Ugh! Had a Munchausen pt today

[AmericanChai]

I am still reeling from it. I have heard of these cases but never seen one up close. The pt has had a long struggle with a mysterious condition that no one could figure out. He was the nicest man. Everyone felt very sorry for his health struggles. just very shocking how anyone can do this to themselves. It would be so incredibly painful. Until he was presented with the evidence (they searched the room and founds lots of it!) he denied everything and acted like he didn't know what they were talking about. He just had a drastic, disabling surgery today because of the injuries he caused. His family is devastated. His nurses are hurt and angry. Just so many feelings.

There was a case on my on-line tube-feeding support board (I am the parent of a tube-feeder) that also caused waves. A little girl severely underweight, multiple GI surgeries, central line, TPN, catheter, who knows what else. She was arrested for putting feces into all her daughter's tubes and wounds. The girl had all the tubes removed and started eating and growing finally, but will be physically and emotionally scarred for life. Ugh.

But to see it today for real, the shocking injuries that were self-inflicted over and over again, his family crying so hard to learn what's been going on. It's going to take me awhile to get over this.

[Meraki]

Why would the nurses be hurt and angry? He's sick, very sick - just with a different sickness then you originally thought he had. Munchausen is about much, much more than him trying to 'fool' people. And why the focus on how nice of a man he was? People with all personalities and backgrounds can development illnesses.

Hopefully he can get the treatment he needs so he can get better.

[SuesquatchRN, BSN, RN]

Munchausen's is horrible, but Munchausen's by proxy folks have a special place in hell reserved for them.

[Meraki]

I see you edited your post and added paragraphs 2 and 3 as I was posting. I have typed out about about ten responses but I think I am better to bite my tongue.

I really hope you have some psych support for him and his family as it sounds as though there is a lot of misinformation and stigma regarding mental illness on your unit.

[AmericanChai]

It is one thing to read about it in textbooks, but to be confronted with it is entirely different. I myself had not cared for the pt for the weeks he had been on the floor (I'm just as student nurse), but the other nurses grew to care for him and his family were very shocked by the degree of manipulation that occurred. He was very very smart and calculated about it, and had obviously done research into how he could deceive the medical community in creating these conditions. If you are human, you will create bonds with people in the act of compassionate nursing and he was one that many liked on the floor.

A pt who suffers from dementia or depression or other types of mental illness, their actions are not usually intentional and don't try to manipulate others in such a deliberate manner. I have seen pt try to manipulate (and usually they are just lonely or very needy or have drug dependencies). It's not our job to judge them, but to take them as they are and treat their conditions and try to get them better. But I've never seen anything like this-- this was in a class of its own! I have been reading up on this condition and it seems to be related to borderline personality disorder which is a really tough one to treat.

I feel very very sorry for the pt's family. I am having a hard time feeling sorry for the pt. per say, except that it's very sad that a person feels they need to do this. He is now being treated by the psych people as is appropriate. It's just a hard thing to wrap my mind around.

[SuesquatchRN, BSN, RN]

Try to imagine being so desperate for attention, of any kind, that you would willingly risk your life for the attention of medical staff. Like a child who only gets attention from his mother when she smacks him will mesbehave just to get something from her.

[AmericanChai]

Try to imagine being so desperate for attention, of any kind, that you would willingly risk your life for the attention of medical staff. Like a child who only gets attention from his mother when she smacks him will mesbehave just to get something from her.

Yes it's very very sad. I think I am also just very shocked by the extent of the medical issues he created-- can't discuss in detail to protect pt privacy, but wow. Just wow. And the nurses and doctors were trying so very hard to make him better.

I wonder if treatment will help him, or if he will always be at risk for self-harm now that he realizes that creating medical issues probably won't help get the attention he seeks?

At least it was himself, and not a chid that he harmed.

[GOMER42]

Why was his family informed?

I doubt he approved that information to be released.

[regularRN]

Munchausen's syndrome is a mental illness - whether by proxy or not.

[mustlovepoodles, RN]

Munchausen's is horrible, but Munchausen's by proxy folks have a special place in hell reserved for them.

Ouch! Muchausen's syndrome is a mental illness. Would you make that same statement about someone with bipolar or schizophrenia or addiction? It's an illness in he same way that congestive heart failure, diabetes, and hypertension are illnesses. It's *not* a character flaw. I understand how upset one would be when it's Munchausen by proxy--I'm a peds nurse, I've seen it myself. But when we delve into the "they're evil and deserve to be punished" pot we're kinda painting the "stuff" on ourselves.

[Meraki]

It is one thing to read about it in textbooks, but to be confronted with it is entirely different. I myself had not cared for the pt for the weeks he had been on the floor (I'm just as student nurse), but the other nurses grew to care for him and his family were very shocked by the degree of manipulation that occurred. He was very very smart and calculated about it, and had obviously done research into how he could deceive the medical community in creating these conditions. If you are human, you will create bonds with people in the act of compassionate nursing and he was one that many liked on the floor.

A pt who suffers from dementia or depression or other types of mental illness, their actions are not usually intentional and don't try to manipulate others in such a deliberate manner. I have seen pt try to manipulate (and usually they are just lonely or very needy or have drug dependencies). It's not our job to judge them, but to take them as they are and treat their conditions and try to get them better. But I've never seen anything like this-- this was in a class of its own! I have been reading up on this condition and it seems to be related to borderline personality disorder which is a really tough one to treat.

I feel very very sorry for the pt's family. I am having a hard time feeling sorry for the pt. per say, except that it's very sad that a person feels they need to do this. He is now being treated by the psych people as is appropriate. It's just a hard thing to wrap my mind around.

It is a hard thing to wrap your mind around and I completely understand how it brought up conflicted feelings. I hope those feelings drive you to read up on mental illness, talk to professionals in the field, and have more opportunity to give you more insight into mental illness.

This is not just attention seeking. These are very deeply ingrained patterns of thinking and behaviour. Some of those maladaptive patterns may have started very early in life when there was no intention or malice - maybe they were survival techniques. Chances are there are traumatic events in his history, possibly abuse or neglect, likely there are neurobiochemical issues as well. Treatment absolutely can help, and it is not as easy as just stopping because you others are aware of the issue. People self-harm for many deep rooted reasons. Munchausen is more on the extreme end but remember in his mind his thought process made this make sense, the vast majority of the population would not put themselves though all that pain and suffering - even 'needy' ones.

And people contribute to their own illnesses ALL THE TIME. Both physical and mental illnesses, so many lifestyle decisions affect health yet knowledgeable, intelligent, high functioning people make poor decisions that lead to health issues every day. I think it is part of the vulnerability of being human.

Mental illness comes in many different shapes and forms, it crosses ages, socio-economic status, evertying. Many, many people with mental illness appear to be functioning very well in life. They are able to keep their illness and the dysfunction it causes to one domain or one area...although in crisis it may spill over into other domains.

[AmericanChai]

Why was his family informed?

I doubt he approved that information to be released.

His immediate family was closely involved in his care. I assume that once his condition was discovered, he would be declared mentally incompetent and the courts would appoint a power of attorney to someone to make medical decisions for him, or they would make the decisions for him. I don't know what was going on in his particular case, except that he had a full time sitter to watch him and there were some social workers involved. I have some friends who work psych and that's what often happens in those cases. They basically lose rights to refuse treatment and such since they are declared to be at risk for harming themselves or others. Someone else (either courts or family) makes those decisions for them at that point.

Good question though!