SPRING HILL — They met at parties and over coffee, bonding over their shared experiences as doctors' wives and the joys and challenges of parenthood and busy social lives.
In time, the conversations took on a darker tone. They spoke of the storm clouds over their lives, which from the outside may appear to be all luxury and privilege.
They commiserated about overworked, absent husbands; about feeling overwhelmed by raising children alone; about the stress that loneliness was putting on their marriages.
Sarah Blackburn, a friend said, could take it no longer. After nearly 17 years of marriage, she was calling it quits. She had started the process of a divorce, but she never got to follow through.
Her husband, Robert, a prominent osteopathic physician who treated some of Hernando County's elite, viciously killed her Jan. 10 in their sprawling home in one of Spring Hill's lavish communities.
Blackburn, investigators said, savagely beat and strangled his wife before shooting her once in the head. He later turned the gun on himself.
The tragedy shocked people throughout Hernando County, but to Wayne Sotile, the incident is a heartbreaking example of a phenomenon that he has studied, worked with and written about for 25 years.
Sotile, a clinical psychologist, and his wife, Mary, in 2000 wrote The Medical Marriage: Sustaining Healthy Relationships for Physicians and Their Families, on the special difficulties facing these relationships.
"There are truly unique challenges of living the medical life," said Sotile. "Among practicing physicians, there's a palpable sense of loneliness and isolation. But they usually don't manifest themselves in things as dramatic as murder-suicide."
Her friends said Sarah Blackburn had read The Medical Marriage and had recommended it to the circle of doctors' wives.
Sotile said the Blackburns' case could serve as a cautionary tale for those who believe prestige and prosperity are salves for marital strife in medical families.
"As a culture,'' he said, "we need to give medical families permission to have common human stress."
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By outward appearances, they were a golden couple.
Robert Blackburn, 55, counted many of Hernando's top government officials as his patients and friends. He was the medical director for local hospitals and agencies ranging from the fire departments to the county jail. His reputation extended past the county borders; last year, he was named president of the Florida Osteopathic Medical Association.
Sarah, 40, was frequently at her husband's side at social gatherings. A licensed X-ray technician, she was also kept busy raising the couple's two teenage children while managing the family's many rental properties.
They lived in a 5,704-square-foot waterfront mansion in the prestigious Lake in the Woods community. But what seemed like a perfect life was more like a gilded cage, her friends said.
"She was very unhappy with the home situation and definitely wanted out of the marriage,'' Kris Lombardi said last week. "She said (Robert) was killing her emotionally and mentally.''
Sarah Blackburn had told her husband that she was filing for divorce. After their final confrontation last Sunday, investigators said, Blackburn told his longtime office manager, whom he called to the home, that his wife wanted to ruin him and take their children and everything he owned.
He then forced the aide from the home, joined his wife in the master bedroom closet, and shot himself in the head.
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Many of the issues that plagued the Blackburns' marriage sound familiar to Sotile. He and his wife, a licensed professional counselor, operate Sotile Psychological Associates and Real-Talk Inc. in Winston-Salem, N.C.
Over the past quarter-century, they have taught thousands of medical professionals and their spouses how to nurture their relationships through their professional challenges.
One of the root problems, he said, is the extraordinary work demands of physicians. As a group, he said, doctors work 60-hour weeks at a rate three times greater than any other profession.
It's not clear how many marriages involving physicians end in divorce. By various estimates, the divorce rate for physicians is thought to be 10 to 20 percent higher than the general population.
Psychiatrists' and surgeons' marriages are at particular risk, according to a study that tracked for 30 years 1,248 people who graduated from the Johns Hopkins University School of Medicine.
At Orlando Health, one of Florida's largest network of medical centers, administrators have asked Sotile to teach young doctors how to handle the stress of balancing work and home.
Dr. Jay Falk, the vice president of medical education for Orlando Health, said health care officials gradually have come to recognize the importance of easing the time demands on physicians.
"The culture has changed a lot," Falk said. "I think it's been very helpful for everyone, even the patients."
Sotile agreed that changes are occurring.
"Now physicians are saying, 'I want better work-life balance,' " he said. "They didn't used to say that. … And remember, this is a profession of people well-versed in self-sacrifice."
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Tampa plastic surgeon Dr. Dan Greenwald and his wife of nearly 25 years, Juli, remember the bad old days.
In their first years of marriage in the Bronx, while Greenwald toiled through surgery training, his wife had serious doubts about the future of their marriage.
"I think if he'd stayed for a fifth year (of training), we probably wouldn't have made it," said Juli Greenwald, who was working in investment banking at the time.
"I wasn't particularly excited about marrying a doctor,'' she said. "It wasn't particularly glamorous. And he was tired and he was depressed."
Dan Greenwald acknowledged the hardships.
"I have a very tolerant, intelligent wife,'' he said. "The things I asked her to do would have been stressful for anyone. I was terrible to be around."
But as Greenwald advanced in his profession and settled on a speciality, the relationship improved. Today, the Greenwalds have two college-age children, Dan works better hours and Juli handles the books at his private plastic surgery practice.
"You have to stay grounded in reality that exists outside hospital," Dan Greenwald said. "Who would ever recommend that all you have in life is work?"
Times researcher Shirl Kennedy contributed to this report. Joel Anderson can be reached at firstname.lastname@example.org or (352) 754-6120.