The third week in September 2021 marked 25 years since the rapper Tupac Shakur was murdered by a sustained fire arm injury at the age of 25. The tragedy of Tupac’s life is not that his genius was cut short by an early death. The tragedy of Tupac lies in the fact that he, like many young men of color, constantly exhibited his expected and accepted violent death. This sentiment is personified with verses like, “My every move is a calculated step/to bring me closer to embrace an early death…”He left behind a vast collection of songs most of which make references to his premature death. His consistent references to a violent death are not some form of prophetic claim, but rather a manifestation of an accepted and expected reality for many young African American and Hispanic men that was true 25 years ago and continues to hold true to this day.The tragedy of Tupac’s life is not that he was the self-proclaimed “rose that grew from concrete,” the tragedy is that the concrete was even laid for him from which to emanate. Twenty-five years later, the same concrete persists only to be stained by the blood of young Black and Brown lives seeking to rise from the depleted soil below. The sense of hopelessness that endures contributes to the continuous cycle of violence that devalues black and brown lives and views young violent death as an unavoidable and inevitable reality. Tupac’s sentiment persists: “Why am I fighting to liveWhen they’re just living to fightWhy am I trying to seeWhen they’re ain’t nothing in sightWhy am I trying to giveWhen no one gives me a tryWhy am I dying to liveWhen they’re just living to die…”Twenty-five years after Tupac’s death, homicide continues to be the leading cause of death in the United States for African American men under the age Tupac was when he died (25 years old).1 Unfortunately, Tupac’s words continue to reverberate throughout inner-city neighborhoods, “And still I see no changes/can a brother get a little peace/there’s a war on the streets.”Violent trauma has increased nationally in the setting of the coronavirus disease 2019 (COVID-19) pandemic.2,3 A disturbing trend has also emerged with a notable national increase in firearm injuries in children <12 years old.3 Multiple theories have been proposed as to why violent trauma has increased since the onset of the COVID-19 pandemic. There appears to be an increase in gun sales and ownership coinciding with the increase in firearm injury in children <12 during the pandemic.3 However, it has also become evident that the COVID-19 pandemic exacerbated many preexisting socioeconomic factors in neighborhoods already at risk for violent trauma victimization before the pandemics onset.2,3 Regardless of the reason, what is clear is that the carnage in certain US neighborhoods continues and nowhere is it more personified than in the New York City (NYC) borough of the Bronx. The Bronx not only has the highest number of NYC COVID-19 deaths to date, it has also seen a 33% percent increase in shooting victims and a 39% increase in homicides compared to the same time period last year.4 In a single weekend at the official end of summer this year, we saw 16 gunshot wound victims and 3 mortalities at [institution name redacted for review], our level I trauma center in The Bronx. The weekend capped off a week that included 4 additional violent trauma mortalities including 2 siblings. Seventy five percent of victims during that violent week were African American or Hispanic males <25 years old. After the recent increase in violent death seen in our trauma center in The Bronx, it is hard not to think of Tupac’s response in one of his songs to his mother’s hypothetical question of whether it will ever change. “…it’s clear it will always be the same/until the end of time.”As medical director of our trauma center’s Hospital Violence Intervention Program (HVIP), I work closely with the trauma surgeon and emergency department physicians. I think I speak for all my colleagues when I say that we are physically and mentally exhausted. The daily declaration of death of young Black and Brown lives is becoming just as much an accepted and expected reality for us, as it was for the bodies on the stretcher before us mutilated by bullets rendering them lifeless.The daily declaration of violent death has become so commonplace that our trauma surgery director, Dr Sheldon Teperman, felt the need to implement an initiative requiring a 1-minute observed moment of silence after every declaration to acknowledge the young life lost. The silence is deafening and speaks volumes but is often disrupted by a desperate mother’s scream, “They took away my baby.”Suddenly, those of us in the room who are parents cannot help but think of our own children. No matter the age our children may be, they always remain those babies we instantly connected with on their birth by seeing in their newborn eyes a piece of ourselves. And when they are gone, a piece of us also leaves to never return. When Tupac Shakur’s mom, Afeni Shakur, was asked about the loss of her son, she said, “I miss his being. He was my son and I miss him as my baby, my boy…I miss interacting with that human being, that perfect being that excited, lovable, really magnificent spirit.”5The moment of silence after a declaration of death in our trauma center allows us all to see that the body laying before us that we desperately tried to save is someone’s baby. And being as such, the very thought of that inconceivable loss is a weight carried by everyone present in the trauma bay or ICU. Amid the silence, the sentiment is palpable and the words of the late Tupac Shakur are even more resonant, “I suffered thru the years and shed so many tears/I lost so many peers and shed so many tears.”Nearly two and a half decades since Afeni Shakur’s loss, many a “magnificient spirit” reminiscent of her son has been lost.5 Perhaps Tupac Shakur was prophetic in his claim that “some things will never change.” But he also left us a reminder that “the old way wasn’t working/so it’s on us to do what we gotta do to survive.” Given the disproportionate effect of both the COVID-19 pandemic and increasing concurrent violent trauma on inner-city communities, it is evident that new forward paths are needed to heal these communities.As pediatricians, we are in a unique position to advocate for initiatives and policies that can impact violent trauma at the individual patient and community level. The physician role in violent trauma prevention should encompass a 3-pronged approach. First, HVIPs should be standardized in all pediatric trauma centers and include strong community ties to establish a network of conflict mediation and mentorship that extends from hospitalized patients to at-risk youth in the community. Secondly, as physicians we can exercise our political capital to advocate for sensible policies aimed at preventing the purchase and transport of firearms across state lines for the sole purpose of being sold on the black market. This can help curtail the flow of illegal guns into affected communities and limit their easy accessibility. Lastly, and perhaps most challenging, will be identifying our role as physicians at addressing macro-level social issues that predispose people to violent trauma victimization. The association of poverty and limited availability of academic and economic resources with violent trauma is well documented.6,7 As pediatricians, we can help politicians value investment in public education and economic resources as a means of violence prevention. Improved access to high-quality primary and secondary education along with increasing accessibility to high-quality job training resources can help propel upward economic mobility, which can in turn help mitigate life course epidemiologic risk factors for violent trauma victimization.We can only hope that the physician, public health, political, and criminal justice communities can collaborate to address the issue of violent trauma as the disease that it is with proactive rather than strictly reactive means. In one of his songs, Tupac states, “Don’t blame me I was given this world I didn’t make it.” Perhaps that was a call to action for all of us to modify the foundation of concrete from which only a single rose is allowed to emanate only to have its stem prematurely cut. Only through multidisciplinary approaches directed at addressing proximal and distal causes of violent trauma can we effectively prevent another generation of children from being raised in communities where Tupac Shakur’s premonition of a violent death before the age of 25 is both an expected and accepted reality.