Last Dance, Last Chance

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