Brandon Littlejohn was shot just after 11 P.M. on Saturday, April 23, 2011. The day had started out cold and rainy, but by evening the temperature hinted at the summer to come. Littlejohn was playing basketball on a court at a corner of Harlem Square Park, in West Baltimore, when his girlfriend drove by to pick him up. He jogged over to her car, said he’d be back in a minute, and returned to the basketball court to tell his friends that he was leaving.
“She heard the gunshots,” Littlejohn’s aunt Roxanne Cunningham told me. “She looked, and he was falling.” One of Littlejohn’s friends helped his girlfriend get him into the car, and she drove him to the hospital. He had been shot multiple times in the chest and lower body, but he was still alive when he reached the emergency room, ten minutes away. “He told her to tell his family that he was sorry,” Cunningham said.
The hospital was the University of Maryland’s R Adams Cowley Shock Trauma Center (universally known as Shock Trauma), the oldest and probably the leading trauma unit in the country. Baltimore has one of the nation’s highest rates of gun violence, and Shock Trauma admits at least two or three shooting victims each week—often, like Brandon Littlejohn, young black men. Frequently, it sees that many cases in a single night. As it happens, Cunningham—a stylish, soft-voiced fifty-seven-year-old, born and brought up in West Baltimore—works at Shock Trauma, managing paperwork for the operating rooms. She was not on duty that night, however, so she didn’t have to watch as surgeons and nurses struggled to save her nephew’s life.
The Trauma Resuscitation Unit, or T.R.U., consists of twelve bays divided by curtains and arranged in a horseshoe configuration around three banks of workstations. Electrocardiographs, infusion pumps, and ventilators hum and beep incessantly, punctuated every few minutes by a ringing phone, followed by a nurse’s voice repeating the cryptic snippets of information relayed by emergency services—GSW face, arrest in the field, blood levels at thirty-nine—as colleagues take notes and ready the next bay.
That April evening, as Littlejohn was rolled into an open bay, a cluster of nurses, an anesthesiologist, a resident, and the attending surgeon descended on him and began performing dozens of complicated procedures at once. They worked with the efficiency and furious intensity of people who have tried to save many, many lives in exactly the same way. As the anesthesiologist took her position at the head of the bed to insert a breathing tube into Littlejohn’s windpipe, a nurse cut off what remained of his blood-soaked clothes, another attached electrocardiogram sensors to his chest, and others performed chest compressions, took samples, passed the X-ray machine over his abdomen, and attached an I.V. line to his arm to begin delivering blood. And then Brandon Littlejohn’s heart stopped.
Statistically speaking, Littlejohn’s chances of survival were now less than one in twenty. For most people who sustain traumatic injuries, whether from bullets or car crashes, death occurs within the hour. The primary cause is exsanguination cardiac arrest, the technical term for losing so much blood that too little is left for the heart to continue to circulate. Even as nurses pumped fresh blood into Littlejohn, it flowed straight back out of his bullet wounds, pooling in his abdominal cavity and soaking the bed on which he lay.
“There’s not a whole lot you can do at this point,” Deborah Stein, the attending surgeon that night, told me. “All you can try to do is get their heart re-started, but while they’re still actively bleeding . . .” She trailed off, gesturing to indicate the hopelessness of the situation. “They basically never make it.” Nonetheless, as soon as Stein lost Littlejohn’s pulse she used a scalpel to make a long, smile-shaped incision below his left nipple, then wedged a stainless-steel rack-and-pinion into the slit, cranking its lever to spread his ribs apart and expose his heart. By clamping the aorta in such a way as to cut off circulation to the lower body, she forced what little blood remained in Littlejohn’s body up to his brain, then cradled his heart between both hands to massage it.
Around her, a tight knot of nurses and residents in pink scrubs continued to work, putting in stitches, administering drugs, hanging fresh blood, suctioning out Littlejohn’s chest cavity. So much was being done to Littlejohn’s body with each fateful minute that the passage of time seemed to slow. “I got him back once or twice, but he kept arresting,” Stein said. Each time Littlejohn flatlined, Stein stopped operating on his bullet wounds in order to palpate his heart again, and each time she revived him his battered body became even weaker. “Everything was out of whack—his electrolytes, his pH, his platelets,” she said. “You’re trying to do two things at once, but you can’t. I just needed more time to fix what was bleeding.”
The third or fourth time his heart stopped beating—Stein lost count—it couldn’t be re-started. Just after midnight, Stein pronounced Brandon Littlejohn dead. He was twenty years old.
Losing a patient is always painful, but losing one like Littlejohn is also exasperating. Even though everyone at Shock Trauma knew that the odds were against him, they also knew that every injury he’d sustained was fixable. He hadn’t been shot in the head or in a vital organ. The holes in his body could have been sewn up—they just couldn’t be sewn up in less than the five or six minutes it takes for the brain to die from lack of oxygen. “It is the most frustrating thing, and it happens all the time,” Tom Scalea, Shock Trauma’s physician-in-chief, told me. “Some kid comes in with cardiac arrest from a fixable injury—an easily fixable injury—and you open them up in the T.R.U. and they kind of come back, and then they die. And then you get to go tell their mom that they are not coming home, when all we needed was a few more minutes.”
The R Adams Cowley Shock Trauma Center is named in memory of the pioneering surgeon who founded it, in the nineteen-sixties, and who is generally considered the father of trauma medicine. Today, Cowley is remembered for developing the concept of “the golden hour”: the idea that the sooner critically injured patients are treated the better their chances of survival. To get patients to properly equipped hospitals as quickly as possible, he developed the country’s first statewide E.M.S. system, including helicopter ambulances.
Earlier this year, the center announced that it was conducting a trial of a procedure that may revolutionize trauma care by buying patients and their doctors even more time. Known as E.P.R., for “emergency preservation and resuscitation,” it is the result of nearly thirty years of work. The procedure has long been proved successful in animal experiments, but overcoming the institutional, logistical, and ethical obstacles to performing it on a human being has taken more than a decade.
The director of the E.P.R. trial is Sam Tisherman, a professor of surgery at the University of Maryland, who works at Shock Trauma. He is fifty-seven, bespectacled, mild-mannered, and quick to blush, and he has an understated sense of humor. He trained as a trauma surgeon more than twenty years ago, but the memory of his first experience of running out of time while trying to resuscitate someone remains indelible. The patient was a twenty-three-year-old man. “We almost saved him,” Tisherman said. “We actually got him in the operating room, and then we just couldn’t keep his heart going.” He had been stabbed in an argument over bowling shoes.
Tisherman had previously launched the trial in April, 2014, at the University of Pittsburgh Medical Center, where he was based until recently, but Pittsburgh has relatively few gunshot victims and no one met the criteria for enrollment. Now that Tisherman has moved to Shock Trauma, it seems certain that the first person to undergo E.P.R. will be in Baltimore, sometime in the coming months.
When this patient loses his pulse, the attending surgeon will, as usual, crack his chest open and clamp the descending aorta. But then, instead of trying to coax the heart back into activity, the surgeon will start pumping the body full of ice-cold saline at a rate of at least a gallon a minute. Within twenty minutes (depending on the size of the patient, the number of wounds, and the amount of blood lost), the patient’s brain temperature, measured using a probe in the ear or nose, will sink to somewhere in the low fifties Fahrenheit.
At this point, the patient, his circulatory system filled with icy salt water, will have no blood, no pulse, and no brain activity. He will remain in this state of suspended animation for up to an hour, while surgeons locate the bullet holes or stab wounds and sew them up. Then, after as much as sixty minutes without a heartbeat or a breath, the patient will be resuscitated. A cardiac surgeon will attach a heart-lung bypass machine and start pumping the patient full of blood again, cold, at first, but gradually warming, one degree at a time, over the course of a couple of hours. As soon as the heartbeat returns, perhaps jump-started with the help of a gentle electric shock, and as long as the lungs seem capable of functioning, at least with the help of a ventilator, the patient will be taken off bypass.
Even if everything works perfectly, it will take between three and five days to determine whether the patient’s brain has been damaged, and, if so, to what extent. There will be more surgeries, followed by months of rehabilitation. Nonetheless, it is possible that the next Brandon Littlejohn won’t die; that he will, instead, be able to walk out of Shock Trauma unaided and capable of playing basketball for many years to come.
Addressing a skeptical audience at a conference last year, Tisherman, awkward in a suit and tie, began his presentation by acknowledging that the idea of cooling a trauma patient is typically regarded as “blasphemy.” Hypothermia is one part of what physicians call “the triad of death.” (The others are falling pH in blood plasma and the failure of blood to coagulate; all three are triggered by severe blood loss, and all three exacerbate one another, resulting in a downward spiral that makes resuscitation increasingly difficult.) “That’s the dogma on the trauma ward,” Tisherman said, to nods of agreement. “Patients who get cold do badly, so we should do everything we can to keep them warm.”
In healthy humans, the body occupies a narrow temperature band between 97 degrees and 99 degrees Fahrenheit. Fifty degrees, the target temperature during E.P.R., is classified as profound hypothermia: the stage at which major organs fail and clinical death occurs. Even with rapid, advanced hospital care, the mortality rate from profound hypothermia is close to forty per cent. From this perspective, freezing gunshot victims seems like lunacy. Scalea told me, “I think it’s a fair statement that, back when we first started talking about it, many or most people thought it was nuts.”
Yet medicine has also long recognized that, in some circumstances, cold can protect as well as destroy. In ancient Greece, Hippocrates recommended packing bleeding patients in snow and ice. Napoleon’s surgeon general, Dominique Jean Larrey, observed that, the farther wounded soldiers lay from a campfire during the Army’s wintry retreat from Russia, the less likely they were to die. Cold buys time by slowing things down. Removing energy, in the form of heat, decreases the rate at which chemical reactions—in this case, metabolism—take place.
Accidents provide many examples of people miraculously saved by cold: an Austrian toddler revived after half an hour at the bottom of a frozen fishpond; a seventy-year-old man in Muskegon, Michigan, who spent forty minutes underwater and made a complete recovery; a twenty-nine-year-old woman who fell into an Arctic stream while skiing, and was pulled out after eighty minutes, limp and ashen, only for her heart to start beating again more than an hour later. In each case, the crucial factor was speed. The victims were essentially flash-frozen, bypassing the lethal damage that the body suffers during a slower descent into hypothermia.
Starting in the late nineteen-forties, doctors and researchers began experimenting with the effects that rapid cooling had on living creatures. In Toronto, the Canadian surgeon Wilfred Bigelow systematically chilled anesthetized dogs while measuring their oxygen intake. He discovered that the animals required about six per cent less oxygen to survive for every degree Celsius that their body temperature dropped, and calculated that, at 20 degrees Celsius (68 degrees Fahrenheit), a dog could survive for up to fifteen minutes on just the residual oxygen diffused in its blood and its membranes.
Bigelow’s early experiments—cooling dogs, stopping their hearts, and then reviving them in a bath of warm water a quarter of an hour later—had mixed results, but the handful of successes inspired two University of Minnesota surgeons to wrap a five-year-old girl in refrigerated blankets in order to perform the world’s first open-heart surgery, in 1952. Today, deep hypothermia is routinely induced during scheduled cardiac surgery, with specially trained perfusionists using a heart-lung bypass machine to gradually cool patients’ blood until body temperature falls as low as 64 degrees Fahrenheit. With the brain’s metabolism, and thus its oxygen needs, reduced by more than three-quarters, doctors can suspend circulation for as long as forty-five minutes without harm in order to operate on a patient’s heart.
However, it is one thing to cool an anesthetized patient before a carefully planned, thoroughly controlled cardiac arrest and quite another to attempt to freeze and revive one who has technically just died. In the nineteen-fifties, while R Adams Cowley was pioneering emergency care, Peter Safar, an anesthesiologist working independently on the other side of Baltimore, was founding the field of resuscitation science. He later became Sam Tisherman’s mentor: Tisherman’s current work at Shock Trauma is, in many ways, the culmination of both Safar’s and Cowley’s work.
Safar’s innovations included the familiar CPR technique of combining mouth-to-mouth breathing with chest compressions, as well as the life-size doll, known as Resusci Anne, that is used to teach it. But CPR still couldn’t save someone who was bleeding to death, and there was a limit to how quickly even the fastest ambulance service could deliver a hemorrhaging patient to the nearest trauma unit.
The beginnings of a solution started to form in Safar’s mind during the mid-eighties, when he read a new study of combat casualties in the Vietnam War. The author, a U.S. Army surgeon named Colonel Ronald Bellamy, concluded that, in order to make an appreciable difference to trauma survival rates, “we need to be able to slow the casualty’s biological clock.” With funding from the military, Safar and Bellamy embarked on an entirely new area of research: to extend the window of opportunity for treating exsanguination cardiac arrest. They called the yet to be invented treatment “suspended animation for delayed resuscitation.”
By then, Safar had moved to the University of Pittsburgh, which is where Tisherman became his protégé. Inspired by Bigelow’s experiments, Safar began to explore therapeutic hypothermia as a way of protecting patients’ brains over longer periods of time. In between his first and his second year of medical school, Tisherman worked with Safar, studying the phenomenon of seemingly miraculous resuscitation following cold-water drowning. In the late eighties, after his graduation and his residency training, he returned to Safar’s lab to work on suspended animation. His goal was to see whether hypothermia might offer a way “to preserve and protect” a pulseless patient for two hours, which was Safar and Bellamy’s estimate of the time required to evacuate a wounded soldier from the battlefield and to conduct basic wound repair. Tisherman spent a decade inserting catheters into the femoral arteries of dozens of large, custom-bred hunting dogs, bleeding them out in less than five minutes. Then he would test a series of variables to learn how best to freeze and rewarm them. “I’m glad I don’t have to do that anymore,” Tisherman told me. A former vegetarian, he finds animal trials distressing.
In 1990, Tisherman and his colleagues published their first results. The findings were groundbreaking: dogs that had effectively died from blood loss and then been rapidly cooled to 59 degrees could be brought back to life an hour later with no brain damage. The cold reduced metabolic activity so precipitously that the oxygen that remained in the animal’s tissues from its final few breaths was sufficient to prevent brain death. During the next several years, by refining their technique and reducing their target temperature, the Pittsburgh group gradually managed to extend the interval between death and resuscitation to three hours.
As evidence mounted that suspended animation might actually work, other researchers joined the field. In 1996, Hasan Alam and Peter Rhee, researchers at the Uniformed Services University of the Health Sciences, in Bethesda, used pigs to expand on Tisherman’s successes. “We got to the stage where we could convert a hundred-per-cent-lethal injury to about a ninety-, ninety-five-per-cent survival rate, neurologically intact,” Alam told me.
To study the procedure’s impact on the pigs’ brains, Alam and Rhee created a memory test for them. Working nights and weekends in the basement of the U.S.U. medical center, they conducted experiments on a series of pigs, each of which was shown food-filled boxes in various colors and trained to recognize which one could be unlatched. Then the pigs were killed, chilled, and resuscitated. Post-resurrection, Alam and Rhee released the pigs into a maze of steel cages to see whether they were able to find the boxes and remember which ones they could open. The researchers videoed each experiment, and the footage makes for unnerving viewing. In clip after clip, you see a pig, open-chested and blood-spattered, its heart beating increasingly erratically before stopping, its flesh drained white. Footage of the same pig a few weeks later shows it eerily pink and whole, clattering across the concrete-floor maze and snuffling with pleasure as it flips open a blue plastic box full of food.
By 2002, Tisherman and Safar were convinced that they had assembled enough evidence to test suspended animation in humans. But it took another twelve years to put together the protocols, approvals, and funding necessary for a clinical trial, and, in 2003, Peter Safar died, at the age of seventy-nine. Although each year seemed to bring fresh evidence of the power of cold temperatures to preserve and protect, suspended animation in humans remained a promising but unproved idea.
On April 12, 2015, a twenty-five-year-old black man named Freddie Gray arrived at Shock Trauma in a coma. His spinal cord had been severed while he was in the custody of six police officers, and he died a week later. Gray’s death—like those of Eric Garner, Michael Brown, and other African-Americans who were killed by police in recent years—provoked an outcry against racism and brutality in law enforcement. There were demonstrations across the country, and in Baltimore the protests lasted two weeks.
Six months later, on a breezy blue Friday morning, Tisherman, wearing pink scrubs, sat quietly behind a folding table in the atrium at Mondawmin Mall. On the day of Gray’s funeral, the mall, in West Baltimore, had been a flash point of confrontation among police clad in riot gear, protesters, and looters, but now the scene was placid. Shoppers strolled, people from a drug-treatment program were distributing needles, and the Black Mental Health Alliance offered free lip balm and brochures detailing its services. Tisherman and Leslie Sult, a clinical-research nurse, were handing out laser-printed leaflets about E.P.R., as part of a community consultation required before the trial could proceed. Among the difficulties facing the trial has been an ethical concern: enrollment is not voluntary. Prospective patients, being clinically dead, will be incapable of giving consent, and the speed of treatment—the decision to begin E.P.R. has to be made within a matter of seconds—precludes identifying, let alone contacting, the next of kin. (The F.D.A. requires informed consent for all human medical trials, but it does grant exceptions for emergency research.)
In Baltimore, the issue of waived consent has disquieting social implications. Of the more than nine hundred people who were shot in the city last year—three hundred of whom died—more than ninety per cent were male, more than ninety per cent were black, and most were under the age of thirty. In the predominantly African-American neighborhoods of West Baltimore, thirty per cent of households live below the federal poverty line. As these neighborhoods lie just north of Shock Trauma, it is a virtual certainty that the first person to be selected for E.P.R. will be black, low-income, and male.
Because of the consent issue, an institutional review board at the University of Maryland required Tisherman to devise a way for people to elect not to be enrolled in advance. He designed a red rubber bracelet, in the style of Lance Armstrong’s Livestrong wristbands, that says “No to EPR-CAT.” (E.P.R.-CAT is the trial’s full name; “CAT” stands for “cardiac arrest from trauma.”) Anyone wanting to opt out could request one and wear it at all times. Another stipulation made by the board was the community-consultation process. Over a three-month period, Tisherman and Sult visited various public spaces, distributing flyers, answering questions, and conducting surveys. There were interviews on local TV and radio stations, and ads in the city’s newspapers.
At Mondawmin, Tisherman and Sult encountered a range of responses. A short woman wearing a head scarf and a denim vest approached the table with a question: “This all about CAT scans?” When Tisherman explained that it was an experimental new procedure for patients who bleed so much that their heart stops, she said, “I don’t think I have that.” Tisherman smiled and said, “Well, you never know,” before describing the trial. Several people asked for directions to the restrooms; others told Tisherman they supported anything that would help save lives. A few talked about the treatment family members had received at Shock Trauma in the past. A woman whose son had died of a gunshot wound nine years ago said, “I will never forget how long they worked to try to save him.”
Only two people voiced objections: both were young black men, and both left before Tisherman could speak to them. The first pointed at Tisherman, smiled, and said, “Y’all heard me say no.” The second man, listening while Tisherman explained E.P.R. to two women, announced, “We’re guinea pigs—your body language says it!”
Tisherman winced. The man’s point was essentially unanswerable. African-Americans have indeed been used as guinea pigs, the unwitting victims of full-body radiation or unnecessary surgeries conducted in the name of research. The Tuskegee syphilis experiment, in which lifesaving treatment was withheld from black men for forty years so that scientists could study the disease, is merely the most infamous example. As a result, mistrust of the medical establishment has long been widespread among African-Americans. In 1982, Clive Callender, a surgeon at Howard University, published a study showing that many African-Americans feared that surgeons might actually withhold advanced resuscitation measures from black patients in order to harvest their organs for sick white people.
Lawrence Brown, a public-health professor at Morgan State University, a historically black college in northern Baltimore, considers the E.P.R. trial’s consultation process and opt-out mechanism to be insufficient—to the extent that it renders the entire trial harmful. He pointed out that the participation rate of minorities in clinical trials is already disconcertingly low; even if E.P.R. proved to be a success, it could further undermine efforts to recruit people of color. “If you save thirty lives a year and you keep thousands of people from participating in the advancement of science, do we really count that as a win?” he asked.
Brown and others have also repeatedly demonstrated that the medical care that African-Americans receive is routinely inferior to that received by whites, in ways that extend beyond issues of access and affordability. One well-documented example is the fact that African-Americans are still, on average, prescribed less medication for pain—an echo of an old slaveholder claim that black people had less sensitive nerve endings than whites and could thus better withstand beatings. Furthermore, research into gunshot injuries, from which blacks are more than twice as likely to die as whites, is chronically underfunded. There is no national funding body for trauma research, no trauma ribbon or month. John Holcomb, a trauma surgeon in Houston, told me that this should be a source of national shame. “There’s more funding in relation to the impact of disease for middle-ear infections than there is for injury,” he said. “Pretty amazing when you consider that trauma is the leading cause of death for Americans under the age of forty-seven.”
Tisherman is all too aware that the medical establishment reflects society’s systemic injustices. Nonetheless, he feels as though the procedure’s potential—giving a second chance to patients who would otherwise almost certainly die—makes the ethical quandaries surrounding a waived-consent trial acceptable. Others strongly disagree. Harriet A. Washington, a medical ethicist and the author of “Medical Apartheid,” a prize-winning history of experimentation on African-Americans, told me, “Often, when people give a rationale for this kind of research they talk about the fact that these people are urgently ill, need immediate intervention, and that better solutions are needed.” Such arguments, she said, conflate research and care, and clinicians and patients are prone to overestimate the efficacy of prospective treatments, a phenomenon known as “the therapeutic illusion.” “This is research, so, by definition, you can’t yet know that the advantages outweigh the risk,” Washington said. E.P.R. could potentially allow a patient who would otherwise have died to survive with debilitating brain damage. In Washington’s view, the E.P.R. trial, by operating without informed consent, “robbed an already marginalized group of the ability to say yes or no to a study that might harm them.”
A couple of months after the visit to Mondawmin Mall, I talked to Leslie Sult about the consultation process. She noted that Shock Trauma had an excellent reputation in West Baltimore, and deep connections with the communities there, but she also acknowledged that hundreds of conversations had brought home to her “just how delicate the situation is.” She said, “The community in general has an over-all mistrust of medicine, and they’re just very protective.”
Decades of research have established that suspended animation works in carefully planned animal experiments. But, with review-board approval secured and the trial finally under way, Tisherman is facing a fresh challenge: translating a laboratory procedure into the messy reality of the trauma unit. In December, 2015, I attended an E.P.R. training session in Shock Trauma’s simulation lab. The plan had been to do a complete run-through of the procedure, but there were so many questions about unforeseen complications that the rehearsal kept grinding to a halt. One nurse wanted to know how the team would be paged, by whom, and when; the protocol requires specially trained medics to materialize from various hospital departments within minutes, as the potential candidate flatlines. Another pointed to a risk that the entire unit might flood, given that the patient would leak not only every last drop of blood but also a potentially limitless amount of salt water. After several minutes of discussion, the team decided that they would direct the bulk of the flow into a garbage can using plastic sheeting and vacuum the rest into a biohazard cannister.
“That was not necessarily a well-oiled machine,” Tisherman said to me afterward. “But it was the beginnings of one.” He demonstrates boundless reserves of patience in the face of the endless delays that the trial has encountered, and his resolve seems to influence those around him. Still, Tisherman estimates that it will be at least another two years before the results from the first patients can be made public. (It is Shock Trauma’s policy not to comment while the trial is under way.) He expects to learn an enormous amount from the very first patient, and has even considered the possibility that he may have to revise the protocol midway—which would, in turn, mean going back to the F.D.A. and the hospital review boards for approval. The trial, he pointed out, may be the culmination of three decades of work, but it is actually just the beginning.
If the technique proves successful, Tisherman hopes that it will also save patients who bleed out from other kinds of injury, such as blunt trauma from car accidents. Eventually, he expects, refinements to the procedure will enable first responders to use it outside the hospital. In the United States, between thirty and forty thousand people a year bleed to death from fixable injuries. Ultimately, if the technique does evolve as Tisherman envisages, it will simply become the next step for treatment after CPR has failed, used to buy time and prevent brain death in almost any situation where a person’s heart has stopped and can’t be re-started quickly. It could save people dying from heart attacks or drug overdoses, or even kids who drown in back-yard pools. “This is almost like open-heart surgery was back in the sixties,” John Holcomb, the trauma surgeon in Houston, said. “It was only done in one or two places, it was extremely complex, it was considered very experimental. And now it’s routine.”
Some years before Brandon Littlejohn died at Shock Trauma, his aunt Roxanne Cunningham requested a job transfer. She had been working in the hospital’s admitting area and could no longer bear to see gunshot victims rushed past on gurneys and surgeons telling family members that they had lost a loved one. “I just used to sit there and cry,” she said. “I knew I couldn’t do that job no more.”
Earlier this year, Cunningham lost another nephew, Anthony Drumgoole, in a shooting. An Instagram photo shows Lil’ Tony, as he was known, grinning in his college-football uniform: he was shot in the head just before 9 P.M. on a Wednesday evening in February, a fifteen-minute walk from Mondawmin Mall and just a dozen blocks northwest of the park in which his cousin was shot five years earlier. “I don’t know why,” Cunningham said. “Nobody knows.”
With two of her seven nephews dead, Cunningham nonetheless considers her family blessed. “So many families have lost maybe three, four children to gun violence,” she said. Brandon Littlejohn’s homicide was one of nine shootings and stabbings reported in Baltimore that April weekend in 2011. Last year was the deadliest in the city’s history; this year, gun crimes look set to match those levels, despite an increase in illegal-weapons seizures and a city-sponsored Safe Streets program, which was implemented following Freddie Gray’s death. “I wish they had E.P.R. when Brandon was shot,” Cunningham said. “I wish he could have had that second chance.” ♦
