Fresh out of medical school in the Caribbean, Henry Bello took the first job he could get on the road to working as a doctor: a pharmacy technician with the city’s Health and Hospitals system. Then, in 2014, he got his break, when Bronx-Lebanon Hospital Center took a chance on the sharp dresser from California, someone who, in his 40s, was arriving late to the profession. He was hired to be what the hospital described as a “house physician.”

With a limited permit from New York State to practice medicine as an international medical graduate, Dr. Bello was essentially an extra pair of hands for the department of family medicine at the 17-story hospital, one of the biggest and busiest in New York City. Dr. Sridhar Chilimuri, the hospital’s physician in chief, said Dr. Bello could treat patients and prescribe medication, as long as other doctors were looking over his shoulder, and only at Bronx-Lebanon. “Not over there — not in a clinic,” he said for emphasis, pointing out the hospital’s doors.

But Dr. Bello’s slow journey to the medical profession, which was punctuated by bankruptcy, at least two arrests and recent sojourns in homeless shelters, came to a shattering end on Friday, when he opened fire with an assault rifle on the 16th and 17th floors of the hospital. After killing one doctor and wounding six other people, he fatally shot himself in the head.

Exactly how — and why — Dr. Bello, 45, wound up sneaking an AM-15 under his lab coat on a sultry afternoon and inflicting mayhem is the subject of a wide-ranging police investigation, and is marked with as many questions as answers. But through records, accounts from hospital officials and interviews with former neighbors, a portrait is coming into focus of someone who strained to achieve professional success while dogged by financial troubles and possibly addiction.

His last known address was a homeless shelter run by Bellevue Hospital on East 30th Street. On Saturday morning outside the weathered brick building, some residents said they had seen him there as recently as a week ago, despite hearing staff members tell investigators immediately after the rampage that he had officially moved out this past spring. He left the shelter in March with a Section 8 rent subsidy voucher.

Dr. Bello stood out among the shelter residents because of his neat dress, which consisted of slacks, button-down shirts and stylish glasses. “Mental health doesn’t discriminate: you could be a doctor, a lawyer, a judge,” said Richard Orta, 50, a resident who said he had overheard a detective interviewing the staff.

The Bellevue center was not the first shelter-like housing Dr. Bello had relied on. In 2014, the same year he was hired by Bronx-Lebanon, he lived at the Bowery Mission Men’s Center on Avenue D, on the Lower East Side of Manhattan. The 77-bed center, which is considered transitional housing, is designed specifically for formerly homeless men who are struggling with drug addiction.

In between the stints at the shelters, Dr. Bello lived for a year in a private apartment on East Second Street in the East Village, where neighbors said he made an impression by being unusually helpful and courteous. A resident in the building, who gave only her first name, Sonia, said that last year, Dr. Bello lived across the hall from her on the third floor in a small apartment with décor she described as minimalist.

“I was pregnant at the time,” she said, “and he’d carry boxes up and down without me even asking. He just offered. You see the stories after one of these shootings where neighbors say, ‘He was the nicest guy,’ but he really was.”

But Dr. Bello presented a different face at Bronx-Lebanon. On Friday, hospital officials said he left in 2015, in lieu of being terminated. The police said he resigned after an accusation of workplace sexual harassment.

Dr. Bello sent an email to The New York Daily News two hours before he opened fire inside the hospital, citing the “bogus complaints” made against him by the hospital. In the email, Dr. Bello said the hospital had terminated his progress toward a full physician’s license. “First I was told it was because I always kept to myself,” he wrote. “Then it was because of an altercation with a nurse.”

In the same email, he relayed that the hospital had cited an instance in which he had “threatened a colleague,” a fellow doctor. Dr. Bello wrote that he later emailed the colleague, “congratulating her for my termination after she sent out an email to everybody telling them to file complaints against me.”

The bitterness expressed in the email, however, provided no hint of what was to come. After the shooting, some doctors talked about possible warning signs — that Dr. Bello was short-tempered and, at times, menacing. A physician at the hospital, Dr. David Lazala, who also works in the family medicine department, told The Associated Press that he had trained Dr. Bello. Dr. Lazala described him as “very aggressive, talking loudly, threatening people,” and added that Dr. Bello had sent him a threatening email after leaving Bronx-Lebanon. Reached by phone on Saturday, Dr. Lazala declined to elaborate.

Surely, a career high point for Dr. Bello was his graduation in 2010 from the Ross University School of Medicine in Dominica, an island in the Caribbean — despite its reputation as a fallback for students who cannot earn admission to medical schools in the United States. But there were troubling signs for Dr. Bello before that.

Born Henry Williams Obotetukudo, Dr. Bello lived in California off and on from 1991 until 2006. It was unclear if he was born in the United States, but he obtained a Social Security card in his late teens. Records showed that, in 2000, he filed for bankruptcy in Santa Barbara, Calif., when he would have been in his late 20s. He obtained his license as a pharmacy technician in California in 2006, and it expired in 2009.

A serious brush with the law occurred in New York City in 2004, when he was arrested and charged with sex abuse and unlawful imprisonment. A 23-year-old woman told the police that he grabbed her on Bleecker Street in Manhattan, and tried to penetrate her through her underwear. Court records revealed that Dr. Bello pleaded guilty to unlawful imprisonment in the second degree, a misdemeanor, and was sentenced to community service.

The felony sexual abuse charge was dropped, which may explain why the episode was not unearthed during a criminal-background check conducted by Bronx-Lebanon. “There was no record of any conviction for sexual abuse,” said Errol C. Schneer, a hospital spokesman.

Dr. Bello also was also arrested in New York in 2009, but that arrest record is sealed.

In recent weeks, despite receiving the Section 8 housing voucher during the spring, Dr. Bello was seen by several residents of the Lower East Side near the Bowery Mission on Avenue D. It was unclear what he was doing back in the vicinity of the program that three years earlier had offered assistance with housing and drug treatment.

“He looked preoccupied,” said Monsey Lapuelta, a neighbor of the Bowery Mission, when shown Dr. Bello’s photograph from news articles about the shooting. “He was very to himself, very quiet, looking down. I never saw him with other people.”

Reporting was contributed by Nikita Stewart, Benjamin Mueller, Nate Schweber, Emily Palmer, Hannah Alani, Elizabeth Tarbell and Vivian Wang.

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