The saddest diseases that I have encountered in my medical career are those of the mind.
Lori (not her real name) came into the hospital with persistent fevers. She had multiple admissions. Blood cultures were positive for multiple types of bacteria. Where was this infection coming from? She improved on broad spectrum antibiotics that covered every type of infection. But she would mysteriously worsen overnight, spike more fevers despite the antibiotics. New blood cultures would be drawn. Now that she was on the antibiotics, the blood cultures were negative. But she still had fevers with no source of infection. No cause could be found for her fevers.
Lori was pleasant and friendly. She was in her early 30’s, white woman with blonde hair. She was attractive, 5 foot, 2 inches, petite. She had an attentive boyfriend who would visit regularly bringing her 5-year-old son. (Son was from her previous marriage.) The son was adorable. His red hair and freckles captured the attention of the nurses. He wanted to be with his mother.
I spoke with Lori about her test results. As her doctors, we were concerned that she was still having fevers. I knew that she had a history of this. I said that we would like to see her 24 hours without a fever before releasing her, but perhaps she was having a reaction to one of the antibiotics. She seemed to take the information in stride, resigned to doing what she needed to do to get better. Meanwhile, all her doctors, including me, we were frustrated by not having an answer of where her infection was coming from. Bacteria must be getting into the blood from somewhere. She did not have dental infections, urine showed no infection, lungs were normal, no skin infections. She was alert and active. She seemed well despite all of this. Even an ultrasound of her heart was done, no infection there either. Where was this coming from?
The next morning, the nurses were a flurry. There was commotion at the desk. The proverbial “shit” had hit the fan. While she had been very pleasant and cooperative to all her doctors, Lori was quite demanding and often rude to the nursing staff. They were seeing a whole different side of her. Well, Lori had “messed with” the wrong nurse the previous night, and the nurse knew something was wrong. The nurse had found some syringes in the garbage of the room, but these were not the type used in the hospital. She had noticed that Lori would spike fevers overnight, and often after spending a long time in the bathroom. The nurse searched her belongings. She had a suitcase, and it was filled with medical supplies. Administration was contacted. Cameras were placed in her room. She was recorded injecting water from the toilet directly into her IV catheter line. The overnight doctor had ordered a staff member to sit in her room. She was a danger to herself.
That is the story that I heard that morning as I came on shift. I was livid. Wasting valuable resources of the hospital, endangering herself, just to get attention. I confronted her with the information, told her what we had found. She was calm and seemed just as surprised as me, as if she was watching someone else’s story. Her face just seemed to say, what should we do now? My anger was quivering inside, but she seemed unaware that this could be her fault. She agreed to see psychiatry and psychology. She knew there was something wrong, but there seemed to be something empty about her response. She just was not there, a disconnect, … perhaps even this was a way that she got attention, feeding her disease.
This is Munchausen syndrome. A psychiatry and psychology consult was ordered. This disease of the mind is characterized by harming oneself to get medical attention. It is associated with emotional disturbance, history of trauma, and other mental disorders. Perhaps even sadder, but I have not seen a case, is Munchhausen by proxy. Harming someone else (like a child) to get medical attention, and getting attention yourself as caregiver.
Lori had several more admissions to the hospital. Now her psychiatric diagnosis was on the medical record as Munchausen Syndrome. She still had physical issues with her prior hospitalizations and multiple prior surgeries. She had real medical reasons for possible future admissions. I don’t know what eventually happened to her, was she ever cured? but I do know the hospital was not the place that would cure her mind. There was not much that I could do for her in the hospital other than complete a course of antibiotics for the self-induced blood infection.
I hope that she was able to get the help that she needed.
Books on Munchausen Syndrome
