Wilson was shot in the head, throat, stomach, leg and ribs. The man held a gun to the side of Wilson's head and pulled the trigger. In that split second, Wilson turned his head and the bullet, miraculously, lodged in the back of his head. The man kept firing, hitting Wilson in the throat, stomach and ribs, until an elderly neighbour on her balcony yelled, "stop shooting that boy, you gonna kill him". "In the ambulance, I could see the blood pressure monitor falling. I could feel air coming in my jaw. I was just so tired, I wanted to close my eyes but the paramedic said 'hey, stay with us', so I prayed with my eyes open," he says. The 2015 shooting was a horrific case of mistaken identity. The day before, Milton Bowden, 29, had caught his wife in that apartment block in bed with another man. Wilson drove the same car, had the same skin colour and was wearing the same fedora-style hat as that man. The shooting left the father-of-two with unfathomable injuries but his physical and mental recovery was only part of the battle he faced. The financial woes were yet to come.

As gun crime and healthcare costs continue an upward march in the United States, the two are intersecting with particular brutality for a vast and increasing number of Americans. There were 39,773 gun fatalities in the US in 2017, the highest in 20 years, according to the Centres for Disease Control and Prevention (CDC). (That's 12 per 100,000 people, compared to Australia's one per 100,000.) Two-thirds were suicides. About 78,400 people arrive alive at emergency departments with firearm-related injuries each year, the vast majority from assaults and unintentional shootings. For those that go on to receive inpatient care, the average cost of their stay is $US95,887 ($134,000), a study by Johns Hopkins University School of Medicine, published in Health Affairs in 2017, found. Shootings disproportionately affect young, poorer males, the study found, meaning victims are more likely to be uninsured and possibly go on to incur crippling debts.

About 29 million Americans are uninsured. More than 86 per cent have insurance, but even that may not be enough, as Wilson came to find out. Big deductibles, surprise bills and restrictive insurance networks are the norm. "You’re making a choice - 'do I get this surgery or do I let my kids go on this class trip?'" he says. "That's not a choice you should have to be making." Wilson said he was forced to make choices between facial surgery and family expenses. Tip of the iceberg The $US2.8 billion in annual hospital charges for gun-related injuries is the tip of the iceberg, says Johns Hopkins Hospital's director of emergency general surgery, Dr Joseph Sakran, who co-authored the study. It doesn't account for lost work and outpatient care such as rehabilitation or therapy.

"The other difficult thing about accounting for [the true cost] is the fact that there’s essentially been a limitation on research," he says. A 1996 provision inserted into a funding bill by Republican congressman Jay Dickey mandated that no funds provided to the CDC could be used to "advocate or promote gun control". Congress redirected $US2.6 million from the agency's budget, the exact amount allocated for firearms research the year before, for traumatic brain injury research. Dr Joseph Sakran. Credit:Johns Hopkins Hospital Although then president Barack Obama directed the CDC to research gun violence in 2013, the Dickey Amendment remains in law and no funding has been re-appropriated by Congress. It has had a chilling effect on researchers. Sakran, who was shot in the throat as a teenager in Baltimore, has mobilised a coalition of doctors in support of universal background checks for potential gun buyers and limiting availability of guns to people with criminal records or a history of violence.

"It's such a polarised topic and it doesn't need to be because the reality is Americans have more in common than what divides us," he says. "Nearly 97 per cent of Americans agree on universal background checks for all firearms [according to a 2018 Quinnipiac University poll]. The problem is that elected officials stand at a divide on a lot of these aspects for, honestly, not a lot of good reasons." Gun reform and medical costs are likely to become hot-button issues in the 2020 election, with several Democratic candidates promising true universal healthcare or "Medicare for all", an issue that has remained on the political fringes until now. (About 20 per cent of Americans have public insurance like Medicare or Medicaid, which cover seniors and low-income earners). But both issues have powerful enemies: the health insurance and pharmaceutical industries, and the National Rifle Association, respectively. "For the first time in a generation, the realisation of a right to healthcare ... is on the horizon," Adam Gaffney, a Harvard Medical School instructor and secretary of Physicians for a National Health Program, wrote in a recent op-ed. "But achieving it requires not repeating the mistakes of history. It means somehow countering a staggeringly rich corporate opposition while at the same time preserving the essence ... of the vision. It is a formidable task, but one that has never seemed so winnable." Forty-nine people were killed in the Pulse nightclub shooting. Credit:AP

Recovering in the spotlight For Patience Carter, a survivor of the Pulse nightclub shooting in Orlando in 2016, intense publicity surrounding the event was a double-edged sword. Patience Carter was attacked online by conspiracy theorists but, because the Pulse nightclub shooting was so high profile, her medical bills were covered. She was attacked by conspiracy theorists who found the aspiring actress and singer's online portfolios and accused her of being a crisis actor in a hoax shooting. But, because the incident was worldwide news, the hospital agreed to cover all medical bills. "I would've had absolutely no way of paying for it, I don't come from a stable home, there would be no way for me to even scratch together a tenth of those bills," she says. "I was looking at the bills flooding my house, like $20,000 for surgery. All these expenses for something I didn't ask for."

Carter, then a 20-year-old college student, was on holiday in Orlando with her best friend Tiara and Tiara's cousin Akyra. As the nightclub was being showered with bullets, Carter and Akyra ran outside but, after realising Tiara was still inside, they ran back in. The women huddled in a bathroom with about 20 others until they heard gunman Omar Mateen's footsteps and he started blasting the bathroom too. Akyra was among 49 people killed. Carter was shot multiple times in both legs and had a painful recovery, learning to walk again and spending almost a year on crutches and in physical therapy. "I was going through a lot emotionally," says Carter, who has since written a book, Survive Then Live, and begun work as an outreach director for the Gun Violence Survivors Foundation. "I felt a lot of guilt about my friend not making it, I was trying to process what I'd gone through, but the biggest toll was seeing the conspiracy theorists attacking me. I was so weak and broken down emotionally," she says.

A bullet remains lodged in the back of Jay Wilson's head. Wilson's recovery was long and painful too. He woke from a three-day coma to find he couldn't talk or write. His jaw and leg had to be reconstructed. In a eerie experience he can't explain, he heard a voice on three consecutive nights in hospital saying, "forgive him". Bowden, as Wilson came to learn, had apparently realised he'd shot the wrong person and fled. As police surrounded him on a nearby highway, he suicided. In his car was a note indicating he planned to kill himself and his children. "I just had this moment of clarity where I didn’t have any other choice but to forgive him," Wilson says. "After that, everything changed." The next morning his blood pressure halved and a tracheostomy tube in his throat came out. He could eat and talk.

But as his condition improved, his insurance company began pushing back on bills, questioning if they were necessary. Two years on, symptoms of PTSD have surfaced. He has foregone facial reconstruction surgeries and physical therapy. A bullet remains lodged in his brain and he suffers migraines and mind blanks. Most of the estimated $US100,000 spent on surgery has been reimbursed by a state-run victims' assistance agency, however he and his wife have lost their credit rating, which is crucial for securing loans and rental leases. His wife needed a "care" credit card - a card for medical expenses that many patients use - and has racked up $US27,000 just to keep the family fed and housed. "I want people to know total devastation is happening, especially when the breadwinner gets shot," says Wilson, who has started the 524 movement to help victims with mounting bills. "The economic toll, the mental toll, the physical toll, all that together is too much. I’m in a hole - in the double-digit thousands - but I’m not worried." Forgiveness has been most important on Wilson's road to recovery. Credit:Rachel Olding