The Secret Within: A totally gripping psychological thriller with a jaw-dropping twist

by Lucy Dawson

  It was my last op of the day that was the big one, and I was grateful to feel my confusion, discomfort, everything else melting from my mind as I scrubbed in. My patient had a bad case of lymphoedema that had caused a build-up of fluid around her waist. Gravity was doing its thing and dragging the skin down so badly she was struggling with basic tasks like urinating, walking and cleaning herself effectively, to say nothing of the recurrent infections she kept getting. Abdominoplasty – or tummy tucks – aren’t normally funded on the NHS and she didn’t meet the usual criteria, being grossly overweight, but I’d fought and fought for her to have her abnormality removed when the Commissioning Groups rejected my request the first time. It went way beyond being a cosmetic issue – it was adversely affecting the quality of her life and I wanted to improve it for her. Plus I was deeply pissed off that they’d said no. Having got my way eventually, I then realised I was actually going to have to get in there and do it. It wasn’t just a case of slicing off a lot of tissue; there were some tasty blood vessels I needed to take care of. Nothing about the op was straightforward, apart from the fact that I might fuck it up and be left with an enormous dead woman on the slab.

  When I finally had her unconscious, I couldn’t help but take a moment to marvel at the sheer expanse of flesh before me. The skin had become crumpled and leathery in appearance, and her navel was so stretched it looked like a vertical letterbox. There were a lot of us in the room and, as ever when we’re under a little bit of pressure, I went into full smooth mode, belying the pre-op panic beneath my own skin. I was smiley, made lots of little jokes, plenty of pleases and thankyous. I started to hum while the anaesthetist, Paul, made some last-minute checks. He wasn’t looking as relaxed as usual either, poor sod. He was going to be glad when we were done and she opened her eyes again.

  ‘Happy to start?’ I asked him, and he nodded.

  ‘Happy, Jim?’ I checked with the surgeon assisting me.

  ‘Ready.’ He gave me the thumbs up. There was nothing for it but to cut. I made my first delicious long slice from hip to hip – wary of straying into her abdominal wall and the internal organs being protected below – to reveal a layer of snow white then yellow fat. It was like watching a painting well up from beneath the surface of a blank canvas as the red threads weaving through the severed tissue began to bead and shine under the theatre lights.

  As ever, the moment I was in, I felt calm. When I was a younger man, the first cut would occasionally trigger a sense of euphoria that would necessitate my needing to lean against the operating table to hide the evidence of my excitement. These days, I experience a much more convenient equilibrium on entry. I made a second incision to free the belly button, and after that it was a question of working through my mental checklist; I separated the tissue quickly but slowed down as I turned my attention to the blood vessels. The last thing I wanted was heavy blood loss. Once they were safely cut and tied, I felt calmer still as I removed the remaining tissue, created a new hole for the navel, painstakingly realigned the abdominals and stitched it all back into place before pulling the skin together. Having closed, I allowed myself a tingle of exhilaration at having got away with it.

  ‘Thank you everyone!’

  We woke her up immediately because of her size, and although she was confused, she asked for her husband. I’d done my bit – now it was over to her. It had been almost four hours, but I’d barely noticed. I really am so much better at functioning in theatre than navigating the far more complex demands of everyday life. But I wasn’t going to think about any of that. I wanted to suggest going for a drink to the team. Usually you can always rely on the anaesthetist to be up for a bit of trouble, but Paul was one of the rare breed who liked to push off back to his family, and while Jim was always polite – as the younger surgeon – I sometimes got the feeling he didn’t much like me or was professionally jealous. Whatever, I was left with no choice but to head home once I’d checked the office and discovered Hamish had cleared off for the day too.

  By the time I arrived back at the empty, dark and cold house, my equanimity had already dissipated. I checked my phone and remembered it was Ben’s swimming night. Wandering into the kitchen, I ate a bit of ham, got myself a beer then mooched back into the sitting room. I couldn’t be arsed to light the fire and only managed ten minutes of Gerard Butler saving the White House before discovering I wasn’t in the mood for that either. I dicked around on my phone for a few minutes, but tiring of that too, threw it down on the sofa. I was restless and considered hitting the gym, only it was now peak after-work time. I’d have to wait for the machines, which would annoy the hell out of me and ruin the workout. I looked around the room, tapping my foot restlessly on the floor, then impulsively jumped up to go and find my laptop.

  Sat at my desk in my study, I started it up, located a file within a file within a file called ‘accounts and expenditure 16–17’, paused and listened carefully to the empty house. Nothing. I was alone. I glanced at my watch. I still had a good hour until they came back.

  I selected a thirty-second film of a half-naked woman, but it was tedious. The next patient had her legs spread. Labiaplasty. Unmoved I clicked on to the next… one of my favourites, who has no idea I look at her whenever I want to. I watched myself examining her, lifting the flesh, remembering how it had felt to touch it at the time… but it wasn’t doing it for me tonight. I sighed tersely and moved on to my most recent addition to the collection: Stefanie.

  It’s always a bonus when the star of the show is someone you know socially. I settled back, watched her come into my consulting room – only to fast forward through the dull talky bit where we had discussed her possible augmentation. I let it start to play as Stef stood up to take off the top half of her clothes, unhooking her bra and sitting on the edge of the couch, ready for me to examine her, while I faffed around washing my hands. Hilariously, because she thought my back was turned, she quickly pinched her nipples to make them erect. I smirked. Yeah, stiff, that made all the difference.

  I watched myself start to inspect her, tracing my finger round the edge of the breast where I was suggesting the implant would fill out the new shape, then laughed – the sound resonating around my empty study – as she immediately picked up my hand and moved it between her legs, the randy bit of old mutton. I bet she doesn’t do that sort of thing for poor old Steve. Handy that she’d worn a skirt too. Almost like she’d planned it. I rolled my eyes and toyed with unzipping my trousers, but found I wasn’t sufficiently interested.

  Instead, I crossed my arms and watched as we began to fuck. She was lying back, legs splayed and eyes closed…

  Nothing. It was no good. I hit pause – just as I winked over my shoulder at the camera lens – sighed and leant forward to pull open my drawer, starting to look around for my blade in among the papers…

  ‘Hello? Dad? Where are you?’

  My heart almost stopped. I slammed the drawer closed and the lid of the laptop down. Luckily, I didn’t even have a semi, so was able to hurry straight out into the hall. Ben was standing there, a multitude of school bags hanging off him, framed by the car headlights beaming in through the open front door. He turned and gave a thumbs up, at which the wheels crunched the gravel before pulling away.

  ‘Mum’s gone to get some milk. She said could you put the lasagne in the oven?’ He began to unload, kicking his shoes off and unzipping his coat.

  ‘What happened to swimming?’ I said, thanking my lucky stars I’d kept it in my pants after all.

  ‘We got a message when we were arriving that the swimming teacher was ill, so…’ He shrugged. ‘Can I play Fortnite?’

  ‘Yeah, sure,’ I said, halfway to the kitchen before catching myself. ‘After you’ve done your homework though.’

  I heard him groan and smiled briefly. And it was ever thus. I located the lasagne, read the instructions and put it on at the right temperature – who says I never cook? – before remembering the laptop. I chucked the food packaging in the bin, before
pausing to fish it out and put it in the recycling, as I’d been instructed to do on numerous occasions, and hastened back to my study.

  ‘Ben? Are you upstairs?’ I shouted, once I was in there. His distant and muffled response was affirmative. I had a clear window. I opened the laptop and winced at the sight of my own naked arse. That would have taken some explaining. I felt my pulse quicken slightly at the thought of being publicly exposed, grabbed my phone, took a quick pic of the laptop screen and sent it through to Hamish via our Snapchat, with the message:

  some new content for you.

  It was by way of an apology for calling him fat earlier. A message pinged back immediately:

  hahahahahaha!

  I smiled. I was forgiven. I could practically hear him running to log in to the practice cameras.

  I deleted the downloaded file on my laptop without a second thought. There would be others. I got up and went to find Ben, who was diligently doing his homework, tapping away on his keyboard. The whole house was nothing but bloody devices.

  ‘Hey buddy, I’m going to jump in the shower. Will you tell Mum the lasagne went in at quarter past when she gets back… Ben?’

  He nodded silently but didn’t look up. I raised my hands in surrender and drifted off. Far be it for me to disturb a genius at work, and God forbid we should have something actually approaching a conversation.

  I stripped off in our en-suite and climbed under the shower, starting to soap myself while contemplating the next few tricky days ahead. I’d packed a bit too much onto the private list, and a former NHS breast cancer patient of mine had popped her tightly permed head back up again. The implants I’d given her had fucked up, and she was scheduled to have them removed on Friday – my private surgery day – so I wasn’t going to be around to correct my own work. While her implants going wrong wasn’t my fault, I was uneasy that I hadn’t taken enough of the surrounding tissue when I’d removed the bulk of the cancer during her original op. At the time, I knew I’d rushed it, but had put it from my mind, given that there was just enough of a border and the chemo would probably catch anything that was still there. It was a worry that my carelessness might be about to bite back, depending on who was down to do her op. If it was Hamish, I’d be fine. Julia, on the other hand…

  And there she was. Back in my head, holding out my coffee.

  I carried on cleaning myself. Her smile… I exhaled, closed my eyes and saw myself removing her clothes, rather than via Stefanie’s brazen manoeuvres. I tried to focus on Stef instead, only for Julia to return. I was kissing her – it was all practically virginal – but then… I pictured us in bed; me on top of her, moving slowly, an expression of wonder and rapture on that angelic face of hers. An intensity crept up on me out of nowhere. I exhaled with a gasp of surprise and after a second or two, rested my forehead on the wet tiles; the longing of a mere moment ago already having morphed into something pathetic and desperate, post release.

  Still her face swam in my head. Oh, this was not good, not good at all. Hamish was right, she was nothing to look at… but the way she looked at me… shit.

  I must have muttered that aloud because I heard a voice behind me say: ‘Yes, that about covers it.’

  I half jerked round, my back still to the door, to see my wife standing there, watching me, arms folded in disgust. ‘I’ve just come back to a kitchen full of smoke that your thirteen-year-old son is trying to sort out because you put the lasagne on to grill, not cook. The alarms didn’t go off, so I assume that means you still haven’t replaced the batteries after I asked you to the other day, when you removed them because the “bleeping” was annoying you. But I can see you’re “busy”.’ She shot me another revolted look. ‘So I’ll sort it out, shall I? Ben said he called you, but you didn’t answer him. He’s in tears down there, just so you know.’

  ‘Well, I’m sorry, but perhaps if we had a little more time together, I wouldn’t be up here doing—’ I began defensively.

  ‘Ah, of course,’ she cut in before I could finish. ‘It’s my fault you can’t even put the oven on properly, then snuck up here for a wank.’

  ‘I’m just tired. I didn’t do it on purpose!’

  ‘You accidentally found yourself having a wank?’

  ‘No! The lasagne! I didn’t grill it on purpose. I’ve done a major operation this afternoon – the obese woman. It went well though, thanks for asking. She didn’t die and I think I’ve vastly improved her quality of life, so…’

  She hesitated, regarded me for a moment and sighed tightly. ‘Just get dressed and come down, all right?’

  I heard her calling Ben, jollying him along, asking if he’d like fish fingers and chips instead, as I climbed out and started to dry myself. Winding the towel tightly round my waist, I walked through the bedroom to our dressing room. Looking at myself half-naked in one of the full-length mirrors, I flexed my arms then drew my already flat stomach in further, turning sideways to examine myself in profile. Good for any age, not just my own, but… I leant forward, closer to the glass, inspecting my hairline before looking myself deep in the eyes. I suddenly had one of those hideous moments when you blink and twenty years have passed. The hopeful boy you were only yesterday is – just for a moment – somehow there again, inhabiting your sagging old skin with a sense of disbelief. I reached out and touched the cold glass, then drew my fingertips back and placed them on the lines under my eyes, before running them incredulously down to the sharp stubble on my chin, now flecked with grey… then the boy was gone again and I stared at everything I had become.

  I’d just admonished my wife for not putting out, when I’d shagged someone else the day before we went on our family holiday, in the private practice room she designed for me… and I’d filmed it. I didn’t give a thought to her – or Stefanie. I felt no guilt. I rarely feel anything these days. The older I become, the more I worry I’m not a very nice man at all.

  So how had Julia apparently cut straight to a taut, infected part of me, so deeply buried I hadn’t even known it was there, and simply lanced it? I’d just imagined us, for want of a better phrase, ‘making love’… Christ. I shivered and sat down on the edge of Storm’s cerise velvet chaise lounge, despite hearing her voice in my head telling me to get up because my towel was damp.

  I was already craving that release again. It was akin to the sensations I’d experienced outside the school when Julia held my hand, and in the corridor at work as she passed me the coffee – only on steroids. Just feeling something was exhilarating.

  But why was she doing this to me? It couldn’t be anything as disappointingly predictable and teenage as simply wanting what Hamish had told me not to have?

  On the other hand, that was preferable to fancying myself falling in love on the strength of two meetings lasting mere minutes, as I had done in the car after ‘rescuing’ her.

  I lifted my head and looked in the mirror again. A frightened man stared back at me. Privately struggling with unfamiliar feelings that seemed to have just temporarily overwhelmed me was one thing. The prospect of totally giving in to them, and where that might lead, was quite another.

  It was imperative that I immediately disengage any fanciful notion of ‘feelings’ for Julia Blythe. I wanted to have sex with her – that was all. But now I might not even bother with that. Hamish was wrong – I actually could take it or leave it. I was perfectly capable of walking away and not pursuing Julia Blythe. Then again, I might just do it for the hell of it. Either way, I was in control. No one else. Me.

  Eight

  Julia

  I frowned, looking critically at the bloodied cavity in the chest of the unconscious sixty-year-old woman on the table. ‘Just move the retractor back a bit, please?’

  As one of the team assisting me obliged, I got a better look at what had been cut away during my patient’s last operation. Her cancerous breast tissue had been removed and implants inserted into the space left behind to create volume again. Her body had responded naturally to this foreign o
bject by forming an internal web of scar tissue around the implants. Unfortunately, this pocket had then started to tighten, causing a severe capsular contraction that had deformed her new breasts and left her in a lot of pain. It was unusual for encapsulation to occur only four months after the original surgery and a particularly cruel blow given everything she’d already been through… Her grown-up daughter had been very upset and wanted answers as to why it had happened.

  ‘I read online that too much touching of an implant before it’s put in can raise the risk of infection. Is that true?’ she’d demanded before the surgery. Her mother reminded me of a dinner lady I’d had as a child. Tight, springy grey curls, glasses and fierce demeanour. You held out your plate to her, got what you were given and were thankful for it. Her daughter was cut from the same cloth. ‘So it could be the surgeon’s fault this happened?’

  Litigious alarm bells rang, and aware from her mother’s notes that Nathan had performed her double mastectomy and reconstruction, I chose my words carefully. ‘There are lots of potential causes of encapsulation, but when I remove the implants today, the pain that your mother is currently in, will stop.’ I turned to Mrs Dowden herself. ‘You’ve decided that you don’t want more implants, though?’

  ‘No, I don’t!’ she’d said. ‘I’d rather be flat and get on with it. I’ve got things that need doing.’

  ‘I’ll take good care of you,’ I said and smiled.

  ‘Yes, you do that,’ her daughter remarked, pointedly. Quite the charmer.

  Once I’d got under way, however, I forgot about her attitude and now, with the first of the troublesome implants out, I was almost ready to do the other side. Except I was concerned to see quite so much of the original breast tissue. Still frowning, I began to trim it back carefully, right up to the muscle. While I was sure that Nathan was confident he’d left a safe border, I wouldn’t have been happy with that much remaining in situ had she been my patient – and now she was mine, I thought privately, I was going to be a bit more thorough.