The Wyrms of &alon

The wound was not unlike a bruise: a patch of darkness beneath the skin. But where bruises had blurred edges and gradated hues, this discoloration was stark and well-defined. It had the sharp appearance of a crochet of black lightning visible through the epidermis. But, whatever it was, it was not content in staying within the skin. Here and there, it succeeded in pushing its way up and out of the epidermis. The forearm was studded with raised nodules studded where the lightning was trying to break free. Where it had succeeded, the nodules split open to reveal mottled growths in green, brown, and violet, coated in a pitch-black exudate that was dusted by sprinkles of bright green. In other places, instead of forming nodules, the skin had undergone ulcerative necrosis. Canyons had rotted their way into the depths of the arm, revealing the fibrous, root-like filaments of black lightning threading within the victim’s flesh. I couldn’t begin to imagine what it must have smelled like.

“Subcutaneous gangrene,” someone mumbled.

Hobwell pursed his lips. “The infection is virulent, and readily transmissible. He looked over to the morbid image on the wall. “But what you see here is just the tip of the iceberg. The disease seems to be polymorphic, and, so far, we have identified two widely divergent modes of presentation: Type One, and Type Two. If you don’t like the names, feel free to suggest better ones.” The Director cleared his throat. “What you’re looking at here is a case of Type One.

“This is cutaneous,” I said. “On the news, they’ve been saying it’s a respiratory condition. What gives?”

“There is a lot of variation in the Type One cases. From what we’ve seen, it can apparently start almost anywhere: the respiratory system, the skin, the mucus membranes, the digestive tract, the genitourinary tract—you name it. I’ve even heard of cases where the eyes were involved as the primary infection site.”

“Good God…” someone muttered.

“Early symptoms of Type One infection include: nausea, vomiting, headache, fever, malaise, cough, and shortness of breath. These then lead to a high fever, severe illness, and delirium, with lesions, ulcers, or tumorous growths like the one above appearing shortly thereafter.”

Another image came into view. There were several gasps.

“Subcutaneous gangrene my ass,” someone said.

The image displayed a pale-skinned patient with lightning growths beneath their skin. Long and fibrous, they branched all across the patient’s left shoulder, upper chest, and neck.

The sight got my mind unstuck in time. I flit back to memories of my anatomy class back in my medical school days. The professor had been a pathologist, the kind Brand might have been had he chosen a slightly different career path. The guy was notorious; everyone—and I mean everyone—called him Dr. Worms, on account of his inordinate interest in parasitic worms: flatworms, hookworms, whipworms, cestodes, trematodes, nematodes, and schistosomes galore. He talked about them the way a kid might talk about dinosaurs. I remembered having felt so off-put by his poetic waxings that I’d engaged in independent research to understand exactly what the fudge was going on. Much to my delight, I learned Dr. Worms was deeply and actively involved with international medical non-profits like Hand-in-Hand to assist in combating the morbidity and mortality from parasitic worm infections in rural areas all over the world.

There: that was the connection. The sight of the filaments beneath the patient’s flesh made me think of one of the conditions Dr. Worms had worked to eliminate in the wild: river bloat. The disease was caused by a parasitic worm spread to victims by the bite of reedflies whose larvae grew in the marshes around tropical rivers. The worms migrated into the victim’s thyroid and fed upon the tissue, causing depression, uncontrollable weight gain, goiter, immune deficiency, and other symptoms of hypothyroidism.

The verisimilitude of the memory startled me. I literally pinched myself in order to bring myself back into the moment. Details I’d thought I’d forgotten had come rushing to me, as if I’d been living my past all over again.

Heggy looked at me with concern, but I shook my head to dismiss her worries.

One of the physicians spoke up: “What’s the incubation period for this fucking thing?”

Hobwell began to answer, but Dr. Horosha cut him off. It was his area of expertise, after all.

“As much as I would prefer to say otherwise, the incubation period is currently unknown. In most situations, there would be little difficulty in postulating upper and lower bounds for the length of the incubation period, however, the abnormal epidemiological timeline of the Green Death significantly complicates this process.” He steepled his fingers. “Ordinarily, we would employ contact tracing to extrapolate backward to the disease’s Patient Zero, but, given the apparent simultaneous emergence of NFP-20 in different locales across the world, none of that analysis is of any use here. An infection with a short incubation period would leave a clear trail of victims in its wake, which would suggest the disease has a very long incubation period, so as to give it sufficient time to traverse the globe. Nevertheless, the widespread emergence of large numbers of outbreaks is far more typical of highly virulent pathogens with a short incubation period. As such, any conclusions reached at the present time are little more than conjecture, and should be treated as such.”

I’m not gonna lie: that was really impressive of him.

“How do we treat it?”

“At present, the most reasonable course of treatment would be a cocktail of antifungals—infulizab, peromethidole and hope for the best,” Director Hobwell said.

Dr. Horosha spoke up once more. “Despite our present uncertainty regarding the incubation period, we can—and ought to—be maximally proactive with regard to preventing transmission on as many different routes as possible. Grim though it may be, I believe the best case scenario we can currently hope for is that the Green Death—”

—Hobwell loudly cleared his throat—

“—Pardon me,“ Dr. Horosha said, “I meant to say, the best case scenario we can currently hope for is that NFP-20 is spread through exposure to bodily fluids: saliva, mucus, etcetera.”

Heggy spoke up. “So, it looks like we’re gonna need to suit up, then. Barrier nursing techniques will be essential.”

Dr. Hobwell nodded. “Dr. Marteneiss has it right. We’re currently advising Barrier nursing techniques and bodily protection are advised. Until we figure out the exact mode of transmission, nurses are going to be split into two groups: those who work with the infected, and everybody else. We’ll impose more stringent isolation protocols once we know more about this thing, how it spreads, and how to treat it.”

“And the worst case…? I asked, meekly.

“Airborne,” Dr. Horosha said, flatly. He turned to the Director. “Building on your recommendations, Director Hobwell, I strongly feel it would be prudent to err on the side of caution and implement airlock isolation of all Wards used for the treatment of NFP-20 patients. You do have the necessary infrastructure here for that, correct? The darkpox protocols?”

“Yep,” Heggy said. “WeElMed is fully up-to-date on airborne control standards. HVAC systems are state-of-the-art, and we got respirators up the wazoo. Heck, you can barely even notice all the ultraviolet lights we’ve got scattered hither and thither.”

Director Hobwell frowned, making his already prickly mustache and sideburns prickle all the more. “In a perfect world, Dr. Horosha, we would do exactly as you suggested. But… if we start treating this like darkpox, the people will react accordingly. They’ll shut themselves away, abandon their jobs, crash the economy, infect the rest of their families, and push us deeper into mass hysteria and social dissolution—and we can’t have that. Right now, the protocol is to sequester fulminant cases only. We’re not going to start an Inquisition. At times like these, faith in the system is our most precious resource.”

Dr. Horosha bowed slightly. “My apologies. I understand. He chuckled softly. “I apologize for the interruption.”

Hobwell shook his head. “No, no… that’s alright, Horosha.” He sighed. “It’s good to see someone who doesn’t measure everything in red and black.”

Dr. Horosha nodded. “It is a pleasure to be here; if only the times were more in our favor.”

“Now,” the Director resumed, “where was I? Ah… how could I forget?” He swallowed. “As I said, NFP-20 causes two very different flavors of disease. A Type Two infection disease initially presents with a narrow range of psychological neurological symptoms, specifically auditory and/or visual hallucinations, psychosis, paranoid delusions, intermittent localized paralysis, and grand mal seizures. However, the one symptom universally present in Type Two cases—arguably the syndrome’s defining symptom—are delusions of negation. Moreover, these delusions are invariably prefigured by a grand mal seizure, though it may not be noticed by the patient if it occurs while they are asleep. Additionally, reports indicate that some of the Type Two patients have begun to display lesions and ulcerations, though of a different character than those caused by a Type One infection.”

The Director tapped the console atop the podium, changing the image to—

—I gasped.

It was the nape of Merritt’s neck.

“Delusion of Negation?” one of the doctors asked.

I guess it’s now my turn to shine. I cleared my throat. “They’re a class of psychiatric disorders in which the patient denies the health, ownership, or physical control of one or more parts of their body, kind of like a phantom limb, but in reverse. For these… Type Two cases, the delusion is very, very specifically Nalfar’s Delusion, a rare… well,” I shrugged, “formerly rare condition where the patients believe that part or all of their body is dead and rotting. It also gives you feelings of impending doom—as if the world is ending.

“That’s… terrifying,” someone said.

“Actually, there’s a tropical species of small, but highly toxic box jellyfish capable of causing feelings of impending doom in those it stings.”

I did not know that. “Do you think there might be a connection?” I asked.

The doctor shook her head. “It also causes agonizing, unremitting pain for a period of several days to several weeks. Not even hyperpotent painkillers derived from cone snail venom can succeed in taking the edge off it.

“I… I see.” I exhaled sharply, feeling the air flow in and out of my dead throat and lungs.

“Unfortunately,” Hobwell said, “it gets worse.”