Left You Dead

57

‘Hello my name is Nadine’ greeted Roy and Cleo Grace in the Intensive Care reception and led them straight back into the Relatives’ Room. She deflected their questions on how Bruno had fared overnight with a pleasant but non-committal, ‘Dr Williams, the Intensive Care consultant, will be briefing you on Bruno’s condition. I can tell you that he had a comfortable night after surgery, with no dramatic changes.’

She offered, as before, to get them drinks and — as if it was Groundhog Day, Roy thought — returned a short while later with a glass of water for Cleo and a coffee with an extra shot of espresso for him, then left them alone.

Cleo squeezed his hand. ‘Maybe he’s improved overnight,’ she said.

‘Then he can go home and murder more hens?’ Immediately, Grace, who was feeling tired and fractious, regretted saying that. ‘I’m sorry, darling, that was insensitive. I didn’t mean it that way, we don’t even know for sure it was him.’

She gave him a look, a gentle, knowing smile that said, Yes, sadly, we do.

Five minutes later, as they entered the curtained-off area, Roy Grace reeled with shock at the sight of Bruno. He looked even smaller and even more dwarfed by all the technology around him than before. But it wasn’t this which gripped his gullet and twisted his gut. It was the sight of the bolt sticking out of the top of the small boy’s head. He had to pinch his mouth with his hand to stop himself from crying out.

From the corner of his eye, he could see that Cleo, who was used to the most terrible sights daily in her work, was shocked too.

The intracranial bolt the consultant had talked about was just exactly that. Somehow he’d been expecting something else — although he didn’t know what. Just something tiny taped to his skull, perhaps. But not this.

It was a proper shiny bolt, with a nut, and a cable coming off it to a black box with a digital display. It was the kind of nut and bolt you might see on a radiator or a bicycle wheel.

The display was giving a reading of fifty-seven.

‘Hi, Bruno,’ he said, trying to sound cheerful. ‘It’s your dad and Cleo here.’ He knelt and kissed his son’s cold, clammy cheek, stroked his forehead and then held his right hand, which was limp and tiny. ‘How are you doing, soldier?’

He studied Bruno’s face intently, but there was no flicker of reaction, his eyes firmly closed. Just a faint motion of his chest as he breathed.

Glancing around, he saw that the doctor had quietly retreated, leaving them alone.

‘Hello, darling,’ Cleo said. She kissed Bruno too, and took his other hand and held it tightly. ‘Your dad and I are here. Can you hear us?’

There was still no reaction.

They sat down in the two chairs beside the bed and talked to him for ten minutes, about school, about Humphrey, about how he was getting on with his computer games, and about the app TikTok.

After a while, the consultant returned. In a quiet voice he invited them to come out for a chat. They returned to the Relatives’ Room and sat back down.

‘This induced coma, he’s still in it?’ Grace asked.

Williams shook his head. ‘No, we ended that early last night. We’ve removed all of his sedation and drugs that would keep him asleep. This is how he is. Did you feel he responded to you at all?’

Grace looked at Cleo. She shook her head.

‘No, he didn’t give any indication,’ he said.

‘I’m afraid, honestly, you’re not going to get any reaction from him.’ Williams paused. ‘You obviously saw the intracranial bolt.’

‘It’s not a good look,’ Grace said, attempting the merest trace of humour. ‘Something out of Frankenstein.’

The consultant continued his sympathetic expression, nodding. ‘It performs an essential task of telling us the pressure inside his skull. I know it was explained to you earlier, but the higher the pressure from the swelling brain, the more it crushes the vital brainstem. In a normal, healthy brain, a reading of five to fifteen millimetres of mercury is normal. We consider badly raised pressure to be above twenty-five.’ He hesitated a moment, then said, ‘As you may have seen, Bruno’s current reading is fifty-seven, and it is rising steadily.’

Cleo was about to reply when the door opened and they were joined by two women in regular clothes. One was in her fifties with an earnest expression and reminded Roy of the actress Helena Bonham-Carter; the other, twenty years her junior, had a slim figure, a tangled frizz of bleached hair and striking features.

‘Mr and Mrs Grace,’ Williams said, a little stiffly, ‘if I could introduce Imelda Bray, our resident counsellor, and Charlotte Elizabeth, who is our transplant coordinator.’

‘Excuse me, who?’ Grace said, looking confused.

‘Ladies, I wasn’t expecting you just yet,’ Williams said testily, as if frustrated by the interruption.

They stood there looking a little embarrassed.

Williams turned back to Roy and Cleo. ‘I’m afraid there has been no improvement in your son’s condition — in fact, it’s got quite a lot worse.’

‘Jesus, what? Does that mean he has any chance at all of pulling through?’ Cleo asked desperately.

Williams looked as though his shoulders had suddenly become heavy. ‘I’m so sorry.’

‘What do you mean worse? I didn’t think it could get any worse.’ Roy choked out the words and looked at the two women. ‘I’m sorry, who are you again? What are you doing here?’

‘Can we go back to Bruno now?’ Cleo pleaded.

‘Just a moment, please. I need you both to focus on what I’m saying. I’m afraid we are not going to see any improvement in your son’s condition. He is stable at this moment, but he is, sadly, brain dead and is not going to get better — there is no chance of recovery. I’ve had his diagnosis verified independently by one of my colleagues — a neurosurgeon — who has not been involved with your son’s care. He has examined Bruno and has confirmed that your son is brain dead. We have run the tests and studied his CT and MRI. He has rising intracranial pressure and a Glasgow Coma Score of three, with no sedation.’

‘Oh God, will you just let us see him?’ Cleo asked, crying.

‘Of course. But I just need to take a couple of minutes to explain who these two people are and what they can do for you.’

‘Are there any other possible outcomes, Dr Williams?’ Cleo asked through her tears.

‘I’m afraid not. I can always get a third opinion, and arrange for further tests to be carried out as soon as possible, so you can have another professional diagnosis. I’d be quite happy to do that. But I don’t feel it will give you the answers you are hoping for. I am sorry but I am certain that your son will not recover.’ He smiled apologetically, gesturing helplessly with his arms. ‘I wish so much that I could give you more positive news.’

‘We do appreciate your honesty, it’s just so hard to take this all in,’ Roy said, his voice trembling. ‘I can’t believe that’s it. Nothing anyone can do. Yesterday morning I dropped him at school alive and well, and now, nothing at all anyone can do.’ He paused and wiped his eyes with the back of his hand, then looked at Cleo before turning back to the consultant. ‘But I do trust your advice, we don’t need another opinion and more tests. We know we’re in a hopeless situation.’

Williams gestured to the two women still waiting near the door, and stood.

‘I thought it would be helpful for you to meet Imelda and Charlotte at this stage, because we may have to move quite quickly.’

‘Meaning what, exactly?’ Grace asked.

Looking genuinely like he felt their agony, Williams said, ‘If you were to consider organ donation, we would have to carry that out soon after a diagnosis of brain death.’

Neither Roy nor Cleo replied. They both just looked at him.

‘If you decide it is something you might consider, Imelda is here to help you deal emotionally with that decision. Charlotte will be able to discuss with you the options regarding organ donation — and I want to stress on her behalf that you absolutely do not have to go down that route if you don’t want to. But, I’m sorry to say, the reality is that our technology can only support Bruno for so long.’

Grace stared up at him, then at the faces of the two women. Then back at Williams. ‘I thought you could keep someone on life support indefinitely?’ Grace said, his voice sounding very small suddenly.

‘Yes...’ Cleo added, clinging on to any flicker of hope. ‘You do hear stories of people in a persistent vegetative state, who make a recovery, sometimes months on, don’t you? Sometimes years on? Mel, the nurse, said yesterday that she’d seen people make a complete recovery.’

‘It does happen, yes,’ the consultant said. ‘But not in this case. We can keep his body technically alive for a while, but Bruno has zero brain activity. If we turn off his life support, he will quietly slip away as his vital organs fail and then we could not use his organs for donation.’

Grace looked up at all three of them and then at Cleo. She squeezed his hand again. ‘So, Doctor — and Imelda and Charlotte — if this was your child, what would any of you do?’

They looked at each other. Then Charlotte Elizabeth said, ‘Three people die in the UK every day waiting for a liver transplant, many of them children and teenagers. The figures are similar for heart and lung transplants. I’ve seen just how much parents of children in Bruno’s situation are comforted by knowing their organs have been given to help other people live. But I would never morally blackmail anyone into agreeing to this. It is an immensely personal decision that you have to make.’

‘It’s really my husband’s decision as Bruno is his son by his previous marriage,’ Cleo said. ‘But what organs would you want to take — harvest?’

‘That would be entirely up to you,’ Elizabeth said, looking at Grace. ‘You could give a part donation, such as heart, lungs, liver and kidneys, or a more full donation, which would include his eyes to help blind people see again, skin, bones, bone marrow.’

‘If,’ Roy Grace said, ‘and only if I agreed, would there be any difference to Bruno whether it was a partial or total donation?’

She gave him a deeply sympathetic and understanding smile. ‘The only difference would be in the number of people he could help.’

‘Is there the remotest danger Bruno would feel anything? Like, pain?’

Charlotte Elizabeth shook her head. ‘It’s a good question and let me assure you that Bruno would absolutely not feel any pain at all. I could explain the process, if you would like?’

Both of them nodded.

‘The first thing to do is perform tests to confirm the brainstem is dead, which we have done. Then the transplant team would want to harvest the organs as soon as possible, after testing they are in good condition. It’s a difficult job but they are really skilled at it. At the same time, the team would be starting to look for suitable recipients, who could be anywhere in Europe. Once they’ve been identified, whether within the UK or on the continent, teams would motorbike or fly in for the relevant parts and rush them to hospitals where the recipients would already be anaesthetized in anticipation of receiving the transplants.’ She paused for a moment. ‘It would be impossible to overstate just how grateful recipients — and their families — are.’

Grace looked at Cleo and saw the quiet encouragement in her eyes. Then he looked up at the coordinator. ‘If I... we... consented, would we ever find out the names — identities — of the people — who received Bruno’s organs?’

She nodded. ‘We can’t initially tell you any names — that depends on whether they or their families agree. But for sure you would be able to know just how many people — and where — were helped.’

Roy Grace nodded, trying to think clearly through his muzzy brain. ‘I’m sorry if I’m being forgetful, but can we go through the situation again as I understand it?’

‘We all understand how difficult this is for you. For anyone,’ Elizabeth said.

‘Thank you.’ His eyes were misting. ‘So, you need to keep Bruno on life support?’

‘That’s correct, yes,’ Dr Williams said. ‘We could maintain him on that for a short while.’

‘But the moment you took him off the support mechanisms, he would pass away fairly quickly?’

‘Correct, yes.’

‘So all of you agree that Bruno is brain dead?’ Cleo asked, partly resigned, partly disbelievingly, and partly just for it to sink in.

‘I’m afraid so,’ Williams said.

Grace sat in silence for some while, squeezing Cleo’s hand and feeling the pressure back. Thinking.

Sandy had vanished twelve years ago. He’d never even known she was pregnant. The last time he had seen her, she was lying in a High Dependency Unit in hospital in Munich, severely injured after being struck by a taxi, plumbed into a forest of life support and monitoring equipment.

Then she had died and left him with his challenging son, who, until that point, he had never known existed.

And now Bruno was lying, similarly, in England, after being struck by a car.

How had it come to this?

He looked up at Dr Williams, at Imelda Bray, at Charlotte Elizabeth. Like himself, he knew, these people were professionals who dealt with situations like this on a daily business. Just as he himself regularly talked to the loved ones of people who had been brutally murdered, for these three, this was just routine, however much they dressed it up with sympathy and understanding. They could have been door-to-door salespeople, he thought darkly for a moment, trying to flog him a vacuum cleaner or an insurance policy or double glazing. They were trying to sell him the idea of transplants. His son’s organs and other body parts.

Feeling a surge of sadness, which he swallowed back, he asked the consultant, ‘Is it going to make any difference if we agree to it now or in a few hours’ time — or tomorrow?’

‘There is some time pressure for you to consent, Mr Grace. With every hour, as Bruno becomes increasingly unstable, the blood supply to his heart and kidneys, in particular, will lessen and the quality of the organs will suffer. Those organs only remain viable for transplant for a short while, so we always try to arrange transplants for as soon as possible.’

Williams looked at his two colleagues. They both nodded.

‘So,’ Grace said, ‘if we were going to consent to organ donation, the sooner we did it, the more valuable it would be?’

‘That is correct,’ the consultant said.

‘Can we go back and see my son?’ Grace asked.

‘We’ll take you to him now.’

‘May I suggest one thing,’ Grace said solemnly. ‘Out of respect, we don’t talk about Bruno’s condition, or anything to do with possible transplants, in his presence.’

‘Understood,’ said Williams quietly.