Last Dance, Last Chance

year of otolaryngology scored higher than he did.
    But his peers were his harshest judges. Anthony was dead-on when he complained that nobody liked him or listened to him. “Simply put,” one resident wrote, “he is unreliable, poorly informed, dishonest and dangerous…do not rehire…the responsibility is too great, the risks innumerable…I fear that lives are truly at stake…”
    Other evaluations were just as damning: “I found many errors in patient care…His response was that ‘It could happen to anybody’…A major problem with Tony is that he will not change his behavior, even if he is directly confronted with a problem…I feel that he has no detectable positive attributes as a physician.”
    “I find him to be dishonest, manipulative and conniving. He has demonstrated a lack of fundamental medical knowledge…his dishonesty and lack of medical knowledge combined with his arrogance make him dangerous.”
     
    Anthony Pignataro was finished with residencies. He vowed that he would never go through another two-year program.
    “He believed in his mind that he had completed the process,” Debbie said. “We moved back to Buffalo, and he prepared to hang his shingle as an expert in otolaryngology in West Seneca.”
    Despite her doubts, and without full knowledge of why her husband had not been asked to return to the Thomas Jefferson program, Debbie Pignataro tried very hard to believe that their future had begun. Even though life hadn’t happened quite the way she pictured it, she had long since grown accustomed to accepting life the way it was.

Part Three
Private Practice

4
    I t was wonderful to be back in Buffalo. It was home, where everyone was wrapped up in ice hockey with the Buffalo Sabres, baseball with the Buffalo Bisons, and football with the National Football League’s multichampion Buffalo Bills, where O.J. Simpson was once a revered hero. Debbie and Anthony watched the thousands of tiny white lights illuminate the Peace Bridge to Fort Erie, Ontario, and they ate the best pizza in the world, Buffalo wings, and “beef-on-a-wick,” the thinly sliced roast beef on a Kimmelwick roll that was Buffalo cuisine. The air smelled of honeysuckle and the salty spray of Lake Erie.
    Debbie felt as if she had finally come out of a long dark tunnel. She didn’t have to pack up the kids and move any longer, and she could be close to her mother and brother. Anthony assured her again and again that he didn’t need any more of the controlling, prejudiced, two-year residencies. After all, he’d spent almost five years trying to fit into their stupid, confining little boxes, and he knew more than the lot of them. He was ready to treat patients in his own practice. Debbie wanted to believe him; the stress of his repeated failures in his two-year programs was almost too much to bear—for either of them.
    Anthony didn’t want to join a group practice or a health maintenance organization (HMO)—if, indeed, he was eligible. And there was his own research.
    “I needed to pursue my own ideas,” he recalled. I needed the freedom to go to the lab at my own discretion. I could not be held down by the demands of a group, where the youngest physician members obtain the least amount of personal time.”
    Once again, Debbie and Anthony were living with his parents—but that was all right; they would soon have their own home. Ralph Pignataro had always helped and mentored his son, and he was still there for him. If he was disappointed by Anthony’s scholastic and residency-program failures, he didn’t speak of it.
    After a few weeks, the younger Pignataros moved into a small two-bedroom apartment of their own. They planned to build a starter house to live in while they paid off some of their debts and saved up enough to open their own clinic.
    Anthony’s father and his best friend owned several acres of land in West Seneca, not far from Dr. Ralph’s home. It was zoned for residential building, and the older men envisioned streets lined with new home construction as Buffalo’s burgeoning population spread to the western suburbs.
    Anthony and his brother Steve were given one lot along the otherwise empty street. They borrowed money to start construction on a duplex. Steven would live on one side of the three-story duplex, and Anthony and his family on the other. Although they would contract most of the actual labor out, they would oversee the building. Anthony and his brothers had worked summers in