SERIAL KILLER: "Doctor Death" Pt. 1

Summary

Killer Minds: Inside the Minds of Serial Killers & Murderers Episode: "SERIAL KILLER: 'Doctor Death' Pt. 1" Release Date: June 30, 2025

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Introduction

In the gripping first part of the deep dive series on Michael Swango, hosts Vanessa Richardson and Dr. Tristin Engels explore the chilling reality of a medical professional turned serial killer. This episode meticulously unravels Swango's journey from a troubled childhood to his calculated descent into murder, providing both a narrative of his actions and a psychological analysis of his motives.

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Early Life and Family Dynamics

Michael Swango was born in 1954 in Tacoma, Washington, into a strict military family. As the middle child of three boys, Michael faced an authoritarian upbringing under his father, Virgil Swango, a decorated army officer. Virgil enforced rigorous discipline, often using his eldest son, Bob, as an enforcer, subjecting Michael and his younger brother to physical punishments (00:08:00).

Dr. Engels highlights the impact of being a middle child in a harsh environment, noting, “Middle children are more prone to rebelliousness, insecurity, low self-esteem, jealousy, and competitive behavior” (05:20). Virgil's traumatic PTSD from wartime experiences further disrupted the family dynamic, as he frequently shared gruesome tales of violence with his sons, normalizing death and desensitizing Michael to suffering.

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Education and Military Service

At 14, Michael found respite from his father's tyranny when the family moved to Quincy, Illinois, and Virgil was deployed to Vietnam. Enrolled in a strict Catholic high school, Michael thrived academically, graduating as valedictorian in 1972. He then attended Milliken University on a full scholarship, where he excelled until a painful breakup derailed his promising path (08:17).

Dr. Engels explains that this heartbreak likely triggered deep-seated abandonment issues, pushing Michael to revert to his military conditioning in an attempt to regain control. He began dressing in military attire, obsessing over weaponry and violence, and collecting gruesome articles in journals, reinforcing his identity centered around power and death (10:20).

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Early Signs of Malicious Behavior

Michael's transition into the Marines was marked by his continued fascination with death, though his stint was fraught with administrative roles rather than combat, leading to his honorable discharge in 1976. Undeterred, he falsified his military service records to gain entry into Quincy College's pre-med program, exemplifying his manipulative and deceitful nature (12:34).

At Southern Illinois University, Michael's inability to connect with peers manifested in disruptive behavior. During a mandatory cadaver dissection project, he mutilated the cadaver beyond recognition, provoking shock and discomfort among his classmates (19:59). Dr. Engels underscores this behavior as a calculated display of sadism and a need for dominance, indicating early psychopathic traits (21:11).

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Escalation of Malevolent Actions

Despite academic prowess, Michael's unsettling behaviors persisted. He became a certified paramedic to immerse himself further in environments of trauma and death, all while maintaining his medical studies. His colleagues began to notice his obsession, particularly his scrapbooks filled with articles on violence, revealing his intent to use them as a defense mechanism should his actions come under scrutiny (24:10).

By the early 1980s, Michael's manipulation extended to falsifying patient records during his medical rotations. His choice to specialize in neurosurgery was driven not by professional ambition but by a desire to control life and death directly (25:38). Dr. Engels comments on how Michael's actions signified a clear escalation, transitioning from disturbing fantasies to tangible, harmful behaviors (21:19).

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The Incident at Southern Illinois University and the First Murders

In 1984, Michael's facade began to crack during his internship at Ohio State University. An incident involving the elderly patient Ruth Barrick marked a pivotal moment. Michael deliberately withheld life-saving treatment from her, allowing her to suffer and eventually die, purely for his own gratification and control (38:14).

Dr. Engels describes this act as “a combination of voyeurism and sadism,” highlighting Michael's complete lack of empathy and his enjoyment derived from others' suffering. Despite suspicions from fellow nurses and a subsequent investigation, Michael managed to continue his medical career, showcasing his manipulative prowess and relentless pursuit of power over life and death (39:24).

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Psychological Analysis and Insights

Throughout the episode, Dr. Tristin Engels provides an in-depth psychological analysis of Michael Swango's behavior. He connects Michael's early exposure to violence and authoritarian discipline with his later development of antisocial and psychopathic traits. Key factors include:

• Authoritarian Parenting: High demands and low responsiveness leading to emotional detachment and aggressive behaviors.
• Desensitization to Violence: Early normalization of death contributed to Michael's fascination and obsession.
• Manipulative Tendencies: Consistent deceitful behavior, such as falsifying records and fabricating military honors, indicating a premeditated approach to evading consequences.
• Sadism and Voyeurism: Deriving pleasure from others' suffering and establishing dominance over vulnerable individuals.

Dr. Engels emphasizes that Michael's actions were not impulsive but rather the result of a deeply ingrained psychological framework shaped by his traumatic upbringing and personal insecurities.

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Conclusion

The first part of the "Doctor Death" series offers a comprehensive look into Michael Swango's transformation from a troubled youth to a methodical serial killer. Through meticulous storytelling and expert psychological insights, Vanessa Richardson and Dr. Tristin Engels illuminate the dark intersections of environment, personality, and malevolent intent that culminate in Swango's heinous crimes.

As the episode concludes, listeners are left with a chilling understanding of how deep-seated psychological issues, combined with manipulative and sadistic tendencies, can drive an individual to exploit positions of trust for destructive purposes. The journey of Michael Swango serves as a stark reminder of the complexities within the human psyche and the profound impact of childhood experiences on adult behavior.

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Notable Quotes:

• Dr. Tristan Engels on Middle Child Dynamics: “Middle children are more prone to rebelliousness, insecurity, low self-esteem, jealousy, and competitive behavior” (05:20).

• Dr. Engels on Michael's Sadism: “This is classic manipulative behavior because he's feigning vulnerability, exploiting empathy and avoiding accountability for personal gain” (41:58).

• Dr. Engels on the Incident with Ruth Barrick: “He orchestrated the suffering of this man for his own gratification” (38:14).

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Sources:

• Primary Source: "Blind Eye" by James B. Stewart
• Podcast Production Credits: Max Cutler, Ron Shapiro, Alex Benedon, Laurie Marinelli, Natalie Pertzovsky, Sarah Camp, Sarah Batchelor, Sarah Tardiff, and Keri Murphy.

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Follow "Killer Minds": Stay updated with future episodes by following "Killer Minds" on your preferred podcast platform and social media @KillerMinds.

Transcript

[Vanessa Richardson]

This is Crime House. Every doctor abides by the mantra, first do no harm. Beyond its obvious meaning, it's an important ethical guideline for every physician to follow to carefully think about their actions so we can trust we're in good hands. Michael Swango took advantage of that trust in the most terrifying way possible. Michael was obsessed with death and destruction. All he wanted was to make people suffer and die. He decided the best way to do that was to seek people out at their most vulnerable. As a doctor, he could unleash all the suffering he wanted and nobody would see him coming. The human mind is powerful. It shapes how we think, feel, love and hate. But sometimes it drives people to commit the unthinkable. This is Killer A Crime House Original I'm Vanessa Richardson.

[Dr. Tristan Ingalls]

And I'm Dr. Tristan Ingalls. Every Monday and Thursday, we uncover the darkest minds in history. Analyzing what makes a killer Crime House.

[Vanessa Richardson]

Is made possible by you. Please rate, review and follow Killer Minds to enhance your listening experience with ad. Free early access to each two part series and bonus content. Subscribe to Crime House plus on Apple Podcasts before we get started, be advised this episode contains descriptions of child abuse and murder. Today we begin our deep dive on Michael Swango, a doctor and serial killer who used his position to harm and kill numerous patients. For years, Michael evaded detection, leaving a trail of death and unanswered questions in his wake.

[Dr. Tristan Ingalls]

As Vanessa goes through the story, I'll be talking about the horrible things Michael witnessed in his childhood, his growing desire to watch people suffer and die, and the underlying psyche at play as he manipulated colleagues and defrauded medical institutions.

[Vanessa Richardson]

And as always, we'll be asking the question, what makes a killer?

[Nicole Lapin]

Hey there, it's Nicole Lapman. This week on Crime House. It's a brand new episode of Scams, Money and Murder, diving into the wolf of Wall street himself. Want to get deeper into these unbelievable stories? Catch our recent episode with journalist Jessica Pressler, the reporter who uncovered the real story of Anna Delvey. Listen now on Apple Podcast, Spotify, Amazon Music, or wherever you get your podcasts.

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[Vanessa Richardson]

From the time Michael Swango was young, he was fascinated with other people's suffering, and he saw a lot of it. Michael was born in 1954 in Tacoma, Washington, to Virgil and Muriel Swango. He was the middle child of three boys, and none of them got to enjoy a normal childhood. Michael's father was a decorated army officer who enforced a strict set of rules. He treated their family like a military unit, designating Michael's older brother Bob as an officer over his siblings. In Virgil's mind, officers were responsible for those under their command, which meant that anytime Michael or his little brother misbehaved, Bob paid the price, usually in the form of a belt whipping. But as much as Virgil clearly loved being in the military, it also haunted him. He frequently abused alcohol and seemed to have a hard time coping with his wartime experiences because he often told his sons detailed accounts of the killings he'd carried out. We don't know the details of what Virgil said, but this couldn't have been good for Michael.

[Dr. Tristan Ingalls]

No, there's a lot going on here that greatly impacted Michael. Firstly, he's the middle child, and middle children are more prone to rebelliousness, insecurity, low self esteem, jealousy, and competitive behavior, as well as difficulty forming healthy attachments. And this is because they often feel overlooked or less valued than the eldest or youngest child, especially in families where there are poor dynamics already there. Which brings us to the next thing that stands out here, his father, Virgil. He's using authoritarian style parenting, which is a parenting style characterized by high demands and low responsiveness. So, for example, there are strict rules and demands for blind obedience with very little communication, warmth, or affection. This parenting style alone is known to lead to negative outcomes, including diminished capacity for empathy, increased emotional detachment, aggressive and controlling behaviors, and impaired ability to form safe and trusting relationships. And for a middle child, who, according to research, frequently gets the least attention, getting only abusive attention can have a very profound impact. Authoritarian parenting is also correlated with higher rates of behavioral deficits and delinquency in children. Also, Virgil is clearly struggling with untreated trauma and As a result, is self medicating through alcohol. And that indicates that there's also emotional instability in the home. And children learn how to regulate their emotions and self soothe through their caregivers. And instead, poor emotional regulation is what's being modeled here. Virgil is essentially teaching Michael that vulnerability is weakness, obedience is a requirement, and emotional expression, with the exception of violence, is punishable or unacceptable. And when we consider all of this, we can see how this environment really shaped Michael's personality and who he would become.

[Vanessa Richardson]

I'm curious, how traumatizing is it for a young child to be confronted with death so early, particularly since he's hearing stories that his own father is a killer?

[Dr. Tristan Ingalls]

Right. A parent's supposed to be a source of safety and guidance and moral grounding for their children. And in general, when that figure becomes associated with danger, deception, or death, it can cause a child to struggle with confusion, guilt, fear and shame. But in Michael's case, it certainly sounds like Virgil was sharing these graphic stories with pride. And without a strong moral framework, he is normalizing death and violence. For Michael, these early exposures don't cause someone to become a killer, of course, because, I mean, his siblings didn't grow up to be killers, but they can affect a child's capacity for empathy, and it can distort moral reasoning or contribute to the formation of antisocial traits if combined with other risk factors. And I've outlined several additional risk factors already so early on in his life.

[Vanessa Richardson]

Well, fortunately, in 1968, when Michael was around 14, he got a break from Virgil's torment. By this point, the family had relocated to Quincy, Illinois, but Virgil wouldn't be there for much longer because he was about to be deployed to serve in the Vietnam War. However, Virgil wanted to be sure Michael continued to learn proper discipline. So he enrolled Michael at a Catholic high school that enforced a strict moral and ethics ethical code. Virgil thought the rigid environment would keep Michael in line, and it did. Michael excelled in this highly controlled environment. When he graduated in 1972, he was the valedictorian. Afterward, 17 year old Michael enrolled at the local college, Milliken University, where he continued to thrive. He'd gotten a full ride, he was making friends, and he started dating someone. He seemed destined for a bright future, just like his dad wanted. But then Michael's girlfriend broke up with him, and he couldn't seem to handle this sudden, overwhelming heartbreak. This was the first time in his life that Michael was personally on the receiving end of serious hurt and suffering. It was too much for him to handle. So he retreated into his military upbringing to regain a sense of control. Michael suddenly began dressing in military attire, including combat boots and fatigues. It seems like he was emulating his father as a way to feel powerful again in more ways than one. Michael became obsessed with weaponry and violence. Not only that, he started pouring through copies of the National Enquirer because he loved reading articles about car crashes and other gruesome deaths. He even cut out the stories and photos and glued them into a notebook for safekeeping. Over time, he had stacks of journals like this. The grisly details seemed to make him feel stronger, more alive.

[Dr. Tristan Ingalls]

The breakup that Michael had with his girlfriend may have activated some deep abandonment wounds, or possibly even mirrored the rejection and inconsistent care that he got from his father. It certainly appears as if it were a precipitating stressor for this escalating behavior. Like I mentioned mentioned, based on his early childhood experiences that normalized violence, Michael was possibly desensitized to it. He likely tried to find ways to bond with his father or even understand him. And because his father emphasized violence and death, it could have caused Michael to believe that violence and death were an identity that he needed to embody. And this likely primed him for some sadism as well.

[Vanessa Richardson]

I'm wondering, why would learning about other people's violent, tragic deaths make Michael feel better about his own life?

[Dr. Tristan Ingalls]

It's actually not uncommon for people to compare themselves to individuals that they perceive as less fortunate or in worse circumstances as themselves. It's something called downward social comparison. Obviously, Michael's taking this a little bit more extreme, because with him, learning about others who suffered likely reinforced his own sense of control and superiority. It also likely helped him diminish the pain of that breakup and allowed him to feel less vulnerable or victimized by comparison. Because if we remember, he was being taught very early on that vulnerability is weakness, and that was just not acceptable in his home. Also, individuals with, let's say, narcissistic or antisocial traits, for example, can activate a sense of dominance or invincibility when they learn about others suffering. It was his way of feeling safer by comparison, smarter by comparison, stronger by comparison, and in some ways validated. But more notably for Michael, he's making the military and his fixation on death his identity, like we talked about. And that stems from his relationship with his father. He's trying to become the version of himself that he believed would be valued, feared, and admired in the same way that he likely viewed his father. And it stems from identity insecurity, emotional deprivation, and A need for power and validation.

[Vanessa Richardson]

Well, Michael's obsession with death might have helped him feel better, but it alienated his friends. By the end of his sophomore year of college, they had all stopped talking to him. Michael acted like their rejection didn't bother him. He was ready to move on from them too. Even though he was doing well in school, Michael dropped out and joined the Marines. He wanted to experience the things his father had told him about when he was younger. If he could just fire a bullet and stand over someone as the life drained from their eyes, that sense of power would last forever. No one could take it from him. It didn't work out that way though. After basic training, he mostly ended up doing administrative work. Then after about two years in 1976, 21 year old Michael was honorably discharged. It's not clear what happened, but Michael had a backup plan. If he couldn't watch people die on a battlefield, he'd do it in an operating room. In Michael's mind, being a doctor was the best profession other than being a soldier. To see people die every day. And if he was clever enough, he could kill them himself and nobody would know. So Michael returned home to Illinois and applied to the pre med program at a local university called Quincy College. He knew his grades were good enough for him to get in, but he wanted to be absolutely sure. So he lied about his military service on his application, falsely claiming that he'd earned a Bronze Star and a Purple Heart. No one questioned it and he was accepted.

[Dr. Tristan Ingalls]

This behavior is very notable because obviously it's indicating several concerning pathological traits such as narcissistic tendencies, manipulation and deceitfulness, lack of remorse or guilt, entitlement and once again, identity insecurity.

[Vanessa Richardson]

Once Michael was on campus, he pursued his studies with single minded focus, double majoring in chemistry and biology. But his academic pursuits weren't satisfying Michael's morbid urges. So he became a certified paramedic. That way he could witness disaster and death, all while bolstering his resume. It all worked just like Michael planned. He graduated near the top of his class in 1979. And that fall, the 24 year old started classes at Southern Illinois University in Carbondale, about 200 miles from Quincy. But while the admissions office had been impressed with him, Michael's classmates kept their distance. This was partly because he constantly wore his military uniform, which they thought was over the top. Not only that, he made a big show of getting up early in the morning to work out and shout Marine chants on the lawn while everyone else was still trying to sleep. His antics didn't win him a lot of friends, and before long, Michael's old feelings of rejection bubbled to the surface.

[Dr. Tristan Ingalls]

This kind of social rejection could be a serious risk factor given the emerging personality traits that I've already outlined. For starters, someone with narcissistic traits would experience something called a narcissistic injury from this kind of rejection, especially after his first big rejection from his girlfriend. A narcissistic injury is a deep wound to a already fragile self esteem. The military behavior, chanting on the lawn and wearing his uniform was an attempt once again to craft a Persona. And that Persona was mocked and rejected and that could trigger rage and resentment in someone like Michael. This rejection was a way for Michael to justify his sense that other people were the problem, and that likely caused him to lean even deeper in that downward social comparison to regain control and a sense of superiority. It also could intensify his need to reassert control and forcing it through dominance, which is a learned abusive behavior from his own childhood. But also, social isolation is a risk factor in itself for someone like Michael, who is fixated on death and violence. His distorted thinking is just intensifying and it's going largely unchecked. And that is concerning.

[Vanessa Richardson]

Well, Michael wasn't about to let his classmates think they were better than him. He was going to make them sorry for being so cruel. They had no idea what he was really capable of. But soon they'd find out and he'd be the one laughing.

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[Vanessa Richardson]

In the fall of 1979, 24 year old Michael Swango started medical school at Southern Illinois University. His main goal was to become a doctor so that he could kill patients without suspicion. But he wasn't making it easy on himself. Michael's classmates thought he was strange and stayed away from him, which meant he had to embark on one of his first major projects on his own first year, students were divided into groups to dissect a specific part of a human cadaver and deliver a presentation on it. But nobody wanted to work with Michael, so he was forced to work by himself. Students were given keys to the anatomy lab and could work on their dissections whenever they wanted. The lab was busiest in the afternoons when faculty were available to help. But Michael only ever went in after midnight so he could be alone and nobody could see what he was doing. When the day came for his presentation, everyone was eager to see what he'd done. This was everyone's first chance to show what they were made of, to show that they were cut out to be a doctor. And when Michael unveiled his presentation, his classmates were shocked, and not in a good way. Michael's dissection was so badly mangled, it was unrecognizable. His classmates were speechless. Finally, someone said it looked like Michael had used a chainsaw instead of a scalpel. The rest of the class laughed uncomfortably. But Michael didn't care. In fact, he liked getting a rise out of everyone. That's why he'd done this in the first place. He wanted to scare them.

[Dr. Tristan Ingalls]

Yeah, this wasn't incompetence or poor judgment. It was a calculated performance, and it was intended to be provocative. And truly, it's rooted in sadism, narcissism, and a need for dominance. He knew that it would horrify the class, like you said, which means that he gets enjoyment in controlling the emotional states of others, particularly through fear. And that is the hallmark of sadistic behavior. It also speaks to his emotional detachment and ability to dehumanize so easily and callously. He saw this cadaver not as a once living human being that had a family and people who loved them, but rather he saw it as a tool that doesn't deserve basic decency and respect. And that is deeply troubling and very indicative of psychopathic traits. He clearly lacks empathy. This was also very attention seeking, which aligns with his narcissistic tendencies. He's attempting to establish superiority because to him, he had to Prove to himself that he wasn't failing to fit in, he was choosing not to. And this was to protect his fragile self esteem and to overcompensate for being perceived as vulnerable.

[Vanessa Richardson]

Do you think this seems like an escalation in his behavior? Obviously we know he went on to become a serial killer, but would this have been a warning sign?

[Dr. Tristan Ingalls]

Yes, this is absolutely an escalation and a warning sign. It's a clear shift from a morbid fantasy to a real life enactment. And while this behavior on its own is not enough to predict future murder, like we mentioned, we know he goes on to become a serial killer. This moment alone is not enough to predict that, but it is very concerning, especially for the medical field. It's an indication that he lacks a standard of professionalism. And it really highlights his true reason for entering the medical field, which is in direct contradiction to the core ethical and psychological foundations of medicine.

[Vanessa Richardson]

If Michael wanted to shock his peers, he definitely succeeded. But when it came to intimidating them, them, he wasn't as successful. Instead of being scared of Michael, they made fun of him. Like always, Michael tried not to let it bother him. And besides, getting to mangle a cadaver like that had satisfied some of his itch to destroy and kill. But it still wasn't enough. He needed more. So he picked up another job as an emt. This time for a company called America ambulance in Springfield, Illinois, 100 miles from campus. It was risky because it was against school policy for him to have a job, so he didn't tell anyone. But people caught on pretty quickly. And yet, Michael didn't get in trouble. In fact, some of his professors actually respected his dedication to getting first hand experience. And things continued to improve from there. Despite his abject showing in the dissection project, Michael passed all his courses and exams. In the fall of 1980, the 25 year old started his second year of medicine school. But it wasn't long before things began to unravel. Throughout that year, Michael prioritized his EMT shifts over his schoolwork. Even when he did attend study sessions, his classmates noticed that he was jumpy, anxious, and always darting off to his next shift. That's because he was addicted to watching people die. And his co workers at America Ambulance had noticed his fascination with tragedy and violence. And it wasn't just his creepy obsession with ailing patients. Michael had started bringing his scrapbooks to work, the ones where he saved articles about car crashes. He cut out photos and news stories while he waited for ambulance calls in full view of his stunned colleagues. Eventually, one of Michael's co workers asked him why he saved the articles. Michael's response was chilling. He reportedly told them that if he was ever accused of murder, he could use the scrapbooks to prove he wasn't mentally competent.

[Dr. Tristan Ingalls]

Well, unfortunately for Michael, that's not quite how it works. We also assess for malingering when we do assessments for competency. And this is precisely why he's already planning a legal defense strategy. And he has not yet killed anyone. And that right there indicates he has a highly manipulative mindset and a growing detachment for moral and legal norms. I have assessed many individuals who planned in advance to appear incompetent or insane at the time of their crimes, even before committing it. It's something that does happen now, bringing these scrapbooks and sharing his obsession with death and violence. He is trying to normalize it among his peers. But more importantly, he is limit testing. First with the cadaver, now this. And the more he tests the limits of others, the more pleasure he gets from their death. Deep discomfort, and in some ways, the more it emboldens him when there are no consequences. Also, this scrapbook that he has is serving like a trophy of sorts. I think he's likely using these images to relive firsthand experiences of similar accidents that he might have witnessed or attended to as a paramedic. And once again, there are a lot of emerging antisocial and psychopathic traits here, including sadism, manipulation, lack of empathy, cunningness, callousness, grandiosity, and an inability to follow social norms or rules.

[Vanessa Richardson]

I think it's fair to say most serial killers try to hide their violent impulses, but Michael seems proud of them. He's almost flaunting them. What does that say about him?

[Dr. Tristan Ingalls]

Yeah, that's more evidence that Michael shaped this into an identity that he thought would be admired by others in the same way he admired his father for similar things. He views this level of depravity as a badge of honor. And this started in childhood with his father doing the same. I think it's also deeply tied to his military identity that he shared with his father, because his father used his military experience to glorify control and power. And that became a psychological framework for Michael, as I've already outlined.

[Vanessa Richardson]

Even if Michael meant what he said, nobody was taking him seriously at work or at school. When it was time for them to start interacting with patients, Michael was useless. But instead of working harder, he started falsifying patient write ups. Michael's classmates knew he was cheating, but nobody ratted him out. They probably figured he'd wash out soon enough. But the professors never caught on to him. And in the fall of 1981, Michael moved on to his third year with everyone else, which meant it was time to choose a specialty. To everyone's surprise, Michael went with neurosurgery, one of the most demanding fields. They didn't know that Michael only wanted access to his patients brains as a way to wield power over them. In his mind, neurosurgeons controlled the on, off, switch to a person's life. And over the course of Michael's third year, almost all of the patients he treated ended up dead. His classmates came up with a nickname for him. Double O Swango, meaning he had a license to kill. They only meant it as a joke. No one actually thought Michael was responsible for the deaths. After all, he was just a med student. But things got even worse. Halfway through Michael's third year, in January 1982, his father died. Michael had barely seen Virgil since he'd shipped off to Vietnam almost 15 years earlier. But his father's death seemed to hit him hard. After Michael came back from the funeral, something had clearly changed. It was most noticeable at work, where Michael started having angry outbursts for no apparent reason. Once, he kicked a cabinet door so hard, he smashed it.

[Dr. Tristan Ingalls]

In many cases where an abusive parent is also idealized, their loss can create an emotional wound that intensifies all unresolved identity conflicts, guilt, and rage. When Virgil died, Michael lost the living symbol of an identity he had been trying to construct. He may have begun to realize his father was flawed after all. Or Michael might have begun wondering who he is without his father alive. But also, given what we know about Michael's personality traits, this reaction makes sense. He equates death with control. And now his father died. That is a direct threat to his illusion of control. It undermined it entirely. And that would absolutely cause someone like Michael to escalate. Because to him, if he can't stop death from happening to people, then he wants to be the one to deliver it and be in full control of it in another way.

[Vanessa Richardson]

In general, what happens in our brains when we experience trauma or grief?

[Dr. Tristan Ingalls]

Yeah, when we have have acute trauma or grief, the same thing happens. The amygdala becomes hyperactive, heightening our sense of danger and stress. And this makes people hyper vigilant, reactive, or emotionally overwhelmed, because that's the emotional center of the brain, the prefrontal cortex, the area that controls logic, decision making and reasoning, as well as the hippocampus, which is the area where Memory consolidation occurs. Those either shut down or become disrupted. So essentially, when we grieve or experience trauma in acute ways like this, the brain shifts into survival mode. Emotions will surge, logic will fade, memories distort, and our inner sense of safety collapses. Most people heal in time. But for some, especially those who already are vulnerable, like Michael, this disruption, this kind of grief and life disruption can become a defining psychological moment.

[Vanessa Richardson]

Michael's behavior was so erratic, his supervisors at his EMT job had to step in. They banned him from treating anybody one on one. From then on, he was only allowed to assist other medics. But Michael kept moving forward. Shortly after his father's funeral, he got into a prestigious internship program at the University of Iowa. Even though Michael's medical school classmates didn't think much of him, he'd fooled his professors, and they'd given him glowing recommendations. As long as he could graduate, he could still make it as a doctor. But in order to do that, he had to finish a process called rotations, which meant he had to basically try out all the different specialties. During the final stretch of his third and final year, Michael started his OB GYN rotation under Dr. Kathleen O' Connor. Dr. O' Connor quickly noticed that Michael wasn't around much, and yet he seemed to be remarkably skilled. One day, Michael performed a history and physical, also known as an H and P, on a patient scheduled for a C section. He was only with her for a few minutes, but he wrote a thorough report. Dr. O' Connor thought it seemed too good to be true, so she checked on the patient. Not only had Michael barely spoken to her, he hadn't even performed a physical. O' Connor realized that Michael had fabricated the H and P. That was grounds for expulsion, so she alerted the Student Progress Committee. When Michael found out, he hired a lawyer, which made the school worry that he would sue. Dr. O' Connor knew she needed a paper trail, so she tried to find Michael's fabricated hmp. But when she searched through the files, it was gone. And it wasn't the only one. A bunch of Michael's reports had apparently disappeared. O' Connor told the committee about it, but no one could figure out where the files had gone. With no proof he'd fabricated any reports, Michael's lawyer was able to negotiate with the school. They agreed to let Michael graduate a year late as long as he repeated his OBGYN rotation and and made up missed assignments. It seemed like Michael was in the clear. But then the University of Iowa withdrew its internship offer when they learned he wasn't graduating on time. Michael was crushed. This was a huge setback. He could feel his sense of power slipping through his fingers and he was willing to do whatever it took to get it back.

[Unknown]

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[Vanessa Richardson]

What is Daddication?

[Unknown]

The thing that drives me every day as a dad is Dariona. We call him Dae Dae for short. Every day he's hungry for something, whether it's attention, affection, knowledge. And there's this huge responsibility in making sure that when he's no longer under my wing that he's a good person. I want him to be able to sit back one day and go, we worked together. We did a good job.

[Vanessa Richardson]

That's dedication.

[Dr. Tristan Ingalls]

Find out [e-mail] brought to you by.

[Vanessa Richardson]

The U.S. department of Health and Human Services and the Ad Council.

[Peyton Moreland]

Are you ready to dive into the unknown? Join me, Peyton Moreland on Into the Dark, the true crime podcast from Ono Media with a hint of horror and mystery. Each week I dive into a different case, breaking down the facts and pondering. Pondering the age old question, why do people do what they do? Now, sometimes the answer isn't so clear. And that's why I'll also explore conspiracy theories, hauntings and all things spooky, from the Green River Killer to the Mothman incident. We will unravel all of the questions that keep us up at night. So don't miss out. Subscribe now on your favorite podcast platform and new episodes drop every Wednesday. Into the Dark, where true crime meets the eerie unknown.

[Vanessa Richardson]

In the spring of 1982, Ohio State University required 27 year old Michael Swango to redo his OB GYN rotation in order to graduate a year late. It was a huge blow to his ego, but he did everything that was asked of him him all while working as an EMT. In the spring of 1983, one year after his original graduation date, Michael earned his degree. Not only that, he received an internship offer from Ohio State University's neurosurgery program. It seemed like his nefarious dream of using medicine as a cover to murder People was back on track. He was officially a doctor, and he was ready to celebrate. The summer before he left for Ohio, Michael kept working as an EMT for America ambulance. He was still on probation for his angry outburst, though, so he wasn't supposed to treat anyone directly. But one day he got a call that a man was having a heart attack. It seems like he was the only medic there at the time. So Michael hopped into the ambulance and headed for the man's home. When Michael arrived, the man was gasping for air and clearly in a lot of pain. This was the opportunity he'd been waiting for. Instead of giving emergency treatment and loading the man into the ambulance, Michael told the patient's family to take him to the hospital in their own car. They were appalled, but Michael told them there was nothing he could do. He watched as the man struggled to get into the car, clutching his chest as his family steadied him. Michael's gaze was fixed on the man as he anticipated his collapse and ultimately his final breath.

[Dr. Tristan Ingalls]

I have a feeling that because Michael was on probation and restricted from providing direct patient care that he used that as a legal shield to withhold care for his own gratification. Except he would be wrong. Even if Michael was on probation and restricted from providing direct patient care, he was still the only responder on the scene of an emergency. He has a moral and ethical obligation as a paramedic to provide care, even if it meant calling for backup or notifying a supervisor. The same is true for me as a mental health professional. The pandemic was a great example. Laws were loosened to allow mental health practitioners to treat patients in states they were not licensed in because there was a demand during a national emergency. There are ethical exceptions for many instances, but particularly in ones where we are the only available provider. The first and most important ethical rule for any health professional is to do no harm. And what Michael did was the opposite. It was a chilling abuse of power, and he used trust as a weapon. He knew that this man and his family were desperate and were unlikely going to question or argue with a health professional during a medical emergency or crisis like this. Michael orchestrated the suffering of this man for his own gratification. This kind of medical betrayal is truly an ethical atrocity. This is a person's most vulnerable moments, and he preyed on them without empathy, without remorse, and without a second thought.

[Vanessa Richardson]

Where does Michael's behavior here lie on the scale of escalation? Michael's he's not killing someone yet, but he's willing to let someone die, which Seems pretty much like the same thing. Is there a psychological difference there?

[Dr. Tristan Ingalls]

Yeah. So first, this and the cadaver and the scrapbooks are all gateway behaviors. It's an escalation arc where it starts with fantasizing, then exposing himself and then action, or in this case, inaction. His fantasies are slowly becoming a reality. What makes it more disturbing, as we already kind of covered, is that he's been planning actively for legal ramifications so that he can commit these acts without consequence or with minimal consequences. And like I mentioned, I think that's what he did here. He thought there would have minimal consequences because he was restricted from giving care and he could shield himself as a result. But this just speaks to the level of determination Michael has. What makes us different is that this was a form of passive murder where he is experimenting with power and laying the groundwork for a future active murders.

[Vanessa Richardson]

Thankfully, the family made it to a hospital and the man did survive. Afterward, they called America Ambulance and complained about Michael. When his supervisors confronted him, he didn't provide any explanation for his behavior, so they fired him.

[Dr. Tristan Ingalls]

And I think he knew on some level that this would be the extent of his consequences. And given that he is in his third year of medical school, he won't need this job for that exposure anymore. Anyway, being fired wasn't a loss for him because he was already getting what he needed from this and moving on.

[Vanessa Richardson]

Michael didn't care. As you said, Dr. Engels, he was leaving soon anyway. So three months later, he began his internship at Ohio State. But he hadn't gotten there through honest means. And pretty soon, it became clear that Michael was out of his depth. Once it was obvious that Michael had no idea what he was doing, his supervisors did some digging. They realized that they'd only looked at Michael's transcripts from Southern Illinois University, but never read Michael's letter of recommendation. In that letter, his old professors outlined every concern they had about Michael and explained why he didn't graduate on time. The OSU faculty was concerned as well. They alerted the Residency Review Committee and said they didn't think Michael should move up from intern to resident. The following year, when Michael found out, he decided to fight back. But this time, instead of getting a lawyer, he acted contrite. He promised the committee that he would devote himself to improving.

[Dr. Tristan Ingalls]

So this is different from how he's reacted in the past. And I think that's because he knew that appealing to the committee's empathetic side first before taking a more aggressive approach would be the smartest way to go. About this. But this is also pretty classic manipulative behavior because he's feigning vulnerability, exploiting empathy and avoiding accountability for personal gain. Given the depraved determination he has to become a doctor, it's not surprising he would weaponize humility to preserve that. He's become skilled at manipulation over the years, which makes him dangerously adaptable. He's also got an established pattern of deceit. I mean, he falsified various types of records, including a Purple Heart and medical records during his rotations. He's charmed professors in the past as well as employers, despite his emerging sadistic and psychopathic traits. And he's a great chameleon. He can superficially mimic whatever is needed in the moment to serve his own agenda. This pivot was designed to stall consequences and preserve the ultimate goal, which is power over life and death. And he was definitely going to go about addressing this threat to his goals strategically, especially when there was still a chance to salvage it.

[Vanessa Richardson]

Thanks to Michael's false promises, he was allowed to continue his internship and see patients. On January 17, 1984, an elderly woman named Ruth Barrick was admitted to the hospital. She'd fallen and hit her head 10 days earlier and had bleeding in her brain. It was serious, but she was expected to recover. A couple weeks into ruth's stay, on January 31st, a nurse named Deborah Kennedy gave Ruth her breakfast and completed her morning check checkup. Ruth was doing well. She was sitting up in bed, alert and engaged in conversation. At 9:45 that morning, Michael came into Ruth's room and told Deborah to leave. Deborah was surprised. Doctors usually did their rounds at 6:30am and rarely came back unless it was a problem. Even then it was the attending physician, not an intern. But even though 29 year old Michael was just an intern, he was still a doctor and therefore above Deborah in the hospital's higher hierarchy. Despite her misgivings, she obeyed his instructions and left. But about 20 minutes later, once the coast was clear, Deborah went back to check on Ruth. And it was bad. Ruth was barely breathing and her skin was blue. Debra called a code and doctors rushed to help, including Michael. They treated Ruth for 45 minutes and met managed to stabilize her. Her breathing went back to normal and a little while later she was able to speak again. But she couldn't explain what happened and neither could the doctors. It seemed to be over though, so they continued the normal treatment for her brain bleed. About a week later, on February 6, a nurse named Ann Ritchie was assigned to Ruth in the neurosurgery unit. Ann knew what had happened to Ruth the week before, so she was especially attentive to Ruth's condition. And at 8am Ann gave Ruth a bath. Ruth was alert and seemed fully recovered from the previous week. However, Anne noticed the pressure in Ruth's central IV line was low. That meant she wasn't getting her medication as effectively as she should. Ann asked for a doctor to check it. That doctor was Michael. He entered the room and Ann left. After a while, he still hadn't come out. Ann was worried. Fixing a central line didn't take that long. She went back to see if Michael needed help. But the curtains were drawn around Ruth's bed, blocking her from view. Ann peeked through and saw Michael hunched over Ruth's chest. He'd stuck a syringe directly into Ruth's central line and he had a second syringe resting on his shoulder like he was waiting to use it after the first one ran out. If Michael had been using the syringes to clear the line like he was supposed to, there would have been blood in the them. But there wasn't any. Anne knew something was off. Before she could intervene, Michael noticed her. He told Anne to get out. A few minutes later, Michael finally left the room. Anne felt a chill run down her spine when she noticed a disturbing grin on his face. Anne quickly checked on Ruth and she wasn't breathing. Anne called for help and started mouth to mouth. When she looked at the up, she saw Michael calmly watching from the back of the room. But he wasn't there to help. According to Anne, all he said was, that is so disgusting.

[Dr. Tristan Ingalls]

This behavior is very similar to the incident when he worked as an emt. It's not just about an unwillingness to intervene during a medical crisis. It was about deriving satisfaction from watching them suffer. This kind of behavior is. Is deeply psychopathic and it is a combination of voyeurism and sadism. And although typically voyeurs secretly observe people in sexual context, he's observing them in what should be private moments nonetheless, while simultaneously deriving pleasure from their suffering. But what really stands out to me is what he said to Nurse Ann while she started mouth to mouth. That is so disgusting. This is a psychological confession. In this moment, he is conveying what he is repulsed by, which is compassion. And he is so deeply emotionally detached that saving someone's life is more repulsive than attempting to take one. And once again, he is doing it in such a way that was discreet enough it could be overlooked, which that in itself likely brought him satisfaction. He's watching everyone scramble to understand and rationalize what happened. And it's another element of power and control for Michael.

[Vanessa Richardson]

Thankfully, other doctors came to Ruth's rescue and began chest compressions. There wasn't time for them to pay any attention to Michael, so he stood back watching the scene play out. And a few moments later, Ruth Barrack died. Anne was certain that Michael was responsible for her death, but she didn't think he did it on purpose. She thought maybe he accidentally let an air bubble into Ruth's central line causing a fatal embolism. However, as Anne talked about it with her fellow nurses, she became more suspicious. A few of them also had stories of sudden deaths or near deaths Michael had been involved in. All within the span of the last few days. They had all witnessed his snarky remarks or sinister grin after handling a patient or whenever there was an emergency. They knew something was very, very wrong and they had to do something about it. The nurses believed Michael had caused four additional deaths in the neurosurgery unit. They raised their concerns up the chain. After a multi week investigation, the hospital came to a conclusion. There wasn't enough evidence to kick Michael out of osu. He was allowed to finish his internship, although he wasn't invited back for a residency. Once again, Michael hit a roadblock in his career. In order to practice medicine independently, he had to finish a residency, but he hadn't applied to any other programs. So in the summer of 1984, the 29 year old returned home to Quincy and got a job as an emt, this time for a different company. By now, Michael didn't bother to hide his fascination with death and destruction. He brought his twisted scrapbooks with him to work openly clipping articles and gazing at disturbing photos. He also liked to put on the news to get updates on tragic stories. Once he marveled at a story about a mass shooter and allegedly said he wished he'd thought of it first. And Michael didn't stop there. He also reportedly told people he was dating multiple women and described his violent sexual sexual fantasies openly at work. That was the final straw for his co workers. They went from politely ignoring him to bluntly telling him to stop talking. Yet again, Michael was rejected by his peers. And just like before, he vowed to make them wish they'd taken him more seriously. One day in September 1984, Michael left work and went to the grocery store. Store. He purchased two things. A dozen donuts and a box of ant poison. Thanks so much for listening. Join us next time as we conclude our deep dive into Michael Swang. Of the many sources we used when researching this episode, the one we found the most credible and helpful was Blind Eye by James B. Stewart Killer Minds.

[Dr. Tristan Ingalls]

Is a Crime House original Powered by Pave Studios. Here at Crime House, we want to thank each and every one of you for your support. If you like what you heard today, reach out on social media at crime house on TikTok and Instagram. Don't forget to rate, review and follow Killer Minds wherever you get your podcasts.

[Vanessa Richardson]

And to enhance your listening experience, subscribe to Crime House plus on Apple Podcasts. You'll get every episode of Killer Minds ad free, along with early access to each thrilling two part series and exciting bonus content. Killer Minds is hosted by me, Vanessa Richardson and Dr. Tristan Engels and and is a Crime House original powered by Pave Studios. This episode was brought to life by the Killer Minds team. Max Cutler, Ron Shapiro, Alex Benedon, Laurie Marinelli, Natalie Pertzovsky, Sarah Camp, Sarah Batchelor, Sarah Tardiff and Keri Murphy. Thank you for listening.

[Nicole Lapin]

Hey there, it's Nicole Lapin. For your next listen, check out Scams, Money and Murder. This week we dive into the true story, the Wolf of Wall street himself. And don't miss our recent episode with Jessica Pressler. That's the journalist who uncovered the truth behind fake heiress Anna Delphi. Listen now on Apple Podcasts, Spotify, Amazon Music, or wherever you get your favorite podcasts.