Ray Duggan will be the first to tell you just how tough he was. Raised to never run from a fight, Duggan started running with a gang at 14.
With his father in prison and absent from his life, the gang was everything to Duggan.
"It gave me a sense of being," said Duggan, now 31.
Running with the Young Bloods in the West End neighborhood of Providence, Rhode Island, Duggan says he felt the need to prove himself.
"I had to make myself meaner and tougher," he said.
He got his first gun at 16 and admits "shooting people and running away from the police" were his adrenaline.
Duggan thought he might one day get shot and killed. He never expected to get shot and paralyzed.
What happens when you don't die?
It was around midnight on October 9, 2004, when Duggan returned home after a car chase with rival gang members. Thinking he'd lost them, he was outside chatting with a friend when two men walked by. He thought they were neighbors until they opened fire. Duggan was hit with a barrage of bullets, one severing his spinal cord.
"It never entered my head about being paralyzed or anything," Duggan said recently as he maneuvered his wheelchair down the street, pointing to the corner where he was shot.
"It was right there. That's where I ended up getting shot ... I fell into the street right here," he said.
For Joel Irizarry, a former gang member from Chicago's northwest side, the memory of the moment he was shot is just as clear. On May 6, 1998, from the driver's window of his car, Irizarry watched a rival step out of an alley, raise his pistol and fire a single shot.
The bullet went through the seat and hit Irizarry in the spine, he said. He was instantly paralyzed. One bullet was all it took.
When doctors told Irizarry he'd never walk again, his whole world shattered. Before that moment, he thought he was invincible.
A double life
Irizarry says he joined a gang for protection. He was a skinny, scared 15-year-old in a neighborhood where there were shootings nearly every day. He couldn't get to school without being harassed, chased, or beaten up, he said.
After joining the gang, Irizarry felt he was leading a double life.
He maintained a good GPA at school, and at home he was a caring son and a good brother for his younger siblings, Irizarry said. But out on the streets, he said, "I made less than favorable decisions."
Irizarry said he was trying to leave the gang when he was shot.
Whether it's drug dealing or gang activities, the outcomes you hear about are always the same, Irizarry said.
"You only hear about death or jail. You never hear about this disability," he said.
Lifelong disability and health care
For Irizarry and Duggan, permanent disability and lifetime health care are their new reality.
According to the National Spinal Cord Injury Statistical Center, acts of violence, primarily gunshot wounds, are the third leading cause of spinal cord injury among American adults. Experts say young, uninsured men are affected disproportionately.
The cost to society is huge. Health care can cost up to a $1 million per patient in the first year alone, and up to $181,000 for each year after that.