A child is dead.

There is a terrifying, soul-piercing scream that a mother makes when she loses a child. This scream is so universal that everyone, in every corner of the emergency department, knows what has just happened when they hear it.

On a sunny summer morning, a young mother of a 3-year-old watched, stunned by ultimate dread, as her little boy ran out into the normally quiet street. On that day, however, the driver of a rainbow-painted Volkswagen bus careened through the neighborhood; 20 minutes later the mother stood in our trauma room, looking as if she might collapse. She told us, through tears and broken English, how she had heard the screech of tires, the crumpling thud. She ran into the street, knelt down to her son, and gathered the little boy into her arms.