Michael Swango: Doctor of Death

Chances are that if you asked any one of Michael Swango's seventy-one fellow medical students at Southern Illinois University what they thought of him they would reply, "He's nuts!"

The university, which sits 350 miles south of Chicago and is one of the state's more esteemed places of higher learning, expects much of its students. In fact, SIU's School of Medicine was the first in the nation to create a written set of criteria to aptly prepare students for an inclusive knowledge of practical medicine while still in their freshman year. The curriculum is tough, and often the light levity formed by bonding between students is the one factor that eases the demanding load of expectations. So, when there is a black sheep in its midst, the organization of students spots him immediately.

Michael Swango was different than the rest of the would-be hopeful doctors. He kept to himself and drew resentment from his peers by spending more time working as a local ambulance attendant than attending his classes and laboratory sessions. That he had the brains to accomplish his studies and extracurricular activities simultaneously might have gained admiration had it not been for an obvious lack of discipline at school, a conceited aire, a sloppy skills-regimen during dissections and a noticeable buttering-up to certain professors.

Classmates recall an incident that took place one day that told them their intuitions were correct — that Swango might not be cut out for the noble profession. Despite his high marks earned on written exams, Swango could not identify the position of the human heart in an x-ray, something that even a novice could do. The episode made a lasting impression on many.

During an early anatomy class, Swango's dissection of a cadaver was so botched that the specimen, which was put on display for all to see, became a school joke. Swango hardly seemed to recognize his blunders and took no notice of the others' ridicule.

Swango had one particularly odd trait that left many professors stunned. If upbraided for making an error during technique, he would drop immediately to the floor to perform a series of self-chastising push-ups, a form of punishment practiced by the military — but not by civilian pre-meds!

A major part of any medical student's training is the education that comes with working hands-on at hospitals with actual patients. Under direct supervision of a trained physician, students are graded on their ability to conduct the history and physicals of patients — this process is called H&P. Students are expected to accurately summarize a patient's health background and assess a proper physical schedule for the patient while under the hospital's care. It is a very important phase of a medical education, for it 1) hones a student's perception of various illnesses and the effects of required treatments while 2) teaching them a professional and caring bedside manner.

But, in the eyes of his classmates, Swango washed out of H&P.

Particularly enlightening to them was his attitude toward death. He demonstrated a morbid interest in critical patients, almost as if waiting for them to succumb. And when they did, he adapted a habit of scratching DIED across their charts in huge red letters. When one pupil asked him how he could be so cold, he answered, "Hey, death happens." And it happened so often to those patients who Swango oversaw that the students — half-jokingly, half-suspiciously — said he was acting as if he had a license to kill. As a parody of James Bond 007, they began calling him "Double-O Swango" behind his back.

*****

Born Joseph Michael Swango, the boy cancelled out his first name at an early age and let his Quincy, Illinois, friends call him Mike. His parents Muriel and Virgil experienced little trouble with him, as he practiced good manners, wore suit coats and white shirts throughout the bead-and-bandana culture of the 1960s, and brought in high grades throughout elementary and high schools. In high school, he topped the honor roll each semester, outshining less-scholastic efforts of two brothers, Bob and John, and a half-brother, Richard. A clarinetist with the Christian Brothers H.S. Marching Band, he won an Outstanding Merit Award for this talent. After graduating valedictorian in 1972, he decided to attend nearby Millikin University College to pursue a degree in music.

Then, in sophomore year, he changed.

The suit coats vanished to be replaced by military fatigues; he painted his up-till-then immaculate automobile an army green; and became preoccupied in things tragic and violent. He started a scrapbook of clippings from newspapers referring to car and plane crashes, bloody military coups, savage sex crimes, arsons and riots. Losing interest in school, he left after his second year to join the U.S. Marine Corps.

This spontaneous move alarmed his friends, but more so his mother. Recently divorced, her marriage had been an on- and off-again affair with a man more interested in his military career than his family; for many years she was the lonely housewife left alone to raise four sons while husband Virgil served two duties in Vietnam. Before the divorce, the family endured sixteen relocations as military transfers took Colonel Swango across the country during the Fifties and Sixties, but after he left for Saigon a second time, his departure had been too much for Muriel. She turned to her favorite son, Michael, to uplift the Swango name into something more than the derivation of ramrods and mortar shells. Hard-studying, clean-cut, talented, well-behaved, good son Michael. But now, he too had tired of textbooks and bandstands and the wheatlands of Illinois, and flew to other parts of the world.

Muriel prayed he would not take up an army career, as had her wayward Virgil. As it turned out, her worries were needless. One stint with the Marines was all Michael could handle. Honorably discharged from Camp Lejeune, North Carolina, in 1976, he returned home to resume his college education. No longer interested in music, he told his happy mother that he wanted to study medicine.

Now attending Quincy College, he majored in both Biology and Chemistry, prerequisites for pre-med schools, and worked after classes as an ambulance attendant at a local medical center. Throughout, he maintained just below an A average. His senior-year thesis, which gained laudits for its exhausting research and meticulousness, also raised some professorial eyebrows: It detailed the true-life chemical-poison murder of a well-known writer in London.

Passing the Medical College Administration Test with flying colors, winning the coveted American Chemical Society Award and graduating summa cum laude, Swango's name was placed at the top of Southern Illinois University's long waiting list of prospective pre-med students in 1979.

*****

The reason that Swango worked for the American Ambulance Service while at SIU, even though it meant losing valuable study time, was simple: He was fascinated by the front-row scenes of gore and violence the job afforded. Chaos excited him, the sight of blood tingled his loins. A tableaux of street curbs dense with ogling crowds, in the street a pile of twisted metal once a pair of cars, and somewhere amid the fusion parts of two human beings that needed to be pried loose — this, to Swango, was ecstasy. And it cost nothing; in fact, the ambulance corps paid him to enjoy the scenery!

In 1982, while Swango was in his last year at SIU, his father died. Never close to Virgil, barely knowing the man, Swango nevertheless did the honorable thing and turned out to show respect alongside his family at the funeral. After graveside services, his mother presented her favorite boy with something she had found among the colonel's personal effects. It was a scrapbook, very similar to the one her son had already started on his own, but more complete; it bulged with columns and photos cut from magazines and newspapers, a virtual dictionary of general mayhem, of the world's worst disasters, of everything from assassinations to mass killings. Swango's reaction when he saw it: "Hell, I guess Dad wasn't such a bad guy after all."

Inspired by his father's creativity, Swango searched local and Chicago papers for any such testimony to bloodletting to thicken his own scrapbook. One evening an associate asked him why the odd fixation. Swango's answer scared the other. "If I'm ever accused of murder," he responded, "this will prove I'm mentally unstable."

*****

Michael Swango would have graduated with the rest of his class in June, 1982, had he not failed a major phase of the curriculum in the semester's final weeks. Assigned to rotation in the Obstetrics/Gynecology ward, he often disappeared or showed up late. Chief Resident Dr. Kathleen O'Connor discovered that he would sneak off to the ambulance service instead of applying himself to important H&Ps on the floor. Taking mental notes, she observed his behavior one day as he moved from room to room and noticed that he seemed to be performing patient visits in an unrealistically quick time. After he left the room of one particular female patient, O'Connor checked with her to learn that Swango had not examined her at all — had not even conducted a simple IV check or blood pressure reading. Yet, he had completed a report on the woman as if he had. More so, his report was so well detailed that the chief resident figured Swango was doing one of two things: fabricating his findings or plagiarizing them from a report done earlier.

Because such conduct jeopardized patients, the board found Swango's deceit unforgivable. Swango knew the committee would act harshly and hastened to hire a lawyer to prevent action. At stake was an offered internship with the University of Iowa's neurosurgery department. Both sides eventually compromised: Swango would not be expelled providing he agreed to repeat the OB/GYN rotations. He consented and Iowa withdrew its invitation.

By the time Swango received his diploma in the mail in early April, 1983, he had left behind a sorry reputation. Southern Illinois University Dean Richard Moy had already strongly indicated in his "dean's letter," which accompanies every graduating student's profile, that Swango was, to put it mildly, inept. Moy clearly pointed to not only Swango's scholastic blunders, but also to an increasing array of attitudinal and professional problems.

Yet, somehow, even before the diploma arrived with the postman, the Ohio State University Medical Center turned down a number of competitive candidates to offer Swango a year-long internship in general surgery to be followed by a residency position in its department of neurosurgery.