In a large room filled with workout equipment at MedStar Union Memorial Hospital's Curtis Hand Center, Keith Mcneill gripped a small clip between his thumb and index finger and placed it on a metal bar. It was a simple task — and just over four years in the making.
Mcneill was sitting in his Toyota Tundra outside a friend's auto body shop in East Baltimore on March 14, 2014, when a masked man approached and began banging on a door.
Mcneill identified himself as a Baltimore police officer. The man pulled out a .45-caliber handgun and opened fire. Bullets punched holes in Mcneill's left arm, his chest, his abdomen.
He remembers a bumpy ambulance ride. He doesn't remember pain. But he avoided looking at his left arm, for fear he'd go into shock.
Hundreds of people are shot to death in Baltimore each year. Hundreds more are wounded but survive. Few remain in rehabilitation as long as Mcneill.
The lifelong Baltimorean had served 19 years on the force when he was shot. He had risen to sergeant, supervising seven officers in the city's Eastern District. Now he's on medical leave, earning a salary but focusing on his recovery.
On each of the more than 1,400 days since the shooting, through multiple operations and endless physical therapy, a precipitous weight loss and months in a wheelchair, Mcneill has drawn motivation from a single goal: To return to duty.
Police work, his wife says, is a calling.
Mastering the hand exercises at Union Memorial is the last step of his medical odyssey — and perhaps the most important since trauma surgeons saved his life.
Four or five of the eight bullets fired at Mcneill tore through his left arm, wrecking the system of bone, tendon, muscle, blood vessels and nerves that make his hand work. Restoring its function is critical for his return to work.
"Sometimes it hurts a little and I'm sore after workouts," Mcneill, 43, said during a recent rehab session. "I have faith I will regain full use of my hand. I'm very patient."
At the University of Maryland Shock Trauma Center, a top-tier facility that sees the most grievous wounds Baltimoreans can inflict on each other, Mcneill recognized the elevator and hallways. He had escorted other victims there.
Now he was the patient. All injured police officers are taken to Shock Trauma.
His heart raced. Then it stopped.
More than 65 police officers have been killed in Baltimore in the last two centuries, almost two thirds by gunfire. Doctors say Mcneill lost so much blood he nearly joined them.
Another officer collected Mcneill's wife, Danielle, and their son, then a junior in high school, and took them to the hospital. She didn't reveal the severity of Mcneill's injuries.
Separate surgical teams attended to Mcneill's abdomen, chest and arm.
"Damage control," said Dr. Thomas Scalea, the center's physician-in-chief.
The doctors performed a procedure new at the time: inserting balloons through the femoral artery in the leg to the aorta to stop bleeding so they could make surgical fixes. It likely saved his life.
Mcneill was in surgery when Danielle arrived, so she settled into the fifth-floor waiting room.
Scalea emerged after hours of surgery. Mcneill was unconscious.
"I did all I can," he told Danielle. "Now it's up to God and Keith."
There would be more procedures to come — Scalea can't say how many. For the first several days, he didn't bother closing the wound in Mcneill's belly because he would just have to open it again to clear debris, make more repairs and tackle infection.
Mcneill remained unconscious. Danielle, who had been his high school sweetheart, gave up her job as a secretary at a Catholic school — and most food and sleep — for life on the fifth floor. As Mcneill was returned to the operating room each morning, she would say a prayer.
Mcneill woke after three weeks. He and his wife cried with relief. He would spend the next year in and out of the hospital, for patches, repairs and complications, and two more returning for other treatments.
"When we do this, a year and a half isn't a long time," Scalea said. "Three years is a long time."
The family imagined each treatment or operation as a step forward. Mcneill, a reserved man speaking publicly for the first time, acknowledged frustration and fear only rarely — such as the moment when doctors couldn't find a pulse in his arm, calling the limb's viability into question.
Every nerve in his arm had been injured or severed, says Dr. Ray Pensy, an orthopedic surgeon at Shock Trauma and the University of Maryland Center for Hand and Upper Extremity Care. He performed his first operation on Mcneil the day after the shooting, and continues to assess whether additional tweaks might offer incremental improvements.
Pensy knew a working hand was vital. When Mcneill woke, he immediately wanted to see his arm. Nurses, fearing the sight would cause his volatile blood pressure to spike, had hoisted the limb up and behind his head to hide the scaffolding holding it together.
During eight or so surgeries, Pensy installed metal rods from Mcneill's shoulder to his wrist and moved tendons and nerves from healthy fingers to damaged ones.
In between procedures, Mcneill was relearning how to walk and talk. Though he watched hours of the Food Network to pass time, he relied on a feeding tube for nutrition. He dropped from 235 pounds to 170 pounds.
His wife, initially queasy about bodily fluids, learned to change bandages, colostomy bags and the feeding apparatus.
Mcneill used a wheelchair during his stay at the University of Maryland Rehabilitation & Orthopaedic Institute and later at the hand center.
He also wheeled himself to court, to testify against his shooter. Police said Gregg Thomas had a grievance when he showed up at the auto body shop, but was targeting the wrong place. After three mistrials, he was convicted in 2017 of attempted murder and gun charges, and was sentenced to life in prison plus 35 years.
The rehab continues. For two years, Mcneill has been visiting the hand center to grasp fat wooden dowels, lift weights, pinch clips. Danielle helps ferry equipment.
"It's a miracle to see him here doing anything," she said. "I couldn't even recognize him after it first happened. His face was bloated and he was hooked up to machines."
Mcneill has found joy in tending to his beloved yard again and using power tools to build a wood trash bin receptacle. A steak lover who settled for mashed potatoes as his first meal after the shooting, he revels now in eating meat.
The strides he has made have left an impression on medical staff. Lauren Davis, his hand therapist, said she rarely sees a patient for so long — and so willing to keep pinching clips.
That wasn't even possible when Mcneill first started hand therapy. He had little range of motion or strength.
Davis began by using her hands to stretch his fingers. She made custom braces for support and later she added bands to stretch the digits. She used paraffin wax to warm his joints and soften scar tissue.
Mcneill has moved onto arm bikes and other gym equipment to build strength.
His progress is evident. When he started at the hand center, he worked on picking up small pieces of cut up sponge. Now he can affix the most resistant clip to the thickest bar.
Doctors are considering transferring another tendon from a healthier finger to a scar-covered one to improve mobility this summer. Moving one of the two tendons that bend the middle finger of his injured hand to the index finger won't harm the former, Davis said, but could require retraining the latter.
Pensy said the recovery after reattaching an amputated hand is less complicated. But Mcneill continues to press for the next thing.
"If you give a mouse a cookie, he'll want milk, and then a napkin," Pensy said. "When you're doing well, you want to keep going. Keith is highly motivated to keep going, and if we can provide more function to achieve his goals then we will proceed."
Mcneill's goal remains returning to duty.
The department he would rejoin is much changed.
Freddie Gray died in police custody, the city erupted in riots and violence surged — a three-year spike in killing that has begun to abate only this year.
Investigators with the U.S. Justice Department found the department routinely violated the constitutional rights of citizens, particularly the poor and minorities, and the city entered a court-enforced consent decree that requires reforms.
Eight members of the elite Gun Trace Task Force were convicted of federal racketeering charges for shaking down citizens, stealing cash and drugs and claiming unearned overtime.
Anthony Batts, the police commissioner when Mcneill was shot, was fired, as was his successor, Kevin Davis.
Mcneill says police still have a positive impact on his community. Darryl De DeSousa, the new police commissioner, said Mcneill is what the city needs.
"Sergeant Mcneill is a courageous officer who possesses the character and attitude that the community wants in a police officer," De Sousa said. "He puts the community first. After going through the unthinkable, all he wants to do is return to doing the job he loves. Just like on that fateful night he was shot, Sgt. Mcneill continues to fight. We will continue to support him and we hope that he can soon return as a full-duty Baltimore police officer."
Back at the hand center, Lauren Davis massaged warm wax on Mcneill's tired hand.
"It will happen," Mcneill said.