The Wyrms of &alon

I went about my morning shift with Merritt on my mind all the way through, and I worried it showed. Every third thought of mine was about whether or not to call her husband to give him a head’s-up over what had happened. Ultimately, the inertia of my stress won out, and I did nothing. I figured I’d tell Storn about Merritt when I told him, whenever that was.

My other thoughts were a mix of the usual and the usual unusual. One of my cases had gotten their test results back; the magnetic imaging showed a slight but undeniable atrophy of the caudate nuclei of the brain and the enlargement of the nearby cerebrospinal fluid ventricles. Combined with their family history of the disease, it added up to as clear cut a case of magrums as I’d ever seen. I felt insufficiently attentive as I broke the news to them, my mind divided against the task at hand. It was hard enough to inform someone that they’d inherited an untreatable neurodegenerative disease; doing so with a whole chunk of my thoughts occupied with the contingencies of Merritt’s situation was almost impossible.

I left the room at the end of that dismal appointment in a sweat, my collar tight around my neck. Ordinarily, I generally looked forward to my work—terminal cases excepted, though, for the obvious reasons. Today, however, I felt like lunch couldn’t have come quickly enough.

Working in clinical psychiatry was demanding in a way that was difficult for people to appreciate unless they had experienced it for themselves. Even the slightest motion or verbal cue—a pause before a word—could be filled with significance, and what your patient saw in you was just as important as what you saw in them. It was difficult to be there for them, in that way, when your mind was elsewhere.

Finally, finally, my lunch break came around. I made my way to the Psychiatric Library at mach speed. Having copious supplies and references on hand was but one of the many advantages of working in an all-purpose teaching- and -research-oriented hospital, especially so, given the nature of my work.

There were two kinds of mental health: the figurative, and the literal. There is the psyche: the mind as we experience it—the thoughts, feelings, urges, perceptions, and pathologies that make us who we are, for better and for worse. But at the same time, there’s the physical mind: the brain, the nervous system, the neurons and axons and hodgepodge wonders of electrochemical prestidigitation that house what poets call the “soul”. Psychiatrists study the figurative mind; neurologists, the literal mind. Neuropsychiatrists, such as myself, study both. Hopefully, within the intersection of the two disciplines, I would find an answer to Mrs. Elbock’s ailment.

Like most newer libraries these days, West Elpeck Medical’s Psychiatric Library was more of a Li-barely than a Li-brary. The Psychiatric Library was one of many places in the city of Elpeck where you could see the scars leftover from when the future had been grafted onto the past. It had tall, imposing bookcases built into its walls, sumptuous lacquered wood furniture, and a thin, wall-to-wall dark green carpeting that gobbled up nearly every sound. But everything else was new: console-screens in the wall, consoles mounted into the retrofitted tables, and even a holographic librarian standing behind (and within) the circular desk near the entrance. She was mostly there for show, with just enough interpersonal AI to help struggling medical students earn a few extra bucks when they gave guided tours of the hospital to tourists from abroad.

Clarisse flickered into view as I passed the desk. I waved hello to her as she recited her programmed greeting.

“Welcome to the—”

—I had more pressing matters to attend to.

Sitting down by an empty table in one of the more comfortable chairs, I tapped my finger on the screen of the console, waking it from its slumber. Waving my hand over the scanner bypassed “public mode” and took me straight to my personal account with the city library network. I endured the twenty second advertisement for Prescott Pharmaceuticals that popped on screen. The only thing more monstrous than, say, the dirty tricks they pulled to keep insulin prices through the roof was the fact that all of it was absolutely one-hundred-percent legal.

I breathed a sigh of relief as soon as the ad ended. Now, I could get to work. And I knew exactly where to go. A couple taps and keystrokes upon the screen, and I found myself face-to-face with a perfectly digitized copy of Hondry’s Delusions, third edition. Though the International Diagnostic Manual of Mental Illness was usually my first recourse, I had a hunch that Hondry would prove the more useful. The IDMMI tended to leave out disorders too rare or controversial to merit official recognition by the International Psychiatric League. Besides, the research I’d done during my residency at East Elpeck Medical had given me plenty of familiarity with Hondry’s book—it was easier to use than most.

Shifting about in my seat, I flicked my fingers across the screen, scrolling down until I reached the table of contents. Hondry’s book sorted topics thematically, rather than alphabetically. I ran my finger down the list of categories: Delusions of thought insertion, delusions of jealousy, delusions of external influence, delusions of misidentification—

—There.

Tapping the word put the pertinent section on screen, and the introductory essay which prefaced it.

Delusions of misidentification, broadly speaking, are the subclass of monothematic delusions that impair the mind’s proper awareness, acknowledgement, and acceptance of the body, either of the individual in question, or those around them. Examples include: denying ownership of a limb (Frett’s Delusion, p. 475), the belief that a family member or pet has been replaced by an identical impostor (Poranogi’s Delusion, p. 479), disconnection between the self and the body (Depersonalization, p. 492), belief and/or experience of sensation in a limb that never existed (Supernumerary phantom limb, p. 526), and even the belief that one’s body is dead, rotting, or non-existent (Nalfar’s Delusion, p. 577).

Nalfar’s Delusion? I’d never heard of it.

I clicked the highlighted text. The display skipped over to page 577.

Nalfar’s Delusion: an extremely rare condition in which the affected individual believes that they are dead, or that they do not exist (physically or spiritually), or that part (blood, muscles, internal organs) or all of their body is missing or dead and decomposing. Common secondary symptoms include hypochondria, depression, and—bizarrely—the belief of the physical invulnerability or immortality of the body, the belief of personal damnation, and the belief in the imminent end of the world (society, civilization, the globe, reality itself).

It couldn’t have been a more perfect match for Merritt’s symptoms. As I continued to read—as expected—Hondry gave a thorough exposition of the syndrome. I found the pathophysiology of the condition particularly interesting. Despite the intense, elaborate nature of the delusion, Nalfar’s seemed to be more a secondary condition than a specific malfunction; the syndrome most commonly appeared in individuals already suffering from an underlying neurological condition: Schizophrenia, psychosis, chronic depression, or migraine headaches. Less unexpectedly, the delusion was also associated with pathologies of the brain: Brain tumors, lesions on the parietal lobe, and atrophy of the frontal lobe.

Here, too, Merritt fit the bill: she had migraine headaches severe enough to cause damage to her brain. It was well within the realm of possibility that headaches capable of giving her synesthesia were capable of giving her Nalfar’s delusion.

My eyes followed my fingertips, scrolling down the digitized pages.

Treatments…?

—There:

Due to the rarity of the condition, a well-tested treatment protocol has not yet been established for Nalfar’s delusion. That being said, case studies suggest that the condition can be self-resolving, dissipating over a period of weeks to months. The disorder may also be resolved following treatment of co-incidental neurological (depression, psychosis, etc.). Direct therapies of note are dosage with antidepressants (opium, amphetamines) or electroconvulsive therapy. Antidepressants are not recommended, due to the high risk of addiction; moreover, to the extent that it is effective in treating the disorder, electroconvulsive therapy has proven to be more efficacious than a regimen of antidepressants.

I clenched my fist.

Fudge…

Leaning back in my seat, I took a deep breath. The phrase “electroconvulsive therapy” ran circles in my mind. I could picture all the nightmares in that future. I could see Merritt, strapped into the leather bed, her eyes darting back and forth like the needle on the voltage meter as the current coursed through her body, the bit in her mouth gagging her screams while I stood to the side, looking over the shoulder of the orderly at the control panel as he twisted the knobs and made her tremble. And when Storn found out… I don’t think he’d ever talk to me again.

Ugh…

The whole scenario made me sick to my stomach. It was like I was living through Dana’s torments all over again. Dana… my older sister, the high queen of my childhood idols. I’d never be able to repay her for having taken up the mantle that Mom hadn’t lived long enough to bear. Dad was often busy with the music scene, playing long hours with radio bands, concert orchestras, private groups—that whole mix of things he needed to do to make ends meet. He did the best he could when he was on hand—sometimes, more than best, I think—but, when he wasn’t, Dana took up the slack. She was the one who always made sure I had dinner to eat; she was the one who drove the car to pick me up from school on stormy days. She was my mentor, and my confidante.

But, when I was an adolescent… she had started acting funny. She’d yell herself hoarse at me for the slightest things: not folding up the clothes quickly enough, wearing anything blue, asking her if she wanted to see the latest movie. First, she stopped going to school, then she stopped bathing. She would search through every book in the house, certain that someone had slipped a recording device in between a pair of pages.

And then, one day, while in a fit of rage, Dana stabbed dad with a bread knife. That was when she had to go away… to a madhouse. I came to dread visiting her at the asylum. The things I saw there changed me. Gone was the bundle of energy that had once been my best friend and most trusted guide. The Dana I knew was buried under a near-perpetual veil of Noxtifell induced stupor. I’d usually find her lying insensate on a sofa, lost in that big, dirty lounge where the radios softly played, and where the world had given up on her. And when the meds wore off, sometimes… she resisted. Then they’d drag her away. I once made the mistake of asking one of the orderlies where they were taking her. His answer is still as clear to me as the day I heard it: “They’re gonna zap her good.”

Electroconvulsive therapy could and did work wonders for the patients who truly needed it. Major depressive disorders, particularly those that drove patients to self-harm or attempted suicide could frequently be remedied with an appropriate use of ECT to a patient who had given their full and informed consent to the procedure. What happened with my sister, though… that wasn’t medicine, it was torture. Even now, I don’t know what hurts me more: the fact that they harmed my sister, or the fact that they shamed medicine itself by turning a valid treatment into a lazy, abusive shortcut for quieting “troublesome” patients whom they had no real interest in actually helping.

I would never forget the orderly’s words. That moment—that memory… as much as it pained me, it was what gave me my calling. I wanted to study the mind, if only to help keep anyone else from losing their loved ones the way I had lost my sister.

Dana’s birthday was coming up. She’d be fifty-five, now, had the pneumonia not taken her from me. I wouldn’t be able to forgive myself if Merritt ended up like that, because of my failure to help her as best as I could.

I closed my eyes.

What to do? What to do?

The sound of a chair sliding out beside me brought me back to attention.

“I take it something’s the matter…?”

“You don’t know the half of it,” I said. Leaning forward, I rested my arms on the tabletop. “I don’t suppose you somehow heard my inner torment.”

“No,” he said. “I passed Dr. Rathpalla while on the way to the cafeteria, and he said you’d been looking a little fidgety this morning. I figured that meant today would be a ‘Psych Library in lieu of Lunch’ day.”

I chuckled.

Statistically speaking, my friendship with Dr. Brand Nowston was about as probable as a winged pig. Yuth Costran liked to call us “the odd couple”—and she wasn’t that far off. The number of anti-parallels between the two of us was really uncanny. He—a true intellectual—was a cell biologist with an interest in, well… everything. I, meanwhile, was a neuropsychologist who merely fancied himself to be an intellectual. Brand was an academic who—half-way through graduate school—had discovered that he preferred the cenobitic life of a laboratory lurker over teaching classes, in rooms, with students; I was a physician who was considering the possibility of going into academia after retirement. I liked talking at length to any number of people; he was the textbook definition of an agoraphobic. I was married, with children; he worked in a lab with his cultures, microscope slides, and petri-dishes. He was a dog person; I wasn’t good with animals, period.

“So… what’s up?” he asked.

“Honestly, I think I’m stuck.”

“You? Stuck? Utterly improbable.”

I shook my head. “It might be because this case is more personal than most.” I looked him in the eye. “It’s Merritt.”

“Elbock?”

“The one and only.”

I told him what had happened, and he listened with all the attentiveness I’d come to expect from him.

Brand Nowston was a damn fine pathologist—the best we’d ever had. He’d always dreamed of becoming lab director, but, sad to say, that would forever be a dream deferred, all on account of the color of his skin. Unlike surgery or internal medicine, where the publicity worked in diversity’s favor—case in point, Dr. Arbond being able to rise to the heights worthy of his prodigious abilities—behind-the-scenes administrative work had, so far, managed to mostly continue staying behind the times. Brand always told me that, all things considered, it wasn’t really all that bad of a deal; “The number of people that a Lab director has to work with? Nah, I don’t think I’m cut out for that,” he would say, with a smile. “If the Angel had had that in mind when He made me, He wouldn’t’ve filled my belly with so many people-seekin’ butterflies, now would He? That, or Mama should have used more cocoa butter on me!”

Brand was very particular about his appearance, being a firm opponent of both the shaved and cornrow hairstyles. He wore his in a perfectly risen muffin of sponge curls that he liked to compare to that fancy fractal broccoli from overseas—albeit less prickly looking. Whereas I usually wore a mild beard, he had zero tolerance for facial hair.

He scratched his chin, reflecting on my summary of Merritt’s case.

“Absolutely fascinating. Had I heard it anywhere other than from your mouth, I don’t think it would have been possible.”

“The problem is there’s no clear-cut treatment,” I said, “And it might take a while to figure out what, if anything, I can do, other than waiting and diagnostics. I feel terrible at the thought of Merritt spending even a single minute on suicide watch, but… that’s hospital policy.” I sighed. “This whole situation doesn’t sit well with me.”

Suddenly, all the console screens in the room turned blue in unison, playing a short, three-note electric chime. Brand and I—and others in the room—rose to our feet as we processed what we were seeing. It was news: live footage from a reporter on the ground.

“Yes, Glenta, as you can see, police have already flooded to the scene,” said the unseen reporter.

The screen showed Union Square downtown, the footage streaming in from an aerostat hovering above the plaza. Skyscrapers towered on all but one side, where the skeletal edifice of a new construction project stuck out like a sketch come to life. The camera panned down to show bodies lying in the plaza, blood splattered in the streets. People ran every which way. Screams and gunfire could be heard, even over the roar of the aerostat’s turbines. The camera then panned over to one of the adjacent buildings. Smoke billowed out through shattered office windows halfway up the building. The image panned down, showing a throng of police officers and panicked onlookers crowding around the base of the building and the surrounding streets. Disheveled businessmen went out in the other direction, staggering onto the streets and shaking their heads. I saw a secretary sobbing.

It was a mess.

The footage cut back to the live feed from the reporter on the ground.

“I’m being told that the shooter is still active. Eyewitnesses who saw him say that he’s an employee of the firm. Please, keep away from the Union Square area until the shooter has been apprehended.”

We could hear the voices of onlookers beginning to scream. Eyes whipped up to the aerostats’ oblong metallic hulls, as if the vehicles above might deign to save them.

The camera tilted up, back toward the building.

“Triun!—Glenta, are you seeing this?!”

The image zoomed in.

My breath caught in my throat: a handful of people rushing into the nearby construction sight were gunned down in a wave. Even the cameraman cursed in horror.

The screen cut to blue. Director Hobwell spoke:

“All available personnel on emergency cycle, please report to Intakes 1 and 2… it looks like it’s going to be a long day.”