It sounded like a picture frame hitting the floor.
“Mackenzie?” Jessica Piascik called out to her 2-year-old daughter, who moments earlier had darted into the master bedroom.
Piascik hurried to the girl. She found Mackenzie standing near the bed, her brown eyes unusually wide. The toddler took a slow step toward her mother, reached out her arms. The back of her Tinkerbell nightgown was wet with blood.
Beside her, a silver-and-black handgun on the floor caught the morning light.
Mackenzie was one of nearly 220 children younger than 5 who were shot in Florida between 2010 and 2015, a Tampa Bay Times analysis found. Thirty-three died.
For a young child, a gunshot wound is a particularly devastating medical event. It may seem obvious, but that’s partly because kids have smaller, more compact bodies than adults. A bullet that travels 6 inches through a child can hit more organs than a bullet that travels the same distance in an adult.
Kids who survive often suffer lifelong consequences. “Their lives are forever changed,” said Dr. Judy Schaechter, chair of the University of Miami Health System pediatrics department.
In Mackenzie’s case, the bullet bore into her belly and escaped through her back, damaging at least four major organs and causing a critical loss of blood.
“It was the worst moment,” her mother recalled. “We literally didn’t know if she would live or die.”
The night before Mackenzie stumbled upon the handgun, Piascik heard what sounded like a gunshot outside her Port Richey home. Her boyfriend at the time, Ralph Ronzino, went out to take a look, .380-caliber pistol in hand.
It was the worst moment. We literally didn’t know if she would live or die.
Jessica Piascik, Mackenzie’s mother
Months earlier, someone had broken into the couple’s car. But on this Thursday in March 2010, Ronzino didn’t find anyone suspicious in the driveway. He searched the yard, then came inside to check the closets and bathrooms.
Ronzino wore the gun “on his person” for the rest of the night, according to the police report. When he retired to the bedroom, he placed it within easy reach on the night table.
The alarm clock sounded early the next morning. A plumber was coming at 9 a.m. to fix the kitchen sink, and Piascik’s grandparents were flying in from Pennsylvania later in the day. Ronzino made a trip to Walmart to buy blinds and cleaning supplies. Piascik started to straighten up.
That’s when Mackenzie took off.
Mackenzie liked the master bedroom; the 10-gallon fish tank fascinated her. Piascik didn’t know Ronzino had left his pistol on the night table. Until that point, he had kept his firearms in another room.
After finding Mackenzie bleeding, Piascik lunged for the phone.
“Help me. Help me. Help me,” she begged the 911 operator.
The operator instructed her to hold a clean towel against the wound on Mackenzie’s back. She grabbed a clean diaper first; it didn’t work. She scanned the room, spotted a tan dish towel in a pile of clean laundry.
“Oh my God,” she cried into the phone. “What’s gonna happen?”
Piascik kept pressure on the towel and held Mackenzie’s hand until the paramedics arrived. They lifted the 25-pound, not-quite-3-foot toddler onto a stretcher and took her by helicopter to a specialized trauma center in St. Petersburg.
Piascik had to stay behind with the police. Two hours later, when detectives allowed her to leave, she called the hospital. The woman on the phone urged her to come quickly.
“A chaplain will meet you outside.”
A team of surgeons, anesthesiologists, nurses and technicians crowded around Mackenzie in the trauma bay. They could tell instantly that hers was a serious case.
The bullet had singed the skin underneath Mackenzie’s ribs. It sent so much energy through her body, her tissue had expanded like a balloon, then quickly collapsed on itself.
The round ricocheted between her tightly packed organs, a tiny pinball that bruised her pancreas, nicked her liver, and tore her stomach from her intestine. In its final act of destruction, it left a gaping hole on her right side near her back.
With kids, we have less time to intervene.
Dr. Paul Danielson, pediatric trauma surgeon at All Children’s Hospital who directed Mackenzie’s care
The trauma team had to work quickly. In an adult, the loss of blood can raise the heart rate as the body diverts blood to essential organs such as the brain, heart and kidneys. A child has less blood to go around and can sustain the response for only so long.
“With kids, we have less time to intervene,” said Dr. Paul Danielson, the pediatric trauma surgeon at All Children’s Hospital who directed Mackenzie’s care.
A top priority: Mackenzie’s digestive system. There was too much damage to simply reattach her stomach to her intestine. Instead, surgeons had to connect the organs at a different point, creating a new pathway for food to travel.
They closed the other tears in her stomach and intestines, repaired her liver, and removed the injured tissue.
The procedure took about 2 hours and 30 minutes.
Mackenzie emerged from surgery with bandages stretched across her belly. Her skin had a translucent quality. Nearly a dozen tubes jutted from her body.
Her mother cried tears of relief when she saw her.
Still, the next few hours would be critical. Mackenzie could easily crash. Danielson and his team would pay close attention to her breathing and blood pressure throughout the night.
A gunshot wound is just about the most serious injury a kid can sustain.
In 2013, a study in the journal Pediatrics found that kids who were shot were more likely to need major surgery than kids injured in any other way. They were also the most expensive to treat, and the most likely to die in the hospital.
“There’s very often serious residual disability, physical and psychological,” said Dr. Garen J. Wintemute, a professor at the University of California Davis School of Medicine and one of the study’s authors. “It can mean lots of trips back to the hospital. The consequences radiate outward from there.”
Mackenzie’s stay at All Children’s Hospital lasted 35 days. The total charges, including the surgery and her time in the intensive care unit, added up to more than $484,000, most of which was covered by Medicaid.
When it was time for Mackenzie to go home, Piascik combed her daughter’s unruly hair and painted her toenails pink. She dressed Mackenzie in a yellow frock with a ladybug on the skirt, taking care not to move the tubes that still extended from her body.
Mother and daughter spent the next several months with Piascik’s parents. Piascik and Ronzino were no longer speaking; he faced criminal charges for leaving the gun accessible to a child and marijuana possession.
At home, Piascik took on the role of nurse. She peeled the bandages from Mackenzie’s skin, cleaned the surgical wounds on her belly, and gave her daily blood-thinner injections.
She also had to help her daughter cope.
Some kids respond to trauma by returning to behaviors they had long moved on from, like sucking their thumbs. Others lose interest in things they once loved.
A trauma that happens early enough can cause a developing brain to be on “threat-detection mode” all the time, making the child afraid to take risks or explore unfamiliar places, said Pat Levitt, who directs the graduate program in neuroscience at the University of Southern California.
“Everything in your environment becomes scary,” Levitt said.
Mackenzie’s world became scary at night.
The first time she had a night terror — the night she came home from the hospital — Mackenzie was sleeping in bed with her mother. Suddenly, she started to wail. She flailed her arms and legs violently, like she was having a seizure.
Piascik sprang from the bed and flipped on the light. She wrapped her daughter in a tight embrace and rocked her slowly. It took several minutes for her to wake up and calm down.
“Just a nightmare,” the mother said. “You’re safe, baby.”
It continued that way for the next two years.
Everything in your environment becomes scary.
Pat Levitt, director of the graduate program in neuroscience at the University of Southern California.
Nearly seven years have passed since Mackenzie was shot.
She’s 9 years old, a devoted Girl Scout who plays goalie for her youth soccer team and loves karate. One day, she wants to be a dentist or a doctor. Or a helicopter pilot who flies sick people to the hospital.
Mackenzie doesn’t remember the accident. She no longer needs blood thinner injections or screams in her sleep. But there are reminders. She can’t eat large meals and sometimes needs her mother to rub her belly to relieve the pain.
This past Halloween, after changing into her Monster High costume, Mackenzie started vomiting. She was in too much pain to trick-or-treat. Piascik rushed her daughter to the closest emergency room, but the doctors there were at a loss. They transferred her nearly 50 miles to All Children’s, where she was treated in 2010.
A specialist later theorized that the scar tissue in Mackenzie’s abdominal cavity had caused a partial blockage of her intestines. She was released three days later.
All of their lives are different now.
Ronzino pleaded no contest to failing to secure a firearm around a child and marijuana possession, and served two years in prison. He did not return calls from the Times.
Piascik trusts very few people around her children. Firearms frighten her. She once had to leave the office where she works when a client came in carrying a concealed weapon.
“Mackenzie has the physical scars,” she said on a recent afternoon. “I have the emotional scars.”
Mackenzie takes it all in stride.
Her scars, she says, are actually kind of neat. The longest one runs the length of her belly and is surrounded by smaller marks that radiate out like tiny beams of light.
“The sunshine,” she calls it.