Benjamin Carl Goldstein stood with his fellow graduates at the Albert Einstein School of Medicine here in 1981 and took the Hippocratic Oath, swearing to care for the sick and hold himself "far aloof from wrong."
The year before, he had joined the militant Jewish Defense League in Brooklyn, where he grew up. After serving as a first-year resident in family practice, he left the Brookdale Medical Center in Brooklyn to join the Israeli army, eventually becoming an activist in the extremist Kach movement in Israel, supporting the virulent anti-Arab policies of the Jewish Defense League's slain founder, Rabbi Meir Kahane.
Sometimes, he talked bitterly with JDL leaders about his life as a doctor in the West Bank town of Hebron, how angry he became when he once tried to save the life of Aron Gross, a Jewish settler stabbed to death in 1983, how his path to the dying man was blocked by Palestinians.
Healer and militant, Goldstein lived on parallel paths until the stethoscope became subservient to the machine gun Friday, when he slaughtered dozens of Palestinians innocently praying in a mosque.
Just after graduating from medical school, Goldstein had written a letter to the New York Times. He noted that the Arabs of Israel had an average of eight children per household and contrasted that with an average of 2.9 children per Jewish home in Israel, saying these rates "assure Israel of an Arab majority in 70 years unless steps are taken to prevent this from occurring."
The newly minted physician went on: "The harsh reality is, if Israel is to avert facing the kinds of problems found in Northern Ireland today, it must act decisively to remove the Arab minority from within its borders."
During the last 13 years, those attitudes had only hardened. And in retrospect, there clearly were portents of the terrible violence.
Two years ago, in presenting a Torah scroll to the synagogue at the Cave of the Patriarchs, Goldstein, who in Israel went by the first name of Baruch and represented the Kach movement in his West Bank settlement of Kiryat Arba, told friends: "The day will come when a Jew will kill dozens of Arabs in the Cave of the Patriarchs to get rid of them."
Goldstein's friends said Friday that they believe several motives are behind the biggest single massacre of Arabs since Israel occupied the West Bank and the Gaza Strip in 1967.
"We believe he did this in revenge for the murder of Rabbi Kahane and to protect the life of the state of Israel," said Barbara Ginsburg, a Kach spokeswoman and a friend of Goldstein's.
"Dr. Goldstein was a quiet, simple, good guy, a sweet guy, the type of guy no one had a bad word to say about him," said Mike Guzofsky, the co-head of Kahane Chai, a U.S. group of followers of the rabbi, who was assassinated in a Manhattan hotel in 1990 after giving a lecture.
"He (Dr. Goldstein) felt the Arabs wanted us all dead. That's where he got his hatred. He wanted to stop the so-called peace process and save the state of Israel," Guzofsky said. "He was driven to kill Arab enemies in an act of desperation. . . . He could not have picked a better day--the first day of Purim, the day when the Jews fight back."
When Goldstein married his wife, Miriam, Rabbi Kahane performed the ceremony. Goldstein eagerly embraced Kahane's calls for violence against Arabs and their expulsion from Israel.
The 38-year-old father of four eventually settled in Kiryat Arba, where the strains of anti-Arab extremism run strong. According to neighbors there, he was greatly affected by the murder of a friend, Mordechai Lapid, and his son by members of the Islamic Resistance Movement, known as Hamas, on Dec. 6.
Noam Aron, a spokesman for the settlers, said that Goldstein had suffered a "mental crisis" after Lapid's death. As the town's chief emergency physician, he was no stranger to Arab-Israeli bloodshed. Fellow physicians who knew him well said Goldstein often refused to treat injured Palestinians.
"The more he had to treat wounded and dead, the more he became convinced that the only answer to terror is terror," said David Ramati, a friend and fellow settler.
Three months ago, Goldstein was interviewed on Israel Army Radio about the stabbing of a Jewish settler on his way to pray at the Cave of the Patriarchs.
"Again, the Nazi-Arab enemy who aspires to attack every Jew because he is Jewish and in the land of Israel has attacked a Jew," the physician said. "The army does not make peace, it does not defend the Jews here, and it cooperated with them (the Palestinians)."
After his attack at the Cave of the Patriarchs, where he unleashed bursts of fire from an assault rifle and lobbed hand grenades, a suicide letter was found in the mailbox of the Kiryat Arba municipal office.
"I enjoyed working with you very much. May it be the will (of God) that you will continue serving our blessed people faithfully," Goldstein wrote. He signed his letter, "With Love of Israel."
Goldstein received an undergraduate degree in Jewish studies and liberal arts from Yeshiva University in New York City in 1977. He also won a scholarship to help pay some of the costs of medical school. Classmates at Albert Einstein School of Medicine remembered Goldstein as mild-mannered, soft-spoken and very religious.
"We're just horrified," a medical school spokesman said. "Most people are."
Goldman reported from New York, Parks from Israel. Times researcher Audrey Britton also contributed to this report.