Belinda was upset, broke, sick, and angry. So doctors decided Belinda's mental health was her biggest problem. Cedars included "Munchausen Syndrome" among Belinda's suspected disorders. A person with Munchausen exaggerates or creates symptoms of illness for attention. Doctors also suspected malingering: fabricating or exaggerating for specific gain (attention, sympathy or drugs for example). Malingering [related to Munchausen] is distinct from somatization in that a malingerer knowingly fakes health problems, while a somatizer feels physical symptoms and believes she needs medical help. Even so, the diagnoses were often listed together in her medical records.
Belinda's treatment plan, to the extent there was a treatment plan, focused on getting Belinda mental help. "Patient has somatoform disorder," noted the psychiatrist who disqualified her for a liver transplant. "These are notoriously difficult to treat without buy-in from the patient." Once a Cedars psychiatric intern called Jonathan. "We think your sister needs to be committed," she told him. The doctor sought Jonathan's input about his sister's mental health history. "I could hear Belinda in the background screaming in pain," he said. "What", he asked the doctor, "have you done about the pain?" Belinda wasn't committed.
When Belinda was at Cedars for liver failure in 2006, one young doctor approached Sharon in a hallway outside an elevator and told her Belinda was "compromising her health for gain." She'd disclosed Belinda's confidential medical information in a very public forum, but the doctor was eager to explain her theory. Sharon, surprised, told the doctor about Belinda's long history of health issues. Sharon offered an example: When Belinda was a little kid, Sharon found her listless and dehydrated, having vomited up her meds. Sharon rushed her to the hospital. That story, combined with Sharon's earlier questions Belinda's medicine, prompted a stinging note in Belinda's charts about an "interesting dynamic" between mother and daughter. "[T]he mother enables the daughter, encourages her almost, to take more narcotics and request them."
That doctor's note still hurts Sharon. The first thing Belinda said to her that day was "I'm in so much pain." She'd only asked doctors what prescriptions she had and if she could take them. And yes, Belinda needed much medical care as a child, Sharon remembers. However, "We did not dwell on Belinda's illness," she said. "We dwelled on brewing her for success in whatever she wanted to do."
Belinda succeeded in most things she tried: acting, directing, dancing, singing, songwriting and DJ-ing. Yet in one aspect of her life she failed repeatedly: getting proper health care. Cedars ordered several psych and social work consults during Belinda's hospital visits, but they were often just circular conversations. Belinda wanted health insurance but couldn't get it. Belinda ranted often about the inequities in Medi-Cal. As she maxed out her credit cards, she'd observe many healthy people paying for prescriptions with Medi-Cal. She'd vent that immigrants (who have kids) seemed to get Medi-Cal easily, while she, who was born in this country, got nothing. Social workers and doctors saw her anger and frustration about Medi-Cal as psychological problem. "Patient seems distressed, angry and somewhat paranoid," a Cedars social worker noted in May of 2005. "She is cooperative but does seem to have a certain sense of entitlement to herself," a psychiatrist noted a week later.
Finally, in September of 2006, Belinda got the good word: She was finally, officially disabled. Her Medi-Cal card was on its way. Belinda was optimistic. She made an appointment at Cedars Sinai Dental Clinic to fix her teeth, eroded from years of illness and vomiting. Belinda visited the dental clinic twice in 2007, but never completed the work. She had other distractions. She still had
money troubles - SSI didn't pay much. Medi-Cal did not cover many of her prescriptions, including Lyrica and her asthma inhaler. And her liver was failing again.