In a remarkable violation of patient privacy, some case studies did print the names of their subjects. What accounted for the animosity toward these patients? In part, Munchausen sufferers rankled doctors because they presented so many opportunities for well-meaning professionals to make mistakes.
It is also telling, however, that the Munchausen diagnosis emerged first in England, at the same time as the National Health Service. In this way, the social and economic circumstances of medicine helped bring needy patients into contact with frustrated doctors; one product of this interaction was the portrait of the despised Munchausen patient. Similarly, it is no accident that the rise of the Munchausen by proxy diagnosis has run parallel with the rise of aggressive behavior in medical patients.
In the H. Yet doctors and nurses are frequently exasperated by what they consider to be pushy behavior. False allegations of M. According to some experts, M. Perhaps this is because their demands are not as easily met by doctors. Reid was a single mother of four who lived in Gardena, a racially diverse town where she was a community activist.
The totality of the evidence supports a pattern of non-cooperation, unrealistic positions, and behaviors by Ms. In , the county approved a million-dollar settlement for Reid. One of the supervisors, Gloria Molina, cried as she apologized to Reid on behalf of the county.
A neurologist at the hospital ordered an MRI, and discovered that Katerina had a tethered cord: her spinal cord was fastened to a benign fatty tumor and could not move freely. A tethered cord can cause various problems, including spinal curvature, back and leg pain, and incontinence. As a child grows, the cord becomes stretched beyond capacity, damaging surrounding nerves and blood vessels. Katerina was beginning to thrive—she attended a nursery school, at which Nicola was a frequent volunteer, and she took swimming lessons and gymnastics.
She was on her way to becoming the pre-Raphaelite beauty that she is today, with milk-white skin, a luminous smile, and a scattering of pale freckles. But she also had several symptoms that, as she grew older, became more pronounced. She experienced continued incontinence, and pain and weakness in her legs, which the tethered-cord surgery does not always correct. Indeed, scarring can make the pain worse. Other symptoms were more baffling: her left eye sometimes rolled upward independently; she had headaches; sometimes she seemed to have double vision, and complained that she saw two Mommies.
She sometimes had choking spells when she ate. During a visit to a physical-therapy specialist in Toronto, a nurse asked Nicola if she had ever considered whether Katerina might have Chiari syndrome, a developmental anomaly in which the lower portions of the brain are compressed. Her symptoms were consistent with the disease, the nurse said. But, in the meantime, Eurico had read about a neurosurgeon in Brooklyn, Thomas Milhorat, who was adept at reading MRI scans for subtler signs of skull crowding.
The de Sousas sought a second opinion from David Frim, the chief of pediatric neurosurgery at the University of Chicago. He also offered to perform the surgery for free. In Canada, the doctor whom the de Sousas informed of their decision, E. In December, , he wrote a scathing letter to them outlining his objections. I strongly feel that advocating posterior-fossa decompression in this particular case is equivalent to advocating acupuncture, herbal medicine, or electromagnetic-wave therapy. In my view, when a surgical indication does not exist, surgery should not be used.
He found that Katerina had abnormal tonsils that were impeding the flow of fluid between the brain and the spinal cord, much the way a classic Chiari malformation would. According to the de Sousas, within a few weeks after the operation all the symptoms associated with Chiari syndrome—the eye-rolling, the choking, the headaches—vanished. Katerina continued, however, to experience pain and weakness in her legs, as well as incontinence; her charts show a number of consultations with pain clinics.
In the spring of , the de Sousas decided to see Frim again. He suggested that the cord might have become retethered—a fairly common occurrence—and that a second operation might be advisable. Once more, he offered to waive his fee, and, once more, the choice was not an obvious one. The de Sousas opted for the surgery. They believe that it did give Katerina some pain relief and greater mobility, though it was not a cure.
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One of the issues in the M. The case file, which the de Sousas shared with me, also contains a passionate letter from Peter Morrice, a pediatrician who saw Katerina. It was my wish that the parents reduce drastically. It is quite possible that at least some of her chronic constipation and urinary symptoms have a psychological origin. On the surface she appears to be a healthy girl though at times sad and withdrawn. Would her symptoms those that still exist diminish if she could be given a rest from investigation and allowed a more normal and happy childhood?
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Ned Jackson makes a darker speculation in the affidavit. The M. During that time, Katerina remained with her parents, pending a possible appearance in family court to decide whether she should be placed in foster care. In the meantime, Katerina did lots of things that propelled her into the world: she took weekly classes in drama, pottery, painting, drawing, and swimming, and she practiced woodworking at a local home-improvement store. She played regularly with her old schoolmate Victoria. As time wore on, the de Sousas began to feel isolated and bitter.
Some acquaintances and friends stopped speaking to the family when they heard that Nicola was being investigated for child abuse. In the grocery store, when neighbors saw Nicola, they escaped to another aisle. They began writing indignant letters, some of them rather ill considered, to various officials, members of the press, and politicians who they thought should know about their ordeal.
They became increasingly terrified of losing Katerina. In May, , the de Sousas received a letter. It was very short, and its tone was dispassionate. I trust the above is satisfactory. Though the accusations against Nicola have been shelved, she is still shaken, and bewildered. How could you be threatening to take our child away? Nicola de Sousa, with Katerina, whom she was accused of harming, and her husband, Eurico. Recommended Stories. Sign in. Get the best of The New Yorker in your in-box every day. This means vein patterns are one-offs. Veins also have the advantage of being enclosed by skin and, unlike fingerprints, can't be altered.
Black analyses mainly the backs, or the dorsum, of hands, as these tend to be predominantly visible in the footage she works with in criminal cases. She first maps a grid of 24 cells on to the hand, covering everything from fingernails to wrist. Then she analyses each cell, looking for identifying marks and studying vein patterns, drawing dark lines over them on-screen to make them more visible.
The features she most commonly checks are veins, scars, freckles, birthmarks, moles, nails and skin creases on knuckles. Each one is scrutinised.
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For example, scars will be classified according to whether they are linear or non-linear, or surgical or accidental, and then by the direction in which they run. When she compares the accused's hand with the database, she can use geometrical formulae to work out the chances of anyone else having the same markings and vein patterns. Black's database - she has now analysed 1, hands - throws up fascinating insights. For instance, you are most likely to get a linear scar on the tip of your second finger, or the middle of the back of your hand.
No one seems to get moles on their little fingers, and if you have moles in the same places on both hands, it will be somewhere in the lower half of a triangle drawn between the knobs of your wrists and second knuckle. On average, men have 50 per cent more scars than women, but right-handed men are more likely to scar their left hands, while right-handed women tend to scar their right - no one knows why. Black is fascinated by the stories that the hands in her database tell.
One of her papers quotes lines from Arthur Conan Doyle's A Study in Scarlet : "By a man's finger-nails, by his coat-sleeve, by his boots, by his trouser-knees," declares Sherlock Holmes, "by the callosities of his forefinger and thumb, by his expression, by his shirt-cuff - by each of these things a man's calling is plainly revealed. Sometimes a case challenges Black's methodology.
In , the Greater Manchester Police asked her to work on the case of paedophile Jeremy Oketch, a year-old pharmacist who had twice raped a two-year-old girl and filmed the assaults. Although it was impossible to prove, the child's silent compliance suggested that she had been drugged. And although the police had 55 minutes of footage to examine, the only visible parts of the rapist were a hand and his penis.
The video was so distressing, recalls Black, that when judge Hilary Manley left the courtroom to view it, she returned visibly shaken. Was Black affected herself?
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But you have to stay objective. It's not my place to go back to analyse the incident, it's my job to find something of value to the investigation. The Oketch case presented her with two technical problems.
First, he was black, "and all the people we had looked at previously had been white. I didn't know if all the features would be as visible on black skin, but they were. That sounds ideal, but such apparent certainty brings its own risks. Black takes a file from a cabinet and slips out her report on Oketch to show me it is in the public domain, having been used in a Crown prosecution. Information is tabulated. Under "Hand" appears a long list of features: "Hand morphology", "Thumb nail groove from asymmetrical lunule", "Vein pattern" and so on. Under "Penis", a similar list: "Penile morphology", "Vein pattern", "Lateral deviation".
Each feature is marked to show whether it's the same on the rapist and the suspect. They all are. Part of this work is knowing how to look; asking yourself what you might not be noticing," Black says. In the end, the match appeared strong. When presented with Black's report, Oketch changed his plea from not guilty to guilty; he got 15 years. That plea change was important, Black says. It meant money that would otherwise have been spent on trials was saved. It also meant the child was spared from having to give evidence in court.
When Black analyses the backs of hands in footage she maps a grid of 24 cells, then looks for identifying marks and highlights in the vein patterns. B lack's team helps police forces around the world - including the FBI, Interpol and Europol - and works on 30 to 50 cases a year.
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In the cases Black has worked on since , the percentage in which the accused have changed their plea to guilty in response to her analysis stands at Black also takes on cases related to circumstances such as those in which the perpetrator has disguised their face. Grants have helped expand the database and her team have reduced the time it takes to compile a report. When a case comes in from the police, Black administrates the project, but the client pays the university; any payment to Black's team could be seen to compromise its objectivity.
Images or video material are delivered on encrypted drives and handed to her in person. Black works in a team of three but she first views all video evidence herself, absorbing the initial shock on behalf of colleagues. After that, she shares material she thinks is important with Lucina Hackman, a senior lecturer in human identification at the department, and both women independently single out the pictures that best highlight key anatomical features.
Then they agree about the offender's important features and a photographic specialist on the team, Chris Rynn, will enhance the images digitally. Once they have established the offender's features, they study images of the suspect, trying to establish a match.
Roughly speaking, the degree of certainty on any biometric is dictated by the size of a data set. Black's is not yet big enough to justify stating a statistical probability, so instead she follows the system used by the judiciary, which objectively grades the possibility of a match.
Even with clear images of a suspect's and perpetrator's hands, it is impossible to scientifically guarantee a match, as that depends on all the anatomical features present. A suspect can be excluded with per cent certainty, but a match can only carry a grade of "strong support" that the suspect and the offender are the same person.
This equates to between a 1-in-1, to 1-in, chance that it could be someone else. Often this is enough for the accused to change their plea as there is normally additional evidence to implicate the person. If you're wondering why no one is investing billions to create million-strong data sets, Black says it's because there's no money for research into catching child abusers. In the forensic field, most research funding goes into DNA, because it's what they know and trust and there's a drive to do things quicker and cheaper.
We think we might get to something that's as good as fingerprinting. We're now looking at whether we can do skin-crease patterns on knuckles," Black says. It could allow us to identify and look for the first-generation producers. It would also mean reducing the strain that these images places on officers. They take a terrible toll. When asked about the possibility that, as forensic hand analysis becomes more common, paedophiles will start wearing gloves, Black is adamant: "They won't.
All through my intimate life. Do you remember how during our chat at Amherst I talked about intimacy? I think I said that intimacy is our only home. I remember when I got my first girlfriend, in college. I thought that was it—I was saved. Me and this girl were into each other something serious, were in our narrow college beds all the time—but you know what? We never had sex. Not once. Every time we would get close to fucking the intrusions would cut right through me, stomach-turning memories of my violation.
I just said that I wanted to wait. I kept the Silence. After a year, we broke up. I tried and I tried and I tried. Took me until I was a junior before I finally lost my virginity. I saw her first in a creative-writing class. I almost threw a party. The mask was strong. She loved the shit out of me. Brought me home to her family, and they loved me, too. Which you would think would have been a good thing. The longer we were together, the more her family loved me, the more unbearable it all got. There was only so much closeness a person like me could endure before I needed to fly the fuck away.
One day, for no reason at all, I found myself saying, We have to break up. There was absolutely no precipitating anything. I had just reached my limit. I remember crying my eyes out the night before in those days I never cried. To be seen. Neither relationship worked. But I kept going. I started sleeping around, too. I needed stronger hits to keep the wound inside from rising up and devouring me. I was hiding, I was drinking, I was at the gym; I was running around with other women.
I was creating model homes, and then, just as soon as they were up, abandoning them. Classic trauma psychology: approach and retreat, approach and retreat. And hurting other people in the process. My depressions would settle over me for months, and in that darkness the suicidal impulse would sprout pale and deadly.
I had friends with guns; I asked them never to bring them over for any reason. Somehow I was still writing—about a young Dominican man who, unlike me, had been only a little molested. Crafting my perfect cover story, in effect.
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And since us Afro-Latinx brothers are viewed by society as always already sexual perils, very few people ever noticed what was written between the lines in my fiction—that Afro-Latinx brothers are often sexually imperilled. Right before I left graduate school and moved to Brooklyn I published my first story, about a Dominican boy who goes to see another boy, whose face has been eaten off, and on the way he gets sexually assaulted. And then in one of those insane twists of fortune I hit the literary lottery.
I stopped writing altogether. The intrusions always hit where it would hurt the worst. I moved on to other women. The years passed. I never took off the mask; I never got help. No one can hide forever. You run out of escapes, you run out of exits, you run out of gambits, you run out of luck. Eventually the past finds you. She was the femme-matador of my dreams. We clicked like crazy. Like our ancestors were rooting for us.
She actually said this. I fell into her family, and she fell into mine. I was the son she never had. We bought an apartment together in Harlem. We got engaged in Tokyo. We talked about having children together. Even the writing started coming again. As rare and as precious as ciguapas. Of course, there were signs of trouble. I even told her, in an unguarded moment, that something had happened in my past. I knew plenty of men who lived double lives. And here I was playing out the patrimonial destiny. I had a double life like I was in a comic book.
She lived with my depression and my no-writing fury and with the rare moments of levity, of clarity. The other women saw primarily my mask, right before I ghosted them. But no mask is that strong. She kept the apartment, the ring, her family, our friends. I got Boston. We never saw each other again. When I was a kid, I heard that dinosaurs were so big that even if they received a killing blow it would take a while for their nervous systems to figure it out.
That was me. The mask had exploded into fragments, but I kept trying to wear the pieces as if nothing had happened. I lost weeks, I lost months, I lost years two.