Along with Dirty John, Dr. Death has become a flagship podcast for Wondery – an advertisement for the brand and channel as much as an investigation into Christopher Duntsch, the Dallas surgeon who killed two patients and disabled many others in the 2010s. The podcast was so successful that it spawned an entire franchise about medical malpractice, criminal negligence, and sociopathy in the medical field – two more seasons (and counting) along with a television adaptation. Christopher Duntsch’s story is an apt starting point for this broader saga, since he was the first American doctor who was ever prosecuted, charged and put in jail for assault, rather than for medical malpractice, on the basis of his surgical actions.

Various people I know in the medical profession have confided to me that there’s a significant overlap between neurosurgeons and sociopaths – and Duntsch’s life and career certainly seems to bear this out. True to its title, the podcast focuses on some extraordinary surgical malpractice – not just killing patients, or disabling them, but subjecting them to excruciating pain. Duntsch’s “speciality” was spinal surgery, and he seems to have had a particular knack for taking minor complications and turning them into major nervous and spinal catastophes.

The podcast is really effective at positioning medicine as Duntsch’s third option after the football field and boardroom, outlining a toxic alpha male trajectory from gridiron to corporate life to neurosurgery. We hear how Duntsch had to be the best linebacker, then the best entrepreneur, and finally the best neurosurgeon – and you sense he was terrified of being average. If he couldn’t be the best, he would be the worst – if he couldn’t be the most prestigious neurosurgeon in the Dallas metroplex, then he would resort to being a “cold-blooded killer,” as he puts it in an email that proved to be critical in his eventual conviction.

During the first part of his career, this involved Duntsch trying to directly parlay his football skills into surgery, by way of an aggressively mechanical approach that saw him dispose of patients as he would a defensive formation. Time and again, he demonstrated a remarkably ham-fisted use of “hardware” – he had basic issues with regional anatomy and the construction of the spine, and in one case transected four nerves and lost a screw in a patient during what was meant to be a routine procedure. No surprise that he tried to parlay this mechanical approach into his business by forming Disgenics, a “replacement parts” company.

The podcast does a great job of evoking this lineback-turned-surgeon, a sociopath on a collision course with other bodies, whether on the football field or under anaesthetic. As host Laura Bell puts it, Duntsch didn’t realise that going harder didn’t necessarily make him better – and he went harder and harder with each patient, whether by using equipment that was outsized, by hurrying the surgery, or by restoring to the most ludicrously makeshift “solutions”. He performed surgery like an insecure footballer, and partied like a footballer too – we hear stories of him coming in to operate after long nights fuelled with cocaine and LSD.

In that sense, Dr. Death is a kind of spiritual sequel to Gladiator, the Aaron Hernandez podcast, since both series deal with alpha males driven to psychopathic excess (or perhaps just enabled) by the masculine fantasies of the NFL. Before taking out his frustrations on the operating table, Duntsch also had a shot at big business, staking his claim on Discgenics, and smooth talking his way into some pretty serious money. It’s terrifying to contemplate just how “professional” Duntsch seemed to his clients, especially those he would eventually kill.

While Duntsch is positioned within the toxic masculinity of gridiron and finance capitalism, he’s also presented as the logical conclusion of a largely privatised health system. The driving question of the podcast is how he could get away with malpractice for so long, and Bell attributes this immunity in part to the health system itself – ostensibly regulated, but so economically deregulated that any surgeon can set up business. Duntsch saw himself first and foremost as a businessman, neglecting his actual surgical practice as he performed a sustained PR campaign that got him positions at several prominent hospitals in Dallas County.

More disturbing, however, is the fact that Duntsch’s reputation quickly started to proceed him, but hospitals either ignored his past, or refused to pass on critical information when he left them. These were both economic decisions, and both forms of risk management. Bell enlists a variety of doctors to testify to the paranoia of hospitals when it comes to wrongful termination suits, as well as suits filed on the basis of prejudicial references. In a climate where a hospital could compromise itself as a business by firing a doctor, or by giving a bad reference, it just didn’t make economic sense for any single institution to regulate Duntsch.

At the same time, we learn that neurosurgeons, and hospitals that employed neurosurgeons, tend to be the largest beneficiaries of a privatised medical system, at least in Texas. Since neurosurgeons bring in an average of 2 million USD a year in Texas, any hospital that wants to thrive as a business tends to have several neurosurgeons on staff. As a result, hospitals were predisposed to accept Duntsch, despite his reputation, as a for-profit decision, regardless of the accumulating rumours of malpractice that accrued across his short career.

Of course, there are hospitals that wouldn’t stand for this treatment, and Dr. Death is keen to level the blame at only a few specific institutions – especially Baylor-Plano, which seemed to do most of the damage, refused to engage with the podcast, and rebranded itself in the wake of the Duntsch affair. Yet Bell also evokes a broader fixation with risk management that’s perversely confined to the economic sphere – a private health landscape where surgical risk is negligent compared to the risk of insurance, liability and lawsuits. Beyond a point, this fear of economic loss is fantasmic, part of the fetish of the hospital-as-business, since there’s no way Duntsch could have realistically sued any hospital that fired him, or that sent him off with a bad reference. He gambled on this disregard for surgical risk and this fetish for economic risk, and for a period he won, leaving his patients either dead or disabled for life.

Dr. Death really shines when it situates Duntsch in these two matrices – an American alpha masculinity that fetishizes endless upward mobility above all else, and a privatised health culture that fetishizes economic risk above actual medical risk. In that sense, Duntsch’s story reminded me of the devastating final episodes of Netflix’s The Keepers, when the fate of Sister Cathy Chesnik expanded out into an excoriating vision of how the Baltimore Diocese simply shipped abusive priests from parish to parish, rather than holding them to any kind of individual accountability. Something similar occurs here, as the system rallies around Duntsch without always realising it, enabled in part by Governor Rick Perry’s health insurance reforms.

The series reserves its most damning criticism for these policies, enacted by Perry in the early 2000s, which made it remarkably difficult to bring suit against physicians by putting a $25 000 cap on pain and suffering. Beyond that cap, patients could only make economic claims, meaning that the people most disadvantaged were those with the least earning power. This was meant to put an end to defensive medicine, and encourage a flood of top-tier physicians in Texas – at least that’s how it was spun. Instead, a series of law academics provide us with a more cynical interpretation – that the laws were designed to privatise healthcare further, make local physicans less liable, and reduce insurance premiums to stimulate the economy. 

For Dr. Death, Duntsch is the logical conclusion of that process, turning the investigation into a kind of political-economic revolt against the powers that be in Republican Dallas. In lieu of institutional support, Bell suggests, a series of lone journalists and doctors had to form a coalition, a collective effort that both culminated in and is embodied by the podcast itself. The very existence of the podcast is in itself a systemic critique, not unlike the one witness that the defence called in on Duntsch’s behalf when he was brought to trial. This single witness for the defence wasn’t there to even “defend” Duntsch but to simply argue his actions had to be perceived in a broader context, part of the “total system failure” the podcast enacts.

That’s quite a radical gesture for a podcast, especially on a network that initially arose out of the Fox family, and that seems to be squarely directed at a Middle American (and in this case Texan) audience base. That may explain the odd discrepancy between style and subject matter here, since while this it’s an incredible story, it’s not always the best storytelling. Even more than Dirty John, Dr. Death doubles down on the Wondery house style – closer to reportage than regular podcasting, with a ripped-from-the-headlines quality that delights in cheesy puns and a clickbaity, grindhouse grittiness that quickly gets exhausting and tiresome.

The pacing, in particular, can be an issue, since Bell moves too quickly ever set the scene. Every incident appears to begin in medias res, making it all feel like a list of incidents, a punchy Wikipedia article with a few first person recounts, rather than an organic and fully-formed narrative, let alone an escalating evocation of surgical sociopathy. This is a podcast to listen to at the gym, or in the midst of intense physical activity, rather than driving, or walking at night, or in a more contemplative space, which is the way I tend to consume podcasts. The delivery almost seems to be keeping time with some imagined physical activity – it’s hyperactive but also overly deliberate, giving a clear sense that Bell is reading from a script. At times, Bell doesn’t even sound real – more like a bot automatically relating a news article.

That said, I found myself accepting this style more and more as the podcast went on. For one thing, Dr. Death is pretty ambitious in its effort to direct a jeremiad against privatised health for a Texan demographic, and it pulls off that feat largely through pacing – by moving at such a breakneck speed that listeners simply haven’t got time to calcify their predilections for healthcare-as-enterprise into a bias against the podcast. There’s also a kind of tact to Dr. Death’s sensationalism – it keeps things perky, and mitigates against voyeurism or maudlin sentimentality in a story that contains some very traumatic encounters with botched surgery.

Still, I came away wanting a little more – if only a clearer sense of Duntsch’s motivation, which isn’t ever quite addressed here. Was he callous, deluded, genuinely sociopathic or even intentionally murderous? Those questions may be unanswerable, but in the heat of its systemic critique the podcast never even attempts to answer them. Like all powerful true crime then, it leaves you curious (I’m especially curious to watch the series), raising as many issues as it addresses, and exuding a flurry and energy that materialises into the impetus and incentive for a franchise as you listen – as if the spectre of Duntsch, while not fully satisfied here, bred a sudden and newfound awareness of a new mode of surgical criminality, and a new possibility for true crime podcasting, lurking at the very heart of the US medical system.