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On Marathon Monday, Laura Hall and Sarah Bush will make their way to Hopkinton for the start of their latest 26.2-mile journey. They will ready their bodies and prepare their minds and they will wait, amid a mass of humanity, for the storied race to begin.

But before they take that first stride onto Main Street, they will do one more thing: They will clasp hands.

Together they will run, because together they have healed. Together they once suffered, and together now they thrive. Maybe it feels as if Laura, her sister’s junior by two years, has been holding that hand for 20 years now, since the awful April morning the word Columbine permanently changed our view of the world.

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These two sisters have emerged from a two-decade tour through post-traumatic stress disorder relying on three primary pillars: each other, their families, and running. So together they take on the Boston Marathon, their interlaced fingers a celebration of who they are and where they’ve been, and of how love, faith, time, and patience can heal.

“We will start hand in hand. And then we’ll do our best,” Laura says. “If we can stick together, we’ll stick together.”

As if the roads of Boston could ever separate them.

Sarah Bush and her husband, Jon, made cookies with their children, Jonah, 12, Vivienne, 4, twins Pearl and Eloise, 7, and Sophie, 10, at their Utah home.
Sarah Bush and her husband, Jon, made cookies with their children, Jonah, 12, Vivienne, 4, twins Pearl and Eloise, 7, and Sophie, 10, at their Utah home.Laura Seitz for The Boston Globe

Scene of a nightmare

Does it minimize something as seismic as the school shooting in Columbine, Colo., to call it a nightmare? For most of us, it’s the first word in the lexicon of mass school shootings, the “ground zero’’ of a relatively recent form of terror that has become so tragically common. For Sarah and Laura Green, as they were known 20 years ago, it is much more personal than that.

Morning, April 20, 1999. Sarah, a 16-year-old sophomore, is sitting down to take a math test. The classroom is quiet, the test has barely begun. The class hears several large explosions. Students look up and look at each other. They figure it’s a science experiment gone wrong or a senior prank unleashed. They get back to work. But the baseball coach suddenly bursts through the classroom door.

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“You’ve got to get the hell out, there’s somebody shooting!” he yells. “Somebody has a gun and they’re shooting!”

It had started outside, but the two shooters have moved into the cafeteria. Laura, a 14-year-old freshman, is eating lunch with a few friends. Chaos erupts. Waves of students are ducking under the lunch tables. A janitor speeds by. “Run!” he yells. With no idea what she is running from, Laura heads upstairs.

Sarah runs toward an exit. She runs with classmates across a busy road, cars honking at their apparent recklessness. The kids spread out across a field. They hear more gunfire, see a SWAT team near the school’s main entrance. They find safety in a nearby home. The woman inside takes them in.

Inside the school, Laura has run into a friend upstairs. They head toward the choir room, where they are quickly barricaded into the choir room closet, along with a group of classmates far too large for the small space.

They wait.

Four-and-a-half hours later, the choir room closet door opens. A SWAT team leads the occupants to safety. They exit through the cafeteria, stepping over bodies of the dead. The two shooters killed 13 and injured 24 before taking their own lives. Laura recognizes some faces. Their skin is gray.

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Laura Hall and her husband, John, played with their children, Max, 7, Olive, 9, Jayne, 5, and Violet, 3, in Saratoga Springs, Utah.
Laura Hall and her husband, John, played with their children, Max, 7, Olive, 9, Jayne, 5, and Violet, 3, in Saratoga Springs, Utah.Laura Seitz for The Boston Globe

The aftermath of trauma

In Columbine, life after the shooting was hard, all normalcy gone. Flashbacks and triggers came daily, though the seeds of PTSD were only starting to take root. For Laura, there was a need to sleep on her sister’s bedroom floor nearly every night, anything to help with bouts of anxiety and depression. For Sarah, the primary symptom was an intense desire to remain positive, to show that the killers hadn’t won.

PTSD is a broad-scale diagnosis with many moving parts. Dr. Gene Beresin, the executive director of The Clay Center for Young Healthy Minds at Massachusetts General Hospital, defines the condition as “a reaction to a traumatic situation in which our life is either actually or perceived to be threatened.”

Beresin parses the condition into three components. The first is remembering, such as flashbacks, nightmares, or intrusive thoughts. The second is numbness, including emotional withdrawal, turning inward, avoiding people. The third, known to science as autonomic arousal, is the “fight or flight” response that can include physical symptoms like palpitations or hyperventilation.

This is what explains Sarah’s need to locate, to this day, an exit as soon as she enters a room. It’s why the two sisters immediately touch base when a school shooting happens, making sure the other is OK. Why Laura wept in her car after the massacre at Sandy Hook Elementary School, having sent her own kindergarten-aged son to school that day. Why Sarah wanted nothing more than to hug the children after the attack in Parkland, Fla., understanding their anguish and pain.

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“I know the feeling these kids are feeling, that feeling of hopelessness,” Laura says. “I just wish that there was more open communication about this. It’s better now than it was 20 years ago, but I wished I could have gone to Parkland and just encouraged those kids, tell them it’s going to be hard and suck for a while, but you can endure.”

Twenty years later

In taking on their grief, running has been a vital cog for both sisters. While Sarah was a member of Columbine’s track team and counts it as one of her best high school memories, Laura was more an unwilling participant in cross country. But having grown up in a family where running was always fun — the entire clan would volunteer and participate yearly at Colorado’s popular Bolder Boulder 10K — it has remained part of the bedrock of their lives.

Now, as neighbors living barely a mile apart in Utah — where each is happily married and settled, with nine children between them — they run together daily. Through pregnancies and baby weight, through rain and snow, from barely making it out the door to recording marathon times fast enough to qualify for Boston, the road has been their refuge, their friend, and their challenge.

“Running is crucial to my happiness,” says Laura, 34. “It keeps me going.”

“It was in our genes,” says Sarah, 36. “I would run a marathon after each baby I had; that kept me moving and kept me healthy through all those child-bearing years. It wasn’t until I was finished having kids that I kicked it up a level.”

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Sarah is running Boston for the second straight year, while Laura is making her debut on the route from Hopkinton to Copley Square. It is a dream realized, but it is no finish line. For these sisters, an unexpected new path opened up roughly two years ago, when Laura was urged by a friend from church (they belong to the Church of Jesus Christ of Latter-day Saints) to speak to middle-school students about Columbine and life afterward.

They found that the words poured forth with new clarity and confidence, words helpful to others.

In sharing their story of trauma and survival, they’ve taken the worst day of their lives and turned it into fuel for empathy.

“It’s incredibly brave,” said critical care psychiatrist Dr. Nomi Levy-Carrick of Brigham and Women’s Hospital. “You have to be incredibly strong to reveal that level of vulnerability. I think it’s also very valuable. The reason we have a diagnosis and talk about this is because there is treatment. I think the kinds of stories these young women are sharing are very powerful. They’re not minimizing that there was suffering, but they are demonstrating not just surviving, but thriving.

“You can have meaning that can be restored even after the senseless tragedy. It’s extraordinary that they can mobilize around this in a concrete way.”

Anniversaries can be tricky. One part celebration, one part reflection, they can move you from the present to the past in an eye-blink. They carry an inherent risk of reliving trauma, but they are valuable, too, like mile markers that prove how far you’ve come.

“The healing has taken that full 20 years,” Sarah says, “and it’s only up until the last couple of years that we’ve actually made quite a bit of progress as far as sharing our story and being comfortable doing that.”

“As each year ticks by, we celebrate in a little bit different of a way,” Laura says. “It’s crazy to realize how much time heals and also to look back. If I would have told my 14-year-old self it was going to take 20 years to feel where I am now, that’s a little bit crazy. You just don’t imagine it’s going to take that long but it really does.”


Tara Sullivan can be reached at tara.sullivan@globe.com.