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The couple even vacationed in Europe in 2003.
As 2004 began, the City of Phoenix was in the middle of several huge money deals in which Keogh's abilities were being put to the test.
His many tasks included coordinating the sale of $500 million in revenue bonds to pay for the light-rail system.
The city also was sorting out how to finance the proposed $350 million downtown hotel. Also pending was a $180 million sale of wastewater revenue bonds.
No one at City Hall seemed to have the slightest doubt that Keogh and his staff would put it all together, just as they always had.
Karlene Keogh says her husband's "symptoms," by which she meant what he had been complaining about on and off since the Mexico trip, reappeared in early 2004.
Keogh's appetite vanished, his stomach and head ached, and he constantly was getting sinus infections and sore throats. Never the best sleeper, he was more restless at night than ever.
Mrs. Keogh says he complained of not being able to concentrate at work nearly as well as he always had.
That June, Keogh was too ill to take his wife out for her birthday. He made an appointment with Dr. Barry Hendin, co-director of Banner Good Samaritan's department of neurophysiology.
During that visit, according to Dr. Hendin's notes, Keogh asked him "to review my situation relative to prior problems with cysticercosis."
The doctor noted that Keogh's symptoms were "suggestive of cysticercosis, [but] without any definitive positive diagnostic studies" to back it up.
Hendin ordered another MRI, as well as an EEG test, the latter to look for irregularities in the brain's electrical activity that may produce seizures. Surprisingly, the doctor did not request an updated test for parasites.
The EEG came up normal.
In October, Keogh received a 7 percent salary increase, to just under $165,000 a year.
His supervisor, Sheryl Sculley (now the city manager in San Antonio, Texas), was glowing in her praise, writing that "you are creative and always willing to figure out a financing strategy. [You are] analytical, creative and outstanding on financial matters."
But Barbara Lang says she had started to see cracks in her friend's normally even-keeled demeanor.
"We'd usually speak every day even before Kevin got into the office," she says, "and he always was a self-critic, even though he was the smartest man I've ever known. But he'd become really unsure of himself, shaky."
Lang recalls that "Kevin did a presentation for a ratings agency, and afterward he told me that he'd slipped, made a mistake. That really bothered him. Then around November, he started becoming paranoid, increasingly so."
As for the MRI, Keogh's earlier experiences with the high-tech machine had left him feeling claustrophobic, and he awaited his appointment with trepidation.
A doctor wrote a prescription for Valium, the bottle of which police found in Keogh's Mercedes after he died. But the anti-anxiety pill didn't help, and Keogh asked the MRI operator to stop the test soon after it started.
A medical dictionary says a psychotic person may suffer from agitation, anxiety, panic attacks, delusions, paranoia, difficulty concentrating and altered sleep patterns.
All that defined Kevin Keogh's state of mind in late 2004.
"He was constantly telling me that he was going to lose his job," Karlene Keogh says, "and that there was a conspiracy to get rid of him. He wasn't eating much, and he wasn't sleeping much, either. But he was very, very convincing about what he said was going on down at City Hall."
That Thanksgiving, Keogh and his wife went to a party hosted by friends. He seemed distracted and distant during the entire evening.
Some of the guests asked Mrs. Keogh if the couple had been fighting.
She explained that he just wasn't feeling well.
Kevin Keogh drove home on the afternoon of Friday, December 3, 2004, utterly spent from his workweek.
Mrs. Keogh says he continued to obsess over that weekend about his job status, apparently convinced he was going to get fired that Monday.
The couple spoke of trying a fresh start in California, with new jobs and a new life. In the short term, they were looking forward to that needed vacation together in Italy.
Mrs. Keogh says she persuaded her husband to make an appointment with local psychologist Dr. Dawn Noggle.
In a letter to Mrs. Keogh, Dr. Noggle later described the hourlong phone conversation she'd had with Keogh that Saturday:
"He related a number of concerns about his [job] regarding performance, others' perceptions of his performance, pressure he was under given the nature of some of the projects he was working on and, most importantly, his concern and belief that he was going to be fired."
But Dr. Noggle noted that "at no time did he indicate that he was hopeless or even helpless. He did not appear to have chaotic thoughts, but did seem somewhat [persevering] in his thinking and speech. There was nothing in his presentation to me to indicate he was severely depressed nor that he was suicidal."
The two planned to meet in person that Wednesday, December 8.
Keogh didn't go to work on Monday, December 6. That day, he phoned city manager Frank Fairbanks to say he was quitting. Keogh told his wife that Fairbanks had asked him to just take the day off and relax.