In May 2011, Autumn Klein and Robert Ferrante bought a stately $500,000 home just a few minutes’ walk from their new jobs with UPMC and the University of Pittsburgh.
Autumn quickly settled in to her new position as head of women's neurology at the hospital system while Bob moved his entire lab, including three mice colonies, from the Veterans Administration Medical Center in Bedford, Mass., to Scaife Hall in Oakland.
For years, he had been designing and conducting experiments seeking treatment for Huntington's disease, amyotrophic lateral sclerosis and other neurodegenerative diseases. He was a well-regarded researcher, and getting his $3 million lab and nine active grants was a coup for Pitt.
Part of the research involved injecting experimental drugs into mice that carried the genetic mutation that causes Huntington's.
Patricia Cipicchio, who started with Bob at the Bedford VA in July 2010, moved with the lab to Pittsburgh. Trish was a full-time research assistant put in charge of the R6/2, a Huntington's colony of mice at a lab housed in UPMC Montefiore. Her duties included preparing and administering the drugs, managing breeding and conducting genotyping.
She was also responsible for sacrificing them, as killing lab animals is known in the research community.
"You're killing tons and tons of mice ñ not just through the experiments, but based on genotype and sex," Trish said. "They cost so much to keep alive, and if you're not going to breed, they get sacrificed."
Once the animals were dead, Trish would preserve the brain tissue, then freeze and slice and stain the samples to measure differences between the control group and the treated mice.
Bob was an early riser and would typically arrive at the lab before 6:30 a.m. Although he was responsible for conceiving the experiments and designing them, Bob spent little time doing hands-on work in the lab.
Still, he was a demanding boss, sometimes a bit eccentric, but with trusted staffers able to joke around. He once changed Trish's computer desktop background to seahorses, and sometimes teased her about her nail polish color.
"His sense of humor wasn't always accessible to everyone," she said. "He was kind of funny, but he also didn't care if anyone else thought he was funny."
He enjoyed serving as a mentor to the younger research assistants in the lab.
"He wanted us all to be doctors," Trish said. "It was great to have someone interested in your future."
Although Bob was private about his personal life, he talked about Cianna all the time.
"He loved her so much," Trish said.
He was also passionate about his work seeking cures for degenerative diseases, including ALS, or Lou Gehrig's disease. He had a prized signed Lou Gehrig baseball bat in his office.
Dr. Robert Friedlander, the chairman of neurosurgery at UPMC who had worked with Bob in Boston and recruited him to Pittsburgh, introduced Bob in 2011 to Neil and Suzanne Alexander, who were potential funders of the ALS research.
The O'Hara couple became active in the ALS community after Neil, who was 46, was diagnosed with the debilitating disease in June 2011.
Bob began to court the couple, soliciting grant money to fund the research.
"It was incredibly slick and practiced," Neil said.
"We knew we were being manipulated. We knew we were being played, and we kind of respected it," Suzanne said.
The Alexanders were desperate for an answer to the disease, and Bob had the credibility in his field to try to offer one.
By mid-2012, the couple had agreed to sign on by providing $50,000 for Dr. Friedlander's lab to hire a post-doctoral fellow, as well as for Neil to participate in the research.
He provided spinal fluid and skin cells for the lab to use to grow stem cells, and the researchers mapped his brain.
Bob participated in some of the couple's events for their nonprofit, Live Like Lou, including going to a Pirates game at which Neil threw out the first pitch.
"We wanted to believe him. We wanted there to be an answer," Suzanne said. "He would attempt to give us hope."
Pittsburgh was a great fit for Autumn. She was a quick walk from work, giving her more time with Cianna. She could balance treating patients with research and writing and enjoyed her new colleagues — who seemed more down to earth than her Boston co-workers.
"I like the easier lifestyle here. A bit different in that every other person is not some big shot somebody-or-other, but I kind of like that. I was getting tired of the overprivileged. I feel like I deal with real people, real issues here," she wrote in an email to a friend.
Moving to UPMC tripled Autumn's salary and gave her autonomy to run her own program. She was awarded research grants to look at managing seizures in pregnant women with epilepsy and was applying for others through the National Institutes of Health.
Autumn had a huge patient population, and the patients loved her.
"'I have to tell you, I love the people of Pittsburgh,'" Autumn told her friend, Dr. Karen Roos. "'I'm in exactly the right place.'"
By the summer of 2012, though, her marriage was troubled.
She was frustrated by her inability to become pregnant and with Bob's lack of support. She had gone through repeated cycles of in vitro fertilization, requiring intramuscular injections at least once per day — in the stomach, buttocks and thigh.
Bob didn't help. Autumn gave herself the shots.
The couple contemplated adoption, but many agencies rejected them, Autumn said, because of their age difference.
It was a lonely time.
In a diary entry dated July 30, 2012, she wrote: "I am here writing now because I am not sure who I can talk to about things. I just found out today my third IVF cycle failed. This time not even fertilization. I am not sure where to go from here. I just know that I am incredibly unhappy. Yet I am not sure why.
"I just feel like something is missing in my life. I think that thing missing is love."
In late August 2012, Autumn's good friend, Dr. Karen Kiang, an international child health fellow in Melbourne, Australia, visited Pittsburgh with her family. Autumn and Bob took them around the city, with an incline ride, ice cream on Mount Washington, sandwiches at Primanti's and a walk along the North Shore.
Karen saw the cracks in her friend's marriage when Bob was condescending to Autumn or chastised her for minor things — like how something went in the dishwasher.
And during private moments Karen and Autumn had over those days, Autumn talked about Bob and their marriage.
Bob had agreed to continue with IVF but told Autumn that if they had another child, she would be fully responsible.
"'It's going to be my kid,'" Autumn told Karen.
She worried about finances, too. Autumn was frustrated with her husband for giving money to his adult children, who by that point were already established and financially secure in their careers — Michael in investment management, and Kimberly as a physician. Autumn was unhappy that Bob was paying so much toward Michael's upcoming wedding.
She worried about being the sole income earner when Bob retired. She had just finished paying off her med school loans and fretted about paying out of pocket for what would be her fourth round of IVF.
And she worried that Bob's brother, who had dementia, had to be relocated — and that Bob was concerned that he could be diagnosed with it, too.
"Autumn worried she'd have to be his caregiver, as well as Cianna's," Karen said.
Within a month of Karen's visit, Autumn discussed leaving her marriage.
"Autumn, are you telling me you're going to leave Bob?" her cousin, Sharon King, asked.
"'I don't know what else to do,' " Autumn responded. "'I see myself alone in a few years. It's just gotten so bad, you have no idea. It's just gotten so bad these last few months.' "
Twice during phone calls with Sharon, Autumn had Sharon ask her husband, Jeff, a clinical psychologist, if there was a specific gene for compassion.
"'Because if there is,' " Autumn said, "'then Bob is lacking it.' "
Her emails to Bob a few months later about her fertility problems emphasized those feelings.
"I hate to say it Bob, but through this entire mess, while in body you have done your duty, you have not been there for me," she wrote on Feb. 9, 2013. "Sorry I am angry about all of this — both not having another kid and your lack of interest.
"It is clear you are not interested. I realize now I have been alone in this entire emotional journey," she wrote. "I am going to speak my mind, as you do, and be angry, because this is the only means of conversation you seem to get — is anger. You stink at picking up on almost all other emotions and I am sorry I right now I just cannot talk to you in person. I can't even speak to you without getting angry."
Six days after Autumn sent that email, Sharon's nephew died.
Both women were going to the services in Baltimore, and they planned to talk extensively during the visit because Autumn didn't want to discuss her marriage on the phone.
"I think she didn't trust him," Sharon said.
He didn't trust her either. Bob had questioned whether Autumn was having an affair and on Feb. 19 he had Googled "does increased vaginal size suggest wife is having sex with another."
If Autumn decided she was going to leave Bob, Sharon and Jeff had already agreed they would head to Pittsburgh to help her move. They would talk logistics in Baltimore.
But then, Bob decided to make the trip for the funeral, too. It was the first time in the 12 years they were married that Bob accompanied Autumn back home.
During the wake, he was polite, cordial and pleasant to be around.
Bob spoke with Jeff, telling him that "'Being married to Autumn is the greatest thing in my life.' "
But Jeff knew about the problems in the marriage and that Autumn wanted out.
Sharon and Autumn never got the chance to talk over the visit, and at the wake, on Feb. 21, 2013, Bob made the family leave early to head back to Pittsburgh.
"I know that's exactly why he came. He knew she would talk to me," Sharon said. "She was walking out of our fellowship hall. She turned around and looked at me — that knowing look — that we just didn't get our time.
"That's the last time any of us saw her."