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

‘Oh dear, I am sorry. I expect she’s got what you had,’ Elizabeth sympathized, while suspecting it might be an excuse. But what could she say? She’d asked where Jacob was and Eloise had said he’d gone up to his room for a rest. Eloise couldn’t be persuaded to stay for lunch so Elizabeth had seen her off at the door, sending her mother, whom she had yet to meet, her best wishes for a speedy recovery.

Once she’d gone Jacob had appeared and taken his lunch up to his room, which had irritated Andrew who’d just come in and had expected them all to eat together.

Then on Sunday morning Andrew had made the mistake of saying that now Jacob was quite a bit better it would be nice if he started going to church again. Elizabeth and Jacob usually went together and if Eloise was staying with them for the weekend she came too. Elizabeth had been in the adjacent room when Andrew had broached the subject with Jacob and had heard every word of their heated exchange. It had culminated in Jacob shouting, ‘He’s your God, not mine! Stuff your religion. I never believed. I hate your fucking church.’ Which simply wasn’t true. For even if Jacob hadn’t had the strength of faith his father had, he’d never minded going to church before. And as the Reverend’s son there was a certain expectation – duty, even – for him to go, although Elizabeth would be the first to admit that duty was no longer a word in Jacob’s vocabulary.

‘It’ll be better once he can get out more,’ Elizabeth had said placatingly to Andrew after Jacob had stormed off. He was clearly badly shaken.

Andrew had nodded half-heartedly, not wholly convinced. ‘Just make sure you talk to the doctor about his medication. Something has to change.’

Jacob had spent the rest of the day in his room, only coming down to eat and take his pills, which Elizabeth no longer took up to him, but set out in the kitchen, calling up to her son when it was time.

She glanced at Jacob now as she parked in the hospital car park. Expressionless and unfazed by the bad atmosphere, he was head down, selecting music on his phone. He stayed in the car while she bought a ticket from the machine and placed it in the windscreen. Then with his earbuds still in and without acknowledging her at all, he got out and fell into step beside her as they walked to the main entrance. It wasn’t until they were in the department that he took out his earbuds, but then of course it wasn’t to talk to her, but to the nurses, some of whom were young and attractive. She saw him turn on the charm and thought of Eloise. Jacob had never overtly flirted with the nurses before.

The routine was similar and they’d attended so many of these check-ups that they knew what to expect. As usual it took nearly an hour to run all the tests, monitor his heart rate and weigh him, before they were called in to see the doctor.

Dr Shah, one of the implant team who they’d seen before, sat behind his desk going through the latest test results. He glanced up and greeted them as they entered, then continued reading as they took the two chairs opposite. Jacob strummed his fingers on his knee and fiddled with the wire of his earbuds, now looped around his neck. He began tapping his foot impatiently as Elizabeth sat perfectly still, her thoughts racing with what she had to say.

‘Well, young man,’ Dr Shah said, finally looking up. ‘You’re doing very well. All your test results are good. Spot on. Let me have a look at you.’

It was the usual routine and Jacob went over to the couch so Dr Shah could examine him. He admired the scar, felt his chest, and then listened to his heart.

‘Perfect. A wonderful strong beat. I’m very pleased. It’s behaving exactly as it should. Well done.’ The examination over, Jacob returned to his seat next to his mother. Dr Shah sat behind his desk again, making a few notes, then looked at Jacob.

‘So how are you feeling in yourself? Fit and raring to go?’ He smiled.

‘Can I start driving now?’ Jacob asked.

Dr Shah consulted his notes again. ‘You’re six weeks post-op next week and everything seems to be healing nicely so I don’t see why not. As long as you’re careful and don’t overdo it. I assume we’re talking about driving a car along a road and not racing?’ He laughed at his joke and Elizabeth smiled politely.

Jacob nodded.

‘You’re starting the cardiac rehab programme next week so there’s no reason why you shouldn’t drive yourself to and from your appointments if that’s what you’re thinking?’

‘Yes,’ Jacob agreed amicably.

‘Good. And no side effects from the medication? You seem to be tolerating it all well.’

‘I’m fine,’ Jacob said.

‘You may find that your new heart reacts slightly differently to your old one,’ Dr Shah said. ‘Especially when you start to exercise. That’s perfectly normal. During the transplant the nerves to the heart are cut. The medical term is denervation. They don’t grow back but that doesn’t matter. Your old heart rate was controlled by your nervous system but your new heart is controlled by adrenalin. It will make your new heart beat faster and take a little longer to slow down. Again, all perfectly normal and it won’t limit what you are able to do. The physiotherapist will talk to you more about this and show you how to warm up properly before exercise. The denervation also means that you will no longer feel chest pain related to your heart. The nerve connections that conducted pain are gone. Any chest pain you feel during activity is probably caused by the healing of your chest after surgery.’

‘I do get breathless if I exert myself,’ Jacob admitted. ‘And I seem to tire more easily.’

‘You will at this stage in your convalescence, but that isn’t because there is a problem with your heart, it’s just because you’ve been out of shape for a long time. As you exercise, your strength and stamina will improve. Another couple of months and you’ll be a new man.’ He smiled again. ‘Any more questions?’ He looked from Jacob to Elizabeth.

‘Yes, I have a question,’ Elizabeth said, steeling herself. ‘About the possible side effects of the medication.’ Jacob looked at her sharply. ‘I wonder if you could advise me?’

‘Of course,’ Dr Shah said.

Elizabeth took a deep breath. ‘My husband and I have some concerns that the drugs could be having side effects, not physical ones but more to do with temperament. I know Jacob won’t appreciate me saying this, but he can easily become irritated and frustrated, even angry.’ She was being as diplomatic as she could. ‘He was never like this before and we were wondering if his medication could have anything to do with it, and if so, whether it could be adjusted. I remember you saying there are different brands.’

Dr Shah shifted his gaze from Elizabeth to Jacob. ‘Do you feel you’re more easily irritated and angry now than you used to be?’

‘Yes. Because I’m fed up with not being able to do what I want,’ Jacob retorted.

Dr Shah was nodding. ‘Exactly my feeling.’ He returned his gaze to Elizabeth. ‘This is about the emotional effects of a long-term life-threatening illness followed by major surgery and months of convalescing. In some patients the drugs can cause physical symptoms like stomach cramps – but Jacob isn’t saying that. Let me assure you that the drugs prescribed are not responsible for any change in Jacob’s level of patience. Personally I think he is coping remarkably well.’ He smiled at Elizabeth, condescendingly she thought, before continuing. ‘Jacob is a young man, full of zest and with a vitality for life. Of course he’s going to feel a bit fed up and irritable. That’s natural, and it will improve and go with time, I’m sure.’ Then to Jacob he said, ‘You’re not feeling depressed are you? If so, I can give you something for that.’

Not more pills, Elizabeth thought, but Jacob was shaking his head. ‘No, I’m not depressed,’ he confirmed.

‘Good,’ Dr Shah said. ‘I think it would help if you start regaining your independence as long as you don’t overdo it. So by all means start driving again. Another month or so and you’ll be back to your old self – indeed fitter with your new heart. Then we can start talking about you returning to work.’

‘Fantastic,’ Jacob said.

‘And, as your mother has brought up the subject of changes in personality,’ Dr Shah continued, ‘you can disregard all that stuff and nonsense you read from time to time in the tabloid press about transplant patients taking on some of the likes and dislikes of the donor. It’s fanciful nonsense that sells newspapers, nothing more. The heart is an organ like any other. It pumps blood around the body. And although we attribute emotion to the heart – Valentine cards and the like – you can’t transplant personality or emotion.’ He laughed at the ludicrousness of the suggestion. Elizabeth smiled weakly and felt a complete fool. Jacob smirked. He was enjoying this, she thought, although he didn’t say anything until they’d left the consulting room.

‘You’ll have to do better than that,’ he sneered as they walked quickly down the corridor together. ‘You and Dad need to get off my case.’ He strode away from her and Elizabeth had to run to catch up with him.

‘Jacob, we’re only concerned for you.’

‘Well, don’t be! Go and smother someone else. I don’t need all your concern, it’s suffocating.’ A passer-by glanced at them.

She followed him through the revolving door out of the hospital. He stopped. ‘I’ve got some things to do in town. I’ll see you later,’ he said, and headed off in the opposite direction to the car.

‘Where are you going?’ she asked, horrified. She ran a few steps to catch up with him. ‘You’re not well enough to be out by yourself.’

He stopped dead. ‘Yes I am. You heard what the doctor said. I need to regain my independence. And where I’m going is none of your business.’ He set off again.

‘But how will you get home?’ she called after him. ‘Shall I wait for you here?’

‘No! For Christ’s sake, no!’ he yelled over his shoulder. ‘I’ll use the buses like everyone else.’ He continued along the pavement towards the main road.

It crossed her mind to run after him but what good would that do? It was likely to make him more angry and she couldn’t physically stop him from going. She wished she could pick him up, put him in the car and take him home as if he were a child. Perhaps she was being overprotective, although she was sure the doctor hadn’t meant this when he’d said he could start regaining his independence by driving a little. Fearing for his safety, she returned to the car to call Andrew for advice. He’d know what to do.

Chapter Thirteen

‘He’s a silly boy,’ Andrew said. ‘What’s he trying to prove?’

‘That he can manage alone and be independent, I suppose,’ Elizabeth offered. ‘But he gets so angry with me. It’s frightening.’ She had yet to tell Andrew what Dr Shah had said about the side effects of the medication having nothing to do with Jacob’s behaviour.

‘I suppose it might do him some good,’ Andrew said reflectively. ‘Make him realize he’s not invincible and he needs us. Try not to worry, I’m sure he’ll phone you soon.’

‘Do you think so?’ Elizabeth asked uncertainly. ‘I am worried.’

‘Once he needs a lift home, he’ll phone. I can’t see him using the buses. It will be an uncomfortably long journey.’

‘I’ll wait around here for a while then,’ she said, only partly reassured.

The ticket had an hour to run and Elizabeth sat in the car with her side window slightly lowered to let in some fresh air, resisting the urge to phone Jacob. She was also thinking about what Dr Shah had said. Not so much about Jacob needing his independence, nor him telling her that the medication wasn’t responsible for Jacob’s behaviour, but what he’d said about cutting the nerves to Jacob’s heart, and that they’d never grow back. She couldn’t remember being told that before the operation but then there’d been so much to take in it might have been mentioned and she’d forgotten. Now his words stuck and resonated with unsettling familiarity, for that was exactly what if felt like to her – the nerves to Jacob’s heart had been cut, severing emotion. Denervation, Dr Shah had called it. He’d said that it was nothing to worry about, part of the procedure, and had no negative after-effects. But how could he be sure? Doctors didn’t know everything. They didn’t get it right all the time. She checked her phone for messages – there were none – and then googled denervation.

A surprisingly long list of websites offering information on denervation appeared and opening the first, she quickly learned that radio-frequency denervation was most commonly used to treat chronic back pain. The nerves around the joints in the back were deactivated, thus alleviating the symptoms. But this wasn’t the denervation Jacob had had and she googled again, this time typing in denervation and heart transplants

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