neurosurgeon, Dr. Lyle Wacaser, Swango seemed to find a kindred spirit. Wacaser raved about Swango. He would brook no criticism of Swango’s alleged haste, sloppy habits, or indifference to patient care. The two seemed all but inseparable, Swango eagerly accompanying the neurosurgeon on his rounds and into his surgeries. Indeed, Swango had persuaded the nursing staff to beep him on his ambulance pager whenever they learned that one of Wacaser’s patients was about to be admitted. That way Swango was usually on the scene even before Wacaser, and sometimes before the patients themselves. This naturally froze Sweeney out of numerous opportunities for clinical experience, and it hardly endeared Swango to fellow students. (The first-come, first-served system for assigning medical students to patients was subsequently changed.) But naturally, Swango’s eagerness made a favorable impression on Wacaser, who found him remarkably pleasant and industrious. He thought Swango’s patient write-ups were close to perfect.
Wacaser was one of several Springfield doctors in private practice who also served as clinical instructors. He was popular among students and highly respected in his field, and the fact that he championed Swango went a long way to ease student concerns about Swango’s competence. He was also eccentric. Wacaser drove around town in a truck that had emblazoned on it in bold letters, “Lyle Wacaser, M.D., Neurosurgery and Light Hauling.” Recently divorced and in his early fifties, Wacaser would often invite students for post-surgery beers at his spacious office in a house across the street from the hospital, where he displayed the brain of a former patient in a jar of formaldehyde on the fireplace mantel. He also threw numerous parties. His office phone could be connected to the hospital’s public address system; Wacaser would get on the system and announce, “Fluid and electrolyte rounds in progress.” The signal sent medicalstudents flocking to the parties, which were often rowdy affairs where they could blow off steam. But Swango didn’t drink alcohol and, despite his close relationship to Wacaser, never attended the parties. Indeed, after Swango’s surgery rotation ended, Wacaser hardly ever saw him, and later realized that he knew nothing about Swango’s background or personal life, even who his parents were or whether they were alive.
During their third year at SIU medical school, students have significantly more contact with patients and are responsible for hundreds of H & P’s in the course of the year. Swango’s classmate Rosenthal noticed that Swango seemed unusually interested in, even preoccupied with, the sickest patients. The hospital maintained a large blackboard on which were written patient names and treatment remarks. When a patient Swango had seen died, he scrawled “DIED” in large capital letters across the person’s name. Rosenthal and other students found this distasteful, almost as though Swango were celebrating the demise and wanted to call attention to it. When Effie Walls, a kindly patient whom Rosenthal had met, and whom Swango had been treating for an injury, died suddenly after a visit from Swango, he scrawled “DIED” over her name as well. Rosenthal went up to Swango and asked him why he did such a thing. “Don’t you feel bad that she died?”
Swango gave Rosenthal a blank look. “No,” he replied. “That’s just what happens.”
It happened often with Swango. A standing joke among the students was that if they wanted to get rid of a patient, they should assign Swango to do an H & P.
One day Zawodniak mused to Sweeney that unusually often, it seemed, when he assigned Swango to do an H & P, the patient would suddenly “code,” meaning suffer a life-threatening emergency. “Do you think it was just coincidence?” But even as Zawodniak spoke, he dismissed the thought, and the two laughed it off. Swango was correct, after all, that death is a regular occurrence in