And something was not. As Deborah slipped into the kitchen to touch up her makeup, she heard a woman talking to her husband of just over a year. "I've seen 28 surgeons," the woman said. "He said, 'I'm sorry. I care,' " Deborah recalls. "Then the gunshots began." The first tore into Tavis's chest. The second struck him in the back as he fled down the hall. Hit two more times, he collapsed, landing dead on the still-breathing Carter, 59, who was bleeding from a head wound in the reception area.
Three days later, staff at the Harbour Court Hotel near Fisherman's Wharf in San Francisco found 48-year-old Theresa Ramirez on the floor of her room in a diabetic coma. Searching her handbag for medication, they found instead two guns, $5,000 in cash and a small notebook containing a list of doctors headed by the name Tavis. At her murder trial earlier this year, a defense psychologist would argue that Ramirez—a breast cancer survivor and former Tavis patient who had undergone 13 breast surgeries in 8 years—suffered from body dysmorphic disorder, a little-known mental illness in which a patient's distorted judgment is reflected in an obsessive quest for perfection through plastic surgery.
Whatever demons drove the wan, emaciated woman sitting in the Santa Clara County courthouse, they weren't apparent when Ramirez, a registered nurse, first consulted Tavis after losing her right breast to cancer in 1988. "Theresa is a delightful 36-year-old lady," he wrote in her medical record that day. An amateur painter who listened to the Rolling Stones as he cut and sutured, Tavis, who had three children from his first two marriages, was popular among patients and fellow surgeons alike. Says his friend Dr. Linda Beatie, a retired anesthesiologist: "He made each of the people he came into contact with feel special."
Tavis would have plenty of contact with Ramirez. In September 1988 he agreed to remove her healthy remaining breast and, in January, reconstructed both with silicone implants as she wanted them to be the same size. Painful scar tissue . formed as a result, so he operated again to remove it. Ramirez subsequently complained that her implants were leaking and uneven in size. In response, Tavis performed further surgery.
And so the serial surgeries continued. But while Ramirez developed a reputation for being impossibly difficult among staff at Petaluma Valley Hospital, where Tavis operated, she downplayed her troubles to her family. In fact, her sister Patricia Bushman, 46, who worked at the same Santa Rosa hospital where Ramirez earned $30 an hour as an orthopedic nurse, discovered that Ramirez had breast cancer only after hearing her paged for an X-ray. Says brother David, 42: "Terri didn't want to be a burden."
Indeed, there seemed nothing aggressive about the Terri that Patricia and David had grown up with in South San Francisco, the eldest child of a fireman and his homemaker wife, who divorced when Terri was 22. To her family, Ramirez, who lived alone with her cocker spaniel Annie, seemed to have made a comfortable life for herself. She invested much of her salary in rental properties, decorated her suburban home with oak antiques and, according to David, "was dating...but picky."
Over time, though, her medical problems, both real and imagined, apparently gnawed at Ramirez. When her HMO initially balked at financing the removal of her silicone implants after Ramirez decided she wanted a new procedure in the early '90s, she went to Tavis threatening to puncture them herself. Then, in 1992, she was awarded $100,000 in damages after claiming that one of her breast implants was punctured when her pickup truck was rear-ended in a car accident. That enabled her to pay Dr. William Shaw, head of plastic surgery at UCLA, to perform a TRAM-flap procedure, in which fat from her abdomen was used to fill her breasts, replacing the silicone. (Both implants were, in fact, intact.)
Yet even after several follow-up operations by Shaw, Ramirez remained dissatisfied. "She kept trying to get it right," says her sister-in-law Laura Ramirez, "but she felt it was botched." That year, Ramirez sued Tavis for malpractice. But in 1995 her suit was dismissed because her attorney was able to gather no evidence.
After that, Ramirez's behavior became increasingly erratic. In mid-1995 she stalked into Tavis's office and called him a "butcher" in front of a waiting patient. She also confronted Dr. Robert Fies, who worked for her HMO, at his office, exposing her breasts and yelling "Look at this!" Fies left his office, and returned later to find that Ramirez had eaten his lunch and then disappeared. In 1996, when she was assigned to a different position at work, Ramirez quit and refused to take a severance package. Instead, she stunned family and friends by enrolling at a barber college in San Francisco.
But it was being diagnosed with diabetes the following year that Patricia Bushman believes pushed her sister over the edge. "As soon as she found out," she says, "something in her mind clicked off." By February 1997, Ramirez had dropped out of barber school and begun giving her possessions to Goodwill.
On the day of Tavis's murder, Ramirez first drove to the Santa Rosa home of the HMO's Dr. Fies. He was out of town, but his name was on the list later found in her hotel room. Also discovered there was an Amtrak ticket to Van Nuys, Calif.—a 10-minute drive from the office of Dr. Shaw.
Although Ramirez maintains that she does not remember the shootings, a jury took nine hours to find her guilty of first-degree murder. But neither the verdict nor the two consecutive life terms Ramirez began serving at California's Valley State Prison for Women in April are of much comfort to Deborah Tavis, or to the family of Kay Carter, who is brain-damaged, wheelchair-bound and unable to speak. Still, Tavis, who has begun working for another plastic surgeon, is trying to move on. "I remind myself that there are so many good people in the world," she says. "That's how I keep going."
Anne-Marie O'Neill
Michael Haederle in Santa Rosa and Gabrielle Saveri in San Francisco
- Contributors:
- Michael Haederle,
- Gabrielle Saveri.
Saved by the Bell Reunion
The hookups, the meltdowns, the memoires
The case reveals what was really going on what they think of each other now!
