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Pam convinced Keith to go in a joyride in the car Keith's late mother had purchased for his father. She got into an accident after she saw Keith was bleeding from his nose.
Mr. Foster did not like Pam as he saw her as a bad influence. She had been in rehab at the age of 11.
However, Pam did provide a clue to the final diagnosis. When Keith started hallucinating and started talking about Jules, Pam let the doctors know it was Keith's recently deceased cat.