James Ellroy - The Best American Crime Writing 2005

One weekend after the blizzard of headlines, Stephen and Jenifer Lipson went out to brunch and bumped into Ken and Anne Arndt. (Ken, by this time, had left his post at Beth Israel Hospital for a private practice in Chestnut Hill.) "We sat at our separate table, formally said hello to one another," Lipson recalls. "But clearly nobody wanted to talk about David. It was too sensitive."

What does Lipson think happened to his protege? "I think somehow he got involved in drugs and it ate him alive and he went over the edge," he says. "Beyond that I don't have an answer. And it's a shame."

If, as friends say, David Arndt has always viewed himself as the star of his own drama, what, in the end, drives the story line? Is his a story of downfall by drugs?

It should be noted that neither of Arndt's criminal cases has yet gone to trial, and he has pleaded not guilty to all charges. But if the allegations turn out to be true, he would hardly be the first hard-driving doctor to get wildly off track because of a substance-abuse problem. John Fromson is a Harvard psychiatrist and president of Physician Health Services, the Massachusetts Medical Society offshoot that provides support and monitoring services for doctors battling substance abuse and mental health difficulties. Confidentiality rules prevent him from discussing any one case, or even confirming a particular doctor's involvement with the program. But he has gained considerable insight from overseeing a program that has worked with about two thousand Massachusetts doctors over the last ten years.

This is not a great time to be a doctor. More than 40 percent of physicians surveyed in 2001 said they wouldn't go into medicine if they had to do it over again. With increased productivity demands and a tightening financial squeeze, doctors are under tremendous stress, and more of them are turning to drugs and alcohol for relief. An estimated 8 to 14 percent of physicians have a substance-abuse problem. In Massachusetts, surgeons are among the most affected.

Fromson ticks off the warning signs: verbally abusive behavior, tardiness, unexcused absences, inappropriate sexual behavior. The signs of strain tend to come first in a doctor's personal life. "When things happen at the workplace," he says, "usually they have been going on for a long time." Even then, he says, the problem may not be confronted, because most doctors are self-employed and only loosely supervised, and hospital management is often hesitant to call doctors on questionable behavior for fear that they will take their patient base to a hospital across town.

All of this means a doctor's substance-abuse problem can go unchecked and then trigger a downward spiral.

And if the drug of choice is crystal meth, or speed as it's also known, the narcotic at the center of Arndt's charges, the spiral can move at dizzying speeds. In his job with the San Francisco Department of Public Health, Grant Colfax has done some pioneering research documenting the prevalence of speed in the gay community. "For many gay men, crystal meth has just completely destroyed them," he says. "People bottom out. It's a question of how far down you've fallen, and if you can get back up."

"If you look at David's personality, speed is the dream drug," Colfax says. "It makes you feel invulnerable."

At some point in conversations about him, just about all of Arndt's friends and colleagues use that word or others like it to describe him and his self-image. Bulletproof. Subject to his own rules. Unbreakable.

Ultimately, that's what makes the drugs explanation, on its own, unsatisfying. After all, the same description fit him even during the long periods in his life when he was clearly not using drugs. Friends were often driven to distraction by Arndt's sense of invulnerability and need for control. But they also saw how those traits could be attractive, especially for patients in need-spurring him to take on the most challenging cases, to fight the toughest battles on their behalf.

But what happens if that need to be in control becomes more important than anything else? "David wanted people to pay attention to him and notice him," says Saiya Remmler, the psychiatrist and former med school friend. "To me, it sounds like a gradual, maybe even lifelong, struggle between greatness and tragic flaws." And what might be at the center of this Greek tragedy? She and other physicians who knew Arndt but haven't seen him in years suggest narcissistic personality disorder, where an exaggerated sense of self-importance masks a chronic emptiness. Then again, only the star of this drama knows the full story.

You do as he tells you. And he is right. The Journalist and the Murderer is a gripping piece of nonfiction. (The original New Yorker piece was published in book form in 1990.) It examines the dance between a controversial figure and a journalist trying to persuade him to share his story-one that is always something of a tango through a minefield. The relationship at the center of Janet Malcolm's book is the one between Fatal Vision author Joe McGin-niss and convicted murderer Jeffrey MacDonald. The first sentence of the book is a pretty clear preview of the analysis Malcolm will render: "Every journalist who is not too stupid or too full of himself to notice what is going on knows that what he does is morally indefensible." To be sure, the field of journalism is ill served by the selection of McGinniss as its emissary. This, after all, is a writer who, according to Malcolm, entered into a revenue-sharing arrangement with his subject and then peppered him for years with flattering, deceptive letters before crucifying him in the pages of his book.

The Journalist and the Murderer, David Arndt tells you, provides insight into his decision not to speak to you at length. It's hard to miss the casting choice he is suggesting for you in the role of this ethically challenged journalist. But his literary reference cuts both ways. After all, the other part to be cast is that of MacDonald, the physician convicted of murdering his wife, two daughters, and unborn son and implausibly blaming the carnage on a band of marauding drugged-out hippies.

In a way, the most thought-provoking portions of Malcolm's book do not involve her indictment of McGinniss but rather her own admissions. She concedes that it was easier to come down hard on McGinniss after he shut off communication with her early on.

Your own mind returns to the conversations you had with Arndt before he, too, stopped talking. "You have no idea what my life is like now," he says in the hall of the Cambridge court. "If you talk to anyone who knew me after residency, you know I am an excellent surgeon. I can no longer do what I do best, through a series of circumstances, some of them perhaps my own doing."

And then, as if on cue, his call for compassion is dislodged by a reassertion of control. "You must not do this story," he says. When you remind him that he can't control whether the story is written, but only how complete it is, he shakes his head. "You can control anything you want," he says.

How?

"Don't turn it in."

Neil Swidey is a staff writer for the Boston Globe Magazine.Hi's assignments have included reporting on the Arab world during the run-up to the Iraq war. His previous profile subjects have ranged from former Red Sox shortstop Nomar Garciaparra to the general manager who traded him, from the brother of Osama bin Laden to the one American charged with putting a price tag on each of the lives lost on September 11.

Spend enough time with David Arndt's story, and you feel as if nothing could surprise you.

His downfall has a cinematic quality to it. After being away from his story for awhile, I was curious to see how it had continued to unfold. The dramatic turns just kept coming.