And even more cruel because Izzy was his best friend.
Even when somebody fails to save a stranger, he usually feels guilty. And here not only it wasn't a stranger, not only Tom Tom helped Izzy die, but technically he killed him. Besides, it is not to neglect the fact that Tom Tom was a simple structured personality, moderate retarded, and he had problems to cope with smaller problems, so how could one expect him to successfully handle this situation?
If he were somehow mentally stronger he would probably realize that a person so cruel couldn't be considered a friend, let alone a best one. But torn between affection for Eloise and a guilt for getting Eloise only after (and probably because) he killed his friend, he couldn't stand the conscience conflict.
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