Keeping Faith

by Jodi Picoult

  "Thanks," Joan says, and then sits down before Millie has a chance to say anything else.

  Metz eyes Millie Epstein with calculation. He knows damn well why Joan wrapped up so quickly--the old bat's loopy. Like Joan, he plans to steer clear of questions involving reincarnation and second leases on life, questions that would only make him the butt of jokes in the legal community. He smiles, catching Millie off guard. From what Joan's told her, he's sure that he's been built up as a piranha. "Mrs. Epstein, you really love Mariah, don't you?"

  Millie's face softens. "Oh, yes."

  "She grew up very close to you, I bet."

  "Yes."

  Metz leans against the witness stand. "You watched her graduate from high school?"

  "Class valedictorian," Millie says proudly.

  "And college? Magna cum laude?"

  "Summa."

  "That's amazing. I barely made it through Freshman English," Metz jokes. "And you, of course, were there when she got married."

  Millie's mouth turns down at the corners. "Yes."

  "I bet you taught her everything she knows about being a good mother."

  "Well," Millie says, flushing modestly, "you never know."

  "I bet you taught her how to help Faith through these difficult times. Am I right?"

  Millie's chin comes up. "I told her over and over: When you're a mother, you stick up for your child. And that's that."

  "Is that what Mariah's been doing all along for Faith?"

  "Yes!"

  Metz pins her with his gaze. "And is that what you're doing now for Mariah?"

  Millie glances at the judge. "So? Is that it?"

  Judge Rothbottam taps his fingers on the desk. "You know, Mrs. Epstein, actually I have a couple of questions." He glances at each of the attorneys in turn. "Apparently our esteemed counsel is running a bit shy."

  Millie preens under his regard. "Go right ahead, Your Honor."

  "I've, um, read in some of the papers that you were...resurrected?"

  "Oh, yes. In fact," Millie rummages in her large purse, "I've got my death certificate somewhere in here."

  "I don't need to see it." He smiles at her. "Can you tell me about it, though?"

  "The death certificate?"

  "Well, no. The resurrection. For example, how long were you clinically dead?"

  Millie shrugs. "About an hour. Signed, sealed, and delivered."

  "What happened?"

  "I got into a shouting match with Ian Fletcher. The next thing I know, I'm lying on the floor and I can't breathe. After that, I don't remember." Pausing dramatically, she leans toward the bench. "Then I'm all of a sudden in a hospital room with Faith leaning over me."

  The judge shakes his head, amazed. "Any medical explanations for what happened?"

  "As far as I know, Judge, the doctors can't explain it."

  "Mrs. Epstein, what do you think happened?"

  She looks at him seriously. "I think my granddaughter brought me back to life."

  "What do you make of Faith's visions?"

  "I believe her. Goodness, if I didn't believe her now, I'd be an idiot, wouldn't I?" She smiles. "Or worse--I'd be dead."

  "Thank you, Mrs. Epstein. Mr. Metz, do you have any more questions?" The attorney shakes his head. "Well," Rothbottam says. "I think I need a recess."

  Mariah watches her daughter leave the courtroom with Kenzie. She's still not allowed to go near Faith, and to her surprise it's harder to keep her distance now, knowing that Faith is no longer ill. She cranes her neck, watching Faith disappear into the hallway.

  She hopes Kenzie is taking care of her.

  From the corner of her eye she sees Ian. Immediately she turns away.

  "Mariah." Joan draws her attention. "You're on after Dr. Fitzgerald."

  "That soon?"

  "Yeah. Are you going to be all right?"

  She presses a fist to her stomach. "I don't know. It's not you I'm worried about; it's Metz."

  "Listen to me," Joan answers. "When you're up there, no matter what he says to you, you look right here." She points behind her, to the row where Faith has been sitting. "She's going to get you through this."

  Dr. Alvin Fitzgerald has no sooner taken the stand than Metz stands up. "Approach!" The attorneys walk up to the bench. "I want to know if this guy interviewed Faith."

  Joan barely spares him a glance. "No, because I knew you'd complain if he did. If there needs to be an interview at a later date, both of our experts can have a chance. However, I can show what I need to show without Dr. Fitzgerald interviewing Faith."

  At this, some of the wind goes out of Metz's sails. "All right," he says tightly.

  "Dr. Fitzgerald," Joan begins, "can you state your credentials for the record?"

  "I graduated from the University of Chicago's medical school, did a residency and fellowship in child psychology at UCSF, and I was the principal investigator on a large grant studying CFS and somatoform disorders."

  "We've heard an awful lot about Munchausen Syndrome by Proxy. Can you tell us if this particular case fits the criteria for that disorder?"

  The psychiatrist shrugs. "Well, there's a lot that matches the basic DSM-Four criteria."

  Joan watches Metz's mouth drop open in surprise as the psychiatrist repeats the highlights of Dr. Birch's testimony. Then she asks, "Are there elements in this case that don't seem to fit MSP?"

  "Yes. For one, Faith's symptoms are real, and bizarre. It's a lot easier to fake nausea than to fake stigmata. As for the hallucinations, I disagree with Dr. Birch. Just because Mariah White was at an institution with psychotics doesn't mean she could make Faith convincingly fake a hallucination--that's like saying that riding on the Bulls' team bus will make you play like Michael Jordan." He grins. "Another discrepancy is that Munchausen by Proxy is chronic. These parents go from emergency room to emergency room so that doctors don't pick up on what they're doing. Yet Mrs. White has taken Faith to the same health-care provider, Dr. Blumberg, repeatedly. She's gone so far as to request him to examine Faith numerous times."

  "Is that all, Doctor?"

  "Oh, I'm just getting warmed up. The perpetrators of Munchausen by Proxy traditionally have an emotionally distant childhood, which Mariah White did not have. But the biggest problem I have with a diagnosis of MSP is simply that there are alternative diagnoses that explain this case equally as well."

  Joan acts surprised. "Really? Like what?"

  "Somatoform disorder, for one. Basically, it's when a patient experiences emotional distress in a physical way. Imagine a child who develops severe stomach cramps every time she has to take a test, because she's so anxious about school. She's truly hurting, but she can't articulate why. Remember Freud's hysterical patients? They were the great-grandmas of today's somatoform-disorder patients."

  He holds up his hands, demonstrating a sort of scale. "It's helpful to consider these disorders by imagining a range," the psychiatrist says. "On one end is malingering, which we've all done: You pretend you have the flu to get out of jury duty, for example--symptoms are intentionally faked to achieve an intended goal. On the other end is somatoform disorder, where a patient unintentionally produces a symptom that looks and feels like the real thing--and doesn't know that she's doing it, much less why. Somewhere in between these is Munchausen Syndrome by Proxy, where symptoms can be intentionally feigned...but for unintentional reasons."

  "So the difference, Doctor, is in the intent."

  "Exactly. Otherwise, these two disorders look similar. Just as in Munchausen by Proxy, a doctor will examine a child with somatoform disorder and not be able to find any organic etiology for the symptom. She may undergo CT scans and MRIs and dozens of tests, to no avail, because the presenting problem doesn't fit with the physiology. However, in a somatoform disorder, the symptom is set off by stress. In MSP, the symptom is set off by Mom. In somatoform disorders, the symptom is real. In MSP, it's faked. Often deciding which is which comes down to a judgment call requiring the knowledge of the con
text of the illness, the players involved, and what gains have been made by them."

  "Then part of the diagnosis involves who's trying to get attention--the mother or the child."

  "Exactly."

  "How do Faith's symptoms fit a somatoform disorder, Doctor?"

  "First, the presenting problem isn't organic. She's bleeding from her hands, but there's no tissue mutilation inside--kind of hard to fake a wound like that. She may be hallucinating, but she's not psychotic. And there's an argument to be made that the illness was brought on by stress, that she unconsciously believes that by being sick, the stressor will go away."

  "Would a divorce qualify as a stressor?"

  Fitzgerald grins. "You catch on fast, Ms. Standish. In a child's mind is the unconscious thought, 'If I get sick, my parents will stay together to take care of me.' Without even knowing she's doing it, the child makes herself ill and draws attention to herself. Not having actually met Faith, of course, I can only hypothesize that her mind is making her body sick, in the hopes that her family will remain intact. And look--it's working. Her parents are both here today, aren't they?"

  "If that were true, would Mrs. White be in any way involved in her daughter's illnesses?"

  "Oh, no. It's all being done psychogenically, by Faith's mind."

  Joan pauses. "How would you go about determining whether Faith's illnesses were caused by her mother's hand or by her own mind?"

  "By default. I'd remove Mrs. White from her child to see if the symptoms abated."

  "What if I told you that a comatose child whose bodily systems were in acute distress was restored in a period of an hour to perfectly normal levels of functioning once she was reunited with her mother after an extended separation?"

  "Well," Dr. Fitzgerald says, "it would certainly rule out Munchausen by Proxy."

  "You're not a hundred-percent sure, are you?" asks Metz. "That it's somatoform disorder plaguing Faith...or that it's Munchausen by Proxy plaguing her mother."

  "Well--"

  "Do children always develop somatoform disorders after messy divorces?"

  "No," Dr. Fitzgerald says. "A variety of maladaptive behaviors might occur."

  "Can you list them for us, Doctor?"

  "Sometimes kids act out behaviorally, or sexually. Grades drop in school. Appetites rise or wane. There's a whole range, Mr. Metz."

  "I see. Are only a small percentage of Munchausen by Proxy cases reported?"

  "Yes."

  "So, although it is a rare disorder, it may be more prevalent than one might think?"

  "That's right."

  "Is it true that most patients diagnosed with MSP are female, with a median age of thirty-three?"

  "Yes."

  "How old is Mariah White, and what sex is she?"

  "She's a thirty-three-year-old female."

  "Is it true that the perpetrators of MSP are usually mothers?"

  "Yes."

  "Is Mariah White Faith White's mother?"

  "Yes."

  "Have most people who suffer from MSP undergone a significantly stressful life event, such as a divorce?"

  "Yes."

  "Did Mariah White just go through a divorce?"

  "Yes."

  "Most of the perpetrators of MSP have some experience in the health field, as either patients or professionals, correct?"

  "Yes."

  "Did Mariah White spend several months in a mental institution?"

  "Yes."

  "Is it true that in MSP, the parents seem very interested in the child's treatment?"

  "Yes," Dr. Fitzgerald says dryly. "But most parents with a sick child--whether they have MSP or not--tend to be interested in the child's treatment."

  Metz shrugs off the response. "Has Mariah White been very interested in her child's treatment?"

  "That's what I hear."

  "Is it true that most symptoms presented in cases of MSP do not often respond to conventional medical treatment?"

  "Yes."

  "Have Faith White's hand wounds resisted responding to traditional clotting medicines?"

  "Yes."

  "Have Faith White's hallucinations persisted in spite of antipsychotic drugs?"

  "Yes."

  "Is it true that patients with MSP are unconsciously looking for attention?"

  "Yes."

  "Is there an incredible amount of attention focused on the case of Faith White?"

  "Yes." The doctor sighs.

  "Is it true that the perpetrators of MSP deny what they're doing, either because they're pathological liars or because they've dissociated from the behavior?"

  "Yes."

  "Has Mariah White admitted to harming Faith?"

  "Not to my knowledge."

  "Does that fit the MSP profile?"

  "Yes, it does." Fitzgerald raises a brow. "Of course, it also fits the profile of a mother who hasn't hurt her child."

  "All the same, Doctor, you've just given me about ten specific reasons that this case looks like Munchausen by Proxy. If it looks like a skunk and smells like a skunk and acts like a skunk...well, you can't say honestly that this is clearly somatoform disorder, can you?"

  Dr. Fitzgerald's mouth flattens into a line. "That's completely specious logic."

  Metz shakes his head. "Yes or no."

  "No."

  "And what does that leave us?"

  The psychiatrist meets the attorney's gaze. "If it's not somatoform disorder," he says, smiling slowly, "I guess it could always be a seven-year-old seeing God."

  SEVENTEEN

  Woman's at best a contradiction still.

  --Alexander Pope

  December 6, 1999

  That," I sing, "was incredible!" Inside me, it feels as if small bubbles are rising, which at any moment may burst into laughter. I embrace Joan tightly. "Where did you find Dr. Fitzgerald?"

  "On the Internet," she says, looking at me carefully.

  Well, she could have found him under a rock for all I care. Not only has the psychiatrist laid the groundwork for an alternative explanation of Faith's symptoms, he's also stood toe-to-toe with Malcolm Metz and won. "Thank you. You made such an issue about getting thrown this surprise on Friday--I didn't think you'd be able to pull together such a good defense strategy this quickly."

  "I didn't, so don't thank me."

  I smile hesitantly. "What do you mean?"

  "I don't have the manpower or resources that Metz does, Mariah. Under ordinary circumstances, I couldn't have pulled it off. I would have walked in here this morning and flown by the seat of my pants. But Ian Fletcher spent the entire weekend in my office, finding Dr. Fitzgerald and corresponding with him on-line and ruminating over this particular defense."

  "Ian?"

  "He did this for you," Joan answers matter-of-factly. "He'd do anything for you."

  A witness stand is a tight spot. You are gated in on all sides. You are broadcast by microphone. You sit on a chair that is so uncomfortable you can't help but straighten your spine and look the gallery in the eye. My heart begins to batter in my chest like a lightning bug trapped in a jar, and suddenly I understand why this is called a trial.

  Joan's heels click on the wooden floor. "Can you state your name for the record?"

  I draw the swan neck of the microphone toward my lips. "Mariah White."

  "What is your relationship to Faith White?"

  "I'm her mother." The word is a balm; it slides from my lips to my throat to my belly.

  "Can you tell us how you're feeling today, Mariah?"

  At that, I smile. "Actually, I feel terrific."

  "How come?"

  "My daughter's out of the hospital."

  "I understand she was very ill over the weekend?" Joan asks.

  Of course Joan knows that Faith was sick; she saw her several times. This formality, this rigamarole, seems ridiculous. Why wade through the theories and hypotheses when I could just high-step to the gallery, sweep Faith into my arms, and be done with this?

  "Yes," I
answer instead. "She went into cardiac arrest twice, and she was comatose."

  "But she's already out of the hospital?"

  "She was discharged on Sunday afternoon, and she's doing very well." I glance at Faith, and even though it is against the rules, I wink.

  "Mr. Metz is alleging that you are a perpetrator of Munchausen Syndrome by Proxy. Do you understand what that means?"

  I swallow hard. "That I'm hurting her. Making her sick."

  "Are you aware, Mariah, that two experts now have stated in this court that the best way to determine Munchausen Syndrome by Proxy is to keep the mother away from the child and look for improvement?"

  "Yes."

  "Were you able to see Faith this weekend?"

  "No," I admit. "I was restrained by court order. I wasn't allowed any contact with her."

  "What happened to Faith between Thursday and Sunday?"

  "She got worse and worse. Around midnight on Saturday, the doctors said they didn't know if she was going to live."

  Joan frowns. "How do you know, if you weren't there?"

  "People called me. My mother. And Kenzie van der Hoven. They were both with Faith for long periods of time."

  "So from Thursday night through Sunday morning, Faith's condition declined, to the point where she was comatose and near death. Yet she's healthy and present today. Mariah, where were you from two A.M. Sunday morning to four P.M. that same day?"

  I look right at Joan, the way we've practiced. "I was at the hospital, with Faith."

  "Objection!" Metz stands and points at me. "She's in contempt of court!"

  "Approach."

  I should not be able to hear their conversation, but they are angry enough to be shouting. "She's in direct violation of a court order!" Metz says. "I want a hearing on this today!"

  "Jesus, Malcolm. Her child was dying." Joan turns to the judge. "But then Mariah showed up, and she didn't die, did she? Your Honor, this testimony proves my theory."

  The judge looks at me. "I want to hear where this is going," he says quietly. "Ms. Standish, you may proceed, and we'll deal with the violation of the court order later."

  Joan addresses me. "What happened when you got to the hospital?"

  I think of the moment I first saw Faith, hooked up to machines and tubes. "I sat down next to her and I started to talk. The machine that was hooked up to her heart started to beep, and a nurse said she needed to page the doctor. When she left the room, Faith opened her eyes." I envision the red flush of her cheeks while the tube was being drawn out of her throat, her voice like brittle leaves as she called for me. "The doctors started to run tests. Everything--her heart, her kidneys, even her hands--were all back to normal. It was...well, it was amazing."