One two, one two, the cadence of a runner’s stride. Inhale in, exhale out, pushing the lungs for air. I know the birds are chirping, leaves rustling, and wind blowing, but all I hear is the cacophony of screaming silence in my head. Pain is there every time my foot strikes the gravel, but I am numb. I no longer feel physical pain. I am amazed my heart still beats. I run, and run, and run, because I must. Always teetering. Am I running toward living, or away, toward dying?

The body is an amazing piece of human machinery—resilient—designed to endure corporeal challenge. My tendons, muscles, and ligaments slowly fail, rotating me in and out of physical therapy. Their sacrifice allows my mind to wander throughout the sunlight and darkness, to establish a new equilibrium. Teaching a broken heart to beat again, even if it is an irregular rhythm.

She was nine, quirky, and deeply loved. Neither she, nor her brother, were easy to bring into the world, both requiring the science and magic of injections and petri dishes. Months of emotional highs and lows, but the gift in the end, indescribable. Instant love, in an imperfect world. She was ours for three thousand, five hundred and seventy-two days.

She was given a cancer diagnosis on a Monday afternoon, and ten days later, she died, curled in a fetal position engulfed in my arms. No more breath crossing her cold blue lips. Her life cut short not because of her disease, but from medical errors. The world stopped. My heart stopped. Life stopped. The only sign of motion were the legs that propelled me forward.

My pain is physical, mental, and emotional. It is not measured on a pain scale. It is an unwanted gift wrapped up in a constraining bow. Over the years, my body has broken down, but the physical pain is easily forgotten. Losing a child leaves emotional scars, in an eternal embrace I cannot escape. It’s weight, a heaviness carried on my shoulders, an uninvited lifelong companion.

When your child dies, you lose hopes and dreams. It is not the natural order of life. Placing them in a cloth-lined box with their favorite stuffed bear snuggled in their arms, lowering their body into the dark cold earth, and marking their existence with a granite stone saying their name is unfathomable. Their life being defined as the dash between the day of their birth and their death.

I ran in the darkest hours of the night when I couldn’t sleep. I ran when I was angry and thought I would harm someone. I ran when my despair was so overwhelming, a knife to my wrist and one clean cut could end the emptiness in my soul.

Her life meant more than ending mine. She lives. I see her floating on the wings of a majestic red-tailed hawk, her melodious voice rustles in the leaves of the passing trees, and her hand rests gently on my lower spine encouraging me to move forward. Our cadence in step, our shared beating heart, still. One two, one two.

Carole Hemmelgarn is a mother of two—always! Patient advocate, trying to make healthcare safer for all. Fledgling writer, experimenting with a new voice. “Seeking Answers, Hearing Silence” first published piece in Health Affairs.