The late Roberto Ardizzone was a physical wreck - the type of high-risk patient who frequently undergoes shock today. The pizza chef from Sicily weighed 372 pounds and stood only 5 feet, 7 inches.

The 32-year-old giant had a big heart and a big temper. He'd do anything for friends, but when his mood swung, he might attempt suicide or punch out windows.

He'd had shock therapy in 1990 to help depression. He wanted it again. But he weighed 100 pounds more than last time. His doctors at the University of Texas-Medical Branch in Galveston refused to do it. He was "morbidly obese," they said. The doctors believed his weight made it too dangerous.

Psychiatrist John Wamble agreed to do it. So did anesthesiologist Aslam Ilahi, who asked the hospital's chief of anesthesiology for advice. "I told her, 'Don't do it. You'll lose his airway,' " says Michael Chavin, then chief of anesthesiology at Baycoast Medical Center in Baytown, Texas.

The airway is a tube inserted to give the patient oxygen during the procedure. According to a Texas Department of Health report, Ardizzone's pre-shock medical assessment stated: "Short, thick neck. May have difficult airway."

Shock therapy went ahead at 11:30 a.m. July 23, 1993. Almost immediately, Ardizzone lost his airway.

"We almost lost him on the table," says Chavin, who rushed in from another operating room to help.

Ardizzone awoke combative, struggling to breathe. He was sent to intensive care. For two days, he remained agitated, screaming, struggling to breathe. He told a nurse he couldn't take it anymore. At 10:50 p.m. July 25, Ardizzone staggered to the nurse's station - face pale, lips blue.

He collapsed and died.

His death certificate lists: "Respiratory Insufficiency, severe; (possible) pulmonary embolism; morbid obesity; hypertension."

Wamble says the death "was an adverse drug reaction. If you look at ECT-related death . . . the major risk is putting someone to sleep."

He says Ardizzone was insistent on shock: "He was a rather emotional fellow. But he was well liked by the nursing staff. If he wasn't jumping up and down hollering, he got along very well with everyone.

"In retrospect, he had a smaller trachial airway than the average person," Wamble says. "But presented with the same situation, I wouldn't have done anything differently."

Ilahi declined comment. After Ardizzone's death, Baycoast stopped doing shock altogether.

Salvatore Ardizzone, the patient's brother, is bitter. He thinks the doctors should have denied his troubled brother's request. He filed a lawsuit in July over his brother's death.

"This is the treatment saved for people society considers worthless. Roberto used to tell me, 'Sal, I want to die. I want to be an angel.' "They" gave him his wish."

By Dennis Cauchon, USA TODAY