Life in Miami has taught me many things. Among them: how to enjoy the outdoors in mid-December, survive the nightlife, order a colada in Spanish or learn the art of UVA and UVB protection while enjoying a day at the beach.

It has also taught me what to do when a bullet has pierced a patient’s superficial femoral artery, the main source of blood to the leg, or what to do when a woman who is eight months pregnant comes in shot in the brain and uterus, through the arm of her unborn child.

It has taught me how to crack open a chest to massage a patient’s heart while clamping off the aorta in order to attempt to reverse the “rude unhinging of the machinery of life.” And, sadly, all too often, it has taught me the delicate art of telling another mother or father that their child who was shot — sometimes for being at the wrong place at the wrong time, or sometimes not — did not survive. Watching the intent faces of parents when I tell them that their son or daughter has just died, prematurely, before their time, is indescribable.

This violence was the point of moving to Miami. After finishing 14 years of post-graduate education, working as a recently minted trauma surgeon was too tame in Toronto, my hometown. With a robust social structure in place, solid public education and universal healthcare system, we simply do not see the level of violence which challenged me during my year of trauma surgery fellowship training in Miami, 2010.

For the 1.6 traumas, on average, I saw each day while working in downtown Toronto, Miami received 15. Working at Jackson’s Ryder Trauma Center, my colleagues and I see the unambiguous and overt local violence wrought by guns on a daily basis. It is much like a war zone. So much so, that the U.S. Army sends its medical teams to our trauma center for training prior to deployment to “real” war zones, thus being exposed to global violence.

But why are there such discrepant rates between Toronto and Miami, Canada and the U.S. or the U.S. and so many other countries? These questions became more pressing after a mass shooting in Aurora, Colo., occurred days after my arrival down south. Then Newtown happened.

After the massacre of the children in Connecticut, the debate on gun control was predictably re-ignited and a similar cycle of media attention and discussion ensued. What is new this time, is that people are asking hard questions, different questions and they want to see concrete change and action, whatever that may mean.

Patients, family members and colleagues are asking more questions about the “why” behind gun violence and focusing less on the agents of harm. Guns are now being recognized as the symptom and sign of a deeper, national pathology. The culture of violence is now being challenged.

Violence, however, takes many forms. While gun violence in the U.S. claims more than 30,000 lives a year, the lack of access to healthcare claims 44,789, according to a study released from the Harvard Medical School in 2009. I also witness this on a daily basis as patients present with the end stages of preventable diseases. Violence is amputating a 35-year-old mother of two’s leg as a complication of diabetes — two years after her first amputation. Violence is operating on an elderly man with a bowel obstruction, and then discharging him back home — to a homeless shelter. Violence is allowing the inexorable progression of disease, because of the lack of access to care, to the point where emergency surgery becomes necessary.

This costs the system more and causes unspeakable and preventable pain and suffering. This is the violence of economic exclusion, of poverty. And it feeds directly into the overt violence of guns, weapons and death.

Each day I go to work, I’m reminded of the strength and diversity of Miami. Each day, I witness friends and colleagues clearly united in the common yet unspoken collective goal of our public mandate, providing care proudly to all in need.

As I ride my bicycle into work, I pass a stunning, large, painted mural when I travel from one of the richest neighborhoods through one of the poorest. It adorns the north side of a non-descript building, on a similarly non-descript street. It is simple, understated and on a backdrop of a mosaic of colors.

To me, these colors represent the diversity and life of Miami. On the mosaic are painted two simple words — two words that represent the potential power of this city and her people to lead the way, when we work and function in equal parts, just like the mosaic behind the words. Words that show me that I still have much to learn from this dynamic city full of hope. Peace, Justice.

Tanya L. Zakrison, M.D., is assistant professor of surgery at the University of Miami’s Miller School of Medicine.