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ST. LOUIS — The bullets came for a young mother doing laundry with her toddler playing nearby. A 6-year-old boy in the backseat of a car on his way to football practice. And a 2-year-old boy sitting on his father’s lap.

Each faces a lifetime of physical and psychological therapy to try to recover from gunshot wounds. For every death from gun violence, many more are injured and permanently scarred when shots ring out. By one tally, more than 81,000 Americans survive gunshots every year.

There were 193 gun homicides in St. Louis in 2017, the highest in more than two decades. But police counted 2,439 reports of one or more people shot or fired at in the city through November 2017, considered first-degree aggravated assaults with a gun. That’s up from 2,132 in all of 2016.

Bullets rip into bodies on a straight trajectory, but often bounce around once inside, tearing through vital organs and smashing bones. Many victims wind up paralyzed or brain damaged.

Rehabilitation: At the Rehabilitation Institute of St. Louis, where patients spend at least 15 hours a week in physical, occupational and other therapies, the number of gunshot victims has increased in the past five years.

“It used to be maybe a couple at a time,” said Tracie Lee-Lambert, director of admissions. “Now we have three, four, five or six at a time.”

Patients range from a teenager involved in a fight that got out of control to an elderly person shot while sitting on the front porch.

Many, such as Tamara Collier, have spinal cord injuries that require lifelong attention and support. On Sept. 1, a bullet zinged through the back door while Collier, now 25, was doing laundry in her mother’s home. She is now paralyzed.

The lifelong health care costs of a spinal cord injury to a 25-year-old can range from $1.6 million to $4.7 million, depending on the severity of the injury, according to the National Spinal Cord Injury Statistical Center.

“A lot of the folks, because they are young, may or may not have insurance,” Lee-Lambert said. “They may have to end up on state-supported care.”

Children hurt: The number of children injured by gunfire and treated in trauma units at St. Louis and Cardinal Glennon children’s hospitals increased from 105 in 2015 to 146 last year.

“We’re seeing a lot more of those types of stories where people are just firing into cars or houses and the kid happens to be in the car or the house at the time,” said Dr. Martin Keller, trauma medical director at St. Louis Children’s Hospital. “It’s such a life-changer for many of these kids, and they did nothing wrong.”

At least eight children ages 9 months to 14 years old were struck by bullets shot into cars or homes in the St. Louis area last year.

Markel Taylor, 6, was shot in the head Sept. 12 near O’Fallon Park. In October, a 2-year-old sitting on his father’s lap was shot and critically injured when someone fired into a car in East St. Louis. The child’s father was killed.

Already this year, an 8-year-old girl was shot in the leg while sleeping in her North County home.

Most gunshot victims who arrive at the hospital with a heartbeat will survive, Keller said. But those with spinal cord or brain injuries face lifelong disabilities on top of psychological trauma.

“Their life is now changed forever,” Keller said.

People struck by bullets that fly into their homes or cars also suffer post-traumatic stress disorder because those safe places have been violated, said Margie Batek, a social worker who developed the Victims of Violence program at St. Louis Children’s Hospital. Through the program, social workers team up with injured children and their families to work on anger management, coping skills and improving their safety.

“I firmly believe after many years of being in the ER, and seeing children come in first for assault, then stabbings, then gunshots, that today’s victim is tomorrow’s perpetrator,” Batek said. “If we don’t intervene early when their very first visits are happening, we will continue to see them come back and the violence will escalate.”

The cost: Gun violence costs the U.S. more than $100 billion a year, according to some estimates that include medical care plus the indirect impact of lost wages, closed businesses, lowered property values and other factors. Taxpayers pick up a lot of that through government-funded health care and taxes that pay for law enforcement and the criminal justice system, according to the Giffords Law Center to Prevent Gun Violence.

There are areas where damages compound year after year.

A large bullet hole in the front window panel of Family Dry Cleaning & Laundry Services in the Baden neighborhood is a reminder of a 2015 shooting that erupted across the street and injured a 1-year-old boy.

Teddy bears rest at the foot of two nearby poles on North Broadway as memorials to the fallen. A third man was also killed next door to the business in recent years.

“Everybody is shooting,” said Vivian Jones, 62, whose family runs the dry cleaning business across from Hickey Park.

In the 2015 incident, the boy’s parents came to the park to watch two groups of women brawl, according to the police report. The boy was left in the car because he was asleep.

Then somebody started blasting.

After scurrying for safety, the boy’s mother returned to the car and drove to a gas station, where someone pointed out a bullet hole in the left rear door around the time the mother discovered her son’s legs covered in blood, according to the report.

He was shot through the legs while sitting in his car seat. The boy was rushed to St. Louis Children’s Hospital. His uncle recently said the boy can walk and recovered well.

Jones shook her head and criticized the parents for bringing the baby to the park, because confrontations can quickly escalate these days.

“Now you step on somebody’s toe, and he’s going to come at you with his Smith & Wesson,” she said.

Gun violence has affected her business in two ways over the past two decades. Along with the damaged window, her delivery truck was caught in a crossfire. And she’s become an expert at removing blood stains from customers’ clothes.

Soak the clothing in her secret mixture of cold water and ammonia, she said, and the blood floats to the top.

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