James Ellroy - The Best American Crime Writing 2005

Given the punishing schedules that doctors in training are forced to endure, it's not uncommon for personal relationships to become casualties. But what Arndt's friends did find curious-alarming even-was the way he handled the breakup.

"Here David is, a very good friend of mine. I was not as close to Steve. But clearly David was the one responsible for the breakup. And David had absolutely no insight into it," says Grant Colfax. "It was all about his problems. It was shocking to me." He and other friends began to pull back from their relationship with Arndt.

Then there was the whiplash of seeing the guys Arndt dated right after Goldfinger. "He ran around with all these Barbie doll boys," says Colfax, who is also gay and is now the director of HIV prevention studies with the San Francisco Department of Public Health. "Is that any different from a straight man who gets divorced in middle age and runs around with trophy wives? No, but it was something that was disturbing to me."

It was as though his friends were seeing a David Arndt, version 2.0-a better-looking package but one that lacked the charm of the original release. "He once told me, 'I'm like Dorian Gray. I just get better looking as I get older,' " Colfax recalls. "It takes a certain personality to just state that. And I thought it was an interesting literary reference, considering what the novel was about."

The central character in Oscar Wilde's The Picture of Dorian Gray manages to defy age and remain youthfully handsome. But he loses his inner compass. In the end, Dorian Gray pays dearly for his vanity.

If David Arndt sounds a little too intense, a little too arrogant, ask yourself this: Aren't those exactly the qualities you want in a surgeon? Because this is what his arrogance looked like for most of his time in the operating room: An intolerance for error. An eagerness to take on the toughest cases. A fearlessness about confronting anyone-be it an orderly or a chief of surgery-who he thought was underperforming. Even as an intern, he would routinely challenge the attending physicians. "Interns are supposed to always back down, but not David," recalls Alexandra Page. "The rest of us were like, 'You go, man!'"

As an orthopedic surgical resident, Arndt would finish a grueling shift at Massachusetts General Hospital and then, instead of going out for a beer with his coworkers, would head back to Brigham and Women's to check on a patient he had treated during his last rotation.

Sigurd Berven, one of Arndt's fellow residents, recalls a memorable case: A teenager was rushed to the emergency room with multiple fractures to his spine and pelvis. He had jumped from the roof of a tall building. Arndt operated on him, but that was only the beginning of his care. "David was the only person who figured out why he jumped," says Berven, now a faculty member and spine surgeon at the University of California, San Francisco. Turns out the boy had just been outed at school.

This, says Berven, was typical Arndt care, no matter who the patient was. Sure, he complained a lot. "But the physicians who get angry, who are difficult to get along with, are almost invariably the physicians who really care," Berven says. He compares Arndt to Eriq La Salle's Dr. Benton character on ER and wonders if his friend's intense compassion ultimately became an unmanageable source of stress. In the face of all the defects and demands of medicine, "there's no precedent for somebody surviving in the field who cared as much as David cared."

But here's another way to view Arndt's commitment, his determination to stay involved in patients' care even after they had ceased to be his patients. "He didn't necessarily know where to draw the line," says Stephen Lipson, who was chief of orthopedics at Beth Israel during Arndt's residency. Maybe that surplus of compassion and of self-centeredness came from the same place. "He wanted to be in charge," Lipson says.

Lipson had known Ken Arndt since their residency days at Massachusetts General Hospital, and thought the world of him. Now, here they were, both chiefs at Beth Israel, both watching their own sons follow in their footsteps. (Lipson's son was several years behind David at Harvard Medical School.) "Ken and I had a real kinship," he says.

Lipson found David to be a superior surgeon in the OR and intellectually stimulating outside of it. So he took him under his wing. While David would soar to great heights, it would be prove to be a bumpy flight.

"David wanted nothing but exceptional results," says Lipson, a soft-spoken fifty-seven-year-old who now works at Harvard Vanguard Medical Associates. But he says Arndt's interpersonal skills didn't always measure up, whether he was twisting around language to confuse people or tearing into them. "If a nurse was doing something and he didn't like the way it was being done-a dressing change, medications, or whatever-he might bark at them: "No, you shouldn't do this! It's wrong! Do it this way! He wanted to run the show. Some nurses would go away crying." Lipson would take him aside, tell him to cool it. "But he would just commit the same flaw another time," Lipson says. "He could not turn himself off from being himself."

Lipson was particularly troubled by one area of Arndt's behavior that arose as his residency progressed. Some male orderlies and nurses were complaining that Arndt had made what they felt were inappropriate comments to them, he says. "I had to warn him not to pursue sexual interactions with other male staff," Lipson recalls. "Otherwise it was going to be a problem, and he could be chastised and reported to the administration."

But still, but still: David Arndt was an extremely gifted surgeon. Lipson found him fun to teach-he would do research on his own, push relentlessly for higher performance from everyone, especially himself. Although some of his patients were put off by his manner, most loved him-they could tell he genuinely cared about what happened to them.

And around this time, friends say, Arndt began talking about needing to get his personal life back in order so he could be a good role model-for his son. Arndt told friends that the boy had been born during his early days in San Francisco, but that it was only after the boy was in his teens and wrote to Arndt that the connection was revived. Arndt kept a picture of him, proudly updated his friends on the teen's achievements in school. One time when Arndt was visiting California, Grant Colfax got a chance to meet the boy and his two female parents.

Things were coming together at work as well. As the capstone to Arndt's residency, Lipson advocated for him to be named chief resident at Beth Israel in 1997. Given his father's longstanding connections there, "it felt like home for David."

Lipson still envisioned Arndt becoming one of Boston's next top spine surgeons, if he could just keep himself in check. He helped arrange for Arndt to do his fellowship in spine surgery (the branch of orthopedics that is closest to neurosurgery) at Tulane University School of Medicine in New Orleans. When Arndt returned to Boston and began working at Harvard Vanguard and at a private group practice, Lipson sent him a steady supply of referrals-a crucial lifeline for a young doctor starting out in an over-doctored place like Boston.

Lipson and his wife, Jenifer, had always enjoyed socializing with Ken and Anne Arndt at hospital functions. "They're a nice Jewish couple," Lipson says, "and so are we." Still, his wife sensed trouble in his continued advocacy for David and cautioned him to keep his distance. Lipson would hear none of it. "I wanted to have to do with him," he says. "But my wife said, 'He's out of control.' Which, in the end, I think was true."

You want warning signs? They were there. In fact, the year 1998 was packed with them, though many of the people who worked with David Arndt wouldn't find out about them until much later.