Chil­dren un­der fire

Al­most two dozen kids are shot ev­ery day in the U.S. This 4-year-old was one of them.

The Washington Post Sunday - - FRONT PAGE - BY JOHN WOODROW COX

The bul­let ex­ploded from the gun’s bar­rel, spi­ral­ing through cool night air to­ward a gray SUV’s back pas­sen­ger-side win­dow. Carter “Quis” Hill was perched in his car seat on the other side of the glass, and as it shat­tered all around him, the round bur­rowed into his head, an inch above the right tem­ple. From the boy’s hand slipped a brightred plas­tic Spi­der-Man mask he’d got­ten for his 4th birth­day, nine days ear­lier.

A white Pontiac blew past, dis­ap­pear­ing into the dis­tance. Carter’s mother, Ce­celia Hill, knew it was the same car that had been chas­ing them for three miles be­fore some­one in­side fired eight shots at her 2004 Volk­swa­gen in what po­lice would call an ex­tra­or­di­nary act of road rage.

Now she shoved her foot against the brake, squeal­ing to a stop in the mid­dle of In­ter­state 90. In the back seat, her son and daugh­ter snapped for­ward against their taut seat belts. Carter’s 7-year-old sis­ter, Da­halia Bohles, looked over at him. Shards of glass speck­led her dark hair, but she didn’t no­tice them at first.

“Mommy, Quis got blood on his head,” the se­cond-grader said, then she reached over and be­gan to wipe it away.

“Stop!” Hill screamed, turn­ing to check on her son, who, just be­fore mid­night on Aug. 6, had become one of the nearly two dozen chil­dren shot — in­ten­tion­ally, ac­ci­den­tally or ran­domly — ev­ery day in the United States. What fol­lows al­most all of those in­ci­dents are fran­tic ef­forts to

the lives of kids wounded in homes and schools, on street cor­ners and play­grounds, at movie the­aters and shop­ping cen­ters.

For Carter, his mother feared it might al­ready be too late.

The bul­let had driven through her boy’s skull and emerged from a hole in the cen­ter of his fore­head. Blood trick­led down over his eyes, along his nose, into his mouth.

“Mommy, Mommy,” he’d been shout­ing min­utes ear­lier, as Hill had fled from the shooter, but now her ir­re­press­ible 36-pound preschooler, with his plum cheeks, but­ton nose and deeply cu­ri­ous brown eyes, was silent. He stared at her.

She faced for­ward and punched the gas, push­ing the speedome­ter past 100 mph. Hill veered off an exit, stopped and leapt out of the car. She rushed to the other side and un­buck­led her son, then wrapped him in both arms and col­lapsed to her knees.

“Help,” he heard her yell into the night, over and over, un­til a pass­ing driver pulled up and called 911.

“Please don’t let my son die,” prayed Hill, a 27-year-old house­keeper at a med­i­cal clinic who had raised her kids mostly alone. She squeezed Carter against her chest.

Hill wished he would cry or scream or speak, even one word, be­cause when Carter was happy, he chat­tered with­out pause about the most im­por­tant things in his life: ba­nanas, or “nanas,” which he could eat for any meal of the day; grow­ing up to be the Hulk, be­cause smash­ing things sounded like the best job; his sis­ter, who was Carter’s fa­vorite friend, even though she wouldn’t let him play with her Bar­bies; fid­get spin­ners, mostly be­cause when his mom called them “finny” spin­ners, it made him laugh so hard that he would hold his stom­ach and fall to the floor.

But there, bleed­ing into Hill’s blue work shirt while sirens drew closer, he still hadn’t said any­thing.

“Is my baby go­ing to be all right?” she asked the paramedics in the am­bu­lance as it sped to the hos­pi­tal, but they didn’t an­swer.

Carter was among the last chil­dren shot that day, a 24-hour stretch of gun vi­o­lence that, ac­cord­ing to po­lice re­ports, left girls and boys from one coast to the other maimed or dead.

About 1:10 a.m., in Kansas City, Mo., 803 miles from Cleve­land, Je­don Ed­mond found a gun in his par­ents’ apart­ment and pulled the trig­ger, ac­ci­den­tally fir­ing a round into his face. Je­don, who died at a hos­pi­tal, was 2.

Eighty min­utes later, Damien San­toyo was stand­ing on a porch in Chicago as a car drove by, and some­one in­side opened fire, strik­ing the 14-year-old in the head. He died at the scene.

Less than two hours af­ter that, at al­most the ex­act same mo­ment, a 15-year-old boy in Louisville was blasted in both legs out­side a club, and a 16-year-old girl in Danville, Va., was fa­tally wounded on a street cor­ner by a round meant for some­one else.

Then, on a Metro car just out­side the na­tion’s cap­i­tal, an 18year-old man ac­ci­den­tally shot his 14-year-old half brother in the stom­ach. Then, in Kansas City, Kan., three teenagers were shot in­side a car, and two of them, one 16 and the other 17, were killed. Then, in a park­ing lot in High Point, N.C., a 14-year-old boy caught in cross­fire was struck in the arm.

Fi­nally, at 11:50 p.m. on an Ohio high­way, 4-year-old Carter was stalked in his car seat.

Hill al­lowed The Washington Post to tell his story and to in­ter­view him, his fam­ily, and his nurses and doc­tors be­cause she wanted peo­ple to un­der­stand all that he en­dured.

What led to his shoot­ing, she said, be­gan ear­lier that night. She was leav­ing her mother’s apart­ment com­plex with Carter and Da­halia when they came upon the white Pontiac block­ing the road. She honked and waited, un­til fi­nally the car backed out of the way. It fol­lowed her onto the in­ter­state. Then came the gun­fire.

On av­er­age, 23 chil­dren were shot each day in the United States in 2015, ac­cord­ing to a Post re­view of the most re­cent data from the Cen­ters for Dis­ease Con­trol and Pre­ven­tion and the U.S. Con- sumer Prod­uct Safety Com­mis­sion. That’s at least one bul­let strik­ing a grow­ing body ev­ery 63 min­utes.

In to­tal, an es­ti­mated 8,400 chil­dren were hit, and more died — 1,458 — than in any year since at least 2010. That death toll ex­ceeds the en­tire num­ber of U.S. mil­i­tary fa­tal­i­ties in Afghanistan this decade.

Many in­ci­dents, though, never become pub­lic be­cause they hap­pen in small towns or the in­juries aren’t deemed news­wor­thy or the trig­gers are pulled by teens com­mit­ting sui­cide.

Car­ing for chil­dren wounded by gun­fire comes with a sub­stan­tial price tag. Ted Miller, an econ­o­mist who has stud­ied the topic for nearly 30 years, es­ti­mated that the med­i­cal and men­tal health costs for just the 2015 vic­tims will ex­ceed $290 mil­lion.

None of those fig­ures feels ab­stract to Denise Dowd. The emer­gency room doc­tor at Chil­dren’s Mercy Hos­pi­tal in Mis­souri has treated at least 500 pe­di­atric gun­shot vic­tims in a four-decade med­i­cal ca­reer that be­gan as a nurse in Detroit. She’s writ­ten ex­ten­sively for the Amer­i­can Academy of Pe­di­atrics and sev­eral na­tional med­i­cal jour­nals, both about how to pre­vent chil­dren from fall­ing victim to gun vi­o­lence and, when they do, how it af­fects them, emo­tion­ally and phys­i­cally.

Dowd can rat­tle off num­ber af­ter num­ber to il­lus­trate the coun­try’s cri­sis, but few are more jar­ring than a study of 2010 World Health Or­ga­ni­za­tion data pub­save lished in the Amer­i­can Jour­nal of Medicine last year: Among high­in­come na­tions, 91 per­cent of chil­dren younger than 15 who were killed by gun­fire lived in the United States.

Like so many oth­ers who have pushed for gun-vi­o­lence pre­ven­tion, Dowd saw an op­por­tu­nity in the af­ter­math of the 2012 Sandy Hook Ele­men­tary School mas­sacre, which left 20 stu­dents and six staff mem­bers dead.

She and her col­leagues con­tacted close to two dozen schools and civic or­ga­ni­za­tions in their Mid­west com­mu­nity, of­fer­ing to give pre­sen­ta­tions about how to pro­tect kids from find­ing the weapons and harm­ing them­selves or some­one else.

Then, just as law­mak­ers in Washington re­jected ef­forts to ex­pand back­ground checks on peo­ple buy­ing firearms and dozens of state leg­is­la­tures con­tin­ued to ig­nore pleas that they re­quire guns to be safely locked away, Dowd got her first and only re­sponse, from a PTA group. Ex­actly three women showed up for her speech.

“Peo­ple just don’t want to talk about it,” said Dowd, who wishes those peo­ple un­der­stood what bul­lets do to kids’ bod­ies.

How rounds re­act upon im­pact can be ran­dom and chaotic. Their size, di­rec­tion and ve­loc­ity, which rou­tinely ex­ceeds 1,500 mph, all af­fect the path of de­struc­tion within a child. Some bul­lets tum­ble in­side the body af­ter punc­tur­ing the skin, de­flect­ing off bone be­fore ex­it­ing at un­pre­dictable an­gles that first-re­spon­ders of­ten strug­gle to quickly iden­tify. Other bul­lets are de­signed to ex­pand, cre­at­ing a widen­ing cav­ity as they shred through or­gans and ar­ter­ies.

Dowd has seen the re­sults in her young pa­tients: lost fin­gers, toes, eyes and limbs, and man­gled spleens, liv­ers, kid­neys, lungs and hearts.

What she has sel­dom seen, though, are chil­dren who live through rounds to the head.

When the pe­di­atric trauma bay’s door slid open, Carter, at 3-foot-3, looked tiny atop the adult-size gur­ney, ap­pear­ing smaller still as he was wheeled into the swarm of adults and bright lights and blink­ing ma­chines tow­er­ing over him.

Eyes pan­icked and neck braced with a minia­ture cer­vi­cal col­lar, he screamed through the oxy­gen mask strapped to his mouth, but the nurses and doc­tors at UH Rain­bow Babies & Chil­dren’s Hos­pi­tal later said they took that as a good sign: His air­way re­mained in­tact.

Still, his odds seemed grim. Ac­cord­ing to the Amer­i­can As­so­ci­a­tion of Neu­ro­log­i­cal Sur­geons, just 1 in 10 peo­ple who sus­tain a gun­shot wound to the head sur­vive it.

The emer­gency room staff checked Carter’s breath­ing and blood pres­sure. They sliced off his clothes with shears, then slid an IV into his left arm and strapped three stick­ers on his chest to mon­i­tor vi­tal signs. Nearby, an or­ange-and-white cooler was packed with four liters of O-nega- tive blood.

“One, two, three,” they counted up, then rolled him onto his side and scanned ev­ery inch of his body, look­ing for cuts or bumps or more punc­tures. They pressed on his spine to make sure it hadn’t been sev­ered.

As the mor­phine be­gan to take ef­fect, he was hus­tled down the hall to a dim room with a CT scanner.

At 12:46 a.m., the images ar­rived on the cell­phone of Efrem Cox, a 34-year-old neu­ro­sur­geon. The doc­tor’s pulse pounded, he re­called. The dam­age to Carter’s head was ob­vi­ous. The bul­let had struck the side of his skull, cre­at­ing a nickel-sized crater in the bone be­fore trav­el­ing 2.3 inches through the right frontal lobe and leav­ing an exit wound as big as a quar­ter. A frac­ture ran from one hole to the other.

Cox, who was at home, headed to his car. The boy, he knew, needed im­me­di­ate surgery.

By then, Carter had re­turned to the trauma bay.

“Please, God,” his mother said, pac­ing next to him as his grand­mother, An­nette Hill, hur­ried in­side.

They had worked so hard to pre­vent some­thing like this from hap­pen­ing to him. Carter wasn’t al­lowed to play with toy firearms, and even when he pre­tended that his grand­mother’s back-scratcher was a ri­fle, she scolded him. The fam­ily hated guns for a rea­son.

As a 7-year-old, An­nette’s brother had been rid­ing on the back of a bi­cy­cle when he was shot in the head. He had lived, but at 54, he still had a bul­let in his brain and four decades of seizures in his past. An­nette had never for­got­ten those times she’d wrapped cloth around a spoon and pressed it into her brother’s mouth so he wouldn’t bite off his tongue.

If her grand­son sur­vived, would that be his fu­ture, too?

“Gumma,” the boy mur­mured, us­ing his nick­name for her, so she walked over and sang him the “Barney” theme — “I love you, you love me” — as she had so many nights be­fore.

“Boop,” An­nette whis­pered at the end, gen­tly bump­ing her fin­ger against his ribs.

Now Op­er­at­ing Room 6 was prepped, and the neu­ro­sur­geons had ar­rived.

Carter was taken up the el­e­va­tor to the se­cond floor, where Cox saw him for the first time. Bits of brain, the doc­tor re­mem­bered, were vis­i­ble along the side of the boy’s head, as blood and teardrops con­verged on his cheeks.

Carter’s eyes darted around the chilly op­er­at­ing room, search­ing masked faces for one that looked fa­mil­iar. He found none. Ter­ri­fied, he wet the blan­ket un­der­neath him.

“It’s okay,” Cox told him, paus­ing to rub the boy’s arm.

The sur­geon un­der­stood the stakes ev­ery time he worked on a child. He was still griev­ing for his own son, who had suf­fered from a dev­as­tat­ing form of ju­ve­nile arthri­tis. The 2-year-old had died of res­pi­ra­tory fail­ure in this hos­pi­tal eight months ear­lier.

There was noth­ing the doc­tors could do.

“Put that aside,” Cox would tell him­self be­fore surg­eries. He had treated at least 30 chil­dren struck by gun­fire in his ca­reer, in­clud­ing a 17-year-old who had been shot clean through the back of his head on Cox’s first night as a neu­ro­surgery in­tern in 2011. He had wrapped the fa­tal wound in dress­ing so the teenager’s mother wouldn’t see it. When the blood soaked through, the sur­geon ap­plied two more pads and wrapped it again.

“There’s noth­ing we can do,” he had told the dis­traught woman that night, but now, with Carter on the ta­ble in front of him, there was some­thing he could do.

For so many rea­sons, that was re­mark­able.

If the bul­let had been a higher cal­iber, it would have cre­ated a larger blast ef­fect — like the rip­ple in a lake from the splash of a base­ball vs. a mar­ble — and rup-

“Is my baby go­ing to be all right?” Ce­celia Hill, whose 4-year-old son, Carter, un­der­went neu­ro­surgery af­ter be­ing shot in an Aug. 6 road-rage in­ci­dent

tured blood ves­sels through­out his head. If it had struck a cere­bral artery, he could have suf­fered a fa­tal hem­or­rhage be­fore doc­tors ever saw him. If it had been de­signed to splin­ter on con­tact, his brain might have been pul­ver­ized. If it had pierced his left frontal lobe rather than his right, he may have been left un­able to speak. If its tra­jec­tory had changed by just 30 de­grees, it would have crossed over the brain’s mid­line and, likely, killed him.

Some­how, none of those things had hap­pened. So, at 2:12 a.m., with Carter se­dated and cov­ered in blue drapes ev­ery­where but on the front of his head, Cox pressed a scalpel into the apex of his small pa­tient’s scalp. He needed to clean Carter’s wound to ward off in­fec­tion, re­pair the cracked bone in the boy’s head and make sure there wasn’t more se­vere dam­age to his brain.

“It’s go­ing to be okay, Mommy,” Carter’s sis­ter, Da­halia, was say­ing in a room down­stairs as she rubbed her mother’s back.

Across the top of the boy’s head, Cox said, he ran a foot-long in­ci­sion from one ear to the other. The doc­tor peeled the skin down to just above the eye­brows and, with a drill, cut out a sec­tion of skull the size of a Zippo lighter. The sur­geons washed out the open­ing and picked away four sliv­ers of bone, none larger than half a Tic Tac.

With the bleed­ing and swelling un­der con­trol, Cox slid the slab of skull back in place and screwed it se­cure with star-shaped ti­ta­nium plates cov­er­ing each hole.

By 3:05 a.m., Carter’s in­ci­sion was sewn shut.

He would live.

In his white Spi­der-Man un­der­wear, Carter sat cross-legged on the floor, bounc­ing a plas­tic toy horse across the ho­tel room’s brown car­pet. For a mo­ment, he didn’t think about the scary men who chased him or how cold it was in the place with the masked peo­ple or why he looked so dif­fer­ent now than he used to.

On his left arm, where the nurses had stuck the nee­dle he hated, was a Daffy Duck bandage, and over the hor­i­zon­tal slice on the cen­ter of his fore­head, where the bul­let had popped out, was a white strip of med­i­cal tape. The hair on the front half of his head that the sur­geons clipped had be­gun to grow back. And there, at the crest of his scalp, was the sur­gi­cal scar: a jagged, el­e­vated ridge, shaped like an up­side­down cres­cent moon and held to­gether by a faintly vis­i­ble coil of clear, dis­solv­able su­tures.

It had been ex­actly one week since Carter’s surgery. Two men, both 21 with crim­i­nal his­to­ries, had been charged in the shoot­ing, but Hill feared re­tal­i­a­tion, so a victim ad­vo­cates group had moved her and the kids to a ho­tel across town un­til they could fig­ure out where to go next.

Carter and his sis­ter hadn’t asked many ques­tions, but both vividly re­mem­bered what had hap­pened that day, which be­gan with a visit to their grand­mother’s home.

He had stood on a neigh­bor’s shoul­ders and dunked a bas­ket­ball in a hoop. Da­halia had climbed on the play­ground un­til she saw a spi­der near the slide. In the apart­ment, they ate pork and greens and watched an “Avengers” movie, and when it was time to go, they all loaded into Hill’s SUV.

Then, the kids and their mom got stuck in the road be­cause of the white Pontiac.

Da­halia: “She was beep­ing her horn, and she was scoot­ing up.” Carter: “Mommy said, ‘Move.’ ” Da­halia: “We got on the free­way, and that’s when they was fol­low­ing us.”

Carter: “They keep on get­ting up and get­ting up and get­ting up.”

Da­halia: “I looked over and saw a man pull up a gun.”

Carter: “It sounded like” — paus­ing, to raise his voice — “BOW, BOW, BOW.”

Da­halia: “They shoot the whole car up.”

Carter, on what the bul­let felt like: “Hurt.”

Da­halia, on see­ing her brother bleed­ing: “I was scared he was about to die.”

Carter, shrug­ging and slump­ing his head to one side, on why he was shot: “I don’t know.”

The boy al­ready had wo­ken up from his first night­mare, trem­bling. His doc­tors couldn’t pre­dict whether he would suf­fer from seizures or de­vel­op­men­tal prob­lems be­cause of the in­jury, but his early progress had given them hope.

Hill was deeply thank­ful he had sur­vived, but she so wanted to erase that night, to go back to the way things had been, be­fore she’d talked to a so­cial worker about find­ing the chil­dren coun­selors.

She saw glimpses of that old life, too, even in their cramped, tem­po­rary home.

“Can I play with her Bar­bies?” he’d started ask­ing again about his sis­ter.

Carter’s mother had tried to ex­plain to him why, for now, he shouldn’t do front rolls on the car­pet or at­tempt a hand­stand against the walls, but he mostly ig­nored her, and in a way that felt good be­cause it felt nor­mal.

When Da­halia pinned him to the bed and wouldn’t let him go un­less he kissed her, Carter squirmed and laughed, but still re­fused.

Hill would soon buy her son a white wool cap to hide his scars. It made Carter, with those plum cheeks and brown eyes, look no dif­fer­ent than he once did, at least on the out­side.

That af­ter­noon, as his mom sat on a bed scrolling through her phone, Carter, still only in his Spi­der-Man un­der­wear, climbed up over the edge to join her. He picked up a re­mote and turned on the TV.

On CNN, two men in suits were talk­ing about the vi­o­lence in a place named Char­lottesville. None of that made sense to Carter, so he changed the chan­nel, to HLN and a show called “Foren­sic Files.”

The cam­era zoomed in on a black pis­tol, its bar­rel turned to­ward the TV.

Carter’s eyes widened, and his mouth slipped open. He stood on the bed, pointed at the screen and an­nounced: “That’s the gun where I got shoot in my head.”

RICKY CARIOTI/THE WASHINGTON POST

A bul­let pierced 4-year-old Carter Hill’s skull just above his right tem­ple and emerged from a hole in the cen­ter of his fore­head. The shoot­ing oc­curred Aug. 6 in what po­lice would later call road rage.

PHOTOS BY RICKY CARIOTI/THE WASHINGTON POST

ABOVE: Ce­celia Hill cleans her son’s face at the ho­tel in Ohio where a victim ad­vo­cates group tem­po­rar­ily moved the fam­ily. LEFT: Efrem Cox, left, and Ni­cholas Bam­bakidis per­formed the surgery that saved Carter’s life.

RICKY CARIOTI/THE WASHINGTON POST

LEFT: Carter runs in cir­cles in the ho­tel room where his fam­ily is stay­ing un­til his mother fig­ures out where to go next. BE­LOW: Carter with his 7-year-old sis­ter, Da­halia Bohles. Both vividly re­mem­ber what hap­pened the day Carter was shot.

FAM­ILY PHOTO

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