Last Dance, Last Chance

show the percentage of oxygen in the blood would be clipped over the end of a finger. If the pulse-ox reading dropped too low, an alarm would sound. A blood pressure cuff would indicate if the pressure fell dangerously low. Both of these were routinely used in hospital operating rooms. However, anesthesiologists also keep track of the heart rhythm and stability with an EKG (electrocardiogram) and maintain an airway in the throat so that the anesthesiologist can breathe for the patient if that should become necessary.
    There is no way to know how many TUBA operations Anthony performed in the late summer of 1997. Apparently, they took place without incident. His operating room staff was sparse at best. Janie Krauss * was twenty-two years old, a recent graduate of a vocational training school. She was not a registered nurse. She was a licensed practical nurse with very little experience. Tom Watkins * was seventeen, a high school junior at Nichols School, who was interested in becoming a doctor someday. Anthony allowed him to dress in scrubs and a mask and observe operations, paying the teenager the minimum wage—around $5 an hour.
    Debbie Pignataro sometimes served as Anthony’s third assistant. She was not a nurse, a nursing assistant, a licensed practical nurse, or an anesthesiologist, but Anthony told her she was fully capable of the tasks he assigned to her. He was a medical doctor, after all. He felt supremely confident in his own ability to teach his pieced-together staff what they needed to know to help him.
     
    Usually, Anthony didn’t know his patients all that well. The women came to him with their worries about being too fat or too flat-chested. The men came because their scalps were shining through their thinning hair. He didn’t know about their spouses, their families, their jobs—and he didn’t care. He was providing a service. He might see his patients once in a preoperative appointment, again as they lay stuporous on the table below him, and once more for a postoperative visit.
     
    Sarah Smith was prettier than most of his patients: a very slender woman with porcelain skin, clear blue eyes, and blond hair. She came to see Dr. Pignataro because her husband’s younger sister had a roommate who recommended him highly. He had performed plastic surgery on her, and she was completely satisfied with her new and fuller breasts. That roommate was Janie Krauss, now Anthony’s L.P.N.
    Seven months earlier, in January 1997, Sarah had undergone some plastic surgery on her nose to fix a deviated septum and her surgeon had also removed a small bump on the bridge of her nose. That operation was completely successful, and she felt generally confident about having more surgery done.
    To anyone else, Sarah looked flawless. At 26, she was a lovely and vibrantly happy young woman. Her husband, Daniel, couldn’t imagine that anything might make her more appealing to him. He had loved her since she was 14 years old.
    Sarah was born Sarah Grafton on May 14, 1971, in Springville, New York. Sarah Grafton and Daniel Smith had grown up in Springville, a town of four thousand people on the Cattaraugus River between Buffalo and Jamestown. Her mother, Barbara, came from a family that had lived there for several generations. Her father, Russell Grafton, remembered her as “Sarah—just Sarah,” but his eyes filled with tears as he recalled a “bouncy” little girl full of energy and curiosity.
    Most parents will agree that each baby has its own little personality, recognizable even at birth. Sarah was a sunny, happy baby, who slept through the night from the beginning. It was fortunate that she was so easy to care for, because her parents were about to face crushing news. When Sarah was six weeks old, they took her brother David, who was four, to Children’s Hospital in Buffalo for testing. The news confirmed what they had feared. David had a progressive disease: muscular dystrophy.
    Because David needed so much care and attention from her mother, Sarah sometimes resented him—but she loved him, too. David couldn’t do chores, so Sarah had to do them all. “She never complained about this role thrust upon her,” Russell Grafton said. “She became David’s friend, confidante, and protector.”
    Her parents divorced in 1979 when Sarah was eight. Shortly after the divorce, Russell Grafton lost his job in the Buffalo area and was forced to move to Iowa for another position. Her mother had to work, and Sarah pitched