As shots rang out, a cheerleader in Ohio, a student-athlete in Colorado, a university research chemist in Mississippi and a 3-year-old New Jersey flower girl visiting Nigerian relatives began harrowing journeys that brought them into the rare fellowship of people who have made remarkable recoveries from gunshot wounds to the head.
Their survival against enormous odds attests to the power of love, prayer, determination and the best that modern neurosurgery has to offer.
But if you step back, listen to them speak and study their smiling faces, which bear few, if any, traces of the random violence that sent them and their families on dark journeys from which others sometimes don't return, you can't help but think there's a simpler explanation: All are living miracles.
Some of their doctors would agree. Similarities between aspects of their cases and that of Rep. Gabrielle Giffords, D-Ariz., make brain specialists optimistic about her recovery.
Even experienced neurosurgeons who have witnessed devastating neurological damage will tell you of the brain's incredible plasticity; the extraordinary ability to generate new brain cells, called neurons, and create better, stronger electrical connections among existing neurons. That plasticity allows patients to get closer to where they were before gun violence knocked them to the ground, literally and figuratively.
Youth, motivation and excellent support systems also go a long way toward maximizing recovery.
"Mortality from gunshot wounds to the brain is very high, 90 percent," said Dr. Alan H. Weintraub, medical director of the Brain Injury Program at Denver's Craig Hospital, one of the nation's top rehabilitation centers.
"Neurological medical complications are very high. But if you get through all of that, the ability for a person to benefit from specialized rehab and end up with a fairly positive outcome is surprisingly high."
Survivors of penetrating gunshot injuries to the brain who get past the early complications "can do much better in terms of outcomes than, say, from a brain injury one might see from a military blast injury or from a motorcycle accident."
Although brain injuries leave some of the pathways by which brain cells communicate in "functional shock, it doesn't mean those pathways are 100 percent totally disconnected or destroyed," Weintraub said.
While much of the improvement in function occurs in the initial weeks to months, language and thinking can continue getting better for two years or more, and even after that, "people learn to compensate."
Others agreed. "The brain is an amazing organ," said Dr. Antonio Chiocca, chairman of neurosurgery at Ohio State University Medical Center in Columbus.
After Rachel Barezinsky arrived at Ohio State University Medical Center Aug. 22, 2006, with bleeding to the brain from a gunshot wound to the head, doctors told her parents that the Worthington High School cheerleader wasn't going to make it through the night. They said she had only a 1 percent chance of survival.
Barezinsky, then 17, had scored a 3 on the Glasgow coma scale, the worst possible number. Her mother, stepmother and father called in their local parish priest to perform last rites. He arrived around 2 a.m.
But sometime after 3 a.m., something altogether miraculous happened. Barezinsky squeezed her stepmother's hand.
Despite the positive development, neurologists said her brain was beginning to swell and insisted she had sustained too much damage to survive.
Her family had a different view: The doctors didn't know Barezinsky, who had spent four tough years in a corrective back brace because of scoliosis, and had hundreds of concerned friends gathered in a hospital waiting room. They fought for surgery to relieve some of the pressure building in her brain from the swelling, although the bullet would be left where it was.
"We told the doctor, you do what you can to save Rachel's life and we'll take care of the rest, whatever comes about," her father, Greg Barezinsky, 50, of Worthington, said in an interview Tuesday.
Rachel Barezinsky, then an incoming senior, had been shot twice by a resident of a local "haunted house" near a cemetery. The girls had driven by earlier in the summer and were going back for another look. One of the hollow-point bullets entered on the right side of Barezinsky's head, tearing through four lobes that control movement, sensation, memory, emotion and impulse control, before coming to rest on the left side of her brain; the other bullet hit her shoulder.
Once she emerged from the surgery, "they told us the surgery went well and Rachel was going to live," her father said. "At that time, we didn't know what neurological deficits she was going to have," which is what families such Giffords' often hear.
Barezinsky was paralyzed on her left side, with no feeling in her arm or leg. She was intermittently confused. A ventilator helped breathe for her but, within a few days, she was scrawling short notes that let friends and family know that behind the tangle of tubes, wires and bandages, the essence of Barezinsky remained intact.
After three weeks in the ICU, she moved to Nationwide Children's Hospital in Columbus for 10 weeks of rehab. The shooting left her with cognitive complications; she'd made up stories to fill the gaps in her memory.
In 2009, she suffered a grand mal seizure that makes her epileptic by definition, although she has never had another episode. She still doesn't remember the shooting (for which she's thankful), the three or four months that preceded it and the two years that followed. She doesn't remember her boyfriend of the time, although she has been told he came by earlier in her recuperation.
"The most frustrating part is not always being able to remember," she said in an interview. "I have gone through countless speech therapy sessions which focus on teaching me memory strategies. I have definitely learned how to compensate for lack of memory."
Now 21, Barezinsky continues occupational and physical therapy to improve her memory, fine motor skills and reduce fatigue and weakness. Through sheer grit, she has made strides unthinkable that summer night in 2006.
She uses an iPad to stay organized and jot down memories. Read her upbeat website, and you learn she has completed her high school education, earned a certificate in pre-school teaching and has worked in a dentist's office since August. She remains determined to get the college education that the shooting put out of immediate reach.
With her youth, formidable will and supportive family and friends, there's no reason she can't get back to "99.5 percent of where she was," said Chiocca, the Ohio State neurosurgeon who rebuilt her skull months after a colleague removed it to prevent further damage from brain-swelling.
"I've never seen somebody do so well from such a massive injury," Chiocca said, adding that he has more often seen them survive "in a chronic vegetative state."
Asked what dreams she still hopes to fulfill, Barezinsky, who describes herself as "very content," didn't hesitate: " I've always wanted to be a mother and I still plan to do that one day. Not anytime soon, but one day."
Patrick Ireland, now 29, was an avid basketball and baseball player and competitive waterskier when he was shot twice in the head and once in the foot during the April 19, 1999, Columbine High School massacre in Littleton, Colo. He's probably best known as the 17-year-old Columbine student who, despite being partially paralyzed, summoned enough adrenaline to crawl to a window and be pulled to safety, as television news cameras recorded his rescue.
During the first week after he was hospitalized and sedated, "there were continually questions about whether I would survive or not," he recalled in an interview this week.
Once he made it through the initial hospitalization, he was transferred to Craig Hospital in Denver for rehabilitation. When his mother asked if he was ready and prepared for the hard work of rehab that lay ahead, he had no idea what kind of grueling regimens he would undergo.
"I'm thinking a lot of hard work, like 6 a.m. basketball practices where you run three hours," he said. "Yeah, sure."
More than 11 years since Dylan Klebold and Eric Harris, who were neither Ireland's friends nor acquaintances, turned their high school library and cafeteria into killing fields before committing suicide, Ireland is a happy, handsome, humble man married to his college sweetheart, Kacie, with a new baby girl named Kennedy Quinn Ireland, a successful business career and a better-than-before game of golf.
In the interim, he has overcome memory loss, and the frustrating inability to articulate words he could hear in his head. He had to re-learn how to read and write.
"You're 17 years old and you've gone through years of schooling and you know in your mind how to do this," he said, "but you can't make the connections to execute on it."
He had to re-learn how to walk and water ski, which he's now doing only recreationally. He harnessed a powerhouse of inner will to keep up his grades, graduate with his class -- as a valedictorian -- and then attend Colorado State, which was just close enough to home that friends and family could provide extra encouragement when he needed it, although his fraternity brothers stepped in as trusted surrogates.
He graduated magna cum laude, then interned at Northwestern Mutual Financial Network, where he's now a managing director.
He wears a brace to support his right leg (which also allows him to feel more stable when he's spending summers "hanging out" in flip-flops) and has some residual deficits, but those are generally limited to problems with fine-motor skills on his right side.
"I don't think there's anything that's extremely apparent if you don't know me, although there's probably times where I might be searching for a word, or trying to remember the right thing I want to say," he said. "But I don't think that's too much different than somebody else who feels as though they have bad short-term memory or something like that."
He can't recall becoming depressed, although he worked through his share of anger and frustration, while asking himself, "Why did this happen to me?"
A more philosophical man now, he added, "On the flip side of that, you could also say, 'Why not me?' The position I was in and the love and support from both my family and friends actually put us in a pretty good position to be able to cope and deal with this.
There's people that would crumble from an occurrence like this. We were able to overcome it and come out better on the back end."
Asked if there ever are moments when he's shaken by what happened to him, he said: "No. I sleep very well."
Yet, he revealed that in simply talking about Giffords' brain injuries, "it certainly brings back memories. Your heart starts to race a little bit. I actually start to feel … like when you're about to faint."
Weintraub, who oversaw Ireland's rehabilitation, said his injuries resembled those the Arizona congresswoman suffered in Saturday's Tucson shootings. "He offers incredible hope and inspiration to what can happen from the anatomy of this type of injury," Weintraub said.
Andrea Michalkova Scott
On Feb. 1, 2010, Andrea Michalkova Scott was left for dead after an attempted robbery and execution-style shooting in a parking lot at Jackson State University in Mississippi, where she was a research chemist in the Interdisciplinary Center for Nanotoxicity.
But thanks to the nature of her wound and the actions of a Good Samaritan that night, she remained conscious and was able to instruct the young man in how to call her husband. Within a month of the shooting, which caused facial paralysis, partial hearing loss and debilitating headaches, she was again working in her field of computational chemistry.
Her husband, Bill Scott, said doctors at the University of Mississippi Medical Center told him she was "very lucky." CT scans of her brain show a trail of bullet fragments around her left ear, a large fragment in the ear canal and a major fragment that lodged at the base of her neck, just a quarter inch from her spine that was surgically removed last March.
Scott also has undergone surgery to remove bone fragments from her damaged ear canal, has been fitted with a hearing aid and wore a special jaw brace for months when she still couldn't open her mouth to eat.
Almost a year later, Scott, 36, who holds a doctorate from Commenius University in her native Bratislava, Slovakia, calls it "a miracle that I can walk, that I can talk, that I can even smile."
Her survival is a greater miracle than either she or her husband may realize, said Dr. H. Louis Harkey, chairman of neurosurgery at the University of Mississippi Medical Center in Jackson, who was not involved in her treatment but reviewed her CT scans and some notes from her medical file.
The CT images indicated Scott was shot at very close range and, as in Gifford's case, in which the trajectory was high and the gunshot wound bypassed critical structures of the brain that govern speech, the trajectory in Scott's shooting was low and also missed brain regions that govern critical functions.
"The trajectory is what makes it survivable," Harkey said.
Had the bullet reached Scott's spine and her spinal cord, however, "it would be an injury like Christopher Reeve, not only paralyzed in his arms and legs, he couldn't even breathe and had to have a portable ventilator," Harkey said of the late actor who became a quadriplegic after being thrown from a horse.
The neurosurgeon said the regions damaged in Scott's shooting were near four major blood vessels supplying the brain, including the carotid arteries that feed the hemispheres, and the vertebral arteries that supply blood to the brain stem and cerebellum. Injuries to those could have caused a massive hemorrhage or major stroke.
"From a neurological standpoint, it could have caused a significant stroke with any outcome from death to significant paralysis," he said.
He observed that Scott also suffered blockage to her sigmoid sinus, the major structure that drains blood from the brain; such a blockage "can be life-threatening."
For her part, Scott has managed to laugh a bit at what befell her on an otherwise ordinary winter evening. When she looks at a picture of herself today, with her bracing blue eyes and blond hair, she says the face she sees "looks younger" than the face before the shooting.
"The nurses were laughing at me, saying it's like having Botox done," she said.
She attributes the lack of wrinkles on the left side of her face to the months when some of her facial muscles were paralyzed.
She has recovered almost completely, except for a small area above her right ear that remains numb. She cannot play tennis or jog as vigorously as she once did, and at the end of each work day, she has to lie down for about 30 minutes because of the headaches. Side effects make her reluctant to take painkillers prescribed to ease the headaches, although she occasionally takes a non-aspirin pain reliever.
She even found a silver lining in the compassion of neighbors, some of whom she'd never before met. Some appeared at her door in New Hebron, Miss., with casseroles. Her church congregation prayed for her and her husband.
"It was absolutely great to find out how great a community we live in," Scott said. "They told me how they prayed for me and everybody was like family."
On Sept. 4, 2005, Stephanie Ayula of Hillside, N.J., was a carefree 3-year-old carrying a bouquet of white flowers at her aunt's wedding in Nigeria. The next day, she and her maternal grandparents were ambushed en route to evening church services.
Her grandfather was fatally shot; her maternal grandmother wounded and Stephanie gravely injured in a hail of gunfire.
Bullets had ripped across her head, tearing away her forehead and scalp, destroying her right eye and leaving her exposed brain hemorrhaging badly. She was treated at a local hospital before being moved to larger facilities in Benin, then Ibandan in Nigeria. As soon as her parents, both health professionals who were unable to attend the wedding, learned of the shooting, they feared Stephanie's death.
"The fear initially was obviously death," her father, Dr. Nelson Ayula, then a medical resident at Newark Beth Israel Hospital, said in an interview Tuesday.
He knew from his medicine and pediatrics training that the most important thing was the quality of care she got early on because "a third of patients who have gunshot wounds don't make it out of the scene," but those who make it past the first two to three days do well.
"As soon as she survived the first two days, I knew she was going to make it, because I've seen it happen," said Ayula, 40.
He then began focusing on bringing her home.
He began inquiring about the best U.S. surgeon to operate on his daughter. With help from hospital colleagues, he arranged for Stephanie to be airlifted to Newark Airport and then taken to Hackensack University Medical Center, where Dr. Arno Fried, the neurosurgery chairman and chief of pediatric neurosurgery, would try to save her life.
Ayula said that when he first saw his injured daughter at the airport, she was heavily bandaged and her face badly swollen, but was able to speak, "I asked if she was in pain and she said, 'Not really.' She knew she was shot."
Fried vividly remembers what he found when he first examined Stephanie, who came in heavily bandaged about the head. "It was pretty dramatic," he recalled.
At the time, he said, her prognosis was "very guarded" and doctors didn't know if she would be able to see with her remaining eye.
Fried's surgical plan was to do for Stephanie what doctors in Tucson did for Giffords, to remove bullet and skull fragments, but not all of them, from her brain; stop the bleeding and remove sections of the skull to allow the brain to swell without creating pressure that could kill brain cells.
"We were able to control the swelling pretty successfully," he said.
But, her father said, "nobody knew at that time … the extent of the damage, if she would walk, and what her cognitive functions would be. We all had our fingers crossed."
Within a couple days of her surgery, Stephanie was back to her normal self, cracking jokes, and demonstrating her natural exuberance. "One time, because she had the bed pan, she asked all the men to leave the room," her father said.
Stephanie remained in the hospital for three weeks. During that time her mother, Iyobosa, a nurse who had been 24 weeks pregnant, suffered a miscarriage with serious complications and was placed on a ventilator in a Hackensack University Medical Center intensive care unit.
She said that when she was discharged, she had that deep feeling that mothers have that Stephanie "was going to be OK now."
Since the initial life-saving surgery, Stephanie, now 9, wears an eye patch. She has undergone many more reconstructive procedures to restore the bones around the eye and reconstruct a skull to protect her developing brain.
Fried calls her the "miracle girl" who is completely normal neurologically. She will undergo additional operations to get her ready for a prosthetic eye. "She's healed very nicely," he said.
Fried said he doesn't often see young patients with such extensive injuries recover so well. "Depending on the type of injuries, it may be in 15 percent of the cases," particularly when the bullet only grazes the skull or "flakes the bone and barely goes into the brain," he said.
In most cases, "the bullet ricochets all over the place, and those are the cases that are not going to do well."
The intense medical attention seems to have had quite an influence on Stephanie, a precocious third-grader who, until three months ago, was home-schooled because of disruptions associated with frequent operations.
She adores math, and every day tells her father she wants to be a doctor. He tells her she can be whatever she wants, as long as she's happy.
In a brief conversation Tuesday night, Stephanie said she wanted to be a surgeon who operates on "the brain and the skull" so she can help adults and children.
The past few years have taught her "to be prayerful." God, she said, "kept me safe."