The Murder in Exam Room 15
Fit, with thick, dark hair and an inviting smile, Davidson grew up in the shadows of the Santa Monica Mountains, north of Beverly Hills, California. Son of a cardiologist father and a mother who taught high school science, Davidson was precocious and smart. At age five he was reading music and playing the violin. His mother, Susan, remembers him as a boy of “too many talents”: Davidson taught himself the piano, mastered the first wave of personal computers, and kept his family laughing with Monty Python impressions. By the time he reached the ripe old age of 10, his mother took him to an open house at UCLA, where an exhibit on heart surgery awed him. That night, he announced to his family his intention to become a cardiac surgeon.
Davidson was as bashful as he was bright. When people asked where he went to college, he’d answer New Jersey, not Princeton, where as an undergrad he began grappling with the inequity plaguing America’s healthcare system. His thesis presented a social-justice argument for universalizing healthcare in America. “We spend more per capita on healthcare than in any other country in the world, yet our overall health compares poorly with that of other developed nations,” he wrote. “Shifting the focus toward positive health rather than desperate measures may be the best prescription for the future of healthcare.”
After Princeton, Davidson blazed through Yale School of Medicine and residencies at Duke—where he met his future wife, Terri—and at the Brigham. Pasceri wasn’t by any means the first aggrieved family member Davidson had come across in his career; almost all surgeons have had unpleasant encounters with a patient or a patient’s relative, especially surgeons such as Davidson, whose docket was consistently booked with high-risk patients. But some of Davidson’s friends think there’s a new wave of patient discontent brewing, driven in part by the demonization of physicians in the media.
“Part of the whole debate over healthcare reform has been labeling physicians as the bad people,” says Joshua Rosenow, a Northwestern University neurosurgeon who was Davidson’s roommate during medical school and remained a close friend until his death. “We’re wasteful. We inappropriately order tests. We can get bought off for a Twinkie, a lunch, and a Post-it note pad. That ends up generating these ideas in people’s heads that the doctors are bad people. And gosh darn it, this guy operated on my mom and she died and he’s going to pay.”
A tirade on healthgrades.com, a knee-jerk malpractice lawsuit, an act of violence—they’re all symptomatic of the rapidly decaying patient-doctor relationship, says Shirie Leng, a retired anesthesiologist and family friend of the Davidsons. Moreover, our culture of litigation has given rise to a system in which surgeons are rewarded for practicing what Leng calls “cover-your-ass medicine.” In other words: avoid high-risk patients and lower your chances of being nailed with a lawsuit or confronted by a disgruntled next of kin.
Davidson had made a conscious decision not to practice medicine that way. As he rose through the surgical ranks, he didn’t steer away from patients whose chances were slim—in fact, he specialized in them. “He was torn,” his father, Robert Davidson, says. “He would take every case that had a chance of succeeding at surgery, even with extremely high risks, and he would do them. And he would call me in his early days and he would be very discouraged because many of these patients were dying. The fact is that they would have died without surgery. Many of them lived who would have died had they not had surgery…. But he took on cases that most surgeons wouldn’t have attempted.”
By taking on the riskiest cases, Davidson regularly shouldered an abnormally heavy load of life-or-death surgeries in which life was never guaranteed. Tempering patients’ expectations was part of his daily routine. Over the years, he spent thousands of hours in conversations with patients and their families, explaining that they might not come out of the operating room alive. It’s a daunting task in a culture that’s notoriously bad at preparing for the end of life and blissfully bullish on the promise of medical technology. Somehow, though, Davidson always inspired optimism, even as the cardiologist explained to families that he couldn’t work miracles and that not all hearts can be mended.
In the summer of 2014, Marguerite Pasceri struggled to catch her breath. It wasn’t the first time her heart had come under strain.
For nearly 50 years Marguerite smoked Newports, finally giving up cigarettes only after a quadruple bypass in 2002. About 18 months later, doctors found she was suffering from a blockage in an artery; she underwent surgery at UMass Memorial Medical Center to clear it. “Butchered,” her daughter, Marguerite Joly, says of the procedure, which she believes was unnecessarily invasive. (Citing privacy laws, the hospital declined to comment.)
Recovery proved challenging. While in the hospital, Marguerite developed an infection in one of the incisions on her leg. The shattering pain she’d felt before the surgery soon returned. Joly convinced her mother to seek care at the Brigham from a doctor named Andrew Eisenhauer, one of Davidson’s mentors. After a successful surgery, Marguerite healed quickly and her family developed a lasting gratitude for the hospital, even though it was a long drive from home.
Life moved along for the Worcester-area family until 2011, when a massive heart attack killed Marguerite’s husband, Greg. That tragic event brought a change to their lives: Joly’s estranged brother returned to the fold. Unlike his unassuming dad, Pasceri was controlling and manipulative, prone to bursts of outrage and intimidation. He’d been arrested as a teenager for stealing guns, served in the Army, and eventually settled in the suburbs of Worcester with his wife and four children. His temper carried into adulthood, and he’d alienated several family members over seemingly minor differences. At the time of their father’s death, Joly hadn’t had a relationship with her brother in approximately 20 years; she’d cut ties with Pasceri in the early 1990s after he threatened to sue her and her husband over a dispute involving some unfinished handiwork. “I wouldn’t say my father’s death reconnected us,” Joly says, “but [afterward] I’d stay in the room with him for more than five minutes.”
Pasceri was heartbroken by the loss. But before his father was even buried, he drove to his childhood home and methodically packed his father’s study into boxes. It was an unusual expression of grief, and it upset his mother. “She didn’t understand what was going on,” Joly says. Pasceri’s grief took other forms, as well: Outraged over $8,100 in medical bills resulting from his father’s death, he penned an angry letter to Representative James McGovern and former Senator John Kerry urging them to investigate hospital billing practices. He also told a reporter at the Worcester Telegram & Gazette, “Truth be told, they do it because they can get away with it.”