When she was younger, her twin sister Maysilee Donner was selected as a tribute for the 50th Hunger Games. The same game that Haymitch Abernathy was in. Maysilee died during the Games and Mrs. Undersee was never the same afterwards, suffering from massive headaches in her adulthood that caused her to lie about in bed all day. Madge told this to Katniss, and she asked why they didn't just get medicines from the Capitol. But was then told that even the mayor had his restrictions.