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Patient Notes

It hardly seems in keeping with the Hippocratic Oath

Typical Zombie

I was pleased to review this sixty-one-year-old man in clinic today, referred for suspected Zombieism. His blood pressure was 0/0, his temperature room, his pulse nonexistent. On examination I found that if I lifted any of his limbs then let go, they couldn’t maintain rigidity and dropped immediately; palpation of the stomach released large amounts of trapped afflatus. I asked the patient to provide a urine sample, but he was unable; he also told me he hadn’t moved his bowels in weeks. Apart from deep, dark circles beneath his eyes, his complexion was extremely pale. I found quantities of loam beneath his fingernails; earth also stained his outer garments, which, once removed, revealed an emaciated frame that had been subjected to repeated blows: both femurs, several ribs, his left tibia, and his right patella had all suffered fractures, while his thorax and abdomen were covered with bite marks unmistakeably left by human teeth. The patient told me that he was a writer who lived a mostly solitary life; three weeks ago, a group of acquaintances arrived at his flat unannounced. After insinuating their way into his home, these “friends” had subjected him to a sickening ordeal: some of them held him down while others inflicted these injuries. They left him lying on his kitchen floor as if for dead. I informed him—with considerable tact—that this was no simile because he was, in fact, dead but unburied. I asked him if he had felt any unnatural impulses, and he confessed to being visited frequently by Baron Samedi—a terrifying albino in white top hat and tails, with a painted face—who instructed him to “destroy as many of the living devils as he could.” Following these visitations, the patient experienced a sense of intense rage toward everyone he encountered, the sequel of which was a desire to bite into them as if they were so many crisp green apples.

In this intimate clearing—one we might imagine portrayed by a Douanier Rousseau, or some such colorful primitivist—he made an exciting discovery: the swelling had in fact burst or otherwise everted so as to reveal a newborn penis.

I told him that given his postmortem condition there was unfortunately no treatment available but palliative care. He took this well, and requested I do what I could, since he found his current condition—insensate, stumbling around the world groaning and drooling, enraged by the meaningless go-round of sublunary lives—insupportable. He had no close family and was living in semiretirement, so I thought it perfectly ethical for me to consent him for a DNR on the spot, before inviting him to lie on my examination couch while I fetched a wooden stake from the supply cupboard. The patient proved surprisingly cooperative when my nurse and I positioned the sharpened and fire-hardened tip of the stake between his ribs, and I then had no difficulty in driving it through his heart with five heavy blows of the mallet. Exsanguination was minimal: some straw-colored fluid oozed from the wound, together with half a cup of blackish blood. I have sent tissue samples for histological analysis but feel fairly certain that my colleague’s initial diagnosis will prove to have been correct.


Two Cocks

I was intrigued to review this sixty-one-year-old man in clinic today. His blood pressure was a little elevated at 132/81, while his temperature and pulse were normal. His physician had added a handwritten note to his extensive case notes that read simply “two cocks.” On examination I discovered that this was indeed the case: the patient had grown a second penis alongside his original one, although there was no sign of a new scrotal sack, testes, or any other major reconfiguration of genitals or gonads. I obtained a history of this new member from the patient: he had noticed a slight welling in the pubis to the left of his penis three months previously. An initial referral to St. Sebastian’s had resulted in a (mis)diagnosis of inguinal hernia. The duty surgeon had simply thrust two fingers into the swelling, pronounced himself satisfied when it subsided, told the patient he had pushed the herniating abdominal wall back through the inguinal canal, and that the patient should re-attend in two weeks so a couple of sutures could be put in to avoid recurrence. However, the patient found the experience “arousing” and, on returning to his home, discovered both that the lump had reappeared, while repeated palping of it induced more—and highly pleasurable—arousal.

Over the next few weeks, the lump continued to swell, while the patient went on annulling any anxiety he might have felt with vigorous frottage. Then, one morning, he awoke in the pale light of dawn to a distinct feeling of recuperation—“Although, to be honest, I hadn’t been aware of feeling ill before.” Beams of lemony early-morning sunlight lanced between the slats of his Venetian blinds, and, once he’d thrown back the covers, tigerishly striped his bare thighs (nude slumber being his custom). In this intimate clearing—one we might imagine portrayed by a Douanier Rousseau, or some such colorful primitivist—he made an exciting discovery: the swelling had in fact burst or otherwise everted so as to reveal a newborn penis; slimmer, younger, and appreciably more tensile than the old one, which lay slumbrous beside it. As he watched, awed, this new member’s pinkly gleaming and up-thrusting glans spontaneously ejaculated a ticker-tape parade of semen. For a few days the patient basked in this serendipitous occurrence: with the new cock came a vigor he hadn’t experienced since his twenties. For some time, the patient has been taking sildenafil to ameliorate erectile dysfunction, but his new cock rendered this precaution unnecessary—and for a while at least, he suspected the new cock might be revitalizing his old one because he found himself able to sustain erections in both membra virilis without recourse to his medication. Enthused by the possibilities of his reconfigured anatomy the patient advertised his novel condition on various dating sites and received a steady stream of invitations to meet. His sexual partners—male, female, and nonbinary alike—were perfectly thrilled by his two cocks and for some time he enjoyed happy congress of innovative kinds: simultaneously penetrating two of his new lovers’ orifices at a time, or one orifice in each of two lovers.

However, it wasn’t long before relations—not between him and his sexual partners but between the two cocks themselves—soured. Early morning once more: the patient awoke in excruciating pain, and throwing the covers aside saw that his two cocks had twined about each other to form a strange and fleshy caduceus. Or, rather, convolvulus, for the younger one—being stiffer—was choking the life out of the older. It was a terrible predicament: quite obviously the pressing need was for the patient to detumesce, yet the sensation of one erogenous zone choking the life out of another was ineluctably arousing. And so, it went on: no matter how he tried to keep them apart—with straps, bands, and buckles—he couldn’t stop his cocks fighting. He’d be strap-hanging on the tube or walking in the park when suddenly the dreadful constriction would renew, his blood pressure would soar, and he’d have to beat a hasty retreat to his home, where he’d beat himself off.

Clearly this hostility could not continue. I advised an immediate penectomy—however, this forced upon us the dread decision: Which of the cocks was to get the chop? Democracy is a complex concept; as in any other form of regime, those who live within one or other system that defines itself as “democratic” tend to have a blind spot when it comes to understanding the relationships between individual, popular, and sovereign will. The minutiae—and for the most part, they are by the generality experienced as such—of psephological and electoral variations within systems of representative democracy tend to leave them not so much cold as fucking bored. A regression to the meanness of their own system is almost inevitable. “We’re the democrats!” That lot, they trumpet, are mere fascists. Is it any wonder that in a world typified by the millimetric registrations of opinion and taste via a global system of instantaneous feedback, populism becomes de rigueur?

Is it any wonder that in a world typified by the millimetric registrations of opinion and taste via a global system of instantaneous feedback, populism becomes de rigueur?

We all gave way: the cocks and I would each have a vote, the patient would retain the casting one, hustings would take place immediately. In the first and only round, the younger and lefthand cock voted for itself, its older, rightist companion did likewise. I voted for the old cock, the patient for the young. The air of solemnity in my operating theatre has never since been surpassed: we handled the kidney dish, the scalpel, the clamps, the forceps, the swabs, the thread, the needles, the needle-holders, the syringes primed with anaesthetics, paralytics, and antibiotics as if they were parts of a god, as yet to be accurately portrayed in an easy-to-assemble guide accessible via YouTube. Miserably, the patient lost his sangfroid as the aperture of his vision started to corkscrew shut. “I never appreciated you!” he moaned, “I took you for granted!” he wailed, regarding his old todger with the deepest and most affectedly human expression I’ve ever witnessed.

For myself, I couldn’t see it his way: on the brink of their final and irrevocable separation the cocks had at last made peace, recognized their common bond, and lost themselves in that littler yet more profound oceanic feeling which wells up from the carmine springs of consanguinity—an emotion yet more piquant, more nutty and intense, when it mixes together brothers of the same father widely separated in years; then it is that the younger cannot help but cleave to the older, while he, in turn, cannot forebear from a sentimental engorgement in the prideful prepuce department. So it was in this schismatic scenario: the head of the younger plunged deep within the velvety hood of the elder’s foreskin so the two formed a sort of croquet hoop of cock, writhing with sinister bloody pulsation. We lost no time in disentangling them, and, with the patient inert—so altogether depersonalized—had no hesitation in sawing through the troublesome gristle. It was a simple procedure and I let my cleaning lady, a Zimbabwean called Perfidy, close up afterwards. After all, she’d been observing this sort of carry-on for years, why shouldn’t she have a go.


Cosmic Vaginismus

This sixty-one-year-old gender-fluid individual asked to be examined by a female doctor, to which I immediately acceded. Who am I to stand against such lunar inundations, but a mere promontory, still part of the mane? Besides, Perfidy hasn’t an ethical bone in her body, and I knew she’d give me the bollocks over a couple of sherbets come lunchtime. Which is precisely what transpired: settling into the snug that lets off the public bar of the Dog & Duck—our favored watering hole—she took a long draft from her 18.5cl glass of hybrid Chardonnay-Chablis and told me all. It was the most extreme case of vaginismus ever. If I liked—and I very much did; this is what I went into medicine for—I could think of it as a cosmic vaginismus, as the patient’s vagina, in clenching, was able to compress all forms of matter with such force that entire star systems—nebulae, even—were reduced to the dimensions of the average pessary.

“But how,” I interjected “could it be that these objects great and terrible were intruded into this poor person’s vagina? It hardly seems in keeping with the Hippocratic oath.” Perfidy was implacable, telling me to shut my cakehole. She’d had enough of this sort of bullshit during the protracted economic crisis following the ZANU-PF-rigged elections in 2013. As ever, a reference to the suffering of her homeland disarmed me. She continued: on the patient disrobing and lying down on the couch, the examination had proceeded. Their body seemed to Perfidy not to be of flesh and blood—or even of a combination of solid and liquid substances as crudely understood—but rather of plasma that continually approximated and re-approximated the human form while glowing with an unearthly beige luminescence. Years of domestic cleaning having desensitized her to even the most grotesque and corporeal of phenomena, Perfidy snapped on rubber gloves and proceeded apace. The vagina seemed to float above the patient, rather than being in any sense implanted or otherwise embodied.

So it was that breeze-blocks went up there, and old Ikea sofas, a two-car garage, and twenty or so rebars carted back from a building site. The vagina just cried out for more.

As she prepared to wield her speculum, the patient told her that, to begin with, they’d enjoyed the medium-sized penises of their lovers being made much, much smaller—and delighted in doing the same to dildos, but soon enough their increasingly vigorous vagina began demanding more and returning less. It became abundantly clear that sex with another human was out of the question when the third man ran screaming into the night, the stump of his penis hosing blood—and the fourth or fifth woman with her index finger or thumb severed did the same. Just as it became painfully apparent that artificial stimulation, no matter how extreme, would no longer result in pleasure once they began a futile practice of inserting bigger and bigger objects into their vagina: big dildos . . . very big dildos . . . disturbingly colossal, multipronged dildos the size of antique coat trees that disappeared in their entirety with a loud schluppp!

They knew they shouldn’t do this at home—or indeed anywhere at all—and they knew that they were risking a perineal tear, or worse, but it was difficult to resist in the fort/da kind of way that characterizes all human interactions with their irredeemably existent bodies. So it was that breeze-blocks went up there, and old Ikea sofas, a two-car garage, and twenty or so rebars carted back from a building site. The vagina just cried out for more.

“Whoa!” I cried at this juncture, adjuring Perfidy—who’d finished her first glass of wine and was knocking back her second—to admit that “you’re making this up. I’ve read or otherwise heard a riff like this one somewhere before.” To which she responded very angrily indeed. Why was it that only what I said was quoted directly, while her own far more important narrative—the case history of this remarkable patient, her Anna O. no less—was merely reported on? It was bad enough that I arrogated the authenticity of being all for my lonesome, worse still was this patronizing attitude toward her, who had been a senior consultant in Obs & Gynae at Parirenyatwa Medical Center prior to her exile.

“Anyway, what I discovered,” she continued, “when I finally took the plunge myself and, in the spirit of all great scientific pioneers from Marie Curie with her pitchblende to Jesse Lazear with his malarial mosquitoes, stuck my head right up their jacksie, was that death didn’t have to be the quiddity to this cunt’s powerful clasp. After my head went in, it wasn’t too hard to work first one shoulder after it and then the other. They’d told me that although the vaginismus was for the most part involuntary, they were able to exert at least some control over this distressing condition for a few seconds, and I suspected a few of the objects they’d put up there might well have managed to make it past the anterior fornix and into their actual cervix without being crushed or pulverized. While not by any means intent on some form of martyrdom involving iatrogenesis—a doctorly death while doctoring—I was nonetheless determined to conduct a thorough examination. However, this proved impossible—”

“What?!” I interjected at this point, but Perfidy disdained to answer, directing me instead to the bar, where I waited for what seemed like 152 years for the barman to catch my eye. When I asked him what he wanted he replied I’d got this the wrong way round—which was as nice a prefiguration of what Perfidy told me shortly after as I can conceive. Back in the snug, with its ox-blood-colored upholstery, and its pulsing-red battery-operated mini table lamp, I gave her a third glass of wine, and sat myself down with my second pint of Theakston’s Old Peculiar between my thighs, which, half-parted, lay athwart the deeply incised and stained surface of the ancient oak tabletop.

“Inside of them,” Perfidy resumed, “it was fairly dark until I turned on my head torch and saw that I had indeed managed to reach their uterus. And what a sight it was! Gooey stria looped down from the warmly pulsating walls of this vast vessel, while the great quantity of stuff they’d managed to get up there was coated in the same quicksilvery mucus. There were the rebars, the breeze-blocks, the Ikea sofa, the two-car garage, all scattered about higgledy-piggledy. And there was more. The first thing that caught my eye was Courbet’s L’Origine du monde in a characteristic frame of the period, gilded and ornately carved with laurels and swags of fruit. The very next thing my eye spied was the Vendôme Column, that petrified example of imperialist priapism the artist had urged the destruction of during the Siege of Paris, and which the Commune—Courbet was briefly the chairman of its Federation of Artists—had indeed enacted. The huge stone and bronze cock, its glans formed by a statue of Napoleon in the guise of a Roman tribune, had fallen across the square to the cheers of the Communards and the strains of a brass band. And, by this radical detumescence alone completed the dyadic oeuvre begun with Courbet’s painting of his lover-cum-model’s genitals. Finding painting and column as it were, conjoined in this exceptional way led me to the correct diagnosis—”

“Which was?”

“Pretty obviously that the cosmic vagina is just that. A sort of portal or gateway, not exactly between worlds, but among them. If L’Origine du monde and the Vendôme column were in it, then by extrapolation from this vast improbability, everything must be.”

“You mean,” I leaned forward, hands gripping the moist sides of my pint glass, “that we’re stuck up there too?”

“Everything,” Perfidy said with fatiloquence, “is, was, and always will be ‘stuck up there.’”


Premature Burial

It was disconcerting to review the treatment of this sixty-one-year-old man in my surgery today. He arrived unannounced from up-country, where the apricots grow in ancient orchards in the greatest profusion. A gaunt figure in clothes as insubstantial as the dust of his native hills, tan and dun-brown-hued, wrapped round akimbo legs and crooked elbows, a scarf like a plume of bluish woodsmoke streamed from this burnt, stubbly neck, and he said, “I’ve a bad problem, Doc. Let me a-put this bundle down first,” which he did, beneath the examination couch, next to the pedal-operated sharps disposal bin that I love. “It’s still me inside this—” He passed a hand over his weathered features: the rocky promontory of his nose, the gulches of his cheeks, the slot canyon of his mouth, the lava dome of his forehead, “this dreadful, devilish corruption.”

“I’m sorry,” I said. “I see no corruption, sir, only the abrasion that Time, that great leveler, applies even to the smoothest of complexions and the most refined of countenances.”

“Be that as it may,” replied my new charge, “I tell you it is a corruption. And it’s your colleagues that’re to blame.” With a flourish he pulled from a pouch under his robes a scroll that, upon unrolling, I found to be his medical notes—ones written in old-fashioned cursive script.

“The cosmic vagina is just that. A sort of portal or gateway, not exactly between worlds, but among them.”

I went to the window, where the daylight helped me pick out from a mass of fussy curlicues and other whimsical embellishments, these basic facts: the patient had recently attended his local generalist’s, where he’d complained of being immured in the body of an old man. He said this condition had crept up on him oh-so-gradually—over decades, in fact—but there was no longer any disputing the reality of it. He couldn’t so much as stand, walk, or smile, without being oppressively conscious of the layer of wanting flesh within which he’d been entombed. He regarded the world through eyeholes cut in a tragic mask of senescence.

Leafing back through the pages I saw that the patient had, at every juncture in his life, not only received appropriate medical treatment, but that his very life had been saved on a number of significant occasions, foremost among them his birth, when, since he’d had a congenital inguinal hernia, tube feeding was required for the first few days. There had been an operation for a strabismus while still a child, which, if unperformed, would have left him wandering round looking like a smacked fish; in his thirties, he ended up in hospital twice with septicaemia, which would’ve meant certain death before the advent of broad-spectrum antibiotic treatments that can be intravenously delivered.

In his early forties, the patient had been diagnosed with Polycythemia Vera, a myeloproliferative blood disorder that, while it may have a whimsical-sounding name—as if born of the union between and East End pub landlady and an ancient Greek goddess—would nonetheless have proved fatal fairly swiftly, were it not for medical interventions, initially regular venesections to dilute the patient’s hemoglobin-rich blood, latterly chemical therapies to regulate his bone marrow’s overproduction of stem cells. Flipping through this history, seeing the sheer quantity of resources necessary to keep this—let’s be frank—this peasant, alive, made me seriously question, for the first time in decades, the socialized health service instituted following the revolution. If I found the man borne, the system sustaining him was yet more so. The Malthusian gap between the people’s ever-increasing desire for the most modish possible treatment, entirely on demand and completely free, and the ability of our small and economically backward country to raise sufficient taxes to pay for it, has engendered this peculiar social consciousness, one of an ever-expanding lack, a Doppler wail of need and recrimination, rising and falling in pitch as the fiery phaeton of our national destiny arcs across the heavens.

And recall, the regime was thrown into crisis last year by a surplus in the apricot harvest. Under such circumstances, the odd-wobbling bubble of advancing medical science and technology sustained by this collective wail—one within which this fellow had lived for the majority of his life—is an utterly unprecedented phenomenon. Sustained being the operative word, because as I rolled up the scroll upon which these revelations were written, I was forced to acknowledge that this party had to stop.

“You are old.” I told him “That is all. And there’s no lifetime warranty for a life. You should’ve died at birth. I’m deprescribing the hydroxycarbamide you’re currently taking. Five hundred milligrams twice daily, wasn’t it?” He nodded his earthen head. “Good. Thank you. All things being equal, you should be dead in a few weeks. Next!”



This sixty-one-year-old cyborg thought it could cicatrize its way into being human—I shit you not—by shooting heparin into its steely belly, making for a series of what would have been, in someone creaturely, subcutaneous injections that deposited globs of the anticoagulant beneath the first few layers of its anticorrosion paint. Where it got the notion from, I’ve no idea. It looked like a complete mess piled up in the corner of my surgery. A torso like a vending machine scorched with a blowtorch (the aforementioned cicatrization was to be completed by self-brazing), limbs resembling single-use hypodermic syringes, the needles for hands, together with bicycle wheels (no mudguards!) in place of any effective propulsion system. As for the buffeted old canister housing his CPU, this had helpful legends under its optic, olfactory, auditory, and oral sensors in a science-fiction typeface that screamed anachronism down all the forking corridors of counterfactuality.

You will forever be chasing reality—going after it, in the manner of a reckless huntsman lost in the snowy woods, night falling, the chilling cries of wolves all around.

When I’d powered it all down and got the consciousness cassette out and paired it with my desktop, I saw its heads-up display and health bar. Poor stupid clunker had about enough power left in it to make a warmish cup of Nescafé. And when I say warmish, I mean tepid. What to do? More heparin of course. What doctor ever tires of fiddling with hypos? They’re the fountain pens of our profession, and in common with writers, we achieve remote effects by proximate injections of liquids. The rice-papery covering of the blister pack, the flick of the barrel to remove the air bubbles (done purely in order to convince my patient that it could aspire to an embolism), and then the swift sliding of the needle into—

Well, well, well! I’d fallen victim to the same mishegas as it! Trying to turn Big Pharma into something like karma. But then that’s the zeitgeist, isn’t it? Ever since my Casio digital watch became sentient in 1971, my adult life unfolded in this way: the tie-dye T-shirts of my childhood morphed into the Che Guevara ones of my adolescence—both kinds rippling, bulging, pitting, cratering, erupting, spewing, pyroclastically flowing, impressing, retaining, hardening, petrifying, chipping, cracking, spalling, disintegrating . . .

“Fugal,” is what the celebrated neurologist my parents consulted said: “Fugal in this respect: you will forever be chasing reality—going after it, in the manner of a reckless huntsman lost in the snowy woods, night falling, the chilling cries of wolves all around, who stops, hearkens to the bleak wind of change soughing in the radio masts’ rigging, then allows himself to jolt away to Weehawken, surge back through the Putnam Valley dead-switching unit, experience resistance in Croton-Harmon (two ohms, or better), before boomeranging once more into this bigger world—one where we inch our way into the near future of space-time, nails in our mouths, heart there as well—and supported solely by our own innate grammar and its near-infinite potential for expression . . . pneuma . . . Qi . . . Zonked zephyrs zigzagging through a bony cage of resistors, transistors, and it’s-the-Intel-inside . . . that forecloses again and again as we merge first with Tilly Matthews’s air-loom, latterly with Eckert’s and Mauchly’s ENIAC . . . And beyond that? Yes! A thousand times, yes! The elemental electricity of that elementary encounter, as the world-girdling murmuration of the human mind-brain condenses to the density uranium-235 requires to become fissionable . . . Day in, day out, day in, day out, day in, day out—as someone even more spark-a-loco than you sparked-up: day in, day out, day in, day out, day in, day out . . . Zeros penetrated by the ones chasing them . . . Off turned on . . . on turned off . . . A fugue, indeed: lumpa-lumpa of alien pixels—disintegration of carious postwar public housing (which regime’s—capitalist or communist—is unimportant), lumpa-lumpa . . . Day in, day out—you get the photo? Everything has been sentient since August 6, 1945 . . . You knew that, what with your watch—or should I say, its strap, its strap rubbing between your legs . . . rubbing and rubbing . . . Time engendering experience—experience engendering time: Heidegger buggering Heidi up some glossy alp; its surrounding picture-postcard valleys enough to disturb us all. Finally.”