Quinzell Covington went on a shooting "caper" for the first time in the late 1990s with his cousins and friends. The tough guys who raised him in ways of the streets pulled the trigger that day

Then one weekday afternoon, one shot the other in the head at close range.

Colter had watched the pair walk by his house and soon afterward heard a boom, then a second. He looked up to see one of the young men fall and the other run off. Within minutes, Colter pushed back neighbors who crowded around, trying to see the body of Andre Miller, 31, who lay on his back in the street. No one tried to help Miller, though, or see if he was alive.

That's because in this neighborhood, Coldstream Homestead Montebello, like other areas in the city, people know criminals are shooting to kill.

"Most of the time, they assume you already dead, " Colter said of residents.

One out of every two people who are shot here die, making it the most lethal of Baltimore's deadliest neighborhoods. The homicides have become so frequent that the community association recruited Colter, a resident, to be its chaplain. His job: to shepherd relatives at crime scenes, organize street vigils and help bury the dead.

"I sort of guide them through the waters, " said the trim, dignified 71-year-old. From his corner, he can point out the spots in the nearby blocks where a dozen people have been killed over the past several years. "When I hear gunshots, I go."

A yearlong Baltimore Sun investigation found that gunshot victims are now more likely to die. Gun violence in Baltimore - and in cities across the nation - is concentrated in poor, predominantly black areas. In the past five years, according to a Sun analysis, 80 percent of homicides by shooting were committed in about one-quarter of Baltimore's neighborhoods.

Residents of a few select neighborhoods are condemned to endure a shocking degree of violence. As in Coldstream Homestead Montebello, some neighborhoods saw shooting victims die at a higher rate than the citywide average of one death for every three shootings.

And that's in a city that ranks as one of the most lethal in America.

The years have brought a devastating and under-recognized shift in Baltimore. Criminals are increasingly aiming for the head and shooting victims repeatedly, often at close range, using higher-caliber guns with extended magazines that enable them to fire more bullets. It's a new degree of ruthlessness that's shocking veteran police detectives and making it tough for trauma surgeons to keep up.

The odds for gunshot victims got worse in at least 10 of the nation's largest cities last year - an overlooked trend behind a surge in shootings and homicides in urban areas around the country, The Sun found. The violence is often confined to certain impoverished areas, such as southeast Washington D.C., Chicago's south side and the north side in Milwaukee.

Colter, police and criminologists see a potent mix of forces at play- here and across the country.

Retaliatory shootings play out over years - not only among rival gang members but among families and friends. The no-snitching ethos is well-established and systematically enforced. The relationship between some communities and the police has fractured, leaving police with fewer clues to solve crimes and parents desperate to try to solve homicide cases. Children grow up exposed to violence, becoming more likely to commit violence.

"It's just a culture that they're in, " said Daphne Alston, co-founder of Mothers of Murdered Sons and Daughters United. She said killers aren't born, but shaped by their circumstances.

"Poverty went into their gun, homelessness, bad parents, bad schools, bad communities, bad church, everything went into those guns - everything that they're not getting goes into those guns, and that's what they shoot, " Alston said.

But many residents believe gun violence defines the city more than it should, pointing to multibillion-dollar waterfront developments, national attractions and major league sports teams. Over the past five years, in one-third of the city's 280 neighborhoods, including many of the wealthiest areas, not a single person died in a shooting.

Still, the power brokers, from police to politicians, know the high homicide rate threatens economic vitality and efforts to draw new residents. And they are scrambling to stop it.

In the violence-torn neighborhoods, many residents are simply afraid. Sometimes they are too frightened, or too accustomed to the sound of gunshots to call 911. In a few cases, shooting victims lay in the street all night until someone stumbled upon the body the next day.

Some seek comfort in a growing number of ministers who focus on helping residents heal. Over and over, Colter finds distraught people looking to him.

Just this summer, he awoke about 3:45 a.m. to the sound of blasts. A few minutes later, he heard two more, bursts loud enough that they seemed to come from a cannon. He jumped out of his bed and peered out the bathroom window.

A young man was lying on his back just feet away on the cracked and buckled sidewalk, bleeding under a tree. The street light spotlighted his splayed body. Colter recognized him as Davon Harper, nicknamed "Turtle, " from the neighborhood.

The gun violence in Baltimore - and in cities across the nation - is concentrated in poor, predominantly black areas. Coldstream Homestead Montebello is the most lethal of Baltimore's deadliest neighborhoods, according to a Baltimore Sun investigation. 

Colter said the 23-year-old victim had been shot and then chased down the alley toward his house. It was there that someone jumped out of a car and blasted him point-blank with a shotgun. Police arrived within minutes.

Illuminated by an officer's flashlight, Harper's eyes were closed, his top lip quivered. The minister watched as he gasped.

"Oh my God, " Colter whispered to himself when the young man's face went slack. "He's gone."

In quick succession, paramedics loaded Harper's body onto a gurney, pulled a sheet over his head and drove off. No sirens. Colter remembers Harper's distraught older sister asking over and over: "Why, why? No matter what he did, he didn't deserve this."

Colter felt he was able to provide a little peace to Harper's mother, who had cancer and would follow her son to the grave within a few weeks. At the memorial service, Colter told Harper's mother that he sensed her son, who had a criminal record, wanted redemption just before he passed away.

No one has been arrested in the deaths of Miller or Harper, and police don't know the motives. Colter knows many people are without closure. The Unitarian minister often recites an old prayer with those who have lost someone to violence: "Thou who are known by many names ... thou who are known and expressed in many ways, it's to thee we come. ... Our request is to make yourself known to us in this hour."

He always prays for one revelation: an understanding why so many are gunned down.

The same question that haunts Baltimore.

Overlooking Lake Montebello and a golf course, Colter's neighborhood in Northeast Baltimore once ranked as one of the city's wealthiest. In the 1800s, William Patterson - whose name is on the Southeast Baltimore park - entertained friends with champagne and strawberries on his lush lawn.

In the next century, the city became the first in the nation to pass a law establishing segregation block-by-block. After legal segregation was abolished, unscrupulous real estate agents convinced white residents to sell low by stoking racist fears. African-Americans, limited in where they could live, bought Coldstream Homestead Montebello homes at a markup. Since then, the enclave for working-class black residents has seen a slow decline and a shift to more subsidized housing.

Today, the area known as CHuM looks like any of Baltimore's progress-stalled communities where boarded-up vacant homes sit next to rowhouses with neatly kept postage-stamp yards and blooming flower beds.

Mark Washington, executive director of the community association, said partnerships with residents, police and city officials have helped make improvements, such as exercise equipment along Lake Montebello and a new picnic pavilion to replace one that burned down. He pointed to one corner where drug dealers were evicted and a store that attracted loiterers was shut down.

But Washington and others are not blind to the gun violence in the neighborhood.

On one block since May of last year, a man and a woman were fatally shot multiple times. An 18-year-old was shot in the head. Another man was shot in the arm and buttocks but survived.

On Colter's own block, police charged a 23-year-old resident with murder in 2014. A bullet grazed a 16-year-old girl last year, and in August detectives arrested a 26-year-old resident in a homicide.

"They are up-close shootings, " Colter said. "If they're driving by, they're going to jump out and come up and storm your porch or your house, and if you run, they're going to chase you down."

Remembering the cries of a man stabbed to death several homes away at midnight a decade ago, Colter sighed. "Oh mercy, " he said, "I call them death screams."

Other Baltimore neighborhoods also witness a disproportionate level of gun violence. The streets proved lethal over the past five years in Belair-Edison in the northeast, where 92 people were shot and 33 of them died. In Oliver in East Baltimore, 55 people have been shot since 2011 and 21 died. In Central Park Heights in the northwest, about one-third of 90 shootings were fatal.

Underscoring those statistics, Baltimore health officials say as little as half of 1 percent of Baltimore's population is responsible for most of the violence.

Many of the homicides are followed a few days later by vigils. Colter helps to organize them in CHuM, explaining to the family the unwritten rules that aim to keep people safe and prevent retaliatory shootings. Stay out of the street, don't hold the gatherings in the heat of the day, and never past dark.

Relatives bring candles to spell out the name of the victim. They share memories. A family member usually reminds the group of the grim reality: "This could have been your brother, this could have been your sister, this could have been your child."

Washington believes the high rate of lethal shootings is linked to the neighborhood's deep roots. So while drugs and gangs play a part, families have lived on the same block for generations, creating long-standing friendships and deeply felt disputes. The bonds allow suspects to get close to victims, resulting in sure shots.

That's not unique to the neighborhood, according to Baltimore Police Commissioner Kevin Davis. Some of the killings in the city this year are over quarrels dating back eight or nine years, he said.

"The streets don't forget, " he said.

As violence becomes an acceptable alternative, the next generation's beefs are playing out on social media, which is used to mock rivals, issue warnings and make daring taunts. Street outreach workers and police detectives say that social media postings have made disputes more contentious and longer-lasting. Threats and insults live forever on the internet.

Even jail inmates post threats online. In one video, an alleged shooter being monitored by authorities made veiled threats against people he believed had been labeling him a snitch. On the private Facebook video shown to The Sun, he said: "If you're involved in my motherf - - line, you just need to know that a lot of motherf - - changes is coming today. I'm putting my foot down."

Hit men, who take murder-for-hire contracts issued on the streets, advertise on social media, according to Davis. Police are tracking a number of hit men suspected in multiple homicides as well as an organized gang known as the 10 Grand Club that will take out targets for that price.

Gang life has become ingrained in many neighborhoods. Some young people find a sense of security and structure in gangs that they don't have at home, even in the face of infighting that has led to a number of homicides in recent years, police detectives say. Gang codes dictate fierce loyalty. Kill orders can't be questioned.

The reach of gangs extends to the women in members' lives - mothers, sisters and girlfriends known as "Bonitas." In the Black Guerrilla Family, Baltimore's most powerful gang, they are not allowed to be members, but they know the code and follow it.

Officers investigate a fatal shooting at the corner of York Road and Coldspring Lane in early September. The mid-day shooting is like many others in Baltimore, where bold criminals are killing, without masks, in front of witnesses. The shooter in this case has not been identified.

Baltimore homicide detective Dawnyell Taylor remembers a case in which police suspected that a 19-year-old killed a fellow gang member. Taylor brought in the victim's mother, who had taken the suspect in as a child because he had no one to care for him. The youth and her son had grown up as brothers and best friends.

When the mother pleaded with the youth to come clean to her, the suspect reminded the Bonita that he didn't have a choice: "Ma, you know the rules."

‘No snitching' takes hold

Baltimore homicide detective Martin Young understands the fear of cooperating with a homicide investigation. Young grew up in Edmondson Village, a community that has struggled with violence. In a collection of about 10 streets, half of the 14 people shot since 2011 died.

His father still lives there. Even the veteran could imagine being reluctant to get involved. He thinks about that when he's off-duty, visiting his childhood neighborhood, and hears gunshots ring out.

"It would be hard for me to come forth, " Young said in an interview. "I would be hesitant. ... It's not that I don't want to help, but you don't know what the repercussions are."

He also knows the alternative all too well - if no one comes forward, the shooter remains free. "Do you leave the individual out there and allow him to kill at will, " Young asked, "or do you do something about that?"

Still, the trail remains cold on many cases. Young recalled two brothers hanging out near the intersection of Cold Spring Lane and York Road one Friday last month. It was about 1:30 p.m. when a man walked up and shot one of them in the stomach at close range. Shoppers crowded the busy commercial strip, and surveillance cameras captured the killing. The shooter didn't even bother to wear a mask.

But the key witness, the victim's brother, has refused to meet with Young, and police haven't been able to identify the shooter.

Young also pointed to a case from January when a young man was kidnapped during the day from his front steps in front of his friends. No one got a license plate number or description. Not a single person called 911. The perpetrators drove the young man to another street, threw him in an alley and shot him to death.

In both killings - and about 65 percent of homicides this year - no one has been arrested. Nationally, about 40 percent of homicide cases remained open last year.

Police say many city residents do call in tips, but they often aren't witnesses or don't have direct knowledge. Others may know something, but are either involved in criminal activity or are too indifferent or scared to speak up. Echoes of a deadly 2002 firebombing of a family's East Baltimore home, in retaliation for reporting drug dealing, still reverberate.

"People who don't live in neighborhoods ravaged by poverty can't understand, well why wouldn't someone tell the police?" said Davis, the commissioner. But, he said, they've got reasons.

"It's fear. It's fear for your own safety, your family's safety. It's very real."

While "no snitching" is a common street rule of nearly every city in the United States, its connection to Baltimore became solidified in 2004, when Ronnie Thomas, nicknamed "Skinny Suge, " distributed a DVD featuring drug dealers warning people to "Stop Snitching" with threats of violence.

The DVD became an underground and national sensation boosted by the cameo of NBA star and Baltimore native Carmelo Anthony, who has since said he does not endorse the message.

More than a decade after the firebombing and the DVD, criminals have not only convinced many residents to stay out of their way, they've devised a way to reiterate and enforce their so-called code.

In the past, Baltimore police Sgt. Robert F. Cherry said, snitches found currency in helping police. As they were often involved in criminal activity, it was to their benefit to trade information for possible reduced sentences or charges.

But because of the power the Black Guerrilla Family has amassed in Maryland prisons, he said, the gang has been able to widely disseminate the message: Don't snitch, join us and we'll take care of you in and out of jail.

The gang's hold became so strong that, for a time, it ruled over the Baltimore City Detention Center. Gang members had sexual relationships with corrections officers and smuggled cellphones and drugs into the center. Last year, Gov. Larry Hogan closed the jail down.

The BGF gang continues to hold sway, according to members of Safe Streets, an organization of violence "interrupters" and mediators, including former inmates, who are based in high-crime neighborhoods. Arrestees must prove to gang members that they're not witnesses in any criminal cases.

When they arrive in jail, they must show what's called their "paperwork, " or court documents such as pre-sentence reports and testimony. Once the inmate is cleared, the gang offers protection.

Police say the court system has inadvertently helped the streets keep its secrets, solidifying the BGF's tight grip, because in recent years they've had trouble quickly obtaining writs, or orders that allow detectives to interview inmates on cases they are working. Sometimes, detectives would take the inmates out of jail and treat them to lunch to try to ply information from them.

The process is now delayed, the detectives said, to involve defense attorneys and prosecutors. Homicide detective Vernon Parker said his understanding was that judges didn't want to be construed as an arm of law enforcement, and not impartial jurists. State Courts spokeswoman Terri Charles said judges were not aware of any problems interviewing inmates.

Even ex-inmates, felons who have long been out of the drug and gang world, abide by the code. Carmichael "Stokey" Cannady served 12 years in federal prison for drug dealing and reformed. He works as the community outreach coordinator for Shoe City, the Baltimore regional shoe seller that puts on anti-violence events.

But, he says, he has been able to maintain his credibility in the community, in part because he remained silent.

"I didn't tell on nobody. I came home with a good name, a good reputation, " Cannady said. "I dealt with the consequence of my actions. I never thought, never, to turn nobody into authorities."

Broken relations

Baltimore's police commissioner, Kevin Davis, remembers the day vividly. It was cold, and Davis, then a newly hired deputy commissioner, was on the scene of a West Baltimore homicide. When he walked into a nearby corner store to use the bathroom, he spotted the owner hurriedly walking up to shoo him away.

"It quickly dawned on me based on her demeanor ... that she wanted me to get the hell out of her corner store, " recalled Davis, who was in uniform. He realized the owner was terrified that someone might spot him in her business and conclude that she had given him information.

In 25 years of police work, Davis had never experienced anything like it.

Since then, he has taken over the department and has had to weather scathing criticism about its practices in poor, black neighborhoods.

The U.S. Department of Justice, which conducted a civil rights investigation here, recently outlined at length how the department routinely violated the constitutional rights of residents by conducting unlawful stops and using excessive force. It was the culmination of years of practices, including "zero tolerance" policing that led to mass arrests, which alienated young black men - and the community.

The effects were also felt in the judicial system, said Cherry. City juries are more suspicious of police, and witnesses are less likely to cooperate.

"Old Miss Betty who sits out on the stoop" isn't giving police tips anymore, said Safe Streets community liaison J.T. Timpson.

"She sees them doing all this unlawful stuff she feels shouldn't be going on, so guess what? She is not going to say nothing because you're just as bad as they are, " Timpson said. "Not every police officer is like that, and we know that. But you have too many boys working that have no business policing the city."

Even the Rev. Andre H. Humphrey, commander of the Baltimore Trauma Response Team, is frustrated. He leads a group of chaplains that work with Baltimore police, responding to violent crime scenes to help victims and family members.

He said he has watched officers slam heads on car hoods and treat family members rudely. "Why should you have to get indignant?" he asked, referring to police.

Some say widely publicized incidents across the country in which black citizens died after altercations with police stoked last year's surge in shootings and homicides in a number of the nation's largest cities. That deadly trend continues this year in many highly segregated and impoverished urban areas, including Baltimore.

In Baltimore, police, union officials and the mayor have acknowledged one version of the "Ferguson effect, " or "Freddie Gray effect" - that officers shied away from doing their jobs for months after coming under increased scrutiny. Gray died in April 2015 from injuries sustained in the back of a Baltimore police transport van. In turn, some criminologists say the city saw a related effect - that criminals were emboldened by the perception that officers weren't policing.

A broader definition of the effect - that violence escalates when communities lose confidence in police - is harder to prove. A study commissioned by the National Institute of Justice recounted the theories: The breakdown can lead to people taking matters into their own hands, to honor codes that encourage people to respond with violence to threats and disrespect, to more "predatory" violence because offenders believe victims and witnesses will not contact police.

The study also noted previous research that found when trust in government erodes, homicide rates increase - before the American Revolution, in the Civil War, and during the political turmoil in the 1960s and '70s.

But more research is needed to determine whether that's what's happening today, the study concluded.

Davis says he's been working to repair community relations and has become a fixture at public forums where residents air grievances. Without the public's help, he knows police can't do their jobs.

Dante Barksdale, an outreach coordinator for Safe Streets, said more needs to be done to protect witnesses. He said prosecutors and police are not careful enough in keeping the identities of cooperating witnesses confidential. When police play witnesses off each other, for instance, saying one had cooperated, the stigma for that witness is impossible to shake, and potentially dangerous.

Retired Baltimore homicide detective John F. Riddick said he has seen detectives, frustrated by a lack of cooperation and under pressure to solve cases, coerce tipsters and force confidential informants to testify in court. In the past, this network of informants was never expected to go to court and had been the lifeblood of investigations.

He also called the department's witness protection program "a joke." He said many Baltimore witnesses have a homing instinct, returning to the city after being placed out of state - "If you grow up in a neighborhood all your life, that's all you know.

"I can understand why people wouldn't get involved" by cooperating with police, Riddick said.

Davis acknowledged that the department needs to improve. "We have to find better ways to incentivize people to come forward with information, and then when people do come forward with information, " he said, "we probably have to find better ways to protect them."

Thomas Abt, a Harvard Kennedy School of Government researcher who has studied places like Baltimore and Watts in South Central Los Angeles, has seen that when homicides aren't solved, neighborhood residents may look to street justice, perpetuating violence. He said the feelings in those urban areas can be bleak: "You're on your own. Nobody cares about you. No one is helping you. No one is coming for you."

Many families feel trapped in neighborhoods where homicide is a part of life. It can feel as if they are left to fend for themselves. Parents from a number of cities that have seen an uptick in violence, from Baltimore to Washington, D.C., Chicago, New Orleans and San Francisco, recount some universal rules they impart to their children to keep them safe.

Don't linger around large crowds in neighborhoods prone to violence because the chances for disputes or gang shootings increase. Don't ride in a car with people you don't know well - they may be involved in criminal activity - or in a car with a large number of young black men, which could make you a target for a police stop.

Ursula Newell-Lewis, a longtime social worker in New Orleans, instructed her son, Charles Newell, 24, not to ride in cars with other people. Some of her friend's sons had been killed.

When he was laid off from his job, Newell thought it was his chance to get out of New Orleans. She bought him a plane ticket to live with her sister in Waldorf, Md. Upon his arrival last November, a family friend invited Charles to go on a short trip to D.C. to show him how to get around safely.

The car was shot up, and Newell was killed.

Raichele Jackson's niece, Ranisha Raven, was killed when at least one gunman fired into a crowd last year at the San Francisco public housing project where she had grown up. She was there to visit friends. "Don't discount having a conversation with the wrong person because now you're with them. It's really that simple, " Jackson said.

Raven died about 15 feet from where her father, Burnett Raven Jr., was fatally shot in 2006.

Andrew Papachristos, a Yale researcher, said violence shows many of the markings of a communicable disease. The closer you are to people who are involved in violence, the more likely you are to get drawn in. Getting a ride or standing with the wrong people can get you killed, as can living next to the wrong person.

He tracked gun homicides in Chicago between 2006 and 2012 and found that, just like HIV, gun violence can be transmitted from person to person through "risky behaviors, " he said. In Chicago, more than 40 percent of all gun homicides he researched occurred within a network of about 3,100 people or about 4 percent of the community's population.

Being a part of that network increased your chances of being killed by 900 percent.

Even a recompense for living in a blighted Baltimore neighborhood can put people in danger. Generations of Baltimore children have been poisoned by toxic lead paint that can cause health and developmental problems. In a sad twist, police said families who received legal settlements stemming from the exposure have become targets of robberies. Police Col. Stanley Brandford said a triple shooting in 2014 was over a lead paint settlement.

Ultimately, a stack of studies has shown that growing up and witnessing so much violence affects children's mental and physical health. The stress that the kids suffer can lead to depression and anxiety, and even affect the development of crucial areas of the children's brains - those involved in attention, memory and behavior control. Nearly one-third of the children will develop post traumatic stress disorder.

Tara Carlson, director of the Center for Injury Prevention and Policy at the University of Maryland Medical Center, said many people in Baltimore see crisis on an almost daily basis. A study by the center found that adults exposed to violence scored an average of 3.8 on an Adverse Childhood Experiences Study test - comparable to people in war-torn Afghanistan - and half of the clients exhibited PTSD symptoms at a higher rate than some living through the war in Iraq.

Though many factors are involved, researchers say the exposure also can put children at risk of becoming violent.

Felton J. Earls, a Harvard emeritus professor of human behavior and development, studied gun violence in Chicago from 1990 to 2005 and its effect on children. He found that exposure to firearm violence doubles the chance that an adolescent will perpetrate serious violence over the next two years.

Parents as detectives

That night in 2015, Cynthia Bruce got the call from her sister. She could only hear her son's name being shouted: "Marcus! Marcus!"

Bruce drove frantically to the 5500 block of Rubin Ave. in Northwest Baltimore, where she saw crime tape and patrol cars and a paramedic pumping her son's chest. Marcus Tafari Samuel Downer, named after the early civil rights leader Marcus Garvey, would be pronounced dead not long after. The 23-year-old graduate of the Baltimore School for the Arts had been shot 19 times while sitting on a porch.

"What gun has so many bullets?" she asked.

Bruce doesn't know who killed her son or why. She has heard different theories. He was killed because he messed with a child's stroller, and the father came and shot him. Maybe it was because he was talking to a neighborhood girl who was someone else's girlfriend.

The shooting occurred during daylight hours and was seen by multiple neighbors. Bruce knows of only one detail that police gleaned from witnesses, that the suspect left in a gray car.

She said the Baltimore police detective won't disclose much in the case - only that someone must have witnessed it but is afraid to come forward. At the Baltimore state's attorney's office, she said, homicide chief Don Giblin asked her if she believed in "karma" because maybe karma would catch up with the killer. She was furious.

Giblin said "the remark was not intended to give this grieving mother the impression that we would not aggressively pursue justice on behalf of her son."

A trained advocate helped Bruce's family through the process, and the state's attorney's office now requires that one is assigned in every homicide case.

Bruce decided she had to take matters into her own hands. Whenever she returned to her sister's house from her Carroll County home and saw the woman who owned the stroller, she would ask her: "When are you going to tell the detective who murdered my son?"

The woman told her she had told police everything she knew. Unsatisfied, Downer visited her mother's workplace to confront her about a perceived lack of cooperation.

The woman filed harassment charges against her. Court records show they were ultimately dropped.

Baltimore police spokesman T.J. Smith said the department is trying to be more responsive to family members seeking answers and updates. He said the department is hiring two victim advocates for the Homicide Unit.

Other parents around the country who carry the same heartbreak have been driven to take action on their own.

Marna Winbush, the founder of Mothers against Gun Violence in Milwaukee, blames deteriorated relations between police and the community. Police Capt. Aaron Raap points to a telling statistic: The number of motorists who failed to stop for police more than tripled to more than 2,500 last year. And Ivy League researchers found in a study released this month that 911 calls dropped 20 percent in black Milwaukee neighborhoods after the beating of a black man by off-duty white officers.

Winbush's son, DeShaun Winbush, 19, was shot and killed in 2003, along with two of his friends. She believes it stemmed from an incident months earlier when a girl stabbed another girl she suspected of fooling around with her boyfriend, one of Winbush's friends. Had someone called the police then, Winbush's mother believes, the events that led to her son's killing might have been prevented.

Winbush said too many cases of officers harassing or physically mistreating African-American teens or young men have made family members of homicide victims silent. She tells them to give her the information, and she will provide it to police and keep their anonymity.

Another mother, Salahaquekyah Chandler, a San Francisco activist, felt that police and the city weren't doing enough to solve the killings of African-Americans. Her 19-year-old son, Yalani Chinyamurindi, was killed last year when he accepted a ride from his job and the car was shot up. She chafed at social media references to her son and other victims as "thugs."

Chandler scratched her son's name, the date he was killed and other case facts into the side of her bronze Nissan Pathfinder - turning it into a rolling billboard seeking tips.

In March, Chandler and other mothers of homicide victims succeeded in lobbying the San Francisco Board of Supervisors to increase the amount of reward money to as much as $250,000 per unsolved case.

In Baltimore, one father is trying to raise money so he can hire a lawyer to investigate the shooting death of his 20-year-old son, Shakim Gilliam.

The young man drove to Belair-Edison with friends in October 2014 to buy some marijuana. From talking to police and his own sleuthing, the father believes he entered an alley near a vacant house to make the purchase when he walked into a setup. He was made to kneel on the ground before someone shot him through the head.

The friends who brought his son there did not call 911. No neighbors called about the gunshots. His son's body wasn't found in the alley until the next day.

Gilliam's father has felt stymied in his attempts to get information from police. Determined to get justice, Shakim Shabazz drove down many times from his home in New Jersey, knocked on doors, and talked with folks. His theory is that two men with ties to the BGF gang held his son responsible for a friend's drug money that went missing.

He uses words like "uncontrollable" to describe what's happening in Baltimore and other cities. "It's kind of like outrageous and like unbelievable how people's lives right now have no value, " he said.

He is angry that no one has been arrested, and he is devastated. It feels to him like it happened yesterday.

"It's been two years, " said an exasperated Shabazz. He tries not to think about timing, and what might have been.

Shabazz was working on getting a larger apartment, so his son would move up to Jersey with him, away from Baltimore. Just before his death, Shabazz assured his son the move would happen, telling him to hang on for a few more weeks.

Last Sunday night, the Rev. Jay Baylor grabbed the microphone and walked to the front of the fellowship hall at the Church of the Apostles in the City, an Anglican church in Mayfield. The neighborhood borders CHuM in the northeast part of the city.

"We experience loss and trauma, " the lead pastor told about 40 attendees. "But that was not God's plan."

It was the first of several healing services in response to recent violence. Over a period of six months last year, at least three people close to members of his congregation had been killed. Among those hurting was the church's assistant pastor, Carletta Wright.

In January, Wright's nephew, Lamont Raheem Malloy, 24, was shot to death in the 1200 block of Patterson Park Ave. in East Baltimore.

Wright grew up in East Baltimore and has overseen candlelight vigils, presided over a dozen funerals for shooting victims and worked to stop violence. Six years ago, when she saw a man armed with a gun chasing another man, she launched herself off her front steps.

"Don't shoot him, in the name of Jesus!" she yelled at them. She was shoved to the ground, and the men scattered. She heard the would-be shooter tell the targeted victim, "You're lucky this time."

Baylor, who was in the area that day, happened to see the encounter. The two ministers paired up to found the Church of the Apostles in the City two years ago.

"These are important issues to the Lord. Issues of justice, issues of healing. … We believe the church has a vital role ... and we've been silent, " Baylor said at last Sunday's service.

A band soon launched into gospel music, and after a few songs, Baylor introduced Betsy Stalcup, who directs the Healing Center International, a faith-based counseling and mentoring ministry in Virginia.

Over the soft notes of a guitar and keyboard, she spoke soothingly, taking attendees into a group therapy session. She told parishioners she would "walk you through grief" and urged them to breathe deeply and slowly.

"In the name of Jesus, " she said. "Release the grief. Release the grief."

Even as they breathed, police detectives were investigating the latest homicide in Southwest Baltimore.

In his neighborhood of CHuM, Colter also has come up with a plan to help the families. He's mulling over a way to promote it, maybe with fliers.

The minister rues that Davon Harper, whom Colter watched die from his bathroom window, had to have his memorial service at the local neighborhood center, and had to be cremated, because his family couldn't afford anything else. The minister knows most parents want a coffin and a grave for their children.

His proposal is to get parents whose children are involved in drugs and gangs to purchase life insurance for them. "For $18 a month, " Colter says, "they could have put them away decent."

Colter realizes that for these families, even that small amount is a sacrifice. But after years of seeing things play out on the streets, he understands that just as some families save for cars or college, the parents here should save to bury their children.

Interactive designer Jin Kim contributed to this article.

Part 3: Oct. 16, 2016 Wounds like combat By Justin George Just after midnight, medics rushed the gunshot victim into the last available trauma bay, and nurses and doctors swarmed. They needed to stop the bleeding. As one staffer cut off the patient's clothes that night this summer, Dr. Jason D. Pasley began a careful search of the man's body for bullet wounds. The holes can be as small as a pencil eraser, and the team rolled the man to check everywhere - behind knees, in armpits, along the hairline. One by one, Pasley called out what he found - a hole in the back, in the buttocks, in the leg - until he got to six. Surgeons call it "bullet hole math." An even number indicates that bullets might have gone through. An odd number raises the likelihood that a bullet may still be in the body. "If the math doesn't add up, you are missing something, " said Pasley, a long-serving trauma surgeon at the University of Maryland Shock Trauma Center in downtown Baltimore. "The more you're shot, the more likely you are to hit something serious, the more likely you are to die." The gruesome ritual has become more common in hospitals nationwide. At Shock Trauma that week, it was the seventh night in a row doctors had had to rely on the crude calculus. Emergency rooms are struggling to save gunshot victims arriving in worse shape than ever before, with more bullet wounds, and increasingly shot in the head. Even as advancements in trauma care have saved countless lives, victims of gun violence have seen their chances of survival drop, exacting a toll on victims' families, medical personnel and taxpayers. More than $80 million has been spent at Baltimore hospitals caring for patients shot in gun crimes in the past five years. During that time, the number of cases doubled and the annual price tag soared nearly 30 percent. Most of the medical costs are now covered by Medicaid, the federal-state health insurance program for the poor. "We spend every night trying to row upstream against this, " said Dr. Thomas M. Scalea, physician-in-chief at the R Adams Cowley Shock Trauma Center, the first of its kind in the nation. The 55-year-old center is named for the pioneering surgeon who coined the phrase "Golden Hour, " the time after injury when trauma patients have the highest likelihood of survival. Scalea says that time can be mere minutes for gunshot victims. He said his experience treating them has become emotionally numbing. "You get outraged for a while, " he said. "Then you get the next one and you go - what are you going to do?" Outside the hospital, first responders are trying to keep up with the merciless uptick in gun violence. Baltimore police officers have begun carrying tourniquets, which constrict blood flowing from wounds, and a national push is underway to make the devices as widespread as defibrillators and as commonly understood as CPR. Police officers in some cities - rather than waiting for an ambulance - load gunshot victims into squad cars to get the wounded to a hospital before it's too late. Both law enforcement and paramedics are adopting military-grade equipment and practices from combat situations. The changes in trauma medicine have coincided with deadly trends on the streets of Baltimore and other major U.S. cities, The Baltimore Sun found in a yearlong investigation. Criminals are using higher-caliber guns with large magazines and bullets that destroy tissue and pulverize organs. Crime scenes are littered with dozens of shell casings, and victims are bleeding out more quickly. Shooters are exhibiting a brazen ruthlessness that surprises even grizzled law enforcement officials.  The increase in the number of gunshot victims creates a challenge for trauma surgeons at area hospitals.  With so many shooting to kill, The Sun found, odds for gunshot victims have gotten worse. For every three people shot in Baltimore, one person dies, making it one of the most lethal of America's largest cities and deadlier than a decade ago. Other cities are also seeing spikes in gun violence and lethality. Among them: Washington, Chicago and New York. The onslaught has left surgeons, public health and other medical professionals outraged and looking for ways to stem gun violence. "What's surprising to me is that we're a society that is willing to live with this, " said Dr. Angela Sauaia, professor of public health, medicine, and surgery at the University of Colorado Anschutz Medical Campus. She said that if gun violence were a disease, a one-in-three chance of survival would be considered an epidemic. "This would be a scandal if it was happening with breast cancer or heart attacks, " she said. Many police chiefs and researchers say that to make real progress, one crucial piece is missing: better data. With scarce federal funding for gun research and antiquated, inconsistent record-keeping, it's tough to track what's happening. The total number of people shot nationwide, for instance, cannot be accurately counted. There is some hope, as public-health and other researchers are devising novel ways to try to understand the violence, by analyzing patterns in where victims live, and figuring out better ways to reach the people doing the shooting. For now, many victims are showing up to hospitals in grave condition. Many will need what surgeons call a "great save." At Shock Trauma this summer, the patient cried out in pain and begged the medical staff to stop examining him. "Don't do that, " he yelled. Then, as if he realized they were trying to help him, he gritted his teeth, urging: "Do your thing, do your thing." Pasley knew the patient had been shot repeatedly. But he still didn't know how many times. The counting is only part of the equation. The patient could have been shot three times, or he could have been shot four or more times, the bullets still lodged inside him. Pasley also had to imagine the possible trajectories of those bullets. Any one could have hit a bone that might have then fragmented and cut an artery or a lung. So the team ordered X-rays and later rushed him to surgery. Unlike about 200 gunshot victims in Baltimore so far this year, he survived. Wounds like combat Scalea has run this storied center and its troop of staff in signature pink scrubs for almost 20 years; he is also professor of trauma surgery at the University of Maryland School of Medicine. When a police officer, medic or firefighter is seriously injured, he is paged to oversee the case. He's one of the most recognized trauma surgeons in the world. But even at the top of his game, Scalea is challenged by the gun violence coming through the hospital doors. Now more than 60 percent of homicide victims are shot in the head, up from less than 15 percent two decades ago, and the number shot more than five and 10 times doubled in the past decade, The Sun found. It's enough to make physicians feel that they are losing a fight over which they have no control. A few months ago, Scalea was confronted with a patient on the brink of death, with maybe a 3 percent chance of survival. The victim had been shot six or seven times - in his chest, his abdomen and his arm, where one of the major blood vessels had been hit. As the ambulance arrived, the man's heart stopped. Scalea opened the patient's chest and began "open massage" on his heart, manually clapping it back to life with the help of blood transfusion and medicine, until his team readied the defibrillator. "We had to shock him three or four times to get his heartbeat to sustain, " he said. It took more than three hours in the operating room for Scalea to get him partially stabilized. The patient was hemorrhaging from his spleen, pancreas and stomach. He needed a transfusion of 20 units of blood - about three times his entire volume. After the man's condition improved, Scalea operated again, this time for more than three hours. Against the odds, the patient survived. "A great save is the term we use in the business, " Scalea said. "We're not out of the woods, but he is far more stable than he was early on. And I'm hopeful." Other nights, it's a great loss, and he must tell another stricken family of a loved one's death. Scalea has witnessed the consequences of two trends behind the increase in lethality. Semiautomatic weapons of a higher caliber are being seized from criminals in greater numbers, and higher-capacity magazines have become the norm in gang and street cultures. Pasley, an Air Force veteran, sees parallels between the multiple-gunshot victims he sees at Shock Trauma to what he saw as trauma director at Craig Joint Theater Hospital at Bagram Airfield, the main hospital for the U.S. military in Afghanistan, where he was deployed in 2014. The carnage in both places is extensive, he said. The difference is that when soldiers are hit with improvised explosive devices, they might need amputations but have body armor protecting vital organs. In Baltimore, when victims are hit, it's often with hollow-point bullets that expand on impact, causing tissue damage and blood loss. At Johns Hopkins Hospital, Dr. Elliott R. Haut, another experienced trauma surgeon, has seen a range of gunshot injuries and patients who have required incisions from "stem to sternum" so that doctors could assess and address the damage caused by multiple bullets. He's seen patients shot in the heart, liver, bowels. "Every body organ you can imagine, " Haut said. "I had a guy recently, he had different gunshot wounds, probably 10 different wounds in and out, here and there, basically from his head to his legs." Gunshot wounds to different areas of the body can require more specialists for consultation and care. A bullet to the heart could require a cardiac surgeon; a head shot could call for a neurosurgeon. In some cases, surgeons stand on opposite sides of the operating table so they can work simultaneously on different areas of the body. "Some of these people need three, four, five operations, " Haut said of the victims. "It takes a lot of work." Baltimoreans have come to believe that the city's top-ranked medical systems have kept the homicide count lower than it would be otherwise. "If it wasn't for the fact that Maryland has one of the best EMS systems in the country, our fatality rate would be much higher, " said Dr. Carnell Cooper, a former Shock Trauma surgeon who now serves as chief medical officer and vice president of medical affairs at Prince George's Hospital Center. Others, including former Baltimore Police Commissioner Anthony Batts, suspect a more sinister corollary is at play- that criminals are firing more bullets and aiming at the head to ensure that the world-class surgeons won't succeed. Baltimore hospitals get three-fourths of the state's gun assault cases, and costs have risen to $19 million a year, state data show. Nearly 80 percent are covered by Medicaid, and patients don't have any insurance in about one-fifth of cases. Those costs, known as charity care, are borne by all residents of the state with insurance as hospital rates are calculated to cover them. Meanwhile, hospitals are staffing up. In 2004, Hopkins had one trauma surgeon. Now, there are six or seven doctors working full-time in trauma care and emergency surgery. A trauma surgeon has been put on rotation at the hospital around the clock as at Shock Trauma, which is a key part of the state's emergency medical system. With these doctors come associated services on call, such as a blood bank, CT-scan technician and staff to ready operating rooms even before an ambulance arrives. Sue Carol Verrillo, nurse manager of the Hopkins surgical inpatient care unit, said shooting survivors can remain hospitalized for weeks, adding to costs. They require vacuum-assisted dressings and extensive pain medications. Many will need long-term care, with occupational and physical therapy. She sees four to six violent crime victims a week and has come to believe that sometimes shooters are aiming to shame with wounds of humiliation. Earlier this year, she said, two patients' eyes were shot out. She said police have told her that some were shot in the buttocks on purpose, as they were running away. Some are deliberately paralyzed. "You're going to be in a wheelchair for your whole life, " she said. "The nature of the wounds have changed." In complex gunshot cases, patients can "bounce back" to her unit, before being discharged from the hospital, when they develop complications such as infections or internal bleeding. Over a three-month period through early March of this year, she had a record 23 bounce-back patients. These patients require double the supplies: another feeding tube, more drains, more dressings that need to be changed two or three times a day, catheters, external fixators to keep bones in place as well as medicine to manage nausea. That can add thousands of dollars to her monthly supply budget, Verrillo said. Haut can't help but think it's all so unnecessary, that these costly injuries could have been prevented. "It's a giant waste of money." Anguish for families, staff Eight security guards caught Lekya Missouri as she tried to push past them. "If you don't let me through right now, " she told them, "you're going to have a problem." The halls outside Johns Hopkins Hospital's emergency department were crowded with police, worried family members, doctors and nurses. Eight people had been shot in one incident the last Saturday in September in East Baltimore. Among them: 3-year-old Kendall Brockenbrough, Missouri's daughter. At Johns Hopkins Hospital, Lekya Missouri, 37, prepares to give her daughter, Kendall Brockenbrough, 3, Valium and apple juice. Missouri has been staying overnight and helping the medical staff care for her daughter. Kendall was shot in an octuple shooting last month. Kendall has been in so much pain that whenever she sees medical personnel enter the room, she gets upset. She has an external fixator device on her left leg where she was shot. Pins are placed through the bone to keep it immobilized; the device is very painful.  Missouri spotted a hospital social worker walking toward her and immediately thought, "No, no, no!" Her mind flashed back to June 2011, the last time a hospital social worker had approached her. Back then, the staff member told her that her husband, Henry Mills, had been shot in the back of the head and killed. Missouri had to identify her husband as he lay on a gurney, his chest and legs covered by a white sheet. She asked hospital workers to wipe up the blood pooling under his head. Mills had been shot by David Hunter, a member of the Black Guerrilla Family, Baltimore's most powerful gang. Hunter, who is serving two life sentences plus 40 years for the crime, is considered a hit man by Baltimore police. This class of shooters, who take murder-for-hire contracts issued on the streets, are responsible for an outsized share of city homicides, police say. This time the social worker escorted Missouri to a trauma bay. Kendall was alive. Her father hovered over her, singing "Five Little Monkeys Jumping on the Bed" to distract her from the pain of a broken left femur and a ruptured artery. She had taken a shotgun blast. "Mommy, mommy, " Kendall sobbed when she saw her. Kendall had been outside with her father when three gunmen approached from different directions and fired on the crowd, according to police. The father had also been hit, in his foot, and it was bleeding. He had refused treatment until he knew his daughter would survive. Missouri jumped in and sang the nursery rhyme with him. Later, as doctors sedated Kendall for surgery, her mother told her how much she loved her. During an eight-hour operation that included two blood transfusions, doctors removed a section of artery from her right leg and spliced it into her left leg. Three surgeries later - to remove bone fragments and scar tissue and close wounds - Kendall is on her third week in the hospital. One day last week, she lay under a pink blanket depicting Disney's "Frozen" movie, her left leg held together by a heavy external fixator that resembled metal scaffolding. She alternated between grimaces, uttering "ow, " and the unsinkable amiability of a toddler. She had been a girl who was gaining independence: She had finished potty training, started picking out her own clothes and could tell her right shoe from her left. Now, Missouri said, she would have to relearn to walk in a rehabilitation hospital, where she is scheduled to stay for up to two months after she's discharged. Kendall wasn't "just shot, " Missouri, 37, said. "It was a life-changing event." Will Kendall have full feeling in her foot? Will her leg grow properly? Will the scars on her skin make her suffer teenage humiliation? These are her mother's worries, and they go on. How long will Kendall need counseling? How long will she need painkillers? And for today, how long will we be able to entertain her by blowing bubbles or playing with an iPhone? When will the violence end? Missouri, who lives in White Marsh, is at a loss to understand why gun violence has hit home twice. She recently bought a Bible looking for answers - or at least a different future. "My kids have suffered. I have suffered, " Missouri said. "Now my youngest daughter suffers." A nurse walked in with a vial of Valium, and Kendall started crying. "She's not gonna touch my feet. No, I don't want her to hurt me, " the girl said. Last week, a doctor removed his white lab coat in an attempt to put Kendall at ease after she asked, "Are you going to hurt my leg again?" This time the nurse promised to stand by the door as Missouri tried to get her daughter to drink the Valium from a syringe through gritted teeth. The girl turned her head, smacked her mother's hand, hid her face. Eventually, Kendall swallowed the medicine. Missouri heaved and hid her face in her hands as she cried. She tells herself she can't be upset at her daughter's lashing out. Missouri says she is grateful. "She's here, " the mother said. "She's here." It's the fear and anxiety that hospital staff also need to tend to, with the help of social workers and pastoral care. And sometimes, they need extra security, as was the case in the shooting that wounded Kendall. A shootout can bring victims, perpetrators and their families to the hospital, and Verrillo has to ensure they remain on opposite ends of the hall. "We have to have very clear boundaries, " she said. It can be difficult to remain at a clinical distance. Dr. Rodney Omron, an emergency physician and associate program director of emergency medicine at Johns Hopkins Hospital, recalls the "execution-style" shooting of an apparently homeless man he often saw on his way into work. Like law enforcement officials, Omron notes a more brazen cold-bloodedness among shooters. That's hard to quantify, but over the past two years, Baltimore, among a number of cities, has seen a steep rise in homicides. In recent months, it seems as if almost every Friday night he has to tell family members a loved one is dead. Omron had to put a breathing tube in his own father and watched his mother, who succumbed to cancer, die in his arms. He served as a physician for the Marines in Iraq. "I thought I had seen everything, " he said. Then he came to Hopkins. He said he has seen mothers suffer heart attacks from grief. He's also tried to comfort patients, sharing with one gunshot victim what his mother often said when she was fighting cancer: "Every day is a different gift from God." The patient disagreed. He'd watched his mother commit suicide and was a victim of abuse growing up. He had just gotten out of jail and, because of his injuries, was facing a life with a colostomy bag. Now he worried his son will never respect him. So he wanted to die. Omron felt powerless. "I have to bear witness to somebody else's sins that I have no control over, " Omron said. "It's like a disease I have no cure for." ‘Stop the Bleed' More and more, the wounds of urban gunshot patients look like those from war. Studies have shown that many of these victims have died from three potentially preventable injuries often seen in battle - massive bleeding, obstructed airways and open chest wounds. A gunshot victim struck in an artery can bleed to death in five minutes. Certain victims, depending on the location of their wounds, could be saved if they receive prompt care. Those parallels have sparked the health field to institute life-saving practices borrowed from the battlefield. Emergency rooms are stocked with Velcro tourniquets to stop bleeding, something that trauma surgeons and federal officials believe will become commonplace in stores, malls and workplaces in the near future. Even school districts are looking at acquiring tourniquet kits, said Dr. Richard Alcorta, state medical director for the Maryland Institute for Emergency Medical Services Systems. Haut, the Hopkins surgeon, carries a tourniquet with him at all times and compares the coming changes to how CPR became more commonplace. "When it first came out, they said, ‘Oh, it's just for doctors.' Now it's for everyone. There are defibrillators everywhere. This is the same thing, " said Haut. The American College of Surgeons and Homeland Security officials are teaming up to make tourniquets widely available and train the public in using them. The national push comes after mass shootings and mass casualty events, such as the Boston Marathon bombing. Homeland Security began the "Stop the Bleed" campaign late last year. In Baltimore, everyday violence warrants the same preparation. The Police Department started issuing tourniquets in 2015, and officers carry them on their belts. Already this year, at least two officers have saved lives using them, and just Wednesday night, a tourniquet was used to clamp the wounded wrist of an officer who accidentally shot himself while approaching a carjacked vehicle. Other cities have already expanded their efforts. In Philadelphia, Temple University Hospital is teaching residents in high-crime neighborhoods how to give life-saving care to gunshot victims, including how to use tourniquets. Also in Philadelphia, police have long practiced "scoop and run" with seriously injured victims. This allows officers to take trauma victims from scenes to hospitals in their patrol cars, bypassing ambulances because speed could save a life. Last year, Philadelphia police took more than 2,250 people, including gunshot victims, to area hospitals. "There have been a lot of lives saved over here because of that practice, " said police spokesman Lt. John Stanford. "We can't just sit here and let this person bleed out, so we throw them in a car and go." Still, most people killed by gunfire die where they are shot, said Dr. Garen Wintemute, director of the Violence Prevention Research Program at the UC Davis Health System in California. "Trauma people don't have a crack at these people. They're just dead, " he said. Even if they make it to the emergency room where trauma medicine has improved dramatically, their odds of survival are getting worse, according to a number of hospital studies across the country, including in Baltimore. In most U.S. trauma centers, even though firearm injuries account for a fraction of injured patients, they result in the same number of deaths as motor vehicle accidents - the most common reason people land in emergency rooms, according to a recent report in the Journal of Trauma and Acute Care Surgery. Researchers say gun violence has become a public-health crisis and needs to be studied like an epidemic. About 11,000 Americans die a year in gun homicides. "It's complex and it requires a broad investigation much like you would do with any disease, " said Dr. Stephen Hargarten, chair of emergency medicine and director of the Injury Research Center at the Medical College of Wisconsin. "We did this with HIV." But there is a lack of data on what's happening at crime scenes. For instance, many police departments don't track how many people get shot and survive. So researchers can't determine how lethal gun violence has become. "We centralize data on cancer, we centralize data on vaccinations, things that are important. Let's put more money into it and start a national intervention on this, " said Sauaia, from the University of Colorado Anschutz Medical Campus, which undertook one of the latest studies on gunshot patients based on a Denver trauma hospital's data. By collecting the data available from the nation's largest cities, The Sun found that gunshot victims in at least 10 cities were more likely to die last year compared to the previous year. But half of the 30 biggest cities don't keep statistics on non-fatal shootings. Funding for gun violence research has dried up in the past two decades, since Congress restricted spending by the Centers for Disease Control and Prevention on studies that could be construed as promoting gun control. Gun rights advocates, including the National Rifle Association, argued that guns are not a disease. Dan Blasberg, president of Maryland Shall Issue, which advocates for gun owners' rights, said researchers should approach their work comprehensively, rather than ideologically. Instead of focusing on suicide by firearm, he said, they should explore the root causes. Part of the fallout from the void in research money is the disappearance of gun researchers. Wintemute determined that there are no more than a dozen active, experienced researchers in the country who have focused primarily on firearm violence. To do his work, Wintemute eventually decided to self-fund the research. "Firearms and the impact that they have on public health gets a very little piece of the pie, " said Dr. Cassandra Crifasi, an assistant professor in the Johns Hopkins Center for Gun Policy and Research. In June, in response to the Orlando nightclub mass shooting, five of the nation's medical associations representing more than 420,000 doctors called on Congress to provide the CDC with funding for gun violence research. Another approach In lieu of scientific study, many medical professionals are intervening in other ways. Many hospitals, like Baltimore's Shock Trauma Center, have noted the "frequent flier" phenomenon, in which victims of violence show up two or more times as patients. Studies have found that these people are much more likely to die in a violent crime once they've been shot or stabbed and survived. Shock Trauma, under Cooper, created the Violence Intervention Program in 1998. The effort connects patients with resources, monitoring and counseling to steer them away from violence. Cooper studied outcomes of the program and found it had a profound effect on participants who reformed and got jobs. About 900 patients have enrolled in the program. Last month, the city health department received a $500,000 grant from the U.S. Department of Justice to start a program like Shock Trauma's. The planned program, called the Baltimore City Thriving Communities Project, will use Safe Streets intervention workers, ex-felons who try to interrupt violence by helping to mediate disputes, in hospital emergency rooms. In Philadelphia, Temple University Hospital's anti-violence program Turning Point does similar work, but goes even further, showing gunshot victims who have recovered a video of their actual resuscitation in the emergency room. It helps victims understand how hard it was to keep them alive, and how many people cared enough to help. The hospital has another program, Cradle 2 Grave, which takes middle-school children through a simulation of what actually happened to a 16-year-old, Lamont Adams, shot 12 times in 2004. The students lie down on gurneys, while hospital workers put red stickers on their bodies to mark where the bullet holes were on Lamont. These programs, along with police efforts to "scoop and run" with gunshot victims, have been underway for years, in some cases decades. Philadelphia's lethality rate has remained largely unchanged for years while lethality rates have risen in other cities. Meanwhile, researchers such as Dr. Daniel Webster, director of the Center for Gun Policy and Research at the Johns Hopkins Bloomberg School of Public Health, are increasingly examining the networks of the victims and the perpetrators. Much of the violence is concentrated in poor, segregated neighborhoods. In the 92 square miles of Baltimore, a Sun analysis found, 80 percent of homicides by shooting in the past five years took place in about one-quarter of the neighborhoods. Webster describes urban gun violence as mimicking the outbreak of an infectious disease. "It's person-to-person exposure and social contacts, " he said. To investigate this idea, the Baltimore City Health Department is exploring the launch of a survey of residents to determine how many people have been shot or victimized and look for patterns. Health officials want to map where homicide victims lived - not where they were killed - to see if trends can be extrapolated as to how gun violence might spread. One man is going directly to the shooters to look for answers. James Evans is the CEO of Illume Communications, a Baltimore advertising firm that has worked for CVS Pharmacy, Timberland boots and Chase Brexton Health Care. He was hired by the city health department to figure out how to the reach the men doing the shooting, to convince them to put their guns down. It's a challenge that has vexed researchers from Hopkins to Harvard University, as well as police departments, trauma surgeons and grieving families. So far he has discovered that shooters are more likely to listen to the women in their lives - mothers, sisters - and that they aren't afraid to die. So he's found another angle that does resonate with them, asking: What if you survive a shooting? What if you're paralyzed? What if you're in a wheelchair for the rest of your life and called "knees down" - a street nickname for these victims. What if you'll need a colostomy bag? Evans, who grew up in Park Heights and lost two family members to violence and more than 10 to drugs, also learned a big reason some of these young men are carrying handguns - not to be aggressors, but to protect themselves. "Those who don't live here, don't understand. ... Like the Wild Wild West, real men - John Wayne kind of men - are expected to carry a gun, " Evans said. "If there was a way for people in those neighborhoods to feel less afraid, there would be less impetus to carry a weapon." In the end, some shooters may be just as scared as everyone else. Baltimore Sun reporter Meredith Cohn and intern Wyatt Massey contributed to this article. jgeorge@baltsun.com Twitter.com/justingeorge ABOUT THIS SERIES Baltimore Sun reporter Justin George spent nine months during the 2015-2016 school year at Marquette University in Milwaukee as part of the O'Brien Fellowship in Public Service Journalism, working on “Shoot to Kill” while mentoring college students and speaking to journalism classes. He traveled to five cities to research gun violence; analyzed crime data from cities across the U.S.; reviewed dozens of studies on violent crime, trauma and guns; and interviewed more than 80 people, including homicide detectives, police chiefs, hit men, ex-offenders, researchers, emergency room doctors, nurses, trauma surgeons, family members of victims, neighborhood residents, prosecutors and survivors of shootings. Four college students served as research assistants as part of the O'Brien Fellowship program. They were Wyatt Massey, Hannah H. Kirby, Natalie Wickman and Matthew Kulling.