Last Dance, Last Chance

academic tunnel…We began to talk about a real house for our children. The winds of fate, however, would not blow in that direction…
    “The practice had grown steadily over six years. Anthony enjoyed his work. Hair transplants, liposuctions, and breast implants were a mainstay of the practice. Having been published in the medical literature several times, the doctor frequently gave conferences and was active in the cosmetic academy as well as many other medical societies. Always eager to learn the latest new technique, he would travel to continuing medical education conferences. Ironically, it would be one of these new techniques that Anthony would use the day our world fell apart.”
    But it wasn’t Anthony’s or even Debbie’s world that truly fell apart. It was the world of a young wife and mother named Sarah Smith.

Part Four
Sarah

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    C onnie Vinetti recovered, and Anthony moved on, unconcerned that the New York State health authorities were still watching him. He was intrigued by a revolutionary new procedure in breast augmentation that he had learned about at one of the conferences for cosmetic surgeons. He had never been pleased by the scars that often remained under the patient’s arms or beneath her breasts after breast implants were inserted. This new technique was known as TUBA (transumbilical breast augmentation), and it involved “tunneling” from the navel (belly button) to the axillary (armpit) area next to the breast.
    An endoscope formed a tubular space through the fatty tissue just beneath the skin, an “expander” widened the area, and then a tightly folded sac was pushed through the groove into place, where it could be filled with saline solution. Any scars would be around the navel, but those would virtually disappear.
    If gallbladders could be removed through the navel, why not use that route to insert breast implants? Board-certified plastic surgeons were having success with the navel approach. Anthony visited one physician in the Southwest and observed a few of the navel-to-breast procedures. He returned to Buffalo, convinced that he was fully prepared to add this new technique to his practice.
    And, in this case, “practice” seemed to be the correct word. An article by one of the pioneers in this new surgery discussed both its positive and its negative aspects. He maintained that, using TUBA, most of the common dangers in any plastic surgery—bleeding, infection, and poor healing—were less likely to occur than in implants placed through larger incisions. However, he warned, “What is the greatest danger from (any) breast implant surgery? Having it done by someone who is not qualified to do it. Many doctors not certified by the American Board of Plastic Surgery are taking quick weekend courses about breast augmentation, including the through-the-navel method, and then just doing it. It is possible for a patient to die from any type of anesthesia and any kind of surgery. Every person should check out the qualifications of the surgeon and the anesthesiologist.”
    The physician who authored the article recommended that even a very proficient surgeon who wanted to learn TUBA had to be prepared to take an intense and comprehensive training course that lasted a full week. It wasn’t something that could be done in a weekend of observation. Surgeons who used TUBA also had to be very skilled at using an endoscope, an internal instrument whose workings could be observed only through a magnified video image. The surgeon had to be able to do this without looking at his hands. “This is an ability that not all surgeons happen to have—even some skillful ones.”
    But Anthony Pignataro didn’t want to take a whole week away from his office; he couldn’t afford to close it down that long. He counted on doing at least three surgeries every week. And he continued to maintain an almost miserly budget in his office surgeries, still believing that anesthesiologists were unnecessarily expensive. After giving sedatives in the form of pills before surgery, Pignataro used his own concoction of intravenous anesthesia: sodium pentothal (known to many people as “truth serum,” and Versed, a narcotic similar in action to Valium.
    He could start the solution flowing into his patient’s vein himself, and then have a member of his staff inject more into the line when he felt it was needed.
    He used only the most basic machines to monitor his patients during surgery. A pulse-oximeter device to