Chief Complaint: Other

We discharged our last patient with his right arm snug in a sling, much to his chagrin. What did he expect, drinking a twelve pack and raising hell on an ATV in the pitch-black night? He was lucky he only fractured his clavicle and not his skull, where his remaining two brain cells vied for dominance.

Overhead lights dimmed as Jordan flicked select switches off and the other nurse grabbed a blanket from the warmer. The ER’s temperature plummeted to a frigid cold during the night hours, as if the hospital’s heater only worked a steady 9-5 gig like most of corporate America. Warm blankets and burned coffee were a necessity, a protective talisman wielded by all night shift healthcare workers. The promise of snow hung thickly in the air, the sky beyond the ambulance bay a thick gray wall. Winter was certainly coming and just like the Night’s Watch in Game of Thrones, we were protecting the wall. At least, that’s what I liked to think. Instead of battling White Walkers, we were engaged in a never-ending battle against disease, pestilence, and good ‘ol human stupidity.

A name popped up on the empty tracker board, evoking a groan from me, which led to a cascade of sighs and bleats of frustration from those sitting at the nursing station. Jordan—crotchety from one too many years of working with the general public—murmured, “Just fucking great, right when we clear the board.”

The chief complaint popped up next to the name, “OTHER”. Noises of despair morphed into clucks of glee. Other. Patients reluctant to give their chief complaint to registration were always the most interesting. Typically, complaints of this nature involved someone’s asshole, or something inserted and lost within said asshole. I’d seen a variety of foreign bodies, standard vibrators, massive lotion bottles—always the industrial size, never a travel sized one—amongst others. It was always the same story. Doc, I was showering and fell. And wouldn’t you know it? The shampoo bottle went right up my ass! As if assholes were a massive black hole suctioning up everything within a five-foot radius upwards.

Or maybe someone’s new Prince Albert piercing was bleeding; an issue I’d seen a time or two.

One or the other, it all came down to assholes and genitals under the Other category.

Jordan leapt up, a wide grin spreading across her face. “I’ll go grab this one, Doc. Want to take bets on what he ‘fell’ on?”

I returned her grin. “I’m going with a golf ball, hole-in-one!”

She rolled her eyes and snorted, “You’re so lame. I’m going with a vitamin bottle, and not one of those pussy ones with 100 tablets. One of those big bastards from Costco.”

***

I hustled to the bathroom and relieved myself. It’d been a few hours since I’d whizzed, even after consuming roughly a gallon of hospital grade sludge. It tasted like shit mixed with gritty dirt, but I needed the caffeine mainlining in my bloodstream. The patients kept streaming in at the beginning of my shift. I’d had a congestive heart failure patient who considered a bucket of KFC “heart healthy”. EMS hauled them in on the stretcher with skin tinted an alarming blue, lungs drowning in fluid from a ruined heart. Nothing a nice ET tube couldn’t fix. There was also a nice young man who ate a large amount of unwrapped cocaine during a routine traffic stop who came in completely gorked—a massive brain bleed—don’t do drugs, kids. And the usual smattering of sprained ankles, runny noses, and drug seekers wanting Tylenol 3s.

Jordan put the new patient in room 14, which was usually reserved for nosebleeds, dental pain, and rashes. His back was to me, giving me a view of greasy brown hair ensconced in an orange beanie. There were two rickety chairs lined up on the wall, reserved for friends/family/fast food bags. Sometimes patients sat in these, but he chose the examination chair, or as we dubbed it, “The Bitch”. “The Bitch” reminded me of a dentist’s chair, except the pedals appeared to be possessed, only working when they wanted to or when Mercury was in retrograde. Jamming down on the pedal induced either no response or caused the chair back to rachet backwards with alarming speed, eliciting curses of “Bitch!” from patients and doctors alike.

Hence, “The Bitch”.

Jordan shot me a look as I opened my mouth to introduce myself. Her eyes radiated contempt, and she gave a subtle eye roll, restrained when compared to her usual exorcist eye acrobatics. A gusty snort of air issued from her nostrils. “Doc, this is Justin. He came in today because he thinks he has worms.”

“Worms? Worms where, Justin? From your butt?” I asked. Worms didn’t faze me. Night was the prime time for afflicted patients presenting with pinworms since the dainty white beasties poked their heads out of assholes during night hours and boy, did those little bastards itch like mad! Not an emergency, but it had to be alarming to have worms streaming out of your ass. But a stunning number of patients hopelessly addicted to meth came in daily, all claiming they felt tiny worms crawling in their skin. I gave Justin a once over and cast my judgment. Based on the pocks of skin scabbed over from hours of scratching and the general way he jittered his limbs about in “The Bitch”, I suspected he fell in the latter camp; the meth-heads.

Blue, sunken eyes peered at me. His skin, pock marked as it was, had a yellowish tinge to it, the first heralds of jaundice, and it hung from his cheekbones, making him appear older than his listed age of 30. In the crook of his arm, I spied fading bruises and healing track marks. He pushed his sweatshirt sleeve over the injured skin, catching my eye as he did so. His pupils were inky pits, almost obscuring his blue irises, even under the bright fluorescents of the exam room, which ought to narrow his pupils to pinpricks.

“No Doc, not my butthole. I got worms inside me.” He scratched his cheek, disrupting a scab with a jagged fingernail. Dark blood welled up from the wound.

“Inside you? What do you mean? Do you see worms mixed in your stool?” I asked, my excitement growing. I’d never had a tapeworm case before and while disgusting, I lived for sick shit. It’s part of the reason I became an ER doc—that, and the whole making a difference thing while wearing essentially pajamas to work.

But my bet was still firmly on meth.

He shook his head vigorously, but his lank, greasy hair didn’t move. “No, they are inside of me! In my skin. I feel them crawling in there, moving,” he pointed to his eye, “They’re in there too. I see them cross my vision, squirming. It’s worse at night. They’re in my lungs too.” He produced a weak cough, not bothering to cover his mouth.

“Cover your mouth when you cough!” Jordan admonished; her voice was as severe as school marm wielding a ruler just waiting to rap the wood across naughty pupils’ knuckles.

Justin looked sheepish, shrinking back into the chair. “Sorry, the worms, they make to do things. I couldn’t cover my mouth. I think I’m running out of time; they’re about to come out!” Panic threaded his voice, making it waver, and a thin sheen of tears popped up in his eyes. Just my luck. Not only did he have mythical meth worms but was also deep in the throes of a psychotic break.

Fucking meth.

Fucking Walter White for making it glamorous.

Using my best-talking-to-animals-and-potentially-dangerous-meth-head’s voice, I asked, “Justin, do you see things or hear things that aren’t there?” Patients answered this question in a variety of ways. Often, they knew their hallucinations were fabrications of an addled brain, but other times… they believed every single hallucination—a much more frightening proposition—especially when patients gushed, “but the voices tell me to kill the President!”.

He glared at me, naked hatred radiating from those wide eyes. “You think I’m crazy! I’m not crazy. I have worms, dammit!” His voice cracked, sparking a dry coughing fit. He raked his nails across his cheek, producing a sandpaper rasp. He pincered his fingers and, with triumph stamped on his features, shoved his fingers inches away from my eyes. “Look! WORMS!”

I glanced down at the shriveled yellow crust he gripped. “That’s dried pus. Not a worm. Sorry, Justin. Hey, by chance, did you use any meth today?”

He glowered at me and thrust his thumbs into his chest with a hollow thump. “You’re calling me a drug addict? You think I’m one of those meth idiots! No, I did NOT use meth today. I’m not a druggie!” He paused thoughtfully, and cocked his head to the side, like a confused puppy, and added petulantly, “I haven’t used meth in like two days.”

My eyes involuntarily rolled. It’s always the same shit. I only had two beers (multiply by four as a rule of thumb for the real number), I was sitting on my porch, reading the Bible, minding my business when three dudes jumped me (I started a fight and got my ass kicked), and I don’t use drugs (their urine drug screen lights up like a Christmas tree). “Tell you what, Justin. I’m gonna do a quick exam and then we’ll talk about this whole worm thing.”

Justin settled back into the chair, his arms still juking this way and that as if he’d grabbed a live wire, but he appeared marginally calmer. Beads of sweat broke out on his brow, welling up like condensation on a glass of iced tea. I placed my stethoscope against his heart and listened to the steady pitter pats of his heart. All good. “Take nice deep breaths for me,” I directed, and a faint wheeze greeted my ears, most likely a souvenir from a pack-a-day smoking habit. Delicately, I pressed on his stomach and elicited no groans of pain.

“Time to look at your mouth, Justin.”

Obediently, he opened his mouth, and a fetid reek washed over me. His mouth hadn’t met the acquaintance of a toothbrush in some time and yellowed teeth, some blackened at the roots, greeted me. Several molars were outright missing. I peered closely at one hole. Something white glinted under my penlight. No doubt an embedded root, broken off from its tooth, but I leaned closer, trying to discern what in the hell I was seeing.

The white thing wriggled.

I jumped back, knocking into Jordan, dropping my penlight on the floor with a clatter.

“What the hell—” she started, but the words died in her mouth.

Justin violently hacked, again, not bothering to cover his mouth, and a stream of dark red blood poured out, streaked with white and yellow threads. The glut struck the linoleum floor with a wet splatter. Dots of blood marred my yellow Crocs and warm liquid soaked my socks.

The white and yellow threads—not threads at all—worms, they were worms dashed in all directions. Some were miniscule, difficult to see against the starkly white floor—excluding all the blood—but others stretched out, inches long, and wriggled, leaving streaks that in another world, might have been artistic brush strokes rendered by an artist enthralled with gore. These larger worms had bulbous red eyes that rolled blindly. One worm, at least a foot long and as thick as a baby carrot, craned its head up, and I saw my stunned reflection in those hideous eyes. Below the eyes, a black hole gaped open and several rows of serrated teeth smirked upwards at me.

Distantly, I heard a high shrill shriek that echoed painfully, causing my tympanic membranes to quiver.

My mouth hung open in my shock and I wrenched my gaze from the nasty creeper leering at me and peered at Justin who I’d nearly forgotten.

Except—

Justin was gone.

Another entity—horrible and evil—had taken his place.

His yellowed skin sloughed off in sheets, exposing masses of thin, squirming bodies. Wet slithers reached my ears, the sound identical to suctioning large amounts of mucus out of a diseased trachea. The bunched-up creatures roughly held a shape resembling a human skull, rows of them approximating maxillary bones and sweeping zygomatic arches. Justin’s startled blue eyes stared into mine and rolled upwards, exposing yellow tinted conjunctiva, and with an audible POP, tumbled from their worm-fabricated sockets.

But they didn’t topple to the floor.

They dangled by thin red cords from lurid craters and a gorge rose in my throat.

Not dangling by optic nerves.

The thin red cords were worms too, segmented sections gleaming with wet mucus. Each pulsed together as if coordinated by a singular heart, located firmly in the chest cavity of hell.

Justin’s mouth unhinged with a wretched tearing and his yellowed teeth plonked out, landing in the spreading crimson on the floor. In each hole, a small white head poked out.

A conglomeration of pink wriggled from the cavernous maw—a tongue from hell—and a sickly voice came from his ruined mouth.

“Doc, you should have listened. I told you and you didn’t believe me.”

I backed up further, my ass hitting the counter behind me. I couldn’t tear my eyes away from the abomination taking shape in front of me, but in my peripheral vision, I saw Jordan crouched down, biting her knuckles hard enough to draw blood. She let loose a muffled scream from around her hand. I tried to speak, but my tongue lay like a dead slug in my mouth.

I produced a thin croak, and the thing delighted at my terror, its rictus grin widening further.

A faint tugging sensation registered in my brain from somewhere around my ankle, inching its way up into my mint-green scrubs. Revulsion filled me as a wet skittering wound its way up my calf and I kicked my leg out violently, vainly attempting dislodgment of the repugnant interloper. A searing lance of pain echoed from my inner thigh, and in my most delicate tissues between my legs, I felt sharp pinpricks of pain making their way up my vaginal canal, worse than every period cramp that radiated through me previously. My eyes bulged from their sockets as torment bloomed in my genitals and a gush of blood soaked the crotch of my scrubs. The not-Justin-thing’s smile broadened, wriggling tombstones smirking at me.

“Just relax, it’ll be over soon,” it cooed.

The stinging agony spread upwards through my torso. My stomach fluttered, not unlike the butterflies experienced with first love, and my esophagus spasmed, bringing up acrid vomit. Unable to help myself, I spewed out brown puke littered with remnants of ramen noodles. My dinner—oh no, oh no, not noodles, worms—joined Justin’s bloody emesis on the floor and convulsed in his spilled ichor. A nasty wet pulling erupted in my nostrils, and a gliding sensation worked its way up the bridge of my nose. An absurd urge to sneeze gripped me, but before I could comply, the sensation gave way to a sharp twinge erupting in the middle of my skull—sudden and brilliant—causing me to see white stars in the periphery of my vision. Within myself, I heard burrowing, gnawing and held tissues tear and rip. Finding my voice, I opened my mouth to let loose a scream.

But—

My mouth snapped closed, no longer under my direction, and I felt my lips stretch in a serene smile. My hands moved of their own accord, commanded by another master, and they clasped themselves in front of my chest, fingers interlaced in an unmistakable expression of contentment. I screamed silently within my head, all the while hearing snapping, gnashing noises erupting deep within me.

A sinister voice spoke, not aloud, but from inside of me. Its tone was low, and each syllable sent a chill through my body, a sensation I felt but at a distance, as it if were happening to someone else.

Don’t resist, it crooned.

My me-ness, my hopes, my dreams, my loves and wants folded inward on themselves, and I shrieked soundlessly, and a creeping consciousness enveloped me, taking complete control. A quick vision crossed my mind—my last thought on this earthly sphere—hellfire, sulfur, and jeering laughter. Then, like a lightbulb burning out, there was nothing left.

***

The two undulating masses in room 14 merged, shedding the human skins they’d consumed, discarding the used-up husks. Jordan laid motionless on the floor, fainted dead away at some point during the monstrous proceedings. Her head rested in a pile of bloody puke, staining her blond hair a stunning Halloween crimson. Wriggling bodies probed at her mouth, ears, nose, entering her and devouring her very being, her soul.

Soon, there would be three.

And after that?

Like a grisly pyramid scheme, they’d spread like bacteria, proliferating within each body the hospital contained, assuming control and obliterating the consciousness and soul of all they consumed.

Then… they’d return to the soil whence they came.

Watching, waiting for the perfect time to rise again.