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Even as a child, watching the surgery take place on his dining room table, Bruce hated Carmine Falcone.
His father tried to explain it afterwards. "I'm a doctor, Bruce. If someone is hurt, it's my job to help them."
"But he's a bad guy!" Looking back, Bruce isn't even sure how he knew that already. What he remembers is his childish frustration, and the subtle, grim smile that played on his father's lips.
"Maybe he is. But is it a doctor's job to decide that, hmm?" He patted his son on the leg. "If I was a policeman or a judge, it would be my job to decide if Mr. Falcone was a bad person. But as a doctor, it's my job to help anyone. Even if they are bad."
He went on to explain about the Hippocratic Oath—a promise all doctors had to take, that they would help people in need and never harm them. He explained that even criminals in prison got to see doctors. And when he was done, Bruce was left with his first major case of cognitive dissonance: believing that his father was noble for doing something that was obviously wrong.
Even before he found out about Elliot's murder, Bruce hated Falcone for that. Saving him was a spot on his father's otherwise perfect record.
Years later, as he learned more about the city's criminal underworld, Bruce came to see Falcone as a symbol of everything wrong with Gotham. Everyone knew what he was, even if the full extent of his influence was impossible to determine—yet he walked the streets, hiding his misdeeds under the thinnest veneer of respectability. Little had changed when Maroni fell. Falcone had just stepped into his place, the clearest proof Bruce could see of Gotham's brokenness.
When he met Jim Gordon, he asked why the police didn't go after him. Gordon said that he wanted to, but they could never get any evidence on him, and his higher-ups leaned on them not to look too hard.
A doctor wouldn't let Falcone die, and a cop wouldn't arrest him. If anything was going to change, a new factor had to come into play.
That became Batman's own oath, just as solemn if a bit hazier in its details. He would stop the bad guys. He would do the dirty work that others had sworn not to. He would stop men like Falcone by any means necessary.
He wasn't a doctor. He wasn't a cop.
He was vengeance.