When the bullet pierced her back and cracked her spine, Vanessa Sims began to blame herself. Why was she, at eight months pregnant, on North Avenue at midnight?
"That was so inappropriate," she still says of being out that night.
It was Father's Day and the moon rose full above East Baltimore. Stay in bed, her boyfriend had told her. He would pick up the fried rice she craved.
Instead, she left their rooming-house apartment, walked down Greenmount Avenue and turned on North Avenue for the carryout. She said she wanted to show off the cute sneakers her boyfriend had given her — purple Jordans.
Two miles away, Dr. Kent Stevens ran the trauma service that night at Johns Hopkins Hospital. Dr. Dylan Stewart, the pediatric surgeon on call, was home in bed after dining out with his wife. Together, the two surgeons had 15 years of experience at Hopkins, and soon they'd be tested by a situation neither had faced before.
Shootings in Baltimore have kept pace with last year's surge in gun violence — about 800 so far this year, including more than 220 homicides — and as they say in the streets, bullets have no names. Stray gunfire hit a 10-year-old boy who was going to buy juice and elderly siblings who were going to lunch. The night of June 19 brought a grim milestone: the youngest casualty.
This victim hadn't been born yet.
A child shot in the womb has a slight chance of survival, and such injuries are exceedingly rare. The Hopkins surgeons only knew of similar instances through years-old case studies. But they knew they didn't have much time.
Sims had heard the crack of fireworks — no, gunshots, she realized.
Two hidden gunmen opened fire on North Avenue, a 911 caller said. The crowd scattered as gunshots burst from behind a 5-foot brick wall. There detectives would later find .40-caliber shell casings. Two men, ages 25 and 30, were wounded. The older man, police said, had vials of suspected cocaine.
One bullet struck the ground beside Sims, 21. She heard shouts: "It's coming from behind the wall!"
Sims ran. She stepped from the curb. A bullet punched her down. It entered the small of her back at her "Halloween" tattoo. (Her birthday is Oct. 31.)
"She doesn't appear to be the intended target," police Detective Nicole Monroe said. Four months later, detectives still don't know of a motive.
The stray bullet tore through Sims' swollen belly.
"We have a pregnant lady here!" a man told the 911 dispatcher.
"Where did she get shot?"
"In her abdomen, it's in her abdomen right now," the caller shouted. "Get somebody here!"
Johns Hopkins was six minutes away by ambulance.
A new start
The pregnancy felt different from the beginning. The nausea that crept in mornings was unknown when Sims carried her two girls. Could it mean a boy, she wondered.
There were larger questions, too. Could she afford a third child? Sometimes Sims considered giving the baby up for adoption.
Her grandmother, Barbara Sims, was already helping to raise her two daughters in Baltimore County. Vanessa Sims was 17 when she had Da'Neia and 19 when she had Paige. Then she and their father split up. She had no job, no savings, no high school diploma. She had her grandmother, though.
"My grandmother's wonderful with my daughters. She raised me, she raised them, she raised her own kids."
Sims was 4 years old when her mother, who was HIV-infected and suffered from lupus, died. Nine years ago, Sims left a group home in New York, where she had been sent after getting in trouble for writing graffiti, to live with her grandmother and four brothers in Baltimore.
But trouble followed her to Baltimore — the nights out, chilling and smoking. At school, Sims said, she fussed with teachers and stormed out of class, and she was expelled from middle school. She also served a stint in juvenile detention for stealing.
When it came time for her release, there was her grandmother's tough love.
"She was like, 'Well, we don't know if she's ready to come home.' Because I was bad — I never stayed home. I was running away. I was bad," Sims said. "But as I got older, the last three years of my life, I started to grow."
Still, the burdens of young motherhood weighed heavy. Her patience buckled last year at the Motor Vehicle Administration.
Paige was fussing, and Sims reacted harshly.
Another woman in line spoke up: "Sister, there are other ways!"
Sims fumed. How dare she? How could this stranger understand?
The woman said her name also was Vanessa.
"I just felt she needed help," Vanessa Butcher-Hopkins said. "Someone to step in and maybe give her advice on being a mother and just dealing with raising a child."
Months passed and they shared text messages. Butcher-Hopkins dropped off Pampers and taught Sims to portion groceries for the week. She suggested the young mother write down her goals in a binder — get her GED certificate, plan for a career — and carry it as motivation. The mentor took a vacation day from work and drove Sims for a sonogram.
It was indeed a boy.
By now, Sims wanted a home with Jimmy Ford, the child's father and her boyfriend of three years, something more than their rooming-house apartment. "Munchkin," she signed his Father's Day card with affection. "Because I'm his munchkin," she said.
Ford has an 8-year-old son, and he taught Sims to soak the nipples of baby bottles so Paige's first sip would taste of milk. It was the way he made the bottles that convinced Sims he was the one. She wanted to raise their son together.
Their boy was due in August.
"Whatever I got to go through, as far as raising him, I guess I'll go through it and hopefully that will better me," Sims said. "But I'm not giving my son to nobody, and for the rest of the pregnancy it was set in my mind: I'm going to keep him."
She was eight months pregnant when a .40-caliber bullet tore into her womb. It smashed the collarbone of her unborn son.
The bullet bored into his tiny chest.
'I'm coming now'
The surgeon's pager went off with code "Delta," the most urgent call. Stevens rushed down to the Hopkins trauma bay.
The ambulance, lights flashing, sirens pealing, rushed through East Baltimore with Sims bleeding on a backboard and taking fluids by IV.
At Hopkins, the emergency team gathered with Stevens and medical residents, obstetricians, anesthesiologists and CT scan technicians.
The ambulance pulled up at 12:23 a.m.
"What's your name?" a doctor asked Sims, because if she could speak, she could breathe. The first priority was to check her airway.
Her heart rate was 84, slightly fast. Her systolic blood pressure was 115, slightly low.
"Can you move your feet?" a doctor asked to rule out paralysis. Her spine was fractured. Her left foot was numb, but Sims was able to move it.
Stevens teaches his medical residents to count the bullet holes. Odd totals mean a bullet may still be in the body. The doctors saw one wound in her belly.
They cut off the rest of her clothes and rolled her. In the small of her back, beside the inked "Halloween," was a second hole. The entry and exit wounds revealed the path of the bullet — right where the baby was, Stevens realized.
Monitors showed the boy's heartbeat was slipping, recovering, slipping.
Exactly how far along was she? Stevens wondered. The child's lungs might not have developed sufficiently for him to breathe outside the womb. What if the baby is bleeding?
Adults can afford some bleeding; not infants — the smallest loss is gravely serious.
Do I order a CT scan? the surgeon wondered. Or do I run her upstairs and operate? A scan would take three or four precious minutes.
"We had to decide," Stevens recalled.
He ordered the scan of her lungs, liver, spleen, stomach. It showed blood in her uterus.
Then Stevens called for an operating room. "I'm coming now."
The third-floor room was prepped and crowded. Sims was placed on the table, sedated and medically paralyzed. She was painted thighs to shoulders with antiseptic and draped.
With a scalpel — a No. 10 blade and the largest used — doctors cut open her belly, right down the middle so they could operate further on her right or left sides.
Half of babies die after being shot in the womb, according to a June 2010 study in the journal Injury. The risk spikes "significantly" when pregnancy exceeds 12 weeks and the uterus expands beyond the pelvis, exposing more of the baby to damage. Sims was 34 weeks, nearly full-term.
They needed some luck.
The boy was turned head-down for birth, and doctors lifted him out.
Into the crowded urgency, Sims' son was delivered by cesarean section at 1:18 a.m. June 20. He weighed 6 pounds, 4 ounces.
He was six weeks premature. Still, the boy should cry.
Dr. Solange Eloundou, the obstetrician on the case, snipped his umbilical cord.
He made no sound at all.
Stop the bleeding
At one minute, a breathing tube was inserted into the boy. His heart beat too faintly to be felt. An IV delivered adrenaline; his heart strengthened, then crashed.
At 12 minutes, doctors performed chest compressions with their thumbs. His heart was no bigger than an egg. Nurses pressed their hands against his tiny body to stanch the bleeding.
The cellphone rang in Dr. Stewart's car as he neared Hopkins. As director of pediatric trauma, Stewart operates on children. Stevens operates on adults. The two surgeons work apart, even on different hospital floors most nights.
Now Stevens was calling from the operating room.
What size chest tubes for an infant? he asked.
Ten French, Stewart said, driving. It was almost the smallest size.
At 23 minutes, doctors cut between the child's ribs, inserting two tubes to relieve pressure. They worried bleeding in his chest was squeezing his heart and lungs.
Stewart parked and entered the operating room crowded with trauma doctors for Sims and the neonatal intensive care staff for her son.
"All these different people that don't normally work together," he observed.
The bullet had broken the child's collarbone. Beneath it runs the crucial subclavian artery. Doctors worried the artery had been ripped. And yet, the child's heart was beating stronger — a good sign.
Newborn blood, however, can't clot like that of adults, and the boy was bleeding out.
His bleeding increased the risk of cardiac arrest, which could interrupt the blood supply to his brain. Doctors could revive his heart only to find the child had suffered brain damage, never growing to walk or speak.
They must stop the bleeding, Stewart understood. The course ahead would require him to cut open the bullet path, to sew and cauterize the torn veins. He called for a pediatric operating room. Nurses rushed upstairs to ready the room.
In a warmed incubator, the boy was wheeled to the fourth floor, and the surgeon began.
The boy took one, almost two, full body volumes of blood. "Meaning everything is going out, and you're putting it all back in," Stewart said.
An hour passed and Stewart pressed on. Was there time?
'The grace of God'
One month later in July, Sims limped off a Hopkins elevator. She walked with hips thrust forward, thanks to two rods and four screws in her spine.
On the eighth floor, in the neonatal intensive care unit, Room 26, the lights were dimmed. Her son slept.
The bullet had missed his subclavian artery. By millimeters, the bullet also missed his heart. His small body swelled after surgery. For two weeks, he needed a ventilator to breathe.
Day by day, he lived.
"It was like a 1-in-a-million shot that you could go through and through the uterus, actually hit the child and not kill him," Stewart said. "It's just luck … the grace of God."
The baby's heartbeat recovered; his brain was unharmed.
Stewart and Stevens could not recall another child born at Hopkins with gunshot wounds. A single bullet had pierced his shoulder and cut a shallow path in his chest. The bullet came out, then hit his elbow, ripping the soft tissue.
Hopkins doctors reviewed the case in July at a meeting of the full emergency department. The quarterly meetings are reserved for the most challenging cases, and this one is to be published in the Journal of Trauma and Acute Care Surgery.
Now, in the dimmed hospital room, Sims peered into her son's crib.
A bandage covered his left shoulder. A pale scar showed on his chest.
"You're a special baby, aren't you?" she whispered.
The boy spent 33 days at Hopkins and went home with Sims' grandmother to Windsor Mill.
The gunshot had damaged the nerves that thread from his shoulder to his fingers. Three months after surgery, his left wrist still drooped. A therapist from the Kennedy Krieger Institute arrived to measure his progress one October afternoon.
"Let's see if this is any better," said Jennifer Wingrat, fitting the boy with a plastic splint. Like the emergency doctors, she had never seen a baby shot in the womb.
His therapists and doctors are waiting to see if the nerves heal. They will decide in December if they must surgically graft the nerves to correct the droop of his wrist. Surgery, however, won't guarantee that his wrist will recover normal range and strength.
"Sometimes, kids who have this injury, I see them for a couple months and they're great," Wingrat said. "Some of them, I see for years."
'Grateful they're alive'
By now, she said the lesson has settled in that some nights can't be undone.
"I wasn't thinking like a woman carrying a life," Sims said. "So me being outside then, that was so inappropriate. For a pregnant woman to be outside at 11-something at night — it's not cool."
The shooting remains unsolved, and detectives have no suspects. Some 70 percent of nonfatal shootings in Baltimore this year remain unsolved, police said.
"Whoever done this … I want him to see this and hear this every day," Ford said. "You shot an innocent kid, man, who wasn't even in the world yet, didn't have a chance to breathe his first breath on his own without a machine, innocent to everything that was going on around him. And you shot him. So I want you to suffer, man."
While Sims recovers, she has been living with Ford at his mother's house in North Baltimore. Scars run across her belly and her back, but her limp has faded.
Each week, she rides the No. 8 bus to the 44 to the 77, an hour's trip, to see her three children. For now, they are better off in her grandmother's care, she said.
On one visit, the storm door banged open to the white rowhouse. Da'Neia and Paige burst out: "Mommy!" Sims bent down to wrap them in hugs; she couldn't lift them.
Inside the home, worn and much-loved, are framed photos of the generations Barbara Sims has raised, and now one more.
"I'm just grateful they're alive," she said. That's all she says, busying herself in the home.
The boy sleeps. Sims nuzzles him. Slowly, he opens his eyes: brown, large.
He was born from gun violence and without a detectable heartbeat, yet he survived.
His mother named him Chance.