“What do you mean?”

“Gabrielle had something called aflatoxin B1-induced hepatocellular carcinoma. Because of the highly unusual nature of this, I ran the tests twice to be sure,” Dr. Maddox said.

Val narrowed her eyebrows. “What’s aflatoxin B1?”

“A potent carcinogen produced by certain molds, namely Aspergillus flavus and Aspergillus parasiticus. These molds grow in soil where there are rotting vegetables or grains. The molds then show up in the foods planted in that soil. Corn, rice and wheat are the most affected.”

“Sounds common. Why is this so unusual?”

“We don’t normally see this in developed nations and the FDA and the Department of Agriculture routinely monitor for this on imported food. Now, don’t get me wrong, we do ingest aflatoxin, it’s unavoidable, but the small amounts that we consume pose little risk. What Gabrielle had was long-term high exposure.”

“How does food cause cancer?” Val tried to wrap her head around this information.

“Aflatoxin causes DNA damage; when this happens the DNA mutates. This is how any cancers start. As a dentist you know DNA is the chemical in each of our cells that makes up our genes. The genes are the instructions for how our cells function. Some genes control when cells grow, divide, and ultimately die. Oncogenes tell a cell to grow and divide. Tumor suppression genes slow down cell division and cause cells to die at the right time. They keep our system in balance. But aflatoxin damages these tumor suppression genes.”

“Wow!” Val sat back, needing a moment to comprehend this. “She was ingesting something contaminated? Something that led to her developing cancer? How… how do you make this kind of mistake… how—” Val stopped mid-sentence. She was at a loss for words.

“Val… let me say that I don’t think this was accidental.”

“Dr. Maddox, if this wasn’t an accident what this all means…” Val practically jumped off her chair, “is that she didn’t develop cancer. Someone gave her cancer!”

Dr. Maddox sat back and crossed his arms and Val couldn’t help but think there was something else. “What is it?” she asked.

“We can’t rule out the possibility that she did this to herself.”

“She gave herself cancer?” Val nearly choked at the thought. “Isn’t that kind of absurd?”

“Not necessarily. In my discussion with her doctor, the one who prescribed the allopurinol, he confided that he thought Gabrielle might have had Munchausen’s syndrome.”

Val knew what Munchausen’s syndrome was. A person acts as if they have a physical or mental illness when they themselves purposely caused the symptoms. Val shook her head in disbelief. “Dr. Maddox, with all due respect—”

Dr. Maddox waved his hand, cutting her off. “Gabrielle visited her doctor many times with odd symptoms, symptoms he could find no cause for. He stated more than once in his notes that he thought these were self-induced.”