When the bullet pierced her back and cracked her spine, Vanessa Sims began to blame herself. Why was she, at eight months pregnant, on North Avenue at midnight?

"That was so inappropriate," she still says of being out that night.

It was Father's Day and the moon rose full above East Baltimore. Stay in bed, her boyfriend had told her. He would pick up the fried rice she craved.

Instead, she left their rooming-house apartment, walked down Greenmount Avenue and turned on North Avenue for the carryout. She said she wanted to show off the cute sneakers her boyfriend had given her — purple Jordans.

Two miles away, Dr. Kent Stevens ran the trauma service that night at Johns Hopkins Hospital. Dr. Dylan Stewart, the pediatric surgeon on call, was home in bed after dining out with his wife. Together, the two surgeons had 15 years of experience at Hopkins, and soon they'd be tested by a situation neither had faced before.

Shootings in Baltimore have kept pace with last year's surge in gun violence — about 800 so far this year, including more than 220 homicides — and as they say in the streets, bullets have no names. Stray gunfire hit a 10-year-old boy who was going to buy juice and elderly siblings who were going to lunch. The night of June 19 brought a grim milestone: the youngest casualty.

This victim hadn't been born yet.

A child shot in the womb has a slight chance of survival, and such injuries are exceedingly rare. The Hopkins surgeons only knew of similar instances through years-old case studies. But they knew they didn't have much time.

Sims had heard the crack of fireworks — no, gunshots, she realized.

Two hidden gunmen opened fire on North Avenue, a 911 caller said. The crowd scattered as gunshots burst from behind a 5-foot brick wall. There detectives would later find .40-caliber shell casings. Two men, ages 25 and 30, were wounded. The older man, police said, had vials of suspected cocaine.

One bullet struck the ground beside Sims, 21. She heard shouts: "It's coming from behind the wall!"

Sims ran. She stepped from the curb. A bullet punched her down. It entered the small of her back at her "Halloween" tattoo. (Her birthday is Oct. 31.)

"She doesn't appear to be the intended target," police Detective Nicole Monroe said. Four months later, detectives still don't know of a motive.

The stray bullet tore through Sims' swollen belly.

"We have a pregnant lady here!" a man told the 911 dispatcher.

"Where did she get shot?"

Lloyd Fox / Baltimore Sun Jennifer Wingrat an occupational therapist for Kennedy Krieger works with Chance Ford who was shot while in the womb of his mother, Vanessa Sims. She was eight months pregnant and shot through her womb in East Baltimore. Doctors saved her baby and the child has a therapy session on Wednesday afternoon at the grandmother's house. The bullet broke the nerves in the baby's shoulder and he can't move his left wrist. Jennifer Wingrat an occupational therapist for Kennedy Krieger works with Chance Ford who was shot while in the womb of his mother, Vanessa Sims. She was eight months pregnant and shot through her womb in East Baltimore. Doctors saved her baby and the child has a therapy session on Wednesday afternoon at the grandmother's house. The bullet broke the nerves in the baby's shoulder and he can't move his left wrist. (Lloyd Fox / Baltimore Sun) (Lloyd Fox / Baltimore Sun)

"In her abdomen, it's in her abdomen right now," the caller shouted. "Get somebody here!"

Johns Hopkins was six minutes away by ambulance.

A new start

The pregnancy felt different from the beginning. The nausea that crept in mornings was unknown when Sims carried her two girls. Could it mean a boy, she wondered.

There were larger questions, too. Could she afford a third child? Sometimes Sims considered giving the baby up for adoption.

Her grandmother, Barbara Sims, was already helping to raise her two daughters in Baltimore County. Vanessa Sims was 17 when she had Da'Neia and 19 when she had Paige. Then she and their father split up. She had no job, no savings, no high school diploma. She had her grandmother, though.

"My grandmother's wonderful with my daughters. She raised me, she raised them, she raised her own kids."

Sims was 4 years old when her mother, who was HIV-infected and suffered from lupus, died. Nine years ago, Sims left a group home in New York, where she had been sent after getting in trouble for writing graffiti, to live with her grandmother and four brothers in Baltimore.

But trouble followed her to Baltimore — the nights out, chilling and smoking. At school, Sims said, she fussed with teachers and stormed out of class, and she was expelled from middle school. She also served a stint in juvenile detention for stealing.

When it came time for her release, there was her grandmother's tough love.

"She was like, 'Well, we don't know if she's ready to come home.' Because I was bad — I never stayed home. I was running away. I was bad," Sims said. "But as I got older, the last three years of my life, I started to grow."

Still, the burdens of young motherhood weighed heavy. Her patience buckled last year at the Motor Vehicle Administration.

Paige was fussing, and Sims reacted harshly.

Another woman in line spoke up: "Sister, there are other ways!"

Sims fumed. How dare she? How could this stranger understand?

The woman said her name also was Vanessa.

"I just felt she needed help," Vanessa Butcher-Hopkins said. "Someone to step in and maybe give her advice on being a mother and just dealing with raising a child."

Months passed and they shared text messages. Butcher-Hopkins dropped off Pampers and taught Sims to portion groceries for the week. She suggested the young mother write down her goals in a binder — get her GED certificate, plan for a career — and carry it as motivation. The mentor took a vacation day from work and drove Sims for a sonogram.

It was indeed a boy.

By now, Sims wanted a home with Jimmy Ford, the child's father and her boyfriend of three years, something more than their rooming-house apartment. "Munchkin," she signed his Father's Day card with affection. "Because I'm his munchkin," she said.

Ford has an 8-year-old son, and he taught Sims to soak the nipples of baby bottles so Paige's first sip would taste of milk. It was the way he made the bottles that convinced Sims he was the one. She wanted to raise their son together.

Their boy was due in August.

"Whatever I got to go through, as far as raising him, I guess I'll go through it and hopefully that will better me," Sims said. "But I'm not giving my son to nobody, and for the rest of the pregnancy it was set in my mind: I'm going to keep him."

She was eight months pregnant when a .40-caliber bullet tore into her womb. It smashed the collarbone of her unborn son.

The bullet bored into his tiny chest.

'I'm coming now'

The surgeon's pager went off with code "Delta," the most urgent call. Stevens rushed down to the Hopkins trauma bay.

The ambulance, lights flashing, sirens pealing, rushed through East Baltimore with Sims bleeding on a backboard and taking fluids by IV.

At Hopkins, the emergency team gathered with Stevens and medical residents, obstetricians, anesthesiologists and CT scan technicians.

The ambulance pulled up at 12:23 a.m.