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up and go make your marriage work.”
    Anthony certainly appeared to be truly repentant. He insisted that he loved her and the baby, and he could not bear the thought of losing her. The other woman didn’t matter at all—she was just some crazy girl. He would never see her again, and he begged Debbie to stay with him and go ahead with their plans until he got another residency. They had too much invested in their marriage—all those years together—to throw it away now.
    Her father’s words played over and over in her head: You forgive once.
    So Debbie did. She had loved Anthony for ten years; she still loved him—and she was pregnant again. She would stay in the marriage. And it wasn’t long before she believed that things were going to be all right again. She wanted so much to believe that.
    They had already decided to leave Baltimore after Anthony had lost his residency at St. Agnes, and it was too late to get into another residency program for the 1987–1988 year. They agreed to move back to Buffalo until Anthony found a better venue for his third year of residency. Debbie was relieved that they were going to be far away from the woman who had called her.
    Together, they packed everything they owned into their car and a rental truck and headed home to New York State. They could stay with the elder Pignataros until they found a place of their own.
    Anthony took a job at a walk-in emergency clinic, the Mercy Ambulatory Care Center, in Orchard Park, New York. In essence, he was a “Doc-in-a-Box,” but he was at least practicing medicine, and he certainly saw any number of injuries, maladies, and illnesses. It was a come-down for him, though; he was in the trenches instead of in the much more rarefied air of a Johns Hopkins’ satellite.
    Anthony began to keep a journal, documenting his reaction to the events of his life and putting forth his philosophies. It would one day become his book, M.D.: Mass Destruction —a paean to himself. This was the manuscript he later sent to me, telling me that his wife, Debbie, was the author. He must have thought it would be better received if someone other than himself wrote it.
    Two years later, he would have more than a hundred pages. The first page began with his accomplishments. Anthony seemed confident that his talent as an author was as brilliant as his skill as a physician. His style was a throw-back to novels from the nineteenth century. It was clear that he wrote with a thesaurus close by—he chose the longest words possible in his almost archaic narrative. He sometimes referred to himself in the third person. The vast majority of his book was about his brilliance as a physician; only occasionally did he mention his family life.
    There were some situations that he didn’t mention at all. He included nothing that might cast a negative light on his prowess as a physician, although he was quick to blame the bad judgment of others.
    Anthony was less than three years out of medical school, and the young doctor didn’t have the experience that older physicians had. All doctors make mistakes once in a while; they are only human, but most of their slips or misdiagnoses are not life-threatening. However, Anthony made a really bad call. He allegedly failed to diagnose a patient who had a severe inflammation of the lining of the heart: bacterial endocarditis. Such an ailment can be mistaken for pleurisy or pneumonia, but it can also be fatal if not treated. This patient died, and a wrongful death suit was filed. Eventually the suit was dropped, but it was a scary thing for both Debbie and Anthony.
    Nevertheless, being back in Buffalo gave the young Pignataros a time of calm in their lives. Everyone fussed over baby Ralph, and it was good to be home again after years away. Even though it tore at Debbie’s heart to see her father so ill—any effort at all made him gasp for breath—he still had the strength of character that endeared him to everyone in his family. To his siblings