Last Dance, Last Chance

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 complain 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.
    Anthony actually thought the trip went well. He presented a paper on a bizarre patient he had treated, a man he said had tried to commit “suicide by scissors.” The patient had driven the scissors’ blade tips into both his eyes. Anthony had worked on him for more than nine hours and had saved not only the patient but his eyesight. Anthony’s paper on the procedure was well received, and he was elated.
    But in June 1991, Anthony’s evaluation at Thomas Jefferson was so negative that once again he failed to be invited back for the second year of a residency program. That made him ineligible to sit for the American Board of Otolaryngology examinations. Once again, he had failed to complete a program. He was an M.D., but it was unlikely he would get hospital privileges—a kiss of death for a physician.
    Residents are expected to achieve at least a grade of 4 on a 1 to 5 scale evaluating their skill in otolaryngology. The records of his evaluation by teaching doctors gavel scores of 1 to 2.5. They commented on his performance in brutally frank terms. One termed him a “medico sociopath,” while another wrote “major questions regarding integrity raised by a large number of resident peers.” Many of the physicians who worked with Anthony found that he had a severe deficit in basic knowledge of the speciality of otolaryngology.
    For all of his boasting about his own brilliance and skill, when Anthony took the preparation test for the Board Certification test, he scored abysmally low. His raw score was in the 20th percentile, and was only in the 7th percentile for a resident in his year of standing, and in the 3rd percentile of his “year group.” Ninety-seven percent of his fellow residents in their senior