Last Dance, Last Chance

Anthony’s little joke because of the “Ralph-Lauren” combination: a dog named for a men’s cologne. The dog grew to be huge—too big for Debbie to handle—but Anthony pointed out that Polo was a good protector for their household.
    “Anthony always had a dog when he was a kid,” Debbie said. “But he was so mean to Polo. He didn’t train him, and when Polo did something to irritate him, Anthony would hit him or kick him.”
    Polo remained loyal to Anthony, and Ralph loved the big dog.
    Anthony was determined to be board-certified, if only for economic reasons. Patients with any savvy knew enough about specialists to ask that vital question. Reference services were more likely to recommend board-certified physicians. He attended a few seminars, and he read medical journals with articles about plastic surgery. He usually traveled to seminars on his own because Debbie was so busy with Ralph and Lauren. He was piling up hours of study, although some of the conferences he attended were too experimental to qualify as continuing medical education (CME) courses.
    Part of Anthony’s Wednesday research was grotesque. He worked on female cadavers as he experimented with underwires beneath the skin to maintain breast implants. He even thought he might be able to bypass implants entirely. He wanted to come up with techniques he could use when he was doing breast plastic surgery—something that would make him appeal to the mass of prospective patients who were looking for plastic surgeons.
    But perhaps more than anything, Dr. Anthony Pignataro wanted to be famous, renowned for his brilliance and innovative thinking. He still thought of himself as a “modern-day Galileo,” a man of such vision that he saw far beyond the ordinary man’s imagination.
    Most of his research didn’t concern life-threatening illnesses. Rather, he was almost entirely focused on ways to improve the physical appearance of his future patients. The way he looked mattered so much to Anthony that he assumed everyone was as self-focused.
     
    In the meantime, Anthony’s practice was growing, but his conditional privileges at the Wyoming County Community Hospital ran out in September 1994. The official reason was that he was still not eligible to take the otolaryngology board exams. However, there may have been another reason.
    One of the most delicate procedures in otolaryngology is surgery in the frontal sinus area. Only a paper-thin layer of bone separates the sinus area at the top of the nose from the brain itself, and any surgeon operating there must have a steady and educated hand.
    On August 3, 1994, Anthony operated on a deviated septum (the center cartilage in the nose) in a 30-year-old man. He clumsily entered the outer layer of the brain, a critical mishap that greatly increased the patient’s susceptibility for brain abscess, meningitis, and nerve damage. In this case, the patient’s brain fluid actually leaked into the nasal passages, but Anthony told no one and sent the patient home from day surgery.
    A senior otolaryngologist who studied the case reported that there were serious questions, of both “omission” and “commission,” about Anthony’s surgical technique. The specialist questioned whether Anthony had the credentials to continue doing endoscopic sinus surgery.
    The following day, Anthony’s hospital privileges were canceled. He was fortunate that the young man with the deviated septum didn’t develop deadly meningitis.
    In 1992, Anthony had fortuitously added a second hospital that gave him temporary operating privileges, Our Lady of Victory Hospital. But in February 1993, Anthony operated on a seventy-one-year-old patient who agreed to elective surgery to remove a laryngeal tumor for biopsy. It was, in some aspects, a routine procedure, but any time a patient is operated on deep in the throat, his main route to get oxygen to the lungs can be compromised. Sensitive tissue can swell or hemorrhage.
    Anthony’s patient died.
    A hospital board reviewed the operation and immediately restricted his privileges. After that, he was not allowed to do elective procedures involving the airway after 1:00 P.M. , and before that hour, he had to be monitored. The chief of surgery and chief of otolaryngology met with Anthony to explain that it was extremely important not to disturb laryngeal tumors any more than necessary, and that he should have been prepared for swelling and excessive bleeding at the site of