Human lives have trajectories that are often complicated, and invariably interesting, when viewed over the span of many years.
Some literary works fascinate us by documenting the life trajectory of a single person. John Updike’s account of the life of the fictional Rabbit Angstrom is a personal favorite of mine, a story that follows his young adulthood to old age over four novels and around a thousand pages.
In my later years I developed an interest in the study of life trajectories, having found myself able to view episodes widely separated in time in the lives of people I’d known in my youth. I may have been inspired by my mother, who would sometimes share her speculations with me about what the future might hold for some of my grade school and high school classmates. She predicted that my friend Dwain, who, as a teenager, was remarkably rebellious and also adept at concealing his borderline-illegal escapades from his parents and school authorities, would become either a criminal or a successful corporate CEO in his adulthood. (Unfortunately the former would prove correct, as I learned decades later. Classmates at the 25th reunion of our high school class, which Dwain did not live to attend, recalled hazily that he was known to be in some way involved in the illicit drug trade before his death and was known to hang out with fast women and drive fast, expensive cars during those years.) In midlife I found myself wondering about other friends from my youth, about how their lives had turned out, and whether their current place in the world could have been predicted from the sorts of people they had been when they were young. I started regularly attending reunions of my high school, college, and medical school graduating classes, beginning with the 25th and the reiterations every 5 or ten years thereafter; I had conversations with the classmates who were similarly motivated to attend such gatherings, and read the autobiographical summaries they produced for these occasions, I’ve sometimes supplemented my knowledge of my subjects by research on the internet, ever since that option became available. I’ve also extended my range of interest to include lives of those who were not classmates, but were people I encountered in other ways during my formative years.
The shapes of the youth-to-retirement life trajectories I’ve learned about are enormously varied. Some seem straight as the course of an arrow and easily predictable. Honor students who graduated from Harvard, that most elite of colleges, who attained success in business or the professions, for example. Others have taken surprising twists and turns and end in unexpected places. Some are inspiring, in that they reveal the overcoming of youthful physical and cognitive impairments; committing to a lifetime of sustained, enormously hard work; or the nurturing of natural gifts to achieve stellar artistic status.
These stories fascinate also because of what they reveal about the character of the person who has lived the life. The actions that have taken place over the greater part of a lifetime can reveal the virtues embedded in the soul. Many lives show a commitment to philanthropy so intense that the underlying compassion for fellow beings is made obvious. Others note artistic achievements flowing from a devotion to beauty and commitment to sharing it with others. So many of these lives have struck me as being equally admirable, and at the same time so different from each other.
Each of these uplifting, positive life stories, obtained by the methods I’ve used, also has a natural limitation. One can know only one dimension of the person’s life, the dimension that is revealed in social conversations and in the public record. Success and personal fulfillment in family and intimate relationships are generally hidden from our eyes, although they also might reveal much about a person’s character, more than we could know from only their public profile.
Some of the life stories in my archive are not nearly so uplifting as those I just alluded to, like that of my friend Dwain. But I’ve come to think that these regrettable life trajectories, lives that went off the rails, hold valuable lessons for us, perhaps even more valuable than those that inspire us.
In that vein, I’m recording here some recollections and research on two lives that went badly astray. Two male physicians I encountered when I was beginning my career in medicine were in later years found guilty of murdering their female domestic partners and were sentenced to prison terms. These two life histories intrigued me immensely; I’ve devoted more time and effort to them than to any others I’ve looked into.
Some of my friends have reacted to my descriptions of these two lives with undisguised distaste. I imagine their unspoken thought is that one’s time and effort are best expended on subjects that are uplifting, not depressing or demoralizing. (There is some resemblance here to Harold Bloom’s argument for reading the classical books of the Western Canon: life gives you only so much time to read books, and since more books have been written and published than any one person could possibly read, you should limit the number of books on your lifetime reading list, prioritizing books acknowledged as great, books that enrich the lives of their readers.)
The counterargument, or the counter-metaphor, is to be found in how we—we civilized people—deal with disasters. We collectively spend enormously more time and energy studying the flight of an airliner that has crashed, or the course of a ship that has sunk, than on flights or voyages that were successful. We are driven to understand the details of what’s happened, when we see something has gone horribly wrong. It is a sad task to undertake, to confront an event that has taken the lives of our fellow beings, but it must be done, and indeed it is an ennobling enterprise, directing our efforts to prevent similar tragedies in the future.
While the chain of events leading to an airplane crash is of interest primarily to experts in aeronautics and engineering, those who design and pilot aircraft themselves, it seems to me the study of human lives gone off the rails should command the attention of all of us. We all must design lives for ourselves and must live with the results when our lives are played out.
I would imagine that every one of us, when learning to operate a new piece of complicated machinery, would try to find out what could go wrong when using it for the first time. What mistakes could one make that might cause the most serious damage, or, worse yet, injure oneself or another person? I would ask this first, before I even thought about the various add-on options and enhancements for the machine. Isn’t this a prudent thing to do? Wouldn’t it be reasonable, at least at times, to think of the living of our lives this way?
The lives of the two murderers were of particular concern to me because both seemed to defy popular conceptions of the kind of person who would murder another. Neither man was given to cruelty, violence, excessive anger, or impulsive acts. Neither’s public persona could have aroused to suspicion of an underlying criminal personality. In fact, in earlier years, both were considered paragons, honored by the medical community and the institutions they served as being at the pinnacle of their profession.
Were the acts they committed totally disconnected from the previous course of their lives? Did they just “snap” at some point, as suggested by the image of “going off the rails?” Or were there shortcomings, personal failings that may have been overlooked in the midst of the accolades, that might have given pause to anyone looking to either as a role model? More disturbing perhaps, can our process of socialization, the family upbringing and schooling we receive in contemporary America, sometimes fail to attune us to traits of others that should warn us about them, alert us that these are not people to emulate?
These are questions I’ve hoped to address by examining these lives.
The internet research I will cite was relatively easy to perform; a trial for murder generates lots of documents in the public record, and the killing of a domestic partner by a formerly esteemed doctor invites coverage in newspapers. Additionally, doctors that go rogue are invariably investigated by their state medical licensing authorities and the results of these investigations also go into the public record.
In the accounts that follow I’ve used the real names of the two men, as well as those of the two women who were their victims. I’ve struggled deciding to do this; it feels like I’m committing a betrayal somehow, especially since one of the men is still living. But what purpose would be served by concealing their identities, since their true names and all the facts relevant to their convictions and deaths have been made public and are accessible on the internet? Identifying them here will allow any reader who is so inclined to research their cases for themselves. I have used pseudonyms for supporting characters.
NORFOLK (UPI) — A police detective says a prominent blood bank director charged with murdering his wife told police he shot the woman after she came at him with a meat cleaver and a steak knife. Testifying Tuesday on the opening day of the trial of Dr. Julian Schorr, Norfolk Det. Tom Pollard quoted the 51-year-old physician as saying he attempted suicide after shooting his wife Phyllis in self-defense. “I threatened if she didn’t stop, I’d shoot her,” Pollard quoted Schorr as telling police. “I kept telling her to stop.” Schorr’s trial before U.S. District Judge Alfred Whitehurst was slated to resume today. Pollard testified that Schorr slashed his own wrists after the Jan. 31 shooting and left three suicide notes. But he then gave up any attempt to kill himself and called his ex-wife, a New York doctor, who notified police. Upon their arrival at the couple’s fashionable Norfolk home, police found the bloodstained body of Mrs. Schorr, 49, under a bed and found Schorr in the bathroom, slumped over the toilet with a razor blade in his hand. In opening arguments, Wayne Lustig, Schorr’s defense attorney, said his client did not commit murder, but was a battered husband who killed his wife in self-defense. “We know from the final analysis that Mrs. Schorr came at Dr. Schorr with a knife and a cleaver and that he was in no position but to fire one warning shot and then two shots in rapid succession,” Lustig told the jury. “This doctor, who is used to saving a life, had to take a life,” Lustig said. But Prosecutor Larry Lawless, in his opening statement, said the crime was murder and not self-defense.
--Suffolk News-Herald [VA], Volume 56, Number 208, 30 August 1978
In preparation for a background court report … Schorr … is writing what amounts to an autobiography focusing on his illustrious medical career, which earned him national acclaim. “I’m on page four now,” Schorr said, flashing one of the few smiles he offered during a three-hour conversation about the Jan. 29 death of his petite and attractive wife Phyllis and the agonizing aftermath. During his four-day trial, he publicly admitted shooting his wife in the neck and chest with a .22 caliber rifle at their home.
-- Suffolk News-Herald [VA], Volume 56, Number 234, 29 September 1978
Dr. Julian Schorr nominally taught me Transfusion Medicine when I did my residency training in anatomic and clinical pathology (“AP-CP”) at the Albert Einstein College of Medicine-affiliated hospitals. He was the director of the blood banks at the Bronx Municipal and Einstein College hospitals, as well as the director of pathology resident training in transfusion medicine in the CP portion of our program. To hold these offices, one must be a physician with proper qualifications, although not necessarily a pathologist. Julian was not. He had obtained his expertise in blood banking technology and management after training as a pediatrician and pediatric hematologist, and he had an ongoing, active clinical pediatric practice while he served on the medical school faculty and oversaw the blood banks.
It was well known among the pathology residents that Dr. Schorr was an absolute zero as a teacher – at least for us in the pathology program. He barely paid lip service to being listed on our faculty roster. In the kindest light, it was said that he refused to teach us about his field because he did not believe blood banks should be administered by pathologists; pathologists did not care for individual patients in their daily practices and transfusions were essentially services to individual patients. Transfusions were also therapeutic rather than diagnostic services, and pathology was essentially a diagnostic discipline. A darker rumor had it that he looked down on pathology trainees as inferior doctors because so many had MDs from foreign schools.
In any case, to the best of my memory, Dr. Schorr attended only one meeting with the CP residents during my year of CP training, a meet-the-faculty type of orientation at the start of the training year, during which he stated, frankly and succinctly, and in full hearing of the other program faculty members, that pathologists should not direct the operation of blood banks. He made no attempt to describe the goals and objectives or curriculum in the blood bank training we were to undergo.
The weekly seminars in transfusion medicine that ran throughout the year of CP training were listed in our syllabuses as being given jointly by Dr. Schorr and his wife, Mrs. Phyllis Schorr. Mrs. Schorr was a medical technologist and the administrative director of the blood banks at the AECOM-affiliated hospitals. As the year ran its course, each and every seminar was presented by Phyllis. Julian had no contact with CP residents, even to check in with them about how well they were mastering the material covered in the seminars and at the laboratory bench.
I don’t recall feeling short-changed by this arrangement at the time, or hearing resentment of it expressed by my fellow residents. We were in our third year of the four-year program and had already discovered that you could learn much from para-professionals, many of whom were better teachers than the doctors who supervised them. And we were just as happy when the doctors who lacked motivation to teach us just got out of the way.
I have quite a different perspective on this now, as a veteran of the pathology profession. I’ve had the experience of being a pathology residency program director, and a pathology department chairman. I can imagine the headaches I would have had if one of the faculty members working under me had been derelict in his teaching duties. Especially a faculty member with a distinguished reputation in his field, and professional connections to faculty members of other departments, who would be difficult to fire and replace. It’s a recurring nightmare for a program director that his graduates, once released to practice independently in the outside world, might have gaps in knowledge or skills that would endanger patients. Further, pathology residency programs, like all medical specialty programs, are regularly and rigorously inspected by an outside agency, and defective teaching in even one sub-field can result in cancellation of a program. I suspect that the reason Julian’s name was fraudulently included on the weekly seminar list was to conceal his dereliction from outside program inspectors; they typically spend time going over such program documents before site visits.
Julian’s thesis that clinical hematologists, and not pathologists, should run blood banks, actually makes a good deal of sense, both intellectually and didactically. Experience and supervised training in clinical hematology prepares one better for the problems encountered in the hospital blood bank, than does examination of the structures of diseased tissues and solid organs, the skills emphasized in pathology training. Many urban academic medical centers do, in fact, employ as blood bank directors, physicians who received their specialty certification after initially training in clinical hematology. (These large centers similarly often employ PhD microbiologists and biochemists to run these sections in their laboratories.). The problem is that this is not the prevailing practice in rural community hospitals, where blood bank directors are typically pathologists. This is an historically established pattern, reflective of rural geography, and the tradition that the hospital pathologist has an office within the hospital and is always immediately available for consultations in emergencies. In these settings, there may not be a clinical hematologist within miles. And all pathology residency programs are charged with preparing their graduates to practice within all settings they are likely to encounter in a practice in the US, including rural communities.
If a person sincerely believes, as presumably Julian did, that all blood bank directors, including those in rural community hospitals, should follow an educational and training pathway through clinical hematology, that this would be of significant benefit to the patient population at large, how should he act on this? It seems to me that the first step would be to acknowledge the size and complexity of the restructuring the hospital systems, medical educational system, and flows of funding and manpower, that would be required to bring about this change. It would be an undertaking that would probably take a generation or more to accomplish. One might begin by trying to persuade the people leading national organizations like the AMA, Association of American Medical Colleges, American Hospital Association, the FDA, etc., etc., to join in this mission. It also seems to me that the last thing a person should do in this situation, ethically, is to silently refuse, as an individual, to participate in the current system, to go AWOL from assigned duties to teach blood banking to pathology residents. The current system is inevitably going to be in place for years, even if there is a commitment to restructure the system; dropping out of individual teaching duties while the old system is still dominant would do a disservice not only to the pathology residents themselves, but could potentially result in harm to patients receiving transfusions at rural blood banks that come to be directed by those residents after they graduate.
Phyllis Schorr, as I said before, presented all the seminars in transfusion medicine that ran weekly throughout the year of CP training. She also tutored each of us individually at the lab bench when we had our one-month intensive rotation in the blood bank. I found her to be a wonderful and dedicated teacher in this setting. We also developed a connection that involved our personal lives. She, it turned out, was a devoted cat person, and I had just become a cat owner, for the first time in my life. It became a project for her to ensure that I loved having cats in my life as much as she did in hers. She provided me lots of technical hints for living with cats, like the names of products that were most effective in eliminating litter box odor. It was unusual at that stage in our careers for resident trainees to develop personal relationships with members of the faculty; most such relationships were friendly but superficial and formal.
I’ve sometimes wondered whether Phyllis worked especially hard at teaching pathology residents because she felt she needed to make amends for Julian’s neglect of us. Just a conjecture, she never said anything that revealed that, as far as I know. Not to me, certainly.
The receptionist at the hospital’s clinical chemistry section once provided me with a totally different take on Phyllis, when she and I and a group of other twenty-somethings were together for lunch. The lunch group frequently gossiped about our faculty and supervisors, all of whom were perhaps a half-generation older than us. I shared some things about Phyllis that I liked, and the receptionist, whom I’ll call Claire, shot back emotionally that “Phyllis Schorr is crazy! Absolutely crazy! A real nutcase.” It turned out that when Claire had come to work at the hospital several years back, she had been assigned the receptionist position at the blood bank. A few months into the job, Phyllis had confronted her angrily and accused her of flirting with Julian and making passes at him. Because Claire regarded the accusation as not just untrue but patently ridiculous, she interpreted Phyllis’s behavior as unbalanced. She went to HR and asked to be transferred to a different position in the hospital.
This was quite at odds with my impression of Phyllis. I have interacted with disturbed people from time to time, and I’m aware that I’m very sensitive to even slightly bizarre thought patterns in others, I’m aware of the way they make me feel anxious, make me want to look for an escape route from their company. I never picked up such vibes during the tutorial and social interactions I had with Phyllis. She struck me rather as a warm, caring, and quite reasonable human being and I enjoyed the time I spent with her.
I struggled to reconcile Claire’s account of the incident with my personal take on Phyllis, because they were so at odds. It was clear that Claire had been wounded by the confrontation with Phyllis, and I fully believed her when she said that Phyllis’s allegations were untrue. But I also trusted my own ability to judge people and I could not believe that Phyllis would have been acting maliciously or that she was actually unhinged when she made the accusation. It eventually occurred to me that the explanation lay in my observation that Phyllis was a person with very powerful emotions, a person who experienced things very deeply. Claire was, in fact, a quite attractive and personable young woman, and it seemed quite plausible that Julian might have felt attracted to her, and that whatever responses these feelings evoked in him were sufficiently subtle that they were not picked up by Claire, but not subtle enough to have escaped Phyllis’s awareness. I could imagine that if she had felt her marriage to be threatened, Phyllis might have gone into a state of denial concerning Julian’s role in the situation and projected all the blame onto Claire.
For none of this did I have evidence, but as a conjecture it resolved the cognitive dissonance.
I did not see either of the Schorrs after CP training. The following year I was sequestered in a different part of the hospital complex, doing research. A few years later they moved to Virginia. The tragic end of their story came about five years later; I learned of it through cocktail party gossip and was later motivated to investigate the details through accounts in a local newspaper. It was sad to learn from the news stories that Julian’s philandering seemed the underlying cause of the marital friction that ultimately cost Phyllis her life, and to remember having seen it in an earlier phase, when denial of Julian’s guilt was still a viable coping mechanism for her.
BEFORE THE MEDICAL LICENSING BOARD OF INDIANA
THE EMERGENCY SUSPENSION OF JOHN DOE, MD
3.2) Dr. Doe [pseudonym for Ernest Stiller] is currently practicing substandard medicine and providing patients with incompetent care, using his home in Three Oaks, Michigan as an office. Dr. Doe keeps large quantities of medical supplies, including intravenous fluids, tubing, needles, and suture in his home. Dr. Doe also keeps large quantities of prescription drugs and controlled substances, sees patients, and writes prescriptions from his home, using prescription pads from his former clinic in LaPorte, Indiana. One patient of Dr. Doe, L.S., died in her apartment on February 4, 1997 while under Dr. Doe's care. The following is a summary of Dr. Doe's medical management of patient L.S. for the four months prior to her death:
d. An autopsy was conducted on the body of L.S. by Dr. Stephen Cole of Grand Rapids, Michigan. The results of the autopsy toxicology testing showed lethal blood levels of hydrocodone and Prozac. The cause of death was determined to be mixed drug intoxication.
Ernest "Skip" Stiller, 1944-2013 (Obituary)
3 Responses to “Ernest "Skip" Stiller, 1944-2013”
My dear friend Skip (Dr. Ernest W. Stiller Jr. MD, FAOA, FAAO) was a powerful man who loved others and lived a life of helping.
Previously, he was a leading-edge orthopedic surgeon who saved many lives and limbs, and developed innovative medical procedures adapted by other physicians.
During the almost twenty years that I knew him, it seemed like every day he was working with someone dealing with some kind of a situation; and made them a priority in his life. He would stop whatever he was doing and go to their aide.
No matter where he was, he had a cheerful constructive outlook in life, which was contagious.
He was a man who especially loved and cherished his children and frequently spoke of their many accomplishments with great pride.
This man was more than a brother to me. His spirit is strong. Over the years he has been a positive force of learning and good in my life.
He will always be remembered and cherished; and I hold a special place in my heart for him. He was the finest man that I have ever known or will hope to know.
Humanity will have to catch up to this man’s decency, he was born 100 years too soon. He would say with certainty that with science and technology “all things will be better beyond belief in 20 years;” and if I know him, he is probably right. He says we have a lot to look forward to.
https://whatsnewlaporte.com/2013/02/13/ernest-skip-stiller-1944-2013/
Ernest Stiller and his first wife, whom I’ll call Allison, were members of my medical school class at the University of Chicago, graduating in 1969.
This was exceptional at the time, and perhaps still is--a married couple going through medical school together. Like other members of the class, I suspect, I often thought of them almost as if they were a single person. This may reflect how inseparable they seemed when the members of our class were dispersed and then regrouped for seminars, lectures, and laboratory activities. They were lab partners for subjects like biochemistry and physiology, and they were together as half a team at the cadaver dissecting table.
Ernie was quite vocal in class, whereas Allison was quiet. He was always the first one to raise his hand to answer a lecturer’s question or volunteer for something. When two volunteers were required, it was a given that Ernie’s raised hand was for both him and Allison. As a result of their volunteering for a teaching exercise assessing the adequacy of our surgical scrub technique, they acquired a nickname as a couple, “the gold dust twins.” (I don’t know if they were aware how frequently the nickname was invoked out of their earshot among members of the class, or if they would have been put off by this.)
The nickname seemed appropriate in view of their physical characteristics. They were so alike in their physical appearance they could have been twins. Both were tall, slender, blonde, and exceptionally beautiful Nordic types. (Members of our class were too young to know about the original gold dust twins, who were cartoon Black children that had advertised a brand of laundry soap many decades prior. We just thought the name sounded perfect for these two golden-haired demi-gods in our midst.)
Hearing Ernie speak so frequently during class, we got the sense not only that he was exceptionally smart, but that he was mastering the subjects without really much effort. For the rest of us, it was a tremendous grind, more rote memorization than had ever been demanded of us in our previous schooling, and we were perpetually stressed out. We looked on with disbelief and envy at Ernie sailing through the process so effortlessly. I remember once when Ernie was selected to do a platform presentation of a paper he had written for a pathology class, he seemed somewhat unsure of what level of understanding the rest of us had of his subject. He felt he had to interject an explanatory comment at one point that “a virus is very small,” as if we hadn’t known that already. It didn’t seem like arrogance; it just appeared he was so far ahead of the rest of us, he was honestly not sure how much he had to simplify his statements to ensure he’d be making himself clear.
There were other ways Ernie was a man apart. He and I, along with two other male classmates and four women (including Allison), were assigned to the same group for tutorial sessions in physical diagnosis. We did some of the learning sessions together, all eight of us, when we examined and took histories from hospital patients. For the sessions requiring us to perform physical examinations on each other, we were separated into two groups by sex. At one of the latter, the instructor for the men’s session, a (male) urologist, started it off by announcing, “Today, guys, we’re going to learn to do rectal exams and examination of the male genitals. I’ll start by demonstrating how to do this. I need a volunteer.” We needed a few seconds to absorb this; the session topics weren’t known to us in advance. Of course, we knew this was coming up eventually within the course, we knew what elements comprised a full physical examination. If Ernie had not been in the group, I imagine there would have followed a few moments during which the other three of us would have looked at the floor and shuffled our feet, gritted our teeth, and, with the thought that we had all signed up for this moment the first time we decided we wanted to be doctors and that this was a time our embarrassment had to yield to our sense of personal integrity, one of us – the most courageous – would have timidly raised a hand and stepped forward. But Ernie was there, and of course Ernie volunteered before the rest of us had even a microsecond to stew in our embarrassment. What I can’t forget is Ernie’s demeanor as all this occurred. He disrobed before us without a trace of reticence, and seemed quite comfortable having his admirable physique on display. Ernie had the body of an athlete and had been a star basketball player at the small midwestern college he and Allison had attended. He had managed to keep himself in excellent shape while doing medical school; most of the rest of had grown paler and pudgier enduring the grind.
The program for our medical school graduation in June of 1969 shows thumbnail portraits of each of us, along with the academic honors we’d received (if any), our chosen specialty, and the name of the hospital where we would commence our post-graduate training--at that time still called an internship--the following month. Ernie’s honors included membership in AOA, the medical honor society, indicating that his grades placed him at the top of the class. There were a few other AOA designates among us, but Ernie was unique among the class in another way. He was not going into postgraduate training in the coming year and had not listed an intended medical specialty. Instead, he had enrolled in the University of Chicago’s graduate school, division of biological sciences, having been accepted as a PhD candidate in the department of biochemistry. Allison was also continuing at the University, as an intern in obstetrics and gynecology at the women’s hospital.
In the years following graduation there were occasional updates from Ernie and Allison in the medical school’s alumni publications. Ernie was awarded a master’s degree in biochemistry from the university and then did a residency in orthopedic surgery, apparently having abandoned the plan for a biochemistry PhD. They then settled in the small city in northern Indiana, near the Michigan border, where they had both grown up, and they established their separate orthopedic and ob/gyne practices there. Some years later, their alumni notes were no longer coupled, indicating, sadly, that the marriage had ended.
The timeline for Ernie from this point onward can be traced from the public record; many of these documents, dating back to 1985, were made public by the Indiana Medical Licensing Board in 1997, when Ernie was convicted by a Michigan court of second-degree murder and his Indiana medical license was revoked. It is a sorrowful tale of escalating personal and professional troubles.
Ernie’s admitting privileges were suspended at the Indiana hospital where he primarily practiced in 1985. Over the next five years he made a great effort to have his privileges there reinstated and to proactively head off the possibility of revocation of his medical license. He initiated a law suit against the hospital, then appealed the unfavorable decision and lost again on appeal. The documents from these years, filed with the Licensing Board, give remarkably polarized portrayals of Ernie’s personality and medical practices. There are many testimonial letters from physician colleagues praising Ernie as exceptionally brilliant, gifted, and devoted to his patients. On the other hand, the hospital records document numerous lapses in the quality of care he rendered to specific patients (including unorthodox prescribing of antibiotics and pain medications), failure to maintain proper patient records, and failure to comply with the requests of various hospital committees overseeing quality of care. There were also distressing surgery complications brought for review.
Ernie meanwhile retained privileges at other hospitals in his locale and was able to continue practicing and operating. One notable case from this period involved repeated surgeries on a patient’s lower back, complicated by infections and mechanical failures, following which the patient was re-operated at a hospital in Indianapolis by an expert back surgeon. The outside surgeon noted the hardware originally implanted by Ernie had been placed in the wrong locations, suggesting, to me, that Ernie had performed an operation for which he had not been properly trained.
In 1986, to defend himself against accusations that his unorthodox prescribing practices for opiates reflected either personal drug abuse or surreptitious selling of drugs, he volunteered to undergo questioning while on a polygraph. The polygraph record was interpreted as showing that he was telling the truth when he denied the charges. In 1990 he voluntarily checked himself into a psychiatric hospital for 96 hours, in order to document that he was neither a user of drugs nor mentally impaired. He received a clean diagnosis for drug use and the examining psychiatrist noted that he had a difficult personality but no formally defined mental disorder.
By the early 1990’s, his admitting and operating privileges had been revoked by all the hospitals in the area; he continued to practice medicine and surgery from his office, where he used a treatment room for procedures that would normally have been done in a hospital operating room. This site was later inspected and found in violation of various safety rules, including those for maintenance of antiseptic conditions within areas used for surgical treatments.
In 1992 he performed an abdominal lipectomy on a female patient—the procedure informally known as a “tummy tuck”—in his office treatment room. He did not have a surgical assistant, and he did the anesthesia himself. The operation entailed a large incision around the lower torso and excision of about 25 pounds of skin and fat. This procedure is normally performed by surgeons trained in plastic surgery, not orthopedists. Because the patient had prolonged unresponsiveness and visible continuing blood loss from the surgical wound postoperatively, she was taken by her relatives to a hospital emergency room, where she was found to be on the verge of circulatory shock and hyper medicated. When Ernie learned that the hospital had admitted her to their inpatient floor, he came to the hospital, around midnight of the evening following the surgery, claiming to be the patient’s attending physician and demanding to see her. Because the hospital’s nursing staff was aware that his privileges there had been suspended, they did not admit him to the floor. He became obstreperous; the nurses called the hospital administrator on duty, who eventually called in the local police to remove Ernie by force from the building.
The patient, who endured and eventually recovered from this surgical catastrophe, was later questioned by investigating authorities. Her recorded deposition is now posted among the items of evidence used by the Indiana MLB in reaching its decision to suspend Ernie’s medical license. Her attitude toward Ernie, displayed in this document, seems unfathomable on first reading. She had been Ernie’s patient for many years, and she speaks of him in words of high praise, even after having received such terrible care from him in their most recent encounter. She denies on questioning that Ernie did anything wrong in his treatment of her, and she deeply regrets that records of the outcome of her treatment are being used against him. He had, in years past, used conventional orthopedic techniques to manage her injuries from a car accident. He performed the lipectomy himself only because she felt she desperately needed it and could not afford to have it done at a plastic surgery clinic, since, as a cosmetic procedure, it would not be covered by insurance. Ernie was willing to do it for her free of charge. She was angry at her relatives, who, she felt, overreacted by taking her to the hospital when she was recovering normally from the procedure Ernie had performed.
Ernie eventually had to give up the bulk of his medical practice, including the performance of surgical procedures and most office treatments, and began to rely on medico-legal consultations for income. Many of the cases in which he testified involved Workman’s Compensation awards. During a trial that took place in 1996, Ernie became enraged at the attorney who was questioning him, screamed at and cursed him. The judge in the case called for Ernie to be forcibly restrained and removed from the courtroom, after which the judge ruled for a mistrial.
He lived, during this period, with a woman named Loretta Sloan, a former nurse, and Loretta’s young children, in a local trailer park. He had treated Loretta for chronic osteomyelitis and was continuing to manage her care and prescribe medications for her. The couple was evicted from the trailer park following an incident in which the local police came to their trailer to serve Loretta with an outstanding warrant, and, noting the squalid condition of the trailer, removed the children to protective custody. Ernie became violent, attacked one of the officers and was again forcibly restrained, arrested and put in handcuffs. Ernie and Loretta then moved to a small wood-frame house in southern Michigan which belonged to Ernie’s mother. Ernie continued his now-limited medical practice from the Michigan house, writing prescriptions for Loretta and other patients; this was later cited by legal authorities as practice of medicine without a license. Although Ernie still held a valid medical license from the state of Indiana, he was not licensed in Michigan and he now no longer had a residence or office in Indiana.
Loretta was to die the following winter, two weeks after moving out of the house she had shared with Ernie, into her own apartment nearby. She died in that apartment, with Ernie present, of what was later ruled mixed drug intoxication. Ernie had unsuccessfully attempted to resuscitate her, and had then implored a neighbor to call for an ambulance (Loretta’s apartment did not have a telephone). Her apartment contained numerous prescription medications, included an opiate (hydrocodone), all of which had been prescribed for her by Ernie.
Law enforcement officials quickly recognized that Ernie’s drug prescriptions implicated him in Loretta’s death, once the death was attributed to drug toxicity; they decided his actions could be considered criminal and wound up charging him with second-degree murder.
Doctors whose patients die because of errors in their medical management are generally not charged in criminal procedures, based on the assumption, true in most cases, that the doctor was acting in the best interest of the patient and the harm done was not intentional but the result of incompetence or negligence. In some cases, however, doctors have been convicted on the criminal charge of involuntary manslaughter, when the doctors’ actions were judged to have been so reckless as to have obviously endangered the patient’s life. Even rarer is conviction for murder, which requires that the prosecution demonstrate the doctor acted with evident malice and intended the death of the patient.
The prosecutor in Ernie’s case claimed that malicious intent was evident in the prescriptions Ernie had written for Loretta in the weeks before her death. They had been directed to a number of different pharmacies in the locality, presumably to avoid having any single pharmacist recognize the risk of an overdose. When the prescriptions were aggregated, the combined regimen, if followed faithfully as directed, would have been at least seriously harmful, if not lethal. The prosecutor argued that this could not have been done out of ignorance or negligence on Ernie’s part; anyone with even the most elementary knowledge of medical pharmacology would recognize that to follow literally his prescribing instructions would have constituted a death sentence.
When I read about Ernie’s trial, I did not find the prosecutor’s case convincing. It occurred to me that there was an alternate explanation for the prescriptions that did not involve malicious intent on Ernie’s part. Loretta, as a trained nurse, would also have been quite knowledgeable in pharmacology; it’s very unlikely that she could have been duped into unknowingly taking a lethal dosage of medications. It seemed to me more likely that neither she nor Ernie had any expectation that she would follow prescribed dosage schedule. So why did Ernie write these prescriptions? I would suggest it was so that once each of the numerous pharmacies had dispensed hydrocodone and the other drugs to Loretta in the customary 30-day therapeutic quantities, Loretta could pool them to form a stockpile that she could keep in her possession, that would feed her habit for many months. There can be no doubt that she was addicted to the drugs. Ernie had arranged for her to have a surgically placed indwelling central intravenous catheter, ostensibly for administration of antibiotics for her osteomyelitis, but an obvious convenience for an addict wanting venous access for opioids. Loretta’s autopsy showed deposition of talc crystals throughout her lungs, a typical finding in addicts who inject ground-up tablets, prepared with talc as a binder, into their veins. Loretta was clearly injecting the hydrocodone tablet material through the indwelling catheter. (The autopsy also showed that Loretta’s osteomyelitis had healed, so there was no legitimate reason for the catheter to have remained in place.) The next question would be why Loretta would have been seeking to build a drug stockpile. This is speculation on my part, but I can imagine it might relate to the fact that she and Ernie had recently stopped living together. If, as a housemate, he had been a reliable source of drugs day-to-day, she might have been worried that the new separate living arrangement might result in a cutoff of her supply.
This possibility seems not to have been considered at the trial. It made me think at first that Ernie’s conviction on a murder charge was a miscarriage of justice, brought about by an overly zealous prosecuting attorney. It occurred to me, on further thought, that what Ernie did to Loretta, if my suspicions are correct, constitute a deeply immoral action against another human being: providing an addict with unlimited amounts of the drug she craved and providing a route of administration maximizing the drug’s destructive impact--fanning the flames of her own self-immolation. The moral equivalent of murder, in my estimate, only with the assent and cooperation of the victim.
One would have expected the defense attorney at such a trial to rebut the claim that Ernie bore malice toward Loretta. The prosecution had not supported this claim with other types of evidence, such as witnessed fights between the defendant and victim or incidents where Ernie had harmed Loretta physically. The defense did not do this; instead their strategy centered on destroying the argument that mixed drug intoxication was the cause of Loretta’s death. They pursued this tack in spite of the testimony at the trial of a forensic toxicologist that supported the prosecution in regard to the death. (Details of this expert’s analysis of the medicolegal examination in the case were later summarized in a popular book, written and published by him; Cohle SD, Buhk TT, Cause of Death: Forensic Files of a Medical Examiner, 2007, pp 264-276.)
The defense did not offer an alternative explanation of why Loretta had died. Instead—incredibly—what they offered was a video clip of Ernie himself, appearing somewhat fazed, responding to a series of questions and performing simple physical coordination tests, administered in the manner of a highway patrolman assessing a drunk driver. The jury was informed that prior to beginning videotaping, Ernie had ingested the same drugs that had been detected in Loretta’s postmortem blood samples, and they were shown lab testing results confirming that Ernie’s blood levels of the drugs, while he was on video, were comparable to Loretta’s postmortem levels. Therefore, the claim went, the defense has reproduced the conditions in Ernie that supposedly caused Loretta’s death, and since Ernie clearly didn’t die, they had debunked that supposition.
I was flabbergasted to learn about this maneuver in a court of law. It betrays an ignorance of the very meaning of a medicolegal cause of death, as well as the way most people understand causation. The cause of death is determined in a medical setting by assessing all the anatomic abnormalities and chemical imbalances, due to diseases or injuries, present in the patient at the time death occurred, and judging which of these diseases or injuries is most likely to have resulted in death (or, alternatively, least likely to have allowed the patient’s survival). It is not required that the putative cause be 100% lethal in all cases (it may be, but in modern times that’s a minority of deaths). I could not believe that Ernie, with his brilliant record in med school and years of practice, seemed ignorant of such an elementary principle of medicine.
The jury didn’t buy it either. I can imagine the way the dialogue might have gone among the jurors in private: “So suppose a guy runs a red light and crashes into another car in the intersection. He’s responsible, right? He has to pay the other guy’s repair bill because he caused the damage by running the red light. Now what if the same guy goes to court and says ‘I won’t pay because I didn’t cause the crash. Here’s a video of me driving through a red light at the same intersection, same time of day, same speed, and I didn’t crash into anybody. Therefore you can’t say the first crash was caused by me. I rest my case.’ Hogwash!” The jury voted for conviction; the judge sentenced Ernie to a prison term on the low end of the permissible range of years for second-degree murder, noting that with the facts of his crime a lower charge of manslaughter could have been considered.
I think it’s reasonable at this point to ask what was motivating Ernie in this downward slide through his later years. He was not pursuing wealth (he had wound up living in squalor), he was not consuming drugs himself, and he was not mentally unsound--none of the usual things you could expect to cause a doctor to go rogue. I have a speculation about this. I think Ernie did, in fact, have an addiction, but it was not to a chemical substance. It was to the adoration of his patients, that small coterie of patients who stuck with him throughout his years of decline and pledged their loyalty over and over, no matter what charges were made against him or what shortcomings of his were revealed. The prosecutor at his murder trial characterized Ernie’s lifestyle as that of a “medical philanthropist,” who provided unlimited medical care without charge to those needy and afflicted individuals who stuck by him. (Ernie’s care for these patients was provided liberally whenever they asked for it, but it was also unlimited in the sense that he did not restrict the treatments to those he was qualified to perform, or even to those that were permitted by law.) A close reading of testimonials from members of this patient coterie reveals something subtle but also jarring when they describe Ernie; they don’t seem to be saying just that he was a kind, honorable, or generous person. They suggest that he was something beyond that, a person above the level of common humanity. They suggest he was worthy of worship. And it begins to sound more and more as though this bizarre, unorthodox medical practice, with its charismatic leader, had taken on aspects of a cult.
Ernie’s first wife Allison went on to a successful career in obstetrics and gynecology and a happy second marriage. There is an inspiring component to her professional career; at age 65 she reduced her work schedule at home and began to participate in missions to Africa for Doctors without Borders, bringing quality practices in obstetrical care to rural villages there. She had to cut short a mission in South Sudan when the war in that region flared up and the situation seemed to have begun to endanger her life; she did not leave before she felt she had tutored the local midwives adequately in performing caesarian sections.
The life trajectories of Julian Schorr and Ernest Stiller have some remarkable similarities, beyond the fact that both were convicted of murdering their female consorts in their later years. I don’t expect that this observation necessarily applies widely to other individuals convicted of the same crime, but I do think it may say something important about the hazards of making a life in our society that’s specific to individuals with extraordinary talents and abilities, which was true of both of these men.
Two negative character traits that both men displayed, beginning in their younger days, and perhaps nurtured by elements in our culture, were hubris and narcissism.
Hubris is evident in the way both men flouted the norms that govern medical practice. Ernie regarded the hospital quality control procedures to which he was subjected with contempt, and Julian, similarly, the standards for residency programs. These rules have been established by communities of physicians through collective discussions and deliberation, over periods of years and even generations, guided by concern for the welfare of patients. Failure to respect these products of communal wisdom by a single individual seems the very essence of hubris.
Narcissism is perhaps most evident in the unorthodox ways both men acted in their own defense at their murder trials. Most people, I would imagine, would be humbled and fearful if placed in this situation. They would engage the best attorney they could afford, one who had much experience in defending similar cases, and would follow his or her advice to the letter, advice which would presumably reflect established norms of legal practice. Instead, both Julian and Ernie saw this moment in the public spotlight as an opportunity to glorify themselves—Julian by supplying the judge with an autobiography extolling his own greatness in the world of medicine, and Ernie by constructing an episode of theater in the courtroom intended to demonstrate the superiority of his own medical mind over that of the prosecution’s expert witness.
Narcissism energizes hubris. As narcissism grows from self-admiration to worship of the self, all of one’s actions become directed to the satisfaction of one’s own purposes and desires. All importance is given the self, and needs and values of others are discounted, as are the rules and ideals defining the communities in which one is embedded. Other persons are seen as instruments for satisfaction of one’s own desires. Phyllis became Julian’s instrument in covering for the lapses in his professional performance, for his not living up to expectations of the medical community. Loretta became the Ernie’s acolyte, providing his ego with the praise and adoration it craved, in return for prescriptions for the drugs that she craved.
Every human being has an inborn deep resistance to the killing of others, as has been demonstrated by the widespread reluctance of soldiers to fire their weapons at enemy soldiers in battle. Modern military training has begun to use psychological conditioning techniques to overcome this resistance to killing. Perhaps the mental barrier to killing could also be overcome in the mind of a narcissist, when other persons take on the appearance of one’s personal instruments, rather than independent, autonomous selves. Instruments become disposable, devoid of value, when they no longer aid, or are actually obstructive, in fulfilling one’s desires.
Perhaps murder is the ultimate act of hubris.
I speculate that the courses of both of these lives were profoundly affected by having taken place in a society like ours, so highly individualistic and so highly meritocratic.
All of us go out into the world, as young adults, with a certain amount of self-satisfaction, a certain amount of pleasure at what we have accomplished to date and the belief that our future lives will benefit our society and enhance our reputations. This comforting aura grows as we further develop our skills, but as we rise through the ranks of our professions it is curbed when we inevitably encounter other individuals who are better than we are at what we do, and we realize that the mistakes we have made, inevitably, in doing our work, may have caused harm to others.
But what if a person is talented in the extreme? What if he goes out into the world and rises through the ranks until he reaches the very apex of the pyramid, and finds himself alone, with no one above him? And no one points out the mistakes? And accolades rain down in abundance? It seems to me that such an individual is at risk of an overgrowth of ego destructive to the soul. And there are inevitably going to be people put in this position; no matter how large the group, how numerous the competitors, logic dictates there will always have to be one person in first place, one to whom no member of the group is superior.
I do not have a solution for such a person. I myself possess middling talents and growth of my ego was curbed by my freshman year in college. I would, however, advise people in my cohort, at the middle level of the pyramid, that they should prepare themselves to sometimes resist the urge to emulate those at the apex, the urge to regard them as role models, in their quest for self-improvement and recognition. They could find themselves absorbing personal traits that are toxic.
In my first year of medical school, I was advised by a high-ranking classmate (not Ernie) that it was a waste of time to attend the gross anatomy laboratory sessions. These were four hours long, three times a week. They involved exacting dissection of a human body, performed by teams of four students at each cadaver table, stretched out over an entire academic year--far more detailed and rigorous than the single-afternoon dissections of frogs and rats in high school and college biology labs. This classmate of mine claimed that if you allotted the same amount of time to studying anatomy books and atlases as you’d otherwise spend in the lab, you could get a better grade on exams. I did not follow his advice or use his strategy; it seemed to me there was something inherently wrong in it. There was no formal system for recording our attendance at labs, and, for all I knew, he might have been correct about exam grades. But it still went against the grain, for me.
Many years later, at the gathering of some of my medical school classmates for our 50th year reunion on the University campus, we were treated to a tour of the new anatomy labs. Our tour guide, the chairman of the anatomy department, proudly told us, and demonstrated, that, although modern digital technology and virtual reality had been incorporated into their departmental teaching armamentarium, the core of the gross anatomy experience for medical students remained the hands-on dissection of the human body, as it had been in our day. This was heartening to hear. After the tour was over, I spoke privately with the anatomy chairman. I related this story about my former classmate, and mentioned that this same person had later become a distinguished researcher at the NIH. I wondered if students still used this strategy, which seemed to me to short-circuit the educational experience that he had designed for them. I also wondered if there was any way to construct anatomy exams that would catch the scofflaws.
He didn’t think there was. Actually, he felt that what my classmate said was probably correct, that concentrated memorization from books would probably result in higher scores on any exam that anyone could design, compared to devoting the same amount of time to the dissecting table.
I expected he would go on to invoke what students owed their future patients, a deeper knowledge of human anatomy than could be acquired by memorizing from books. He didn’t though. Instead, he spoke of what each student owed to his peers in the dissecting group. They were working as a team, and each of them owed something to the team. If they skipped out on a lab to study at home, they were letting down the other members of the team, depriving them of the full experience of the day’s exercise in dissection.
Imagine that, seeking to motivate the actions of a person by appealing to their obligation to their community, not just to themselves! How often is such a thing invoked in our egocentric society, where all incentivization now seems to require directing benefit to the self?
