Ep 30-Oh Snap! Another Sociopathic Surgeon! (Part 1)

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 2 (00:01):
Amanda.

Speaker 1 (00:03):
Jenna, that sounded very aggressive how the heck,
are you Aggressive as?
Heck, very excited to be here.
How are you?

Speaker 2 (00:12):
Yay, I'm great, just loving the fall life.
I know, the other day I wentthrough Caribou on my way to
work.
They have a really convenientlittle hut.
I tried to avoid it.
But really convenient littlehut.
I try to avoid it, but damn,the hut was calling me.
I drove through and I was likeI'll take a caramel high rise,
please.
Thank you very much.

(00:32):
And when I got it it waspumpkin spice and I wasn't
hating it.
I mean, I don't know if theydid that to me on purpose.
It was probably an accident,but it was a happy accident
because I was like that's here,oh yeah.

Speaker 1 (00:46):
It's fall official.
I have definitely already takenadvantage of the fall flavors
at good old Starbucks.
Yum.

Speaker 2 (00:55):
Yummy.
And, by the way, no shade toStarbucks, because Starbucks and
I were born the same year inthe same city, so I mean, that's
where my heart lies, butStarbucks, you guys, you don't
have a hut on my way to work.

Speaker 1 (01:10):
So there is a Starbucks by my office, which is
dangerous because when I dropRay off at daycare, I like order
a mobile to go, and so it'sready by the time I get over
there.
The only thing is it's a verybusy intersection so it gets
hard to get out to get to theoffice.

Speaker 2 (01:30):
That's all right, because you've got your lot tied
up Exactly.
Fuck on while you're waitingfor traffic.

Speaker 1 (01:37):
And you know what?
I just have one of those really, really nice jobs now where
there's no micromanaging person.
So if I'm there at 802, if I'mthere at 747, you know what?
No one cares, because they'rejust like oh, you did your job
today, thank you.

Speaker 2 (01:52):
I'm just like god, what's that like?

Speaker 1 (01:54):
I know that sounds like such a foreign land when
people work in hospital life,because I used to be there, you
guys.
But I'm telling you, oh, thereare some bright lights out in
the world, wow yes, you'reliving the dream girl.
I'm living vicariously and I'mso proud and so jealous at the
same time so, yeah, I guess,other than being so excited

(02:21):
about the fall drinks, I wentand got my mom's this weekend,
so my front porch is looking allnice so we're not just for our
uk listeners.

Speaker 2 (02:30):
We're not talking about your, your parent, your,
you know family.
We're talking about plants.
Yeah, the flowers.
Oh yeah, cute me mom's, memom's on the porch and I keep
her there, water her from timeto time.

Speaker 1 (02:49):
Yeah, my husband and I took our niece to the store to
give my brother andsister-in-law a little reprieve
from the four-year-old madness.
So she ran errands with us andshe was so excited to be at
Sam's Club.
Um, so she ran errands with usand she was so excited to be at
sam's and she was like, well,adam walked her in like on his

(03:09):
shoulders and she was like youknow, like am I gonna get my
head on the?
door and then I could hear themyelling, like in the where the
carts are, like outside wherethe moms are.
I was like, oh my god.
And then he brings her out inthe cart and she's yelling sales
club, sales, club, sales.
And it was big it was.
I think that was on saturday,so I mean it was busy and

(03:32):
everyone loved it oh my gosh,that was fun.

Speaker 2 (03:35):
I mean, listen, most people aren't that happy.
It's like a fun fight in there.
We like the prices, but, lord,we don't like to have to go
through the aisles.
And you, my dear, I thought youwere the person who ordered
ahead of time to get them tochuck the shit in your car, so
you didn't have to go in.
You're like, oh, this would bea good outing.

(03:55):
I am?

Speaker 1 (03:59):
I am Well see, we had like just errands that we had
to do.
And then I was like well, Ishould offer to take my niece,
because it was my brother'sbirthday this weekend, and so I
was like oh, a little quiet time.

Speaker 2 (04:13):
Um, yeah, steve, listen, appreciate, appreciate,
um, and return the favor toSunday.
Okay, I'm just saying the nameover the rainbow.

Speaker 1 (04:28):
Sam's.

Speaker 2 (04:28):
Club will be fun.
Honestly, I love looking at itthrough a child's eyes because
you know, as an adult going inthere, you've got your list.
You're like, okay, I'm preparedfor battle, I'm going to go
down this aisle, I'm going to godown that aisle, I'm going to
try not to get sidetracked byall the samples, and you know

(04:49):
the people that are fightingover the deals.
And no, I don't need anothersweatshirt in my life.
No, I don't need another cellphone plan.

Speaker 1 (04:56):
But also it's only $8 .
You're like T-Mobile Shut up, Igotta go.

Speaker 2 (05:07):
I'm happy with my service.
Bye.
But you know what your niece islike woohoo, look, candy.
You know you're like okay, yeah, we can buy yours with the
candy.
Yes, she likes it.

Speaker 1 (05:18):
It's the big store.

Speaker 2 (05:19):
Yes.

Speaker 1 (05:19):
Everything is so big.

Speaker 2 (05:21):
Well, speaking of honestly, there's no good segue
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Speaker 1 (07:53):
I have never heard of old glory before, but I need to
check that out because mynephews may like something
absolutely, I'm all for and I'ma planner, a header, we've
talked about this.
I am always prepared.
So you think I haven't thoughtabout christmas and stuff, or
you know, girl I I'm, you know,you are inspiring me to be a

(08:17):
little more organized.

Speaker 2 (08:18):
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that where these days, peoplecan get anything on Amazon.
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(08:39):
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So, glorycom, I'm going to belooking into it myself.
Stay tuned, listeners, allright.
So, alleycats, we do have anepisode that I tried.

(09:01):
Unfortunately for everyone, Iread a book and when I read a
book, it's really hard to narrowit down and I'm learning.
It's a learning curve, butthere's so much I want to share
about this case that it's atwo-parter Two-parter, so we're
going to do part one today, butonce again, alleycats, I'm

(09:24):
mixing it up because we're goingto start with a chart note
rather than starting with a case.
It's a nine minute read, butit's worth it, because I want
you to keep this learning inmind, because today's case
epitomizes what we're about totalk, so welcome to our chart

(09:45):
note.
Chart note.

Speaker 1 (09:51):
Oh my gosh, we did the same thing, I felt the
bubble so I had to stop.
But I was like, oh, we're there, we nailed it.

Speaker 2 (09:58):
We nailed it, amanda.
Welcome to the chart notesegment, where we learn about
what's happening in medicine andhealthcare.
All right.
So today we're talking aboutnarcissistic personality
disorder.
Welcome to the chart notesegment where we learn about
what's happening in medicine andhealth care, all right, so
today we're talking aboutnarcissistic personality
disorder Disorder.
I said it like I said it likeI'm from the East Coast.
It's the disorder according tothe DSM-5 criteria, and we'll

(10:19):
talk about some treatmentoptions too.
Options too.
So a narcissistic personalitydisorder is one of several
personality disorders thatpeople can be diagnosed with,
and it involves features likearrogance, lack of empathy and
self-centeredness.
You may have heard the wordnarcissistic more than once in

(10:39):
your life, and perhaps it wasused to describe an individual
who seemed to want to be thecenter of attention frequently
or was boastful at times.
Narcissistic personalitydisorder can involve these types
of traits.
However, they tend to be muchmore severe and significantly
negatively affect their abilityto function correctly.

(11:01):
So it's a little bit differentthan liking the limelight or the
spotlight.
So an individual with thispersonality disorder will
typically have an extremely highor exaggerated sense of
self-importance, a strong desireto be admired virtually at all
times and struggle to haveempathy for others.
However, behind the grandiosefeelings, empathy for others.

(11:27):
However, behind the grandiosefeelings, the sense of
superiority and excessiveconfidence, is a fragile ego
that can be easily damaged bycriticism.
Individuals can also becomevery envious if others receive
praise and validation as arebuttal.
It's common for people withnarcissistic personality
disorder to try to belittle andput down others to inflate their
own self-esteem.

(11:48):
These individuals also tend toprioritize their own thoughts,
feelings and needs above thoseof others and often disregard
what others might say or feel.
Because of these issues, peoplewho have narcissistic
personality disorder willstruggle in many life areas,
especially interpersonalrelationships.
So, according to thenarcissistic personality

(12:13):
disorder DSM-5 criteria, theessential features of a
personality disorder areimpairments in personality, self
and interpersonal functioningand pathological personality
traits.
To diagnose a narcissisticpersonality disorder, the
following criteria must be metSignificant impairments in

(12:34):
personality functioning,manifested by impairment in
self-functioning or identity.
Excessive reference to othersfor self-definition and
self-esteem Regulation.
Exaggerated self-appraisal maybe inflated or deflated or
vacillate between extremes.
Emotional regulation mirrorsfluctuation in self-esteem or

(12:57):
self-direction.
Goal setting is based ongaining approval from others, so
personal standards areunreasonably high to see oneself
as exceptional or too low basedon a sense of entitlement,
often unaware of their ownmotivation.
Impairments in interpersonalfunctioning, either A or B.
A empathy impaired ability torecognize or identify with the

(13:19):
feelings and needs of others.
Excessively attuned to thereactions of others, but only if
perceived as relevant tothemselves.
Over or under estimation oftheir own effect on others.
And or b intimacy Relationshipsare largely superficial and
exist to serve self-esteem.

(13:39):
Regulation Mutuality isconstrained by little genuine
interest in another'sexperiences and predominance of
a need for personal gain.
So pathological personalitytraits in the following domain
are characterized by Antagonism,which means grandiosity.
Feelings of entitlement, eitherovert or covert.

(14:01):
Self-centeredness.
Firmly holding to the beliefthat one is better than others.
Condescending towards others.
Attention-seeking, excessiveattempts to attract and be the
focus of attention of others.
Admiration-seeking.
The impairments in personalityfunctioning and the individual's
personality trait expressionare relatively stable across

(14:22):
time and consistent acrosssituations.
personality trait expressionare not better understood as
normative for the individual'sdevelopment stage or
sociocultural environment.
personality trait expressionare not solely due to the direct

(14:44):
physiological effects, so likeof drug abuse or medication or a
general medical condition likea severe head trauma.
So in addition to the criteriamentioned above, the DSM-5
narcissism guidelines also pointout nine different features of
narcissistic personalitydisorder that professionals

(15:05):
should look for when diagnosingthe condition.
So number one inflatedself-esteem or a grandiose sense
of self-importance orsuperiority.
Two craving admiration.
Three exploitativerelationships like manipulation.
Four little to no empathy.
Five identity is easilydisturbed, like they can't

(15:29):
handle criticism.
Six lack of attachment andintimacy.
Seven feelings of depression oremptiness when they're not
validated.
Eight a sense of entitlement.
Nine may feel like others areenvious of them or they may envy
others.
So an individual must possessat least five out of nine of

(15:50):
these traits, many of which canbegin to appear at a young age.
Like most mental healthconditions, the exact causes are
unknown, but personalitydisorders are especially complex
and various factors caninfluence their development.
Environmental ones, especiallya person's upbringing, can play

(16:12):
a role in narcissisticpersonality disorder.
For example, being excessivelypraised or overvalued by parents
, peers or teachers can lead toan inflated self of
self-importance and arroganceseen in the disorder.
Self of self-importance andarrogance seen in the disorder.
On the other hand, abuse,neglect and criticism can also

(16:32):
be a contributor, and this mightlead to the attention-seeking
behaviors that arecharacteristics of narcissistic
personality disorder, so likemanipulation and lack of empathy
for others.
Certain behaviors can also belearned from those around them
at a young age.
Unfortunately, it can reinforcethe personality disorder
because it can result in theindividual getting what they
want.
So genetics and neurobiologycan also be important when it

(16:54):
comes to the development ofnarcissistic personality
disorder.
Some characteristics can beinherited, and changes or
differences in brain chemistrycan contribute to the formation
of the condition.
A narcissistic personalitydisorder is one of the most
difficult mental healthconditions to treat, because
many people with the disorderfeel they don't have a problem,
even though it causes themdistress and impairs their

(17:16):
ability to function.
Therefore, most NPD peopledon't seek out help and the
condition will continue topersist.
If someone does try to findassistance, it's often due to
coexisting issues usually seenalongside NPDs, like depression,
anxiety, bipolar or substanceuse.
Medication will often beprescribed to help manage the

(17:39):
symptoms of these conditions,but there aren't any medications
recommended to treat NPD itselfof these conditions, but there
aren't any medicationsrecommended to treat NPD itself.
Instead, psychotherapy is aprimary treatment.
With NPD, individuals have adistorted sense of themselves
and their actions andmotivations are often
contradictory.
While people may exhibit traitslike grandiose or inflated

(17:59):
sense of self-importance, abelief that they're special, and
display other arrogantbehaviors.
That's often a coping mechanismfor their insecurities.
They're often used to try andmask their self-doubt.
To try and satisfy this,they'll crave attention and
validation from others, and ifthey don't receive it, they
become hostile or vindictive.
Therapy will attempt to replacethe distorted thinking patterns

(18:22):
and behaviors with morepositive, realistic ones and
teach individuals with NPD moreproductive and effective ways of
coping, instead of resorting toattention-seeking and other
damaging behaviors for relief.
Therapists who work with peoplewith NPD must be extra careful
not to criticize the individual,since people with the condition
are often resistant totreatment at first.

(18:44):
Over time, trust and rapportmust be built for progress to be
made and eventually they canrealize that they can make
significant progress if theycooperate with the therapist and
the advice that the therapisthas to offer.
So, in conclusion, despite thechallenges that NPD creates, it
can be addressed.
With the right resources,people can learn how to cope,

(19:05):
mend their relationships withothers and have happy, healthy
and successful lives.
Now for our case, resourceswill be listed in our show notes
, but the primary resource forthis episode is a book by Ann
Rule called Last Dance, lastChance.

(19:25):
And so a lot of what we knowabout the intricacies of this
case is from that book.
Trigger warnings this episodewill discuss emotional abuse,
medical malpractice and murder.
So be warned.
Anthony Pignataro was born May12, 1958, in the West Seneca

(19:47):
neighborhood of Buffalo, newYork.
Anthony's father, ralphPignataro, was a prominent
surgeon in the Buffalo area andAnthony grew up in a wealthy
neighborhood on a grand estatein West Seneca.
He attended Nichols School,which was a prestigious private
school.
He had an older sister,antoinette, and younger brothers

(20:08):
, ralph Jr and Stephen.
They lived a life of privilege,having all their wants and
desires fulfilled.
They lived a life of privilege,having all their wants and
desires fulfilled.
Dr Ralph Pignataro wanted hisfamily to have only the best and
Anthony idolized his father.
Dr Ralph was also belovedthroughout Buffalo.
Deborah Rago was born in ErieCounty, new York, on July 22,

(20:30):
1957.
Her mother, caroline, was ahousewife and her father, frank,
supported the family with hardphysical labor.
She had an older brother andshe was the little girl her
parents had hoped for.
Her family was close-knit andloving.
They worked hard and they spenttime together when they could.
There weren't many luxuries tobe had, but there was a lot of

(20:51):
joy.
Debbie started working at 16.
She worked retail at a mall andlater got a job as a pharmacy
technician.
In early July 1978, debbie met atall, dark, handsome Anthony at
a dance.
They began dating and fell inlove.
Debbie was so enamored with hisintelligence and charisma that

(21:13):
she overlooked the fact that heoften said the wrong thing to
people, frequently embarrassingher with his loud and sometimes
rude remarks that hurt otherpeople's feelings.
She excused his behaviorbecause he seemed so oblivious
that he'd said anything wrong.
They continued dating and theybecame very serious.
But Anthony said that hecouldn't marry Debbie until he

(21:35):
decided on a career.
He wanted to go into medicineto please his father, but he
felt he could be good atanything he set his mind to.
Anthony said that while hedidn't want to let his father
down, he also didn't want to lethimself down.
He explained that he'd beenblessed with special gifts and
possessed intellectualcapacities far beyond those of

(21:55):
most men.

Speaker 1 (21:58):
Anyone feeling sick oh my God, I don't know if you
guys heard my head rollingaround.

Speaker 2 (22:07):
Dude, get over yourself, it gets worse Anyway.
So he thought he should go intocomputers, because most people
had no idea how vital computerswould become, he told Debbie.
But then again he wasfascinated by the prospect of
becoming Dr Anthony Pignataro.
He liked the idea of eventuallybeing able to work side by side
with his father.
Anthony took self-confidence tonew heights.

(22:30):
He was full of hubris, butDebbie chose to see his
confidence as his strengthrather than an overblown ego.
In the end, anthony decided toapply to medical school, which
pleased his father immensely,even though Anthony's older
sister had gone into medicine.
Neither of his brothers had, soI guess it didn't count because

(22:51):
she was a woman and Dr Ralphalways wanted to have his son to
practice medicine with yeah, Imean right on?
no really, guys.
Come on.
Debbie knew it would be a longhaul before anthony finished
medical school.
She didn't mind.
After all, she and anthony wereboth deeply in love with.

(23:15):
Anthony.

Speaker 1 (23:19):
Do you see what I did there?

Speaker 2 (23:20):
I see what you did there.

Speaker 1 (23:21):
I hate it for her, but I like what you did there.

Speaker 2 (23:24):
She vowed to help him and support him as he made his
way through medical school andhis residency.
To his absolute shock, anthonywas not accepted at any medical
school on the mainland of theUnited States.
He just did not Let go loser.
Anthony did not make the cut.

(23:45):
Perhaps it had something to dowith the fact that he did almost
nothing to prepare for the MCAT, believing that his
intelligence was obviously goingto help him sail through the
exam.

Speaker 1 (24:02):
Oh, of course I'm Anthony.
I don't need to study for theMCAT.

Speaker 2 (24:07):
The only medical school that was willing to take
him on was the unaccredited SanJuan Bautista School of Medicine
in Hathoray, puerto Rico.
The tuition was almost as highas the tuition at Harvard at the
time.
No worries, daddy Ralph paidthe bill to the tune of $24,000
a year, plus all of Tony'sliving expenses in Puerto Rico.

(24:30):
Okay, I'm so happy to see thatyou have the equivalency to

(24:54):
today's money, because I waslike okay, other estimates that
suggest it could be around98,755 in 2025.

Speaker 1 (25:01):
Which I'm like.
Obviously I didn't go to medschool, but that seems like on
par for what med school costs.

Speaker 2 (25:06):
No, yeah right.
I don't know.

Speaker 1 (25:09):
If you know, please write in.
Thank you.
We love learning new things,thank you.

Speaker 2 (25:14):
And it's a lot of money.
You and guess what?
The classes were taught inspanish, in spanish, and he
didn't speak spanish oh my god,what a poop I like.

Speaker 1 (25:27):
Should that not have been a qualification to be
accepted?
How did you fill out theapplication so?

Speaker 2 (25:34):
yeah, boy had to learn fairly quickly, but nobody
actually can tell whether ornot he graduated, because he
left after two years andtypically it's four years for an
md.
You know, we can draw our ownconclusions there.

(25:55):
But Debbie and Anthony werefinally married on June 15, 1985
, which was almost eight yearsafter Debbie had her first dance
with Anthony.

Speaker 1 (26:06):
Yay.

Speaker 2 (26:06):
Ralph.
No Things were looking up forAnthony.
His dad secured him a residencyat St Agnes Hospital thanks Dan
in Baltimore, maryland.
The facility was a satellitehospital of Johns Hopkins, but
the prestigious university'sadministration didn't entirely
run its facilities.

(26:27):
Of course, though, anthony wentaround telling everyone that he
worked at Johns Hopkins.
He definitely used the name toinflate his importance whenever
he could drop it intoconversation.
He opted to transition fromOB-GYN because quote female
problems didn't interest him.
End quote.
I mean, why would you go?

(26:47):
And that's all you're going tofind there Just rocking in my
chair back and forth?
Why would you go into OB-GYN ifyou don't care about female
problems?
What an asshole dude he's like.

Speaker 1 (27:01):
I guess I'll see women in clinic, but not if they
have a problem so the author oflast, last dance, last chance?

Speaker 2 (27:11):
I mean, it's only women's problems, am I right?
You can't, you can't have anyother problems.

Speaker 1 (27:17):
Why do people go to the freaking doctor?
You fuck, I'm just like anyspecialty.
If they didn't have a fuckingproblem, they wouldn't be at the
doctor.
If you're an OB-GYN, do youknow what it means to be a care
provider?
You fuckweasel.
None of them have a problem.

Speaker 2 (27:34):
Anyway, dude, provider, you fuck weasel.
None of them have a problemanyway, dude, did he not look up
what it meant before he wentinto?
Oh my god, anyway.
Uh, no, well, thank god forwomen all over that he decided
not to go into that, although,yeah, god anyway.
So in the book last dance, lastchance and rule surmised that

(27:55):
it was because he was attractedto this field merely because he
wanted the glory of being to bethe person, or getting to be the
person, that handed the parentstheir new baby.
So that appealed to his ego andnothing else.

Speaker 1 (28:07):
He's like oh, look at me, I'm God.
He's your baby.
It's like no, I grew that Handit over.

Speaker 2 (28:13):
Thanks, I think she was right on.

Speaker 1 (28:15):
Thank you for bringing it from one threshold
to the other.
I'm handed over.
Thank you.

Speaker 2 (28:21):
At any rate, he ended up choosing general surgery,
likely to follow in his dad'sfootsteps.
So that meant that he was oncall every third night and when
he was home he was sleeping orstudying.
So Debbie longed for the timewhen he would have his own
private practice and they couldbe a family.
Debbie went to work in aplastic surgeon's office to earn

(28:41):
money to help support herfamily and two years later, in
April 1987, she gave birth totheir son that they named Ralph
after Anthony's father.
But Anthony started to growmore and more distant Red flag,
which hardly seemed possiblesince he wasn't home much.
To begin with, he begancriticizing Debbie's weight and

(29:03):
appearance, pointing out that hewould work out at Gold's Gym
every day for hours.
But what was she doing to stayfit?
Meanwhile, he insisted on hercooking the things that he liked
, regardless of whether she wastrying to eat healthier to
please him.
Now feel free, Go ahead andrant.

(29:24):
I just want to punch this guyso hard.

Speaker 1 (29:28):
I'm just like I'm at home raising baby Ralph, Keeping
our household together.
Oh, and I had to get workbecause you suck, so how about
rub my feet?
You fuck.

Speaker 2 (29:42):
Exactly.

Speaker 1 (29:45):
And my appearance.
I'm sorry.
I grew a human being.

Speaker 2 (29:49):
Yes, yes, really honestly, you should have been
burned at the stake, but anyway,we're going gonna get less than
that, but all right.
So the phone calls.
Phone calls started, a woman'svoice and then a hang-up.
And then someone left acassette tape in the back of
debbie's car.

Speaker 1 (30:08):
It was recorded for our young listeners a cassette
tape no, seriously, cassettetape was.

Speaker 2 (30:15):
How do you explain a cassette tape, amanda?

Speaker 1 (30:18):
I know I'm, I know I'm like okay, so it has,
because I'm like do we stillcall it film if it's just audio?
I mean like, okay, younglisteners, if you can remember
back to what like a videotapewas, it's a mini version of a
videotape and it only has audioon it, but it was literal tape,
like you had to rewind it andfast forward it and like you
couldn't on it, but it wasliteral tape, like you had to
rewind it and fast forward itand like you couldn't pull it
out of the thing just like a vcor yeah, like a videotape oh god

(30:42):
, whatever I mean, and when yourewind them, it went it did, and
we used to make mixtapes forour friends which was pretty
much like a spotify list oh mygosh.
Yeah, you used to wait till thetop nine at nine came on and you
had to like hit it right at theright time, or you like missed
your favorite song.

Speaker 2 (31:01):
You're like no, but there was commercial breaks,
because you know what friends wedidn't have spotify back then,
that's actually a really newthing anyway, this cassette tape
was in the back seat ofdebbie's car, so it was planted
there, and it was a recording ofAnthony flirting with another
woman, so it was clear that hewas having an affair.
Heartbroken, debbie called herfather for advice.

(31:22):
Her father, an Italianimmigrant, said Forgive, but
only once, and so she did.

Speaker 1 (31:33):
Or I'll cut him, is what he should have said.

Speaker 2 (31:35):
There was a brief honeymoon period during which
Anthony was doting and contriteuntil his contract at St Agnes
wasn't renewed, which he neededin order to become a
board-certified surgeon.
So he was humiliated.
The family moved back toBuffalo, where they lived with

(31:57):
Anthony's parents for a while,before moving into a place of
their own.
Anthony took a job that he feltwas way beneath his stature,
working at a walk-in emergencycenter.
On the contrary, he proved hewasn't even qualified enough for
this job.
He missed a crucial diagnosisof bacterial endocarditis, which
is a severe inflammation in thelining of the heart and that
can be deadly if it's nottreated in time.
Patients with this conditionexperience symptoms like chest
pain, fever with chills,shortness of breath and possibly

(32:20):
irregular heartbeats.
Anthony failed to consider thisillness as a possibility, and
that turned out to be fatal forthe patient.
The patient died and Anthonywas hit with a wrongful death
lawsuit, which was eventuallydropped.
Anthony viewed this as a luckybreak and that his own
involvement was more of a sadcoincidence, rather than taking
any responsibility for it.

Speaker 1 (32:42):
And at this point I'm still like did you even
graduate school?

Speaker 2 (32:45):
Because you were only there for two years so he
somehow landed a residency atGeorgetown University in DC, and
when Debbie moved there withRalph to join them a month later
, he carried on verbal abusingher.
He would say stuff like haveyou looked at yourself in the
mirror lately?
Do you think I want to be withsomeone who looks like that?
I just want to punch this guyin the throat so badly right.

(33:07):
All of a sudden, anthony decidedhe didn't want to be a general
surgeon.
After all, he was going tospecialize in otolaryngology.
To make this decision afterspending over a decade of his
life on education and trainingwas virtually unheard of.
He'd started his undergraduatedegree in 1976 and medical
school in 1983.
And now, in 1987, all he had toshow for all this was a half

(33:31):
completed residency experience.
He still did not have the sameprivileges as a board-certified
doctor, and yet he was notdeterred from chasing this new
specialty, even though itrequired him to switch his focus
yet again.
Otolaryngology residencies aresignificantly longer, lasting a
minimum of five years, comparedto other specialties that may
need only three or four years.

(33:52):
Of course, tony's passion forhis new focus was not about
sinus problems or ear-relatedconditions, nor was it about
helping to cure head and neckcancers.
Nope, he was all aboutappearances.
Elective plastic surgery waswhat really appealed to him and
knowing what we've learned abouthim thus far, it makes perfect
sense.
Incidentally, there's no shadeto people who've undergone or

(34:16):
who are interested in plasticsurgery.
I just found it telling that hewasn't drawn to any of his
passions for altruistic reasons,like helping people boost their
self-esteem.
He was merely in it for themoney and the prestige.
Unfortunately, his newfoundinterest didn't improve his
attitude and he continued to bean asshole to everyone around
him.
Staff members and colleagues atGeorgetown detested him,

(34:39):
finding him conceited andself-serving.
For example, on New Year's Eve1988, when he was 30 years old,
he was supposed to be coveringthe ER, but instead he walked
out in the middle of his shiftto get drunk at a nearby bar.
He walked out in the middle ofhis shift to get drunk at a
nearby bar.
By some miracle he didn't getkicked out of the program, but
he didn't even appreciate thatfact.
Instead he griped and moanedabout everyone was out to get

(35:02):
him.
He was the victim.
They're all idiots atGeorgetown, blah, blah, blah.
In the middle of his secondyear there he left to try a
different program.
This one was at ThomasJefferson University Hospital in
Philadelphia.
Since he didn't finish atGeorgetown, he was going to have
to do another two to threeyears at this facility.
Ever faithful, debbie continuedto accept the changes and

(35:25):
accommodate her husband'sselfishness.
In June 1990, they moved north.
By that point Debbie had givenbirth to their daughter, lauren.
Now Debbie was essentially asingle parent to two little
children, too far away from herfamily or in-laws to receive any
help.
Funnily enough, anthony didn'tseem to be able to outrun his

(35:46):
troubles.
Shockingly, people at ThomasJefferson didn't seem to like
him any more than his colleaguesat Georgetown.
What are the odds?
Anthony supposed that peoplewere jealous of him.
That's why they didn't seem tolike him any more than his
colleagues at Georgetown.
What are the odds?
Anthony supposed that peoplewere jealous of him.
That's why they didn't like him.
After all, he came fromprestigious programs like Johns
Hopkins and Georgetown.
Maybe that explains his scores.

(36:08):
After his first year, doctorshad to score residents on a
scale of one to five.
Typically, successful residentsachieve a grade of at least a 4
.
Anthony scored between 1 and2.5 across the board.
I mean, would you want this guyup your sinuses?
No thanks.
One comment from his evaluationdescribed him as a medical

(36:31):
sociopath.
From his evaluation describedhim as a medical sociopath.
Another comment warned thatAnthony shouldn't be rehired for
his second year of residency,fearing that lives are truly at
stake.
It seemed that Anthony may havehad as much of a problem with
his skills as he did with hispersonality, so he was not

(36:51):
invited back, and here he wasfailing out of his third
residency in six years and alsoin regards to the comments and
the scores.

Speaker 1 (37:06):
I feel like when people are scoring, grading
rating, whatever their students,we try to give them the benefit
of the doubt.
Yeah, because it's like youlike them as a person, yeah,
give them the benefit of doubtand like you don't want to,
unless it's truly like youshould not hire this person,

(37:26):
you're gonna be like graze overit.
You know like no, they werefine, you know whatever, but for
someone, because also itreflects on the program.

Speaker 2 (37:35):
You know, if you didn't adequately prepare
someone, so I mean it's it'sdamning on either end.
You don't want to be known forpromoting somebody who's
inadequate, but you also like,yeah, feel for the person.

Speaker 1 (37:49):
There's always some good quality you can latch on to
and try and highlight so thatyou can put the best forward,
and not necessarily but forsomeone to screw their odds for
having a career, but they didnot hesitate literally describe
you in the notes as a medicalsociopath and say that lives are

(38:10):
truly at stake.
I mean right how do red flags?

Speaker 2 (38:13):
be a fly-in.
Bless them for being honestabout it though, oh my gosh.

Speaker 1 (38:18):
Yes, absolutely.

Speaker 2 (38:18):
So board certification exams for an
initial specialty need to betaken within seven years of
completing medical school.
So our Tony was out of time.
He was ineligible to take anyboard exams administered by the
American Board of Otolaryngologyand it made it doubtful that
he'd ever be hired anywhere.
So Anthony balked.

(38:39):
He told his wife that theseprograms were out to get him
ever the victim.
Yeah, they were out topigeonhole him and he wasn't
going to conform to their whims,whims, okay, is it whimsical to
promote patient safety?
I don't know.
So he figured he'd had enoughexperience.
He was ready for patients.
So time to move back to WestSeneca Now.

(39:01):
Board certification is notrequired in order to practice
medicine, but most hospitalsrequire it to ensure that high
quality staff are employed andalso to reduce liability in the
case of malpractice lawsuitscoming up.
So Anthony would definitelyhave a super hard time getting
hired as an ENT without it.

(39:22):
But that didn't stop him.
He made a plan If he couldn'tget privileges on his own merit,
he would work for someone whocould.
He discovered an elderlyphysician on medical leave who
was recovering from a coronarybypass and offered to help him
several days a week to cover hispractice.
Because they worked together,he was granted hospital
privileges to see their mutualpatients.

(39:44):
In 1992, the Wyoming CountyCommunity Hospital granted him
access to its facility.
He was employed as an assistant, but he would still be allowed
to treat patients.
Somehow he schemed his way intoworking at a second hospital as
well, our Lady of Victory,where he would be allowed to run
his own surgeries.
But this con didn't last toolong.

(40:06):
In February 1993, he operatedon a 71-year-old patient at Our
Lady of Victory.
The surgery was to extract alaryngeal tumor for biopsy.
Since this was a surgery deepin the throat, the airway was of
particular importance becausecomplications would compromise
airflow, like swelling orbleeding.

(40:27):
Additionally, there's a risk ofinfection and also compromising
a patient's vocal folds, asthey're vulnerable in this type
of surgery.
But Anthony didn't secure theairway and swelling ensued.
The patient died, I know he wasthen restricted from performing
any surgeries after 1 pm andbefore 1 pm had to be
accompanied by another surgeonto monitor him.

(40:48):
Right, they must haveconsidered this an accident.
But seriously he was luckybecause they should have canned
his ass.
His contract at the hospitalwas set to expire in september
that year and, not surprisingly,it was not renewed.
Anthony continued to assist atthe first hospital, but he
screwed up there as well.
He operated on a 30 year oldman's deviated septum in August

(41:12):
of 1994 and nicked the outerlayer of the brain so that CSF
cerebrospinal fluid leaked intothe patient's nasal passages.
This placed the patient at riskof meningitis, severe nerve
damage or brain abscess.
These are risks that areinherent to this type of surgery
, but instead of acknowledgingthem, he completed the procedure

(41:33):
and said nothing to anyone.
Luckily, the patient survivedin spite of him, however, the
news reached an ENT specialistat the hospital who questioned
whether Anthony had thenecessary credentials to perform
the invasive procedure in thefirst place.
So the next day the WyomingCounty Community Hospital
canceled his privileges Around.

(41:55):
This time the elderly physicianhe was covering for returned to
work and no longer needed Tony'sassistance.
So Tony applied to work in ENTand plastic surgery at two
different facilities in New York.
Neither place was interestedbecause he couldn't prove that
he'd been board certified ineither specialty.
So he didn't have a prayer.
To circumvent this.

(42:15):
He appealed to the AmericanBoard of Cosmetic Surgery and
Facial Cosmetic Surgery,requesting certification.
This was something that anexperienced ENT doctor would
have been able to achieve oncethey completed an additional
one-year fellowship in cosmeticsurgery, but that would mean
he'd have to have anotolaryngology diploma.
Since Anthony didn't have thatdiploma, he turned to the Thomas

(42:40):
Jefferson University Hospitalin Philadelphia for help.
His last residency program,anthony thought that one of the
chairpersons may have sabotagedhim.
To gain eligibility for theexams, he sued the residency
program.
He hoped to prove in court thathe was qualified and had been
misjudged by those overseeinghis advancement.
To make his case, he selected aphysician that he thought would

(43:02):
treat him favorably and askedthis man to write a report on
his behalf.
So this doctor had to work asan investigator and interview
various specialists who'dactually worked with Anthony
during his program and thenwrite a conclusion.
The plan backfired, however.
The statement that theinvestigating physician provided
the courts with describedAnthony as a lazy loser who did

(43:24):
not respond to constructivefeedback and would routinely
show up late for rounds,constantly claim that he'd
completed work he'd not done,lie about having seen intensive
care unit patients that hedidn't see, fabricate laboratory
data, fabricate physical examdata, fabricate information
about post-op patients that he'dactually not seen, and the list

(43:45):
went on and on and on.
So this didn't do anything todeter Anthony, but instead he
said the report was unusable forhis defense and he dropped the
suit.
So I mean any one of us wouldjust want to just go take
ourselves out to pasture andshoot ourselves.
I mean that's just so awful.

(44:06):
But it was never his fault, hewas always the victim.
His father was always thevictim.
So now it was the spring of 1995, and Anthony had to find a
different way to prove hislegitimacy as an ENT physician
surgeon to the American Board ofCosmetic Surgery and Facial
Cosmetic Surgery, because in hismind he was well-qualified.

(44:26):
So he just didn't have thatpesky residency diploma.
So in his inimitable ballsyapproach he faked one.
His vague diploma said hecompleted an ENT residency at
Thomas Jefferson UniversityHospital on October 31st 1991.
Halloween, spooky and fitting.

Speaker 1 (44:49):
You're going to make one up from the place.
You just called for help andyou found out you couldn't get
it.

Speaker 2 (44:54):
But even if he had completed the residency there,
the date would have been toosoon for him to have finished it
.
But whatever, the board didn'tfollow up.
Apparently they permitted himto take the exam and in April
1995, he passed.
This secured Anthony theaccreditation that he needed to
offer plastic surgery at his ownprivate practice.
I mean, on false pretenses.

Speaker 1 (45:15):
I'm shocked he passed .

Speaker 2 (45:17):
Yeah as well.
Yeah, so Anthony set up his ownpractice with the help of his
wife.
Debbie handled his books andthey purchased the basics for
the office, including examiningroom, furniture and equipment,
as well as malpractice insurance.
Anthony planned to have anoperating room in the basement
of the building, but this wouldtake longer.
He wanted to reach a pointwhere he was autonomous and

(45:39):
would never again have to dependon anyone but himself.
If he had his own operatingroom, it wouldn't matter that
hospitals didn't accept him.
Initially, anthony began seeingbasic ENT patients with ENT
problems.
Except on Wednesdays,wednesdays were days reserved
for what he called his quotecurrent research endeavor, end

(45:59):
quote.
He was searching for thatirresistible service that would
bring people through the doorand make him a lot of money.
He wanted to invent somethingthat would make him rich and
famous.

Speaker 1 (46:11):
Like maybe do that on a Saturday, because actually
you're not making any money atall on wednesdays.
So like, bro, maybe afterdinner like homework or saturday
, sunday even, like it's notlike you're hanging out with
debbie anyway I don't know.

Speaker 2 (46:30):
It's pretty gruesome.
He started by working on femalecadavers and was implanting
wires for what he called animplantable bra what does
literally my favorite yeah,under the skin taking the bra
off.

Speaker 1 (46:45):
Can I get a permanent one?

Speaker 2 (46:47):
no, thank you, and a wire, implanting these wires
into these cadaver boobs andlike trying to string them up
and he knows nothing about what.

Speaker 1 (46:59):
Can you imagine?

Speaker 2 (47:00):
they're from me, I'll take your bra off, oh, and then
permanently being poked, but ohman fuck no, especially one
with a real.

Speaker 1 (47:09):
It was a real wire too.

Speaker 2 (47:11):
Oh my god, no, do God , absolutely not, no.

Speaker 1 (47:13):
Do not even own.
Fuck that Weirdly Do they evensell those?

Speaker 2 (47:18):
anymore.
Oh, the external ones, probablyWith a real wire.

Speaker 1 (47:24):
Internal.
I mean are people buying?
Hey guys, are people stillbuying?
Okay, well, I will say the.
I can tell you who's notselling those Handfulcom.

Speaker 2 (47:33):
Handful.
They are not.
Handfulcom Promo code stayssuspicious.
Anyway, weirdly, hisimplantable bra never got off
the ground Joking.
But his next invention gainedhim notoriety A snap-on toupee.
Oh, okay.

(47:53):
So Bras to hair anthony.
Anthony and his dad had agenetic predisposition to male
pattern baldness and anthonybegan to lose his hair in his
mid-20s, which you know forsomebody super vain this.
You're so vain you probablyworry about your hair falling
out.
Yeah, douchebag, douchebag Inhis 20s.

(48:16):
So he learned about the variousways that titanium can be used
in body implants and we knowabout that.
In audiology we have titaniumimplants for bone conduction,
hearing solutions and otherthings.
But anyway, he wanted to applythis technology to attach a
hairpiece to a person's headssemi-permanently.

(48:39):
But how to get this off theground?
Who would volunteer their headfor his research?
He thought of Cy Sperling, thepresident of Hair Club for Men,
the famous commercial where hesays I'm not only the president,
I'm a client.
That was it for Anthony.
He knew he had to do it on hisown.

(49:00):
His father took some convincingbut eventually agreed to
implant four titanium screwswith an abutment that snapped
into the opposite couplingadhered to a hairpiece.
After three months ofosseointegration the hairpiece
went on and it worked.
Suddenly, with media coverage,men would fly into Anthony's
practice for hairpieces of theirown.
He was featured on variousshows, including CBS Nightly

(49:24):
News and the Maury Povich Show.
In each show he demonstratedhis hair implant device.
Imagine it.

Speaker 1 (49:36):
Pop, pop, pop, pop.
Voila, I'm not bald anymore,imagine it.

Speaker 2 (49:40):
I mean, I guess you don't have to worry about like a
strong breeze coming throughbecause that baby is snapped on
andrew's book describes how anthAnthony felt so relaxed and
casual during his hairtransplant surgeries that he
sometimes ordered pizza to eatduring the procedure, and one
patient recounted how theyjoined him by eating the pizza.

(50:03):
The patient ate the pizza aswell during the surgery.
Money started rolling in and hewas living the big life.
He celebrated his success bydriving a red Lamborghini and
sending expensive gifts to astripper whose breasts that he'd
enlarged With his pop, pop, pop, pop, pop snap on wig.

(50:25):
Anthony was on the rise to thesuccessful plastic surgeon he'd
always dreamed of being.
However, he didn't stay on topfor long because, unlike his
hair, money and fame didn'tcompensate for a lack of
experience and proper training.
In August of 1997, 39-year-oldTerry Lamotti headed into

(50:47):
Anthony's office for aliposuction procedure.
Shortly after arriving, she wasgiven some pills and asked to
sit in the lobby.
She remembers feeling woozy andunfocused and being brought
down to the basement operatingroom of Dr Pignataro's practice.
Even in her medicated state,she became concerned because the
basement didn't appear to be aproper facility and her gut told

(51:09):
her that something was wrong.
When she woke up at five thatevening, remember, she went in
in the morning.
She woke up at five.
She was fully dressed somehow,and her husband drove her home.
She didn't feel right.
She began hemorrhaging blood.
Terry's husband called Pinotaro, who reassured him it was just
blood-tinged fluid and it wasperfectly normal, so there was

(51:30):
no need to worry.
Meanwhile, Terry discoveredjagged wounds between staples
that seemed to have been placedhaphazardly across her abdomen.
She was in terrible pain.
Her family took her to theemergency room the next morning
and it turned out that Terry'sintestine had been cut during
the surgery and she was septicand the staples were cutting off
her blood supply to her abdomen.

(51:54):
Typically, liposuction onlyrequires a few small incisions
for that fat-sucking cannula toenter, but she had 18 to 22
stitches all the way across herbelly.
The wounds were lefthalf-opened and not sutured.
If Terry hadn't gone to thehospital when she did, she would
have likely died.
But Anthony was furious.

(52:16):
He snuck into her hospital roomat 2.30 in the morning one day
while she was in recoveryRemember he had no privileges in
this hospital.
He started flipping through herchart and then screaming at her
to go home, that she had noreason to be there.
I mean, how scary for Terry.
But Anthony was forciblyremoved from the premises and
banned from entering, but thiswasn't to be the last victim of

(52:37):
Anthony's, not even that summer.
So next week we'll learn moreabout his victims and other
heinous acts, investigations andoutcomes.

Speaker 1 (52:47):
Oh my God, I am so looking forward to next week.
We're just getting started.
I am so just on the edge of myseat of this story already.

Speaker 2 (53:00):
Yeah, it is crazy, and there is a crazy twist that
you won't see coming.

Speaker 1 (53:07):
God, I love a twist.
I can't wait for next week.
Thank you for bringing this.
We also really needed thisbecause my thing last week was
so freaking depressing.

Speaker 2 (53:18):
Yeah.

Speaker 1 (53:18):
This is perfect, perfectly crazy Snap, snap snap,
snap, snap.
What a friend.

Speaker 2 (53:25):
Pop, pop, pop, pop pop.
Just picture him like pullinghis toupee off and then waving
around victoriously.

Speaker 1 (53:33):
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yeah, okay.
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Speaker 2 (55:20):
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Write in, tell us about yourexperiences with stand shoes,
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So thank you for that.

(55:41):
Is it time for our medicalmishappening?
It's this time.
Well, so this time we got anemail the title of which says
the mystery of the missingscalpel.
Oh boy, it started.
Yeah, it doesn't sound good.
Dear amanda and jenna, I'm abig fan of your podcast and it

(56:03):
makes me, alternatively, laugh,cry and cringe as I learn about
important issues in health care.
With your funny quote bestfriends chatting around the
coffee table, quote style.
Aw, thank you, we're a big fanof you, they write.
I've been a surgical nurse forover 15 years.
You name it, I've seen it,except for the day that made me

(56:24):
question reality.
It was a routine gallbladderremoval, straightforward.
Our surgeon was experienced,the patient was stable and the
atmosphere was relaxed enoughthat someone actually said this
will be a quick one.
Oh man, rookie, mistake younever say that.
No, knock on wood, knock on wood.
It's like if you don't saybreak a leg, instead you say

(56:47):
good luck when someone goes onstage, it's just bad luck, right
?
So anyway, that was me.
The email goes on to say midwaythrough the operation, during
our final instrument count, wecome up short One scalpel blade
missing.
Oh no, now, if you've ever beenin an OR, losing an instrument
is like losing a baby on a plane.

Speaker 1 (57:09):
Seriously.

Speaker 2 (57:12):
Every protocol slams into place.
We count again, we check thefloor, we check the patient's
drapes, trash even the surgeon'spockets Nothing.
The x-ray tech is called inbecause if a blade is inside the
patient we need to knowimmediately.
Everyone is dead, silent,staring at the monitor but
nothing shows up Clean, clear,no blade.

(57:32):
Then the anesthesiologistclears his throat and says Guys,
we turn.
He points to the ceiling vent.
There, wedged in the grate,gleaming like Excalibur, is our
missing scalpel.
It has been flicked by accidentduring a handoff, hit the vent
at the perfect angle and lodgedthere like some modern art

(57:54):
installation.
The room erupted half relief,half disbelief.
The patient came through fine,never knowing they were nearly
the star of a medical mystery.
And myself, well, I now triplecount instruments and check the
ceiling.
Thanks for reading this on theshow.
If you do, I'll freak out.
Love Dee, I'll be freaking out.

(58:15):
Dee, love Dee.
Go ahead and freak out, freakout, go ahead, have a freak out,
freak out, for sure.
I obviously thought it was avacation.

Speaker 1 (58:26):
How did they get on the ceiling I know, and then the
ceiling?
Was like wait what is there, ohmy, somebody must have been
very.
It was obviously very sharpplayed and somebody was very
quick to flick and then likethen kind of didn't fall Flick.

Speaker 2 (58:37):
I don't know if it's that sharp Quick to flick.
I know that's a bit crazy.
Thanks, Dee.

Speaker 1 (58:45):
Thanks, dee.
Well, I guess we already knowwhat's coming up next week.
Can't wait for part two of thisDoogie McScoogie.
So until then, don't miss abeat.
Subscribe or follow Doctoringthe Truth wherever you enjoy
your podcasts, for stories thatshock, intrigue and educate.
Trust, after all, is a delicatething.
You can text us directly on ourwebsite at

(59:06):
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(59:27):
bring you more content next week.
Until then, guys, stay safe andstay suspicious.

Speaker 2 (59:37):
Goodbye, goodbye, goodbye, goodbye what happened
to my mouth.

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