NAME: PAISLEY, MARTIN
Clinician: Dr. Anil Varghese
Martin Paisley, a 17-year-old male with JI2, presented unconscious on March 11, in critical condition due to acute cranial trauma caused by blunt injury to the head. Following cessation of vital signs and pronouncement of clinical death, activation of JI2 “post-mortem” changes began and Martin was recruited to the M-Plagge trial by Dr. Lane Ballard.
General observations
Martin was seventeen years old when first diagnosed with JI2 on January 3 and regular check-ups confirmed the continued presence of the juvenile hormone. He was a student at the Faculty of History at the University of Oxford where by all accounts he was flourishing. His sister Catherine Davis had been named his guardian, and encouraged him to defer for a year after his condition was reported to her, but he resisted.
Initial progression of JI2
13 MARCH. The first stage of the transition has proceeded along anticipated trajectory although much faster than previous observations have indicated. Muscle tremors have ceased. The epidermis has begun to develop a thick layer of keratin forcing rigidity but only briefly. Internally, there is a catastrophic destruction of the prior form’s tissues, as lungs, kidney, spleen are being broken down into an autodigestible “mush” but only a limited period of stasis, much shorter than before. A needle biopsy has revealed that clusters of individual cells have returned to an embryonic state, embarking upon a secondary developmental path.
Research thus far has suggested that the fertilised human egg contains the hereditary programming for two very different and specialised patterns of body development. Humans have typically developed upon a singular path as witnessed by the standard phases (zygote, blastocyst, fetus, neonate, pre-adolescence, etc.) but this transition indicates a possible “branching” during puberty in which the secondary form might be triggered if certain conditions are fulfilled. But there are still questions I can’t answer: What are they? Why is this happening now?
14 MARCH. Sac-like epithelial clusters detected, which will develop into the “wing-buds” over time. Already, bones have lightened considerably, faster than we’ve observed previously. Multiple air sacs established, extending into the humerus, the femur, the vertebrae and the skull. The external layer of keratin has begun to resolve itself into the first layer of the nymph’s plumage (dark brown). Rigidity of the body form is substantially reduced now that the initial interior re-organization has taken place. The new organs (heart, lungs, stomach, liver) have been established and are functioning smoothly. Martin blinks frequently during marked cycles of alertness and motor activity.
15 MARCH. At the request of Dr. Lane Ballard, Martin has been started on the M-Plagge trial.
Course on M-Plagge
The secondary instar—or growth stage—has been inhibited, as suspected. M-Plagge appears to be functioning successfully as a blocking agent, reducing substantially the effects of the juvenile hormone. If these tests bear out over time, then M-Plagge might offer some hope of stalling the development of early symptoms in JI2 patients and reducing the possibility of transformation.
16 MARCH. Martin shows striking changes. His expression is alert, and his rigidity is distinctly reduced. Small interactions include bouts of staring in which his eyes appear to track—or focus intensely—upon anyone who enters the room. But I can’t dismiss the feeling that he recognizes me. Dr. Ballard insists this is sentimentalizing but there is evidence that suggests otherwise. He has shown renewed signs of awareness, including frequent openings of the mouth as if to yawn or speak. It should be noted that the anatomy of the vocal cords has been significantly altered. All that remains of its previous function is a high chirruping sound.
17 MARCH. On a higher dosage, Martin shows improved posture. Despite the limitations of his body, he has begun to move. Gestures of the truncated metacarpus, something like little waves? His behaviour is remarkable. No prior patients have demonstrated anything like this responsivity. But what does it mean? The rapidity of metamorphosis in other patients means our tests are now of vital concern. Might there be a way to communicate with Martin? I think so.
First test shows a limited range of responses, but a basic method of communication (one blink for no, two blinks for yes) has been established. fMRI scans indicate that perhaps more of the language centres of the brain (Broca’s area) have remained intact, or perhaps their function has been amalgamated into processes directed by an enlarged hippocampus? When questioned as to whether the subject could understand me, subject blinked twice.
If the subject’s identity remains intact at any level, this raises serious concerns about current regulations re: cremation. Previous subjects showed no signs of awareness but the speed of the instar development prior to M-Plagge is astonishing. Dr. Ballard has expressed unease with this line of questioning, fearing that evidence of subject identity may raise concerns with the Medical Research Council, which could jeopardize our primary trials. I have argued repeatedly that establishing the full nature of the condition is the only way to develop an appropriate treatment.
18 MARCH: M-Plagge dosage increased to 5 gm. daily. Initially Martin responded well, but over the course of several hours his movements became increasingly frenetic. Metacarpal gestures resumed but with some urgency. When restrained, he went through a series of muscular convulsions. Concerns over a possible seizure forced us to reduce the dosage.
(transcription taken from 18 March video record)
Dr. Varghese: Martin, can you understand me? (Two blinks.)
Dr. Varghese: Are you in pain?
(One blink. A long pause. A second blink.)
Martin looked at me directly when I asked him that question. I could track his eye movements.
19 MARCH: A reduced dosage of M-Plagge has allowed us to reach a better balance with Martin. Responsiveness returned to previous levels. He seems to experience minor convulsions when I leave, followed by a series of flexing gestures, increasingly urgent. Martin becomes quiescent when I return.
I have commissioned an Eye-gaze Response Interface Computer Aid (ERICA), which will allow a camera and infrared light to track Martin’s gaze on a computer screen as it focuses upon key icons, words and in some cases letters. Communication should be much more rapid and efficient.
The success of the ERICA unit has now allowed for a number of long conversations to be recorded. Martin has been able to identify images of members of his family: his living sister as well as his deceased parents. His memory, however, is not perfect, as at times he is unable to distinguish between past and present, imagining his parents still to be alive. When questioned about this, he indicated, “They are dead, I know they are dead, but sometimes I seem to remember clearly that they are not dead. My mind is lying to me.” This sense of confusion has recurred throughout subsequent sessions. “I feel pulled by something,” he indicated. “Like someone is in the room next to me, shouting for me. Sometimes it is very loud. They are impatient.”
20 MARCH: Martin has indicated his sensations are “muddled.” He feels “an absence, and sometimes a presence. A terrible shadow in his mind.” Might this be the inhibiting agent itself? Dr. Ballard says there is no way to verify without reducing the dosage in which case he fears the transition—effectively inhibited thus far—might resume. He has expressed concerns that new treatment approvals are likely to be delayed by current regulatory uncertainties and has informed me the M-Plagge trial is set to expire in seven days.
21 MARCH: Martin is minimally response.
23 MARCH: Dr. Ballard and I met today to discuss Martin’s progression. I’ve suggested we attempt to contact Martin’s sister and obtain consent for the trial to be extended indefinitely. Dr. Ballard has refused, claiming DONATION agreement prevents any further contact with the family. He insists that the cremation order must be enforced as scheduled and that not enough evidence exists to demonstrate the presence of the host’s identity. I suspect his concerns are for M-Plagge which has been expedited for further clinical trials in current JI2 patients. But surely Martin has demonstrated that our current frameworks for understanding the condition are inadequate? This is no disease.
(transcription taken from 23 March video record)
Dr. Varghese: Martin, do you know where you are?
Martin: Yes. At the Centre.
Dr. Varghese: Do you know what is happening to you?
Martin: Yes.
Dr. Varghese: Can you describe it?
Martin: Why?
Dr. Varghese: Because (a hesitation) there are others like you. You know that, don’t you?
Martin: Yes.
Dr. Varghese: They’ve changed. We want to know what they might be experiencing.
Martin: Yes.
(Twenty seconds elapse.)
Martin: I know what is happening to me. At least, I think I know. I’ve stalled, haven’t I? I’ve got stuck along the way. I can’t tell if I’m going backwards or forwards, anymore. Or which way I’m supposed to go. I keep having dreams.
Dr. Varghese: What do you mean, Martin?
Martin: There was something I was supposed to do.
Dr. Varghese: What?
Martin: I feel as if I’m failing a test I didn’t study for. I used to have dreams about that, you know. I had such awful dreams. Anxiety dreams.
Dr. Varghese: I’ve been having dreams as well.
Martin: I know.
Dr. Varghese: How do you know that, Martin?
Martin: Except they aren’t dreams. They’re more like memories. I am remembering something I was supposed to have done. A place I was supposed to go.
Dr. Varghese: Where?
Martin: I can’t tell you. You wouldn’t understand.
Dr. Varghese: Tell me about your memories, Martin.
Martin: Everyone got there ahead of me. Everyone is waiting for me.
Dr. Varghese: Does this frighten you?
Martin: I’m afraid of staying. I’m afraid they’ll leave me behind now. They’re out there and they are waiting for me. They want me to come with them. While there’s still time. I want to go now. May I go now? I want to go now. Please.
25 MARCH: Today Dr. Ballard told me the termination will be processed despite all my arguments. He has not reviewed my transcript. I don’t know what to do. Last night I had a dream. I felt as if someone was calling me. It was Martin’s voice but I knew it wasn’t Martin anymore. I don’t understand how Ballard can go through with this, knowing what we know.
I have registered a complaint with the Medical Research Council but I have been told that regulatory procedures have been temporarily suspended and Ballard has been given authority to proceed. Security has been posted outside Martin’s chamber and I have not been permitted any final contact.
27 MARCH: AS per protocols, Martin P. was injected with a succession of saline, sodium thiopental, and a lethal mixture of potassium chloride and pancuronium bromide, a paralytic designed to prevent spasms. Time of secondary death recorded as 2:32 pm. His body was delivered for autopsy prior to cremation.