Bello had worked at Bronx-Lebanon as a family physician before resigning in the face of a sexual harassment complaint two years earlier. He blamed a specific colleague for derailing his career and, he claimed, costing him $400,000. Hours before the attack, he emailed the New York Daily News with a rambling account of his grievances: he had been told he was fired for keeping to himself, then for an altercation with a nurse, then for threatening a colleague. The shifting explanations fed a fixation. Dr. Maureen Kwankam, who had overseen his dismissal, later said bluntly that they fired him because he had been erratic and had promised to return and kill them. The colleague Bello held most responsible had taken the day off -- a coincidence that likely saved that doctor's life but could not save anyone else on the sixteenth and seventeenth floors.

Bello went first to the sixteenth floor. He confronted a doctor in the hallway, shouting about being abandoned when he was in trouble, then pulled the rifle from his coat and fired. The shot missed. The doctor fled, yelling a warning. Bello moved into the nurses' station and shot at everyone inside, wounding six people in total -- three doctors, two medical students, and a patient. He then poured gasoline from a juice container over the nurses' station and set it alight before climbing the stairwell to the seventeenth floor. There he encountered Tracy Tam in the hallway. She was randomly targeted, the hospital's chief physician later confirmed. Bello shot and killed her. He then barricaded himself in an office, set himself on fire, and shot himself in the chest. He staggered out of the room and collapsed.

Tracy Tam was a family medicine physician and a graduate of Touro College of Osteopathic Medicine. She was 32 years old. Among the wounded, Justin Timperio, a first-year family medicine resident, suffered injuries to his liver, stomach, intestines, and lung and was transferred to Mount Sinai Hospital. His father, an oral surgeon from St. Catharines, Ontario, said his son had come to the Bronx because there were not enough medical school positions in Ontario. Oluwafunmike Ojewoye, a second-year resident and Temple University School of Medicine graduate, was shot in the neck. A gastroenterology fellow was struck in the hand. Two medical students from Ross University School of Medicine were also shot, one sustaining injuries to the head and knee. A patient was injured but listed in stable condition. These were people in the middle of ordinary workdays -- residents early in their careers, students still learning, a patient seeking care -- caught in the path of one man's rage.

The attack laid bare a vulnerability particular to hospitals: they are open institutions by design, built to receive anyone who walks through the door. Bello entered using his former employee identification. He carried the rifle, purchased eight days earlier, beneath a white coat that no one in a hospital would question. The Bronx-Lebanon Hospital Center, founded in 1962 through the merger of two older Bronx hospitals, served one of the most underserved communities in New York City. It was a place where young doctors came to train because the need was great and the work was real. The shooting prompted renewed conversations about workplace violence in healthcare settings and gun access, but for the people who worked those floors, the reckoning was more immediate. A colleague had returned to a place of healing to do harm, and the randomness of who lived and who died -- a shift covered as a favor, a day off taken at the right moment -- was the cruelest part of all.