Then, on Jan. 28, 2013, Elkus trekked the 55 miles to a medical complex in Newport Beach, an Orange County enclave with one of the most expensive housing markets in the country.

He went to the second-floor urology department and checked in under the alias. A nurse ushered him to an examination room. And when the doctor, a married father of two named Ronald Gilbert, walked through the door, Elkus pulled his Glock and squeezed the trigger 10 times, according to prosecutors. The shots punched through the doctor’s chest and neck, ending the physician’s life just days before his 53rd birthday.

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Elkus then turned to a nurse. “I’m insane,” he said, “call the police,” according to testimony reported by Patch.

But the shooting was not, according to law enforcement, the work of a psyche cut loose from reality, but that of a sane man derailed by revenge. As Elkus’s murder trial opened this summer, prosecutors argued that the shooting was tied to an earlier botched medical procedure that had left the defendant with a guttering sex drive and erectile dysfunction, as the Orange County Register reported. Elkus’s anger snowballed over two decades, eventually spurring him to homicide.

“Mr. Elkus began to blame all of his problems on this procedure,” prosecutor Matt Murphy told jurors, according to the Los Angeles Times. “Whatever went wrong in his life he’d blame on the procedure. He obsessed over this.”

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The jury agreed, finding Elkus guilty of first-degree murder in late August. On Monday, Elkus, 79, in a wheelchair and nearly deaf, was sentenced to spend the rest of his life in prison.

Elkus and Gilbert first crossed paths in 1992, the Times reported, when Elkus walked into a Veterans Affairs hospital in Long Beach complaining about frequent urination.

Gilbert was only a resident then, a friendly presence at the hospital who played piano for patients on the weekends, according to the Times. He worked alongside doctors who diagnosed the patient’s problem as urethral stricture — a narrowing of the urethra. Gilbert recommended the surgery, the Register reported, but did not participate in the procedure aimed at widening Elkus’s urethra.

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Elkus was left with incontinence, a low sex drive and erectile dysfunction. Making matters worse, different doctors later told Elkus that he had been misdiagnosed and that the procedure had been unnecessary.

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Eventually, Elkus blamed the loss of a longtime girlfriend whom he’d hoped to marry on the medical problems caused by the VA work. The grudge fixed on Gilbert, and continued to boil until Elkus decided to seek revenge. According to prosecutors, the retiree purchased his gun in December 2012. He also mapped out directions to Gilbert’s office.

In the meantime, the doctor’s career rocketed. Besides his medical practice, Gilbert and a partner started a pharmaceutical company focused on treatments for sexual dysfunction. The day before walking into the examination room where Elkus waited, Gilbert had received a $30 million offer from a corporate buyer.

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“I will never understand how cruel that is,” Gilbert’s partner told the Times after the murder. “To have that moment followed 12 hours later, 14 hours later, by something like that. In a million years, you couldn’t script that.”

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Elkus was arrested but pleaded not guilty by reason of insanity.

At his trial, his attorneys argued that the defendant was not in control of his actions on the day he gunned down the doctor. An antidepressant Elkus was taking in the days before the encounter weakened his inhibitions, the defense argued, the Times reported. Dementia and brain damage further incapacitated his control and empathy, the defense stressed.

The trial lasted three weeks. After 40 minutes of deliberation, the jury returned a guilty verdict. On Monday, Gilbert’s family was given the opportunity to speak at the sentencing hearing.

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“The world was robbed of a model citizen,” Gilbert’s wife, Elizabeth, told the court. “Our children were robbed of an amazing father.”

Elkus, however, was not listening. He’d pulled out his hearing aids as the family members spoke, according to the Times. He put them back in to hear Judge Patrick Donahue deliver the maximum sentence.