Three Moments of an Explosion

by China Miéville

  One of the reasons I took her is that I read there were rooms where you had to go in one at a time. You’d be alone with one of the actors, and they’d talk to you. One-on-one performances.

  “When do you get to be an audience?” I kept saying.

  I phoned Jonas while she was in one of those rooms. “I’ve been feeling like she’s having an affair.”

  “Don’t be stupid. Tor’s crazy into you. So. When are you going to come see these videos?”

  We fixed a day.

  She came out of the room and said to me, “Are you ready to go?”

  “How was it?”

  “Meh.”

  One of the actors was standing in the doorway of the little room. He was a young skinny guy with dark skin and long hair, wearing a ticket collector’s uniform. He was watching. I couldn’t tell his expression past the big old glasses he had on, but he was looking at her, hard.

  Jonas met me at a side entrance to the hospital.

  “She’s here today,” I said.

  “I know. She’s in a different building. I want to show you something that happened last week.” He took me to a meeting room and we leaned in around his tablet while he started the footage. “So this is like a final exam for some of these guys. Seriously, you tell anyone I’ve shown you this and I am out on my ass, you understand?”

  A ceiling camera looked down. A young woman sat before a desk, perfectly still. It was a full second before I realized it was Tor. A medical student came in, scribbling on a clipboard.

  “Miss Benedict,” the student said. The sound quality was not good but you could hear her nervousness. She shook hands with Tor and sat down. “I’m Dr. Chung. Please tell me what I can do for you.”

  Tor was silent for a moment. She glanced to her right and waited, then said, “I have a pain.”

  Her voice was low and totally unlike her own.

  Jonas paused the image.

  “So she’s supposed to have a pain down in her side,” Jonas said. “Appendicitis.”

  “A classic,” I said.

  “This is about the eighth student she’s done. She’s been at this all day.” He restarted the footage. “All fine until now.”

  “Where’s the pain?” Chung said.

  “This pain began on the back of my neck,” Tor said. “It started two days ago in the hollow at the back of my neck, and it’s spread down my spine and up into my skull. It’s spread into all my limbs.”

  I looked at Jonas.

  “Can you describe the pain?” Chung said.

  “It’s a pain like melting plastic. A hot pain. It started almost unbearable and I was screaming. But then it seemed to cool and as it spread out across me it left my skin hard.”

  “Excuse me?” said Chung.

  “Where the hot goes it leaves my skin as hard as my fingernails. And covered in raised patterns. See?” She held up her arm. Chung wrote notes.

  “What’s she talking about?” I said. “What condition is this?”

  “You tell me,” said Jonas.

  On the screen the door opened and a senior doctor I vaguely recognized came in.

  “I’m sorry, I’m going to have to interrupt you,” she said. “Ms. Chung, can you wait outside, please?”

  The student left and the doctor stared at Tor and the screen went blank.

  “I wish she hadn’t stopped the filming,” Jonas said. “But apparently, that doc, Sheila, she asked Tor if she was OK. Because this sure wasn’t appendicitis. She was way off-script. Tor says she’s sorry, she’d mixed up another project, though excuse me, what the fuck? She says it had been a long night, she laughs it off, and she comes back and does two more hours of appendicitis, and it’s fine.”

  He swiped through his files. “Then. Three days later,” he said. “She’s Agnes Ball, chatty hypochondriac with gastroenteritis. First couple of sessions no problem.”

  A different room, a different desk. Tor stood against the rear wall. A student entered.

  “So, Doctor,” Tor said immediately. She lifted her long sweatshirt and bared her midriff. The young man blinked. “Things are moving below here,” she said. “I think I have eggs inside me, moving around in my blood. They were tiny, like flaxseeds, at first, and it was painful but I knew it wouldn’t kill me. But then they grew and changed shape, and now I have a cluster in my thigh, and a cluster in my left hand, and some right here in my belly. I’m worried because I’ve been dreaming in languages I can’t speak.”

  Jonas froze the image of the student’s confusion. He swept slowly through a collection of others.

  “Yeah,” he said, looking at my face. “Every few times, now, she comes out with symptoms like this. When we ask her about it she says she got confused, that she’s doing another project. Does that make any sense to you? Some play … ?”

  “No.” I said. “If she’s doing anything like that I don’t know about it.”

  “Remember these students are babies, man, they don’t know what they’re doing, so they hear this shit and their first thought is, ‘Oh fuck, I should know this!’ They hear this and they’re going to try to cure her of this stuff.” Somewhere in the building Tor was helping make doctors. “If she keeps up like this we can’t use her,” Jonas said.

  “There’s more?”

  “Yeah. They’re not all recorded. It’s crazy stuff. What did you say?”

  I hadn’t realized I had.

  “Nothing, man,” I said. “Let me see what you’ve got.”

  What I must have mouthed, what I was thinking, was anagnorisis. It’s when a character makes a big discovery.

  “I woke up yesterday,” she said on the screen, “and my hands were ghosts’ hands, Doctor. They were still there but they were faint so I could see through them, and I couldn’t pick anything up because they weren’t solid.”

  “We all love her,” Jonas said. “She’s great, best SP ever. Seriously. So we kept trying to say it’s no big deal. But man …”

  “I’ve been vomiting, Doctor, and when I look at it afterwards it’s nothing I’ve eaten. I’m sicking up someone else’s puke.”

  “My feet won’t touch metal, Doctor. Like a magnet against a magnet. I ran up a fire escape and there was no sound at all.”

  Tor’s family moved to Seattle three years ago and her dad’s a piece of work and he’d be no help. And I like her sister a lot, so I wasn’t going to scare her with this, not without good reason.

  “Will you let me do something?” Jonas said. “I want my buddy Zak to talk to her.”

  “A shrink?”

  “Yes, and don’t look at me like that. Come on, man, let’s just rule stuff out. We both know Tor. Maybe she’s fucking with us. Maybe this whole thing is some kind of art project. Maybe she’s performing.”

  “Of course she’s performing.”

  “You know what I mean. But you get why I want Zak to talk to her, right?”

  “You can’t tell her I know anything about this,” I said. He crossed his heart with his finger.

  I’m sitting here drinking this shitty coffee. Jonas and I are checking our watches, making sure we don’t miss what we’re here for. Bund I’m sitting here reading this schedule and thinking, Hey, I should have gone to some of these sessions.

  We should be here to figure out what this work is all about. To get with all the SP debates, all epoxy and overhangs. Whatever’s going on is all about the SPs. And if I’ve learned anything in the last few years, I know there’s nothing standard about a standardized patient. That I do know.

  Do you know how many illnesses just never get figured out? Someone goes to the doctor. They’re in agony, they say. The blood work’s fucked. Something’s wrong, maybe even badly wrong. Specialists are called and checklists checked.

  Then a month later? Everything’s fine. The patient’s glowing. And no one ever knows what happened.

  We constantly hear about people dying of mystery diseases. We rarely get to hear about all the people who have them and just get better. If they w
ere really going to reflect medical practice, some huge proportion of SPs would just deliver a mix of incomprehensible symptoms, then walk out again leaving no one ever with any idea what just happened, or what to do about it.

  But instead of learning this stuff proper, we’re sitting here, Jonas and I, waiting for just one presenter. And she’s not even really presenting.

  Dr. Gower’s doing the after-dinner talk. She’s the comedy entertainment.

  “You want to hear the most outrageous thing?” Tor said. “Someone in the hospital sent a psychiatrist to talk to me.” She gaped performatively.

  “You’re kidding me. Why?”

  “I am not kidding you. It’s the most stupid thing.”

  We were driving to an outlet mall: she said she wanted more clothes to be higher-end patients.

  “What’s the story?” I said.

  “So, you know how the last couple of weeks I’ve been kind of a bit distracted?” We hadn’t discussed this at all until that moment.

  “Yes?”

  “I made a couple of silly mistakes, I sort of lost my place, I guess you could say. And they’ve decided because of that I have lesions or early onset Alzheimer’s or that I’m schizophrenic or I don’t know what. I’m so pissed.”

  “That sounds dumb,” I said. “That sucks. And there’s nothing I need to worry about?”

  She smiled and it really did seem like the kind of smile she would have done before.

  Jonas told me to come to the hospital right away. “Tor’s not there,” I said, and he said, “Dude, get here.”

  He took me to a little room.

  “I told this guy that we work together, that you’re a researcher,” he whispered. “That’s close enough, right? So—” He put his finger to his lips and ushered me in.

  The patient was a tubby guy in his sixties, lying very still in the raised bed. He watched me with wide frightened eyes.

  “Mr. Brandon,” Jonas said. “This is my colleague I spoke to you about. Could I ask you to show him what you’ve shown me? Tell him what happened?”

  With slow, careful motions, Brandon undid his pajama top. “Just like a burning pain,” he said. “All over.”

  “Where did it start, Mr. Brandon?” Jonas said.

  The patient carefully pulled his top open.

  “Back of my head,” he said. “Like I was being burnt alive. Spread from there all over.”

  His skin had keratinized. He held his pajamas wide. I could see patterns across his hardened skin.

  “It cooled down and left it like this,” he said.

  Jonas put my hand gently on Brandon’s body. The skin was tough and brittle as plastic, in a pattern creeping around his flanks, over his shoulders, around his neck like a spread of damp, from his spine. There were raised, darker markings across the hard patches. They looked like hesitant script.

  Brandon blinked. He said, “Can you help me?”

  He was just a guy. Had lived in the town most of his life, worked in the Education Department, liked fishing. No serious previous conditions.

  “He thinks it’s cancer,” Jonas said. “I don’t blame him. It’s not cancer. You don’t know him?”

  “I don’t know him. Neither does Tor.”

  “You don’t know that, man.”

  “She doesn’t know him.”

  —-

  Diane did some poking around when we saw the schedule for the conference and decided to come. Dr. Gower’s a real researcher. Her doctorate is psychology, though, not medicine, and the work she’s going to be talking about is real, though she obviously has a sense of humor about it. I figure her after-dinner speech is going to be one of those inside jokes. Like some of the stuff that wins the IgNobel Prize—a joke, bund a real insight too.

  It’s called “Veering Off-Script: Mistakes, the Shakes, Psychotic Breaks during SP Performance.”

  I’m sure that’s hilarious to the attendees.

  We came to this conference just for the banquet. We have our meal tickets. I’m planning to laugh in all the obvious places. But afterwards, we’re going to talk to Dr. Gower, Jonas and I. We’re going to explain our predicament.

  What examples does she have? She knows the history of this kind of thing. Of going off-script. What if this has happened before, whatever this is? Maybe it means something. Maybe we can fix it.

  Brandon was weak and growing weaker. The dermatologists were bewildered. “He’s delirious,” Jonas said, “but he doesn’t have any fever at all. If anything, he’s getting colder.” Brandon’s hallucinations were getting stronger but you could still, just, talk to him.

  The last few times we’d met friends for a drink or supper, Tor had been at least partly still in character. She wasn’t not herself, she was herself-in-patient, she was herself bund her role. Someone studious, or worried, or boisterous, and ill. Always ill.

  I wanted to talk to her about this, of course I did, but she was so focused in that state, she felt almost implacable. I didn’t know how to say anything.

  “I can see in the dark, Doctor,” she said to one student, one day. Jonas showed me the videos when anything unscripted happened now.

  “They’re so going to dump her,” he said.

  “Perfectly,” she said on-screen. “Much better than I ever could in the light. And I breathe out more than I breathe in.”

  “I started writing a letter to the president of the ASP,” Jonas said. “I could ask her if she’s ever heard of anything like this.”

  We’d been reading up. In 1963, Howard Barrows trained the first SP. She simulated multiple sclerosis and paraplegia. In 1970, Paula Stillman hired women to talk about their imaginary children’s illnesses. Didn’t help us.

  “I’ve been imagining like a secret history of the ASP,” Jonas said. “Like some Opus Dei shit. Knights-Hospitallers, boom-tish. Right? Like maybe the Association of Standardized Patients has a paramilitary wing, a black-ops wing, a psy-ops wing.”

  “Please stop talking shit, this is Tor,” I said.

  “OK, OK. Listen to me, I need to tell you something. Someone else has the same thing Brandon does.”

  The second person to come down with the condition, at least in this area, was Ms. Dean, a woman in her thirties. She was deteriorating quickly. She wouldn’t let me in like Brandon had, so Jonas had to describe to me what was happening.

  That night I watched Tor closely and she told me I was making her feel uncomfortable. I said she was making me uncomfortable too, and I gestured at her clothes that were hers and also not hers. Sometimes, when I felt really bad, I wondered if “she” was even a useful category any more.

  “You’re being weird,” she told me. “I need some time.”

  I gave her an awkward hug and begged her to stay. “We need a breather,” she said. “Just a couple of weeks. I’ll go stay with Stacey. This is us-management.”

  The same day Tor drove to her sister’s house, Ms. Dean died.

  “Her skin’s going soft again now,” Jonas said.

  “Now that she’s dead.”

  “Yes.”

  He was blustering but he was stricken that she had died.

  We weren’t good at this. We dithered, failed to think of strategies while whatever was happening happened faster. Two more people were admitted, their skins hardening with obscure messages.

  In the children’s ward, he told me, two young girls had spent the day puking and crying.

  “So?”

  “So one’s on the kosher option,” Jonas said. “And she’s puking up sausage meat. Which her buddy ate, but which she is not chucking. They’re throwing up each other’s puke.”

  I called Stacey and she told me Tor was out, having a think, that I shouldn’t worry, that Tor loved me a lot, that she’d call me soon. “She’s one of the good ones,” she said.

  “I know,” I said. I called Jonas and told him I had to go get her.

  “OK,” he said, “but first you need to talk to Danny Merchant.”

  “Who?”

>   “An SP,” he said, and I remembered that I’d met him, that he’d qualified in Tor’s training class.

  “What’s the deal?” I said.

  “He did a gig for us a few days ago. I just heard about it. It went wrong. He started describing an illness that doesn’t exist.”

  There was no footage. Jonas told me that Merchant had not repeated any of the conditions Tor had described. “He was talking about how he grew a new limb for a day,” he said. A hairless tail from the middle of his chest, studded with thinly skinned organs like tumors. “Swears absolutely blind he doesn’t remember anything about it.”

  We met him in a little café in the low-rent area where he lived. “How’s Tor?” he said.

  “I want to talk to you about what happened the other day,” Jonas said. “You remember,, you were doing lower abdominal pain? And then about halfway through …”

  “I know what you’re talking about,” Danny said. “But no, I don’t remember. I only know because they told me about it. I don’t know what to tell you.”

  “When did you last speak to Tor?” I said.

  “What? Not since the course,” he said. “But I was thinking about her recently. I don’t know if maybe because everyone else has started talking about her.”

  “What?” said Jonas, and “Who has?” I said, at the same time.

  “You said something about her when you asked about this before,” he said to Jonas. “And, I don’t know, I’ve just been hearing her name around. I don’t know if that had started before I did whatever they keep telling me I did.”

  There might be viruses that go back through time. Whatever condition he had, he did not have it in as pure a form as Tor, I could tell. I was sure his presentations would be more vague and incoherent than anything she said. He didn’t seem clear on any script. Still, I bet somewhere someone’s in hospital with a little nub on his or her chest. Maybe it’s like a big skin tag.

  Danny doesn’t have whatever this is like Tor did, but he does have something. She was Patient Zero. Epiphany’s contagious. More SPs have started describing more random conditions, that should be impossible, and that used to be.