His pager buzzed three times with a message: level one gsw pediatric. Life-threatening trauma. Gunshot wound. Child.
Ray Winans swiped his key card and opened the doors to the busiest emergency room in one of the deadliest U.S. cities.
“Where's the GSW?” he asked a security guard.
“Back over there.”
Winans sidestepped a cluster of empty wheelchairs and strode down a long corridor.
“Where is he at?” he asked a nurse.
Winans, a broad-shouldered 39-year-old who speaks with the confidence of a stage actor, took a long breath, then pulled back the beige curtain. The child, Mario Brown, who had just turned 17, had yet to arrive from a CT scan of his abdomen and the .22-caliber bullet lodged in it.
Slumped in chairs against one wall were his sister, whose clasped hands rested on her lap, and his cousin, who had Mario’s blood on his pants. Both had tears in their eyes.
“I'm not the police,” Winans told them. “I'm here to help you all. I'm here for you.”
They stared at the empty bed and said nothing.
As a counselor trying to steer boys and young men away from violence in his native Detroit — which has the third-highest homicide rate in the country behind St. Louis and Baltimore — Winans knows the difficulty of getting them to take his message seriously. Danger resides in the abstract until it becomes real. And in the moments and days after somebody takes a bullet and survives, it is very real.
He views each case as an opportunity that might never come again.
Winans would wait for Mario.
The young black men who pour into Sinai-Grace Hospital with gunshot wounds often remind Winans of himself.
He grew up in a downtown housing project in the 1980s. It was the height of the crack epidemic, and though his mother worked on and off as a gas station cashier, it was his father’s crack business that paid the bills. His father didn’t hide it from Winans. Drug dealing was simply part of life.
And of death. On Easter Sunday in 1988, Winans was 9 when his 27-year-old father, Fred Caldwell, was shot and killed by drug dealers outside their home.
Winans has distinct memories of that time: The overwhelming weight of hopelessness. The angry yearning for revenge. The premonition that he too would die young.
I could never even imagine a world without violence, let alone a city without violence."
At 14, he joined a local faction of the Bloods and a year later beat a man to death with a hammer. He was tried for second-degree murder and was sentenced to remain in prison until his 18th birthday.
When he got out, life fell into a rhythm: sell drugs, get busted, go to prison.
The cycle was disrupted in 2009, when a family friend who owned a grocery store gave him a job stocking shelves. The pay wasn’t much, but Winans liked the feeling of honest money. It was also the first time he could be there for his only child, Rayionna, who had just turned 9. Winans had been in prison most of her life.
Still, he remained bound by the codes of gang life. In 2010, police began investigating him for a murder. Even though he knew a friend was the killer, Winans chose not to snitch, leaving his fate in God’s hands. Get me out of this, he prayed, and I'll do everything I can to change myself and to help other young men.
Weeks later, the friend confessed.
Winans joined several groups that provide mentoring and began to understand the side effects of a life enmeshed in violence. Many young men in Detroit had post-traumatic stress disorder and treated it with alcohol and drugs.
Last year, a local professor studying patterns of urban violence sought out Winans for his expertise and at lunch confided that he had never known anybody who was murdered.
Winans was stunned. It was as if the professor, who is white, lived on another continent.
“It messed me up. I told him he was a damn liar,” Winans recalled. “I said, 'You lived in Detroit your whole life and have never known someone who got killed? Get out of here.’”
“I could never even imagine a world without violence, let alone a city without violence,” he said.
Mario Brown, the second of three children, grew up in northwest Detroit, in a well-kept neighborhood of pitched-roof, brick homes where front doors are adorned with American flags.
It was by every indication a stable and loving home. For Mario’s birthday most years, the family drove to Ohio to the massive Kalahari indoor water park.
He was especially close to his father, Cedric, a stay-at-home dad. All summer long, they fell into a daily ritual of working out at the gym together, playing pickup basketball for hours and battling each other in the video game NBA2K.
Then in 2011, one night just before Christmas, when Cedric Brown was 36, he got in a fight and died a few blocks from the house after being run over with a car. There were no witnesses and no charges.
Mario, who was 10, lost interest in video games and basketball. His mother, Nikki Brown, hired therapists to come to their home, but Mario never engaged much with them. He didn't want talk about his father. When his grandparents asked questions, Mario shook his head and told them he was all right.
“There were no tears,” his mother said. “He lost a part of himself when his dad was killed.”
Nikki Brown, a clerk at TJ Maxx, watched Mario slipping into a life she didn’t condone.
In high school, he started smoking weed. His mother felt powerless to stop him. They argued about teenager stuff — curfew, girls, driving.
He lost a part of himself when his dad was killed.”
Nikki Brown, on her son Mario
Mario towered over other students, but still got picked on. The way Nikki Brown saw it, school offered too many distractions — fights, drugs, girls — and too few after-school programs or other worthwhile diversions.
So last year, when he was a sophomore, Mario and his mother decided to shift him to a curriculum in which he spent two days a week at school and the rest at home taking classes online.
But he only sank deeper into rebellion. He was failing classes and staying out after midnight.
His mother was at work last fall when a neighbor called to tell her Mario had shot off a gun outside the house.
Brown, who owns a 9-millimeter Glock for protection and is licensed to carry it, knew it wasn’t her gun. She had it with her that day. When she rushed home, Mario denied ever possessing a gun let alone firing one. There was no police investigation, and his mother allowed herself to believe him.
“We don't live in the Wild West,” she said. “He was raised around guns, but he knows they are not a toy at all.”
Months later, around 6 p.m. on Thursday, May 17, Mario met some friends at a cookout several blocks from his home and a few doors down from his grandparents’ place.
Nearly two dozen people were gathered in the front yard at 7:15 p.m. when a man walked up with a gun.
He fired six times. The shooter, who has not been arrested or identified by police, got away. Everybody was all right except for Mario.
At 6-feet-4 and 300 pounds, he was a big target.
His 19-year-old sister, Simone, happened to be pulling up to their grandparents’ house after getting off work and was stepping out of her carwhen she heard the shots.
She rushed over to see Mario crumpled on the asphalt. Simone, her cousin and a friendhelped Mario to his feet and into the car.
Mario moaned in the backseat as they raced to Sinai-Grace a mile away.
The hospital, which is part of the Detroit Medical Center, received 220 gunshot victims last year, more than any other hospital in Michigan.
Many of them were seen by a young, black emergency-room physician named Tolulope Sonuyi. Not long after he started working there in 2011, he began noticing that several of his shooting patients looked familiar: He had treated them for gunshot wounds before.
He understood his experience was nothing new. In 1989, researchers published a multiyear study that tracked 501 trauma survivors who had been seen at another Detroit hospital. Its conclusion stuck with Sonuyi: Urban trauma is a chronic disease with a five-year mortality rate of 20%.
“This is a public health crisis,” Sonuyi said. “Violence is contagious.”
It disproportionately affects black males 15 to 34, who make up 2% of the U.S. population but composed 38% of the 14,415 shooting deaths in 2016, the most recent data available from the U.S. Centers for Disease Control and Prevention.
This is a public health crisis. Violence is contagious.”
Dr. Tolulope Sonuyi
Sonuyi decided he had to do something. Two years ago, with $200,000 in grants from local nonprofits and the hospital, he started Detroit Life Is Valuable Everyday — or D.L.I.V.E. The idea was to reach young victims of violence while they’re being treated at Sinai-Grace in hopes of breaking the cycle of violence.
“I had to re-imagine my role to one of being intentional about creating preventative solutions as opposed to just sewing them up and sending them on their way,” said the 36-year-old doctor.
A counselor meets with every gunshot or stabbing patient at Sinai-Grace between age 14 and 30. Nearly 90% of them have joined the program, which involves months or even years of counseling. Sonuyi said none of the 80 participants have been shot or stabbed again.
He connected with Winans and another counselor — officially called violence intervention specialists — through a network of black men who serve as mentors and advocates for youth in the city.
“They've lived lives out here on the streets of Detroit,” Sonuyi said. “They can connect with a lot of these young men. They are the true difference-makers.”
In the first year of the program, Winans received a letter from President Obama honoring his achievements as a mentor. He keeps it in his office along with a photograph of himself in a prison uniform and a portrait of his father taken shortly before he was killed.
Among those Winans has helped is Jerry Persail, who was waiting for a bus in 2016 when two men tried to rob him. He ran and took a bullet to the right knee, landing him at Sinai-Grace.
“I was in a dark place, man. I was depressed,” said Persail, now 24. “I just wanted to get my life back. Start walking, start working again.”
After Persail got out of the hospital, Winans called or texted him every few days. They went out for hot dogs, and when Persail said he wanted to provide for his mother, who was on dialysis, Winans connected him with Detroit Manufacturing Systems, a company that makes dashboards for Ford. He got a job on the assembly line.
Retaliation never crossed his mind, he said.
Left: Jerry Persail, left, and other members of D.L.I.V.E. walk through the halls of Sinai-Grace Hospital on their way to a violence prevention teleconference. Right: Survivors of gun violence listen to victims and perpetrators share their stories during a livestreamed event in New York. (Robert Gauthier / Los Angeles Times)
In the two years since he was shot, Persail has rarely missed his weekly peer support session at the hospital.
In the early evening of May 17, Persail and 10 other survivors of gunshot wounds drank soda and ate pizza as Winans ran a projector that streamed an event from New York in which victims and perpetrators of violence told their stories. One woman spoke about forgiveness for the man who shot and killed her son years ago. A man talked about changing his life after spending several years in and out of jail.
At 7:41 p.m., Winans’ pager buzzed three times.
He had to go.
Winans leaned against a wall in the emergency room waiting for Mario, whose sister hadn’t moved from her chair.
Then their mother arrived with a family friend. Winans introduced himself as Nikki Brown wiped away tears and mascara.
Twenty minutes later, a nurse wheeled in Mario.
He lay on his back staring at the ceiling. The beeping of a heart monitor pierced the quiet in the room as Mario bit his lip in pain.
Winans broke the silence.
“We've never met, but I love you, bro,” he told Mario.
“Do you love this woman?” he said, pointing to Mario's mother. Tears welled in the teenager's eyes. He nodded.
“Good, ’cause she loves you. We love you.”
Winans told Mario about his work as a mentor and about helping people find jobs or get their GEDs. He said that hours earlier other young men like Mario — victims of violence — had been steps away at a weekly group meeting.
Mario nodded but kept his eyes focused on the ceiling.
“I don't want to bury my son,” his mother said. “I don't.”
Just after 12:30 a.m., five hours after the shooting, Mario was released from the hospital. His mother stroked his dreadlocks as she wheeled him outside. The teenager leaned onto his right hip, taking the pressure off the stitched-up wound. The bullet remained in his side, to be removed in coming weeks.
“You've got a hell of a support system,” Winans said.
As Mario climbed into the backseat of his cousin’s car, Winans promised to see him soon.
The next day, Nikki Brown wanted to make sure her son knew he was loved. She invited over relatives and put chicken wings on the grill.
Everyone tried to act like it was an ordinary cookout, but the truth was unavoidable: If the bullet had struck a few inches higher, the gathering might have been a funeral.
A few minutes before 9 p.m., Winans showed up and settled next to Mario on the couch as if he were a member of the family.
Mario let his relatives do the talking. His grandfather said he was frustrated that young people don't listen. His mother told Winans that her son wanted to change his life.
The dark living room fell quiet as cartoons flickered on the muted television. Everyone’s gaze turned toward Mario. He stayed silent.
Left: Ray Winans comforts Nikki Brown outside her home the day after her son, 17-year-old Mario, was shot. Her father looks on. Right: Ray Winans visits Mario and Nikki Brown at their home in northwest Detroit. (Robert Gauthier / Los Angeles Times)
Winans thought about losing his own father and how he wished he'd had a mentor. He tells shooting victims the things he would have wanted to know back then. He turned to Mario, locking eyes.
“You're going to have a lot of PTSD from this, bro,” he said. “This is going to affect you.
“I know how you feel not having a father, because I've been there.”
Mario looked down at his hands. Off in the corner, below a family portrait, sat an urn filled with his father's ashes.Mario didn’t want to talk — not about his father, not about the shooting.
After an hour, Winans went outside to speak with Mario's mother. She began to cry.
“I just can't bury him,” she said.
“You won't,” Winans said. “We won't.”
Then he glanced at his pager. He had to get back to the hospital.