by Shanna Hogan
Welch drew blood and conducted various tests, including an echocardiogram, which showed a normal heart rhythm and no sign of defect or disease. As part of the examination, he also took a reading of her blood pressure. The results were 160 over 110, which was considered high, and he diagnosed her with mild hypertension, or high blood pressure.
After conducting the tests, Dr. Welch invited Martin back into the exam room. Because of Michele’s elevated blood pressure, he prescribed Lisinopril, a treatment for hypertension. For her mental issues he prescribed sertraline, an antidepressant also known as Zoloft. After writing out the prescriptions, he asked that Michele take the pills for one week and then report back on the results.
Although Welch concluded that Michele was healthy, he suggested the surgery be postponed because of her high blood pressure.
“It would be ideal for her to get that under control before surgery,” Dr. Welch said.
At the suggestion of delaying the procedure, the smile faded from Martin’s face. “Well, I guess we’ll wait then.”
Once they left the clinic, Martin told his wife she would be fine and that they would be moving forward with the surgery as planned.
* * *
The first week of April, Alexis arrived back in Utah for a weeklong stay. On April 1, she accompanied her parents to their final presurgery consultation with Dr. Scott Thompson at his satellite office in Draper. During the drive, Michele expressed anxiety about the surgery. “I think we should listen to Dr. Welch,” Michele told her husband. “Let’s just hold off for a while.”
“No,” Martin snapped back. “You’re not doing that.”
“Let’s just wait until the summer when Alexis will be home for three months,” Michele said. “It will give me time to get my blood pressure under control and lose weight.”
“You’re having it now!” Martin demanded angrily. “I’m too busy and Alexis is here to take care of you.”
Michele repeated her concerns about her blood pressure, but Martin was insistent.
“If you don’t have the surgery now, you’re not getting it,” Martin snarled. “I already paid for the anesthesiologist and the operating suite!”
From the backseat of the car, Alexis was shocked by her father’s angry outburst.
“She was talking to my dad, saying that maybe we should delay the surgery,” Alexis recalled. “He had a very strong reaction … He was raising his voice and very animated.”
Eventually Michele abandoned her protests, grew quiet, and stared blankly out the passenger window. By the time they arrived in Draper, Martin’s fury had cooled.
In Dr. Thompson’s office, Michele detailed her past medical history on the patient intake form. Although Martin had told the surgeon that he was a psychiatrist, Michele identified him on the form as her primary care physician. She listed her hysterectomy as her only prior surgery, and stated she had no ongoing health problems.
Dr. Thompson conducted a physical examination and discussed plans for post-op care. Once again, Martin answered all of the questions for his wife.
“She has a little bit of high blood pressure,” Martin told Thompson. “I had it checked out and the doctor has her on an ACE inhibitor.”
Thompson didn’t believe such mild hypertension would be a problem.
“Martin was really the one who directed this discussion,” Thompson remembered. “Michele always deferred to Martin on those issues, for example, the blood pressure, the medication; those kind of things were always handled through Martin.”
Michele expressed her reservations, and asked the doctor if it would be beneficial to lose weight prior to surgery.
“It would only make a difference if you lost fifty pounds or more,” Thompson told her. “And you don’t need to lose that much.”
Still, Michele seemed hesitant, seemingly fishing for reasons to postpone the procedure. Thompson tried to ease her concerns.
“I know she was nervous about surgery, because I specifically remember saying, ‘Okay. We’re signed up for a lot of surgery here, for your forehead, your mid-face, and your lower face. But we could do less if you wanted,’” Thompson later said. “‘That would be a little easier to recover from.’”
But Martin stated they would proceed as planned.
Toward the end of the appointment, Thompson explained the medications Michele would need to take as she healed. For the pain, he prescribed thirty tablets of Vicodin, also known as Lortab. To reduce swelling, she would take a steroid, Medrol. An antibiotic called cephalexin would stave off possible infection, while Phenergan would prevent nausea. The eye ointment erythromycin would help healing. Finally, he prescribed seven tablets of Ambien to assist with sleep, if needed.
As they discussed the medication, Martin pulled a piece of paper from his pocket and slid it across the table—the list of medications he had assembled after poring through the Physicians’ Desk Reference.
“I’m really concerned about my wife,” Martin told the surgeon. “She doesn’t handle pain well. She gets anxious. And I just really want to make sure I have everything I might need in the postoperative period for these issues.”
Instead of Vicodin, he asked the surgeon to prescribe her thirty doses of Percocet, a stronger pain pill. In case her jaw was swollen and she had difficulty swallowing pills, he requested a Lortab elixir, a liquid painkiller. And to calm Michele before and after surgery, Martin insisted on a prescription of Valium, an antianxiety medication.
“She gets very anxious and I’m concerned that she won’t do well without these options available,” Martin said. “I just want to have all the options available to me.”
At the mention of anxiety, Michele looked over at her husband and softly smiled.
Alexis, seated next to her parents, was mortified—her father was basically ordering medication from the surgeon as if he was calling for takeout.
“I was really embarrassed because my dad was telling the plastic surgeon what medication he wanted,” Alexis recalled. “He’s a plastic surgeon—he knows what medications are appropriate to prescribe. It was not my dad’s place, and I just thought it was very, very strange and embarrassing.”
Dr. Thompson also found the request abnormal and out of protocol. Percocet and Valium were not part of his normal regimen. Under normal circumstances he would never trust a patient with so many dangerous narcotics, but because Martin was in the medical field, he made an exception.
Thompson granted all of Martin’s requests, under the agreement that he would monitor the administration of the drugs. The surgeon jotted out prescriptions for fifteen Valium pills, thirty tablets of Percocet, liquid Lortab, and increased the dose of Phenergan to treat nausea from six to ten pills. Thompson made a note in his files that the drugs were being prescribed only at the request of the patient’s husband, who was also her primary care doctor.
But Thompson also issued a strong warning. The drugs, he said, could have overlapping side effects, and there was no reason for them all to be taken at once. If combined, the medication could dangerously depress Michele’s breathing and be potentially deadly.
“This is more medication than I usually prescribe,” Thompson said. “Be very careful and only take what you need.”
Thompson handwrote all of the prescriptions and passed them across his desk. But when Martin noticed Michele’s name had been misspelled as “Michelle,” using two Ls, he asked for them all to be rewritten.
Following the appointment, Martin dropped off Michele and Alexis at home and returned to work. He collected the prescriptions from the pharmacy and later had a rented hospital bed delivered to the house to assist in his wife’s recovery.
Around 6 P.M. that evening, Martin called home and told his wife he would be working late. As Michele hung up the phone, Alexis noticed the worried look on her mother’s face.
“Can you go drive by your dad’s work?” Michele asked. “See if his car is in the parking lot?”
Alexis got in her mom’s car and drove by the
Developmental Center. Martin’s car was not there.
* * *
Days before the surgery, Martin called a family meeting, assembling Michele, Alexis, Rachel, and Damian. Vanessa was excluded. At the time, Martin was still carrying on the ruse that he was dying. When he began to talk about his illness, Michele and Alexis quickly locked eyes, exchanging a knowing glance. They knew he wasn’t dying. Why would he continue this charade?
Martin began explaining the provisions addressed in his will. “If I die,” he said, “Alexis will be in charge of the estate.”
At that, Michele flinched. “Well, what about me?”
Michele wondered why she, as his wife, wouldn’t be the executor of his estate. Martin waved his wife off, dismissing her concern and repeating, “Alexis will be the executor.”
“It was bizarre,” Rachel recalled. “He wanted to go over each detail of his will and what was in the will. He said that Alexis would be made executor of his will if anything were to happen. And he kept referring to Alexis.”
Then he passed out three handwritten checks, to Alexis, Rachel, and Damian, for five thousand dollars each.
“What is this for?” Rachel asked, looking down at her check.
“It’s a gift,” Martin told his kids. “I just want to give you this money.”
“Wow. Thank you.” Damian hugged his dad.
But Rachel and Alexis found it strange—there was no apparent reason to give them the money. It was uncharacteristic of their father.
“It was very unusual,” Rachel later said. “He had never done anything like that before.”
14.
The din of the cardiac monitors reverberated off the walls of the cool, brightly lit operating room at Lakeview Hospital in Bountiful. In the center of the room, Michele lay prone and sedated on the surgical table. She wore a white paper gown, her hair tucked under a cap. A ventilator tube protruded from the side of her mouth, and an IV line was inserted in her arm. Situated on a metallic tray at her bedside, steel scalpels, tweezers, scissors, and other sterilized surgical instruments were primed to carve into her pretty face.
It was Tuesday, April 3, 2007—the day of Michele’s fated face-lift and the beginning of the last full week of her life. She had just eight days left to live.
Early that morning Martin and Alexis had escorted Michele to the hospital. Dressed in surgical scrubs, Dr. Thompson greeted the MacNeills in the waiting area.
“I’m really nervous.” Michele winced.
“That’s perfectly normal.” Thompson gently patted her hand. “Most patients are nervous before surgery.”
Once again, Thompson tried to ease her anxiety, explaining what to expect during the procedure. The anesthesiologist checked Michele’s vital signs. Although her blood pressure registered as slightly elevated, the anesthesiologist said it wouldn’t be dangerous.
“Are you sure?” Martin’s tone was laced with condescension. “Do you know what medications my wife is on? Are you sure that when you give her the anesthesia there won’t be any interaction with that?”
Standing beside her parents, Alexis grimaced, embarrassed by her father’s arrogance. “I vividly remember that because it was embarrassing,” Alexis said years later. “Because the anesthesiologist obviously knows medication interaction.”
Martin kissed his wife and left the hospital, saying, “I have to get to work. See you tonight.”
At 8 A.M. Michele was admitted into surgery—a procedure scheduled to last six to eight hours. Scalpel in hand, Dr. Thompson made the first incision, slicing her skin near her scalp, circling behind the ears and around her hairline. He meticulously stretched the skin and lifted the muscles around her jaw upward, suturing them in place. He connected two flaps of skin, trimming off the excess flesh around her jawbone. Carving deeper under the skin around each side of her temple, he lifted the flesh of the cheeks, stitching it securely to her chewing muscles to fill in hollowness. Through the incisions near her scalp, he flattened the wrinkles in her forehead.
Thompson then slashed along the creases in her upper eyelids, removing the extra skin. The bags under her eyes were tightened by going beneath the skin using the incision from the side of her face, correcting the appearance of fatigue.
Throughout the operation, Thompson periodically stepped out of the surgical room to update Alexis on the progress.
By 3 P.M., the surgery was complete. Michele’s bruised and battered face was wrapped in gauze and bandages. A drain was placed under the bandages to collect blood and fluid. Cold ice pads shielded her eyes, leaving Michele temporarily blind.
The surgery had lasted seven hours and was considered successful, with no problems concerning Michele’s vitals, heart rate, anesthesia, or excessive bleeding.
Thompson placed a call to Martin. “I’m pleased with how it went.”
About two hours later, Michele awoke from the sedation and was transferred to a hospital room, where Dr. Thompson went to her bedside to check on her. The surgery had always been intended as an outpatient procedure—and Martin had requested an early discharge—but Michele told the doctor she wasn’t ready to return home. “I want to stay here overnight,” she uttered groggily.
Thompson and Alexis called Martin on speakerphone to explain Michele’s wishes.
“Mom wants to stay the night,” Alexis said.
Martin sighed. “We need to go home. I’m on my way to the hospital now.”
“What’s the big deal?” Alexis asked. “We have good insurance. It’s just staying one night for observation.”
“We made plans, Alexis,” Martin grunted.
By the tone in her father’s voice, Alexis knew he was furious. “He was very angry. He wanted her to come home,” Alexis recalled. “He was mad at my mom.”
Thompson interjected. “Because of how long she was under anesthesia, it would be a good idea to monitor her breathing and vitals overnight.”
On the surgeon’s recommendation, Martin relented. An hour later, he arrived at the hospital to pick up Alexis, and they headed home so she could pick up items she needed to stay overnight at the hospital. She then drove the Suburban back to Bountiful to sleep at her mom’s bedside, propped in a chair.
That night, while his wife slept fitfully at the hospital, Martin and Gypsy exchanged twenty-four texts.
* * *
Early the following morning, Dr. Thompson checked on Michele. Although she said her face ached, she was alert and responsive when she answered the doctor’s questions. Thompson slowly unwound the layers of bandages, slicing off the gauze, which was sticky with blood. He checked for bleeding under her skin, ensured her facial nerves were intact, and reviewed her vitals before rewrapping her wounds with fresh bandages.
Michele was discharged and released into Alexis’s care with a list of instructions.
At home, Alexis guided Michele into the master bedroom, where she tucked her into the rented hospital bed, which was positioned in front of the television. Alexis planted herself beside her mom on the bedroom couch.
For the rest of the day, Alexis was her mother’s caretaker—administering medication, assisting her with using the restroom, and feeding her small bites of food and sips of water. Using her medical training, she monitored Michele’s vitals. Alexis also rubbed her mother’s legs to help her circulation and prevent possible blood clots, which can form during prolonged periods of inactivity.
“I really wanted to do a good job helping her—she was my mom,” Alexis said years later. “So I was taking her vitals, blood pressure, pulse, rubbing her legs, things like that.”
Late that evening, Martin came home and told his daughter he would take over care. “You need to go get some sleep,” he said.
“No, Dad.” Alexis shook her head. “I’m just going to stay here with Mom and sleep on the couch.”
Martin, however, was adamant.
“At first I said I didn’t want to leave my mom,” Alexis recalled. “He insisted that I leave. He pretty much forced me out.”
Exhausted, Alexis went to Ada’s room, crawled beside her niece in her princess bed, and fell asleep.
In the master bedroom, Martin handed his wife a handful of pills, telling her to take each one. Once she passed out, he stayed up into the early morning hours, texting Gypsy.
* * *
Alexis awoke the next morning at about 6 A.M. and went straight to her mother’s bedside. She found Michele asleep in the hospital bed, tucked under the covers with her head lolled to the side.
“Mom. Wake up, Mom,” Alexis said softly, stroking Michele’s arm. When Michele didn’t stir, Alexis nudged her softly. “Mom. Mom. Mom.” Seizing her mother gently by the shoulders, Alexis jostled her. “Wake up, Mom. Mom!”
Michele groaned but remained listless.
“I went over and tried to wake her up and she wasn’t waking up,” Alexis later testified in court. “She was completely sedated and out of it.”
Checking her blood pressure and pulse, Alexis found Michele’s heart rate low, her breathing shallow. Storming out of the bedroom, Alexis found her father in the kitchen and confronted him. “What happened?”
“Um. Oh. I don’t know,” Martin stammered.
“She won’t wake up. Mom’s obviously overmedicated.”
“Oh. Well. I … I guess I must have done something wrong,” he muttered. “I must have given her too much medicine.”
They both knew Michele was sensitive to narcotics. While in her daughter’s care, she had requested only one pain pill.
“What did you give her?” Alexis asked. “Why would you give her so much?”
“I thought she needed them.”
Alexis demanded a list of the medications from her father, grabbing a nearby promotional notepad marked with the insignia for the allergy medicine Zyrtec to write down his responses.
Martin told Alexis that at midnight he gave Michele Valium. An hour later, a pain pill. That caused her to vomit. At 1:30 A.M., he helped her take Phenergan, two Percocet, and an Ambien.