Munchausen’s by Proxy Revisited

For Dana Always



The phone rang just as they were going into Operating Theatre 6. Everyone was hustling around, small plastic wrappings flying in the air, selfish determined, hands reaching under over and through other limbs after the same end. And the phone continued to ring.

“Dammit, can SOMEONE get that” Dr. Plant slammed his fist full of syringes on the counter “Where the hell is Mel? He should be here by now, this is ridiculous, not ONE cart ready. NOT ONE!”.


And where is the fuckin receptionist.”.


Dr. Plant knew it was the nursing staff who answered phones. Government tightening their belt and Veteran’s suffered the ramifications


.When he was angry, he reverted back to the mind set he had almost 50 years ago when a nurse would no more man a phone as wear black stockings. They had the candy stripers and orderlies for that. What ever happened to Orderlies?


“Hello” more of a statement than a greeting. Dr. Plant opened the desk drawer in Melvin’s office where they were scavenging, and pulled out a memo pad. As he pulled out the pink tablet, something caught his eye, way back in the corner.


It was Melvin on the other end of the line, calling in for the third time in a week.  Dr. Plant hung up without a word, carefully placed the pads back in the drawer and made a mental note to come back and inspect this discovery without prying eyes.


This was getting out of control. Melvin was missing work and the entire staff suffered the repercussions. Melvin always said he was the most necessary employee in the unit.  They could NEVER do surgery without him, though that day they proved they could.   HIS philosophy The less I  give, the more I get back. They couldn’t live without him, he bragged. He said it would be a snowy day in Houston before they fired him.


The truth was it was the VA.  They don’t like to fire anyone, too much paperwork.  He was no more necessary than a janitor. As hard as Janitors work, it isn’t a job that requires training. Anyone can sweep a floor and unclog a toilet, they just choose not to. The same held true when it came to the mediocrity of Melvin’s chores. Fill the cart,  for surgeries.


A job a seven year-old being asked to set a table, which, Mel could not.. And it was almost always consistent, Melvin said he could do it in the dark. But he felt he had the staff by the short ones and acted out accordingly. He felt he had the right to gripe and complain about a simple change in routine, on the same level the surgical team did when something bad went down in the OR. .


Every morning he would rise and Gayle would here the same thing.


“I really hate my job, let’s move”.


Gayle was intensely affected by this. They had a nice place, everything was content, beautiful. Melvin gets it in his craw and his determination wins out. But she tried her best to placate him. If this were the only job he felt this way about, Gayle would support him in changing jobs. But every job he had, he hated. Gayle felt bad for him that he could not find a place to retire from.


The rest of the group did a collective sigh and completed the task at hand, not willingly, begrudgingly – more so.


Melvin had called to tell Dr. Plant he was sick and Dr. Plant just slammed down the phone.


There seemed to be a rhythmic rumble to their voices asking the same question they had the last two times this week that have caused nothing but dissent among the troupes.


“He is sick again? Truthfully, has he ever been well?”. Crystal asked.


Crys is a surgical nurse.  One of Mel’s favorite prey whom he despised and ridiculed to others, but to her face he was as sweet as New Orleans bread pudding. .


Melvin collected people. And he kept them in separate emotional cages, making certain one thought the other detested them.  They only knew what he wanted them to. He knew everything about them that they didn’t want him to.  That way when one would make a demand of her, she could complain to the other. You know, always kissing ass, all the time thinking HIS ass was getting kissed. Now he was sick,a again aand instead of worry, his coworkers dwelled. it had been almost 10 years of the same mantra. It was just ridiculous. How long could he stay away before everyone except him could do his job.


I think he’s got that Baron von..” Crystal trailed off.

Munchausen’s Syndrome” Dr. Plant said “and yes, I have no doubt, but the problem is, once we give him that diagnoses some jackass will tell him it is a handicap and soon enough we will be paying him for a five day work week, whereas he would only work one day.”.


“That’s just the same as hypochondriac Dr. Plant”.


“Different word same result, Munchausen’s just sounds more legitimate.  Both are considered an affliction”  He mumbled, but not low enough as it bounced off the white gleaming tile of the Arena.


“I thought it was Munchausen’s by proxy.” Lora, a assistant nurse shrugged.


Crys and Dr. Plant exchanged looks, and at once became startled at the other’s reaction. There was an uncomfortable pregnant pause.


“No that is when someone wants to make someone else get sick” Lora corrected herself. “and Melvin doesn’t seem the sort to share attention.”.


Again, silence.


Gayle, Melvin’s wife, adored Melvin and certainly would not be so commited to him if Melvin was the monster they were all alluding to.


Gayle was a devoted wife, pandering to Melvin’s every wish. She appeared to find no fault with Melvin.


Gayle found many faults with Melvin, but not one worth mentioning to him.  That would only hurt his feelings.


“Above reproach” Gayle would strike out should someone interject otherwise.


But the reality is, every moment she spent with him, building him up in one way or another, it was like Pavlov’s dog, he rang the bell she came running in trained response.


“Yes honey, they asked about you”.   When, in fact, no, her mother, sister, daughter, son did not ask about Melvin and in fact threatened to hang up if Gayle mentioned him.


“Yes honey, you are right, you are always right” when Melvin would start bitching about Crystal being lazy causing Melvin to do her job.


Or Dr. Suarez being inept. It was always something. If for one moment Gayle reached out and tried to bring rationality into the endeavor, be the devil’s advocate in order to work through these things, she would meet Mel’s resistance and accusations of red coating.

“OK Honey, we can go and sit in the hospital waiting room all day Saturday while you wait for a doctor to check out a pimple in your bum” .


Bless his heart, that one made him quite hysterical. Gayle was lavished with a play by play on every instance pus flowed from an orifice …  in the most intimate areas. A real treat.  It made for a mediocre sex life at best.


Candace had told Gayle 14 years prior, “Do not trust him with your checkbook” and “You need to control him about going to the doctor.  He will drag you along and make you think he is dying if he sees you are buying it.  He LOVES to stay in hospitals,  He craves the attention and the intimacy.”

Intimacy?  She explained that he liked to be treated like an infant.  He liked the reticence a caretaker needed to overcome in order to perform the physical tasks.  Changing bandages, bathing him, etc.  Since they had been together Melvin had surgery on his neck, ankle, breast, arms, ass, ears (thrice), mole removals (a dozen or so times), testicles, mouth and stomach. It’s exhausting just thinking about it. And Gayle was there for him. She never left him alone.   She was the sole household support for 18 months after his ankle surgery that would not heel because he refused to stop smoking.


“You can close” Dr. Plant reached toward the surgical sponges, Crystal went to get one for him. When she handed it to him, she pressed her hand against his, and regretted it at once.


“What if he misinterpreted it?” She thought “I just wanted to see if he was as concerned about Melvin as I am.”


Dr. Plant was already on task. He scrubbed out, dried his hands and tossed the towel in the trash instead of hamper. Without correcting he whisked past the good mornings and typical beginning of the workday questions that people were no more interested in the answers than he was in responding.


“Did you have a good evening last night?”.


“A successful surgery, Doctor?


:How do you like this weather, Doctor?”.


“Where the hell is MELVIN,  DOCTOR?”


He pushed the 8 digit code into Melvin’s workroom door lock, having to repeat it.


AT that moment, you would never believe he was a skilled crafty surgeon, handling nerves like silk thread. His anticipation of what he may discover betrayed him as he made another effort. He could barely push in one number without attacking the others. It gave way, he edged into the room, barely opening the door, trying to keep attention at bay. He left the over head light off opting to work with the small ambient lighting under the cabinets.


He pulled open the drawer, caught himself stepping back quickly. He stooped down, then crunched down further. He went back to the light switch flipping it on and turned back to the drawer. He scanned the room. .


“Maybe I picked the wrong drawer” he thought. The pink pad was there. No, it was the right drawer.


The item was gone. He rushed out of the room headlong into Crys.


“Ok, what’s going on” he asked, Crys pulled him into Mel’s office, grabbing his forearm disrespectfully.


“Did you take something from this drawer?” he had one hand on his hip, the other outstretched to the suspect drawer.


“Wha???what??” Crystal now had a new twist on this already complicated story. .


“This drawer! This morning when Melvin called, I went to get a pad of paper to write a message on and there was a small tubular item. I didn’t get a good look, but I know it was there. Now it’s gone”.


Crystal went to the drawer and started taking things out, methodically to make certain she replaced them in the exact same space.


“What was his excuse for not coming in.” Crystal continued her search.


“It’s something with Gayle” Dr. Plant sat down on the special ergonomic chair Melvin had to have. He had the carpal tunnel surgery anyway – too far gone Melvin whimpered.


Crystal stopped short, and decided her search was futile. With one quick whisk, she swiped all the crap she had just retrieved back into the drawer. .


Melvin had been lamenting as of late. More so … more pressing than usual. He was having monetary problems. Crys had difficulty understanding this since Melvin just got back from a cruise, his third in two years. Right after he declared bankruptcy. And that new SUV. He traded in his car and Gayle’s little truck Mel’s mother bequeathed to Gayle, leaving Gayle home alone in the foothills of Mt. Washington. Gayle didn’t seem to mind. It was isolated and quite beautiful. She didn’t need a car anyway. The days of BMW’s and sports cars were long gone. Melvin wanted an SUV, Melvin got an SUV.


Now she was sick. Doctor Plant expressed concern, albeit misguided concern. He was worried Melvin would be gone even more so now if Gayle was experiencing physical difficulties.


Crys on the other hand was concerned about Gayle and Melvin.  Not many folks in the unit were fond of Mel.  Most had tossed their rose colored glasses long ago.


“Well that makes sense” they would say about Mel’s fan club “only people like Melvin can stand to be with him”   Whispers in the lunch room “That great minds think alike, and so do theirs”.


But back to the vial. It had to be there – Crystal didn’t doubt the doctor, what reason would he have for pursuing such an idea. So where did it go?


Melvin had played his cards or coworkers, one and the same, to his ideal. The chosen would all speak to Mel, but never to each other. An example of his rhetoric, Melvin said he wasn’t prejudiced bringing up instead, a friend of his from Houston, Sharon.


“Now Sharon, she is prejudiced, but she can’t help it, she’s black”


Uh huh. Just like that. Impervious. Melvin told his wife if he were to find out she had ever been with a black man before him, he would divorce her and never touch her again.


Gayle started to have health problems as suddenly as going to bed one night and waking up a completely different person. Her mother experienced heart problems having several bypass surgeries. Gayle felt it was from the repeated cortisone shots her mother got from a young age after having her leg broken in a horrific accident on the Eden’s Expressway. Althoug she may very well have gotten those problems genetically, Gayle thought.


Clink. The vial fell as if, out of nowhere, to the ground. And shattered. The vial’s label, irremediably confusing, lay at the toe of Dr. Plant’s blue, blood stained clog. .


Immediately Crys reached for it, Dr. Plant in the same moment crushed it further with his toe.


He knew what it was. It was egg white mixture that when added to another element, (not available to the public) becomes Propofol.   A drug that will paralyze you, as it was expected to do, used in surgery as the patient is lulled into sleep. Once the drug takes affect, the patient is completely paralyzed, dependant upon artificial means to survive. Michael Jackson died from this dangerous brew.


Dr. Plant took Crys’s hand “Forget about this, you are to mention nothing.”.


He then went into Mel’s drug supply searching for an indistinguishable placebo to take the place of the vial Crys and Dr. Plant collectively sent smashing to the floor. He found another set of vials in Mel’s back room. Dr. Plant was both preoccupied with finding the innocuous substance and concern for the reason the powerful confection was in his drawer to begin with.   Melvin was not allowed to take whatever he pleased.  Melvin was to be in control of these dangerous substances.  And control meant making certain staff members did not take the opiates home for emergencyOR recreational use, including himself.  It is not unusual for nursing staff and Melvin to slip vials in their pocket to be restocked later.  But this was hidden in the back of the drawer.


He knows he should contact the authorities, but the chancellor would definitely nix that in lieu of Dr. Plant handling it internally. And the issue of going into a desk drawer of one of his subordinates. It is legal, and in most sectors of medicine, accountable. But this was a government facility and patients cry out about the most insignificant of issues, the staff is even worse.  So his option was too confront him, or the path of least resistance, supplementing the original material and keeping vigilant..


He had learned years before when the snap top glass vials first came into play, he and several of his students had spent days trying to prove it wasn’t tamper proof. By the third day, one of his more reclusive students had found the solution to the problem that virtually never existed. He presented the vial to Plant. The doctor was immediately impressed, how did he do it?  Maybe he didn’t. It may still have a medicinal substance and the student was pulling Dr. Plant’s leg. He went to snap off the glass reservoir, he saw the barely, almost invisible, break, right along the snap line.


Superglue. And when Dr. Plant opened it, it was devoid of any medicinal matter.


He sat in the back room of the supply closet, a scrawl of “do not disturb and yes that means you” on the glass window incased in the door.


He went thru 10 different vials, all lay around him on the counter and floor. All with the dry egg white residual .


“Shit, what a mess. I need to make certain Rusty (the rehab Bulldog the VA had adopted) does not come back here.” he said for no one to hear.


And finally, the last vial (of course it was the last one, otherwise he would keep going on) Perfect break. He laid it down carefully, scrimmaging thru the wasted product to get his PDR and find a substance that will duplicate it in appearance, while having no affect at all.


Crys had already started her endeavor. She was quick at the “reservoir snap off”. She often commented, when she could get no one else to, that her bottles could be put back together in the snap of her fingers, She would then snap her purple gloved digits to what sounded like a squeak and fart. .


Crys was afraid Melvin was absconding morphine for either Gayle or himself. Whatever, she was due back in the OR toot sweet and didn’t have time to meditate a good reason. All she could get her hands on without suspicion was Sufentanil.  She had placed it in her pocket with the intention of having Mel restock it.  One of the strongest opiates on the market. She put the substance tin the jeririgged vial, to the clear line, carefully sealing it with the SuperGlue they use to close certain wounds. Potent stuff. She needed to make certain that she either call Mel tonight, or be here first thing in the morning to advise him about the circumstances, and the drug switch, blatantly ignoring Dr. Plant’s orders top keep mum.


She scurried to the medicinal closet, more of a huge storeroom, where Mel talked on the phone incessantly, napped or ate one of the MANY meals he has throughout the day. She ran headlong into Dr. Plant who had just left his vial in the drawer. He immediately backed into the room as Crys entered. She needed to be discreet.  As Dr. Plant started messing about, she leaned against the counter, opened the drawer with her hands behind her back, slipping the vial into the drawer. .


“Dr. Plant, we have a full  – and then some schedule.” Crys tried to sound insouciant. “We are an hour behind. Are you ready?” .


And with that, both convinced they had, independently ,saved face for the unit and Melvin. But why? Melvin was never part of a solution because he was the problem.


But his pathetic puppy dog eyes, always alleged superfluous pain. But not so much that he couldn’t Scuba Dive. Crys has no idea why she decided to cover for her. Dr. Plant on the other hand, is relieved it is over. He will talk to Melvin in the morning. If he shows up.


That night a norther moved in making a silky blanket of white on the trees and slate rock cliffs with the first snow of the season. Crys had nothing but getting home on her mind. Dr. Plant had a dinner party tonight. It was Friday. Neither had thought about that. No one works weekends at that hospital. And all was forgotten.


For the time being.


10:30pm.


The Med’s Closet (aka Melvin’s office)


Buttons pushed, door creaks open, a drawer is pulled out, a hand reaches in and finds not one, but two vials. Upon inspection, one was Propofol, the other morphine. Enough Propofol to put an elephant under. And the second vial had a label alleging just enough morphine to be able to sleep thru the finality of tonight’s activities. She wasn’t told about this second vial, so she decided to keep it. Curious, but not enough to investigate. It had to be a quick in and out.


The woman climbed into her Uncle’s SUV and headed straight away to make it there safely.


When she got to the door, she gently kicked the snow off her boots, quietly opening the screen door and the glass paneled front door. Uncle Melvin was in the front room, smoking a cigarette, watching the omnipresent weather channel. He had it turned on in every room. Why? No-one ever knows. .


She took out the Propofol and handed it to her uncle without a word.


“Thanks for doing this Tricia, I couldn’t leave her she has been so sick” He broke the silence. and then he smiled. “You are staying here right? I mean, I really don’t want to be here alone for… you know.”


“Yeah, I’ll stay, but once it’s done I’m out of here. You won’t need to see me until you cash that triple indemnity.”  Aunt Gayle had saved her life, doing whatever she could to get Tricia off drugs.  She really didn’t want to be around for this.


Tricia went to take a shower and put on Gayles favorite Chenille robe. “I think I’ll take this” as she pulled it snug around her waist. She grabbed a full glass atomizer with White Diamonds perfume,and added it to other treasures in the pockets.


“She won’t be needing this either. “


Her mom, Melvin’s sister, would be by shortly, so she wanted to settle in, pull up the vial of the morphine and sleep.


She was still squeamish about these matters. Her mother on the other hand was a seasoned veteran. After her shower Tricia went under the sink where Uncle Mel kept about 100 disposable syringes. She made her selection, a fine needle, the liquid didn’t look viscous. She pulled the vial of Sufentanil she unknowingly thought was morphine, out of her purse, popped the reservoir top not noticing it had been corrupted. . She put the full syringe, enough to put down an army, in her pocket and found her way to where Uncle Melvin was mixing his potion. Tricia shuttered..with fear, elation? Out of debt, she kept telling herself. Out of Debt.


Uncle Mel put his fingers to his lips “shhhhh. I don’t want her to wake up, I don’t think I could do it if she did”.


Tricia gave him the okay sign and with that Uncle Melvin was behind the door to the bedroom where Aunt Gayle was sleeping.


Tricia took the syringe out of her pocket and decided to “main line” it rather than intramuscular. It said in the PDR (Physician’s Desk Reference).that it could be used for either. The syringe was not quite empty as she fell back on the couch hitting her head on the small slip of wood in the arm. She started snoring.


1:00 am.


Candace opened the front door ever so slightly an immediately fell back against the door, amost falling on the icey deck when she was greeted by Gayle washing dishes.


“Oh, you got here. I was worried, the snow, so beautiful” Gayle said softly.


“But it is underneath the superficial that can be dangerous.”.


Prophetic.


Candace simply shrugged, trying to appear nonchalant, sitting down on the antique cedar chest. She peeled off her gloves, boots and the winter garb she thought earlier today was unnecessary. She kept Gayle in her gaze, certain any minute she should keel over, but Gayle looked sprightly. Did Melvin change his mind?


She went to the bedroom, creeping past her daughter who was no longer snoring.


“Melvin..Get up wake up!” .


Melvin jumped up. Oh my God, I took some of Gayle’s clonopin. Didn’t want to be awake..You know”.


He jumped out of the bed without realizing Gayle wasn’t there.


“It’s over Candace!!!! Florida here we come.! I can’t pack fast enough. How long do you think the inquiry will last? How long does a coroners inquest take? Oh is that the same as an inquiry in general? And the insurance…?


“Melvin”


“MELVIN!” Candace could not believe she was related to this man, any glimmer of rationale just slips out the door when money is involved.


“WHAT” He sat down and tied his shoes, ready for the incoming traffic. He started to practice his call to the police.


“Melvin, shut the fuck up!” Do you notice anything” Candace cried, distressed at the unexpected turn of events and irritated with her brother for his lack of common sense.


“No..what..WHAT ?”.


“Where is Gayle” Candy folded her arms, leaned against the wall focusing on the spot where Gayle usually lays her head.


“What? .. fuck where is she, did she pass out somewhere?”.


Gayle opened the bedroom door.  “That shot you gave me really hurts!


Mel plopped solidly down on the bed, staring at Gayle as if she were the second coming.


 “Mel, Crys is on the phone, she needs to speak with you”.   Gayle dried her hands on the towel over her shoulder. 


“Oh and I think something is very wrong with Tricia.”


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