From the moment he entered medical school in the late 1970s, people around Michael Swango thought he was a little odd. But even though he expounded upon his obsessions with violent death and serial killings to anybody within earshot, almost nobody connected him to the string of deaths among patients under his care. When an investigation finally took place at the Ohio State medical center, hospital administrators sympathized with Swango--against the direct testimony of patients and nurses--and seemed more concerned with how revelations of a murderous doctor might affect their public image than with the safety of their clients. And, remarkably, even after being released from prison in Illinois, where he had been convicted of (nonfatally) poisoning several of his coworkers, Swango was able to obtain positions at hospitals in South Dakota and New York. When American authorities finally started to pursue his case, he fled the country and began plying his trade in Zimbabwe. In June 1998, after being captured during an attempt to reenter the United States, he was sentenced to 42 months in federal prison--on fraud charges related to his employment in New York.

The truly frightening aspect of Blind Eye is not the relentless chain of murders, but the ease with which Swango was able to repeatedly slip through the cracks in the medical system, simply by lying about the nature of his felony conviction. James B. Stewart methodically traces every step of Swango's career, laying out a straightforward narrative with all the suspense of a well-crafted thriller. Although attempts to "explain" Swango's behavior through psychopathology and a historical rise in the incidences of serial killing derail the ending somewhat, Blind Eye is still a must-read for true crime buffs--or anyone who enjoys good journalism. --Ron Hogan


From Publishers Weekly
In a harrowing and exhaustively researched account of neglect by the medical profession, a Pulitzer Prize-winning editor and author (Den of Thieves) presents convincing evidence that alleged serial killer Michael Swango injected a minimum of 35 patients with various toxic substances during the 15 years he was a medical student at Southern Illinois University, an intern at Ohio State University Medical Center and a physician at various hospitals in the U.S. and in Africa. In addition, the author makes a strong case that Swango, who has been described by many as charismatic, was responsible for the severe digestive upsets that plagued his colleagues and friends due to poisoned food and drink. Since Swango has never been evaluated by a psychologist, Stewart relies on the work of medical researchers who view serial killers as psychopathic narcissists. The major strength of Stewart's study, however, rests on his expos? of poor medical monitoring practices. For example, when female nursing personnel linked mysterious patient deaths to Swango's injections, male physicians dismissed their suspicions. Swango was finally sent to prison in 1985 after being convicted of poisoning his co-workers while he was employed as a paramedic. After his release, he found work at other teaching hospitals because they were not required to check with the national practitioners' data bank, a self-monitoring mechanism endorsed by the AMA that Stewart considers inadequate. Currently serving time in prison on fraud charges, Swango faces an FBI investigation for murder. Agent, Amanda Urban; 9-city author tour; TV satellite tour. (Sept.) Copyright 1999 Reed Business Information, Inc.


From Library Journal
Pulitzer Prize-winning journalist Stewart, noted for Den of Thieves, elevates the story of a peripatetic doctor who leaves behind a trail of dead patients beyond the true-crime genre. This compelling look at one bad seed becomes an indictment of an industry that ignores and even covers up the errors of its own. (LJ 9/15/99) Copyright 2000 Reed Business Information, Inc.


The New York Times Book Review, Lance Morrow
Blind Eye is wonderfully done.... An elaborate journalistic reconstruction that has the fascination of an acutely observed and troubling novel.


From The New England Journal of Medicine, April 6, 2000
In Blind Eye, a book that lays the foundation for an indictment against medicine, James B. Stewart, the recipient of a 1988 Pulitzer prize for his reporting on the stock-market crash and insider trading, has assembled the known facts of Dr. Michael Swango's 14-year career (1983-1997) as a suspected medical serial killer. Swango is referred to as a suspected serial killer because he has never been convicted of murder and is currently in federal prison for committing fraud in his applications to work as a physician. The facts are these: Swango came from an unloving home dominated by a tyrannical, cruel, and often absent father and a loving but inadequate and frustrated mother. He graduated as the valedictorian from his Catholic high school in Quincy, Illinois, in 1972, attended Millikin University for two years, enlisted in the Marines for two years, and then graduated summa cum laude from Quincy College, having already started on his road to fraud by falsifying his military record when applying to the college. Enrolling at Southern Illinois University's medical school in 1979, Swango quickly stood out because of his odd, militaristic, and antisocial behavior. He failed to graduate with his class in 1982 because of what Stewart describes as startlingly apathetic and fraudulent activity on an obstetrics and gynecology rotation. By that time a macabre circumstantial association was already evident between his presence and patients' deaths. Although he came within one vote of expulsion, Swango graduated in April 1983, bound for a neurosurgery residency at Ohio State University (OSU). It is at this point that the conspiracy of silence begins. The narrative is often chaotic and choppy, yet Stewart is adroit at detailing the institutional and individual naivete, the incompetence, the old-boy mentality -- in short, the tragicomedy of medical administrative errors -- that, along with Swango's luck and charisma, combined for a 14-year career as a suspected medical serial killer. Beginning with the statement by the director of neurosurgery and head of graduate medical education at OSU that "I don't read dean's letters," those in the medical profession, both here and abroad, do not fare well when examined as critical appraisers of their peers as guardians of the health of strangers. Despite a between-the-lines letter of warning from Southern Illinois University, OSU hired Swango, who proceeded to hover, like some lethal Goya-esque spirit, over the unexplained deaths of five patients (by Stewart's count). After a mysterious death in February during Swango's surgical internship, the administration at OSU conducted what can only be called an incredibly inept and superficial investigation. This ineptitude, of course, was only compounded later in the form of what will strike the reader as a self-serving coverup that comes very close to becoming obstruction of justice when local and then more distant authorities turned to OSU, asking difficult questions about OSU's initial opportunity to catch Swango. Swango too often found himself inexplicably near the beds of patients who died but had recently been very alive -- in other hospitals around the country and, eventually, the world. Abetted by the proclivity of some members of the medical establishment to protect self and institution over others, including patients, Swango learned early to count on a sloppy and cavalier system of credentialing. As Stewart tells the story, the trail from Ohio led to equally gullible administrators and their sloppy checking of credentials in Virginia, North Dakota, New York, and then to Zimbabwe, where the innocence and susceptibility to what must be a certain amount of charm continued, both within and outside the medical communities into which Swango insinuated himself. Although the author documents the credentialing mishaps in all the different venues in an apparently balanced way, his own curriculum vitae as journalist and commentator begins to unravel, unfortunately, when it counts the most. We first learn, for instance, that Stewart is from Quincy, Illinois, the same town as Swango, on page 287, the same page where he discloses that the judge he glorified 150 pages earlier is a long-standing family friend. His journalistic skills shine no better than his ability to handle conflict of interest. Swango's first lawyer goes unnamed. Stewart's reference to a primary work, David Abrahamsen's Confessions of Son of Sam (New York, Columbia University Press, 1985), is "as quoted in" another work, a sloppy technique not allowed in high school. And despite the author's explanation that he is preserving the confidentiality of sources who fear retaliation from Swango, the absence of documentation of sources, references, and citations is inexcusable. The author's worst sin, however, is his unsupported and unreferenced tirade against the entire medical establishment, which ranges from criticism of the National Practitioner Data Bank to his broadside against the "widespread failure of state medical boards to enforce statutory standards." Swango's release from prison is scheduled for July 15, 2000. The latest news about him comes from the Cleveland Plain Dealer. In articles published on January 11 and January 17 of this year, this newspaper, from a state highly sensitized to Swango's past, quoted an unnamed federal source as saying that Swango would be facing murder charges before his release. One can only hope that any appropriate murder charges will stick. This book is not as important for its story of a rogue killer as it is for its reminder that all of us fail dismally when it comes to minding the store. In my 13 years on Connecticut's medical examining board, I cannot think of one case brought to us by another physician. It should be the standard of practice to try to segregate any colleague who we think may be likely to hurt an unsuspecting but trusting person who comes to us sick and asking for help. Reviewed by Richard M. Ratzan, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.


From AudioFile
Stewart follows the infamous career of Dr. Michael Swango as he lies, distorts, cheats and maneuvers his way through life and career, committing crimes against hospital staff and patients. Swango's fascination with almost undetectable poisons is even more terrifying than the outright murder he commits. Boyd Gaines is superb as narrator, taking the listener through all the facts, events and detective work that Stewart compiled. Even the gory scenes are a fascinating exposé of how the medical establishment ignored both the warning signs and actual reports of Swango's actions. M.B.K. (c) AudioFile 2000, Portland, Maine-- Copyright © AudioFile, Portland, Maine


From Booklist
Pulitzer Prize^-winning journalist Stewart's thoroughly researched new book tells an appalling story that will upset many readers and may even shame the medical profession into cleaning up its act. Michael Swango, long fascinated by violent death, took five years to obtain his M.D. because of scholastic problems and lackadaisical patient care (he was fired from a part-time ambulance job for endangering a patient). Despite his questionable record, Ohio State gave him an internship and residency in neurosurgery. When moderately ill patients in the hospital at Columbus began to die unexpectedly, questions were raised about Swango's involvement, but the university hushed things up. Swango's reputation was further damaged in 1985 when he was found guilty of putting arsenic in the food and drink of several ambulance crew colleagues, and he spent two years in jail. Nevertheless, Swango obtained further residencies in South Dakota and New York--and patients in both places suffered like those in Ohio. Careless checking of his residency applications and institutional stonewalling gave Swango a free hand. Eventually, he obtained a hospital position in Zimbabwe, and patients began dying once more. Arrested on returning to the U.S., Swango was again jailed. The FBI believes he was responsible for as many as 60 deaths. Stewart castigates the medical profession's blind eye, asserting that "the loyalty among physicians makes police officers `blue wall of silence' seem porous in comparison." In conclusion, Stewart lays out steps the government must take and enforce to deal effectively with future Swangos. William Beatty


From Kirkus Reviews
The shocking story of Dr. Michael Swango, who, despite being a convicted felon suspected of murdering dozens of his patients, was allowed to practice medicine. Best-selling author Stewart (Den of Thieves, 1991, etc.) brings us inside the life of a killer who thrived in a medical establishment where doctors typically cover up for other doctors, where hospital administrators live in constant fear of litigation, and where regulatory agencies don't share crucial information. At Southern Illinois Universitys medical school, Swango kept to himself, but classmates noticed that patients who came into contact with him tended to die. After graduating, Swango got a prestigious medical internship at Ohio State University. In February 1984 at Ohio State, patient Ruth Barrick died immediately after Swango treated her. Later a nurse saw Swango injecting a patient with a syringe; the patient almost died. The nurse who accused Swango was ignored and, in a pattern that would repeatedly benefit Swango, other doctors circled the wagons to defend their colleague. As more patients died, Ohio State initiated an in-house investigation, led by a fellow doctor, that fully exonerated Swango. Hospital administrators refused to even reprimand him, because they ``didn't want to be sued by Swango as a result of unfounded charges and nurses' gossip.'' When his internship was up, Swango worked as a paramedic in his hometown of Quincy, Ill. He related fantasies to his co-workers about killing people. When Swango brought in donuts, his co-workers got sick. After a few more poisonings, Swango was arrested and convicted. A felon, he nonetheless went on to practice medicine in South Dakota, New York, and Africa. In each place, patients died mysteriously under Swango's care. Finally, upon his return from Africa, the FBI arrested the young doctor for falsifying medical records. He's currently in prison, but could be released within three years. Although Stewart writes skillfully about the medical establishments unforgivable code of silence, he never quite succeeds in taking us very far into Swangos warped mind. Thus, were left to guess about his psychotic motives and thought processes. -- Copyright ©1999, Kirkus Associates, LP. All rights reserved.


Review
Lance Morrow The New York Times Book Review Chillingly thorough....Wonderfully done....An elaborate journalistic reconstruction that has the fascination of an acutely observed and troubling novel.

Scott McLemee Newsday A remarkable piece of reporting.

Jerome E. Groopman The Wall Street Journal Stewart tells a riveting tale of terror, a true page-turner.


Review
Ellen Clegg The Boston Globe Stewart penetrates the hermetically sealed world of medicine. In the process, he exposes the arrogance and the fraudulent professional courtesies that allowed Swango to move ahead unchallenged. In other words, Stewart does the work that hospital administrators and supervising physicians in Ohio, South Dakota, and New York should have done.


Review
Ellen Clegg The Boston Globe Stewart penetrates the hermetically sealed world of medicine. In the process, he exposes the arrogance and the fraudulent professional courtesies that allowed Swango to move ahead unchallenged. In other words, Stewart does the work that hospital administrators and supervising physicians in Ohio, South Dakota, and New York should have done.


Book Description
No one could believe the handsome young doctor might be a serial killer. Wherever he was hired -- in Ohio, Illinois, New York, South Dakota -- Michael Swango at first seemed the model physician. Then his patients began dying under suspicious circumstances. At once a gripping read and a hard-hitting look at the inner workings of the American medical system, Blind Eye describes a professional hierarchy where doctors repeatedly accept the word of fellow physicians over that of nurses, hospital employees, and patients -- even as horrible truths begin to emerge. With the prodigious investigative reporting that has defined his Pulitzer Prize-winning career, James B. Stewart has tracked down survivors, relatives of victims, and shaken coworkers to unearth the evidence that may finally lead to Swango's conviction. Combining meticulous research with spellbinding prose, Stewart has written a shocking chronicle of a psychopathic doctor and of the medical establishment that chose to turn a blind eye on his criminal activities.


About the Author
James B. Stewart is the author of Follow the Story: How to Write Successful Nonfiction, Blood Sport, and Den of Thieves. A former editor of The Wall Street Journal, Stewart won a Pulitzer Prize in 1988 for his reporting on the stock market crash and insider trading. He is a regular contributor to The New Yorker and SmartMoney.


Excerpt. © Reprinted by permission. All rights reserved.
Chapter One Southern Illinois, the triangle of land north of the junction of the Mississippi and Ohio Rivers, 350 miles from Chicago, feels more like the Deep South than like the industrial Midwest. Summers are hot and steamy, and in June 1979, most of the students and faculty members at Southern Illinois University in Carbondale who could get away after graduation had fled, leaving the campus feeling sleepy and underpopulated. An exception was the medical school, whose year-round schedule enabled students to complete the standard four-year medical school curriculum in three years. They began during the summer, spent the first year at SIU's main campus in Carbondale, then moved to SIU's campus in Springfield, the state capital, to complete their degree. Late one June night, James Rosenthal, a newly admitted member of the SIU medical school class of '82, was sitting in a college dorm room, sweating from a combination of the heat and his anxiety over an enormous stack of introductory medical texts: anatomy, physiology, biochemistry....The topics seemed endless, the books huge. He should have been asleep. He turned out the lights and noticed that another window in the adjacent dorm was still brightly lit. It was Rosenthal's classmate Michael Swango, wearing military fatigue pants and doing jumping jacks. Swango was lean and muscled at a time when fitness was far from most students' minds. He'd been in the Marines, and his name was stenciled on the military garb he usually wore to class. It was weird, Rosenthal thought. Many of his classmates had been antiwar protesters. Swango was the only member of the class he knew who had been in the military. Swango's military garb and fanatical devotion to fitness were noticed by just about everyone in his class at SIU. Besides the military fatigues, he wore combat boots to class. When Rosenthal and other classmates struggled out of bed in the morning after a late night of studying, they would often see Swango outdoors doing early-morning calisthenics, chanting Marine cadences. Sometimes, at breakfast in the cafeteria, they teased him about his uniforms and military bearing. Swango bridled at their ribbing and increasingly kept to himself. Everyone in the class was soon nearly overwhelmed by the workload and the battery of tests administered to first-year med students. As a relatively new medical school, SIU had been able to build a curriculum from the ground up, unfettered by traditional approaches. It was the first medical school in the country to create a written set of criteria for the medical degree, criteria derived from an extensive survey of medical educators. The goal was to graduate students prepared for careers in primary care -- family practice, internal medicine, pediatrics, and obstetrics/gynecology -- as opposed to research or the subspecialties, such as ophthalmology and cardiology. Every first-year medical student was required to take and pass 476 written tests during the first year. Each test covered a curricular "module," such as heart murmurs, within one of the core topics, such as the heart. Ten to fifteen closed-book tests were given every Saturday morning on the modules that had been covered in classes that week. Notes and textbooks weren't allowed in the exam room. That didn't deter Swango, however, from using his notes during the exam. He would choose one of the tests, take it, then choose his next test topic and sprint from the room back into the hallway. There he would frantically page through his notes and books, cramming for the second test. Then he would return, take that test, and repeat the process. His fellow students were dumbfounded, and some were disgruntled. Dashing into the hallway between tests seemed perilously close to cheating, though it wasn't expressly forbidden. As the weeks went by and Swango continued the pattern, several students mentioned to him that they thought it wasn't fair, but Swango was defiant, and continued his cramming. Inevitably, other students began to do likewise, which led to considerable faculty concern. Finally Chandra Banerjee, the first-year professor of pulmonary medicine, admonished his students: "Goddammit, no Swangoing." A new word was coined. "Swangoing," the noun, or "to Swango," the verb, described the practice of racing into the hall and cramming between tests. Swango was notorious not only for his test-taking regimen. During their first year, medical students dissect a cadaver. A ritual familiar to every medical student, the process bonds students and they usually remember it for the rest of their careers. At SIU, the first-year students were divided into groups and each student was assigned one part of the cadaver to dissect and present to the rest of the group. Swango's assignment was the hip and buttock region, including the gluteus muscles. Students had keys to the anatomy lab and could come and go on their own time. Many worked late into the night, though the lab was busiest in the afternoons, when faculty members were on hand to offer advice and suggestions. But Swango never came in during the day or evening, preferring to work on his dissection after midnight, when the lab was usually deserted. Indeed, some members of his group, who never saw him in the anatomy lab at all, wondered how he was going to make his presentation. What Swango gained in privacy from his unorthodox hours he lost in guidance from faculty and other students. For when his presentation finally came, and he unveiled his dissection, his fellow students gasped. He had transformed the hip region of his cadaver into an unrecognizable mess of tangled flesh and bone. As some classmates described it, it was as though he had done his dissection using a chain saw rather than a scalpel. Even Swango finally recognized that he couldn't adequately describe the region's anatomical characteristics using his own handiwork. He abandoned the cadaver and completed his presentation by showing his group pictures from an anatomy text. Swango had few, if any, friends at SIU; his fellow students later realized they knew almost nothing about his past, his family, his education, or his military service. Yet the combination of his weird garb, chiseled physique, odd nocturnal habits, "Swangoing," and now the cadaver mishap, made him one of the best-known of the seventy-two members of the class, much talked about and derided at the many class parties and gatherings, from which he was usually absent. The cadavers remained on display in the anatomy lab, and members of Swango's group made a point of showing their friends Swango's mangled handiwork, generally with a comment like, "Can you believe this?" One classmate, Kevin Sweeney, paraded nearly half the class through the anatomy lab to see it. The experience must have been humiliating for Swango, who had received almost nothing but praise and perfect grades before enrolling in med school. Michael was the second of Muriel and John Virgil Swango's three sons. (Richard Kerkering, Muriel's son from a previous marriage, lived with his father.) Michael had excelled at the private Catholic boys' high school he attended in Quincy, Illinois, beginning in 1968. Bob and John were educated at public schools, but -- largely at the insistence of his mother, who recognized that he was academically gifted -- Michael was enrolled in Christian Brothers High School. The family wasn't Catholic (his father once described his religion as "the brotherhood of man"), but Christian Brothers was perceived as academically superior to the public schools. John Virgil Swango also liked the strict ethical and moral foundation of the Catholic curriculum. He didn't want Michael to become an antiwar activist like his older brother, Bob. Virgil needn't have worried; Michael seemed oblivious to the social and political upheavals sweeping the country. While Bob listened to Bob Dylan and the Rolling Stones, Michael's favorite popular music group was the brother-sister duo the Carpenters. He was a model student, named to the honor roll every year. He took the usual precollege course load, but the only topic in which he seemed to show unusual interest was the Holocaust, which was covered in world history. He ranked in the ninety-seventh percentile on his college aptitude tests. Though he ran on the track team during his freshman and sophomore years, he wasn't very athletic. He participated in a whirlwind of extracurricular activities: he was a class officer, and served on the student council, yearbook, and newspaper staffs. His main interest mirrored his mother's love of music. He was a talented pianist and spent many evenings playing classical music for his mother. He was the band's first-chair clarinet, as well as its president, and he sang in the glee club. As a senior, he performed the demanding Mozart clarinet concerto in the band's spring concert, the only student featured as a soloist. Mrs. Swango had bought him a Buffet clarinet, an expensive brand manufactured in Paris and used by many leading players. He was so precocious that his clarinet teacher, who played in the Quincy Symphony and taught at Quincy College, recruited Michael for the Quincy College Wind Ensemble, which toured Illinois during Swango's senior year in high school. When Michael graduated from Christian Brothers in 1972, he was showered with honors: the "Outstanding Musician" and John Philip Sousa band awards (followed by a party for band members and their parents hosted by his mother); a citation as a National Merit Scholarship finalist; and the place of class valedictorian. A flurry of articles in The Quincy Herald-Whig, the local newspaper, memorialized his achievements. His mother clipped the articles and circulated them among relatives. A 1972 yearbook picture shows Michael in his band uniform, smiling, with tousled blond hair. Curiously, in the same yearbook he described his "ambition" as "to be an Illinois State Trooper." As his class valedictorian and a National Merit finalist with high test scores, Swango would have been highly sought after by top colleges and universities all over the country. But minimal college counseling was available in Quincy, his parents were relatively unsophisticated about higher education outside the military, and almost all his classmates stayed close to home; consequently, Swango's horizons seem to have been limited. He decided to attend Millikin University, a small, private liberal arts school in Decatur, Illinois, about a three-hour drive from Quincy, where he received a full-tuition scholarship in music. Millikin's music department was highly regarded in Illinois, and was considered the school's strongest department. As he had in high school, Swango excelled academically at Millikin, earning nearly perfect grades during his first two years. But during his first year, a girlfriend broke off their relationship. Though he had typically worn a sports jacket to class, which was unusual in the early seventies, after the breakup he began to dress in military garb. He painted his old Ford Fairlane in camouflage olive green. When a friend asked him about this, he said he planned to join the military and was fascinated by guns. About this time, too, he first mentioned an interest in pre-med courses. And he showed an intense interest in photos in the local paper of car crashes, which his classmates found peculiar. By the end of his sophomore year, he was spending more time alone, and his friends and roommate had less and less contact with him. That summer, he enlisted in the Marines, and didn't return for his junior year. No one ever heard him play the clarinet or the piano again. Michael completed basic training at the Marines' boot camp at San Diego, where he was trained as a rifleman, earning the designation of sharpshooter. His personnel record states that he entered the service at St. Louis, attended administrative procedures courses at Camp Lejeune, North Carolina, and Washington, D.C., and was working at Camp Lejeune in 1976, when he received an honorable discharge. He received a National Defense Service Medal and a "Meritorious Mast," a minor commendation. When he returned to Quincy after his discharge, Swango was lean and fit and carried himself with military bearing. He announced to his family that he wanted to become a physician, something that especially pleased his mother, who had once worked as a medical secretary. He enrolled in pre-med courses at the local community college and had no difficulty gaining admission to Quincy College for the following fall. A small, private college founded by the Franciscan Brothers in 1860, and still affiliated with the Catholic church, the school had long drawn applicants from students at private Catholic high schools, mostly in Illinois. But the population of such students had been dwindling. With his near-perfect grades at the more competitive Millikin and his outstanding high school record, Swango must have been one of the college's top applicants. Still, after he was admitted he decided to embroider his record. On a form he submitted to the college's public information office, he falsely claimed that he had received both a Bronze Star for heroism in combat, and a Purple Heart for combat wounds during his relatively brief tenure as a Marine. Swango was an outstanding student at Quincy College. Having abandoned music, he plunged into the sciences, earning a 3.89 grade-point average with a double major in chemistry and biology. He studied prodigiously, working late into the night at the college library or in the science labs. In contrast to high school, he pursued few outside activities. He didn't participate in any sports; and in the yearbook he listed the biology club and the college radio station as his only extracurricular activities. In a further reflection of his newfound interest in medicine, he worked part-time as an orderly at Blessing Hospital in Quincy and became a certified emergency medical technician. During his senior year, Swango wrote a paper, evidently his senior thesis in chemistry, on the poisoning murder of a prize-winning Bulgarian writer living in exile in London. It isn't hard to fathom why the death of Georgi Markov might have drawn Swango's attention. As the Bulgarian crossed the busy Waterloo Bridge in central London in September 1978, he felt a faint pricking on his thigh. A heavyset man mumbled, "Sorry," to Markov as the man stooped to pick up an umbrella he had dropped. That night, Markov developed a high fever and then violent nausea. He died four days later. An autopsy discovered a tiny capsule, about the size of a head of a pin, embedded in Markov's thigh. The capsule, which could have been carried on the tip of an umbrella, contained a poison called ricin, a castor-bean derivative that causes fever, vomiting, and finally massive blood clots throughout the body. In sufficient doses it is invariably fatal; "there is no specific treatment...other than making the person comfortable," according to the U.S. Navy's Bureau of Medicine and Surgery. There was also no pathological test for the presence of ricin, which left no identifiable trace in the bloodstream or body. Though the Bulgarian secret police were suspected in Markov's death, the murder remains unsolved. During his senior year, Swango took the Medical College Admission Test (MCAT) and applied to a number of medical schools. He graduated summa cum laude in 1979 and won the American Chemical Society's award for academic excellence. Competition for admission to any accredited American medical school in the spring of 1979 was intense, as it had been ever since the baby boom generation began graduating from college in the late sixties and applying in droves to professional schools. This was the case not just at the country's most prestigious institutions, but also at newer, less well-known medical schools such as Southern Illinois University. Demand for doctors was so strong that lucrative careers awaited med school graduates. Huge numbers of applicants with good records were rejected from every medical school to which they applied, and many migrated to medical schools in foreign countries, Mexico being a common destination. Swango's classmate Rosenthal, despite good grades in his science classes at highly regarded Knox College and decent scores on the MCAT, had been rejected outright by sixteen schools before securing a place on SIU's waiting list. Another of Swango's classmates had applied for seven years in a row before she was accepted. Applications to U.S. medical schools were funneled through a centralized office in Washington, D.C., which sent preliminary applications to the medical schools named by the applicant. If a medical school thought it might be interested, then, and only then, would it send a candidate its own application. Besides needing outstanding grades in a pre-med curriculum and high MCAT scores, applicants had to sit for a personal interview in which their maturity, commitment, and aptitude for medicine were evaluated. Because it was founded in part to improve medical services in southern Illinois, SIU accepted only Illinois residents and looked for a commitment to family practice in small-town or rural Illinois. After a committee evaluated all the information candidates submitted, SIU (like other medical schools) placed them into one of three categories: "Reject," "Accept," or "Accept When Place Available." Muriel proudly reported to family members that Michael had been accepted at several medical schools. Given his excellent academic record and test-taking ability, Swango would have been a strong candidate. His work in a hospital as an orderly would also have worked in his favor. And SIU would have been especially interested in someone like Swango, who was from Quincy, part of the area the medical school was meant to serve. Yet his classmates speculated that Swango had been admitted from the waiting list, because he moved into the dorms late, along with students who, like Rosenthal, had been admitted at the last minute. They surmised that Michael hadn't performed well in the admissions interview and wondered what he had answered when asked why had wanted to become a doctor. Among his classmates, the decision to become a doctor formed a large part of their getting-acquainted conversations. Swango never participated in these conversations; he seemed blank when the topic surfaced. Swango never expressed any interest in patients. Still, apart from the cadaver incident, nearly everyone conceded that Swango seemed hardworking and disciplined. Some classmates were astounded to learn that he was working as a paramedic for America Ambulance in Springfield while a first-year student. Not only was outside employment during the first year frowned upon (Rosenthal had to get permission from the dean to teach a Sunday school class in Carbondale), but Swango was commuting to a city one hundred miles away. And his violation of the antimoonlighting policy was particularly brazen, for the Springfield hospitals the ambulances served were affiliated with SIU and staffed with many SIU residents and professors. These staffers soon realized what Swango was doing, but no one on the faculty complained. He passed all 476 tests, however unorthodox his methods, and all of his courses, including anatomy. One member of the class had to repeat the first year, and one person flunked out, but when the rest of the class moved on to the second year in Springfield, Swango was among them. The central Illinois city of Springfield, with a population just over 100,000, seems a metropolis compared with Carbondale. It boasts the state capitol building and is steeped in the lore of its most famous resident, Abraham Lincoln, whose restored home is a major tourist attraction. The city is attractive to SIU because its two hospitals, St. John's and Memorial, are much larger than any in Carbondale, and it is there that SIU medical students gain their first clinical experience. Beginning with the second year, the medical school's curriculum turns away from basic science and anatomy to disease-oriented courses, including pharmacology, radiology, and pathology. Pathology, which includes toxicology, the study of poisons, seemed particularly to fascinate Swango. It was taught by a popular professor, Dr. John Murphy, who was favorably impressed by him. During their third year of SIU's medical school, students undergo a series of rotations, including pediatrics, obstetrics and gynecology, internal medicine, and surgery. In the surgery rotation, students were assigned in pairs to give oral presentations. Rosenthal and Swango were partners, and at Rosenthal's suggestion, they chose to discuss the repair of certain defects through open-heart surgery. A relative of Rosenthal's was a heart surgeon and volunteered some original papers the students could use. But Rosenthal ended up having very little contact with his partner. This may have been because Swango was still working for the ambulance corps and frequently was either unavailable or fidgeting because he was going to be late for ambulance duty. But it was also because Rosenthal didn't like being around Swango. He was jumpy, nervous, and seemed unable to relax. He wore a beeper and would rush off whenever the ambulance service called. The pair ended up giving their presentation in two discrete sections, which might as well have been separate reports. Swango had assembled several slides and gave a creditable, if unmemorable, performance. But given that the topic was heart surgery, his subsequent performance in class was baffling. Swango's class assembled at the start of each day for what's called morning conference; one day Dr. Roland Folce, the chairman of surgery, led a discussion of X rays. He put a chest X ray on a screen and pointed to a shadowy area in the middle of the image. He looked around at the class, then focused on Swango. "Mike, tell us what's in this picture," he said. Swango was silent. Finally he said, "I don't know." There were some titters from other students. "That's the heart, Mike," Folce said, sarcastically emphasizing the word "heart." It was almost as big a debacle as the cadaver incident, for any medical student this close to getting his degree should have been able to recognize the heart on an X ray. It was so obvious that his classmates concluded that Swango must simply have panicked and frozen. Yet the episode was one of many that led some of his classmates to conclude that Swango was taking a surprisingly cavalier approach not only to medical school, but to the well-being of his patients. One of the first clinical assignments medical students receive is to take histories and perform physicals -- "H & P's" -- on hospital patients. Students interview patients, record their medical histories, undertake routine physical examinations, and post the results on the patients' charts. Depending on the patient, the procedure can take anywhere from a half-hour to ninety minutes. His classmates observed that Swango was completing his entire rounds in less than an hour, sometimes spending what seemed like as little as five minutes with a patient. Yet he filed complete H & P's. In at least one instance, another student charged that Swango had plagiarized or fabricated his entire write-up. The claim triggered renewed talk and concern about Swango among his classmates; Rosenthal and several others even wondered whether Swango should be reported to the Student Progress Committee, a group of twelve faculty and two students that heard complaints of student misconduct. But no one did so. Within their third-year rotations, students can choose areas of specialization. There was a standing joke at SIU that the dumb and the lazy chose anesthesia; the smart and the lazy went into radiology; the dumb hard workers chose pediatrics; and the smart hard workers went into neurosurgery. Thus, it came as a surprise to many when Swango concentrated his courses in neurosurgery, especially considering the cadaver incident. Neurosurgery, involving delicate operations on the brain and other parts of the nervous system, is one of medicine's most demanding (and highly paid) specialties. It is emotionally taxing, because patients needing neurosurgery are often in dire straits, and because deaths and catastrophic incidents on the operating table are probably more common than in any other area of practice. Still, competition for internships and residencies is intense. But Swango was no more forthcoming to his classmates about his choice of a specialty than he had been about why he had chosen medicine as a career. Swango's decision came as a particular shock to his classmate Sweeney, who had been so dismayed by the cadaver incident and thought Swango was ill-equipped to practice medicine at all, much less neurosurgery. Furthermore, neurosurgery happened to be Sweeney's area of concentration as well, so he and Swango would share patients and work closely together. The two were jointly assigned to a resident, Mark Zawodniak, who would oversee their work and act as a mentor. Though that meant Sweeney and Swango had to see each other virtually every day, they avoided each other as much as possible. Though most students sharing a neurosurgery specialty would observe each other's surgeries, Sweeney stayed away from Swango's -- he was horrified by the prospect of what he might see -- and Swango never showed up at Sweeney's, either. Zawodniak, though he was genial and friendly, also developed an aversion to Swango. When Swango was out of earshot after one particularly frustrating encounter, Zawodniak turned to Sweeney and lamented, "What did I fucking do to deserve him?" But finally, in the person of a faculty 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 postsurgery 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 medical students 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 a hospital. Zawodniak, Sweeney, and many of their classmates were developing a black sense of humor under the twin pressures of medical school and hospital life. After about five deaths in patients who seemed to be recovering satisfactorily, all of them soon after an H & P by Swango, Zawodniak coined a nickname for his seemingly disaster-prone protégé: Double-O Swango. Other medical students thought the nickname was hilarious, and soon it was in widespread use. "Double-O Swango" meant License to Kill. Copyright © 1999 James B. Stewart

FROM THE PUBLISHER

No one could believe the handsome young doctor might be a serial killer. Wherever he was hired -- in Ohio, Illinois, New York, South Dakota -- Michael Swango at first seemed the model physician. Then his patients began dying under suspicious circumstances.

At once a gripping read and a hard-hitting look at the inner workings of the American medical system, Blind Eye describes a professional hierarchy where doctors repeatedly accept the word of fellow physicians over that of nurses, hospital employees, and patients -- even as horrible truths begin to emerge. With the prodigious investigative reporting that has defined his Pulitzer Prize￯﾿ﾽwinning career, James B. Stewart has tracked down survivors, relatives of victims, and shaken coworkers to unearth the evidence that may finally lead to Swango's conviction.

Combining meticulous research with spellbinding prose, Stewart has written a shocking chronicle of a psychopathic doctor and of the medical establishment that chose to turn a blind eye on his criminal activities.

FROM THE CRITICS

Publishers Weekly

This true-crime story of a serial killer doctor is handled by journalist pro Stewart (Den of Thieves) in unsparingly lean and mean terms. Broadway actor Gaines is equally wry and knowing in his telling, dwelling on the macabre details with barely suppressed relish. The villain, Dr. Michael Swango (even his name sounds creepy), worked his way through medical schools and numerous residency positions--allegedly poisoning and killing as many as 60 patients along the way--before finally being jailed on lesser charges. Obsessed with violence and death, Swango also moonlighted as a rogue ambulance paramedic. When Swango's reputation in the U.S. was finally scorched, he went on to practice his mayhem in Africa, before returning home to face incarceration. Stewart's hard reporting skills yield a great nail-biter of a story, making for riveting listening. Simultaneous release with the Simon & Schuster hardcover. (Sept.) Copyright 1999 Cahners Business Information.

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