One Minute Later

by Susan Lewis

  She gazed blindly out at the passing scenery, unaware of how tightly her hands were clenched, feeling only the huge knot of anxiety in her chest, tightening harshly as her thoughts moved ahead to what lay in store, loosening for the few moments she was able to think of something else. She tried desperately to obliterate the feeling she’d had on leaving Deerwood that she was seeing it for the last time. She understood that nerves had taken hold of her instincts, and fear was painting false and terrifying scenarios in her head. It was to be expected: she was very sick, so of course she’d be torn between an awful, clawing dread and random surges of hope; anyone would, in her position.

  Right at this moment she could feel every living part of her being pulled back to the farm, as though something tangible was stretching and straining over the increasing distance, trying to stop her from going any further. It felt hard to breathe, not just because of the heightened pressure in her lungs, but because of the panic she was trying so hard to control.

  I’m going to die. I know it and I have to face it, but I can’t. I don’t want to leave my beautiful baby. I want to watch him grow up and I want to stay with Josh for ever.

  As her throat locked around the intensity of her fears, and tears stung her eyes, she tried hard to centre herself; to detach from the overwhelming sense of dread and reach for calm and hope.

  Feeling Josh’s hand cover hers, she brought his palm to her cheek and rested against it. He always seemed to understand when she needed physical contact, how important it was for her to draw strength from him. She thought of the song ‘You Raise Me Up’ and how perfectly the words captured everything he did for her. Yes, she could stand on mountains with him, and she could walk on stormy seas, because he made her more than she could ever be without him.

  Now she must be strong for him, and for their precious son who was sleeping quietly in the back.

  Both their mothers, Gil, Mark and David, were following on behind in Gil’s car. Michelle and Sam were coming tomorrow so they could be there too during the surgery, and afterwards when she was brought round. Gina had already booked everyone into a nearby hotel where they’d be staying for the next few days, possibly a week, until Vivi was ready to go home again.

  I will go home. I will, so I must stop thinking I won’t.

  Her emotions brimmed each time she thought of how lucky she was to have so many people around her who cared. It wouldn’t be true for everyone, although she wished it were. Jim had family who loved and cared for him, who had been there to will him through his surgery and the terrifying time after when it had taken so long to bring him round. She wouldn’t think about the complications he’d endured, they weren’t relevant to her, he kept reminding her, because she didn’t already have a VAD that had to be removed from the tissue that had grown around it.

  It was the middle of the afternoon by the time Josh brought his grandfather’s new Volvo to a halt outside the hospital’s main entrance, and while David came to take over the driver’s seat Josh went inside to fetch a wheelchair for Vivi. She didn’t need one, she insisted, but Josh’s expression made her sit into it anyway, and she was grateful to feel it taking her weight. She watched her mother go to lift the still sleeping baby out of the back seat and bring him over for a kiss. Vivi knew he was going to be thoroughly spoiled while she was here, which was fine, just as long as they brought him to see her every day, and of course they would.

  So there really was no need for the tears burning her eyes, or the sobs that were trying so hard to tear themselves free from her chest. She was going to see Jack again in no time at all, and before she knew it they’d all be on their way home.

  Feeling Josh’s hand on her shoulder, she put her own over it and looked up at him. ‘Ready?’ she said with a smile that was meant to bolster them both.

  ‘Ready,’ he said, matching her tone.

  They were welcomed in reception by Angela, the VAD nurse they’d met several times already, a plump, energetic woman with a no-nonsense manner and kindly eyes. As she led the way through to the ward, glancing over her shoulder as she spoke, she was explaining once again that either she, or one of her team, would be on call through the night to answer any questions Vivi might have, or to help in any way she needed.

  The room that was to be hers for the next few days, apart from when she was in theatre, of course, and during the immediate recovery period in ICU, was on the second floor of the west wing. It was a private room that Gil had insisted on paying for, with a large window looking out to the gardens where other people with heart conditions, young and old, were taking slow walks with their loved ones, while small children who didn’t understand what was happening played catch.

  While Angela went off to organize some tea, Josh helped Vivi out of the wheelchair and pulled her gently into his arms. She looked around the room. There was a TV on the wall, a small bathroom in one corner and a complicated-looking adjustable bed.

  ‘OK?’ he whispered.

  She smiled and tilted her mouth up for a kiss. ‘Do you think I should get undressed already?’ she asked. Then added wryly, ‘That’s the trouble when I’m around you and there’s a bed nearby, I can’t wait to get my kit off.’

  Laughing, he said, ‘Why don’t you just lie down for a while? You’re probably tired after the journey.’

  She was, and yes she wanted to lie down, so she let him help her onto the bed and watched him draw up a leather chair with wooden arms to be close to her.

  ‘It feels vaguely surreal being here,’ she said, ‘even though we knew it was coming.’

  He nodded agreement, as if he too wasn’t properly connecting to reality. ‘The good part of it is,’ he said, ‘we could be on our way home again in a couple of days.’

  Liking the sound of that she clasped his hand and gave it a squeeze, glad he’d decided to forecast the shortest time she was likely to be here. The longest was about a week, maybe a few more days if something didn’t go as planned. ‘Matias Velez should be here to talk to us soon,’ she said, referring to the surgeon they’d spoken to at length during their preparatory visits. He’d promised to come and see her the day before the surgery and now that day was here. As her insides churned with a sickening onslaught of nerves she said, ‘Can you think of anything else to ask him?’

  Josh shook his head. ‘Nothing we haven’t asked already, but it won’t hurt if we need to ask it again.’

  Vivi looked up as another familiar face – Rosamie, one of two Filipinos on Angela’s team – came in with a tray of tea and set it down on a table beside the bed. After greeting Vivi with a hug and a kiss, the same for Josh, she said, ‘I’ll be back shortly to start filling in the pre-op forms. They’re pretty standard, so nothing to worry about. Is there anything you’d like to ask now?’

  ‘Will my family be allowed to come in later?’ Vivi said. ‘Our little boy is with them, and I’d like to see him before he goes to bed.’

  The nurse broke into a smile. ‘We’ve all been looking forward to meeting him, so of course he can come.’

  Wryly, Vivi said, ‘Provided he’s not hungry or sleepy he’ll be happy to meet you too. He’s very sociable, just like his daddy.’

  Josh gave a comical shrug, as if to say is it my fault it’s in the genes?, and began to pour the tea.

  ‘No more solids after these biscuits,’ Rosamie cautioned. ‘Remember, your surgery’s scheduled for eight tomorrow morning.’

  Although Vivi already knew that, she felt her mouth turn dry. A bolt of fear surged through her as though to rip every last shred of hope and confidence from her failing spirits. She wouldn’t be able to eat even if she wanted to; she could barely even breathe as she struggled to stop the panic doing its worst.

  After Rosamie had gone Vivi said, ‘I think we’ve had enough now. Can you get me out of here?’

  Smiling, Josh said, ‘I will, just as soon as …’

  ‘OK, I know what you’re going to say, that it can happen as soon as everything’s …’ She took a breath. ‘I
don’t want to have the op, Josh, I just want to go home – I’m sorry, I know it doesn’t help to hear me say that, but can you at least get me some Valium? I’m tearing myself to pieces here.’

  After going outside to talk to the nurses, he returned with two white pills and helped her to sit up while she washed them down. Their effect seemed to be almost instant, although she realized that was more psychological than physical.

  As she lay back against the pillow Josh held her hands and coaxed her through some breathing exercises, taking air in slowly, counting to five and gently releasing it. She looked around the room, holding tightly to him, and began to feel weirdly as though she was caught in a dream. Reality was fading again, just like when they’d arrived, only now it was going too far away.

  Realizing the tranquillizers were making her light-headed, she pointed to her oxygen supply and lay still as Josh connected it to her nasal specs. It took only a few minutes for her senses to stabilize, and to her relief there was less panic charging around her system now.

  She wasn’t going to die. She’d get through this like everyone else, and by the time Jack took his first steps she’d have forgotten all about how afraid she was on this day that she’d never see them.

  They looked up as Matias Velez came in. He was a slight, swarthy man of around fifty with short silver hair and hawkish eyes – and hands that Vivi had decided on first meeting were reassuringly as she’d want a surgeon’s to be, clean, strong, not too big, and lean.

  ‘Hi, you guys,’ he said cheerfully, shaking hands with Josh and coming to perch on the end of the bed. His manner was so casual and friendly he might have been an old friend dropping in for a chat while passing, rather than someone who was going to break open her chest tomorrow and perform a major surgery on the most vital part of her body.

  He didn’t seem worried, so she shouldn’t be either.

  ‘How was the journey here?’ he asked, and grimaced before she could answer. ‘Don’t tell me, it was awful and you spent every minute of it wishing you could turn around and go home. Well, don’t worry, you’ll be making that trip soon enough. Luckily for you we’re a lot more experienced at carrying out the VAD ops now than we were a few years ago, so you shouldn’t be here for long. Also good to know is I’ll have one of the top teams working with me so you’re going to be in very safe hands.’ He smiled as he turned his over as if to prove it.

  Vivi smiled too, appreciating his understanding of her nerves and the way he was trying to calm them.

  Then he said, ‘We’ve already talked about possible complications – stroke, bleeds, cognitive impairment, so we don’t need to go there again. Today is all about thinking positively and focusing on how much better your other organs will function once the VAD is in place, and how much stronger you’ll feel.’

  Wishing he hadn’t mentioned the complications, Vivi said, ‘The operation will take four hours, is that right?’

  ‘It could be longer,’ he replied. ‘It all depends what we find when we go in, but, as you haven’t had any previous surgeries on this leaky valve of yours, I’m not expecting any surprises.’ He smiled and continued, ‘The main issue with you right now, as you know, is your pulmonary artery pressure; it’s far too high and we need to get it down. I had a guy just a couple of weeks ago whose reading was around sixty, slightly lower than yours, and by the time he was lifted from the operating table with the VAD in place it had already dropped to thirty. So it’s not only effective, it’s fast.’

  Josh said, ‘How old was this man?’

  ‘A lot older than Vivienne,’ Velez replied, ‘so we’ll expect to see similar, if not even better results by the time she’s in recovery tomorrow.’

  Taking courage from that, Vivi said, ‘I’ve read … Actually, I think I asked this before, but will the VAD prevent me from having a transplant in the future?’

  His answer was swift and frank. ‘Yes, if it performs well for you. As you know, we get very few hearts for transplant, so you’ll inevitably go to the bottom of the list if the VAD is doing its job. This isn’t to say a transplant can’t happen; if it’s the right heart for you and it isn’t suitable for someone on the urgent list it could be yours. It’s a bit of a lottery, I’m afraid.’ His expression sobered as he said, ‘What happened to you, when you were called for transplant and it didn’t work out, was very unfortunate. It’s not so unusual. Some people have even got as far as being anaesthetized ready to receive a new heart before it’s discovered that for one reason or another it can’t happen. It’s very frustrating and distressing. Of course, if that heart had been made available we wouldn’t be sitting here having this conversation, and you’d already be some weeks into recovery with no device, drivelines, or batteries to worry about. However, this is where we are – which isn’t bad, it just isn’t what you’d hoped for.’

  Swallowing drily, Vivi said, ‘And I can live for ten years with a VAD?’

  Velez shrugged. ‘Ten, fifteen, maybe longer. There’s a lot of progress being made with this technology, especially in the States, so I’d say, by the time you’re ready for a new pump, several years down the line, something even better will be available. Which isn’t to say there’s any reason to lack confidence in the Heartmate III – this is what we’re giving you tomorrow – because it’s bang up to date, and has performed excellently in all clinical trials, as well as for the people who currently have them.’

  Vivi nodded slowly, knowing this was what Jim had now, and willing herself to feel pleased, or at least reassured.

  Josh said, ‘And device maintenance?’

  ‘Everything will be explained to you before you leave the hospital, but you can take it from me that your iPhone is way more complicated. An important factor will be keeping the driveline clean so it doesn’t become infected. How you carry all the paraphernalia that goes with it, the batteries and computer, will be up to you. Most women use a kind of backpack, which makes the weight easier to deal with, and it doesn’t get so much in the way.’

  ‘What about charging the batteries?’ Josh asked.

  Vivi knew he was confident about this procedure, and had read up on it more times than she had, so going over it with the surgeon again was no doubt his way of drumming it into her.

  As Velez answered, she felt her mind drifting, needing to break free of the words in search of a place that had no definition, no contact at all with what was being said, or what was going to happen tomorrow. She knew Josh would continue to listen, and because he was a surgeon himself he’d understand it all far better than she could. He was merely double-checking what to do if the pump failed, how possible it was for a blood clot to occur before, during or after surgery …

  There were so many dangers, and he needed to prepare for them all. She did too, and she guessed she’d get used to having to connect to the mains each night, keeping a constant check on the heavy batteries, and to the pain that no one had discussed much, but she knew about it because Jim had told her.

  She must have fallen asleep, because when she opened her eyes Velez had gone and only Josh was there. She thought he was sleeping too, until she realized he was watching her, and they both smiled and reached for each other’s hands.

  ‘They’ll be here soon to start your pre-surgery checks,’ he told her. ‘Apparently it’s nothing you haven’t experienced before, all quite painless, and after that the family will be able to visit. Do you think you’re up to it?’

  ‘Of course,’ she replied. ‘I want to see my boy.’

  His eyes shone with love and concern as he regarded her carefully. She looked at him too, taking in how handsome and strong he was, how steadfast and brave. He deserved so much more than this: someone who could properly share his life and his dreams, someone whose heart was able to beat as freely and passionately as his. She wondered if he had any regrets, if deep down he wished they’d never met …

  He said, ‘Tell me what you’re thinking.’

  She felt her insides clench as she pulled away from the t
ruth, for she didn’t want to admit that the fear was back, the dreaded certainty that something would go wrong tomorrow. Nor did she want to ask about regrets; he’d never admit to them if he had any, and if she weren’t feeling so sorry for herself she’d know that the only one he had was that she had to go through this.

  In the end, she said, ‘I want you to know that the most important thing this pump will do to my heart is make it strong enough for me to love you even more than I do already.’

  His eyebrows rose sardonically. ‘I wouldn’t have thought that was possible,’ he teased.

  Tightening the hold on his hand, she said, ‘No, maybe it isn’t.’

  Everyone visited that night, grouping around the bed and making a fuss of Jack, who enjoyed every moment of the limelight. It was an easy way to avoid discussing tomorrow’s surgery, for Josh had already warned them that Vivi didn’t want to think about it while they were with her. There would be plenty of time when they’d gone – and early tomorrow, before she was taken to theatre. This was provided she slept; more likely she’d be awake all night, worrying and crying and trying desperately to rid herself of the fear that she’d seen her family for the last time.

  She didn’t want to leave them. She didn’t want to imagine their grief, or the empty space she’d create in their lives, or how it would close as the years passed and they carried on without her.

  When it was time for the visit to end Josh came to take the baby from her, and as he lifted him up in his arms she knew that if she’d had the strength she’d have tried to take him back. Jack’s face was rosy, his dark eyes bright with interest and excitement as his little head flopped onto his father’s shoulder and his fist remained clamped around her finger.