Here's how it gets fucked up: he slides into the right private practice. He makes easy money working with upper west side adolescents on their affluent problems. He has a kid. One of his patients commits suicide. He spirals. He divorces the perfect wife. He goes on sabbatical. He neglects the perfect child. He moves. He gets a new license. He starts again.
John (Lucas) Kane was not Senator John Kane's first-born, but he got the first-born name and the first-born treatment—old money privilege and a debilitating expectation to be the perfect extension of his narcissistic parents. Instead of hating him for it, older brother Walker—from the Senator's first failed marriage—became obsessed with him, trying endlessly to recruit Luke as an ally against the oppressive adults of their world. Luke occupies a strange place in the family, simultaneously hating his own weakness under the weight of their domineering father and punishing Walker for being likewise weak.
From birth, everything in Luke's nature has been carefully edited and rephrased to create an image suitable for the family. His passion for art disdained in favor of political intrigue. His genius for chemistry and anatomy diminished for more social or masculine traits. The Senator won as he always did and Luke crafted himself as the perfect WASP with the perfect credentials. But he didn't give up on science, pursuing a medical degree first and psychiatry after. While in medical school he met his future wife, who fell for the mask Luke had been wearing for years.
That mask held for some time. Luke survived residency and parental scrutiny. He was best man at Walker's wedding. Walker wasn't his. He and his wife settled into a beautiful brownstone. He joined a practice with a family friend. They had a child. Life progressed along happily by all the usual markers, absent his real interest in any of it. The mask began to thin.
A patient died. This happens in medicine. But there is a difference in tone when a gunshot victim dies on the surgical table and when an otherwise boring case of rich kid ennui ends in a heroin overdose. Luke was cleared immediately. Of course he was. But it hung on him like a miasma. He obsessed over it, until his license lapsed. Until his marriage crumbled. Until he abandoned everything he had ever known and moved cross-country to escape the stink of his own failure.
But wherever you go, that's where you are.