Three in the morning, and he was screaming again. No need for an alarm clock with Jack in the house, Fiona thought, lurching bleary-eyed to his room.

He’d only moved in a month ago, but already she’d replaced the furniture in the guest room with his racing car bed and bookcase, all to make him feel at home. It wasn’t working. “What is it, Jack?”

The light switch clicked under her hand, bathing the room in cheerful yellow light. He was sitting upright, eyes open and staring, fast asleep. Doctor McNulty had been firm on the subject. There was no need to wake him–just guide him to the pillow then tuck him back into bed.

It was no surprise to anyone that Jack was troubled, but Fiona would have been a lot happier about the whole situation if she’d known the slightest thing about parenting. “You’ll be fine,” her sister had said, the first day in the hospice. “Just love him, and the rest comes later.”

But that was the problem–Fiona didn’t love him.

She disliked her nephew intensely; his running nose and blank stare, the way he left the food she cooked uneaten on his plate, his rejection of every attempt at kindness.

Communication was non-existent. How was your day at school? Do you want more peas? Shall we watch a film? All were met with the same, glassy-eyed passivity.

The only time he seemed capable of making a sound was the middle of the night, when the screaming was loud enough to set the neighbours’ dogs barking.

“Are you ok?” She perched on the edge of the bed beside him. Last week he’d made the mistake of putting her arms around him, and he’d punched her nose hard enough to make it bleed.

This time, she laid her hand on top of his, feeling his fingers unclenching from the knot of bedsheets. “You’re ok. Just a bad dream.” “I want Mummy.”

Fiona sighed. “I know.” There was a smear of blood on his mouth–a bitten lip or a loose tooth–and she wiped it away with her pyjama sleeve. “We both miss her. Do you want a cuddle?”

Jack shook his head. Fiona felt relieved. “That’s fine. Shall I tuck you back in?” She wrapped the sheets tightly around him. It was a sensation she had always loved, but the boy might have been made of wood for all the appreciation he showed.

“Sweet dreams, Jack.” “There aren’t any,” he said. He didn’t open his eyes. “What do you mean?” “There aren’t any good ones left.”

“Of course there are,” she said, squeezing his hand, reaching for platitudes. “I know it’s hard. It gets easier, I promise.” “You promised before,” he said. “You promised it was gone for good.”

Fiona felt heat rush to her face. Two years is a long time when you’re five years old, and it hadn’t occurred to her that he’d remember her throwaway comment.

He’d been a cheerful toddler at the time, easy to entertain with cartoons and sweets and trips to the park during Gwen’s stays in the hospital.

Fiona had brought him up at visiting time on the night of the operation, both of them giddy with relief at the sight of Gwen waving from the far end of the ward.

“Will Mummy be home soon?” he’d asked, as they left. “Soon.” “And the bad lump gone for good?” “That’s right.” “You promise?” “I promise.”

He’d beamed up at her. She’d felt the stab of guilt even then, but it had felt good to give voice to her hope, as if saying the words might make them true. She’d been wrong, of course–they all had.

Gwen, who’d taken up running and yoga and swore she’d never felt better–the surgeon who’d been so pleased with the results–the oncologist who’d bartered hair, fingernails and stomach contents for a few extra months of life. Gwen had clutched at every hope, no matter how remote.

By then Fiona had understood the futility of it all. Gwen had spent her last fortnight in the sterile kindness of the hospice, wasted with disease and puffy from the steroids, but still able to smile at Jack long after she lost the ability to do anything else.

“We thought it was gone,” Fiona said, into the awkward silence of the bedroom. “We really did. But sometimes it comes back no matter what you do.” Jack looked at her with that cold, fish-eyed stare she was growing to hate. “You shouldn’t break promises.”

“I’m sorry. I shouldn’t have said it.” She stood, suddenly tired, frustrated, distant. “Go to sleep. We can talk more in the morning.” She left the hall light on, and stumbled back to the warmth of her bed. In the morning, she’d call Doctor McNulty again and see if there was another approach to try, because “give him time” wasn’t cutting it.

She was almost asleep when she became aware of Jack standing over her, dinosaur dressing gown hanging open over his Minions pyjamas. “What is it?” she asked. “Do you want to come into the big bed?” The boy shook his head. There was a dark smear over his mouth, and he was holding something in his cupped hands.

“Is your mouth ok?” Fiona flicked her bedside lamp on. It flared, dazzlingly bright, then imploded with a dull thud as the bulb blew. In the instant of illumination, she saw that Jack’s lips and chin were smeared with blood, as though he’d plunged his jaw into a bowl of raw meat.

“What happened to your mouth?” “Nothing,” he said. “You’re covered in blood.” She sat up and took his hand, meaning to lead him to the bathroom. Instead, her fingers closed around a moist, warm lump clutched in his fist, that she thought at first was a ball of wet toilet paper.

She dismissed the thought as ridiculous; why would he be carrying wet tissue in the middle of the night? “Give me that.” Jack released the object without protest into her hand.

Nestling in her palm, as though it belonged there, was a raw, malignant-looking aggregate of meat and gristle that made her think of a cancer, or what a child might understand the word to mean.

Her mouth opened, and she made a sound that was halfway between a retch and scream, and the thing leapt–there was no other word for it–directly towards her mouth.

Her jaws slammed shut, catching its edge between her teeth, which rebounded with a rubbery squeak, as though she’d tried to bite into a squash ball.

Blood-warm liquid, rank and purulent, flooded her mouth, and as she opened her mouth to gag in horrified disgust, the thing forced its way over teeth and tongue, worming its way down into her throat like a monstrous parasite.

Her flailing arm caught the lamp, and it crashed to the floor. She drooled strings of spit and blood, every attempt to inhale serving only to suck the rotting mass of tissue further into her airway. The room reeked of bleach, and fear, and decay.

“You promised it wouldn’t come back,” Jack said. “But it did.”