Kalk was restricted to supervised visits with his children at the St. Louis County courthouse. According to court files, the same month Kalk was arrested at the Galleria, visits were suspended because of his "repeated verbal threats, hostility and aggressive behavior" toward courthouse staff.

Earlier in 2007 a judge ordered Kalk to be escorted around the building by a security guard at all times after he got into a heated argument outside the courtroom with his wife's attorney.

"The way I fought was a stupid way of fighting," Kalk says. "I was rebellious, and I defied authority and thought that somehow that would work. It was really a psychiatric problem that didn't allow me to see I was humiliating myself and everyone else."

Another of Kalk's bizarre ads compared an incident with his associate Jim Stewart to the movie Dude, Where's My Car?
Another of Kalk's bizarre ads compared an incident with his associate Jim Stewart to the movie Dude, Where's My Car?

On June 17, 2008, St. Louis County Circuit Court Judge Larry Kendrick ruled against Kalk. The doctor was granted monthly one-hour supervised visits with his children and ordered to pay more than $94,000 in total child support, despite his claims throughout the proceedings that he was penniless.

The decision sent Kalk into a rage, prompting him to fire off a blistering three-page letter to Kendrick, calling him "a disgrace to the memory of [his] mother" with "the morals of a Nazi." Using a black marker, he scribbled insults directed at the judge on several printouts of Wikipedia entries, including the ones for "tyrant," "fraud" and "alcoholic." Kalk then submitted them as court documents. Kendrick declined comment for this story.

Aside from the occasional bounced check and unpredictable behavior, some former employees and patients say Kalk's work was largely unaffected by the chaos in his life.

"We all did notice, but personally, to me, it never interfered with the work atmosphere," says Irma Osmancevic, who spent a year as Kalk's secretary. "I can't say anything but good things about him, because that's how it really was."

Patients say he was generous with his time and concerned with their troubles, both medical and personal. "As we knew him, he was so smart, so sharp," says Donna Etling. "I cannot believe he's doing all these things. He must have two sides. He was so kind, polite and helpful, and willing to go out of his way to find information. He gave us all the time in the world. This other side of him, I did not see."

Occasionally, though, Kalk's patients noticed something was awry. "I went to him one time and he tried to get me to buy my medication from him in cash," recalls Janie Richie. "When I didn't, he got really kind of hateful. After that, I never went back."

Court documents reveal that Kalk was in dire financial straits. A detailed income report he submitted to the court during the divorce shows his practice lost more than $90,000 in 2006. One of his biggest expenses, $56,000, was advertising.

Kalk frequently paid to appear in local publications, particularly Riverfront Times. Beyond promoting his business, many of the ads refer facetiously to his personal turmoil. In the September 7, 2006, edition of Riverfront Times, Kalk published a spoof of the Bobby Darin song "Mack the Knife," which ends with the line, "Look out ... old Kalky's back!!"

Another ad, from the October 19, 2006, edition of Riverfront Times, is designed to look like a strip-club promotion. It refers to his medical office as "Club 711 West," and the text over his picture beckons patients to "Come Party with One of the Smartest Doctors on the West Side, 7 Days a Week."

"You could probably say [my illness started] about the time I started running the ads in the RFT," Kalk says. "That was clearly abnormal."

In July 2007 RFT slapped him with a cease-and-desist order after he repeatedly plastered newsstands with magnets bearing the portrait of Che Guevara and the tag line: "A Revolutionary Doctor: alexanderKALKM.D."

In 2007 and 2008 collection agencies and medical-billing companies hounded him about his credit-card debt and unpaid bills. The state Department of Labor and Industrial Relations contacted him several times regarding back pay he owed to his employees, and the Internal Revenue Service garnished his wages after he failed to pay his taxes.

"Because I was ill, I was becoming less organized at collecting money from insurance companies," Kalk explains. "I'd also taken on too much responsibility of leases of medical equipment. The overhead for medical equipment costs was too high. It reached a point with zero money. No money at all."

Kalk filed for bankruptcy on April 15, 2009, claiming more than $1.1 million in liabilities and just $300 in total assets, in the form of a used TV set.

Jim Stewart arrived at Kalk's office on Old Ballas Road as a new patient on a fall day in 2006. He was 47 years old with dark gray hair slicked back across his head. He suffered from cerebral palsy and other ailments and was earning a living chauffeuring prostitutes.

"A girl would do out calls, and I would take them to the calls and wait and take them back. If they flipped a light or called, I'd go in and get them," Stewart recalled last month at his squalid Brentwood apartment, where he lives with his ailing mother and two cats. "I met Alex through a stripper and a hooker that I knew. I needed a doctor; I was sick. She said, 'He's great, he's one of my clients.'"

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