(A mock-up of the billboard Wondery paid to put in front of the hospital where its subject used to work)
While the state of modern journalism can often seem pretty dire, investigative, serialized podcast series stand out as one of today’s few bright spots, one of the last places you can still find people willing to pay for good reporting. Tackling some of the same stories that in years past might have gotten one sensational episode on Dateline NBC, the more expansive, more bingeable podcast format seems to allow them to become both more memorable and more consequential.
The best of these series retain the lurid appeal of the news magazine while offering the opportunity to go deeper; to tell stories that resonate as much as they titillate. The podcast is also becoming the go-to medium for in-depth profiles of fascinating sociopaths, allowing us to marvel at the sheer breadth of human behavior as we go about our mundane daily drive to work or do chores around the house.
Podcasts’ status as a new medium, in which the rules have yet to be codified crystallized for me a few weeks back, when I sat in a dark screening room at United Talent Agency with a group composed largely of fratty, agent-y men in suits listening to a non-fiction account of an evil surgeon. The screen, almost vestigial now, displayed a still graphic. Many in the crowd wore the custom eye masks we’d been given, to add to the audio immersion effect.
The show was Dr. Death, from Wondery, the same podcast production company that brought us Dirty John, last year’s thoroughly addictive series about a stalker/con artist who inserted himself into one Orange County family and nearly tore them apart. Dirty John would seem hard to top — the story of a psychotic con-man who spent his days playing Counter Strike, posing as a doctor and telling fake war stories. He was a character simultaneously familiar but totally unique, a brilliant schemer who was also, even in his late 50s, kind of an idiot slacker — like Fatal Attraction meets a Judd Apatow movie. It was also perhaps the definitive portrait of Orange County, California. Dirty John ended up being wildly successful and is currently being adapted for a television show on Bravo.
Dr. Death, a story Wondery’s producers heard about through Dirty John‘s tips email, feels perhaps less like a show on Oxygen, though it’s arguably more relevant. It profiles a spine surgeon named Christopher Duntsch, who operated on 38 people, 33 of whom were left either dead or with some form of permanent paralysis. You listen in horror to what feel like slow-motion car wrecks, captured in Wondery’s signature immersive soundscape, as Duntsch drills screws meant to anchor bone into soft tissue and inexplicably snips nerve bundles that control important motor functions, causing irreparable harm.
So many podcast series, from Serial to S-Town to the incomparable In The Dark, set out to solve a mystery. In Dr. Death there’s no question as to who the killer is, but there are still a few mysteries to unravel. Chief among them is the mystery of whether Duntsch was homicidal or simply criminally inept. The next question is how he was able to continue performing surgeries even as he butchered patient after patient.
It’s those two question combined — the lurid, unstoppable search for an ultimate motive, and the more concrete question of how the medical system allowed this to happen and how we can fix it — that make listening to Dr. Death feel like you’re eating cake and taking your medicine at the same time.
Of course, podcast producers are subject to the same profit motive that helped facilitate a guy like Duntsch, but to their credit, Wondery’s producers seem to have realized that a story like Dr. Death‘s needed to be built on a foundation of solid reporting. In order to tell the story they hired Laura Beil as the lead reporter. Beil is a journalist who has specialized in science and medical writing for 20 years, and lives in the Dallas area where much of Christopher Duntsch’s story takes place. She was a National Magazine Award finalist in 2016 and in 2018 won the Victor Cohen Prize for medical science reporting.
Despite her qualifications as a reporter, Beil was also a podcast newbie. I spoke to her by phone this week about the series itself, and about the challenges of working in a new medium.
So, tell me about the genesis of Dr. Death, and how it grew out of Dirty John.
Basically someone listened to Dirty John who knew about the story of Christopher Duntsch emailed in and said, “Hey, you should get a load of this guy.” Because he had gotten a lot of local media attention, but I don’t think he was getting huge national attention. And so, the producers started Googling and decided that he would make a good story, and then they contacted me because they were looking for a local reporter in Dallas who could work on the story.
On that note, tell me a little bit about your background. Was there anything you had to teach yourself in order to better tell this story? Was this familiar territory for you?
Well, it was familiar content-wise because I’m a medical reporter, so I’ve never covered anything else. I do medicine and science. What was totally new was that I’m a print journalist. And in fact, when they called me, I was kind of like, “You know I’m a print reporter, right?” But they were great, they were willing to kind of show me what I needed to know in terms of audio and interviewing for audio, and making an audio podcast. As long as I could do the reporting and the writing, they were willing to show me the rest, and it worked out great.
So many of these serialized investigative podcasts, they tend to grow out of some kind of mystery. And then in this case, it seems like if there is a mystery it’s just, what is this guy’s deal? Do you think we get an answer at the end of the show?
See, this was actually one of the disadvantages that I had. Like a lot of these podcasts, they do start out as a mystery, or they have a big plot twist in the middle. And they have a really compelling sympathetic through-character that you can sort of latch onto the whole time, like in S Town, or Serial. And I had none of those things. I mean, the guy who you think is guilty from the first episode really is guilty. And also, I knew that I was dealing with a story that probably half the listeners from the first episode were going to Google and find out the end.
So it really came down to the reporting and the telling of the story itself. I knew I had to get across that even if you think you know the story of Christopher Duntsch, you don’t really know the whole story. And so, that was one of my goals to start out with, is to just report the hell out of it. What can I find out about this guy? How did this happen? It’s not just about what happened, but how did this occur? And from that, it became apparent that the story is really about our healthcare system. It’s not just the story of Christopher Duntsch, it’s a story about the American healthcare system. And so, that’s really what I zeroed in on, the whole systemic failure that allowed this to happen.
You did have a crusading whistleblower character in there.
Yeah, I do, and there’s another one that comes in later. So yes, there are definitely heroes in the story. And that wasn’t a manufactured thing. There were some doctors and some plaintiff’s attorneys, and later on journalists, who were all working to try to stop this guy.
I know you talked to a lot of his college friends, how far back into Duntsch’s childhood did you want to go? Did you find out if this guy was torturing animals as a child or anything like that?
I could only go as far back as his Memphis days, so I did go back to Memphis, and I did talk to quite a few people who knew him in high school. Some are on the tape, some are not, just for space reasons. I did talk to as many of his high school friends as I could. I couldn’t go beyond that. And then for his early background, I relied on the testimony that his parents and his family gave at his trial, where they talked about his history. I wanted to talk to his father, and his father indicated that he did want to, but his appellate attorney wouldn’t allow that for reasons that I don’t understand. I didn’t want to create a two-dimensional villain, and his dad, I think, would’ve provided the most humanizing voice in the story, but the attorney just wouldn’t allow it.
There’s a lot of attorneys not allowing things in this story it seems like.
Yeah, for sure.
It’s weird because he seems like a normal guy through most of his early life, and then he turns into this really entertaining sociopath, kind of like the guy from Dirty John. How much of his crazy emails and phone messages did you have to throw out in order to focus on the main story? Was there anything that was particularly hard not to include?
Well, the whole email that’s coming up in episode three… It’s hard to pick out because it just goes on and on. I limited myself to those emails that were produced as evidence in the trial, because the D.A. had hundreds, but I figured the most important ones were the ones that play a role in the trial. And then there were comments that he made himself on the Dallas Observer article [about him]. Those were way more telling than the emails, I thought, because if you just read through those you get kind of a look into his mind.
How many of them struck you funny? Because that one where he says that, “I’m God, Einstein, and I do what I want, but also I control things behind the scenes without anyone knowing” in the same sentence… that just cracked me up.
I didn’t take them as funny, I took them as really creepy though.
Sure, yeah. I listened to this with some friends at one point, and there was a lot of cringing at the medical butchery descriptions. How much did you worry about putting too much of that in there and it being too gory, or too graphic?
Yeah, that was a concern. Believe it or not, there was stuff I took out. So, they’re not as bad. The first one is the most graphic. And there were a couple of reasons for that. One, since the [Mary] Efurd case in the one that eventually goes on trial, I thought it was important to know what happened in that case, so that’s one. And the other part of it, is that the reason that it kind of starts out like that is you really need to know from the outset how bad a surgeon he was. I needed to establish — it’s not just that he was a little bit bad, he was horrible. And so, I tried to include those details that would really establish how bad he was. He was putting stuff in the wrong place. He’s cutting arteries. His surgeries actually get even worse. By the time we get to Jeff Glidewell, it’s horrible. But those graphic descriptions are only in the first episode, because you had to know.
Speaking only for myself, I could have listened to seven hours of the incredibly graphic stuff. I kind of wanted there to be three hours more of that, but when I was listening to it with some friends, they were putting their hands over their heads and saying “No, no, no!” They never turned it off though, which I think is telling, but it seemed like they were having a hard time listening.
It’s interesting, because when I heard at the premiere, people were reacting to things that I didn’t anticipate them reacting to. Like, I could hear the people around me reacting. I expected some oohs and ahhs, but, for instance, the missing screw, when you get to the part that there was this screw where he had put it into the muscle. That was the thing that people around me were really reacting to. I didn’t really expect that one to create quite such a reaction.
Were there any surgeries that he actually did correctly?
There was one. One lucky person actually improved. One improved, and I think there were four, maybe that weren’t hurt, but they weren’t helped either. And then the rest were injuries. But there’s one lucky person who escaped, you know?
So, the other big mystery as you already pointed out was like, how did the medical system allow this to happen? What do you think are some of the contributing factors?
Well, that’s what takes six episodes to tell. I mean you can’t really boil it down. That’s why we have these hours and hours of tape, but that said, there are a few fundamentals that were wrong. Duntsch, he’s an outlier for sure, but he exposed a lot of larger truths about the healthcare system. And so, one of the overriding things is that when he was at a hospital and it would become apparent how incompetent he was, the hospital would let him go, but they wouldn’t do it in such a way that would warn everybody else.
And so, they wouldn’t report him, so there wasn’t a paper trail. That made it easy for him to hide from his past for a certain period of time. And frankly, if it hadn’t been for a couple doctors who were watching him, who knows? It might’ve taken longer. He’d had a whole string of bad surgeries before it even came to the attention of the medical board. And the medical board was the only ones that could really stop him, but they didn’t know.
How much of a factor is a for-profit medical system in helping this to happen?
Yeah, I think the fact that he was a neurosurgeon was also a contributor. Because neurosurgeons, they bring in a lot of money for their institution. And so, he was an attractive hire. Would they have been just as willing to take on a pediatrician who had some baggage? Of course, a pediatrician couldn’t have done as much damage. But neurosurgeons are big money makers. It’s a lucrative surgery. It’s lucrative for the hospital.
And so, I think that’s what made him an attractive hire. There’s a different crew at Dallas Medical Center now, but you have to think that the reason his hiring was fast-tracked was because, you know, he was a neurosurgeon and he told the administrator, “Yeah, and I’ve got a bunch of patients who are ready for surgery. I just need to be able to do it.” And he was able to explain away why he had left Baylor, and they looked at the National Practitioner data bank and there was nothing there, because Baylor hadn’t reported him. So, yeah, I think the fact that he was in a profession that brings in a lot of money for hospitals was certainly a factor. But there was so much that came together. It’s hard for me to pinpoint any one thing, because it was so many things.
I sort of equate it to a plane crash. Planes don’t crash because one big thing goes wrong. Planes crash because lots of smaller things go wrong at the same time. That’s why planes don’t crash that often. So, in this case, it was just a lot that went wrong, starting with the fact of Duntsch himself. And the fact that the system failed doesn’t absolve him of the responsibility of what he did, and I want to make that clear. I’m not saying it was the system’s fault. I’m saying the system played a role in it, but it was clearly his fault.
What storytelling tools did you discover from working in a podcast format that you didn’t have before, or maybe didn’t think about before?
One thing I learned is that there are a lot fewer details if you’re asking people to hold the story in their heads. You have to be spare and selective with the details. So, ask the producers. They did a lot of cutting to my script, because I’m used to print where you can put a few more details in, and you can have a little more… have other characters, or other names, or other information in, because when you are reading, if you miss it, you can just go back and check. You can take in more from a printed article. But from a script, you’re asking people to remember everything you just told them. That was probably the biggest adjustment for me, was just the spareness of the script.
And also, to let the tape tell as much of the story as possible. Because I’m on there clearly, but when you can tell it through the tape, it’s so much better. And so, when you’re writing, it’s like, “Okay, well, what is this have to do with the tape that’s coming up?” Something in print, you don’t have these really long quotes for people. I have to say, it was nice to do something different. I’ve been writing in print for a long time, so I really enjoyed the chance to do something different.
I know you’ve done this for a long time, but what are some of the things you have to be careful about in reporting a story like this? What are the potential pitfalls for you as a reporter?
Well, let me think for a second. Probably with any medical story, really, you want to be most careful with the patients themselves. So, I always try — it’s like how do you tell their story, and what happened to them, and what they’ve lived through, but without really exploiting them? You have to be very careful with that. They’re not just props in your story, they are real people who’ve lived this, and you need to just be respectful of that, and not fall into tropes, and not exaggerate what they’ve been through, but also not diminish it. And that’s really true for any medical story, I think.
Were there podcasts that you looked to as an example, or that sort of influenced you when you knew you were going to be doing a podcast story like this?
No. I have to confess, I had not listened to Dirty John before they called me. But I started listening to a whole lot more podcasts after. I started this back in December, and I started listening to a bunch of podcasts really carefully after this. But there would be certain things that I would hear and like and not like. For example, I never knew before I started this that I had such strong feelings about sound effects.
Were there some that you were trying to avoid sounding like. Do you mind mentioning any of those?
Let’s just say that this was a back and forth discussion for a lot of it. And they’re great at Wondery, and they’re really good at doing what they do. And so, there were times that I would say, “Do we really need to have… ?” And they were open to it all. They could’ve just said, “You’re the print person, leave this to us.” But I would err on the side of less is more. Like, let the story speak for itself. But on the other hand, they knew you had to have certain sounds to make the experience really real for people, and really immersive.
And so, in the end, I did have to trust them, and I do. But that was probably the one thing that was hardest for me to get used to was that balance between my wanting spare sound effects and their wanting to make a good podcast. But I did have to let go and trust them. I’m really appreciative to the producers for even entertaining the discussions with me as much as they did, because let’s be honest, I don’t know anything about making a podcast.
It seemed to work out.
Well, it was a team effort. It was for sure, a team effort, and it was a good team. I was really lucky that the first people to ever call me up and say, “Do you want to make a podcast?” were really good at it.
Going back to neurosurgeons being really lucrative for hospitals. How much do you think that affected Duntsch’s decision to become a neurosurgeon in the first place? Was that something that he knew?
From the people that I talked to… First of all, only Duntsch knows that, and I can’t read his mind. But from the people that I talked to, it wasn’t so much the money, it was more that neurosurgeons are really prestigious, and they’re like one of the top people… Like, if you go back and listen to what [Duntsch’s college friend and football teammate] Chris Dozois says, and how [Duntsch] was not great at being a linebacker, but he wanted to be the best one. He wanted to be the one that was front and center and really out there. And so, I think if you translate that to his desire to always want to be on top and to always want to be the most prestigious, I would guess that, that had probably more to do with it than the money. And I don’t know that he really ever even wanted to be a neurosurgeon.
It was just the status.
That would be my guess. I don’t know, but that would be my guess. It was the status, because his friend Rand Page, said that he actually never intended to be a neurosurgeon, that he was gonna work at this [stem cell treatment] company and make his fortune there. So, he would have the title of neurosurgeon, but he wouldn’t actually have to do surgery.
Well, thank you for your time. Do you want to add anything?
No. What did you think of it?
I loved it.
Did you come into it cold?
Yeah, and I listened to it twice, happily.
Did you think it was too gruesome?
No, for me, I love that stuff. I could’ve done more, like, the actual surgical details, but listening to it with other people, I could see how you’d want to leave some of that out.
Yeah. Well, if you want to just put in there that after the first episode it’s a lot less gruesome.
Actually, one thing you asked about, the pitfalls. You just reminded me, that was another danger that we were really grappling with. [We wanted to profile] enough patients where it was established what he did and the pain he caused, but there was also a danger… the only way I know to describe it is a sort of victim fatigue. I didn’t want listeners to grow tired of people’s pain. And so, as it goes along, there’s sort of less and less about what he did to each person. And it wasn’t that each one wasn’t a tragedy in and of itself. It’s just that I figured the listeners would sort of get it, that he was really bad, and he ruined a lot of people’s lives. And I didn’t need to go into all the gory details. Once you got past Mary Efurd, I really didn’t need to get into all that, because you got it. And I didn’t want to seem like I was exploiting them, or making it sensational by really going into the horrible details of what he did each time. Does that make sense?