It was B'Elanna who rewrote his holo-family program not Tom, because she said it was too unrealistic that they were constantly praising him, obeying him unquestioningly, and being perfectly perfect.
From what I could interpret of the episode, he didn't have creative control over the program after he agreed to let B'Elanna rewrite it. And he literally chose to abandon the family entirely when initially faced with Bell's death because he felt guilty over not being able to fix it as a surgeon and afraid of having to confront the death in general. Latent Image really dives into that guilt of being unable to do his job of saving people, to the point where he essentially breaks and becomes useless as a doctor, all because he simply made a choice to save Harry's life instead of someone else's. I've watched Voyager dozens upon dozens of times since I was 13, it's my favorite of all the shows, I can and will go toe to toe on this (respectfully).