The Darkness Within

  Chapter Five

  The Reverend Andrew Wilson was going about his normal early-morning duties. He’d let Mitsy, their old Labrador, out for a run, had taken his wife and son up a cup of tea and now set out across the Maybury village green to unlock his eighteenth-century church, St Stephen’s. Mitsy had followed him as usual, circling playfully at his feet, despite her age. Dressed casually but wearing his clerical collar he walked swiftly across the damp grass, still wet from the rain of the night before. At 8 a.m. on a weekday he didn’t expect to see many of the villagers out; the commuters had already left for the station in the neighbouring town, so he tended to see the same few faces: the milkman who also delivered groceries, the paperboy finishing his round before going to college, and two dog-walkers. They all greeted him as usual with a warm, pleasant but slightly formal, ‘Good morning, Reverend,’ and he replied using their first names. He knew most of the villagers in his parish by name and he liked the village way of life. His previous parish had been in a deprived inner city which he’d initially believed was his calling. He’d done his best for five years and then asked to be moved, saying he felt he could no longer meet the challenges with everything else that was going on in his life. The bishop had been very understanding, and three months later he and his family had arrived here.

  Unlocking the outer door, Andrew left Mitsy sitting obediently in the vestibule as he unlocked the second door and went into the main body of the church. He savoured the welcoming aroma of well-oiled oak, candle smoke, and the slightly musky damp of the solid stone walls. It was reassuring and comforting; a reminder of age and endurance. The church had stood here for nearly 300 years and would remain long after he had left this earth. That he was merely passing through and part of a bigger plan helped nudge his considerable worries into a slightly better perspective.

  Facing the altar, he stood at the end of the aisle and crossed himself, then went to a box on the wall and switched on the lights and heating. Mrs Tremain, much-respected chairperson of the parish council, would arrive punctually at nine o’clock as she did most mornings to say a prayer in memory of her dear departed husband, and she didn’t like to be cold. Then at ten o’clock his darling wife, Liz, would lead the Bible study class while he went about his many duties in the parish. He would return to lock the church at nightfall as he did every evening apart from Sunday when he held Evensong. It was a pity the church couldn’t remain open twenty-four hours as it had in previous times – offering shelter and warmth to the needy – but vandals and thieves had put a stop to that some years before when they’d stolen the silver candlesticks from the altar and smashed a stained-glass window.

  Andrew went up the aisle to the little altar with its white cloths, simple wooden cross, Bible, and candles in steel holders. Lowering his head he began his usual silent prayers, thanking the Lord for all that He had blessed them with, remembering those less fortunate and those living in famine and war-torn countries. He asked for guidance to make decisions wisely, and then mentioned by name parishioners who needed some extra help: Mr and Mrs James, whose son had been injured while serving in the army abroad; Mrs King’s husband, who was recovering from stomach surgery; Mr and Mrs Watson, who had just moved into a nursing home and whom he would visit later that afternoon; and last but not least his own son, Jacob. He always felt slightly uncomfortable, almost guilty, asking for help for his own, but he was sure the good Lord understood why it had become absolutely necessary. He wouldn’t have asked had it not been essential. Forgive me Lord for asking again but if it is your will … He struggled now; his prayer needed to be answered even if it wasn’t the Lord’s will. He was desperate and his wife was desperate too, and if he was honest they were both struggling with their faith, as they were being tested as never before. When life went well it was easy to have faith, he acknowledged, but when it went badly, really badly, and you stood to lose your only child, it was surely enough to shake the faith of even the most devout and ardent of believers?

  ‘Please don’t test me further in this way,’ he said as part of his prayers. ‘Anything but this. Not my son.’ As he spoke, the small inner voice of God reminded him that He had sacrificed His only son for the sake of humanity, which wasn’t what Andrew wanted to hear at all. He finished praying by thanking the Lord again and then asking that this day be the one.

  Uncharacteristically, Mitsy began frantically scratching at the church door. Crossing himself, Andrew turned from the altar just as the door flew open and his wife Elizabeth ran in, without her coat and out of breath.

  ‘What is it?’ he asked, panic-stricken, and fearing the worst news possible.

  ‘They’ve found a donor!’ she cried. ‘It looks a good match. We have to leave now. Come on! I’ve left Jacob getting up. We’ll phone and cancel our appointments from the car. Be quick.’

  Mitsy barked as though sharing this good news, and as Andrew hurried after his wife he thanked the good Lord for answering his prayers, and promised he’d never ask for anything for himself again.

  Upstairs in the rectory Jacob had managed to wash and partially dress himself and was now sitting on the edge of his bed trying to catch his breath. Stick-thin, pale, permanently exhausted, and out of breath even with the minimal exertion, he’d been off work sick for nearly a year. At 23, having left university with a degree in business studies, he’d been six months into his first job when illness had struck, and a range of symptoms were eventually diagnosed as congenital heart disease. His heart began failing fast and he and his parents were told that a heart transplant was his only hope. While he didn’t have the strength of faith his parents had, he did believe in something – a deity? He too now said a short prayer of thanks before texting the good news to his long-term girlfriend, Eloise.

  His parents arrived in his room together. He couldn’t remember a time when they’d looked so relieved and happy. While his mother helped him finish dressing his father checked his bag, which had been packed since he’d been put on the transplant list, ready and waiting for the call. Downstairs they shut Mitsy in the kitchen with food and water (a neighbour would take her out later) and barely thirty minutes after receiving the call they were on their way, overjoyed, but not forgetting that another family had lost a loved one to make this happen.

  Chapter Six

  At the transplant centre a specialist team of doctors and nurses was now assembling as two operating theatres were being prepared, one to remove the donor heart and the other to implant it into the recipient. It was unusual for the donor and recipient to live so close – just twenty miles apart. The transplant programme stretched nationwide and organs often had to be transported miles and at great speed when a donor was matched with a recipient at the other end of the country, although neither the donor’s next of kin nor the recipient of the heart would be aware of this. Their details were confidential and would be kept secret unless they both wanted to know who the other person was. Sometimes the recipient wanted to thank the donor’s next of kin, and if they agreed they were sensitively put in contact with each other, but this was unusual, and often resulted in a heart-warming story in the press or on the news.

  It wasn’t just the heart that was being removed. The donor’s family had given consent for all of his body to be used, so as well as his heart going to Jacob, the kidneys, liver, lungs, pancreas, intestine, corneas, skin, nerves, veins, tendons and even the bones from his legs were going to benefit others.

  When Jacob arrived at the transplant centre with his parents they were shown to a single room where nurses weighed and measured him, checked his temperature and blood pressure before listening to his chest to make sure he was well enough to undergo surgery. He confirmed he hadn’t had anything to eat that morning; they then took a blood sample and gave him a pot for a urine sample. The anaesthetist arrived, explained what he would be doing and asked him if he’d ever had a bad reaction to an anaesthetic before. He hadn’t – the only surgery he’d had in the past was a tonsillectomy at the age of six. The tw
o surgeons leading the team arrived shortly after and the atmosphere in the room became electric – joyous, with a sense of occasion. They went over the procedure again with Jacob and his parents and reassured them that all would be well. It was a good tissue match, they said, and they would gown up now and see him later. Before prepping began, Jacob’s parents had to say goodbye. ‘We’ll be here when you wake,’ his father told him.

  ‘And I’ll phone Eloise,’ his mother said, knowing that it could be a few days before he was out of intensive care and could receive visitors.

  One of the nurses gently showed them out, reminding them that Jacob was in very good hands – the best. She suggested they went into the city and had some lunch to pass the time as it would be at least four hours before there was any news. She would call as soon as Jacob was out of theatre. They thanked her, but before they left they made a detour to the hospital’s little chapel, where they asked the dear Lord to watch over Jacob and the donor family who had given so generously and were now grieving over their loss.

  Chapter Seven

  After the transplant and following usual practice, Jacob was taken directly to the intensive care unit where he was kept sedated, connected to a ventilator to help with his breathing, and given a drip passing fluids and medication into his arm. As with the other transplant patients, doctors and nurses monitored him around the clock until he was stable enough to be removed from the ventilator and brought out of the drug-induced coma.

  As Jacob rose up through the layers of consciousness, he began swearing and cursing at the nurses, saying things he wouldn’t have done when fully awake. He told one nurse to ‘fuck off’ and another that he’d like to ‘give her one’, before trying to grab her breast.

  ‘That’s not very nice coming from a vicar’s son,’ she joked, aware it wasn’t the patient talking but the cocktail of drugs – particularly potent after a transplant.

  As soon as he was fully conscious Jacob returned to his normal self and, still slightly confused, asked politely, ‘Where am I?’

  ‘You’re in hospital, Jacob,’ the nurse said. ‘You’ve had your transplant and everything is fine. We’re moving you to a different ward soon and your family will be in to see you again later.’

  Relieved, he thanked the nurse and then fell into a more natural sleep. The next time he woke, his parents and Eloise were at his bedside, his mother, holding one hand and Eloise the other, while his father stood at the foot of his bed, smiling. The glow from the ceiling light caught his hair, circling his head like a halo, and just for a moment Jacob thought he’d died and was in heaven. After a few seconds, reality hit him, and he remembered what had happened.

  Jacob’s recovery continued well and after a few days he was allowed out of bed to go to the toilet, and from then on he was encouraged to walk a little each day. He was very weak to begin with but the doctor and nurses told him that was only to be expected. In addition to undergoing major surgery he’d been weak in the months prior to the operation when his own heart had been failing. He’d only been able to take a few steps before he was out of breath and feeling dizzy, and going to the gym had become a distant memory. But that would change once he was deemed well enough to embark on the supervised cardiac rehabilitation programme run by a physiotherapist in the hospital gym. He was looking forward to gaining some muscle strength and getting fit again.

  His chest hurt whenever he moved, coughed or cleared his throat but that was normal too. The surgeon explained that he’d had to cut through his sternum to operate and it was now held together by wires, which Jacob could feel clicking slightly when he moved. It would take six weeks for that bone to heal, during which time, it had been emphasized, he mustn’t put it under any stress, which included not lifting anything heavier than a litre of milk. No pushing, pulling, twisting, or driving, as turning the steering wheel put pressure on the sternum. What would happen if he did exert pressure on it Jacob didn’t want to know. He was already having unsettling dreams about being stitched together like Frankenstein’s monster. The less he was told about what they’d actually done in the operating room or the details of what could go wrong, the better.

  He was allowed home three weeks later and it wasn’t a moment too soon. Alone in the single hospital room and with only his parents and Eloise allowed to visit – to minimize the risk of infection – Jacob had developed cabin fever, and knew he was becoming tetchy and short-tempered. To have been holed up for much longer would have driven him mad. For the first week he would have to return to the hospital every day for a check-up, then once a week, then every other week, and then once a month for the first year. After that, assuming he stayed well, his appointments would be every three months for two years and then every six months for the rest of his life. If he had any health concerns he had to return to the hospital immediately. But as he said goodbye to the nurses, thanking them again for all they’d done, returning to the hospital was the last thing on his mind. He was about to enter the world again and with a new heart in place, he intended to live life to the full.

  His parents carried his case and bags to the car and he sat in the rear, as his mother took the front passenger seat and his father drove. He put his earbuds in straightaway. He wasn’t being rude but they’d exhausted conversation during his long stay in hospital and they really didn’t have anything left to say to each other.

  His mother held his bag of medication protectively on her lap and it wasn’t long before she was sorting through it, reading the instructions on the huge assortment of boxes and bottles. She’d put herself in charge of his medication and had told him she’d bought Dosette boxes. As soon as they were home she’d put the pills he needed for the week into the boxes so none would get missed or taken twice. It had been drummed into them how important it was for him to take the tablets as directed and at the correct times. There were plenty to take: two types of immunosuppressants, antibiotics, blood-pressure-lowering drugs, diuretics, aspirin, anticoagulants, painkillers, and those were only the ones he could remember. Doses of some of them would decrease and even stop over time but he’d have to take immunosuppressants for the rest of his life. If he didn’t take them his immune system would recognize his heart was not his, label it as a harmful invader and attack and destroy it as if it was a virus.

  His mother would also be looking after his appointment card for the time being, and the printed handouts containing the lists of post-operative dos and don’ts. They had seen the dietician together and while much of the advice had been common sense – eat low-fat foods, limit cholesterol, salt and sugar intake – others were more specifically for transplant patients: fresh produce had to be washed well before cooking or serving as the bacteria and viruses it harboured could be transmitted to the transplant patient, whose resistance was lowered by the immunosuppressant drugs, rendering them more susceptible to infection. His potassium intake had to be managed, as did his fluid and calorie intake. The dietician had said that his new heart would be put under strain if he carried extra weight, but he’d been fit and healthy in the past so there was no reason why he wouldn’t be again. There’d been so much talk about his new heart that what had once been an innate organ like any other body part had become a living entity in its own right, and he was starting to resent the time and attention it demanded.

  But what Jacob hated the thought of most were the biopsies he’d have to have once a week for the next six weeks. He’d already had two and couldn’t stand the thought of more. He had to lie on the operating table while they gave him a local anaesthetic, cut a hole in his neck and pushed a wire down the vein and into his heart to cut out a small piece. It was then sent to the lab and examined for signs of tissue rejection. ‘Transplants aren’t for the faint-hearted,’ his surgeon had said. Arsehole!

  It was a little after 3 p.m. and as Jacob gazed out of the side window listening to his music he suddenly realized he was very hungry and craving meat, which was a first. Since meeting Eloise at university he’d become a vegetarian as she wa
s, although he still ate fish, cheese and eggs. But right now, after all that healthy eating in the hospital, he was craving meat: a rump steak or a rack of ribs, rarely cooked red meat that he could sink his teeth into.

  ‘What’s for dinner, Mum?’ he asked, removing an earbud so he could hear her reply.

  She turned to face him. ‘I’ve made a vegetarian cottage pie,’ she said, pleased he was regaining his appetite. This dish had become one of his favourites and she’d put time and effort into making it. ‘Eloise is coming as soon as she can dismiss her class.’ Eloise was a primary-school teacher at a school not far from where she lived with her parents – about an hour away.

  ‘Any chance of some meat?’ Jacob asked. ‘I really fancy some tonight.’

  ‘Well, yes, if that’s what you prefer,’ his mother said, surprised. ‘I’ve got some steak in the freezer. I’ll take it out as soon as we get home.’

  ‘Count me in,’ his father said chummily, glancing at his son in the rear-view mirror. Neither of them were vegetarians except when Eloise joined them for a meal. Jacob knew that given a choice his father would much rather have meat than Quorn or soya beans any day. He threw him a conspiratorial wink in the mirror.