The Best American Crime Writing 2005

Neil Swidey
The Self-Destruction of an M.D.

from the Boston Globe Magazine

The kid was born into medicine. He was on track to becoming one of Boston's next great spine surgeons, taking his place alongside his father among the city's medical elite. But on this day in January, the forty-three-year-old sits on the dark bench in the dimly lit gallery of Middlesex Superior Court in Cambridge, watching the parade of career criminals take their familiar positions, wearing expressions of defiance or boredom. Look in his eyes, however, behind the boxy glasses, and you can see flashes of bewilderment. How did I get here? He watches as a paunchy guy charged with conspiring to kill a cop asks the court officer if he can give the large, weeping woman in the front row "a kiss and my lottery tickets" before being led away. And then the clerk calls out his number: "Case number thirty-eight-David Arndt."

As the prosecutor and the defense lawyer take their positions before the judge, Arndt advances to his designated spot in front of a tattered computer printout that reads defendant, stooping his six-foot-two frame a little so his right hand can reach the railing. He is wearing a brown pin-striped suit. A taupe trench coat hangs over his left arm.

His appearance has rebounded from the unshaven, sunken-eyed mess that was on display in his mug shot last summer, though his physique is still a ways from the chiseled, rippled showpiece it was before everything fell apart. The pretrial hearing is over in just a few minutes, and he pulls his trench coat close to his chest and exits the courtroom.

You follow him into the hallway and call to him, "Dr. Arndt."

The words stop him in his tracks. Dr. Arndt. For the better part of a decade, that wasn't just his name, it was his identity. The domineering surgeon cutting his path-loved by some, loathed by others. But respected. That identity has been confiscated along with everything else he valued so much-standing, status, power. Now he's just another David standing in a criminal courtroom wondering what his future holds. He turns to look when he hears the words. But he recognizes you, throws up his hands to block his ears, shakes his head, and walks away. You suspect he'll come back. When you'd met a week earlier, in another court, in another county, he'd walked away then as well, at his lawyer's instruction, only to return and demand that you hold off on writing about him. "To do otherwise," he told you in his sonorous voice, "would be to engage in Murdoch-style journalism." You found it surprising that this man, given what he so infamously did in his operating room, not to mention what he's accused of doing in the weeks and months that followed, would choose to deliver a lecture about professional standards.

On this day in Cambridge he returns again, and the lecture is more expansive and comes with a reading list. "Are you familiar with Janet Malcolm's piece in The NewYorker entitled 'The Journalist and the Murderer'?" he asks. "It was published in two parts. Do you know her work?"

You shake your head no.

"You should," he says.

You ask him how he came across the article.

"I read," he says, narrowing his eyes. "Didn't you take any journalism courses?"

That's when, for the first time, you begin to understand the experience many of his former colleagues have described to you. Now you're the lowly scrub nurse-or even the seasoned superior- whose competence is being so pointedly challenged by Dr. David Arndt. And, just as they have explained it, he does it in a way that suggests he has no choice but to do it, and that he is confident, in the end, you will appreciate being made aware of just how far you've fallen short of his expectations.

There's an intensity to David Arndt that never seems to slacken, a way in which he seems both hyper-aware of his very public collapse and oblivious to it. Overnight, the high-octane, Harvard-trained Arndt became the doctor who left his patient on the operating table so he could go to the bank to cash a check. In an instant, that summer of 2002, the news went national. But the profound professional embarrassment would turn out to be only the beginning. Within two months,Arndt would be charged with statutory child rape, indecent assault, and drug possession. He would file a "poverty motion," the surgeon in one of medicine's most lucrative specialties asking the court to pay his costs. And then, in a separate case nearly a year later, he would face one more charge, this one for possessing metham-phetamine with intent to distribute.

"His downfall is almost operatic in its tragedy," says Grant Colfax, a Harvard-trained doctor who was once one of Arndt's closest friends. As Arndt prepares to stand two separate criminal trials, Col-fax is like many of the people who knew him well and are now left scratching their heads. Their emotions oscillate between two poles: There's the lingering disbelief that such a brilliant and compassionate doctor-some say the most brilliant and most compassionate they had ever known-could seem to self-destruct in such a spectacularly public way. Then, perhaps more troubling, there's that voice inside them, which had been muffled deep for so long, the one that kept telling them it was only a matter of time before David Arndt's self-absorption and sense of invincibility finally got the best of him.

David Carl Arndt was born on October 10, 1960, in New Haven. Kenneth Arndt was attending Yale medical school and living in student housing with his wife,Anne. Many of the other med students weren't even married yet, never mind parents. The couple's baby became an immediate attraction for Ken's classmates. "From the time he was extremely small, David was a very bright guy," says Jack Barchas, one of Ken's good friends at Yale and now chairman of psychiatry at Weill Cornell Medical College in New York. "And he just radiated happiness. We'd go over there for brunch-lox and bagels-and here was this little kid, always interacting."

When David was almost two, the Arndts packed up for Boston, so Ken could do his residency in dermatology at Massachusetts General Hospital. They had another child, a daughter. Ken would begin climbing the ranks of Boston medicine, joining the faculty of Harvard Medical School and eventually becoming chief of dermatology at Beth Israel Hospital. Years later, Anne, a psychologist, would also join the Harvard Med faculty. Friends describe the couple as charming, warm, stylish, and smart.

Growing up in Newton, David stood out. Extremely bright, no doubt about that. Tall too. Kathy Sias was his neighbor and one of his best friends. She ate dinner with his family, accompanied them on ski trips to their place in New Hampshire. Longhaired David was intense and intellectual but fun to be around. What did they do together? "A lot of drugs," she says, chuckling. "Just about everybody in our clique did during those days."

She and other friends say David, who attended Weeks Junior High School in Newton and the private Cambridge School of Weston, was always pushing limits. (He kept a boa constrictor as a pet, says Sias.) They also say Anne and Ken seemed hipper and easier for teens to talk to than other parents in the neighborhood. But Sias says that as she spent more time with the family, she changed her mind. "They were as unclued-in to teenagers as most parents, but they thought they were more clued in," she says. "His father was remote. His mother thought she knew everything because she was a psychologist. 'Oh, it's just a phase,' she would say about anything going on with David."

(Through their attorney, Stephen R. Delinsky, Ken and Anne Arndt declined to comment for this story, and David declined to talk beyond his brief conversations outside of the courtroom. "Dr. Arndt's parents respect, love, and admire him very much and are deeply concerned that your proposed article about David will seriously compromise his ability to achieve justice," Delinsky wrote. The couple "are confident that when all the facts are presented in court, David will be found not guilty in both cases.")

Though David would eventually become comfortable in his homosexuality, it's not surprising that his teenage years were more difficult.

"Looking back, I think he was aware of it, but I don't think he wanted to be," Sias says. "If he had admitted that he was gay, he would have probably lost a big part of his circle of friends." He dated girls, including Sias. "For about a week and a half," she says. "We went back to being best friends."

After logging time at the University of Massachusetts at Amherst from 1978 to 1979, Arndt left the state for San Francisco. He immediately soaked up the ethos of the city-part tie-dyed Haight-Ashbury hippie, part Tales of the City free spirit. The son of Harvard faculty members enrolled in a "university without walls" college called Antioch West. The downtown school awarded students course credit for their life experience. It no longer exists. He quickly earned a bachelor's degree and became a mental health counselor, working with the homeless who, in the parlance of San Francisco, were housed in "homeless hotels." Arndt's living quarters weren't much better.

On April 7, 1982, Arndt married a woman from India named Shobha Hundraj Nagrani. They would file for divorce four years later, and it became official in December 1987. Many of his friends say they knew little about the circumstances surrounding the marriage. What they did know about Arndt during this period was that he was into writing, literature, the arts scene. He was passionate, smart, insightful, alive.

And arrogant.

"One of a kind," says Harvey Peskin, who was a professor in San Francisco State University's clinical psychology graduate program when Arndt enrolled in 1983. What set him apart was the way he put everyone around him, especially the professor, on notice. "Professors tend to believe that students have to work to earn their respect," Peskin says. "David felt that the professor was the one who had to earn the right to have his respect."

As the yearlong class wore on, Peskin, who had initially been irritated by Arndt's chutzpah, found himself wanting to pass his brilliant student's test. David Arndt has that effect on people. "I don't think his behavior changed much," Peskin says, "but I think I changed."

But Arndt would begin changing in other ways. One day in 1983, he walked into a San Francisco clinic where Stephen M. Goldfinger, a psychiatrist who oversaw mental health services for the homeless, was presiding over a case conference. Afterward, they talked, and soon they were dating and then living together. Goldfinger was thirty-two, Arndt twenty-three.

Arndt earned his master's degree and turned in his tie-dye for extensive travel throughout Asia, gourmet cooking, and an intensified focus on his career. He began contemplating medical school and took some supplemental pre-med classes.

It was around this time that Jack Barchas got a call from Ken Arndt. Barchas was then the director of a prestigious research laboratory at Stanford. His old Yale med school pal told him that David was living in California and for the first time was thinking about pursuing medicine. "Ken, it's probably easier for me to talk to him about it than you," Barchas said. "Have him come see me."

As it turned out, Barchas's lab had just been given a very early and crude MRI machine, which the researchers were about to experiment with using rats. Arndt volunteered to help. In no time, he had all but taken over the project. "He was like a navy SEAL," Barchas recalls. "Just willing to do it and not waiting to be told." Arndt suggested to Barchas that they write an academic paper about their findings. When it was published, the name of David Arndt was listed first, followed by a bunch of respected researchers with actual titles after their names.

Years later, when Barchas was serving with Ken Arndt on the editorial board of the Journal of the American Medical Association,and he would ask about David, Ken would say, "It's all coming together for him."

In 1988, David Arndt came home. He made his way to the hallowed ground of Harvard Medical School, where his father, one of the nation's top dermatologists, was a heavyweight. If relations between him and his parents had been strained during some of his time in San Francisco, they appeared to be back on track. But David didn't advertise his connections. Occasionally, a classmate would notice the author's name on their dermatology textbook. "Kenneth A. Arndt-any relation to you?"

"Yeah, that's my father," David would reply casually.

And no one who saw David in class-with his burning intelligence and remarkable self-possession-would question whether he had the goods to get into Harvard on his own. Soon after Arndt joined the medical school's class of 1992, Steve Goldfinger joined the Harvard faculty. They shared a gracious Victorian in Jamaica Plain that was well appointed with the artwork they had collected together on their travels-Balinese puppets, Burmese wall hangings, Borneo masks. They frequently had Arndt's med school friends over for dinner or cocktail parties. What those friends saw was a couple that seemed to enjoy life and each other's company. They had a couple of dogs and a garden that Goldfinger faithfully tended to.

This is not the average med student experience. "Most of us came as unformed characters, having spent all of our time studying to get to Harvard," says Timothy Ferris, a classmate of Arndt's who is now a primary care doctor at Massachusetts General Hospital. "We came as receptors of knowledge, not producers. David immediately stood out as someone who appeared to have a fully formed character. He could do the work. He was confident. Most medical students were still so afraid that they spent all their time studying. David was organizing parties. He had a life. He had a car. He had a nice house. While the rest of us were putting our personal lives on hold for four to eight years, David had balance. He was where we all hoped to be. The fact that he was gay only added to that. The most mysterious part of us- our sexuality-and here is a guy who has it all figured out."

Not that there weren't moments that gave his friends pause.

Grant Colfax appreciated Arndt's tremendous warmth and easy ability to talk intelligently about literature, politics, life. Like most of Arndt's friends, he found something magnetic about him. "But he had some clear character flaws," Colfax says. "To my dearest friend, he was outwardly rude and uninterested. He couldn't even exude the bare social graces. She asked me, 'How can you be friends with such a jerk?' I saw what she was saying, but he had always been really kind to me and fun to be around."

A few years into med school, Arndt accompanied Colfax to a gym near campus. "David was totally dismissive of the whole thing," Colfax recalls. "Then, overnight, he had to be the best." And so David Arndt, who up until this point had stood out only by what he said, also began to stand out by how he looked.

His nondescript physique was soon gone. He became even more toned as his weight training intensified during his general surgery internship at Beth Israel Hospital. On a warm spring day in 1993, Alexandra Page, a med school friend and fellow intern, had brunch with Arndt and Goldfinger. Afterward, Arndt showed her the new gym he had just switched to. "We went inside," she remembers, "and it was just flush with attractive young men."

It's only looking back now that Page can recognize that visit as a sign of trouble ahead. Goldfinger, she says, "was a wonderful guy, incredibly bright and interesting, but he wasn't an Adonis."

The relationship with Goldfinger would last through Arndt's first year of residency. But friends detected a change in Arndt's priorities, starting with his surprising choice of residency. He had always talked about neurosurgery. But when he didn't get into the Harvard neurosurgery residency program, he decided against pursuing the field elsewhere and switched gears. He secured a spot in orthopedic surgery at Harvard. In medical circles, neurosurgery has the reputation-fair or not-of attracting the intellectuals and orthopedics, the jocks. Arndt's interest in fixing other people's bones and muscles dovetailed with his growing concern with developing his own.

The breakup with Goldfinger came in the summer of 1994. They had been together for almost eleven years. Their lives were interwoven. Arndt had found someone new and wanted out. He moved into an apartment in the South End. Goldfinger had an exhaustively detailed legal agreement drawn up providing for the division of their art collection, arrangements for the care of their dogs, and a financial settlement. For more than a decade, Goldfinger would argue, he had paid for nearly all of Arndt's living, travel, and entertainment expenses (but not his tuition). The expectation had been that Arndt would absorb more of their shared costs after he entered private practice. So the most controversial provision in the agreement was this: Beginning in 1998,Arndt would be required to pay Goldfinger 9 percent of his income over the next fifteen years, not to exceed $500,000. Arndt signed the agreement.

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.

When Arndt returned from New Orleans, Stephen Lipson asked his protege about his experience. Arndt told him it went great, neglecting to mention the federal law he had broken while he was there. On May 29,Alfredo Fuentes submitted a passport application under a false name, and Arndt filed a supporting affidavit. Fuentes had been Arndt's domestic partner for several years, and he had moved with Arndt from Massachusetts to New Orleans. But Fuentes was a Venezuelan who was in the States illegally. The fraudulent passport application, Arndt would say later, was their attempt to head off deportation.

Three months later, in the early morning hours, Fuentes was sitting on a bedroom couch talking to a man named Roger Volzer in Volzer's Provincetown home on Cape Cod. After Volzer got up to blow out some candles, Arndt, who had been staring at the men through a window, used his surgeon's hands to rip out a screen and climb into the house, according to the Provincetown police report. Volzer would tell police that Arndt punched him in the head, pushed him out of the bedroom, and then threw a chair at him. Arndt was charged with assault and battery, burglary, and malicious destruction of property.

Volzer eventually decided not to press charges in exchange for Arndt's agreeing to pay him $30,000 and to attend weekly anger-management counseling. Christopher Snow, Volzer's attorney, says Arndt's supporters lobbied his client, telling him a conviction could derail a promising medical career.

But if Arndt dodged a bullet, he hardly acted grateful during their meetings, says Snow. "In the 'if looks could kill' category, he was a murderer. He acted if the proceedings were an incredible invasion on his otherwise important life. He had absolute contempt for the fact that someone might have the audacity to hold him accountable for his bizarre and destructive behavior."

In the end, Snow has said,Arndt paid only $18,700 and failed to follow through on counseling.

In the fall of 1998, Arndt pleaded guilty to the misdemeanor passport violation in federal court in Louisiana. He was sentenced to three years' probation and fined $3,000. But because he had renewed his medical license a few months earlier, he would not have to report that conviction to Massachusetts authorities until his next renewal period two years later.

The fines and legal fees, meanwhile, were adding up. His breakup agreement with Goldfinger, the one that required Arndt to pay 9 percent of his income to his former partner, was slated to go into effect in 1998. So just when Arndt had finished up his lengthy medical training and was about to start making some real money- the 2002 median salary for spine surgeons was more than $545,000, according to the Medical Group Management Association-the financial vise was beginning to tighten.

Arndt argued in court filings that the Goldfinger agreement should be invalidated because he had signed it under duress. The case slogged through the courts and arbitration until a Superior Court judge upheld it in 2000. Goldfinger would never collect a dime.

Even with so many distractions, Arndt seemed able to wall off his personal problems from his professional work.

James A. Karlson, chief of orthopedics at Mount Auburn Hospital, had known Arndt since residency and practiced with him both at Harvard Vanguard and in their four-surgeon group practice. Arndt had privileges at most of Boston's top hospitals but began focusing his attention on Mount Auburn when the veteran spine surgeon there started to cut back. Karlson says there were a few low-level concerns about Arndt, such as tardiness, but no indication of his mounting personal problems. "He had certain problems that we didn't pick up on," Karlson says. "Should we have? 'Could we have?' is a better question."

The care of Raymond LaVallee-Davidson offered a few clues. In the summer of 2001, Arndt operated on his back at New England Baptist Hospital. LaVallee-Davidson says Arndt told him the surgery would take about eight hours. It took eighteen, and even after that, Arndt told him he had been unable to finish the job. Because

LaVallee-Davidson suffered serious complications, it wasn't until December that follow-up surgery was scheduled at Mount Auburn. Just after six o'clock on the morning of surgery, he was being prepped by hospital staff and about to be anesthetized. "I had asked them to hold off, because I had a few questions I wanted to ask Dr. Arndt before I went under," the forty-four-year-old recalls. Four and a half hours later, hospital staff told him they had been unable to locate Arndt, and so LaVallee-Davidson got dressed and made the four-hour drive back to his home in Skowhegan, Maine. Four days later, he says, he got a call from Arndt saying he had overslept. LaVallee-Davidson, who says that initially he found Arndt to be "probably one of the most compassionate people I have ever met," is now among Arndt's former patients suing him for malpractice.

Early on the morning of July 10, 2002, Charles Algeri, a former Waltham cabdriver with a history of back problems, arrived at Mount Auburn Hospital and was prepped for fusion surgery on his lumbar spine. Algeri says Arndt arrived late and unshaven, with dark circles under his eyes. "He said his car had been towed because he had parked in a bus stop," Algeri says.

Like most of the cases Arndt took on, the surgery for Algeri would be a complex, all-day affair. According to state investigative reports and interviews with some of the people involved, this is what happened: The first incision was made around 11:00 a.m. In the OR during the afternoon, Arndt twice asked the circulating nurse to call his office and ask if "Bob" had arrived. By the second call, the receptionist informed the nurse that "Bob" was Arndt's code name for his paycheck and told her to tell Arndt the check would be delivered to him there.

Just before 6:00 p.m., Leo Troy, one of Arndt's fellow orthopedic surgeons from their private practice, was passing by the front desk near the operating room when a secretary asked him if he could take the check to Arndt in the OR. Troy had a few minutes before he was scheduled to operate on another patient, so he had planned to look in on Arndt anyway. He went into the OR, handed Arndt the check, and then observed the surgery for a couple of minutes. Then, Arndt asked him if he would watch his patient for "about five minutes." At the time, Arndt was about seven hours into the surgery. Algeri was under anesthesia and had an open incision in his back. It's not unusual for surgeons doing long procedures like this one to step out to use the bathroom. Although he is not a spine surgeon, Troy says he had assisted Arndt before and was "qualified to close up the patient in an emergency." Arndt then turned to a salesman from a medical device supplier-sales reps often sit in on complex surgeries in case there are questions about the equipment-and said, "Let's go."

A few minutes later, a nurse walked into the OR and asked where Arndt was. Told he had stepped out for a few minutes, she said, "I bet he went to the bank." She had apparently overheard Arndt talking about it earlier. Troy and the rest of the OR staff were incredulous. They tried paging Arndt. Hospital administrators were notified. The decision was made to wait for Arndt to return and, if he didn't come in a timely manner, to try to find a spine surgeon from another hospital. Troy, who calls Arndt an excellent surgeon, says he never had any doubt that he would return.

And he did. Thirty-five minutes later. He admitted he had gone to the bank, and the OR staff said he seemed surprised that they would be upset with him. He finished the surgery about two hours later. Mount Auburn suspended Arndt's privileges the next day, and after an internal review process, the suspension was reported to the state medical licensing board.

"This has got to be a joke," Nancy Achin Audesse said after the report hit her desk.

It was July 25, 2002. Audesse is the executive director of the Massachusetts Board of Registration in Medicine. By the summer of 2002, she was more than familiar with the name David Arndt. The board's year-plus investigation into Arndt's conviction on the passport violation was wrapping up. (He would get a formal reprimand.) He told the board he had no choice but to lie-if he didn't, he said, his partner would have been deported to Venezuela, where he said wealthy homosexuals are persecuted and killed. "He was always presenting himself as the victim," Audesse says.

Still, the reason for his suspension from Mount Auburn was so outlandish that she was convinced someone was putting her on. He left his patient in the middle of surgery to go cash a check at the bank?

After doing a round of interviews-Arndt told an investigator he had some "overdue bills" and needed to get to the bank before it closed at 7:00 p.m.-the medical board voted on August 7 to suspend his license. Audesse issued a press release.

At 7:00 a.m. the following day, she was sitting in her dentist's chair, getting extensive work done. At 9:00 a.m., she called her assistant, who was panicked. "You have to get in here now," she told Audesse. "This place is crawling with TV news crews!"

"This story went national so fast," Audesse recalls. "I did sixteen straight interviews, numb and drooling."

In the public, the jokes spread-A Harvard doctor, and he never heard of direct deposit? And then the conjecture-Overdue bills? Who insists on cash these days besides drug dealers and bookies?

As for Arndt's patient, Algeri had no idea what had happened until he got a call from Mount Auburn officials the day before the news was going to break. Told that Arndt had left him during surgery to go to Harvard Square, Algeri, a six-foot-five, 315-pound guy who sports a Boston Bruins baseball cap, a goatee, and a ready laugh, replied, "What, for a cappuccino?" He watched the media circle around Arndt for a week before coming forward with his lawyer, Marc Breakstone, who later filed a malpractice suit.

For a doctor who had always craved attention, David Arndt suddenly had more than even he had ever wanted. The news, when it found its way to his med school friends scattered across the country, took the wind right out of them. They had a feeling Arndt would cause a stir wherever he went, maybe put his career in jeopardy by telling off a hospital chief. But this?

Nearly two years later, Alexandra Page still keeps a newspaper clipping about the interrupted surgery on the desk in her office outside San Diego. It's yellowed now, but when she refers to it during an interview, it produces fresh tears. "We all make mistakes," she says, "but this was so heinous, so volitional. I'm just aching for him, for whatever must have happened in his life that caused him to do this."

During his interview, Sigurd Berven breaks down at the same point. Same with another friend of Arndt's from med school, Saiya Remmler, who is now a psychiatrist in Lexington. "What could be more important? You know, the guy's on the table," Remmler says. "To this day, I don't know how anyone could do that, let alone one of my classmates."

But then how to explain Remmler's reaction when she first read about the incident, how she put down the newspaper, turned to her husband, and said, "It doesn't surprise me." Remmler says that Arndt was funny, charming, and really smart. "I felt lucky to have him as a classmate." But, she adds, "he was also really narcissistic, and I guess I knew there was this compulsive streak about him- addictive almost. And so deciding his needs are more important than his patient's life-that sounds narcissistic to me."

About a month after news about the check-cashing broke came another bombshell. Arndt would be charged with four counts of statutory child rape and one count each of indecent assault and battery, drugging a person for sexual intercourse, contributing to the delinquency of a child, and possession of the drugs ketamine hydrochloride ("Special K") and methamphetamine. Middlesex County prosecutors allege that on September 5, Arndt was driving through Central Square in Cambridge and stopped to invite two boys, ages fifteen and fourteen, into his car to get high. Then, they allege, after dropping off the fourteen-year-old, he had sex in his car with the fifteen-year-old. The boys waited four days before contacting police. They said that Arndt had given them his cell phone number and told them his name was David. According to court records, when police dialed the number, Arndt answered, and he later admitted to having the boys in his car but said he had no physical contact aside from brushing one of the boys on the shoulder.

Soon after came Arndt's "poverty motion," asking the court to pay his costs because, according to his lawyer, he was indigent and his parents needed to save for their retirement. (His parents disputed the lawyer's account; he is now gone, and their lawyer, Stephen Delinsky of Eckert Seamans, is representing their son.)

Then, in August 2003, almost a year to the day after he first made headlines, Arndt made a splash again. He was arrested on August 8 and charged with possession of methamphetamine with intent to distribute. According to the postal inspector's report and other court records, on the morning of August 7, Arndt reserved a room at the Chandler Inn in Boston's South End for that night and asked that a party by the name of Frank Castro be added to his reservation. He also asked if any packages for him or his guest had arrived. Around 8:30 p.m.,Arndt checked in to Room 501 but apparently didn't stay there that night. Around 1:30 p.m. the next day, Arndt appeared at the front desk. Told that a package had arrived for Room 501 but that it was not in his name, Arndt signed for it and took possession of it. What he didn't know was that, the day before, postal inspectors in Los Angeles had found the six-pound Express Mail package addressed to Frank Castro in care of the Chandler Inn suspicious enough to get a federal warrant. Inside the box, they found a large, pink penis-shaped pinata. Inside the pinata, they found about two pounds of a white crystalline substance that tested positive for methamphetamine. That discovery led to a sting operation at the Chandler Inn, which in turn led to Arndt standing in Room 501, sweating profusely, trying to explain himself to a postal inspector.

The postal inspector reported that Arndt told him he had met Frank Castro online a few months earlier. When authorities went to Arndt's apartment in the South End, a man identifying himself as Alfredo Fuentes told them he and Arndt used to be partners but were now just roommates. He said Arndt knew a Frank Castro from med school.

In fact, authorities were able to track down Frank Castro, an orthopedic surgeon. Castro and his office manager explained that he had been in surgery in Tennessee for the entire time of the incident. Informed of the parcel containing narcotics that had been addressed to him, Castro told the inspector that of the few people he knew in Boston, "only one could be desperate enough to do something like that." David Arndt. He said he and Arndt had been friends since they were lab partners during their premed days in San Francisco but had not been in touch in some time.

David Procopio, spokesman for the Suffolk County district attorney's office, says that while the investigation is ongoing, Castro has been cooperative and "the only person against whom charges are warranted, according to the evidence now in our possession, is David Arndt."

Because of the new charges, Arndt was found to have violated his bail on the Cambridge case and it was revoked. (Earlier in the summer, Arndt had been found at Logan Airport carrying at least $12,000 in cash and his passport. The passport was revoked, but he was allowed to travel in the United States.) He would eventually be released, after posting $50,000 cash bail. But for two months, home for the surgeon and son of privilege was a cell in the Nashua Street Jail.

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.

Arrogant, compassionate, and reckless, David Arndt seems incapable of living his life in anything but capital letters.

Not long after this piece was published, federal prosecutors swooped in and took over the county drug case against him. They alleged Arndt was a serious drug dealer, part of a wider ring, and that the undercover sting at the Chandler Inn exposed just a glimpse of his illegal activity.

To support their case, they produced testimony in court papers from several unnamed witnesses. The most sensational allegation: that Arndt was supplementing his income by practicing "back-alley medicine." This image of Arndt, the once-rising star in the dazzling constellation of Boston medicine, furtively sewing up bullet holes in drug-trade players unwilling to go to the hospital might be dismissed as too implausible by even immoderate screenwriters. But for people who lived through Arndt's real-life fall, nothing could be considered too over the top. Even the language attributed to Arndt fits the part. One witness said the former surgeon had boasted he would have no problem "disemboweling," with just a "quick swipe of the scalpel," anyone who "ratted" on him about his drug deals.

With the new federal charges, Arndt was ordered held without bail. In the Middlesex County case involving charges of statutory child rape, a trial date was set for the fall of 2005.

Meanwhile,Arndt's malpractice insurer agreed to pay $1.25 mil-ion to Charles Algeri, the former cab driver Arndt left anesthetized on the operating table while he ran out to the bank. Algeri says Arndt botched his surgery so badly that he was left with excruciating pain and had to undergo two additional operations to try to correct the damage.

Having battled his own drug addiction years ago, Algeri says he often finds himself replaying in his mind the fateful morning when he went under the knife with Arndt. "The day he showed up, I should have known better. I said to myself, 'There's something wrong with this guy.' Dark circles under his eyes, unshaven-he was a mess. But what am I supposed to do? Ask him to pee in a cup? Piss off the guy who's about to cut me open?"

On June 29, 2005, after spending nearly a year in jail, Arndt walked into a courtroom and pleaded guilty to a host of federal drug charges, including conspiracy to distribute methamphetamine.

He did so knowing that sentencing guidelines will require him to spend a minimum of ten years in prison. The prosecutor said she will recommend a sentence of fifteen to nineteen years.

In court, Arndt was unusually contrite, telling the judge he had been addicted to drugs. "I was out of my mind," Arndt said, "and being incarcerated probably saved my life."