Later in his conversation with the physician, which Hornung described as "a continuous ramble," Kalk admitted that he didn't have the funds to cover the payroll checks. As for the criminal charges, Hornung noted, Kalk "instructed me on how to handle the investigation: his way, or not at all."

Three days later, on December 15, 2006, Hornung phoned the Missouri Board of Registration for the Healing Arts and the Bureau of Narcotics and Dangerous Drugs — the two state agencies that regulate physicians — to alert them to Kalk's agitated state. Within a week, both agencies began their own inquiries. When Kalk paid his debt to his employees on December 18, the bad-check charges were dropped, and Hornung closed the case.

"Legally, it had to be [the] end of my involvement," says Hornung, adding that he wished he could have helped Kalk seek treatment. "That's honestly why I did what I did. "

Dr. Alex Kalk gave this list of insults to a St. Louis County judge.
Dr. Alex Kalk gave this list of insults to a St. Louis County judge.
One of Kalk's bizarre ads was made to look like a strip-club promotion.
One of Kalk's bizarre ads was made to look like a strip-club promotion.

Growing up, Kalk led what one family friend calls a charmed life. "He was athletic, he was good-looking, very smart," Rob Zaleski remembers. "He was one of these kids who seemed to have it all."

The youngest of five children, Kalk was raised in Chicago's Hyde Park neighborhood. He went to the same University of Chicago private schools that President Obama's daughters would later attend. In high school he was editor of the school newspaper and captain of the basketball team. Even then, says his sister Debby Kalk, her brother was interested in medicine. "He worked in labs at a local university. He had a relationship there."

After high school, Kalk moved on to Tufts University in Massachusetts, studied biology and graduated cum laude. At Tufts University School of Medicine, he earned a spot in the Alpha Omega Alpha Honor Medical Society. He completed residencies in the surgery department at the University of California-San Diego School of Medicine and in the family medicine branch of Kaiser Permanente in San Diego.

During this time, Kalk's father suffered congestive heart failure. Despite working a busy schedule, Kalk insisted he be moved to San Diego so he could care for him. "His dad really went downhill in those last few years," Zaleski says. "He was not in a good way. [Alex] is a workaholic, but he devoted all of his free time to caring for his father."

Later, Kalk fell in love with a Missouri native, and the couple was married in St. Louis County in June 1997. In 2002 the couple moved to St. Louis. She wanted to be closer to her family, while he longed to start his own private medical practice.

"He disliked working for an HMO because he generally saw about 40 patients a day and got to spend limited time with each one," sister Samara Kalk writes in an e-mail. "Working for himself in St. Louis, he spent large amounts of time with each patient and answered their questions and responded to their problems by phone and e-mail without billing them for it. He is a very caring doctor."

For two years Kalk worked in the urgent care unit at St. Anthony's Medical Center. In late 2004 he began an affiliation with Missouri Baptist and opened his own office.

By 2005, according to divorce files, Kalk's marriage began to crumble. The couple separated in December 2005, and a month later, his wife filed for divorce.

"He was just in shock. He could not believe that this was happening to him," says older sister Debby. "It sent him careening off."

Julie Kalk, Dr. Kalk's ex-wife, declined an interview request for this story. Her maiden name, which she adopted after the divorce, is being withheld. Her Clayton attorney, Lisa Moore, did not respond to several requests for comment.

Thousands of pages of court filings from the lengthy divorce proceedings — in which Kalk represented himself, though he had no legal training — reveal a dispute that turned hostile as the estranged couple bickered over custody of their two young daughters. Kalk's actions, meanwhile — both in and out of the courtroom — became increasingly bizarre.

"Although the Court understands the stress of a divorce proceeding can cause individuals to become anxious and upset and act in ways that are not normal for them," a judge wrote in November 2007, "[Kalk's] behaviors have been so far outside anything this Court has ever seen that his actions are not explained simply by the stress of divorce."

On October 27, 2007, security guards at the Saint Louis Galleria noticed what appeared to be a man wandering the lower level of the mall clad in a wedding dress, veil, light-blue Crocs and a blond wig. It was Alex Kalk.

When asked to leave, Kalk became "loud and abusive," the guards informed Richmond Heights police. Later, after his arrest for disorderly conduct, he told police he was going to a wedding in costume and was at the mall to get his makeup done.

"It should be noted," the police report states, "Kalk was already wearing makeup."

"There are things I did due to a psychiatric condition," Kalk says regretfully of the incident. "It's certainly not typical of my life's behavior."

More than anything, adds Kalk, it was the sheer enmity of the divorce that launched his downward spiral.

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