Last Dance, Last Chance

The doctor was brilliant, a pillar of his Utah community. He was a devout Mormon, a loving father, and a husband whose affection for his wife, Michele, seemed boundless. They had built a life that was the envy of their neighbors—a beautiful home, four healthy children, a future bright with promise. When Michele was found dead in the bathtub in 2007, the story was a simple, devastating tragedy. Her husband, Martin MacNeill, claimed she had insisted on a facelift and, weakened from the surgery, had accidentally drowned while bathing. He was heartbroken, a man shattered by the sudden loss of his soulmate. His children grieved with him. The community rallied around him. The story was sealed, tragic but closed.

But stories have a way of unraveling, thread by tiny thread. A daughter’s nagging suspicion. A sister’s memory of a strange phone call. An offhand comment from the family's new, unusually young nanny who moved in just weeks after the funeral. These small inconsistencies began to pile up, each one a loose stitch in the perfect tapestry of the grieving husband. The official narrative held firm, but underneath, another version of the story was taking shape—one of secrets, affairs, and a chilling, calculated deception. The question was no longer just what happened to Michele MacNeill, but who was the man everyone thought they knew so well?

This gap between the public facade and the private, monstrous truth is the territory Ann Rule spent her career exploring. A former Seattle police officer turned writer, Rule had a unique gift for seeing the cracks in the masks people wear. She immersed herself in the lives crimes destroyed, often corresponding with killers themselves to understand the darkness that drove them. For 'Last Dance, Last Chance,' she meticulously gathered the whispers and doubts that surrounded Martin MacNeill, piecing together the unsettling clues that law enforcement initially missed, revealing how a man could orchestrate the perfect life, and the perfect murder, right in plain sight.

Module 1: The Anatomy of Deception

The story of Dr. Anthony Pignataro is a case study in the architecture of a lie. The book reveals how a charismatic exterior can conceal a deeply flawed and dangerous character.

A key insight here is that narcissistic personalities construct an elaborate reality to support their ego. Anthony Pignataro didn't just lie; he built a world where he was the hero. He saw himself as a modern-day Galileo, a brilliant physician held back by jealous peers. He wrote a manuscript, M.D.: Mass Destruction, which was a tribute to his own genius. He framed his professional failures as the result of conspiracies against him. This was his truth. He was completely oblivious to how others saw him, shrugging off complaints about his arrogance or insensitivity. This self-mythologizing is a massive red flag. When you encounter someone whose story of their own life has no room for error or accountability, be cautious.

From this foundation, we see another critical point. Deception is often enabled by the victim's own hope and idealism. Debbie Pignataro fell for Anthony hard. She saw their first meeting as a scene from a movie. In the early years, she consciously chose to see his flaws as strengths. His arrogance was confidence. His rudeness was just an artless way of speaking. She built a narrative that supported her choice to be with him. This is a deeply human trait. We want to believe in the people we love. But the book shows how this very human instinct can be weaponized by a manipulator. Debbie forgave infidelity and endured constant criticism, always holding onto the hope that the "good" Anthony would return.

This leads to a chilling realization. A pattern of professional failure is a strong indicator of personal character defects. Anthony’s career was a train wreck. He failed to complete residency programs at Georgetown and Thomas Jefferson University. His evaluations were disastrous. Peers called him "dishonest and dangerous." He was sued for malpractice after a patient died. He forged credentials. Yet, he always had an excuse. He blamed jealous mentors, incompetent colleagues, and institutional politics. Debbie, and others, believed him. But Rule shows us that professional and personal integrity are intertwined. How someone handles their work—their honesty, their accountability, their diligence—is a direct reflection of who they are. If someone is a disaster in their professional life but claims to be a saint in their personal life, something doesn't add up.

And here's the thing. Small deceptions are practice for big betrayals. Anthony’s life was a series of escalating lies. He started with small social offenses and exaggerations. He moved on to professional deceit and infidelity. He used his medical practice as a cover for his double life, telling his wife he was traveling for business when he was actually with his mistress. Each lie that went unchallenged emboldened him for the next, more audacious one. The book demonstrates that character is a muscle. And for Anthony Pignataro, the muscle he exercised daily was deceit.