It is always hard to adapt a story and transform it from one medium to another. But how do you take an immensely popular podcast based on a true story and fit it into an eight-episode miniseries? Dr. Death’s showrunner Patrick Macmanus had that challenge. I got to talk to Patrick Macmanus about turning a podcast into a tv show, making unique entry into the true-crime genre, having actors play against type, and if he believes Dr. Duntsch did all of this on purpose.

How was it like to turn a podcast into a TV show? How is that different from adapting a book, or having an original story?

To me, I don’t find it all that different from adapting a book or adapting any other IP. The difference is I feel like if you’re a part of adapting a very successful podcast that the reach of that is something that far exceeds the majority of other pieces of IP. In the case of Dr. Death, when I was first lucky enough to earn the gig, and I fought tooth and nail to get it, I didn’t know at the time what it was going to become. I listened to two or three episodes prior to them premiering, and I definitely knew from a storytelling perspective that we had something really special. We had a special bad guy. And we had very special heroes. And we had this deeper dive into the ultimate bad guy, which in my [perspective] would be the systematic failure of the hospitals. But I didn’t know at the time it was going to become 50 million subscribers. So that was just one of those things that became a little bit daunting because you didn’t want to mess it up. And it was such a built-in, ready-baked, story already. You really have to be really bad to mess this up. And thankfully my writing team saved me from being bad every single day.

How did you go about taking a true story to podcast to miniseries?

I had nothing to do with the podcast itself. But what was so beneficial was Laura Beil, who is the journalist of the podcast, had accumulated such a library of research, from depositions to court transcripts, to interviews. We had thousands of pages of research. I remember it being delivered to me on multiple disc files and my eyeballs bulge. The biggest challenge was digging through all that material and piece together the ultimate narrative. And on top of that, we were given access to Dr. Kirby, Dr. Henderson, and Michelle Shughart, who also were an immense vault of information themselves. And since I was never good at math and science in school, I desperately needed some experts outside of the podcasts to help me figure out how to be a neurosurgeon in many ways. And I was very lucky [to be connected] with a neurosurgeon at Sibley Hospital in Washington DC, where I was living at the time, who really helped me get all the dialogue down in the pilot episode. Then from there, I had two other neurosurgeons who were on there from a day-to-day basis on the show and they were the ones who helped up achieve some semblance to [how these operations look].

You said you fought tooth and nail to get this show. Why were you so passionate about it?

I was working on another series on SyFy called Happy!, and I was sitting in my office in New York. And Happy! is a show that I wish had another twelve seasons. It was such a great show.

My mom says the same thing. She’s a huge fan.

That’s awesome! I was just talking to Chris Maloney like three weeks ago and we were bemoaning the fact that it died the way that it did. And Brian Taylor who really was the genius behind that show, he and I continue to stay in touch and cry some animated tears over that one. But I appreciate your mom, please send your mom my regards. I appreciate that.

Will do!

So I was sitting in my office and I had my headphones and I was listening to the first two episodes and there was a door open behind me and then I heard someone behind me and it was our production designer. And I guess whatever look I gave her was so awful she was like “Thanks Patrick, it was really great to see you too.” And I said “no, not at all. What I was listening to was so devastating.” But it was sort of what I alluded to before. But I hadn’t found a “bad guy” character like this before. He was a different kind of bad guy because he’s this narcissistic sociopath. He genuinely believed that he had done nothing wrong and that everyone else was at fault. And I found that to be a really compelling bad guy. He was doing it for a traditional-sociopathic-on purpose. And then on top of that, we have our good guys, and our good guys are just every-men. There are these two guys who are just as perplexed as we are as viewers, who are trying to figure out how somebody with his training could possibly be doing this. And they don’t have badges, they don’t have guns. They just have righteous indignation in this system they believed in. And to pair them with Michelle Shughart, these are two guys who are a little past being middle-aged men, to pair them with a young driven assistant district attorney I just knew it had all the making of being something really special in the true-crime space. What we set out to do in the writers’ room and what we hoped to achieve, was to reinvent the genre to a certain degree. Not completely. To have all the markings that people are used to seeing in the true-crime genre and to have a completely different bad guy and a completely different good guy at its center was something that was really compelling to me.

What was interesting about the casting is that so many people are playing against type. Joshua Jackson and Christian Slater were heat throbs in their past. Alec Baldwin lately has been doing comedic roles and AnnaSophia Robb has played a lot of teen characters. It leads it to be even more unexpected that these are the people fighting against Duntsch and this system.

You’re absolutely right. Alec was the first one to sign on. When he was floated to me and when he called me and we had a long conversation about it. One of the early things I told him is what I love about this role is that it’s different from everything that he’s played in his career. And the idea to have this actor who gave the infamous Malice speech to be playing the caring doctor, it felt completely against type and I wanted to see what he would do with it. And in my opinion, he killed it, he played an amazing job. And Christian, the first time Christian and I met we had breakfast, and I’m not somebody who doesn’t get starry-eyed. It’s one of my superpowers that I don’t really care about celebrity. And I think actors trust me because I don’t buy into that. I just stopped breakfast halfway through and said “Sorry, I have to say this. I would never say this, but I grew up with you man. You were like an idol of mine” And Christian being Christian was like “oh man, that’s nice, that’s really good to hear man. I appreciate it.” But he’s the comic relief. And he embodies it in such a real way. And the real Randall Kirby, he short of underplayed him quite frankly. The real Randall Kirby is about 100 times what Christian played him as. He is an immense character. And I agree, I didn’t have a big deep dive of AnnaSophia’s [work], but I did know enough to know that this was something that was different from her. And I saw her in The Act, and she just disappeared in that role. I sort of fell in love with her in this role. Right from the first audition, I knew it was her. And this obviously Josh is a whole other thing. Obviously, he came in late in the game, and I owe him a tremendous amount of gratitude that he was so open to joining us that late in the game. And while we all grew up in Josh at all, and I said this in front of him, and I don’t want to sound insulting, but I think this is the finest performance he has given in his very long career. And it’s revelatory. It established him as someone to take watch of for the rest of his career because I feel like he disappeared into this character and had to play a 20-year-old and 43-year-old in the same day sometimes, and it was flawless. I think he’s extraordinary.

How much were the real people involved in the TV show?

I was put into contact with Dr. Kirby, Dr. Henderson, and Ms. Shughart right away. They were on our speed dial and writers’s [too]. Anytime we thought we were losing focus, or anytime we thought we were off the horizon a little bit, we picked up the phone and called them and they got us back on track. I and all of our writers owe them a tremendous amount of gratitude for how active they were. And it was really lovely to finally meet them. The first time I talked to them was three years prior to Tribeca. And to never have seen them face-to-face, COVID threw us for a loop there. But I was so lovely to have them outside in New York with us, they’re good people. And quick anecdote, the first time I spoke to Dr. Kirby, it was Thanksgiving morning, and he called me and he was huffing and puffing and I was asking why he was out of breath and he said “I’m just hiking the stairs here. I have a 55 [pound] pack on my back. I’m getting ready for my ascent on Everest.” And I was like “wow. Really?” And he said, yeah, just training to go up Everest.” And we keep talking and he goes, “hey listen to me. If you stick with Randall Kirby I’m going to win you an Emmy.” And I said “Alright Dr. Kirby. I’m gonna hold you to that.” So if anyone thinks that Slater is overplaying [Kirby] I like to point that out. He’s bombastic for sure.

What was it like filming during a pandemic?

Well, we got shut down about two days before principal photography last March. And we were shut down until August last year. Production is always challenging. There are always long grinding days, and you always expect the unexpected. But there is a camaraderie in production that is something I hold near and dear to my heart. I get to hang out with the crew and with the cast and the ability to commensurate over the tough days. COVID took that part away. We weren’t allowed to socialize and the set was appropriately quiet and separate and all the things we had to do. And that took away a bit of the fun. But I will say everyone hunkered down and did their jobs with grace, and humor from time to time. I’ve been asked a couple of times while doing press for this “what’s my proudest moment?” And I wish I had this really sweet anecdote on set. But it was the crew and their families who let them come to work every single day and help get us over the line. There was never a moment where I felt where we weren’t doing something special and doing it together. And while I wish no one had to go through something like this. I wish we could have supplied ice cream trucks and pizza trucks and the things we normally do to keep up morale, I’m just proud of everyone who came together on the show. It was tough, but we got through it. And I think we delivered a good product at the end of the day as well.

All of this takes place in Texas, and Texas has laws that make it hard to take action against doctors. Do you think this would have happened in different states?

The short answer to this is: “yes I do.” I think the tort reform laws that were put in place in Texas are egregious as they relate to allowing things like this to happen by putting a cap of $250,000, that to me is unconscionable, but the point to me of this story wasn’t to eviscerate the administration or system or Texas, it was to reveal that this is a problem across the country, and at times around the world. If nothing else comes from this show other than it being entertaining to people, I hope people take a lot more agency over their safety. Our production company has put together the For The Patients Campaign, that’s meant to give information and tools to the general public so they can find out all the information they can on their doctors, so they can do a deeper dive of research before they sign on with a doctor, and ultimately, hopefully in a perfect world, we will be able to bring some action to people for who they vote for because it does begin at the ballot box. You can find out what politicians think about things surrounding medical safety pretty easily and I would urge people to vote for their own safety and the safety of their loved ones. 

What was your favorite scene?

I can’t say it’s a single scene, but one of my favorite moments was the second half of episode 104. It was very early in the process before there were any other writers. I pitched the fantasy sequence to the studio because I knew it was problematic that Dr. Henderson had never been in contact with Dr. Duntsch until the trial and that we had to find a way to put them on the screen together. One of my favorite short stories and films is An Occurrence at Owl Creek Bridge, which is one of the first pieces of literature which played with the idea that you think someone is alive, only to find out that they’re dead. So I concocted this idea that Henderson had to work through all of his doubts and fears about the system in the fantasy sequence that would ultimately bring him into contact with Dr. Duntsch himself. I will say that thing I’m most proud of in that sequence because it was an early thing that we concocted and I feel like Jennifer Morrison, who is the director of it, and Ahmadu Garba, who wrote that amazing episode, knocked it out of the park and I think it’s pretty cool. 

You’ve been very close to the story for years now. Do you think Dr. Duntsch was doing his work poorly on purpose or is he just incompetent?

I’m firmly in the camp that he was a narcissistic sociopath who could not see beyond his own mistakes. I do not believe that Christopher Duntsch went in purposely trying to hurt and kill people. Now that being said, it doesn’t matter if he was trying to do it on purpose or that he was so narcissistic that he couldn’t see his own mistakes. Anyone with any semblance of humanity in them  would have seen what he was doing and checked themselves and would have been like “I can’t go back in until I figure out what’s going wrong in these surgeries. Henderson in the finale says and, it was a recurring interview question that we had with a bunch of doctors, any doctor that we interviewed during the course of making this show, was that if you were in Duntsch’s shoes, what would you have done? And the recurring theme, the answer that kept coming back almost verbatim, was “If I had one of those surgeries, I would have never allowed myself into an operating room again.” It was paraphrased from doctor to doctor, but that was the recurring thing that anytime a doctor messes up, they have to step back and put on their back foot for a while because they’re afraid of repeating their mistake. And the fact that Duntsch was completely incapable of analyzing himself or trying to figure out what was going on, the man deserves to be in jail for the rest of his life. It is almost worse, in my opinion, is worse than if he was going purposely, psychopathically going in and hurting these people. Because at least with a psychopath you can find an excuse for it. Like that this guy genuinely didn’t know that he was doing something wrong, it’s far more terrifying to me than any psychopath. 

All Dr. Death episodes are available on Peacock now.

This interview has been edited for clarity and length.