After the End – Clare Mackintosh

Leila looks around the courtroom. Only the handful of press given permission to attend are moving, their pens making swift marks in shorthand, recording every word the judge speaks. Everyone else is quite still—watching, waiting—and Leila has the strange sensation of being frozen in time, that they might all wake, a year from now, and they will still be here in this courtroom, waiting for the ruling that will change so many lives. Leila swallows. If it is this hard for her, how impossible must it be for Pip and Max to listen to the judge’s words? To know that in a few moments they will hear their son’s fate? Before the break, Max and Pip Adams were sitting at opposite ends of the long bench seat behind their legal teams. They are still on the bench, but the distance between them has contracted, and now they are sitting close enough to touch each other. In fact, as Leila watches, and as the judge draws closer to his ruling, she sees movement. She could not say if Max moved first, or Pip. She can’t be certain they even know they are doing it. But as she watches, two hands venture slowly across the noman’s-land between them, and find each other. Dylan’s parents hold hands. The judge speaks. And a courtroom holds its breath. before one Pip Dylan was six hours old when I noticed a mark behind his left ear the size of a thumbprint. I lay on one side, watching him, my free arm curled protectively across his body.

I watched his perfect lips quiver a breath, and I traced my gaze across his cheeks and round the whorls of ears still too new to have found their shape. And then I saw a thumbprint the colour of milky tea, and I smiled because here was something totally new and yet completely familiar. “He’s got your birthmark.” I showed Max, who said He’s definitely mine, then, and tiredness and euphoria made us laugh so much the nurse popped her head round the curtains to ask what was the commotion. And when Max had to leave, and the lights were turned low, I touched the tip of my finger to the milky-tea mark that linked the two people I loved more than anything else in the world, and thought that life could never get more perfect. There’s a low keening from somewhere on the ward; an accompanying murmur from a parent up as late as I am. I hear the squeak of rubber shoes in the corridor, and the bubble of the water cooler releasing a dose, before the shoes take it back to the ward. I rest a hand gently on Dylan’s forehead, and stroke it upwards. His hair is growing back in fair wisps, like when he was a baby, and I wonder if it’ll still be curly. I wonder if it’ll turn brown again, like it did when he hit two.

I trace a finger down his nose, careful not to touch the narrow tube that snakes into one nostril and into his stomach. The endotracheal tube is wider than the feeding one. It pushes between Dylan’s lips, held in place by two wide strips of tape, one across his chin, and one above his lips. At Christmas we brought in the sticky moustaches that fell from our novelty crackers, and chose the curliest, most extravagant for Dylan. And for a few days, until the tape grew grubby and needed changing, our almost-three-year-old boy made everyone around him smile again. “Is it OK to touch him?” I look across the room, to where the new boy is; to where his mother, anxious and uncertain, hovers by her son’s bed. “Of course.” The charge nurse, Cheryl, smiles encouragingly. “Hold his hand, give him a cuddle. Talk to him.

” There are always at least two nurses in here, and they change all the time, but Cheryl is my favourite. She has such a calming manner I’m convinced her patients get better just from being in her presence. There are three children in this room: eight-month-old Darcy Bradford, my Dylan, and the new boy. The name Liam Slater is written in marker pen on the card stuck to the end of his bed. If the children are well enough when they’re admitted to intensive care, they get to choose an animal sticker. They do the same on the nameplates above the pegs at Dylan’s daycare. I chose a cat for him. Dylan loves cats. He’ll stroke them oh so gently, and widen his eyes like it’s the first time he’s felt something so soft. Once a big ginger tom scratched him, and Dylan’s mouth formed a perfect circle of shock and dismay, before his face crumpled into tears.

I felt a wave of sadness that he would forever now be wary of something that had brought him so much joy. “I don’t know what to say,” whispers Liam’s mum. Butterfly breaths flutter her throat. Her son is bigger than Dylan—he must be at school already—with a snub nose and freckles, and hair left long on top. Two thin lines are shaved into the side, above his ear. “Pretty cool haircut,” I say. “Apparently everyone else’s parents let them.” She rolls her eyes but it’s a pale imitation of a mother’s frustration. I play along, giving a mock grimace. “Oh dear—I’ve got all this to come.

” I smile. “I’m Pip, and this is Dylan.” “Nikki. And Liam.” Her voice wobbles on his name. “I wish Connor was here.” “Your husband? Will he be back tomorrow?” “He’s getting the train. They get picked up, you see, on a Monday morning, and brought back on Friday. They stay on-site during the week.” “Builder?” “Plasterer.

Big job at Gatwick airport.” She stares at Liam, her face ashen. I know that feeling: that fear, made a hundred times worse by the stillness of the ward. There’s a different atmosphere on the cancer ward. Kids up and down the corridors, in the playroom, toys all over the place. The older ones doing maths with the education team, physios helping reluctant limbs behave. You’re still worried, of course you are—Christ, you’re terrified—but . it’s different, that’s all. Noisier, brighter. More hopeful.

“Back again?” the nurses would say when they saw us. Soft eyes would meet mine, carrying a second conversation above the lighthearted banter. I’m sorry this is happening. You’re doing so well. It’ll be OK. “You must like it here, Dylan!” And the funny thing was, he really did. His face would light up at the familiar faces, and if his legs were working he’d run down the corridor to the playroom and seek out the big box of Duplo, and if you saw him from a distance, intent on his tower, you’d never know he had a brain tumour. Up close, you’d know. Up close you’d see a curve like the hook of a coat hanger, across the left side of his head, where the surgeons cut him open and removed a piece of bone so they could get at the tumour. Up close you’d see the hollows around his eyes and the waxy tone of skin starved of red blood cells.

Up close, if you passed us in the street, you’d flinch before you could stop yourself. No one flinched in the children’s ward. Dylan was one of dozens of children bearing the wounds of a war not yet won. Maybe that’s why he liked it there: he fitted in. I liked it, too. I liked my pull-out bed, right next to Dylan’s, where I slept better than I did at home, because here, all I had to do was press a button, and someone would come running. Someone who wouldn’t panic if Dylan pulled out his Hickman line; someone to reassure me that the sores in his mouth would heal with time; to smile gently and say that bruising was quite normal following chemo. No one panicked when I pressed the button that last time, but they didn’t smile, either. “Pneumonitis,” the doctor said. She’d been there for the first chemo cycle, when Max and I fought tears and told each other to be brave for Dylan, and we’d seen her on each cycle since; a constant over the four months we’d spent in and out of hospital.

“Chemotherapy can cause inflammation in the lungs—that’s what’s making it hard for him to breathe.” “But the last cycle was September.” It was the end of October. What was left of the tumour after surgery wasn’t getting any bigger; we’d finished the chemo; Dylan should have been getting better, not worse. “Symptoms can develop months afterwards, in some cases. Oxygen, please.” This last was directed to the nurse, who was already unwrapping a mask. Two days later Dylan was transferred to paediatric intensive care on a ventilator. The atmosphere in PICU is different. Everything’s quiet.

Serious. You get used to it. You can get used to anything. But it’s still hard. Nikki looks up. I follow her gaze to where it rests on Dylan, and for a second I see my boy through her eyes. I see his pale, clammy skin, the cannulas in both arms, and the wires that snake across his bare chest. I see his hair, thin and uneven. Dylan’s eyes flicker beneath their lids, like the tremor of a moth within your cupped hands. Nikki stares.

I know what she’s thinking, although she’d never admit to it. None of us would. She’s thinking: Let that boy be sicker than mine. She sees me watching her and colours, dropping her gaze to the floor. “What are you knitting?” she says. A pair of needles pokes from a ball of sunny yellow yarn in the bag by my feet. “A blanket. For Dylan’s room.” I hold up a completed square. “It was this or a scarf.

I can only do straight lines.” There must be thirty or so squares in my bag, in different shades of yellow, waiting to be stitched together once I have enough to cover a bed. There are a lot of hours to fill when you’re a PICU parent. I brought books in from home at first, only to read the same page a dozen times, and still have no idea what was happening. “What year’s Liam in?” I never ask why kids are in hospital. You pick things up, and often the parents will tell you, but I’d never ask. I ask about school instead, or what team they support. I ask about who they were before they got sick. “Year one. He’s the youngest in his class.

” Nikki’s bottom lip trembles. There’s a blue school sweater stuffed into a carrier bag at her feet. Liam’s wearing a hospital gown they’ll have put on when he was admitted. “You can bring in pyjamas. They let you bring clothes in, but make sure you label them, because they tend to go walkabout.” Cheryl gives a wry smile. “You’ve got enough on your plate without chasing after a lost T-shirt, isn’t that right?” I raise my voice to include Aaron and Yin, the other two nurses on duty, in the conversation. “We’re busy enough, certainly.” Yin smiles at Nikki. “Pip’s right, though, please do bring in clothes from home, and perhaps a favourite toy? Something washable is ideal, because of infection, but if there’s a teddy he particularly loves, of course that’s fine.

” “I’ll bring Boo.” Nikki turns to Liam. “I’ll bring Boo, shall I? You’d like that, wouldn’t you?” Her voice is high and unnatural. It takes practice, speaking to a sedated child. It’s not like they’re sleeping, not like when you creep into their room on your way to bed, to whisper I love you in their ear. When you stand for a moment, looking down at the mess of hair poking out from beneath the duvet, and tell them Good night, sleep tight, don’t let the bedbugs bite. There’s no soft sigh as they hear your voice in their sleep; no echo as they half-wake and mumble a reply. An alarm sounds, a light flashing next to Darcy’s cot. Yin crosses the room, reattaches the oximeter to the baby’s foot, and the alarm stops, Darcy’s oxygen levels reading normal again. I glance at Nikki and see the panic in her eyes.

“Darcy’s a wriggler,” I explain. It’s a while before you stop jumping at every buzzer, every alarm. “Her parents are normally here in the evenings, but it’s their wedding anniversary today. They’ve gone to see a musical.” “Ooh, what are they seeing?” Yin has seen West Side Story eleven times. Pinned to the lanyard around her neck are badges from Phantom, Les Mis, Matilda . “Wicked, I think.” “Oh, that’s brilliant! I saw it with Imogen Sinclair as Glinda. They’ll love it.” Eight-month-old Darcy has meningitis.

Had meningitis: another reason why her parents are having a rare evening away from PICU. They’re finally through the worst. “My husband’s away, too,” I tell Nikki. “He travels a lot, with work.” I turn to Dylan. “Daddy’s missing your big day, isn’t he?” “His birthday?” “Better than a birthday.” I touch the wooden arm of my chair, an instinctive gesture I must do a hundred times a day. I think of all the parents who have sat in this chair before me; of the surreptitious strokes from superstitious fingers. “Dylan’s coming off the ventilator tomorrow.” I look at Cheryl.

“We’ve tried a few times, haven’t we, but this little monkey . Fingers crossed, eh?” “Fingers crossed,” Cheryl says. “Is that a big step forward?” Nikki asks. I grin. “The biggest.” I stand up. “Right, my darling, I’ll be off.” It feels odd, at first, talking like this, with other families all around you. You’re self-conscious. Like making phone calls in an open-plan office, or when you go to the gym for the first time and you think everyone’s looking at you.

They’re not, of course, they’re too busy thinking about their own phone call, their own workout, their own sick child. So, you start talking, and three months later you’re like me—unable to stop. “Nanny’s coming to see you at the weekend—that’ll be nice, won’t it? She’s missed you terribly, but she didn’t want to come anywhere near you, not with that horrible cold she had. Poor Nanny.” It’s become a habit now, this prattling on. I’ll catch myself talking out loud in the car, at the shops, at home; filling the space where See the tractor? and Time for bed and Look with your eyes, Dylan, not your hands should be. They tell you it’s good to talk to the kids. That they find it reassuring to hear Mum and Dad’s voices. I think it’s us who find it reassuring. It’s a reminder of who we were before we were PICU parents.

I drop the side of Dylan’s cot, so I can lean over him, my forearms resting either side of him, and our noses touching. “Eskimo kiss,” I say softly. He never let us forget that final good-night kiss, no matter how many cuddles had been given, how many raspberries blown. “Keemo!” he’d insist, and I’d drop the cot side once more, and lean for a final good night, and he’d press his nose against mine and wrap his fingers around my hair. “Love you, baby boy,” I tell him now. I close my eyes, imagining warm breath on my face, sweet from bedtime milk. Tomorrow, I think. Tomorrow they’ll take out the tube, and this time it won’t go back in. I kiss his forehead and raise the cot side, making sure it clicks safely into place so he can’t fall out. “Night, Cheryl.

Bye, Aaron, Yin. See you tomorrow?” “Off for three days,” Yin says, holding up both hands in a hallelujah. “Oh, so you are—you’re going to visit your sister, aren’t you? Have a lovely time.” I look at Nikki Slater, who has pulled her chair a little closer to her son, so she can rest her head beside his. “Get some rest if you can,” I say gently. “It’s a long road we’re all on.” I say good night to the girls at the nurses’ station, and to Paul, the porter who brought Dylan from the cancer ward to PICU, and who always asks after him. I collect my coat, find my keys, and walk to the car park, where I feed another ten pounds into the ticket machine. You can buy season tickets, if you’re visiting someone in intensive care. I always make sure new parents know about it, because it all adds up, doesn’t it? Especially when you have to bring two cars here, like Max and I often do.

It’s ten pounds to park for twentyfour hours, but they’ll give you a week for twenty quid, or a whole month for forty. I bought the month ticket in November, and again in December, but when January came and I stood by the office with my purse in my hand, I couldn’t bear to ask for another month’s parking. It felt so . defeatist. We wouldn’t be here for another four weeks, surely? Not when Dylan was so much more stable. Frost glitters the tarmac. I scrape the ice off the windscreen with an Aretha Franklin CD case, and put the heating on full blast till the glass clears of mist. By the time I can see, it’s so hot I have to open the window to stop myself from falling asleep. The drive home takes a little over an hour. The hospital has accommodation for parents—three bedsits with tiny kitchens as new as the day they were installed, because who thinks about cooking when your child’s in intensive care? We stayed there for most of November, and then Max had to work, and Dylan was critical but stable, and it felt right to give up the flat for someone who needed it more.

I don’t mind the drive. I stick on one of my programmes and before I know it I’m pulling up on the drive. I’m listening to Bringing Up B, a podcast recorded by a mum who sounds about my age. I don’t know B’s name, only that she has two siblings, she likes piano music and velvet cushions, and she’s profoundly disabled. We’ve known for a few weeks now that Dylan has brain damage, not just from the tumour, but from the surgery required to remove as much of it as possible. Thinking about it makes my chest tighten until I feel as though I’m the one who needs help to breathe, and so listening to Bringing Up B helps me find perspective. B can’t walk. She spends most of her time lying flat on her back, watching the CDs her sisters have strung into a shiny mobile to make rainbows on the ceiling. They collected the CDs from friends, and B’s mum found them ribbon and buttons, and they chattered to B as they argued gently over what should go where. There was laughter in her mum’s voice as she told the story for the thousands of listeners she won’t ever meet, and I wondered how many of them were like me.

How many were listening with tears in their eyes but fire in their hearts, thinking, I can do that. I can be that mum. The house is dark and unloved, the answerphone blinking. A neat pile of post on the table in the hall tells me Mum’s been here, and sure enough, there’s a Tupperware in the fridge marked lasagne and a note by the kettle saying Love you, M & D x. I feel suddenly tearful. My parents live in Kidderminster, where I grew up—more than an hour across Birmingham from the house Max and I bought just outside of Leamington. They visit Dylan at least twice a week, but Mum’s caught one cold after another, and they both decided it would be best to steer clear of PICU for a while. Nevertheless, every few days one or both of them still makes the two-hour round trip to Leamington to make sure their daughter and beloved son-in-law are eating. My parents fell for Max almost as quickly as I had. Mum was charmed by his accent; Dad by the earnest way he promised to take care of their only daughter.

With Max’s relatives all in America, my mum made it her duty to fuss over us both. It’s too late to eat, so I put the lasagne in the freezer with the others, and make a cup of tea to take to bed. I pause in the hall and look around in the shadowy light thrown down from the landing. It had seemed extravagant, buying a four-bedroom house when we only needed two. Future-proofing, Max called it. “We might have a whole football team of children.” “One will do for now!” I’d laughed, finding it hard to visualise Dylan as anything other than an enormous bump that meant I hadn’t seen my feet in weeks. One will do. My breath catches. I open the door to the dining room and lean in the doorway.

This will be Dylan’s new room. The little blue-and-white nursery upstairs was already too babyish for a two-yearold more interested in football than Peter Rabbit; this time last year we were talking about redecorating. This time last year. It feels like another world, and I screw up my eyes against the what-ifs that jab at me with accusing fingers. What if you’d noticed sooner? What if you’d trusted your instincts? What if you hadn’t listened to Max? I open my eyes and distract myself with practicalities. Dylan’s almost three now. He’s easy to carry, but in a few years he’ll be too heavy to take upstairs to bed. In the dining room, there’s space for a wheelchair, a special bed, a hoist if we need one. I imagine a mobile of shiny CDs above Dylan’s bed, dancing rainbows across the ceiling. I close the door, and take my tea to bed.

I message Max. Good day today—sats stable and no sign of infection. Our boy’s a fighter! Fingers crossed for tomorrow x I’m too tired to work out the time difference, or whether Max will already have left Chicago for New York—the last leg of this trip before he comes home. There was a period in my life when I could have told you what time it was anywhere in the world. New York, Tokyo, Helsinki, Sydney. I could have recommended somewhere to eat, told you the exchange rate, suggested a good hotel. The cabin crew in business class aren’t just there to pour drinks and recite the safety briefing. We’re PAs, chefs, tourist guides. Concierges in a five-star hotel. And when the work stopped, the party started.

Dancing, drinking, singing . Whenever I miss the good old days, I remember why I left. I couldn’t do the hours on long-haul once Dylan arrived, not with Max away so much with work, so I swapped my stylish blue uniform for garish polyester, and luxury layovers for budget trips to Benidorm. Full-time for part-time. I didn’t love it, but it didn’t matter. It worked for Dylan. For our family. And then, when Dylan got ill, I stopped. Everything stopped. Now, PICU is my job.

I’m there by seven, before the winter sun makes it across the car park, and I leave long after it’s dark, long after the night staff have come on duty. I take a turn around the hospital grounds midmorning, and again in the afternoon, and I eat my sandwiches in the parents’ room, and the rest of the time I sit with Dylan. Every day, every week the same. Upstairs, I switch on the television. When Max is away the house is too silent, my head too full of the beeps and whirs of intensive care. I find a black-and-white movie and turn down the volume until it’s almost inaudible, and pull my pillow into a Max-shaped lump beside me. Three times they’ve tried to extubate Dylan. Three times he’s crashed and they’ve had to put him back on the ventilator. Tomorrow they’ll try again, and if he can manage on his own—if he can just keep taking breaths . then he’ll be one step closer to coming home.


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