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An entire family was found shot to death in their Pennsylvania home on Saturday in what authorities have determined was a murder-suicide.

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Mark and Megan Short, who were found dead along with their three children, were brought to national attention last year when the New York Times and other outlets documented their struggle to get medication for their daughter’s heart transplant.

Police arrived at the Shorts’ Sinking Spring home after a concerned relative alerted them that Megan had failed to show up for a scheduled lunch date. According to the Chicago Tribune:

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District Attorney John Adams said a handwritten note that “appeared to be a ‘murder-suicide’ note” was found in the family’s Sinking Spring home Saturday afternoon. Police said they found all five dead of gunshot wounds and a handgun near one of the adults, but they didn’t say which one or say who they believe was the shooter.

“This is an apparent tragic domestic incident,” Adams said Sunday. “Our thoughts and prayers go out to the families at this difficult time.”

Last year, the Shorts were the subject of a story in the New York Times, where Megan Short detailed the family’s difficulties acquiring medication for her then 1-year-old daughter, Willow—medication Willow needed to keep her body from rejecting her transplanted heart. “Every single month it seems like it’s something,” she said at the time.

In April, she expressed some of her anxiety over her family’s ordeal in a post on the blog Philly at Heart:

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I have anxiety and nightmares. Certain smells and hallways trigger memories every single time. Yet sometimes the memories return out of nowhere like a beeping sound from someone’s phone reminding you to monitor the alarms. None of this ever got easier. It took me nearly two years to recognize how much I was truly impacted by the experiences.

I don’t think PTSD ever truly goes away but, with therapy, medication, and the right support, I have begun to loosen its grip on me. As I work on my own mental healing, I wanted to share my experience so that other heart parents know they are not alone.

Officials also discovered that there had been “domestic issues” between Megan and Mark. There is currently no information available on who fired the shots.