. And she had taken a realistic, practical point of view: pediatrics was one of the few specialties where her sex would be an advantage.

So following a years rotating internship at Harbor General in Torrance, she completed a two-year residency in pediatrics at Children’s Hospital in Los Angeles, the same hospital where Sara Shimoda was to train ten years later. And then she and her husband Jim, a pediatrician by that time too, moved back north to Marin County.

In twenty years she had altered somewhat. Her figure was now decidedly narrower at the top than at the bottom. Her clear-rimmed glasses were bifocal and thick enough to magnify her brown eyes; her short brown hair was going gray. Sometimes she waxed a little too enthusiastic and startled people. And she could be sarcastic and a little overbearing and formal when she was ill-at-ease.

As the staff began discussing Mindy’s case, Evelyn realized that the possibility of deliberate poisoning would at least have to be explored. It was a highly unpleasant conclusion. No pediatrician was trained to look for it. Accidental poisoning was not so uncommon, occasionally occurring even in hospital settings. Sometimes salt would inadvertently be mixed into a formula in place of sugar. But deliberately? Repeatedly and before their very eyes? Unthinkable. Or nearly so. But Evelyn knew that Sara was finally considering it. So were they all. It might not be the answer, but it required examination despite Sara’s understandable reluctance.

“You might contact Boyd Stephens—he’s the San Francisco coroner,” Evelyn heard Rainer Arnhold suggest to Sara.

“Yes, he’s an expert on toxicology,” Dick Stein agreed. “We need to have some sort of proof before we can act. He may be able to help.”

“Oh, and this week’s
Journal of the American Medical Association
has an article about mothers poisoning their children in hospitals, apparently out of some sort of misguided desire to be centers of attention themselves,” Rainer went on. “I believe the syndrome has been called Munchausen Syndrome by Proxy. I’ll give you my copy.”

“Thank you,” Sara said.

The meeting continued, but Evelyn Callas only half listened to Dr. Arnhold’s presentation of a patient with respiratory problems and Dr. Carte’s report on minimal brain dysfunction in children. She had been struck by a thought that suggested a solution to the puzzle of Mindy’s condition.

When at ten o’clock the meeting was finally adjourned, Evelyn flew after the departing white coat of Sara Shimoda and cornered her in her office.

“Sara, I’ve got it! I know what it is,” she said.

“What?”

“What’s being given to Mindy. I know what it is. It’s got to be a sodium cathartic—it’s got to be Epsom salts. Now what’s in Epsom salts?”

Neither of them knew.

“Let’s see your
Goodman and Gilman.
Do you have it here?” Evelyn persisted.

Sara did. She lifted the heavy pharmacology book and handed it to Evelyn, who hunched over it, leafing through the pages, her brown eyes intent.

“Sodium magnesium sulfates,” she read. “Now how can we test for the presence of those? Can we test for sulfates? See if we can get the magnesium—I know we can get the magnesium!”

But because they both had patients to see and were late already, they did not have time to pursue Evelyn’s idea. And, as Evelyn found out later, it would soon cease to matter.

3

Priscilla Phillips sat comfortably in the low, vinyl-upholstered, orange chair the hospital provided, her legs and feet trim in hose and low-heeled shoes, and looked down at her daughter. Mindy lay back in Priscilla’s lap, sucking eagerly on her bottle; she had definitely improved. Sara had indicated that she might possibly discharge Mindy today and Priscilla had whooped in excitement at the news.

“It will be a double celebration,” she’d said to Sara. “Today’s my thirty-second birthday.”

“Let’s keep our fingers crossed then,” Sara said.

Priscilla studied Mindy as she held her. Priscilla tried to avoid comparing her children, but sometimes this was inevitable. She saw none of Tia’s beauty or charm in Mindy, who had a broad nose, slightly flattened against her high cheekbones, much yellower skin, and a wider face. Now even the bangs which Priscilla had proudly cultivated—thicker than Tia’s had ever grown—had been shaved off with a razor so an IV could be placed in a scalp vein. This mutilation had been accomplished, Priscilla had complained to Steve, by a doctor without children of her own. Apparently it had never occurred to Dr. Janet Specht how a mother would view the results. Priscilla thought the uneven shave made Mindy ugly and destroyed her best feature, and for no reason. Dr. Specht could have used a different vein for the IV.

And Priscilla found Mindy less gratifying a child than her sister had been. Mindy did not accept things the way Tia had. She was a fighter—noisy and hard to please when she was irritated, which was often. She screamed at night, sometimes for hours. Still, Mindy had been with them only three and a half months—she was not legally adopted yet—and her previous experiences in a Korean orphanage and a Korean foster home hardly amounted to a stable home environment. Priscilla was a trained social worker, and she knew how hard it was for children to adjust to new family situations.

The doctors didn’t really know what was wrong. They knew she had gastroenteritis, but they couldn’t find a cause. Perhaps it was because Mindy was Korean, Priscilla had often said. It was a point she and Sara had discussed. After all, Priscilla had been told by the adoption agency to expect diarrhea at first. That was a standard warning issued to all adoptive parents of Asian children. Or maybe it was just a bad attack of flu, she had suggested. They had all come down with it in the days before Mindy’s hospitalization. Priscilla and Steve, Erik and Jason. The whole family.

Priscilla moved awkwardly on the uncomfortable chair. She had learned a great deal with Tia’s illness. She knew all about IVs and NGs, about electrolyte values and blood tests, about reducing substances and special formulas and dehydration.

She had always insisted on total involvement, repeatedly informing the medical staff that nothing bothered her more than to be left out of things. Once an ugly scene over Tia’s care had developed at the Kaiser hospital in San Francisco. That had been in July, when the new year’s group of interns joined the staff, fresh from medical school. Some of the new doctors reacted defensively to her questions at first, but she had explained that she only wanted to help, and certainly she was proficient. In fact, they ultimately allowed her to take Tia home with an open tube in place that led directly to her heart. Priscilla believed herself to be the only parent they had ever trusted to handle this procedure without supervision.

And she knew she had earned the respect of most of the nurses on the ward. Some had become real friends. In the beginning, Debby Roof, one of the pediatric nurses, couldn’t stand Priscilla—thought she was high-handed and bossy—but Priscilla had won her over with her constant devotion to Tia.

Priscilla bent over Mindy’s wriggling, slight figure and without a trace of false gentleness competently adjusted her bottle. When Mindy was finished, Priscilla swung her over a shoulder and began a brisk patting. So far Mindy had been on oral feedings and a naso-gastric tube had not been necessary, but the bottle alone could not provide enough fluid. Priscilla knew that Mindy needed the IV for rehydration, and that when her peripheral veins—which they preferred to use for the IV—had been depleted, Sara and the other doctors had been forced to try two other sites for cut-downs, to get down to the larger, deeper veins in Mindy’s ankles. There they had found one vein completely missing and the other unusable. That is why the surgeons—and it had taken two of them—had worked so hard to place the line in Mindy’s inner elbow. Shrieking in panic, she had been held down, her screams ringing through the ward. After this there was only one other vein available in the other arm. In an emergency they could try the jugular. At that point, Priscilla understood that they might run out of time.

4

An hour and a half later, Steve Phillips sat on the floor by Mindy’s bedside with his sons, Erik and Jason. Priscilla thought it was important, and so did he, for the whole family to spend as much time together as possible, even if it had to be at the hospital. Mindy, after all, had not been with them very long, and she needed to feel that she belonged.

His family, it seemed to him, was just about perfect—but for the death of Tia. His two sons were blond and sturdy: Erik had just turned eight and was a smart kid—he took after his mother in that, Steve acknowledged—and Jason was five, sweet and serious. They were a happy and loving family, a solid family, despite the arguments they sometimes had.

Mindy was out of her crib and playing with the boys on the floor. She was full of piss and vinegar today, Steve thought. Things were definitely on the upswing this morning. Steve had given her the bottle of Cho-free himself, and she had practically inhaled it. The nurse had been in and noticed it, smiling. It appeared they might even be allowed to take Mindy home. Damn, he hoped so.

Neither he nor Pris did much to hide their emotions. That was why Debby Roof had suggested that they meet with Dr. Shimoda. To let it out, talk about the pressures, hang it all out there to dry—that was how he looked at it. They had met at the hospital last Sunday. Afterward he had stayed for almost twenty minutes, confiding to Debby that Mindy’s illness was putting a strain on their marriage. It was worse than the pressures on Erik and Jason, though that was the topic they had mainly discussed in the meeting with Sara. Talking had been a relief, he thought, eyeing Mindy as she crawled toward him, trailing her tubing. He smiled down at her and helped her to stand against him.

Priscilla always wanted to talk everything through. Partly it was her social worker’s training, partly just her personality, but when things turned rough for him, Steve retreated to the garage, puttered around morosely, and immersed himself in TV. Sometimes when he talked he felt he might explode, and he was too big a man for that.

He couldn’t have held a position in juvenile hall as a group counselor very long without that basic insight. If he exploded around those kids, he could do irreparable damage. It was the same at San Quentin, where he had worked for a year as a correctional officer in ‘69 and ‘70. Day after day he had walked into that yard unarmed. When he thought about it, all he had between himself and oblivion at the hands of some space-case with a hand-sharpened spoon was a brass whistle. So he didn’t explode. Not physically.

He thought it was all right to yell. He was big enough at 6 feet and 215 pounds, with a big bull neck disappearing into wide shoulders, to intimidate a lot of people. And he knew that if you have a nice South Carolina drawl and talk in pictures so sharp and real that the guy you’re facing really sees what’s in store for him should he put one foot outside the line you’ve set up for him, that sucker listens. That’s what he’d learned. Maybe it
was
intimidation, but if they didn’t cross Steve Phillips, he damn well wasn’t going to cross them. And that was the bottom line, he felt. Or at least it was as good a way as any to put himself across. Because underneath was something a lot softer than he cared to admit.