The sun streams in my surgery window overlooking  the garden next door. For years our neighbours were older and the garden neatly manicured. The only sounds of summer were the occasional tinkle of tea cups on a sunny afternoon or the delicate trimming of rose beds. The garden eventually became too much, fewer cups for afternoon tea, and the house went quiet. We watched as it came on the market and failing to sell, was rented out.

Without warning there were dogs barking and children playing in, what was now, almost a meadow. A garden bursting with energy. The grass was soon tamed and grew a trampoline.  Shouts and yelps of children and dogs, orange juice and ice cream, radios and rackets. Noisy happy sounds of youth.

Happiness betrayed. We met the family and their two girls to learn they both had cystic fibrosis.  A cruel winter. One died before we got to know her well. Then, their second daughter began to deteriorate. The outlook was poor. We all knew, her mum, dad, family and friends. And, within a short space of time, a second beautiful daughter died.  A delightful  girl whose bravery was humbling and heartbreaking.

Spring breaks into summer, the sun streams in the window and I hear, once again, the sound of distant lawnmowers. But, the garden next door is silent. The silence of absence.

Domhnall MacAuley is primary care editor, BMJ