Last Dance, Last Chance

surgery.
    Anthony was indignant that they should lecture him as if he were a mere intern.
    Anthony’s privileges at Our Lady of Victory expired in September 1993, and the hospital did not renew them.
    Anthony no longer had any hospital where he was welcome to operate or treat patients. He applied for privileges in otolaryngology and plastic surgery in Irving, New York, and at Buffalo Mercy Hospital. He wasn’t accepted because he had no proof to back up his statement that he was board-certified in those specialties.
    Anthony suspected that one of the department chairmen at Thomas Jefferson Hospital in Philadelphia might be blocking him by failing to endorse him as a doctor of good moral character worthy of taking the board exams. He fought back by suing his last training hospital and the chairman.
    Thomas Jefferson submitted the names of seven ear, nose, and throat specialists to serve as arbitrators. Any one of them was competent to evaluate Anthony’s level of skill in this speciality.
    Characteristically, Anthony balked. He came back with his own list of three otolaryngologists. That was no problem for Thomas Jefferson Hospital; they agreed to let the matter be decided by the very first doctor on Anthony’s list.
    Although Anthony was intelligent enough, he was ultimately self-defeating. In his rage at anyone who had the temerity to block him from doing what he wanted, he often failed to reason things out carefully. He apparently expected the past to disappear into a kind of mist where no one remembered details.
    “Dr. H.,” the physician whom Anthony himself had chosen, set about gathering statements that were either for or against the subject. He interviewed specialists who had worked with Anthony Pignataro. Usually physicians tend to close ranks and protect each other. So many things can go wrong in diagnosis, treatment, and surgery that they are hesitant to point fingers at other doctors, knowing that they too could make mistakes. Not this time.
    In the end, Dr. H.’s report was scathing. The doctors who had worked with Anthony in Philadelphia recalled that he was lazy and slipshod when he came into the residency, and that he never improved while he was there. “He would routinely show up late for rounds, claiming he had done work he had not done, say he had seen intensive care unit (ICU) patients that he had not seen, fabricate laboratory data, fabricate physical examination data, fabricate information about postoperative patients that he had not seen. This was routine…”
    Anthony scoffed at his evaluation. “If I had been such a bad doctor…practicing for four years…If I were as bad as I’m made out to appear, I’m sure that something would have happened by now.”
    As indeed it had. More than one “something” had happened. He had simply forgotten the dead biopsy patient and the young man whose brain had been pierced by an errant blade.
    Dr. H. said that no one at Thomas Jefferson should be compelled to recommend that Anthony take the otolaryngology board exam. He concurred that Pignataro was in no way qualified for either skill or good moral character. Stung, Anthony challenged the findings of the arbitrator he himself had chosen, and he requested a review in federal court.
    In May 1995, Anthony withdrew his lawsuit, and it was dismissed.
    Actually, he cared very little about the practice of otolaryngology. It was only a stepping-stone for him on his way to plastic surgery. He had had minimal formal training in that delicate art, although he still attended every conference he could afford where plastic surgeons gathered. He leaned toward techniques that were more experimental than accredited. Aware that there was a lot of competition in plastic surgery, Anthony focused on procedures that were new and dramatic, something that would attract patients to him.
    And he continued to work on his permanent subcutaneous underwire to lift sagging breasts.

5
    D r. Ralph Pignataro could see no wrong in his doctor son, nor could his wife. Anthony considered his father his greatest mentor. He had always spent hours on the phone with his father, discussing the cases he saw in medical school and residency. Anthony said he idolized his father, and that was probably true.
    Both Dr. Ralph and Dr. Anthony were bald. There was a strong balding gene in the Pignataro family, and Anthony had started to lose his hair when he was only 23. He continued to be vain about how he looked. He tried comb-overs held in