Doctors in hospitals have the weirdest concept of customer-centricity. They give all their patients an appointment at nine and let them simmer for the rest of the day. It’s their way of making sure they won’t ever have to sit idle, waiting for patients who cannot read clocks. Doctors are convinced their time is far more valuable than that of their patients and make no bones about driving that message home.

Richard Willis had been twiddling his thumbs for over three hours in the waiting room before his name was called out. Two weeks ago, he passed out while getting up after dinner. He’d minimised the event, assuring his wife that it was his low blood pressure playing tricks on him. Two days later, he fainted again in an underground train on his way to work. His GP couldn’t find anything wrong with him, but when Richard told him about his headaches and bouts of double vision, he sent his patient to the hospital for an EMR scan. Today, Richard would hear the results of that test.

The specialist waiting for him was a matronly forty-year-old woman with a butch haircut and the wrong colour of lipstick. To Richard’s amazement, she lit a cigarette as he entered the room.

‘Sit down, Mister Willis,’ she said, blowing grey smoke at him. ‘I’ve got some bad news for you. You have an aggressive, stage 4 brain cancer.’

The message hit home with the force of a twenty-pound-head sledgehammer. Even when his GP prescribed the EMR scan, Richard, naively, hadn’t been all too concerned. He had a bit of a headache and sometimes he couldn’t see straight. So what? He could handle that. He worked hard in a stressful job. Sometimes, he felt the strain, but it wasn’t too bad. He was a young, healthy male with a bright future before him. Only six months ago, he’d been promoted to the position of assistant manager. He was the youngest-ever employee in his company who made it to that grade.

‘What?’ was all he managed to say.

The doctor showed him the scan on her monitor.

‘The bastard’s nestled snugly in your brain stem,’ she pointed out. ‘An operation can never completely remove the tumour without irreparably damaging your brain. Despite weeks of radiation therapy sessions, the tumour’s remaining bits will grow again, and you’d be back at square one. The cancer is now half the size of a golf ball. Untreated, it will kill you in two weeks. With surgery, you have two months, but I can tell you right now it’s not worth it.’

‘There’s got to be something you can do,’ Richard stammered, ‘I’m only thirty-two. I’m married with two small children. This shouldn’t be happening to me.’

‘Oh, you’re one of those guys who believe that the universe has to be fair, that you can’t be touched because you’re bright, young, and have kids,’ the doctor sniggered. ‘Doesn’t work that way, Mister. Fairness has nothing to do with it. You bought a bad lottery ticket, and that’s all there’s to it. Plenty of people do. You’re no exception.’

‘This can’t be! You have to help me, doctor,’ Richard pleaded. ‘Please, at least, do something. I don’t care what; I’ll take any risk. Experimental procedures, untested drugs, anything!’

The doctor leaned back, taking a deep pull from her cigarette.

‘Medically speaking, your case is hopeless,’ she told him. ‘There’s nothing I can do about that. There’s an alternative approach I could propose, though.’

‘Tell me! I’ll agree to anything to save my life,’ he begged.

‘The gods need their number, Mister Willis,’ the doctor said. ‘If you want to be saved, you’ll have to give them somebody else. Not just anyone. Someone who’s a close relative of yours. No strangers or aunts-twice-removed. Your wife or one of your kids. A parent or grandparent. A sibling, a brother or sister in law, or one of their children. You and your wife come from large families. You can take your pick. Surely, one of them deserves to live his or her life less than you do?’

Richard was shocked.

‘Is this your idea of a sick joke, Ma’am?’ he asked. ‘This is crazy!’

‘Do you see me laughing, Richard? Do you?’ the doctor said, staring him straight into the eye. ‘A life for a life. That’s the only deal you get.’

She opened one of the drawers in her desk and retrieved a file, which she then opened for Richard’s perusal. It contained a bundle of pictures of a sad, middle-aged woman and two girls in their early twenties. They were his wife, Bessie, and his two daughters, Lexi and Olivia, twenty years older than they were today. Bessie had grown fat and was shabbily dressed. She had bruises on her face and arms. The interior she was sitting in looked worn down. Empty liquor bottles stood on the kitchen counter. His daughters were sporting awful tats on their arms and legs. Lexi even had them on her throat and face. They wore whorish make-up and clothes. He could see the needle marks on their arms.

‘That’s what’ll happen if you die,’ the doctor said. ‘Your family will go straight down the drain. You can still prevent it. Choose life and offer them a better future.’

She dipped in her drawer again and put a plastic-sealed syringe in front of Richard. The syringe was filled with amber fluid.

‘Take this. It’s a poison that doesn’t leave a trace,’ she explained. ‘It acts immediately. No pain. An autopsy will come up with heart failure, end of story. Now, off you go and don’t take too long to decide. In a week, you won’t be able to walk anymore. Clock’s ticking, tick-tock.’

It took Richard two full days coming to grips with the situation. He told his wife the scan didn’t show anything to be worried about and pretended to go to work each morning whereas, in reality, he spent his days sitting on a bench in Regent’s Park. He wasn’t a murderer, he told himself; he wasn’t even a violent person. It was inconceivable he’d plunge a deadly syringe in one of his kin’s neck to buy himself a new lease on life. On the other hand, he was young, and he did have a responsibility towards his wife and daughters. He didn’t want Lexi and Olivia to turn into crack whores. Richard couldn’t get the pictures the doctor had shown him out of his head. After a while, he caught himself reviewing his family members and scoring them on their merits to live or die. He never got along well with his older brother, Frank. Frank was a first-class arsehole, who beat his wife and terrorised his three children. He was an animal. All he knew was how to make other people’s lives miserable. Frank being dead would make a lot of people happier than Frank being alive. Richard owed everything to his parents. Sending him to Cambridge had cost them an arm and a leg, but they never complained. There was no way he’d repay their kindness by sticking the Needle of Death in their veins. His grandmother was another matter. She was an overbearing, whining, mean bitch, who only loved herself. How old was she? Eighty-six or eighty-seven? She hadn’t long to go anyway. Trading in the few remaining years she still had left for a life like his, with such low mileage, seemed like a decent bargain. It’s not as if she’d ever made the world a better place. His wife’s sister, Cleo, and her husband had a spastic child with a mental handicap. Lizzie sat in a wheelchair all day, drooling, with an absent look in her eyes. Surely, that was no life worth living? Her parents were deeply religious. Although they’d known something was terrifically wrong with their child way before it was born, Cleo had resolutely refused to terminate the pregnancy. Lizzie was twelve by now. Richard knew that taking care of her was a drain on both parents. The strain on their marriage was showing. Their two other children suffered as well. All their parents’ attention was absorbed by this black-hole sibling that never gave anything in return. Michael, Lizzie’s oldest brother, was exhibiting bursts of aggressive behaviour, which were causing problems at school. Taking Lizzie out of their lives would be an act of mercy.

He still had five days left. What should he do? His moral objections against murdering a family member had crumbled gradually during his two days in the park. He imagined he could feel the malignant presence in his brain stem extending its probing tendrils along his synapses. It wouldn’t take long before they found the off-and-on switches in his cerebrum. Any moment now, he expected to lose his eyesight, mobility, or fine motor skills. It was Thursday. During the weekend, he’d be unable to tear himself away from Bessie and the kids. He had to act today, or tomorrow at the latest.

He decided to no longer postpone what he needed to do and took the District Line to East Putney where his grandmother’s flat was. She was the logical choice. Frank was at work, out of reach — and Richard doubted whether he’d be enough of a physical match for his taller and heavier brother. Better not to take the risk. He could have dropped by to visit Cleo, but that would have been odd. He’d never done that before. What reasons could he offer her to make the visit plausible? None. To be honest, Cleo was a bit of a pain. Self-righteous raised to the power of ten, she was. They’d never spent much time in each other’s company. And why would he kill Lizzie? It was not her choice to be a potted plant. Cleo and her husband just would have to live with the consequences of their ethics. Anyway, the coincidence of his unusual visit with their child’s death would set off all alarm bells. No, granny was the only true option left to him. She lived alone; no witnesses there. She’d be surprised to see him on a weekday but not hesitate to open the door. When he rang her doorbell, he was fully committed.

The ride on the underground to the hospital was marred by dizzy spells and nausea. For a while, Richard feared he’d black out again. The adrenaline rush caused by the success of his mission kept him on his feet. He arrived at the hospital right after lunch break and was surprised to see the waiting room empty. The nurse at the reception consulted her monitor and immediately booked him an appointment. Richard couldn’t believe his luck.

He barely sat down when the doctor arrived, still munching on her club sandwich. She motioned him to follow her into her office.

‘I’ve done it,’ he said after the door had closed behind him.

‘Sure enough, you did it,’ the doctor agreed.

‘When will I get better?’ Richard asked. ‘I expected to be cured right after I sent the old lady off, but I got really unwell on the train on my way over here. How does this work? Are you going to operate on me, and will the procedure then be a success or what?’

The doctor lit a cigarette.

‘I already told you. You are a medical write-off,’ she finally said. ‘What you did doesn’t change any of that. Actually, you were operated on this morning.’

‘What?’

She got up and led him by the arm, walked him to the elevator, and took him up to the sixth floor. The hallway on the sixth floor was dead calm. Two nurses were chatting with each other, but when Richard passed them by, he noticed their lips weren’t moving. They seemed as if frozen in time. The doctor tugged at his elbow and directed him into one of the post-surgery revalidation rooms. A man with a bandaged head was lying in the bed. A multitude of wires connected him to half a dozen monitors. None of them was functioning.

Richard looked at the man in the bed and exclaimed ‘That’s me! What’s this? What’s happening here?’

‘Nothing much, as you can see for yourself,’ the doctor answered. ‘You’re dead. That’s what happened.’

‘But I did what you told me to! We had a deal. I should live!’ Richard simpered.

‘I didn’t tell you what to do,’ the doctor said. ‘I gave you a choice. You made all the decisions. That’s what this is all about. I’m just a bookie taking the bets of the punters.’

‘Punters, bets? What are you saying? You’re not making sense!’ Richard wailed.

‘Sure, I do. They were betting on whether or not you’d kill, who you’d kill, how long it’d take you, whether you’d succeed or not. The whole gamut,’ she explained. ‘There are hundreds like you every day. I’ve got a business to run, entertainment to provide.’

‘But you told me I would live!’ Richard whined.

‘Yeah, well, I lied,’ the woman shrugged. ‘Given the number of games I run each day, the amount of miraculous healings would soon catch everybody’s attention. We can’t have that. You’re a horse that has run its course — better just accept it.’

‘And my family? What’ll happen to them?’ Richard asked after staring a while at the dead man in the bed.

‘I never lied to you about them,’ the bookie said. ‘I showed you the most likely outcome. It has an eight per cent probability. Not high, but the odds of other outcomes are even lower because of the high number of possible scenarios. If the future was all fixed, there’d be nothing left to bet on, right?’