The Murder in Exam Room 15

Marguerite was not going to live. After two days of intubation, her blood pressure plummeted and her kidneys shut down. Joly gathered with Pasceri and other family members in the hallway to confront the fact that their mother was dying. The conversation lasted only a few minutes; seemingly preoccupied, Pasceri nodded and barely said a word.

The family entered the hospital room shortly after Marguerite was removed from the ventilator on Saturday, November 15, 2014. Joly sat at her mother’s side, dabbing her lips with a moist sponge. Marguerite suckled on it, too weak to speak or take a sip of water. Joly leaned in close and softly whispered in her ear that it was time to go meet Dad. She said that he was over on the glider swing in their backyard and needed help with the crossword puzzle.

As his sister guided their mom into the unknown, Pasceri buried his face in a pillow in an unexpected fit of rage, “screaming into a pillow,” Joly says. “Screaming.” Then, suddenly, he transformed. Rage turned to calm, which turned eerily to bliss. He threw his arms around Joly as they walked down the hallway and told her she was the best daughter any mother could have. “He had this beaming smile on his face,” she says. “He was just jubilant.”

In the weeks after Marguerite’s death, Joly met with her brother several times to discuss the idea of suing someone, though they could never agree on who was at fault. Whenever she raised concerns about the care provided at Saint Vincent, Pasceri dismissed them and pinned the blame directly on Davidson. Unbeknownst to anyone, he had been obsessively collecting information on amiodarone and poring over his mother’s medical records. Among them, her final pathology report noted that his mother suffered from nearly a dozen heart and lung issues. It made no direct connection between amiodarone and Marguerite’s cause of death. “It’s very unlikely that she died of amiodarone,” says Philip Newman, a board-certified cardiologist who has been practicing for 35 years and is an associate professor of medicine at the University of California–Irvine. “[Davidson] did everything right.”

In early January 2015, the family gathered at Marguerite’s house to divvy up her belongings. It was an unusually warm family moment as they sat around the dining room table, sharing memories and a few laughs. Then, out of nowhere, Joly recalls, “We’re sitting there, and [Pasceri] looks over at me and says, ‘You know, I really feel cheated.’”

Scientists say grief is a state of being—emotional and physical—that stems from craving what you can’t have. In extreme cases, grief is more like an addiction “than it is a stress response,” says Holly Prigerson, a professor of sociology in medicine at Cornell’s medical school and one of the world’s foremost experts on complicated grief disorders. “Certain people—particularly vulnerable people, insecure people, people who were extremely attached to someone who dies—feel they need to get back at whoever robbed them.”

We tend to talk about grief as if it is a snowflake—an individual experience that cannot be replicated. Turns out, that’s not the case. “There are obvious, detectable, discernible, real patterns in how people psychologically respond to loss,” Prigerson says. “We’ve shown that. People like to feel everyone is different and unique, but people are humans, and humans respond to things in a predictable way.” Grieving can be ­therapeutic, but prolonged and heightened grief is a serious condition classified as prolonged grief disorder. In fact, studies show that people afflicted with prolonged grief are at a significantly heightened risk of suicide six months, even 10 months after losing a loved one. “They want to kill themselves,” Prigerson says. “They feel like without this person, life isn’t worth living. There is a definite link between these seemingly normal symptoms of grief and yearning for someone, and wanting to kill yourself.”

Pasceri, of course, didn’t take only his own life. And that’s where his case veers dramatically from the norm. Murder-suicides ­account for only 2 percent of the nearly 40,000 suicides in the United States each year. And yet although they are exceedingly rare, these tragedies tend to follow similar trajectories. They almost always have two things in common, according to Thomas Joiner, a psychiatrist at Florida State University specializing in suicide research. First, the perpetrator is afflicted by mental illness, whether diagnosed or not. Second, the decision to commit suicide comes before the decision to commit murder. Joiner contends that these tragedies aren’t born from flashes of fury. Instead, he says, murder-suicides are rooted in perversions of virtue: The perpetrator acts out of a twisted sense of justice, mercy, duty, or glory. “The catch is that the individual doesn’t realize this perversion,” Joiner says. “They just think it’s merciful or dutiful or just.”

It seems obvious, and yet unsatisfactory, that heightened grief likely splintered Pasceri’s psyche and triggered a fatal lust for perverted justice. Inside Pasceri’s twisted brain, he seemed to have forgotten that it had been ­Davidson who’d saved his mother’s life. Sixty-six days after his mother died, Pasceri woke early on the morning of January 20 and drove to the Brigham one last time. “The doctor is dead. I am dead,” he reportedly wrote in his suicide note. “There is nothing more anyone can do.”

When Deb Marvin first heard the news on TV, she didn’t make the connection right away. There had been an awful shooting at the Brigham, but Dr. Davidson never crossed her mind. It wasn’t until her son, Jeff, called and asked if she had heard about “Grandpa’s doctor” that the pieces fell into place.
All murders are tragic. The acute sense of loss inflicted on Davidson’s family is staggering—three children age 10 and under, a wife, parents, a sister, and a newborn daughter who will never know him. But there’s a butterfly effect associated with the slaying of doctors—the stilling of hands that extend and improve life for so many—that amplifies the collective sense of loss.

Marvin first encountered Davidson in 2012. It had been a brutal year. Her 28-year-old son, John, who served in the Navy and toured in Iraq, died in a car accident that January near their home in Connecticut. Six months later, her 25-year-old son, James, who served in the Army National Guard and survived a tour in Afghanistan, unexpectedly died in a Connecticut hospital after a brief illness.

Following James’s funeral, Marvin—an operating-room nurse for more than three decades—visited her 80-year-old father, Clifford, in Maine, and was alarmed at his frail appearance. “He couldn’t walk 20 feet without being short of breath,” she says. Marvin took him to Eastern Maine Medical Center, where an ejection fraction—a test that measures the amount of blood pushed out with each pump of the heart—came back at 15 percent. “Eastern Maine Medical Center said, ‘Nope, there’s nothing we can do,’” Marvin recalls. “They didn’t even refer us on.”

Still grieving her sons’ deaths and leveled by the prospect of losing her father, Marvin began researching physicians at the Brigham and landed on Davidson. At their first meeting, she heaped an emotional plea on the surgeon: “I said to him, ‘I’ve lost my two sons this year; I just cannot have another major loss in my life.’” Davidson didn’t flinch. He explained that while he wasn’t God, he believed that he could save her father’s life. Over several consultations, the Marvins hashed out a treatment plan with Davidson, discussing the risks, and the fact that as a Jehovah’s Witness, Clifford couldn’t receive blood transfusions. Davidson did what the best doctors do: He deftly navigated the technical, emotional, and spiritual variables until it was time to put his surgical skills to the test.

In November 2012, Marvin’s father entered the operating room. After several hours of anxious waiting, Davidson “came out with just a shit-eating grin on his face,” Marvin says. “And he said that everything went perfectly…. He was so reassuring. We all started crying. And he hugged all of us.”

In the wintry weeks after Davidson’s funeral, Clifford, now a healthy 82, could be found clearing his driveway after each snowstorm that pounded his home in Houlton, Maine, a small town just west of the Canadian border. The octogenarian, who had been written off years ago, owed each shovelful of snow, each thump of his heart, to Davidson. “He gave my dad his life back,” Marvin says, lamenting the senselessness of Davidson’s death. “It’s just so unfair.”