by Ann Rule
“What’s goin’ on?” Frank Rago asked her.
“I don’t know, Dad,” she said, worried that this wasn’t at all good for her father’s health. Her dad had been going downhill since her wedding three years before. But he kept asking her what was wrong, and he was a very strong man, despite his illness. Finally, she told him that Anthony had been unfaithful to her.
“Debbie,” her father said sternly after a long pause. “Listen to me. You forgive once. Now hang up and go make your marriage work.”
Anthony certainly appeared to be truly repentant. He insisted that he loved her and the baby, and he could not bear the thought of losing her. The other woman didn’t matter at all—she was just some crazy girl. He would never see her again, and he begged Debbie to stay with him and go ahead with their plans until he got another residency. They had too much invested in their marriage—all those years together—to throw it away now.
Her father’s words played over and over in her head: You forgive once.
So Debbie did. She had loved Anthony for ten years; she still loved him—and she was pregnant again. She would stay in the marriage. And it wasn’t long before she believed that things were going to be all right again. She wanted so much to believe that.
They had already decided to leave Baltimore after Anthony had lost his residency at St. Agnes, and it was too late to get into another residency program for the 1987–1988 year. They agreed to move back to Buffalo until Anthony found a better venue for his third year of residency. Debbie was relieved that they were going to be far away from the woman who had called her.
Together, they packed everything they owned into their car and a rental truck and headed home to New York State. They could stay with the elder Pignataros until they found a place of their own.
Anthony took a job at a walk-in emergency clinic, the Mercy Ambulatory Care Center, in Orchard Park, New York. In essence, he was a “Doc-in-a-Box,” but he was at least practicing medicine, and he certainly saw any number of injuries, maladies, and illnesses. It was a come-down for him, though; he was in the trenches instead of in the much more rarefied air of a Johns Hopkins’ satellite.
Anthony began to keep a journal, documenting his reaction to the events of his life and putting forth his philosophies. It would one day become his book, M.D.: Mass Destruction—a paean to himself. This was the manuscript he later sent to me, telling me that his wife, Debbie, was the author. He must have thought it would be better received if someone other than himself wrote it.
Two years later, he would have more than a hundred pages. The first page began with his accomplishments. Anthony seemed confident that his talent as an author was as brilliant as his skill as a physician. His style was a throw-back to novels from the nineteenth century. It was clear that he wrote with a thesaurus close by—he chose the longest words possible in his almost archaic narrative. He sometimes referred to himself in the third person. The vast majority of his book was about his brilliance as a physician; only occasionally did he mention his family life.
There were some situations that he didn’t mention at all. He included nothing that might cast a negative light on his prowess as a physician, although he was quick to blame the bad judgment of others.
Anthony was less than three years out of medical school, and the young doctor didn’t have the experience that older physicians had. All doctors make mistakes once in a while; they are only human, but most of their slips or misdiagnoses are not life-threatening. However, Anthony made a really bad call. He allegedly failed to diagnose a patient who had a severe inflammation of the lining of the heart: bacterial endocarditis. Such an ailment can be mistaken for pleurisy or pneumonia, but it can also be fatal if not treated. This patient died, and a wrongful death suit was filed. Eventually the suit was dropped, but it was a scary thing for both Debbie and Anthony.
Nevertheless, being back in Buffalo gave the young Pignataros a time of calm in their lives. Everyone fussed over baby Ralph, and it was good to be home again after years away. Even though it tore at Debbie’s heart to see her father so ill—any effort at all made him gasp for breath—he still had the strength of character that endeared him to everyone in his family. To his siblings and cousins, nieces and nephew, Frank Rago was “Uncle Junior,” a vital and integral part of a wide, extended family. His advice was always solid. Everyone called Uncle Junior for counsel or for comfort.
Debbie followed his directive to forgive her husband once, but it was to be the last advice her father would ever give her. On November 16, 1987, Frank Rago slipped into severe congestive heart failure and was taken to the hospital to undergo diuresis in an effort to remove the fluid that was drowning his lungs. Caroline and Carmine were at the hospital with him, and Debbie was home with her infant son, waiting for word. But Anthony had gone deer hunting with his father at dawn. He assured Debbie he would carry his pager with him in case she needed him. Hunting was very important to Anthony—both hunting for deer in New York and later for big game in faraway countries.
Debbie needed him that day, and needed him badly. Oddly, Anthony chose to immortalize that last day of Frank Rago’s life in his book by prefacing it with a description of his successful shot into the heart of a white-tail deer.
“I was confident he was dead,” Anthony wrote of the buck he shot. “As I descended from my stand I knew that no animal could withstand such a violent penetrating chest wound. As I followed the trail, my pager began to beep. I canceled the signal and caught up with my trophy. Knowing my passion for this sport, neither my answering service, nor my wife, would risk the wrath of my response to the disturbance of a loud audible beeper in the silence of the forest. I had the deer gutted and field dressed as soon as possible, and began the half-mile drag back to our vehicle with the innate fear that the page was real…”
Even so, when Anthony learned that his father-in-law’s condition had worsened, he stopped to shower and change. “But I neglected to shave,” he added. “Stepping off the elevator, we presented to the ICU, Carmine, my brother-in-law, greeted us with the most crestfallen expression of bereavement as he simply shook his head, ‘No.’
“Deborah erupted with the most gut-wrenching expression of pain that I ever remember. Her best buddy was gone. I knew that nothing has hurt her as much as this…”
Debbie Pignataro withstood several emotional losses that year. Her father was gone. Her husband had been unfaithful, and more and more he was often missing when she needed him. Still, she was made of steel as well as velvet, and she kept going. The Pignataros made Debbie welcome. The news of Anthony’s dalliance with another woman was apparently common knowledge in the family, because Lena took Debbie’s side, confiding to her that she understood how Debbie felt. “It happened to me, too—twice,” Lena said.
That shocked Debbie, but it reassured her, too; Dr. Ralph and Lena certainly had a strong marriage now.
“In many ways,” Debbie remembered, “we had a wonderful year. I was pregnant again. Anthony was always sending me flowers and cards saying he loved me. I didn’t worry about him cheating on me, and we were both looking forward to summer when our new baby would be born.”
The prospect of a new baby proved to her that life went on after all, even though she still grieved for her father. After her second cesarean—this one an emergency procedure—Debbie’s baby emerged on June 5. It was a girl, just as the ultrasound had shown. But the atmosphere in the delivery room was strangely stilted, and the newborn was whisked away for what they told her was “testing and stabilization.”
Her name was Christina Marie—just as they had planned—but there was no joy in her birth. Her head was enlarged and misshapen. “She had a brain tumor that had been growing for months before she was born,” Debbie said sadly.
Christina had no significant brain function, and neonatologists agreed that she couldn’t survive without being on a life-support system that would breathe for her. Even then, barring a miracle, the baby girl would never move beyond a vegetative state.
Debbie and Anthony made the heartbreaking decision to give their permission to take Christina off the life support system. They arranged for a simple burial service.
“I was still in the hospital,” Debbie said. “Anthony, Lena, and my mother went to the cemetery to bury my baby. There was no funeral. I didn’t even get to go to her burial.”
Before Debbie could recover from the surgical birth and the grief over the baby she never saw, Anthony left Buffalo. He had been accepted into another residency program, this time at Georgetown University Medical School in Washington, D.C. He told Debbie that she and Ralph should stay behind with his parents until he found suitable housing for them.
It was necessary for him to go—he couldn’t be board-certified in any specialty until he completed a residency program. Both Debbie and Anthony had struggled for too many years to give up on Anthony’s dreams now. But it was such a lonely time for Debbie, and she grieved for her father and her lost baby girl on her own.
Anthony’s third year of residency began on July 1,1988. He found a town house to rent in Alexandria, Virginia, and Debbie and Ralph joined him in late July.
“The neighborhood wasn’t what I’d expected,” Debbie said. “It was nice, but everyone was older, and no one had kids. We moved later to Wheaton, Maryland, and that was better.”
Anthony became critical of Debbie’s appearance. She was never thin enough or pretty enough for him. She recalled, “He would ask me, ‘Have you looked at yourself in the mirror? Do you think I want to be with someone who looks like that?’”
So Debbie began to diet and tried harder to please him, but her self-confidence drained away every time Anthony let her know that she wasn’t quite good enough for him. In truth, she was still a very attractive young woman, but she saw herself through Anthony’s critical eyes.
Anthony had switched his speciality to otolaryngology, which dealt with diseases of the ear, nose, and throat. It would take two more years of training for him to be certified. Anthony wrote in his continuing journal that he was doing rotations in plastic cosmetic surgery and had become fascinated with facial reconstructive surgery.
“These were the areas that interested me the most,” Anthony wrote. “I always believed this was the logical extension of my prior engineering school, and the many summers I spent working on construction. It was the perfect match of intellect and artistry.”
If Anthony could help people with this combination of specialties, Debbie would be proud. She prayed that this program would be smooth. In two years, they could move home to Buffalo for good, and Anthony could open a practice that would provide them a good living but, more important, would be beneficial to his patients, giving them hope and a new life.
But Anthony ran into more problems. Later, he blamed his troubles at Georgetown University on the fact that he lost his mentor, the one senior physician he felt understood his potential. Dr. Louis Gilbrath* was as important an influence on him, he said, as his own father was. But Dr. Gilbrath had coronary artery disease, which required bypass surgery. The surgery was only partially successful, and Anthony’s idol and teacher was forced to retire early.
Despite this explanation, it was more than losing Dr. Gilbrath that marred Anthony’s years at Georgetown. Even with his intelligence and goal-oriented lifestyle, Anthony still had no skill in dealing with people, especially his own peers.
“As is often the case with the changing of the guard, turmoil ensued,” he wrote. “Subversion and discord pervaded both the staff and the resident team…”
It was true he wasn’t popular with the staff and his fellow residents. He was boastful and, as some of his fellow students thought, conceited. In a residency program where no one ever had enough sleep or free time, the team had to pull together, and many of his peers felt that Anthony was only out for himself.
Beyond Anthony’s arrogance, there were other reasons why he wasn’t doing well at Georgetown: He broke rules that should never be broken. At Christmastime in 1988, Debbie took Ralph, who was twenty months old, home to spend the holidays with his grandparents. Anthony couldn’t go; he was scheduled to be on call. But on New Year’s Eve, he walked out of the ER. He went to a bar and got drunk. This total lack of regard for the residency program at Georgetown did not go unnoticed. He was chastised severely. When Debbie heard about it, she was horrified. She held her breath, hoping that Anthony wouldn’t be dismissed from the program. In the months that followed, she relaxed a little. He remained at Georgetown.
Debbie became pregnant again in February 1989, eight months after they had lost their first baby girl. Her obstetrician hastened to assure her that Christina’s tumor had been a very rare thing, and no more likely to happen again to her than to anyone else.
It was a good pregnancy. Debbie carried her baby to term, listening throughout her last months of gestation to Anthony’s growing dissatisfaction with the otolaryngology department at Georgetown. He was gloomy and disgruntled because, once again, he was not being treated with the respect he felt he deserved.
In Wheaton, Maryland, on October 2, 1989, Debbie had a third cesarean and gave birth to a perfect little girl. They named her Lauren. Now they had one of each, and Debbie was fulfilled. Any further pregnancies would be risky for her after so many surgical deliveries. She lived through her children and her husband, content to stand behind them.
Anthony called the situation at Georgetown a “maelstrom” and said he didn’t think that he could finish out the two-year residency. No one appreciated his knowledge or listened to his theories. If Dr. Gilbrath were still in charge, things would have been different, Anthony said. Gilbrath understood what he was capable of. With this new regime, no one recognized his talents.
Perhaps Anthony could see the writing on the wall. He would say later that he got out just in time. “I adroitly avoided this maelstrom by placing into a final PGY-V [senior year] at Thomas Jefferson University Medical Center in Philadelphia.”
Anthony had not completed the two-year program, and he had virtually slipped back to where he had been two years earlier. Of course, it meant another move. In June 1990, the Pignataros packed up again and relocated to Marlton, New Jersey, a suburb of Philadelphia, on the other side of the Delaware River.
Anthony was still seeking his credentials in otolaryngology. Although he described himself as “gregarious and personable [and a man] who worked well with people,” that clearly wasn’t true. He was no more popular at Thomas Jefferson than he had been at Georgetown. This time, he blamed it on the jealousy of the other residents. He was entering at the senior level, and he felt the others resented that. “As hard as I tried to break the ice,” he remarked, “I was never truly accepted as part of the new team. There was an almost tangible air of envy because I had come from such a reputable program. The others had paid their dues together, and hadn’t seen the sort of road I already had.”
It was true that he had just spent two years studying the human ear, nose, and throat, and he was repeating much of what he’d done in Washington D.C., but he was not particularly adept. Worse, he clashed with almost everyone he worked with. Ironically, Anthony’s patients adored him. He had a charismatic bedside manner, and they preferred him to some of the other residents.
Debbie had begun to dread spending time with the other residents and their wives. In social situations, Anthony could be counted on to say something offensive. Debbie, of all people, knew that he could insult people and never know it—or care. She loved him still, but she could see why he wasn’t successful in human relationships. He had so many grandiose dreams and such confidence in himself that he seemed to forget that other people had their own issues. “I was embarrassed,” she said, “and I usually tried to talk about it with him afterwards. He just said ‘I was only kidding’ or told me I had no sense of humor. He didn’t seem to understand that he was constantly hurting people’s feelings or making them mad with his ‘jokes.’”
He hurt Debbie’s feelings, too. He continued to comp
lain that she was “too dumb” or “too fat” or incapable of keeping up with him socially in his climb to the top. Anthony had always found time to keep himself in top physical shape, and he expected perfection in his wife, too. Debbie had gained a little weight in her four pregnancies, but she wasn’t fat—not to anyone’s eyes but Anthony’s.
Debbie got a part-time job in another plastic surgeon’s office, leaving her babies at a day care center. She hated leaving Lauren and Ralph, but she had no choice; they needed her income. One of her features that Debbie had always disliked was her nose, and her employer gave her a greatly reduced rate to make it smaller. She was thrilled with the difference in her appearance, and Anthony was so impressed that he decided he would get his nose fixed, too. He fretted about his appearance a lot, and he was devastated because his hair was thinning rapidly.
Debbie made lots of friends among her neighbors in Marlton, and she liked her job, but the evenings were not pleasant; she had to listen to Anthony complain about his rejection at work. It was a monotonously familiar theme.
Anthony was not only a resident physician, he was also an inventor. He was always tinkering with better ways to do things, and he talked about getting patents for some of the ideas he’d come up with. On weekends, he went fishing with his son and his father—an activity that he said helped him survive what was going on at Thomas Jefferson.
“It made the countless hours of abject isolation in the workplace seem meaningless. I simply looked forward to the opportunity to begin my private practice. Soon we would be headed home again to take root and pursue this goal.”
Debbie looked forward to a bright spot in the onerous year: a trip to Maui for a medical conference, where they joined the rest of the residents’ class. Lena stayed with Ralph and Lauren, and Debbie hoped the excursion would be like a second honeymoon. But it turned out to be a disaster. They had one of the worst arguments of their marriage, which ended with Anthony storming off and leaving her, once again, alone.