In room twenty-one of the intensive care unit there is a comatose man, the ventilator that breathes for him, a tower of intravenous drips, and the Emanation. As I walk in, the Emanation scurries out from under the blankets, shoots up the line of the patient’s leg to perch on his blue toes, and screeches at me. Its mouth is a dry hole with a desiccated worm of a tongue inside it, and sharp, sharp teeth; its skin the gray of weathered stone spotted with moss and lichen. The Emanation is tiny, which is unexpected—a squirrel—no, a marmoset.
The room is silent, though each screen blinks, and bright words run across the monitors one after another—all alarms are off while I am in the room, though I could still hear the beeping coming from elsewhere in the ICU. The sink in the corner has been filled with hot water and plugged, also as requested. I am not used to this level of cooperation and courtesy.
These are the tools of my trade: paper and ink from a specialty supplier, the Perceivers’ stamp, a drawing board. I pull the red ink stamp out of my breast pocket—warm ink stays soft—as I learned from my late mentor, Helen. I incline my head to the Emanation and the patient, then murmur the ritual words, though I have to do it twice. The first time I stumble over the words, still huffing and a little dizzy, I suppose, from climbing four flights of stairs, dodging Emanations on every stairwell. Or maybe it is because I turned sixty this fall. I ignore the sudden pounding in my right temple and start the chant again. Outside the door, a couple nurses and one of the custodial staff gather to watch me. The rest of the doctors and trainees are dutifully working at their computers as if I am not even here, though a few send me surreptitious looks. I do not think there are any like me out there, not a single other Perceiver in the room.
The Emanation of the patient’s illness—the marmoset—hides, cuddles against his chest, but I have enough of an idea to begin. So I return the stamp to my pocket and sketch on my paper and pad, approximating the disk of its small face, filling in the curve of the ear, the feathering of hair on its forehead, the watery globular eyes, the sensitive prehensile tail, the finer details of the fingers.
Soon enough there is movement, and the Emanation reemerges, hanging down from the side of the bed now, watching me. I tilt my drawing pad until it has a full view of its own visage. This is an uncommon specimen. I have pages and pages of monkeys and apes of various sizes, the ones that accompany kidney disease and hide among the dialysis machines and in the shadows behind the curtains, behind the rooms of sleeping people. However, I have never seen a marmoset. From the patient’s history I assume this is the Emanation of a toxidrome.
I would have to dig into Helen’s notes later to see if she described one before. Helen never threw anything away but never organized either. In the first few months after her death, spurred by a sense of my own mortality, I started to collect all our drawings—we were both proficient artists, a necessity of the job—with plans of creating an illustrated medical textbook for the Doctor Perceiver. I wanted to make something better than the haphazard booklets that I had in my training: something glossy and shiny and weighing at least ten pounds, something for posterity.
Helen trained with Perceivers who were around in the days of the dragons of scarlet fever, the great mire-monster of diphtheria, the bat-like conglomeration that covered the skies from tuberculosis—for a whole winter, they told her, there were so many bats hovering over the city that even those without the Perception could sense them blocking the sun. In some parts of the world, you can still find the swarms like a shadow over the earth. She kept those pictures—murals, really—from her mentors: creatures akin to those drawn by William Blake, cosmic, apocalyptic. People believed in Emanations then, and in the work of those who dispelled them.
These days, I see different Emanations. Not dragons to slay, but the pale cave-creatures of addiction, waving their watery eyes and slithering tentacles. Other Emanations of shadow, vortexes in which a person may lose all energy and signs of themself, and the harder they struggle the deeper they fall. And now this, a fuzzy little marmoset causing multi-organ failure. They are fearsome in a different way, though. Thinking of the dragons of old, I wonder if the smaller, diminished creatures that afflict our age are telling us something about what we have become.
These days Perceivers are no longer considered practitioners of the mainstream branches of medicine; changes in another arcane system, that of medical billing, have made it impossible for the hospitals to be reimbursed for our services. The billing changes came out of left field and we—who considered ourselves gifted with privileged sight—were ironically blindsided. No one knows exactly what happened, though when one considers that drug companies could not sell as many drugs or medical devices with more Perceivers around, what happened is no longer surprising.
In the beginning, whenever Helen and I had a trainee get the glint in their eye and we knew they were going to join our specialty, we’d toast with the gin she had hidden away in her cupboard. Helen would say, To the one we caught, and I would say, To the future. But fewer and fewer doctors came to train under me each year. The idea of the textbook fell by the wayside.
The marmoset chitters, pleased with my drawing. It pulls down the picture to see it fully. I have altered its features in my drawing to allow a more benign countenance—no teeth, all smiles, cuddly, less like a creature extra from a monster movie. In accepting its likeness, the Emanation itself also acquires a more friendly appearance.
That was the first trick Helen taught me when I was her student. She was a patient teacher but did not suffer fools. Gaining her approval felt to me like gaining the favor of the gods.
The marmoset perches on my shoulders and then clambers onto my head, where it musses my hair. I take out the disk of red seal ink from my pocket and, raising my arm, press it gently against the back of its head. The Emanation is not entirely corporeal, so this has to be done carefully, but also with complete conviction.
The ink makes a bright red stripe against the back of one quivering ear. This angers the marmoset and it tries to wash itself off, with the result of getting the red oily paste elsewhere on its face.
Close enough.
I stamp the page with my engraved seal, bearing down hard on my right hand so the red ink seeps into the paper, and then peel the picture off the sketch pad. The marmoset twists its little head, starting to sense that something is wrong, but by that time, the seal is done and the binding complete.
The Emanation tries to scream but finds that it cannot. It is sealed into this more benign form. It opens its mouth to sink its teeth into my hand but finds itself toothless.
A step takes me to the sink, and I plunge the piece of special-made rice paper into the water, still warm. I see the black ink beginning to dissolve, leaving a trail all the way through the inches of water. My red seal remains in place.
The Emanation makes a last choked sound of protest, then twists and runs back to the man in the bed. Even as it runs it begins to dissolve, the lines of its features running liquid and then blurring together, dribbling off the edge of its ear, tumbling as dark splashes of shadow onto the bedsheet, and then off a runnel formed by the sheet to drip onto the floor.
I get close enough to see the slight mark of the red ink on the corner of the sheet, all that is now left of the creature.
I emerge from the room, and the sounds and smells of the ICU return. The patient’s nurse goes in to restore all the alarms—though they will no longer ring; his blood pressure has improved. I find a nice, out-of-the-way corner of the ICU with a working computer and sit to catch my breath. My head aches. I begin the laborious process of writing up my findings, with enough changes to the language that my services could be billed by the hospital to the insurance company.
It still bothers me—the whole process, even after all these years. Non-Perceivers are never quite sure if I am crazy or not, seeing all these things they cannot see. But we, the Perceivers, are the only ones who see the Emanations as they see us. They never need to be convinced of my sanity or of my power. In a strange way, though we hunt them, they are with us inside a circle of understanding, a secret society in this lonely, halfway house of a world.
Since Helen died, I have practiced alone, as the younger folks who joined our practice one by one drifted away, either to parts of the country that still rewarded our specialty or to other fields altogether—anything more respectable (and better paid) than this. Helen would have railed at it—our field edged out of being considered a legitimate practice in medicine while I hunkered down and ignored it. I always felt ashamed of this, how long I let it go on without doing anything, just hoping the tide would turn. Some part of me was glad Helen was not here to see it.
“Dr. Sun?” A young woman comes to stand by my desk. She blinks rapidly, looking everywhere but at me: the table, the floor, then a stop somewhere over my shoulder. “Thanks for coming, and for, you know, fixing him. We were doing literally everything we could and none of it was helping.”
For a moment I feel a sharp jab somewhere behind my eyes, but then it passes.
“Lana,” I say, then, glancing at her badge, “Dr. Davis. Thanks for the consult.”
I should have known this was not a coincidence, my first consult from this major teaching and research hospital which had disowned Emanation practice years ago. I was wrong about there not being any Perceivers on the unit; here is one with a greater natural gift than I have seen from anyone else in the last twenty years.
At our last meeting, Lana told me she was not going to specialize in working with Emanations. Offhand, she relayed the advice of another mentor, one who had told her, with absolute candor, that there was a hierarchy of importance in the hospital. After listing the surgical specialties and the top earning medical specialties, he said, you’d have to get to the bottom of the pile before you came to the people who worked with Emanations.
(How long am I going to keep this grudge? Against my own trainee?)
We exchange pleasantries. Lana tells me she started five months ago and is rotating through all the ICUs; the training is hard, but she loves it. I watch as she sits down, gets up, puts her hands inside her pockets and then takes them out again. She has on her winning smile, but I detect a faint smell of smoke around her, as if she has been sneaking out for cigarettes.
“I still see them, that’s the problem.” Lana huffs out a breath. “They haven’t dimmed at all.”
“I know there’s a rebound period,” she cuts in before I respond, swaying from one foot to another, her eyes darting around her, holding herself closely between her crossed arms, “but it’s been five years and they haven’t dimmed, only gotten blurrier around the edges, big shadows with shimmery outlines.”
I pull out a chair for her, and she sits, fiddling with the ends of her stethoscope.
“This place is overrun with them,” I say.
“Yes,” she says, “all the doctors and nurses and facilities people who have any Perception have moved on or gotten jobs elsewhere.”
I come to a new understanding of the fresh crow’s-feet stamped at the corners of her eyes, the brackets of fatigue drawing her mouth tight.
“I take the elevators, and there’s three of them in there with me,” Lana says. “I take the stairs and every landing is crammed with them. I try to avoid them, and I end up walking into people. They’re even in the bathrooms. Some of the ones that linger—you know, even after the person is dead—have tried to follow me home, climb in my car with me.”
I nod. Perceivers often experience this duality: the terrible loneliness of being one of so few who can see the Emanations, and the terrible claustrophobia of being crowded with no relief.
“I can’t go on like this,” Lana says. “I have to stop seeing them, or to get rid of them—something.” She swats the air. “Even now, that one is still following us.”
“Which one?” I ask, looking around. Other than a blood-red bull with its gold-tipped horns and baleful glare in the cardiac bed three rooms down, I see nothing.
Her eyes flicker between me and somewhere behind my shoulder. It is the place where something would hover over me.
I glance back. Nothing. Yet she stares at it with such fixity that I can almost feel the ghostly breath stirring on the back of my neck; and then, another feeling—that I am cresting the zenith of a roller coaster, suspended before the fall.
“What do you see, Lana?”
I sound calm. That is good.
She blinks, then shakes her head. “A darkness, it has . . . tentacles—legs, maybe. Multiples of them. It’s shimmery on the outside but dark on the inside.”
“Look at me, Lana. Focus on my nose. Good. Now let your eyes go a little blurry, like you’re trying to see through my head.”
“A spider—no,” she says, “an octopus, or squid. It’s wrapped around you, Dr. Sun. Can’t you see it?”
Helen was never able to see her own Emanations either. Not the rat-like creature when her cancer came back, nor the eerie, elongated horse—one of several—that followed her after her bone marrow transplant began to fail, before all the infections. Perceivers are too close to their own illness to see the Emanations of their own disease.
Another reason why it is not good to be alone for so long.
“I can’t see it, Lana, because it is my own Emanation.”
“Oh my god,” she says, “what do I do? Do you need to get admitted to the hospital? Should I call a code?”
She looks at me, focuses entirely on me for the first time since she sat down to talk. Instead of panic, I feel the brightness of this very moment, compressed and shimmering, and with it a curious sense of clarity.
“Let me teach you to dispel it,” I say.
“Oh, Dr. Sun . . .”
“I’m reaching down to get a piece of paper and a pen. Tell me about the creature, whatever details that you can.”
She is entirely still. “It has iridescent coloring on its . . . skin. There are rushes of color over it: red, then yellow then purple then white. There’s a dark eye in the middle of its body.”
“Hold the pen, and keep looking at my face.” I press the pen into her hand and slide the paper under her arm. “Don’t look at what you are drawing, and don’t lift your pen from the table. Just keep going.”
“This is crazy. I can’t draw.”
“You are the only person who can see my Emanation. Lana. I need your help.”
She shakes her head, then follows my instructions. I watch the squiggly line appear under her left hand. “It smells, too. Like—old blood clot. Like salt and rotting plant matter from the deep ocean.”
Her fingers twitch over the thin paper, gouging it in places, but she adjusts her hold on the pen and keeps going. I am watching a picture of a squid materialize under her fingers upside down, the body enlarged and bulbous, the tentacles barbed. She is a better artist than she gives herself credit for.
Then she stops. “I don’t need this to diagnose what’s wrong with you, we have scanners and labs. We have medicine.”
“You can help me more in the next five minutes than what you can do with a million dollars of testing and a week in the hospital,” I say, keeping my tone light.
An iridescent squid means a rupturing aneurysm. I recall now the pain in my head, how it started this morning on waking, and has only worsened over the past few hours. The sudden dizziness, that scintillating blur over my vision. Aneurysms can tear fast. Can ten minutes mean life or death to me if she doesn’t do it right? Should I have her call a code? No, it will take longer than ten minutes to get to a scanner even within the hospital. If this thing bursts open in my head this very minute then—well, then no amount of modern medicine will help.
“Alright,” she says, and then, “Oh god, look at this picture. This is terrible. You can’t make heads or tails of this thing.”
“Just keep the pen moving.”
I begin my own sketch on another sheet of paper, basing the picture off what I have encountered in my practice and from what I could see of Lana’s. A reflection of a reflection. I feel lightheaded from the risk of it all, or is that from the Emanation? Sitting next to each other in a corner of the ICU, we do our work. All the world distills itself down to this.
“I’m sorry I’m so bad at this,” Lana says. She looks panicked.
“Do you remember when you saw your first Emanation?” I ask.
She nods, her hand starting to move again, “My sister was sick a lot as a kid—cerebral palsy, lots of hospitalizations. And I would often see this glimmer next to her bed, usually after sunset. I thought at first that it was an angel, or some kind of guardian spirit. Then I finally saw it one day, and it was an enormous bat. It was horrible.”
She shudders.
“My mentor, Helen—Dr. Vivien,” I find myself saying, “saw her first when she was sick with leukemia as a child, spending long nights in the cancer wards. The fluorescent light from another child’s bed snuck under her door and between the curtains and came to her bedside, and she saw a massive, elk-like creature with a head full of antlers rising like the flames of some eternal fire, and it burned so bright she hid under the blankets so as not to go blind.”
I surprise myself. I haven’t said Helen’s name aloud to nearly anyone for years, so it feels odd on my lips.
Lana looks at me, I think, with pity.
“How does my drawing look, Lana?” The fingers of my right hand are beginning to tingle.
“Oh, that is so good,” she says, taking over the piece of paper and adding touches of her own: streaks on the creature’s skin, splotches and bumps on the body. I try not to think of how it currently has me in its grips, and use the rest of the ink on my seal affixing the stamp. As I hold down the seal, I can feel big, fat drops of cold sweat springing out across my forehead, where it blazes hot and cold, my nerve endings aflame. The sweat drips down my face and a ringing sounds in my ears.
The pain in my head starts to get worse. I keep my hand on the seal, as if doing so could keep the pain at bay, as if focusing and doing anything would keep the pain at bay.
“It’s coming over, Dr. Sun. It’s looking at its picture.”
“Good,” I croak. “Destroy the paper.”
Lana looks around. “What do I do, tear it up?”
“Burn it.”
“How?”
Remembering the smell of smoke: “Your lighter.”
“Oh hell, how did you . . . Yeah. I have it,” she fumbles with her scrubs’ pockets and finally pulls out her lighter.
Flick flick and the fire is there. I am shaking so hard the paper appears to waver on its way to the flame, like a white flag, then the next moment it is caught, it is aflame. I smell the char. I hear the whooshing and the breath of the fire. I feel as if the whole of my body is being compressed and drawn through the eye of a needle.
The room is too hot, and too cold. Blood pumps through tiny arteries nestled against the paper-thin bones of my ear.
I am at Helen’s bedside. This is the fourth, maybe fifth time we are doing this since her transplanted bone marrow failed. I finish sketching the whole menagerie of Emanations and ready the stamp, but she holds her hand out to me. She says, It’s ok. They’re mine, and they can have me now. I am done with the fighting. Let me go. And God help me, I do as she asks. But why did she ask me to give up? Why did she leave me here, all by myself, to deal with all of this? Did she not know that my life cannot sustain the loss of her without being itself unutterably diminished, with nothing to fill the gap and no one to come after us, and it has seemed pointless and meaningless for so many days, as if I were simply waiting for an end?
The air smells of smoke. I hear the exhalation and muted roar of the fire. I open my eyes and see: the squid, a creature of the deep sea, suckered on to my side.
The Emanation is on fire, and I am on fire. Its skin splits and sizzles and heats and burns my skin, its shrieks coming like hot air through the puckered holes in its flesh.
And I can only think, stupidly, that I want to live.
Diminished as I am, an old fool, as I am. I still want to live.
I have work to do.
I pull the small disk of the red sealing wax from my pocket and flick the lid open, and the ink is more than warm, it is hot, it runs and sizzles on the skin of the squid, and then drips onto my coat. The smell of old blood and putrefaction and the dark cold wet ocean floor assails me.
And then it is gone.
The room returns.
Lana’s face, her eyes huge, the whites showing on top. A blood pressure cuff is going off on my right arm. My wrist hurts. Someone has drawn an arterial blood gas on me.
There is a crowd.
“Check the right pupil again.” I look up at the source of the voice, a young man, burly, too-long hair, the type who would smile while they stuck a chest tube in me. “There was asymmetry, wasn’t there? It looks like it’s responding now,” he is saying.
Murmurs of assent, but also some shrugs. Old ladies fell over all the time, it wasn’t a medical emergency.
I glance at Lana, whose smile is widening into a grin.
“We need to get you downstairs to the emergency department for a quick eval, Dr. Sun,” Chest Tube Guy tells me.
Fine. It will be a couple of boring hours in the ED for blood work and tests. But they won’t find anything, maybe just a slightly enlarged vessel needing a routine CT in a few months. I’ll be home tonight, if a little late, but with enough time to find the papers I gathered for my illustrated encyclopedia, and to re-create the likeness of the marmoset.
Two nurses help me into a wheelchair. I am assigned an earnest medical student to be my escort. Before I round the corner, Lana is there.
I recognize the look in her eyes, that glint.
“I’ll see you soon, Dr. Sun,” she says. “Can I give you a call, later this week, to talk?”
I nod, and then I am rushed away.
Helen, we caught one.
• • •