“Let me say the gout was real. When she first became my patient, her complaints were all consistent for gout, and the tests confirmed she had it. Then things escalated.” The doctor reclined back in his chair and looked at the ceiling. “She reported respiratory problems, muscle cramps, she felt that she had heart palpitations, achy joints and thought she had arthritis. Recurrent infections were a big one for a while. So were digestive problems. There was also diarrhea, nausea, tingling in her feet, chills.” He sat forward and focussed his gaze on Val. “Many of the symptoms were unclear, inconsistent, were not controllable, and according to her, did not respond to treatment. Blood tests revealed nothing wrong with her. More involved tests revealed nothing either. She then came to me with relapses that seemed to spark new symptoms that she wanted me to test for. And she had the names of these tests at the tip of her tongue. Again, it’s all a red flag for Munchausen’s.”

“I see.” Dr. Quinlan’s description was pretty convincing. “Can you tell me what causes this syndrome?”

“Causes are not clear. Childhood trauma and abuse are the common culprits. The likely sufferers are women age twenty to forty, which Gabrielle fit. They also typically have some knowledge of the medical field, and are very cunning. Why do they do this? They want sympathy. Some sources say they enjoy the satisfaction in deceiving important and powerful people, such as doctors.”

Val nodded, listening to what the doctor was saying. Dr. Maddox had said almost the same thing. This certainly fit Gabrielle.

“Munchausen’s is a psychiatric condition,” Val stated. “Is it possible that Gabrielle was also bipolar? Could this have caused it too?” Perry Logan, Gabrielle’s first husband suspected this and Val wanted to know what a healthcare professional thought.

Dr. Quinlan sat back again and appeared to think about the possibility. “Personality disorders are common in people with Munchausen’s. A diagnosis of bipolar depression is usually based on reporting of symptoms by the patient, and a psychiatric evaluation. Though, out of the multiple symptoms Gabrielle complained of, none were consistent with this.”

“What about liver cancer,” Val asked. “Anything consistent with that?”

“Liver cancer? Yes, Dr. Maddox did mention that she had it, but no, she never complained of symptoms consistent with any kind of cancer.”

It was Val’s turn to sit back and think. The doctor was treating Gabrielle for gout. A real ailment. But Gabrielle reported no issues with her kidneys, though she had signs of past kidney damage. And she might really have had bipolar. Again, not reported.

And Jesus, if she wanted to give herself cancer and knew that she had it, or thought that she had it, why not invent likely symptoms. Why not tell her doctor that she thought she had it? Have him test for it. Wouldn’t that be what she wanted if she had Munchausen’s?

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