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
