Keeping Faith

by Picoult, Jodi

  Healing others has been killing her.

  Just before the elevator doors open, I say what has been on my mind since Kenzie telephoned. “You have to call Colin.”

  “I already did. He told me to call you.”

  “But–“

  “He didn’t care about the court order either.

  He said you ought to be here, too.”

  Then we are on the pediatric ICU floor.

  I follow Kenzie to Faith’s room–she’s been moved since I last saw her. At the glass window, I stop. My mother is sitting on a chair beside Faith’s bed, and I’m struck by how old she suddenly looks. Faith …

  well, I would not have recognized her at all.

  Full of tubes and pads and wires, she looks so small on the narrow bed.

  A nurse moves like a shadow as I enter.

  My mother stands, embraces me. Without speaking,

  I sit down in the spot she’s vacated.

  Right now I understand those mothers who can lift automobiles off children who are pinned, women who step heroically in front of bullets. I would give anything to be the body that is lying so still. I would give anything to take her place.

  I lean over, my words falling on her face.

  “I never told you that I’m sorry,” I whisper. “For a long time I was so busy with myself that there was no time for you. But I knew you would still be waiting for me, when I was ready.” I touch my hand to her cheek. “It’s your turn, now. Take your time. When you look over your shoulder–days from now, months from now–well, I’m not going anywhere without you.” I close my eyes, listening to the fleeting, occasional whir of the machines feeding into Faith. One piece of equipment picks up its pace, beeping with quick regularity. The nurse looks up, frowns. “Something’s going on,” she says, reading the printout from the electrocardiogram. “I’d better page Dr. Blumberg.”

  She’s barely left the room when Faith’s eyes fly open. They focus on Kenzie first,

  then my mother, and finally come to rest on me. Faith opens and closes her mouth, trying to speak.

  The doctor flies into the room, pulling his stethoscope from around his neck. He checks Faith’s vital signs, murmuring quietly to her as his hands move over her body. “Don’t talk yet, kiddo.” He nods to a nurse, and she braces Faith’s shoulders while he extracts the endotracheal tube. Faith coughs and gags, and then her voice comes in a sandpaper snap. “Mommy,” she rasps, smiling, her bandaged hands coming up to frame my face.

  Keeping Faith

  SIXTEEN

  So lonely ’twas that God himself Scarce seemed there to be.

  –Samuel Taylor Coleridge,

  “The Rhyme of the Ancient Mariner”

  December 6, 1999 Because it is bitterly cold, the snow does not stick to the pavement. It swirls beneath the undercarriage of Mariah’s car; it lies down in her path before twisting out of reach of the wheels.

  Mariah keeps her eyes on the road. She concentrates on where she is going, on when she will arrive.

  “Dr. Birch,” Malcolm Metz says,

  “did you interview Faith White this weekend?”

  “I went to the hospital, and I did get to see her, but we didn’t speak.”

  “Why was that, Doctor?”

  “She couldn’t conduct a conversation. She was comatose.”

  “Were you able to speak to anyone affiliated with her case?”

  “Yes. I spent some time with a doctor in charge of Faith’s medical care, who outlined her symptoms and test results for me.”

  “Can you tell us what you learned?”

  “She was admitted for observation due to unexplained bleeding from the hands. Once hospitalized, she developed a high fever,

  along with febrile convulsions, renal-system failure, and she went into cardiac arrest. This wasn’t caused by pulmonary problems, nor does it seem to be a myocardial infarction,

  myocarditis, or a cardiomyopathy. In short, the doctors are treating the symptoms without necessarily knowing the cause.”

  “Could any of these symptoms have been caused by her mother?”

  “I suppose so, under the right circumstances,”

  Birch says. “Of course, in this case, since Mrs. White has not been present at her daughter’s bedside since Friday, I’d have to say that the bleeding and the fever are the symptoms most likely produced by her hand. I would have to reserve final judgment until interviewing Faith.”

  Metz pauses in front of the witness stand.

  “In your expert opinion, Dr.

  Birch, how would you summarize the case of Faith White?”

  “Again, this is hypothetical without a chance to talk to the child herself. But if the interview corroborates my gut feelings, I’d have to say that she’s a victim of Munchausen by Proxy. The child is obviously failing, and requires immediate long-term separation from her mother to ensure her mental and physical health. Her father is the obvious alternative–he can provide a supportive, loving, and mentally healthy environment for the girl. Of course, this is all dependent on whether the physicians can patch up the damage that’s already been done. But if Faith is a victim of MSP, if she comes out of the coma and is separated from her mother and given constructive psychotherapy, I think her prognosis would be excellent.”

  “Thank you, Doctor.” Metz glances at Joan. “Your witness.”

  Joan braces her hands on the defense table.

  She is wearing her kick-ass pink suit, as she likes to call it, and feeling confident. “Dr.

  Birch, are you here at the request of Mr.

  Metz?”

  “Yes.”

  “Has he paid you to be here?”

  “Objection,” Metz says. “Asked and answered.”

  “Withdrawn. How many years have you been practicing?”

  “Twenty-three.”

  “In those twenty-three years, how many patients have you treated?”

  “Oh … five hundred? Six?”

  Joan nods. “I see. Out of those five or six hundred patients, how many have you personally diagnosed with Munchausen Syndrome by Proxy?”

  “Sixty-eight.”

  “In each of these sixty-eight cases, did you have a psychiatric interview with the mother?”

  “Yes.”

  “In each of these sixty-eight cases, did you have a psychiatric interview with the child?”

  “Yes.”

  “Have you had a psychiatric interview with Mariah White?”

  “No.”

  “Have you had a psychiatric interview with Faith White?”

  “No. She’s in a coma, for God’s sake.”

  “So you’re basing your diagnosis of this case –of this incredibly rare disease–on newspaper articles you’ve read, and doctors’ reports,

  and seven-year-old records from a psychiatric institution … oh, and on hearsay?”

  “No–“

  “You can’t truly diagnose this illness without interviewing Faith and Mariah, can you?”

  The psychiatrist’s cheeks flag with color.

  “I can make a contingent diagnosis. I’m just one step removed.”

  Joan arches a brow. “I see. So, you’ve … contingently diagnosed Mariah White with Munchausen Syndrome by Proxy. Are there any other diagnoses this case might support?”

  “Well, there’s always something, Ms. Standish.

  But having studied this syndrome for years, I’d say it’s a likely diagnosis.”

  Joan looks at a pad. “Have you ever heard of somatization disorder?”

  “Of course.”

  “Could you define it for us?”

  “It’s when a child manifests symptoms that are psychologically induced–in other words, he’s sick, but it’s his mind that’s making him sick.

  Imagine a child who breaks out in hives every time his father has visitation rights; the child is expressing some internal psychological disturbance with physical symptoms. Often it’s an unconscious means of getting attention.”

  �
�Have you ever seen clients with somatization disorders?”

  “Many times.”

  “It’s far less rare than Munchausen by Proxy, then.”

  “That’s correct.”

  “Is it true, doctor, that often the victim of a somatization disorder looks a lot like a victim of MSP?”

  “Yes. In both disorders, the presenting symptoms have no organic etiology–in MSP because they’re faked, in somatization disorder because they’re psychologically driven.”

  “I see. How do you go about diagnosing somatization disorder, Doctor?”

  “You’d interview the parents and the child. And you’d order many medical tests.”

  “The same strategy you’d use to diagnose Munchausen Syndrome by Proxy, then.”

  “Yes. However, in MSP separation from the parent results in a disappearance of ailments.

  If the child suffers from somatization disorder, they’ll continue.”

  Joan smiles. “May I approach the bench?” Judge Rothbottam beckons the attorneys. “Your Honor, can I have a little leeway here? I’d like to bring in a live exhibit.”

  Metz frowns at her. “What the hell have you got? A chicken?”

  “You’ll see in a second. Your Honor,

  there’s really no other way to make my point.”

  “Mr. Metz?” the judge asks.

  “Why not? I’m feeling charitable today.”

  After Rothbottam agrees, Joan nods to Kenzie van der Hoven, who walks to the doors at the rear of the courtroom. She summons a bailiff, who enters with Faith in tow.

  Faith is wearing a pink dress a shade lighter than Joan’s suit. Her hair is bright and silver, her smile infectious. She waves at Mariah as she approaches, and doesn’t seem to see the press snapping shut its collective jaw. With the exception of her pallor and tiny bandages at her throat and palms, there is no evidence that hours ago the girl was hovering on the edge of death.

  Malcolm Metz does a double take. He turns to Colin, who is suddenly very interested in his lap. “Did you know about this? Did you?”

  But before Colin can answer, Joan speaks.

  “Dr. Birch, do you know this child?”

  “I think … I assume … that it’s Faith White,” he says.

  “When was the last time you saw her?”

  “Late Saturday night. She didn’t look like she’d live through the weekend.” His eyes are wide with wonder, riveted to Faith.

  “How does she look to you now?”

  Birch grins, triumphant. “Absolutely fine.”

  “What’s your explanation for this?”

  The psychiatrist looks proudly at Malcolm Metz, then at Joan. “Clearly,

  my hunch was right. Mariah White is suffering from Munchausen by Proxy. When sequestered from the mother by court order, Faith’s illness–very obviously–abated.” He gestures toward Faith, sitting primly beside the guardian ad litem. “I only hope that the court continues to keep her mother at a distance.”

  Joan smiles broadly. “Doctor,” she says, “I can’t thank you enough.”

  Somewhat flustered, Malcolm Metz announces that the plaintiff rests. He doesn’t trust Joan Standish as far as he can throw her, but he certainly isn’t about to question her if she wants to make his case for him. He touches his client on the shoulder after the judge orders a short recess. “Let’s go get some coffee,” he says to Colin. “It’s looking good, don’t you think?”

  “Joan,” Mariah says, as soon as they are alone in a small room the size of a janitorial closet, “what are you doing?”

  “Trust me,” the attorney says.

  “You’re making it look like I hurt her! Why didn’t you tell Birch I saw her Sunday?”

  “Well, because you’d get slapped into jail right now, for one.”

  Mariah narrows her eyes. “Faith isn’t making herself sick either, you know,” she says.

  Joan sighs. “Mariah, there are three branches to your defense: to prove that you’re a fit mother, to prove that Faith isn’t psychotic,

  and to show the judge there might be a different disorder, other than Munchausen by Proxy,

  to explain what’s going on. It’s a loophole defense–we just need to come up with an alternative to the plaintiff’s story. And if our story is better than theirs, we win. It’s that simple.” She stares directly at Mariah. “I’m not trying to place the blame on Faith instead of you. I’m just trying to arrange things so you get to keep your daughter.”

  Mariah looks up. “All right,” she says,

  resigned. “You do what you have to.”

  Judge Rothbottam peers at Joan over his half-glasses. “Ms. Standish,” he says,

  “I believe you’re entitled to make an opening statement, if you’re so inclined.”

  “You know, Your Honor, I wasn’t planning on making one–“

  “Ah,” the judge mutters. “Maybe God does have a hand in this case.”

  “–b after all that’s been happening, I think I actually would like to say a few things.” She gets to her feet and walks in front of the defense table. “This is a confusing case,” she says flatly. “It’s confusing because it’s a custody case, but there’s a side issue going on, too. And we can’t help but notice that issue–namely, that there’s a reason this little girl has been in the news. If you listen to all the reports, well … Faith White says she’s seen God. Pretty wild, don’t you think?” Joan smiles, shakes her head.

  “Mr. Metz says that all this is her mother’s fault. That somehow Mariah White is managing to get Faith to hallucinate and see God, and is physically harming her daughter to boot. And,

  actually, I think that’s pretty wild, too.”

  Joan turns toward the window, looking at the rapidly falling snow. “You know, I just read the other day that Eskimos have over twenty words for snow. There’s crusty snow, there’s sleety snow,

  there’s powder. I might look out this window and see something beautiful. Mr. Metz might look out and think it’s going to make the commute a mess. And,

  Judge, you might look out here and see a day on the slopes.

  “There are many ways to look at the same thing.

  You’ve seen Mr. Metz’s case. I’m going to show you the same facts, but I view them a little differently. In the first place, unlike Mr.

  Metz, I don’t think this is a case about Mariah White. I think it’s about Faith. So I’m going to prove that, number one, Faith is a happy little girl. She’s not sick, she’s not psychotic, and she’s certainly not comatose.

  I’m not going to prove whether or not she’s seeing God, because that’s not my job. My job is to show you that she’s psychologically happy, she’s physically okay, and she’s going to act the same way no matter which parent she is living with. The question is: Which parent should that be?”

  Joan takes a deep breath. “The answer is Mariah White. And that’s the second thing I’m going to prove. Regardless of what happened seven years ago–right now, the best parent for Faith is her mother.” She trails her fingers on the edge of the defense table. “Mr. Metz has given you his interpretation of the circumstances surrounding Faith White. He’s shown you what he wants to see. Don’t rely on his eyes.”

  Dr. Mary Margaret Keller seems nervous on the stand. Her eyes dart about the courtroom as if they were following a mouse no one else can see. She crosses and uncrosses her legs.

  And when Joan first asks her to list her credentials, her voice shakes.

  “How long have you been a child psychologist,

  Dr. Keller?”

  “Seven years.”

  “What are your specialties, Doctor?”

  “I do a lot of work with younger children who’ve suffered family trauma.”

  “Why were you chosen to be Faith’s psychiatrist?”

  “I was referred to Mrs. White by her own psychiatrist, Dr. Johansen. He called me up and asked me, as a favor, to take this case.”

  “How many times did you see Faith?”

&nb
sp; Dr. Keller folds her hands in her lap.

  “Fourteen,” she says.

  “What sorts of things did you do?”

  “Basically, I watched her play. It’s an excellent way to pick up on disturbing behaviors.”

  “What were some of the behaviors you noticed?”

  “Well, there was a very strong defense mechanism she’d developed–an imaginary friend who could keep her safe. Faith referred to her by a certain name–her guard, I thought she was saying. It made wonderful psychological sense: A little girl who’s been dealt several difficult blows found someone to protect her. I thought it was very healthy.”

  “Then what happened?”

  “Mrs. White became concerned because Faith began to exhibit behaviors not consistent with her upbringing. She was quoting Bible verses, although she’d never seen a Bible in her life. And there were a couple of instances where Faith came in contact with an ill person, and managed to make them better.”

  “What did that lead you to believe, Doctor?”

  Dr. Keller smiles ruefully. “I didn’t jump to any conclusions at first. But I started to wonder if instead of calling her imaginary friend her “guard,” Faith was actually saying “God.”" She removes her glasses and wipes them on the hem of her skirt. “Seeing God is usually a sign of psychosis,” she explains. “It didn’t sit well with me, because Faith was able to function normally in every aspect of her life, with the exception of these hallucinations.

  But I recommended to Mrs. White that Faith go on a trial run of Risperdal.”

  “What happened when she was taking the medicine?”

  “She became groggy and tired, but the visions didn’t abate. We tried a different antipsychotic medicine, and she still exhibited this behavior.”

  “Finally, Dr. Keller, what did you decide to do?”

  “I called in a colleague, a specialist in childhood psychosis. He observed Faith and agreed that she didn’t seem psychotic. I felt validated. There are a great deal of things I don’t understand in this world, but I do know what a psychotic child looks like, and Faith isn’t it.”