Mother, Heal Thyself
Susan Hyde’s daughters spent years in and out of hospitals with a puzzling array of ailments. But what if they weren’t the sick ones?
Photograph by Mark Hooper
Miriam says: This article is chilling. I cannot imagine what these children’s lives were like. Why haven’t there been criminal charges on Susan Hyde. Even if she has a mental illness, she still abused her children. (December 17th, 2009 at 4:28pm)
No one envied Susan Hyde’s schedule. The 29-year-old mother of three young girls spent a typical week trying to eke out a paycheck and be with her children as much as she could. Working the overnight shift as a paramedic three days a week at Cook Children’s Medical Center, in Fort Worth, made that difficult. Not that Susan complained. Her girls were her life. She kept detailed baby books that showed every stage of their development. Even if she had just come home from a night shift, she would stand in front of her house, exhausted, waiting for the school bus with her daughters. Most evenings, she would give them a bath and sing songs like “You Are My Sunshine.” She treated the girls to Chuck E. Cheese’s for their birthdays, did craft projects with them, and took them shopping for clothes she could hardly afford. Her energy amazed those around her. “People would always say, ‘I don’t know if I could do that,’” said her mother, Patricia Andersen.
Susan’s routine was further complicated by her daughters’ medical issues. Six-year-old Heather had been diagnosed with attention deficit hyperactivity disorder and had been seen by doctors for breathing and blood sugar problems. Four-year-old Amy had been tentatively diagnosed with cystic fibrosis, a disease that affects the lungs and digestive system. Beth, who was almost three, was being treated for seizures and breathing problems and was often put in a wheelchair when she and her mother left the house.
In December 2006 Susan told doctors at Cook Children’s that Beth was suffering from abnormal stools, a frequent cough, and recurrent pneumonia—all symptoms of cystic fibrosis. Statistically, the odds of two half siblings—Amy and Beth have different fathers—being diagnosed with the rare and fatal genetic disease were remote; all three of the parents would have to be carriers, and even then each child would have only a one in four chance of developing CF. But the doctors’ fears seemed to be confirmed by a “sweat test,” which showed that Beth had elevated levels of chloride. Susan tried to look on the bright side of this devastating news. If doctors had an explanation for Beth’s symptoms, perhaps they could alleviate them.
But the little girl’s other problems worsened. Later that month, Susan wheeled Beth into Cook Children’s complaining that she had experienced an increasing number of seizures and would often turn blue. A physician team that included a pulmonologist, an infectious-disease specialist, a cardiologist, and a neurologist couldn’t pinpoint the cause of the attacks. Confounded, they admitted Beth to the hospital and hooked her up to an electroencephalogram (EEG) machine to monitor seizure activity.
Meanwhile, questions were mounting about Beth’s cystic fibrosis diagnosis. A genetic screening test showed that Beth had no cystic fibrosis mutations, a result that didn’t rule out CF but certainly lessened the possibility. In fact, Beth’s pulmonologist, Karen Schultz, began to wonder if Beth really had all these problems. Perhaps, she thought, Beth’s problem was her mother, who Schultz was concerned had been misreporting Beth’s symptoms. To test this theory, Beth’s hospital room was equipped with a hidden video camera. (The girls’ names have been changed to protect their identities.)
During Beth’s weeklong stay, from December 28, 2006, to January 4, 2007, Susan visited whenever she had a free moment, rushing between home, work, and Beth’s bedside. Beth didn’t have any seizures on camera. Nor did the camera capture any strange behavior on Susan’s part. Then, just as Beth was due to be released, Susan told the nurses that Beth had had a seizure in the bathroom—when the girl had been disconnected from the EEG and was out of the camera’s range.
Susan had also made a curious remark a few days earlier. She told the nurses that she had seen Beth on a video screen at the security area near the emergency room. That was odd. The video monitor tracking Beth’s stay was located not at the easily accessible security area but in a separate, secure room. No one was sure how Susan knew about the monitoring, just as no one was sure if Susan had taken Beth into the bathroom to fake a seizure off camera. But now, it seemed, the suspicion was mutual.
Schultz and her colleagues weren’t alone in their skepticism of Susan. Since 2000, when Heather was first brought to the hospital with mysterious symptoms, a series of health professionals had crossed paths with Susan and suspected that something wasn’t quite right. Susan brought her daughters to numerous hospitals for a bewildering variety of ailments that doctors often could find no evidence of. She gave medical histories that didn’t seem to add up.
All of this came to a head roughly a year and a half after Beth’s admission to Cook Children’s, when Susan found herself in court, fighting to keep her children. During the proceedings, more than eight thousand pages of medical documents were introduced, dating as far back as the nineties (some of them tracked Susan’s own medical history). The paper trail of doctors’ uncertainties ran through hundreds of visits the family had made to physicians and emergency rooms. The evidence the jury heard was grim and, at times, lurid. Prompted by Susan’s reports of a host of symptoms and maladies, doctors had subjected the three girls to a staggering number of tests and medications and even a surgery.
Attorneys for the Department of Family and Protective Services painted a portrait of Susan that was in stark contrast to her image as a selfless parent. This Susan Hyde was someone else entirely, a mother who, for reasons perhaps not known even to her, had falsified a series of medical ailments that turned her daughters into pharmaceutical pincushions. The list of medications the girls had been prescribed was daunting: Phenobarbital, Klonopin, Albuterol, Atrovent, Xopenex, Tobramycin, Pulmicort, Trileptal, Flovent, and Adderall, to name a few.
Matthew Cox, a pediatrician at Children’s Medical Center in Dallas who assesses child abuse and neglect, had not treated or examined the girls but reviewed their records for the state and found glaring inconsistencies in their medical histories. He testified that this was a case of “pediatric condition falsification,” a form of medical child abuse that, in its most extreme form, is popularly known as Munchausen by proxy. “By far,” said Cox, “this is the worst case I’ve reviewed or even read about.” (Susan, it should be noted, has never been charged with a crime. This story is drawn from multiple sources, including doctors’ trial testimony regarding the records.)
Susan wept on the stand, distraught at the prospect of losing her daughters. At the very least, she hoped that her daughters would be placed in the care of her mother and stepfather. But in the end, neither her tears nor her hopes moved the jury. On June 30, 2008, the state took Susan’s children from her, presumably for good.
The British pediatrician Roy Meadow first coined the term “Munchausen syndrome by proxy” in a 1977 medical journal article. Meadow had seen cases of parents who seemed to have done repeated, intentional harm to their children and disguised it as a medical issue. The phenomenon appeared to be a variation on Munchausen syndrome, in which a patient falsifies information or symptoms about himself to seek attention, sympathy, or treatment. (The condition is named for the eighteenth-century adventurer Baron von Munchausen, who was famous for telling outlandish stories about his life.)
One of Meadow’s case studies involved a six-year-old girl with recurring urinary tract infections who had been admitted to the hospital twelve times and undergone numerous catheterizations and seven major X-ray procedures, including a barium enema. She had been on antibiotics that caused drug rashes, fever, and bouts of lower abdominal pain. After the hospital staff grew suspicious of the mother’s reports, however, they started monitoring the girl’s urine samples. When the girl provided the sample with the help of her mother, the samples came back abnormal and tainted with blood; when she was supervised by a nurse, the sample was normal. After the hospital accused the mother of deliberately interfering with her daughter’s care, the six-year-old’s problems disappeared.
Meadow acknowledged that such cases are rare; pediatricians, by necessity, should usually trust parents’ accounts of their children’s symptoms. “But at the same time,” he wrote, “we must recognise that when mothers are wrong they can be terribly wrong.”
Three decades after Meadow coined the term, it has become a staple of popular culture. The best-selling novelists Jodi Picoult and Jonathan Kellerman have used Munchausen by proxy as a plot device in their books, and the condition has popped up in television dramas as diverse as The X-Files and Judging Amy. It’s not hard to see why. The idea rubs raw contemporary anxieties about “helicopter parents” who smother their children with attention and a medical establishment that seems at once godlike and all too fallible.
In the medical community, debates over Munchausen by proxy have grown heated and, often, confusing. Experts disagree about the very definition of the condition and have suggested a host of alternative names. Though “Munchausen by proxy” is still the most common layman’s term, many in the field use the phrase “factitious disorder by proxy” (FDP) or a broad, self-defining term such as “child or adult maltreatment through deliberate ‘problem’ falsification/deception.” Munchausen by proxy is usually reserved for the very worst of these cases. Some activists question whether Munchausen by proxy even exists.
Susan Hyde, a stocky blonde who often breaks into a friendly laugh, resides in a small yellow fourplex in Ennis, sixty miles southeast of Fort Worth, with two aggressively curious cats. Her tidy home is a shrine to her three blond girls, whose images adorn every wall of the pink living room. Behind her couch, a framed quotation from the Bible reads “These are the children God has given me. God has been good to me. Genesis 33:5.” Next to it, a photo of her girls shows them wearing matching lavender shirts and blue jeans, giggling for the camera.
By last fall, Susan was no longer working, leaving her plenty of time to think about her future. When I met her in October, she sat cross-legged on the floor and her mother, Patricia Andersen, joined the interview.
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