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Chapter Seven

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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 was, 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.

‘Oh Jesus!’ Jacob exclaimed as the rectory came into view. A large Welcome Home bunting was draped across the front of the house and bunches of balloons festooned the porch. ‘Did you have to?’

‘It was your mother’s idea,’ his father said, ignoring the blasphemy. They only used Jesus Christ’s name with reverence.

‘We can soon take it down,’ Elizabeth said, feeling a little hurt. She’d wanted everything to be perfect for his homecoming. ‘I thought you’d like it.’

‘Suit yourself,’ he said with a shrug.

Clearly they were going to have to continue to make allowances during his convalescence. It was almost impossible to imagine how frustrating it must be for a lad of Jacob’s age to have to deal with chronic illness and then a major operation. But at least now he was home, and with time, patience and understanding, nature would do the rest. Allow at least six months, the surgeon had said, then gradually life will return to normal.

The Darkness Within: A heart-pounding thriller that will leave you reeling

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