#CN visible bones

[artistictentacles]

Waited until I had both of them to post them together. A pair of spooky illustrations I did over the last few weeks on and off.

On the left is @slgma's OC Leonard on the right is Cortez. Love the subject of knighthood and armors so you might see more of that soon.

[niennandil-me-writes]

Ouroboros

CN: gore, consensual/romanticized violence, cannibalism, dementia/rabies analogies, exposed organs, can be read as suicide

[Commission for @noxachi. Qin belongs to them.]

These things are true: The world is ending. The world has been ending for a while. The world is at the culmination of ending right now.

These things they know: They are each other’s world.

Everything else has fallen away like the meaningless background noise they had slowly realized it to be. No places, no time, no sound, the only thing they perceive is the other’s body, and the other’s voice in their head, calling them closer, whispering sweet words of desire and desperation. They have forgotten how to talk. They have forgotten a lot, but nothing that matters.

You’re mine, Teo says, and it sounds like Make me yours.

I am yours, Qin says, and means Be mine.

An outsider would have taken them for human beasts, driven to madness by the approaching apocalypse, now lost in an endless fight where they viciously attack each other until one lies dead on the ground, body torn and broken while the winner devours their flesh, only for them to rise again after a while and immediately resume the fight. They might have thought, rather foolishly, that this behavior was motivated by a mutual hatred.

Someone who knew them would notice the awe in their eyes as they look at each other, the joy beneath the sadism in their laughter, and the love with which they cradle the other’s corpse in their arms, and that the desire that makes them rend and chew and swallow each other’s flesh is a deeper hunger than anything bodily. 

That person might weep at seeing them like this, maybe remembering what they don’t: Who they used to be. What they lost. That they are now so far gone they are not even aware of the world ending.

This onlooker would be an even greater fool, unable to see what they see, feel what they feel, twice even, once for themself, then for the other. And what do they care if the world is ending, when their world is ending and beginning anew every time one of them falls?

Theirs is a love language written in blood and yelled in screams and gasps and moans of pain. Their embraces so close they leave scars. Kisses so deep they taste of flesh. A love so greedy and so selfless, giving each other all of them and taking everything as well, not being satisfied until they are utterly, completely, one.

To him they are the altar he’d pray at, and the deity he’d pray to, if he’d ever been a religious man, if he cared about anything but Qin. To them he is their executioner, the knife that slits their throat to sacrifice them, to drink their blood and eat their flesh. And at the same time, he is their pet, their puppy, their attack dog, who they feed of their own flesh, who bites their hand, and who obeys their every command, no matter if that command is kill, or die for me.

They are no longer running away, he is no longer chasing them. Too strong is the desire for the other’s touch. Together they are sprawled on the ground, him pinning them down, them pulling him closer. His fingers find their way into their hair, tangling and tearing at the matted mess that used to be the color of moonlight but he has turned into a blood moon.

Teo, Qin calls for him, and he remembers that that is his name. He looks down at them, into their eyes, and then he is drawn towards them as if by gravity. His mouth smears bloody kisses over their naked skin, trailing black veins barely visible beneath the blood and gore. Kissing becomes biting becomes tearing and rending flesh until his teeth meet their bones, and they both moan with pleasure. 

Now their hands are in his hair, even dirtier than theirs, guiding his head exactly where they want him. He follows obediently. Their fingers wander to his face, scratching his bearded jaw while he chews on them.

Puppy.

From them it sounds just like his name. 

Closer.

He puts his hand to a wound and slips his fingers inside them, caressing them from within. He can feel the pain he inflicts, blood gushing from his own body just as much as theirs, but only when they utter a whimper does he join in with a soft scream. There’s nothing in this world that makes him feel what doing this to them does.

Closer!

Two hands in a big wound on their stomach, and he starts ripping them open. Exposed organs in front of him make his breath go heavy. He can feel something fall out of himself, and onto Qin, blood and viscera mixing. They are one.

I love you.

Neither of them knows which of them said it. It doesn’t matter.

Their hands reach for his chest. Nails digging under skin, ripping aside flesh. He whimpers as they hold his heart in one hand, looking up at him in a mix of delirium and fascination.

He cups their chin in his hand. Tilts his head in question. There are no words left to him. There is only them.

This… you are so beautiful. A smirk splits their face. Their fingers play with his heart. I wish this moment would last forever. 

He trembles from their touches and words. Takes their other hand in his and kisses it, then bites off their finger. They giggle. They understand.

Then they say: Let us end now, sweetheart. Like this. In this perfect moment.

I love you, Qin. This time, it does come from him. I am yours. And he leans down, so they are skin to skin, and teeth to flesh. Rending and tearing, chewing and swallowing.

Devouring. Being devoured.

Until there is nothing left.

Until there is only them.

The world might end tomorrow.

Qin and Teo end today.

[cagemasterfantasy]

Cleric (Trickery domain)

Cleric Spells

Cleric level 1: Charm Person and Disguise Self

Cleric level 3: Mirror Image and Pass Without Trace

Cleric level 5: Blink and Dispel Magic

Cleric level 7: Dimension Door and Polymorph

Cleric level 9: Dominate Person and Modify Memory

Blessing of the Trickster: Starting when you choose this domain at 1st level you can use your action to touch a creature other than yourself to give it advantage on Stealth checks. This blessing lasts for 1 hour or until you use this feature again.

Channel Divinity: Invoke Duplicity: Starting at 2nd level you can use your Channel Divinity to create an illusory duplicate of yourself. As an action you create a perfect illusion of yourself that lasts for 1 minute or until you lose your concentration (as if you were concentrating on a spell). The illusion appears in an unoccupied space that you can see within 30 feet of you. As a bonus action on your turn you can move the illusion up to 30 feet to a space you can see but it must remain within 120 feet of you. For the duration you can cast spells as though you were in the illusion's space but you must use your own senses. Additionally when both you and your illusion are within 5 feet of a creature that can see your illusion, you have advantage on attack rolls against that creature given how distracting the illusion is to the target.

Channel Divinity: Cloak of Shadows: Starting at 6th level you can use your Channel Divinity to vanish. As an action you become invisible until the end of your next turn. You can become visible if you attack or cast a spell.

Divine strike: At 8th level you gain the ability to infuse your weapon strikes with poison (a gift from your deity). Once on each of your turns when you hit a creature with a weapon attack you can cause the attack to deal an extra 1d8 poison damage to the target. When you reach 14th level the extra damage increases to 2d8.

Improved Duplicity: At 17th level you can create up to 4 duplicates of yourself instead of 1 when you use Invoke Duplicity. As a bonus action on your turn you can move any number of them up to 30 feet to a maximum range of 120 feet.

Gods in this domain their alignment and their symbol:

Beshaba CE Black antlers, Cyric CE White jawless skull on black or purple sunburst, Leira CN Point-down triangle containing a swirl of mist, Mask CN Black mask, Shar NE Black disk encircled with a border, Tymora CG face up coin, Waukeen N Upright coin with Waukeen's profile facing left, Fharlanghn NG Circle crossed by a curved horizon line, Olidammara CN Laughing mask, Ralishaz CN 3 bone fate-casting sticks, Tharizdun CE Dark spiral or inverted ziggurat, Shinare N Griffon's wing, Hiddukel CE Broken merchant's scales, Olladra NG Domino, The Traveler CN 4 crossed rune-inscribed bones, Cults of the dragon below NE varies, Garl Glittergold LG gold nugget, Lolth (Lolth is also the villain of the dnd adventure out of the abyss sorry not sorry) CE Spider, Tiamat LE Dragon head with 5 claw marks, The Daghdha CG Bubbling cauldron or shield, Hecate CE Setting moon, Hera CN Fan of peacock feathers, Hermes CG Caduces (winged staff and serpents), Tyche N Red pentagram, Apep NE Flaming snake, Bes CN Image of the misshapen deity, Set CE Coiled cobra, Hermod CN Winged scroll, Loki CE Flame.

Source: Players Handbook

[leatherbookmark]

1. sometimes the characters in this book do things because It Was Written (ie jgy fighting paperman!wwx with a sword, jgy and sms needing to “heal their wounds” before leaving etc) and it’s understandable but a little bit irritating. everything would’ve been FINE if mr jin “stabs himself to distract someone, hides qin strings into his abdomen” guangyao didn’t suddenly Need To Rest A Little

2. both exr and the cn version mention fairy’s claws leaving very deep wounds in sms’s chest, but the japanese edition went “nah that’s not enough” and added the tiny detail of visible bones and, uh, okay, this is where you lost me

[whump-captain]

No. 17 - Field care 101

"Please don't move!" | hemorrhage | dread

(950 words, OC)

this one's actually from the main story! the moment shit gets unquestionably, irreversibly Real.

---

CN: panic, trapped under rubble, broken bones, paranormal happenings, body horror (monster), tension, monster attack

---

Cutter knows everything is going to turn out fine. But the radio silence sparks an ember of worry inside him nonetheless.

There are hundreds of reasons Joy might be silent right now, a great deal of them perfectly harmless. The most likely one being probably that she simply got sick of talking to him. She strikes him as a no-nonsense woman, which he just can't help but balance with increased nonsense of his own. Yes, they are a little bit screwed, but that's no reason to lose heart, especially not when they only have themselves to count on. They have to keep moving and for that, they have to keep up their spirits.

Even though "moving" does fall rather outside of Cutter's range of ability right now. The dull, pulsing ache in his left leg won't let him forget of the pile of rubble still pinning it down; the freshly sutured wound on the right isn't hurting at the moment, but he's trying not to get used to it. He half-lays on his back, propped up on his and Joy's backpacks so that he has a decent view of the ruins around him. Stray rays of moonlight filter in through the hole in the collapsed ceiling, granting just enough visibility for the scattered debris to become shapes in the dark. Ahead, a half-standing doorway opens into pitch black - the way Joy has walked off at least two hours ago now.

Cutter thumbs one of the dials of his walkie-talkie. The small clicks of switching channels sound like gunshots in the absolute quiet. Maybe he should radio and check in. Make sure Joy is indeed just not in the mood to chat and not, say, had a fall of her own and passed out, or something. She said she knows urbex, but accidents happen. And it would be nice to hear another person's voice, or really anything at all that wasn't this all-encompassing silence.

The silence breaks.

The sound rips the air like wet calico cloth, an inhuman, reverberating scrape of glass on concrete. It drags out in a shrieking vibrato and then suddenly peaks, spiking an octave higher before it shatters into a hundred quieter voices that die straight away. It's deafening, it's piercing, it's sentient, and Cutter's blood runs cold. He has to gasp, suddenly, his breath has hitched. All around, shadows close in and deepen no matter how hard he tries to look.

It was true, then. There is a monster here. There is another sound, like a knife stabbing a block of ice, and this time it repeats in a discordant rhythm.

Footsteps.

It's coming.

Cutter's hand tightens on the radio. "Joy," he whispers into the front of it. "Joy, where are you? Did you hear that?"

There's no response for what feels like an hour. Cutter's heartbeat feels loud enough to fill the room. There's a hollow pit where his lungs should be, every breath feels like it's catching fire. The sound wanes. Where is it? Is it gone? What is it, to begin with? He tries to search his memory for any research he may have done on anything like this, but his thoughts are yanked back to the present, to the bladed shadows and deepening silence. Where is it?

The radio spits a note of static. "We heard it." Joy's words come through as a hiss, barely there. "It's a huge… something, I have no idea. It's left now. I don't- I don't think it has eyes."

There it is: information. Not a lot but something, the frailest rope for Cutter's mind to grab and pull itself out from the storm of useless fear. He lifts his radio, but he has to pause; wait for his breath to even enough to speak clearly. "What else did you see?" he whispers. "Where did it go?"

A beat of silence, stretched into another eternity. Something rustles in the distance, like shifting sand mixed with glass. Cutter's hand is shaking and the radio's antenna draws zigzags in the air.

"It has… limbs, I think," Joy says in another small crack of static. "Like, mantis-like. I don't know how many. I think- I think it went downstairs from us."

Cutter wants to ask why she said "us". His hand with the radio freezes halfway up to his mouth.

There's movement. Somewhere, in the deadly darkness behind the doorway. His blood rushes double-time and adrenaline fills him like current, everything goes blurry apart from the pinprick spot right in front of him, the rectangle of pitch black where something is moving. The stabbing sound comes again, slower. It matches the movement.

Everything in Cutter's mind is screaming at him to run. But his body knows better. It's frozen, held in place by the burning static of fear just as much as it is by the rubble that pins him. He can't move. Can't do anything but watch as the shifting shadows unglue themselves from the dark and take shape in the moonlight.

It does look like a mantis. If mantises glistened like oiled glass and had translucent, horribly jointed blades sticking out at random from their bodies. If mantises moved as if their limbs had rotten a long time ago.

It doesn't, indeed, have eyes. It jerks its head back and forth like a glitching video skipping frames.

It listens.

Surely it hears Cutter's heart, pounding in his chest like it's trying to rip away. As slowly as he can, he holds his hand over his mouth. His breath comes short. He's ready for each to be his last. He lays still and doesn't even dare to shiver.

The radio's receiver light blinks once.

Static bursts out like a hatching wasp.

The monster leaps.

[doctorfoxtor]

how does one even leave their consciousness at someone's front door step? well who am I to question our queen Willow anyway tbh

100 days of productivity

day 40 + 41

CVS/RS

20-25% of presenting PEs do NOT have an associated DVT

no impact of steroids on silicotic lungs

isocyanates → NSCLC

ILO categories of profusion of small opacities in pneumoconioses (esp CWP/silicosis): cat 0 = no small opacities, cat 1 = few opacities, cat 2 = many opacities but normal lung markings visible, cat 3 = normal lung markings virtually absent (can choose two adjacent categories to assign if it's felt to be borderline, can choose the same category twice)

CNS/Ophthal/Psych

Bowlby-Parkes stages of grief: numbness, pining, disorganisation & disrepair, reorganisation & recovery

progressive brainstem symptoms not explained by a single localisation → vertebral artery disease (?dissection, especially if h/o chiropractor or unsupervised yoga)

chronic small subdural haematoma from 2 weeks ago with no focal deficits or AMS - no need to evacuate

on the same track, if neurological decline is slow, then you can pretty much rule out epidural bleed

meningitis w/ PCN + cephalosporin allergy: USA vanc + moxifloxacin ± cotrimoxazole (OR) UK chloramphenicol ± cotrimoxazole (OR) meropenem monotherapy (mero covers Listeria!); all these regimens are acceptable here

Parkinson-like symptoms but LL rigidity > UL rigidity ± falls: this is ischaemic, NOT neurodegenerative! falls occur *late* in parkinsonian illness, not early

severe dementia (MMSE <10) is a contraindication for anticholinesterases; only memantine is approved for MMSE <10

Endocrine/Repro

insulin resistance → excess insulin production → defective/dystrophic lipogenesis → ectopic fat pockets → release of inflammatory mediators from fat pockets → upregulation of plasminogen activator inhibitor 1 (PAI-1) → inhibition of tPA → procoagulant state

X-linked vs AR adrenoleukodystrophy: AR (Zellweger's) presents in infancy, is rapidly progressive and kills in adolescence; X-linked presents in adolescence and is far more indolent and survivable

rapid improvement in blood glucose is actually assoc w/ acute worsening of microvasculopathy (esp retinopathy); long term improvement in blood glucose is ofc assoc w/ bettering of microvascular dz

Rheum/Derm/Immuno

anti-ribosomal P Abs are specific for lupus encephalitis

hyaline cartilage (carTWOlage = type 2 collagen) is avascular and gets nutrition from synovial fluid diffusion

response to osteoporosis therapy → procollagen-1 propeptides (PICP, PINP, osteocalcin) (bone formation markers)

colloid plasma expanders, like opioids, directly act on mast cells to secrete histamine

GIT

generally, anti-TNFs are only used in IBD that is active despite use of 5-ASA + thiopurine + MTX; the exception is fistulous Crohn's, when anti-TNFs are started ASAP

King's College criteria for APAP-induced ALF for txp referrak: I ACHE (INR >6.5, Acidosis w/ pH <7.3, Creat >3.5 mg/dl, Hepatic Encephalopathy grade 3)

CT is scan of choice for acute pancreatitis; CT is usable in chronic panc but MRI (MRCP) is ideal

80-90% of pancreatic cancers are assoc w/ KRAS2+; only 50% are assoc w/ p53-

by the way! faecal elastase/trypsin is the best measure of chronic pancreatitis, w/ elastase <200 mcg/g being diagnostic

in hepatorenal syndrome, terlipressin causes splanchnic vasoconstriction and reduces splanchnic volume, as well as reducing afferent arteriole pressure and thence renin secretion

SIBO vs short bowel syndrome: SIBO causes not just diarrhoea but also bloating and abdominal discomfort but not marked fat malabsorption and definitely not oxaluria/oxalate stones; both cause folate/B12 deficiency, dehydration, electrolyte disturbances

Onc/Haem

slight increase in PT/aPTT or slight drop in platelets will NOT explain large scale ecchymotic bleeds; in such a patient who is also taking aspirin, blame aspirin

generally, B-cell lymphomas are more common than T-cell lymphomas

that said: Sézary is a form of advanced, more virulent mycosis fungoides (MF: patches of erythema, SS: widespread erythroderma ± keratoderma as well as leukaemic infiltration of marrow)

ID

MTB doubles in 1 day; T. pallidum doubles in 2 days; M. leprae doubles in 2 *weeks*

Pharm/Toxo

cranberry juice is not as bad a culprit as grapefruit is, but it also has some pretty significant interactions (especially 2C9 which metabolises eswarfarin, the active enantiomer of warfarin; expect INR to skyrocket)

100 mg desferoxamine chelates 8 mg iron

[wolves-against-the-world]

Chapter 2

Summary: The wolves are out for the monthly hunt, but of course things don't go as planned. CN body horror (?) and gore obv

The moon stood high in the dark night sky, not tainted by the few clouds hovering in the glow like ghosts. Silvery light leaked through the bare branches, illuminating dark shapes moving silently through the trees. It was going to snow soon, they could smell it in the frigid air. The dry cold made every sound as sharp as breaking twigs.

They wore only light clothing that was easy to discard. They didn't need anything warmer. Most of them.

“Took you long enough,” Sasha growled when Eike and Milo emerged from the shadows.

“Sasha,” Attila reprimanded him mildly.

Sasha huffed, but didn’t comment further. The wolf was getting impatient. “Was your search successful?”, Attila asked.

“We have the map if you mean that,” Milo replied, waving said map for emphasis. “But I doubt there's a point in discussing it right now.” He nodded at Eike. Despite the cold, his short hair was plastered to his forehead.

“That's true.” Attila couldn’t help smiling. Only now he raised himself from the fallen tree he had been sitting on. He began to open his shirt.

“My friends, this is the night we hunt. And pray for the great wolf to give us something tasty.”

“Fucking finally.” Sasha threw off his clothes. He wasn’t young anymore, but he’d retained his lean, muscular shape long after he'd been relieved of the hard physical labour his life had been marked by. His brown skin shone silvery in the moonlight as he shifted. Bones cracked rapidly as the sections broke apart, reconnecting with a snap and healing in place. Hair broke through skin, covering pulsing muscle. The shells of his face unraveled to form a snout, teeth coming forth, tearing through flesh, and Sasha howled in pain and relief as his wolf was finally freed. The dry leaves crunched under his paws, easily big enough to crush a smaller mammal.

Sasha stretched with a hum of pleasure, every movement elegant and fluent despite his greyed fur.

He looked at Attila with glowing eyes and licked his scarred snout. This is gonna be fun.

Now that the permission had been issued, Eike couldn’t hold back any longer. He could barely throw off his jacket before the shift began. His transformation was slow and painful. Every single change was visible in his gaunt body. The claws came forth first, the fingers drawing in on themselves to form paws, covered by thick brown hair soon enough. His head snapped back when his spine began to lengthen, the vertebrae in his neck rearranging for a form on four feet. He finally collapsed when his legs snapped, the femur breaking to accommodate the change of ratio in his limbs. Eike didn’t have enough breath to scream. The process was disconcerting to watch, even after so many years. It took about two minutes until it was over.

Eike’s wolf was small, barely bigger than a medium-sized Saint-Bernard, but much sleeker, with long legs and slim shoulders. His light brown fur was only broken by a white spot right on the tip of his tail.

Eike was panting heavily, but he picked himself up without complaint. Sasha allowed him to lean against his flank until he stopped shaking.

Eike let out a whine when he saw his torn clothes on the ground. Attila had to suppress his laughter. That was the price he paid for bundling up so much before a shift. Now he'd have to go back naked when dawn came. Perhaps that way he would learn.

Milo helped Attila stash their clothes in a plastic bag under a fallen tree, before he stepped back and shifted. Milo knew exactly that he was sexy, and he moved like it. It was unfair, almost. Nobody should look this good during a shift. The noise was unpleasant, but he claimed it barely even hurt, and within seconds, he had taken his new form.

Milo shook himself, his thick copper fur shining in the moonlight. His teeth glinted in the moonlight when he yawned. One fang had broken off long ago, but it didn’t taint his grin. Even standing on all fours, his shoulders were on the same height as Attila’s head.

He stretched every paw individually, letting the claws come forth before retracting them again to soften his step. Eike pressed up to his flank in an affectionate gesture, but kept his head and tail lowered. Milo let out an amused snort and licked Eike's ear.

Attila suppressed a smile. The wolf made it easier to show affection that the human form didn’t permit. Milo’s fur was also very warm. Sasha brushed Milo’s flank as he stepped towards Attila. The three wolves watched him, ears raised in expectation. Their breaths formed white clouds in the cool air as they waited for their leader to speak.

“Blood and a blessing for us.”

The wolf inside him roared, and now Attila didn't suppress it anymore. The beast was thirsty for blood and he allowed it to run free. Finally.

He laid his head back and howled. It rang out between the trees like a battle cry.

His body burned with the shift. The shards of bone normally firmly connected broke, being pulled into their new shape and reconnected with the itch of healing wounds. Layers of bone that formed his face stretched outward, teeth and claws grew and ripped through formerly intact skin. The pain numbed his senses, but while the man died and the wolf came forth he felt more alive than ever.

Even before his paws touched the cold earth, he could smell the winter night, the smoke from far away houses, the trails of humans who now slept, safe and sound behind fragile defenses that they thought impenetrable. And most importantly, he smelled fear. The animals felt their presence and they were scared. He could hear them rustling through the underbrush, trying to hide from the threat that had encroached on their territory. Attila shook himself and stretched to get rid of the ghosts of pain in his joints. It was about time he could run with his pack again.

The wolves greeted him enthusiastically as Attila stepped forward to take his place at the front. He wasn't much bigger than Eike, yet the others respectfully lowered their heads as he passed by. His thick iron-gray fur nearly melted into the shadows, only contrasted by the white hairs around his nose, witness to the many years that had passed.

My brothers. It is time.

Milo and Sasha positioned themselves behind him on both sides, and Eike took his position behind them, forming a diamond shape. The moonlight turned them into shadows between the trees. Only their ears twitched in search of prey.

Attila howled and the others joined in.

The hunt had begun.

Their paws left deep gouges in the earth as the wolves leaped forward, their lust for blood finally unleashed. They had barely passed half a dozen trees before Eike howled in primal triumph and threw himself at an animal that had been too weak to flee. It was only a small deer, but Eike radiated glee as he dug into the hot meat until his fur was painted black.

At least it's not a rabbit again, Milo commented.

They laughed. Eike could catch up with them when he was back in control.

The forest was dark and silent except for the heavy drumming of their paws on the frozen ground. For a while they only ran and enjoyed the wind running through their fur. The scent of the night was amplified during the moon, intoxicating in its complexity. The ground under their paws was cool, every leaf a reminder they were where they were supposed to be.

They only stopped for a moment to take a few sips from the small stream, before the wolf once again demanded to run. Animals fled from their path, but it took a while until something suitable showed itself.

Milo and Sasha saw the stag at the same time and leaped at it side by side.

What could have been side by side.

They collided in the middle of flight and crashed into the leaves in a mess of fur and claws and limbs. The stag stood frozen for a second before it made the smart decision to run for its life.

That was my prey, you ass!

- Yours? I saw it first!

Milo pushed Sasha off of him. Sasha pushed back so hard Milo crashed against the next tree. Three seconds later they rolled over the earth in a snarling storm of claws and teeth.

How can a wolf of your age be this incompetent?

- I'M incompetent? Who almost jumped on my back there, huh?!

Take your ass out of my face?

- Take your face out of my ass, what's wrong with you?

I wouldn't do this voluntarily for a million kronor, you- Ow!

They dissolved into laughter as the offended tree bombarded them with leaves and smaller branches.

Attila shook his head and chuckled to himself. If there was a genuine fight going on, he would have intervened, but it was hardly the first scuffle between the brothers he’d witnessed. They knew how to use their claws without breaking skin.

They all needed to let off steam sometimes.

Attila sat down and laid his tail over his paws to watch his brothers play. He'd nearly given in to the desire to follow the stag, but decided against it. Hunger was only a faint pinch in his stomach right now. He had had a decent dinner only an hour before to prepare for the night.

The real pleasure was the hunt itself, the feeling of the night air in his fur, the community of the pack, the fear of the prey, and the taste of blood after the killing bite. That was something no human food could match (although he had had a damned good steak once.)

A little wistfully, Attila realized even the hunt had lost some of its pleasure for him. Maybe that was the privilege of a simple pack member: Never having to think further than the next kill. To just enjoy the night, without any worries beyond your assigned task.

Maybe they could find a bear tonight, or a moose. Enough for them all. Humans could fill a wolf more than any animal ever could, but they were frail and weak and small, it was never enough for everyone, even in a small pack like theirs. The new technology made it hard to hunt without arousing suspicion, not to speak of - he sighed at the thought - having his pack get attached to people.

Give up, it's over! Milo had taken the upper hand and pressed Sasha down with his weight, one paw on Sasha's throat in a fake threat. His tail waved a bit too much to be entirely convincing. Sasha roared in frustration, writhed, tried to bite him, but Milo was far too big and heavy to shake off.

Attila got up and shook leaves from his paws. His brothers didn't pay him any attention.

How unfortunate for them. Attila threw himself onto Milo's back. His claws dug deep into the thick fur, holding on easily without breaking skin. The sudden weight ripped Milo to the left and made him somersault into a tree, where he vanished in a shower of dry leaves that rustled disapprovingly.

Attila released his grip well before that. He rolled over the ground and landed on his paws again. His body was tingling from the excitement, and he kept his head low, the growl just at the back of his throat.

For a moment, nothing moved. Milo had stopped against the tree, all four feet in the air, covered in dead leaves. He blinked at Attila from his upside down position as the silence stretched, only broken by their heavy panting.

Attila cocked his head in challenge. He could hear Sasha get up somewhere behind him. Good. Two enemies were always much more fun to deal with. Well?

Milo staggered to his feet and dropped to a crouch, ears pressed to his head and tail low between his legs.

I’m sorry, he began. We didn't want to-

It's alright my friend, Attila interrupted. Who says I can't join in if you're having fun? He grinned. Unless you're too scared to challenge an old wolf.

Maybe it was a mistake to show himself susceptible to this kind of childish game. It wasn't exactly a sign of leadership to play around like a pup. But the devil take him if it didn't feel good. He missed a good fight.

Milo and Sasha looked at each other. Milo's ears twitched as they communicated on a level Attila couldn't access. They separated, Milo to the left and Sasha to the right. Attila waited. He stood calm, seemingly unmoved by their threat, his head held high to seem as tall as possible against his much bigger opponents. Milo and Sasha circled him. He couldn't possibly keep them both in check at the same time, even by listening to their steps. Milo lunged forward and slashed at him, forcing Attila into a defensive stance, as Sasha threw himself at him from behind. They almost got him.

Almost.

He heard Sasha's paws scrape the earth as he prepared the attack and it was just loud enough to calculate exactly what Sasha was aiming for. Attila avoided Milo's purposefully ill-aimed swipe, dropped to the ground and rolled on his back. Sasha sailed far over his intended target and Attila took the chance to kick Sasha's exposed belly as hard as he could. Sasha squeaked as his controlled flight turned into a wild somersault that ended with him crashing right into Milo – again. The two wolves tumbled into a stack of leaves that exploded in all directions, where they came to a rest.

What the fuck, Sash?

Do better then, Sasha snapped.

Before they had time to disentangle themselves, Attila was over them and set his front paws down on their necks. He could feel his claws dig deep into their pelts, so close to the vital arteries pumping hot blood. It seemed like a good plan, but you might want to work on the execution. He huffed. You know, there's plenty of time to cuddle later. You’re brothers, there’s no shame in it.

Fucking hell, Sasha said plainly.

Now it's obvious that I won, but we have to stick to the protocol, Attila explained. I ask you, do you give up and accept my-

Attila was slammed against the tree so hard his vision dissolved into static. Something heavy landed on him but rolled away, while Attila himself vanished in a sea of crunching leaves and mud. It took several seconds to bring his thoughts into some kind of order. What the...

There's a problem, Eike said.

No shit. Attila felt very tired all of a sudden. A problem. What a surprise.

Attila staggered to his feet and shook himself to get rid of the dizziness. All it accomplished was making him fall on his side again. He thought he heard Milo say something, but the ringing in his head drowned out almost everything else. He found stable ground under his numb feet. He stood.

Somewhere, Sasha and Milo got up, not without a salve of creative curses. Sasha audibly kicked at something, spraying leaves everywhere.

This is probably the worst night I've had in-

Shush, Milo hissed. Look. He flicked an ear at the shadows between the trees.

Eike had stopped his flight at the end of a long swath of destruction to the local flora and visibly strained to get up. Fresh blood had left a shimmering trail on the ground.

Sasha pricked up his ears and scanned the area. Nothing.

All he heard was Eike who limped over to them, cursing with every step. Blood dripped from his flank. Sasha felt his fur stand on end. If it took this long to heal, it must have been a deep injury.

Stay back, Sasha ordered. He stepped forward, staying inches behind their leader. Attila hadn't said anything in a long time.

What is it? No answer. Attila only stood there, eyes and ears fixed on the shadows.

Yes, Pawel, tell them. What is it?

What the fuck?! Milo nearly leapt into the next treetop. He looked around in barely concealed panic, neck hairs puffed up like a startled cat. There was nobody in sight.

I thought- I thought we can't talk to others without an agreement, Eike stammered.

We can't.

Attila's formerly firm stance dropped.

This is our territory. After the long silence, the statement was pathetic. What do you want?

The voice only laughed. Sasha growled and stepped forward until he stood right next to his pack leader, close enough for their shoulders to touch.

Attila was shaking.

What do I want? I think you know, dear friend. It's been too long.

Sasha couldn't help but flinch. The wolf stepped out of the shadows where a second ago Sasha would have sworn nobody had been.

Eike's description had been spot-on. The wolf was nearly Milo's size, which was ridiculously large even for a werewolf, and entirely jet black. Blood shimmered on his paws.

The moment the wolf revealed himself, Attila's expression changed. He squinted and let out a low growl.

Scram, before we tear you apart.

Again they heard the laughter that let Sasha's fur stand on end. For the first time in his life, it felt like there was an intruder in his thoughts. Even during his first full moon it hadn't felt so... wrong.

Attila roared and threw himself at the interloper. Sasha and Milo ran to help, but the duel had already dissolved into a storm of claws and teeth. Attila and the black wolf had become little more than a growling, spitting ball. To get between them now would have been suicide. Instead they circled the fight, waiting for a chance to strike without endangering their leader.

Blood splashed on the ground, hot and sweet in the cold air, and Attila cursed in a language none of them understood. In the moonlight, Sasha saw Attila's claws tear into the strange wolf's flank, but the following shriek wasn't the enemy's voice. The black wolf's claws ripped his skin open like a zipper, exposing a shimmer of white on his back.

Attila lost his grip. The black wolf dug his teeth into Attila's shoulder and threw him against a tree like a ragdoll. Milo managed to move in and land a hit, but even though he opened a long tear on the enemy's back, the black wolf shook him off and ran.

Sasha chased after him. The smell of blood led him where his eyes couldn't. The strange wolf was hurt and Sasha ran on rage and adrenaline. There were few things who made him furious, but one of them was sassy little intruders who-

Sasha, wait!

He ignored Attila's order. The black wolf had slowed down behind a swath of underbrush. He had to be tired out. Just a few more meters and Sasha could tear out that damned intruder's throat.

SASHA!

The clang of metal echoed in the forest like cannon fire. Sasha had just enough time to wonder what the hell had happened before the ground dropped out under his feet and the world vanished in a dark red wave of agony.

For God's sake, Sasha! Attila had to bring up all his self-control to not roar his frustration into the night sky. The world spun as he tried to stagger to his feet. Shadows danced around him, faint lights flowing into a nauseating prism. The pain in his shoulder nearly overwhelmed him. If Milo hadn’t come to his aid, he might not have made it at all. Eike just stared with eyes wide as teacups, little more than a beige ball of anxiety.

What just happened?

Come along, but watch out. Making his way along the trail Sasha had left took an eternity. Every step hammered a silver spike into his spine. If he walked any faster, he feared his leg would give out entirely. Milo and Eike flanked him, every sense sharpened to detect any and all movement. If they were ambushed now, with three of them already injured, it was over.

Sasha was lying on his side in the middle of a small path between the trees. Not even his ears twitched as they approached.

Stay back, Attila ordered. Milo's protest came as a wordless mixture of anger and fear, but he didn't dare to disobey. At least the demonstration this morning had done something.

Won't the other wolf come back?, Eike asked.

Attila didn't dare shake his head in response. He couldn't afford to pass out now.

Not tonight.

Attila stepped forth and shuddered at the sight. A massive bear trap had shut around Sasha's leg, driving its teeth deep into his shoulder and nipping away at his rib cage. They couldn't open that in their wolf form, that was for sure. Attila squinted and tried to see more in the darkness. There was blood dripping from the wound but... it was not enough for such a grave injury. Attila carefully inspected their motionless brother. Sasha was strong. He had already endured far more than this without fainting, so why now?

Great wolf, it can't be...

His senses already told him what he didn't want to believe. The smell of burning flesh was faint, but impossible to ignore. Attila lightly touched the trap with his paw, and immediately withdrew, cursing at the pain.

Milo, run back and get our clothes, quick.

He flinched when Eike suddenly appeared next to him. He pressed into Attila’s flank, looking for reassurance he wasn’t sure he could give. A werewolf that uses silver against his own kind? Is that even... He didn't finish the sentence. Maybe he didn't know how.

It's against everything we believe in.

Attila sat down heavily and rested his snout on Sasha’s flank. His fur was cool on the outside and speckled by frost, but the undercoat was warm, pulsing gently under his touch. His heart was still beating, but for how long?

Eike. Attila closed his eyes. About fifty yards over there, behind that oak tree is the Lindkvist boy. Bring him here. Alive. Can you control yourself?

Eike looked around as if he was searching for the spot Attila meant. He had hoped the boy would take his chance to flee while nobody was looking. Eike liked the Lindkvist family.

Uhm, can I ask why we-

Attila snapped at the air inches from Eike's leg. Stop asking so much.

Eike thought it better not to say anything else.

Crap.

Eike cursed himself. The black wolf had surprised him just as he was finishing his meal. As a pack, an enemy like that was no problem, but he had tricked them, taken them out one by one, and now Attila and Sasha were injured and-

The boy cowered in a small hollow at the base of the tree. Eike could smell him long before he reached the oak. Hell, the whole forest could smell him. He smelled of cigarette smoke, sweat, and fear. And sweet, fresh blood.

Eike stopped dead in his tracks. The thought hit him out of nowhere. Yes, the boy smelled of blood. He was hurt. Simple prey if there ever was one. He just had to sneak around the tree and-

Pull yourself together! Eike shook himself to focus on the present. He wasn't a youngster anymore. In human years he'd be dead or in a nursing home. Milo always said it only took time, that it had taken him over a hundred years to gain full control over his urges, but that knowledge wasn't very helpful when he’d fucked up again.

The boy had curled up against the tree, making himself as small as he could. He whimpered faintly when Eike's wolf came into sight. Eike wagged his tail in a ridiculous attempt to look a little less threatening. Konstantin's jacket was ripped at the shoulder and his blood had soaked the fabric. Eike abruptly stepped back when the wolf inside him shrieked in lust for blood. He wanted to rip the boy apart here and now, taste the blood and flesh-

Eike shook himself and scratched his ear. If he scratched enough, the burning pain brought him back to his senses. When he was reasonably sure he had himself under control, he gently nudged the boy with his nose. Konstantin stared at him with wide eyes and began to cry.

Fuck.

Eike grabbed the boy's jacket with his teeth

– the blood was so close he only had to bite down, it would be so easy –

and heaved Konstantin to his feet. He couldn't allow his own judgments right now. Attila knew what he was doing. For a moment it seemed like the boy would pass out. Eike nudged him gently until he started walking. If he could see anything through the mess of black hair in front of his eyes, he didn’t know, but he walked.

Attila turned his ears towards Eike when he approached, but didn’t look up. He had pressed up against Sasha's back to keep him warm, and gently licked his ears. He wasn't sure for whose comfort.

At the same time, Milo returned with their clothes. Attila heaved himself to his feet and searched through the bag. They needed something thick and sturdy that wouldn't tear easily. He chose a pair of pants that seemed durable. Sasha wouldn't need them right now.

Eike, watch out for the kid, I don't want him to run away. He shook himself. I hate this.

Shifting was always awful. When the moon stood high and clear and the blood called for them, it was easy to forget the pain in the ecstasy of embracing the night. Once a wolf had transformed, they would stay that way until the sun rose.

After all, what absolute madman would try to shift back when the moon was still up?

The process drew itself out much longer than the shift some hours ago, and Attila had to fight for every small step. The back had to shorten, claws and teeth draw back into flesh and bones align in a new pattern, making his body writhe and twist in and out of shape.

None of that was fun to begin with, especially when he was already wounded. Every cell seemed to get torn apart and reassembled, but in the end, he was back in a human body. A human body with some rather wonky proportions and a lot of hair, but they couldn't be picky now.

Attila fell to his knees and didn't try to get up. Blood poured over his back, searing hot. He didn't want to know how bad it was. To shift like this was a labor he hadn't attempted in many years, for good reason. Every heaving breath was too little to sustain him. He could barely lift his hands without trembling. I'm too old for this shit.

Absolutely. And if I might add, you're also completely nuts, old friend.

Welcome back. Even laughing hurt. His body lusted for blood and the feeling of the wind in his fur, to have claws and sharp teeth. This body was wrong and very vocal about the fact.

Sasha blinked slowly. Even in thoughts, his voice sounded tired. I deserved it, didn't I? Maybe it's not only you who's getting old.

Shut up. Attila forced himself to get up, holding on to Milo for balance. They didn't have much time.

He grabbed the pants, ripped them in half and wrapped the fabric around his hands. When he looked up he met Konstantin's blank stare. He hadn't tried to run. He just stood there, shaking, with Eike as a silent watchman behind him.

“Hello, son.” It was hard to speak in this form, the vocal cords not fully formed, but his voice was surprisingly calm. “As you might see, we have a problem here and I require your help with this.”

The boy didn't move. Of course not. It was a ridiculous request, cruel, even.

Eike, give him a little push, please. Eike obeyed and the boy stumbled forward. New tears ran over his cheeks.

“You're werewolves,” he whispered. “Father... and, and that- who is that?”

“I'll tell you everything later.”

I swear by all that is holy, if you die now, I will follow you into the deepest pits of hell just so I can kick your ass.

Sasha laughed. I wouldn’t want it any other way, old friend. His eyes were falling shut again.

Attila grabbed the trap. He could feel the silver even through the protective fabric, but there was no time to adjust his grip. Konstantin knelt down beside him and closed his hands around the metal. He hesitated when he saw the black blood dripping from the wound. Please hold on. Just a little longer. If there had been enough time, Attila would have prayed. A drop of pure silver could kill a healthy wolf given enough time. It had been a popular torture method back in the rare cases a wolf was caught alive. Silver sneaked into your body and poisoned you from within, burning its way through every cell. With a wound like this...

The fabric tore over the sharp edge. Smoke rose where his hands touched the metal. Attila didn't allow himself to let go. The trap squeaked pathetically, but with Konstantin's help, it finally opened. Milo grabbed Sasha by the neck and pulled him away. The trap shut with a bang that echoed between the naked trees. Attila let out his frustration and pain in a low growl and waved his hands to cool them a little. His fur was scorched and the skin painfully sensitive.

He had expected a scream, a growl, some sort of noise when Sasha came free, even if it was just a declaration of pain, but nothing came. Sasha was still.

Attila, little problem. Milo was a notorious optimist. Attila had seen him joke around after being subjected to harrowing torture.

Now he was outright panicking. Forget that, big problem, huge problem. I'm not sure if he's still breathing, or maybe he is, I don't know, can someone else check?

Panic wanted to rise up in his chest. The surge of raw emotion almost made him shift back into his wolf form. But not yet. There was more to do for him first.

Calling out to Sasha, physically and mentally, did nothing. Milo was too jumpy to even stand still, so Attila had to send him away to check on Sasha in peace. His mind blanked out when he didn't find a pulse. They couldn't lose anyone else. Not now. Not like this.

Not him. Please not him.

No, there was something! He did have a pulse, weak and irregular. Sasha was still alive.

Deep breaths. He needed to stay calm, or the others would break down. That was the very first duty of any pack leader: To stay in control, to radiate calm and steadfastness, so that his brothers could forget their own fear and act.

When this is over we need to hold a proper funeral. The last rites too. He deserves that.

Eike's ears and tail dropped. You don't mean-

Attila ignored him. “Konstantin, I need your help again.”

Two rapid, stumbling steps rustled through the leaves as the boy tried to flee. Eike reacted instinctively, grabbing his pants with his teeth. Konstantin fell on his back with a startled yelp. He curled up, shielding his throat, and began to cry.

“I'm sorry! I'm sorry I was out here when I shouldn't, I'm sorry I was rude, it won't happen again, I promise! I'll forget about this, I won't tell a soul, I'm a good christian, I-”

Attila gently grabbed his arm and lifted him back onto his feet to lead him over to Sasha's motionless form. The moon called, and this time Attila allowed it to form his hands into claws again. He didn't let go. The boy tried to free himself, but his motions lacked urgency. His face had gone blank, too numb even for fear. "Please."

“I know that you're a good christian, son,” Attila said. He looked Konstantin in the eyes. He deserved that much. At least that. “And believe me when I say this isn't what I wanted to happen. But in these desperate times I don't have a choice. I'm sorry, son. God bless you.”

Attila didn't give himself time for doubt. He dug his claws into the boy's throat and let the sweet blood stream out.

He could only hope it wasn't too late.

On AO3: https://archiveofourown.org/works/35879680/chapters/89922412

[bisexualhobi]

"yoongi: I think everyone needs to move on from mint haired yoongi and accept the real icon: jet black hair with his forehead visible." THANK YOU omfg. i feel so strongly abt this. mint yoongi is cute but very scene/emo era. yoongi in the esquire shoot... daechwita.... the mots one concert... YES!!!!! why do the stylists like making him look 5+ years younger with a smooth little coconut. like in general why does bts get the q tip look so often... they're Men

PLS I have no idea. every time i see seokjin in a bowl cut i get 5 years taken off my life expectancy the man is 30 and they keep styling him like a teenager. there are ways to make bangs work without using a bowl cut, besides his forehead is SO powerful!!! yoongi too i think the ones that get the less effort put into their hair styles are yoongi hoseok and seokjin. hoseok has had the same haircut for 4 years except for CNS and the dynamite mv that unleashed his powerful forehead and then it went back to jail. yoongi needs to always have an undercut and his bangs styled in a way that gives it body and complements his bone structure 

[tawnwen-writes]

Young morphs (or those during the early stages of reset) are darker in color, as a rule of thumb. They also tend to be more volatile in shape and have noticeable gyri/sulci-like patterns on the surface of their torso and head (where the CNS happens to be closer to skin). Though if a Morph is thriving, enough adipose tissue should render it less visible. Regardless of their inherited anatomy, their limbs typically take up a large portion of their body mass. 

Physically they are weaker, more bendy (bone-like formations are still volatile and soft), and motor control is very reflex-driven.

Super skittish, they have a predilection for hiding in dense foliage at the top of tall plants. They stick very closely to their pod at first, and leave shortly after they are fully grown.

[nam-nam-joon]

fruit

Pairing: yoongi x reader

Genre: mild angst, fluff

Wordcount: 4.6k

Warnings: None. Just soft, soft fluffy love and platonic affection in this one.

Summary: the last day of your vacation with your best friend, Min Yoongi, in Toronto

You wake to dry, cotton sheets and a comfortable silence, only broken by cars noisily starting off after the lights change on the street below the window. The first thing you see is the horribly outdated and blocky AC, and to escape its horrid look you roll over on the other side.

You squint your eyes at the sight of someone sitting with their back propped against the headboard, big headphones dangling around his neck, his phone in between his fingers.

With a sigh you close your eyes again before stretching your arms over your head.

"Do you ever sleep."

His chuckle is the first sound of him that greets your ears, just before his voice reaches you moments later.

"Occasionally. Had pleasant dreams?"

You only hrmpf into the pillow, as every trace of whatever had occupied your mind during its state of rest had been wiped clean after you'd opened your eyes. "What time is it, anyways. Do they still serve breakfast downstairs?"

He scoffs, and you crack open an eye to see him frowning at the opposite wall.

"They call that breakfast, pff yeah. Dunno. You wanna go for breakfast here?"

He sounds a little disbelieving, and when you focus on his face again you find him looking down on you, the frown slightly lessened.

You shrug. "It's free."

He rubs his right hand over his face and pinches his eyes. "It's our last full day here, I think we can treat ourselfs to something a little more enjoyable."

He mentions it so casually but his words have a deeper impact on you as you roll over on your back, staring at the ceiling.

The last day already...

One week of holiday was not nearly enough time, in your opinion, but it was what had been given, and there was no way of changing it now.

One week already.

"Can't believe we've been here for a week already! Feels... I don't know. Doesn't feel like a week."

"I know." He replies, pushing back the blanket and swinging his legs out of the bed. He waits, briefly, to avoid slow blood, before standing up and stretching his back, dropping his headphones off to the nightstand.

There's a brief moment in which you can admire the muscle and bones shifting in his back as he rolls his shoulders, the lack of a t shirt giving you full view over the smooth skin stretching over his frame.

You look away before he could notice, not wanting to add tension to the calm air that surrounds you both.

You doubt he'd take offense, or worse, think you were checking him out - he knows you don't work that way, and it's okay, but a part of your brain still thinks he might interpret it wrong.

Oblivious to your inner conflict, he trudges over into the bathroom, stopping to pick up his pair of black skinny jeans from the chair he'd unceremoniously dumped them on last night, and bends over to pick a fresh pair of briefs out of his suitcase.

When he emerges again, the scentwave of his deo and aftershave comes rolling out of the bathroom behind him, and you're almost done with checking off any new notification that had arrived as soon as you'd opened your phone.

"Get up," He throws your own clothes at you, and you lazily lift a hand to block them from smacking right into your face. "We don't have all day to lounge."

Contrary to his words just now he flops back down on the bed after shrugging into a shirt and oversized jumper, tapping on his phone for a while. Then he sits back up again, shuffling his feet until they're far enough into his shoes so that he can tie them.

You're thanking yourself for having the minds to have showered last evening and can thus safely skip it this morning, shortening the get-ready routine significantly.

"What do you wanna do today?" He speaks loudly through the door as you close it behind you, and you avoid your reflection in the large mirror spanning almost the entire opposite wall as you contemplate for a moment.

"Give me some options!" You shout back, then, unwilling to get your brain to remember what things you already crossed off your bucket list and which were yet to be done.

Yoongi groans at your passiveness, but you hear him move across the room to the physical copy of the list you'd written out three weeks ago, anxiety riddled and excited about this trip coming up.

He lists several things while you dry off, put deo on and get dressed, but two catch your attention.

"Aren't the aquarium and the CN Tower like... right next to each other?"

He stops, and as you open the door again you find him furrowing his eyebrows at the list and stack of flyers in his hands.

"Yeah, they are." He then agrees, and a smile spreads on your face.

"Let's do those today?"

"And the Distillery District tomorrow?"

"Works with me." You stop by your suitcase and pick up a scarf, not wanting to be fooled by the seemingly pleasant weather that is visible through the big windows.

The air outside is so fresh it nips your cheeks until they're red, and you're glad as Yoongi leads the way down into the closest subway station. Warm air rushes out from the tunnels as you await the next train's arrival, nervously checking to see if you're on the right side of the station.

"Aquarium first?" He has to step close so you can hear him over the wind rustling and the tires screeching, and you feel yourself leaning forward further into him to answer, speaking directly into his ear as you confirm.

He turns his head after hearing you agree, and the smile that flickers over his usually so passive face fills your chest with warmth.

It's a bit of a walk from the southernmost station to both Tower and Aquarium, and during that walk you come past some of the skyscrapers that make up the core of Downtown's business district.

There are a lot of people out and about, and during a wait at one of the red lights Yoongi slips his long, cold fingers through yours.

You gently tug him forward as the light switches to green and he's still caught up running his eyes over the architecture that surrounds you both, but doesn't protest as you drag him along.

He needs a moment to file through your backpack until he gets the preprinted tickets out and can present them to the teenager at the doors, who automatically lifts the corners of their mouth and bids you a good stay.

Darkness envelops you as you enter the rooms filled with big glass windows providing a glimpse into the tanks beyond, inhabited by all sorts of critters that you can find in the oceans.

It's so warm that your scarf and jacket soon become obsolete, and you turn to stuff them into your backpack while Yoongi simply pushes the sleeves of his jumper up.

You must've taken longer than expected, because when you turn back and around, your companion is nowhere in sight. Granted, in the dim light and with his inky hair he doesn't exactly stand out, but you're not too worried. If all comes down there's still cell reception in here, but even then it would surprise you if you wouldn't find each other sooner.

Unconcerned you continue walking through the halls, gazing in wonder at all the fish and other lifeforms.

You just caught sight of a sign lit in rainbow colours when a tap on your shoulder makes your head turn, finding yourself face to face with a flustered looking Yoongi. His lips are parted for air and he looks like he's been jogging, the crease between his eyebrows giving him a look of utter annoyance to the untrained eye.

To you the worry in his gaze is clearly visible, the distress that makes him press his lips into a thin line as he silently stares at you in a mixture of exasperation and relief.

"What?" You ask, worry beginning to gnaw at your own heart now. "Did something happen? Did you lose something?"

You're up and ready to go back, eyes already peeled for whatever it is he dropped now, even before he sighs and looks away briefly.

"You." He says then, and over the childish-accusing ring of his voice you hear the wavering that comes before tears. "I thought I'd lost you, idiot."

He wraps his arms around your shoulders, one hand grabbing his own elbow and locking you into the hug as he drops his head against yours and breathes out heavily.

You close your own arms around his middle, softly holding him, rubbing over his spine before letting go. "I won't go anywhere without you."

He only glares at you before forcefully taking your hand and linking your fingers before tugging you forward, evidently still not over the thought of having lost you earlier.

As the biggest tank comes into sight you gleefully step on the slowly moving walkway that is only wide enough for one person, but Yoongi doesn't seem to mind walking besides you, one hand still clasped in yours, the other stuffed into his pocket.

The blue light from overhead makes him look paler than usual, and he watches the big sea turtle pass over the glass tunnel with interest.

So captivated by the sight of the sharks is he that he almost walks smack into a children's pushchair, and barely manages to avoid stumbling over the toddler that is standing up at its side, holding on to it.

The father is quick to apologize and Yoongi is too overwhelmed to say anything but look taken off guard, so you tug on your hands and pull him behind you on the walkway, softly snickering.

His eyebrows lower as his eyes focus on you.

"Oi."

"Sorry." You turn your head to hide the grin that is still on your face, and he clicks his tongue and grunts before pulling on your hands so you take a step closer and he can put his free arm around you, angrily hugging you and seeking comfort after the small shock just now.

When you come to the jellyfish you take selfies and pictures of each other with the orange illuminated, slowly moving beings, forms radiant in front of the unnaturally shining blue water.

You snap a particularly good one of Yoongi, looking up at the orange jellyfish, its colour emitting enough glow to dip his cheeks and nose in its colour, while the lower half of his face is touched in blue. The back of his head and his hair mix with the dark background, making the colours on his face pop even more.

His eyes glint appreciatively as he studies the photo after you hand him his phone back, and he softly rests his forehead against the side of your head as he sends a copy of it to you.

You have a blast leaning over the side of the big tank you previously passed through via the glass tunnel, stretching your hand out as far as you can to touch the rays that peek out of the water and let themselves be pet.

"Look, Yoongi look!" You yell excitedly as you finally manage to touch one of the flat fish's heads, the skin surprisingly smooth and slick to the touch.

He stands a little further away, arms crossed and his chin resting in one of his hands, simply observing you having fun, while a small smile plays around his lips.

Before you can fall over the wall and join the multitudes of ocean creatures down below he gently asks if you're ready to go on.

It's only the gift shop that is left now, and you two have a great time exploring all the ways they make money here.

A box of soft plastic things to put on fingers particularly intrigues you, and Yoongi makes the mistake of stepping close behind you to see over your shoulder. In the next moment his face is met with five wobbling tentacles, each one sprouting from your fingers.

He manages to suppress his shout of unpleasant surprise but can't help the shudder and disgusted expression on his face, before it shifts into morbid interest and he steps closer after having leaned back rather hastily before.

"Gross." He comments, catching the tentacle that is your pointer finger and giving it a testing squeeze, up where it's all rubber and not finger anymore.

You giggle and let him pull them off one after the other, glad to finally have fresh air on your fingers again.

The big shark plushie looks more cuddly than terrifying, and you catch Yoongi putting away his phone after your hand, previously petting one of the sharks, pauses.

"Did you...?"

His face is blank as he tilts his head in question.

"What?"

You narrow your eyes at him but don't say anything else.

There's nothing really worth your money, so you exit through the doors at the end. Wary of the change of temperature waiting outside, you open your backpack and pull your jacket out again, and after shrugging into it signalling with a nod you're ready to go on.

Once past the doors and back in the cold air, you begrudgingly pry one of your hands out of its pocket as Yoongi demands to hold it again. With the next gush of wind you shiver and hastily wedge both hands back into your pocket, despite Yoongi's protest as his large hand doesn't want to fit through the opening at first.

You find a corner shielded from the unforgiving breeze, where you sit on the edge of the freezing cold stone bench and dig into the sandwiches you'd picked up at a Tim Horton's prior to the Aquarium.

After splitting the chocolate chip cookie and wiping your hands you lean back, momentarily satisfied.

The sun is out from between the grey clouds from this morning, but even now it is quite cold.

You think it to yourself, and notice it again when Yoongi makes sweater paws around his hands and his shoulders softly shake.

"You should've put on a jacket." You lightly scold him, more worry than annoyance in your voice as you wrap your scarf around his neck and upper body. "Let's get into that Tower now, get warm again and then go see what the city looks like from up above."

He doesn't say anything but follows close to your heel, jumping ahead and through the doors before you.

There's a security checkpoint before you can get much further, but after that one's passed you can see the trickle of people leading from the cash registers towards where the elevators must be.

On your way there you come across informative panels on the wall, stating facts and more interesting stuff.

"Ohh you can even go on the top of the viewing cabin! That'd be so cool!"

"You're crazy."

You elbow him and he huffs out in fake pain.

The elevator attendee speaks almost continuously before the doors close, but whatever they're saying is tuned out as the ascend begins and the floorboards are suddenly see through, the ground rapidly shrinking.

Yoongi jumps slightly at the sight, instinctively grabbing your sleeve, and you run a hand over his in comfort without having to look.

The sight out of the big windows is truly breathtaking, and neither of you says something for a good while after arriving on top.

The sun is already setting in the distance when you finish your second full round.

"There's another walk without windows downstairs."

He doesn't need to add the question mark at the end of his sentence for you to agree to the question he didn't ask.

Instead of accompanying you around the walkway, he just stops halfway around, leaning on the handrail and staring out into the city that grows darker with every minute.

It's not even much colder up here, if you don't count the wind, and you realize that's probably one of the main reasons Yoongi decided to stay on the side shielded from the strong breeze.

After completing the round you sidle up to him and join him looking towards the dying sun.

Heartbeats pass by in silence, Yoongi eventually dropping his eyes from the burning star and focusing on his fingers holding on to each other, hanging over the handrail.

It must be cold for him, even with the scarf now, and you turn, walk towards the doors, expecting him to come join you on your way back inside, but he doesn't.

Instead he lifts his head again, looking towards the horizon, and you quietly slip your phone out to take a picture of his form. The edges of his pullover, the strands of his hair caught in golden sunlight, he is looking absolutely ethereal.

With your legs to both sides of his, your arms wrapped around his middle and your chin resting on his shoulder you share a bit of your warmth with him. After a moment he leans back into your touch, his hands coming up to touch yours where they snuck into the kangaroo pocket on his sweater.

For a moment you both watch the sun through narrowed eyes, and you wish you could preserve this moment forever.

The city sounds are a long way down, the cold is bearable, and Yoongi is everywhere - under your hands, in between your legs, wrapped in your arms, his scent briefly in your nose every time you take a breathe, the side of his head the border of your vision on your right.

He turns, eventually, to face you. The height difference makes you look up to him, a soft expression of love on your face.

He takes his time studying your face, one hand coming up to cup your cheek, his bony thumb grazing over the area of your cheekbone that has become weirdly numb from the cold.

With the sun in his back his hair has a halo. It fits, you think.

He swallows, and parts his lips, as if to say something, and you catch the way his eyes flicker down to your lips, and suddenly the warm flutter of love and adoration in your chest is no longer there, the smile drains from your face and worry spreads throughout your body.

Yoongi knows you're different than that, he knows that little touches mean something different for you than for most others. He knows you don't want slobbery make-out sessions, and he knows you don't date because why bother when everyone is just so focused on the one thing that you don't want, anyway?

So why would he...?

The fear he might not be different from them bubbles up in you, but you fight it down. This is Yoongi, not some fuckboy. This is Yoongi, with his cold hands and big sweaters, who needs you to hug him even after you're the one to scare him. Yoongi, who needs to be reminded to eat and drink after getting too immersed in his work, and Yoongi who tells the guys approaching you and your girl friends at the club to back off when they don't want to take no for an answer.

Yoongi, who cares so much about every one of his friends.

"I was thinking," He begins, and you can't help it when your stomach drops. He's finally had enough, you think, he can't take it anymore. The displays of physical affection have gotten to him after all, even though he promised he knew you didn't mean to flirt through them. This vacation will be the last one with your best friend, and you swallow through the rush of blood threatening to drown out his words.

"I- You know I love you, right?"

No, you don't, not really. You know he does, but your heart is pounding away in your chest at the meaning his words have, could have, but you nod anyways, just to hear his next words.

"I love you, _______."

"Are you breaking up with our friendship?" It bursts out, and you hate how your voice trembles, hate how vulnerable you sound, even to your own ears. Yoongi knows of your fear of staying alone, of people pointing it out again and again and not giving you the space to accept it, allowing you to try growing comfortable with it.

The way his eyes widen and his mouth gapes, suddenly at a loss for words does nothing to ease the fear worming its way through your gut, making your knees weak.

"I- No! _______, no. I- Oh god, no. No no no."

He slides the backpack off your shoulders and places it aside before enveloping you in a bear hug, holding you so close and secure that you can finally breathe again.

"No, please, please don't think that. I wouldn't, not in a million years. You mean too much to me, do you understand?"

He pulls back, and now his eyes are frantically searching and holding yours, desperate to give reassurance that has left you. Making sure you hear him, see him before his next words.

"That's why I was wondering, if you would be up to make this-" He gestures between you, and you follow his movement with slow eyes, still not knowing what he's getting at but confused since it's not going in the direction you were thinking of. "-a permanent thing?"

"What?"

He lets out a soft sigh and his gaze dances off to the side briefly, hooded eyes under furrowed eyebrows searching and holding on to something before his face clears, the soft, uncertain smile that shows he's excited about something but also incredibly nervous at the same time, and clears his throat shortly.

"_______. Will you be my zucchini?"

You continue to stare at him dumbfounded, but the way he so proudly said the last word, however ridiculous it sounds, slowly melts the ice inside you.

A giggle bursts through your throat, tight with uncried tears, and you clap a hand over your mouth to stop it, eyes still wide and fixed on the person in front of you. Another slips out, and through the conflicting emotions inside you, you ask:

"My what?"

"...Zucchini." Yoongi replies, slightly less sure of himself now. “That’s what-” He fiddles with your scarf before pulling out his phone from his pocket, tapping on the screen and putting something into it. His eyes flicker up to yours, and he continues while pulling something up on his screen. "I looked it up. It's what- It's what people use for each other in a queerplatonic relationship."

He holds out his phone for you to see, and with still big eyes you scroll through the text and quickly read it.

"I, um. I didn't know about that. Um. Wow." You shake your head in disbelief as you hand the phone back to its owner. As he slips it back into his pocket his eyes meet yours again, and through the continuing silence you remember he's still waiting for an answer.

That's when the weight of what he asked sinks in, and your eyes snap back to his, your mouth opening and closing without a sound escaping it.

"You... And me?" Your voice breaks at the end, disbelief making your tongue thick.

Yoongi nods, a wider smile flickering over his face as he runs his hands over his pullover, wanting to grab on to something for comfort but refraining from doing so.

"You're asking me... to be in a queerplatonic relationship? With you?"

He nods, biting on his lower lip, now shifting his weight from one leg to the other.

It's stupid how long it takes your brain to fully wrap around the words and their meaning.

When they do, it's like a drop of sunlight has fallen straight into your stomach.

"Yes. Yes! Min Yoongi, yes! I'd- I’d love to be your ...zucchini."

And you spring forward, into his arms, and he picks you up and spins you around once before setting you back on the ground.

You're both laughing, and finally the tears run freely, out of relief now.

You mush your lips into his cheek, the grin not dropping from your face, even after you press your foreheads against each others.

"God I'm so glad you said yes. That'd have been a sad rejection."

"We could've been each others... celery or something."

That cracks him up and his lips pull back over his teeth. "Zucchini sounds better though."

"Min Yoongi. My Zucchini."

You wrap your tongue around the words and really feel them, testing out how they sound.

He grins back at you, and for a moment everything's perfect again.

Then he shudders and shivers in your embrace, teeth suddenly clattering as his shoulders start to shake uncontrollably.

"Oh my god, go back inside, now!"

You rip yourself out of the soft hug you'd shared and push him through the doors, back inside, before going to collect your backpack and following him.

He's still grumbling about the cold when you spread out the takeaway indian curry and rice over the ridiculously large bed which’s blanket is draped over Yoongi's freshly showered form.

He'd hopped under the water right after you'd gotten back from the CN Tower, before you had gone out alone again to get dinner a last time.

He sucks in air through his teeth now as he takes the first bite of his curry - spicy, to get the warmth back into him.

"If you wouldn't have had a meltdown we could've gotten this over with so much sooner."

He looks over to where you're sitting, and the shy need to confirm you're really not taking offense at his lame comment makes your lips stretch into a smile. You're quick to wipe it off your face in favour of fake annoyance, though, and glower at him half-heartedly.

"If you hadn't been so cryptic I wouldn't have had any reason to worry, you gummybear."

Right after the rather stern words leave your mouth you can't hold the grin back any longer.

"Speaking of which," He says, before putting his styro box with curry down to lean over the side of the bed and retrieve something from the drawer of the nightstand. He's dressed in long-sleeve shirt and sweatpants, and you watch in amusement as it rides up as he stretches. Before you can hold back you reach forward and poke his soft side.

He flinches and turns his head, the look of pure offence making you laugh.

"Sorry, sorry!" You're quick to apologize, but he still gives you a level 3 death glare before flinging a golden package into your face.

"Here, have these and keep your nasty fingers to yourself."

He goes back to shovelling the curry, while you squeal over the sweets.

"Haribo! They're my favourite. Thank you!"

He continues to duck his head, but you can see the way he smiles into his food.

"Request." He says after finishing his serving and leaving a rest for tomorrow.

You pick it up and transfer it into the fridge, before wiping nonexistent dirt from your hands on your pants.

He crawls out of bed to stand in front of you, and you tilt your head in question to his one word sentence.

"Can I kiss your cheek? Please?"

The smile is back on your face in an instant.

“Yes. And you really don’t need to ask every time, ok?” You hug your arms around his ribcage, revelling in the feeling of his lips touching your cheek, your temple. How his arms are heavy and warm and reassuring around your shoulders.

"I love you." You whisper into his shirt, and the warm fuzzy feeling in your chest threatens to burst it.

"I love you too." After a pause, he quietly adds, "Zucchini."

author’s note: i loved the positive feedback on my last ff, and i’d love it if you’d leave a comment after reading this one :3

all the fuzzy happy love to you, wherever you may be right now. i hope you have a great day. <3

[thecreaturecodex]

Dynne

Image © Jules Feiffer, accessed here

[Commissioned by @menaceomysterio. At this rate, I’m pretty sure I should invest in a copy of The Phantom Tollbooth]

Dynne CR 4 CN Aberration This creature appears to be a roughly sculpted humanoid shorter than a man, composed of a smoky blue substance. Its facial features are contorted in a rictus of mirth, and the air visibly shimmers around it.

A dynne, sometimes called an “awful dynne”, is a strange creature composed of pure sound. Their bodies appear as if they were gaseous, held together by the vibrating sounds they collect. Particularly intense noises, such as volcanic eruptions, earthquakes, or massive explosions, may spontaneously create one or more dynnes. Dynnes love noise, the louder and more dissonant the better, and they gather up sounds in their bodies as they hear new things. A dynne can mimic the sounds they hear skillfully, but rarely choose to mimic anything other than commotion and discord. A dynne that goes without regular exposure to loud noises withers as if starving, and absolute silence literally kills them with prolonged exposure.

If threatened, a dynne uses sound as a weapon, firing pinpoint blasts of noise keen enough to damage flesh and bone or producing mighty rows loud enough to deafen an entire room at once. They prefer to avoid confrontations, however, through bluff and bluster. Dynnes are typically jolly creatures. They can squeeze into very tight spaces, and enjoy resting in confinement—bottles and flasks are a favorite spot, which can lead them to being confused for genies. This is thought to be the source of their species name, as they greatly enjoy puns and wordplay. Dynnes frequently associate with bards, particularly those with a fondness for avant-garde music. A dynne stands a little over five feet tall.

Dynne   CR 4 XP 1,200 CN Medium aberration Init +3; Senses darkvision 60 ft., Perception +7 Defense AC 15, touch 13, flat-footed 12 (+3 Dex, +2 natural) hp 51 (6d8+24) Fort +5, Ref +5, Will +6 DR 5/magic; Immune sonic; Weakness vulnerable to silence Defensive Abilities amorphous Offense Speed 20 ft., fly 40 ft. (perfect) Melee 2 slams +5 (1d4+1 plus 1d6 sonic plus reverb) Ranged sound lance +7 touch (3d6 sonic plus reverb) Special Attacks clamor Spell-like Abilities CL 4th, concentration +8 (+12 casting defensively) At will—ghost sound (DC 14), ventriloquism (DC 15) 3/day—cacophonous call (DC 16), sound burst (DC 16) 1/day—thundering drums (DC 17) Statistics Str 12, Dex 17, Con 17, Int 8, Wis 12, Cha 19 Base Atk +4; CMB +5; CMD 18 Feats Combat Casting, Skill Focus (Bluff), Toughness Skills Bluff +14, Escape Artist +9, Fly +15, Intimidate +14, Perception +7, Perform (comedy) +6, Stealth +8; Racial Modifiers +4 Bluff, +4 Intimidate Languages Auran, Common SQ compression, no breath, sound mimicry (any) Ecology Environment any land or underground Organization solitary, pair or tumult (3-12) Treasure standard Special Abilities Clamor (Su) Three times per day, a dynne can make a noise so loud that all creatures within 30 feet must succeed a DC 17 Fortitude save or be deafened for 1 day. A creature that succeeds the save is not deafened but is dazzled for 1 minute by the noise. A creature that successfully saves is immune to the clamor of that dynne for the next 24 hours. This is a sonic effect, and the save DC is Charisma based. Reverb (Su) A creature struck by a dynne’s slam or sound lance attacks must succeed a DC 16 Fortitude save or be sickened for 1 round by the vibrations. A creature struck twice or more that failed the save is staggered for 1 round instead. This is a sonic effect, and the save DC is Constitution based. Sound Lance (Su) As a standard action, a dynne can fire a deadly beam of sound. Treat this as a ranged touch attack with a range of 120 feet and no range increment. A creature struck takes 3d6 points of sonic damage and is exposed to the dynne’s reverb. Vulnerable to Silence (Su) A dynne within the area of a silence spell or similar effect is staggered and takes 1d6 points of damage per round (no save).

[ncfan-1]

A Book of Viscera

Mary Keay didn't believe in unsolvable mysteries, and as it happened, she didn't believe in coincidences, either, not where fear was concerned. But whether a mystery could be solved in a human lifetime, that was another matter. And perhaps the book of poetry Doctor Tillerson had had in her safe wasn't worth the effort, after all. 

So I had to choose what to write as my last fic of 2018, and I chose this. You’re welcome.

[Also on AO3 | Dreamwidth | Pillowfort]

[CN/TW: Animal cruelty, non-explicit murder]

------------------

There were so many mysteries in the world whose answers were just out of reach, just beyond the grasp of man. It was like a jigsaw puzzle with three of the pieces missing. You were so close to having a full picture of what was going on, but there were gaps, and the gaps would never be filled in. But Mary Keay knew someone who had a very different perspective on what jigsaw puzzles were good for, and she didn’t believe in unsolvable mysteries, anyways. There was nothing beyond her ability to uncover. Whether she could uncover it in her lifetime was another matter.

It would have helped to know whether Doctor Tillerson had found the books separately, or if they had come to her as a set. It seemed to strain credulity that one person could just find two of the books in separate incidents, without it having some immediately visible effect on her person, but then, her Gerard had tracked down three to date, and the first he’d found, the very first…

Coincidence, perhaps. And perhaps it was merely coincidence that book of bones and book of skin (originally) were both written in Sanskrit. The books couldn’t all be written in English, after all. The world was a big place—vaster by far than you could imagine, and tighter than you ever dreamed—and fear gripped the minds of all people. The Flesh was so random that coincidence was certainly a possibility.

Mary didn’t especially believe in coincidences where fear was concerned, though. The connections were there, like glistening strands of silk holding it all together. And coincidence offended her sense of mystery, anyhow.

Mary was still a child when she had first set about learning Sanskrit. At the time, she had thought that learning Sanskrit was necessary to truly put the skin book to its full use—Doctor Tillerson had been such a mutilated, incomplete thing that Mary thought that writing in English just wasn’t the thing (And to be fair, her best results had always come from Sanskrit). Learning to speak and read and write in Sanskrit would make it easier to discern just how the skin book worked, and the bone book bore learning more about, as well.

Her mother had been confused. Her mother was gone often enough, exhausted by her work at the Institute and what the Eye asked of her in return for its patronage, that it had been easy to hide the books from her, even when that entailed regular disposal of bent and twisted animal bones. Mary told her mother that she was just broadening her horizons, and Elsa von Closen, daughter of (an impoverished branch of) a noble house, took to that explanation enthusiastically. Started pushing Mary towards French and German and Latin, but still, it was better than nothing.

Mary didn’t think her mother had ever suspected, which was delicious. Her mother, whom she had watched more than once wrench secrets from the minds of the unwilling, whom she had watched convince their landlord into lowering their rent—“You will never know how I knew; just know that I could tell everyone else what I know”—couldn’t tell that her daughter had two items of power tucked away in her matchbox of a bedroom. It was enough to buoy Mary whenever the process of becoming literate and conversant in Sanskrit hit a snag.

She was nearly a woman by the time she had gained mastery in the language, and her studies of the books of skin and bone could commence in earnest. Always, the skin book took precedent. Mary would admit that readily. It called to her more clearly than did the bone book, and it held such possibilities…

She’d tested animals first—that was easier, that was less dangerous—and had met with disappointment. Whatever power the skin book was granted as a conduit of the End, it did not appear to extend to animals; the skin book was a horror for humanity only. On the rare occasion she managed to skin a pelt fit to write on, once Mary had sewn it into the book, there was no effect. Nothing happened, and more than once she had ripped out the stitches with a snarl, flinging the pelt into the nearest alleyway bin with a short, sharp stroke of her arm.

(This was, as it happened, rather more difficult to hide from her mother than had been the simple storage of the two books in her childhood bedroom. Mary wasn’t quite as good at cleaning specks of blood from her skin and her clothes as she had thought she was, and of course her mother noticed. Elsa always looked at her so strangely when Mary came home after an experiment with one of the local stray cats.

“Mary, darling, have you been in a fight?”

Mary found her own place to live not long afterwards.)

Mary’s early alliances had been born primarily to facilitate the business of procuring fresh bodies for her experiments. As was the same in every age of its existence, London had a robust network of connected persons (and otherwise) who didn’t need much of a reason to kill someone, and didn’t ask much in return for an excuse to satisfy their own urges. Just small favors, really, and if it meant that Mary was remembered as someone helpful, someone resourceful, so much the better.

She learned the tricks from them. She took what she needed from them. Not that any of them ever seemed to realize that that was what was happening; no one ever seemed to realize that they were just as much a commodity as the people whose fear they consumed. If Mary had to guess, she’d say that glutting your own base urges too frequently doesn’t do much for your intelligence. Discipline is better for the mind.

Always, the most emphasis had to be on uncovering and mastering the secrets of the skin book. But in between that, there was time for the bone book.

Not that the bone book, as it seemed, had too many secrets to yield up. It was a simple book of poetry about dying animals. And it wasn’t especially good poetry, either. It had neither artistry nor grace; it was just a cacophonous mess of blood and pain and fear.

(Writhe on the ground with a spear in your belly Writhe and the tip drives in deeper Like a spoon in a pot the spear tip gathers your innards to itself Ready to yank them out and dash them to the ground Your dimming eyes will be filled with the red sight of your mutilation You will not escape with a scar)

Mary sometimes wondered at the age of the books. The skin book was, it was clear, quite old. The earliest pages were in a dialect of Sanskrit that her studies informed her was quite archaic, and though time had neither left the earliest pages rotten nor unreadable, they clearly bore the withered marks of great age. The bone book, on the other hand, was written in a much more modern dialect of Sanskrit; Mary had encountered only a handful of words she couldn’t make sense of.

As best as she could tell, all the bone book did on its own was drop bones. That, it did quite a lot of, constantly dropping bird and rat and snake bones, and other small bones Mary couldn’t identify. Mary did wonder sometimes why the bones all seemed to be bent and twisted into such odd shapes. She perhaps could have come by the answers if she had allowed certain of the people in her little network to examine it, but Mary was not a novice, and she knew how this game was played. You don’t win by showing all your cards, after all.

(You are trapped fast between two giant pincers The prongs are soft and ridged and yet unyielding Struggle all you like and you will never escape You quiver in this iron embrace for eternities untold And then, pressure And then, agony as that terrible pressure descends upon your wing And then, a tearing that is like the tearing of the world as it is flung into the void You will never fly again)

On its own, the bone book was rather uninspiring, but Mary was not a child to be fooled by uninspiring appearances. Naturally, it was time for experiments.

She tried reading poems over the corpses for a while. That elicited no results that Mary could discern.

She tried copying some of the shorter poems into the margins of her newly-created pages. That created a mess of sometimes astonishing proportions. The results were so badly garbled that Mary found the pages completely unusable, and had no choice but to rip them out.

She had tried writing the entries in the style (if you could really call it thus) of the poems in the bone book. All that did was produce inferior results, equal to Mary’s first experiments with humans when she was a young woman.

It was just a book of viscera, after all, and when Jurgen Leitner had come sniffing around asking if Mary had anything strange she’d like to sell, she offered it up to him. Showed him the way it dropped bones almost constantly, and struggled not to laugh when he took the thing much more seriously than he ought to have, and paid her a sum that certainly far exceeded the temporal value of the book. It wasn’t like she disabused him of the notions that had clearly popped into his head. She wished him joy of it, and sent him on his way. The money he’d given her could be considered recompense for all the times he’d been in her bookshop and not bought anything.

(The blood that pounds in your veins rushes to water the earth You have been running so long, and all for naught The hunters wear your kin’s skins as trophies and soon they will wear yours You shall be a trophy for your hunters and a symbol of terror to your kin You shall never see your cubs again)

The bone book was Leitner’s now, and Mary didn’t expect to see it again. When the library was attacked, she suspected it had either been reclaimed by the Flesh, or simply been destroyed. So long as no agent of the Flesh realized that it was she who had kept it out of circulation for so many decades, Mary didn’t really care what became of it.

And then, first of the three he found, of all the books of power he could have found, her Gerard carried it back to her one night.

Perhaps it was a coincidence, but that offended Mary’s sense of mystery too much for her to ever accept it. The idea that the mystery would outlive her offended her even more, but ah, well, that was what one’s children were for. And she had a certain contingency plan in the works, anyways.

But being stamped with Leitner’s seal had not made the bone book any less opaque than it had been when its cover was unmarked. Mary tried a couple more experiments, just to see if things she’d not tried before might yield results, but nothing.

“Huh,” Mary muttered one morning as she leafed through the little book, a slight frown stealing over her mouth.

There was a new page.

[niennandil-me-writes]

Goretober 26: Melting

cn: fire, burns, claustrophobia, amputation, underage character

Burning wood, melting metal, hot oil. Alarm bells ringing, crackling flames licking over beams, splintering, and bursting, explosions somewhere behind, but not far enough behind. Charlie is scurrying through the corridors, taking the opposite direction of what she knows to be the emergency exit ways (ways that she knows are blocked by crates and machinery, even though they really shouldn’t be, even though everyone is constantly talking about that they shouldn’t be, but nobody knows where else to put the stuff).

Finally, she reaches the big hall that is so familiar to her. Only a few more steps and she’ll be there. She has to get there before the flames do, she has to warn them, she has to help them, she has to –

Charlie hears the loud creaking sound a split second before the impact, and then she’s lying on the floor. She tries to get up again immediately, and it’s only then that the pain reaches her adrenaline-filled brain. The wooden beam that came down from the ceiling has completely crushed her right leg and part of her arm as well. She twists around, trying to scramble away like a wounded animal. The pain is getting worse, bone splinters piercing her flesh from the inside.

Charlie screams out. “Help!” She doesn’t even know if it’s for her own sake or to somehow alarm the workers beyond the doors of the hall. “Help! Please!”

It’s getting hotter. The flames are all around her now.

“Help! Fire!”

Why is nobody coming? They must have heard the alarm, right?

And then she hears more creaks, more bangs, as two more beams come down from the ceiling. And then, beneath the creaking and cracking, the cackling of fire and the ringing of the bells, she notices another noise. Her ears twitch. They’re muffled, through layers of walls and wood, but Charlie can hear voices, panicked.

“Mum?!”, she calls out. “Mama?” Her voice is hoarse from screaming and from the smoke streaming into her lungs. She coughs. She can’t pick out single voices, can barely make out words. She doesn’t know if she wants to. “Mum…” It’s just a whisper now.

Then another loud crack from behind her. And she knows what it means. Just seconds later, the fire reaches her body, about to tear it asunder the way they just did the wood. The flames lap at her crushed leg first, and she’s glad she has no feeling left there. She can smell her own skin burning. Almost smells like bacon at first and then becomes charred coal.

Her curiosity gets the better of her. If she’s going to die here, she might as well see what it looks like. She twists around again and looks at what is visible of her leg. Her clothes are already burnt up and flames are dancing over her skin. For a moment, she watches, almost fascinated, and the fire wanders over her clothes to the rest of her body. This time, Charlie feels it all. She screams, and then the scream becomes a cough as she’s gasping for air that is becoming scarce in the hall.

Flames are lapping over her body, consuming her, melting her skin. They reach her face, and her entire view becomes fire, red and orange and white, searing hot and biting cold at once. She can’t scream without flames creeping into her throat. It’s a pain so all-consuming that she can’t even tell what parts of her body are affected, or if her body even still exists or has been eaten up entirely by the fire.

It' been only a second, it’s been a millennia, and she’s close to passing out when there’s another noise, muffled, but not by walls.

“There’s someone there!”

Steps coming closer, and then suddenly a strong gust of wind that takes her breath away, and must be doing the same to the flames, which die down. Charlie’s body is still burning, though, like invisible flames dancing under her skin.

She tries to blink her eyes open, but only one of them obeys. The other must have burnt up the way it hurts. She squeezes both shut again.

“We’re gonna get you out of here!”

Hands grab her and she screams out in pain as they dig into her melted skin. They pull and yank, but the beam is still holding her crushed body to the floor.

“She’s stuck!”

“We gotta amputate.”

She can’t see, but she can feel the flames creeping closer again.

Please, just leave me here. Save the others. Save my mothers. I’ll die anyway. The words won’t leave her cracked mouth. Please, please, my mothers. You’re only wasting your time. She tries to listen for the voices from the other hall, but there’s too much else, and her ears are burned up as well.

The pain from her leg being hacked off barely registers. She doesn’t have the strength to struggle against her saviors, make them understand. So she gets carried out as the factory caves in behind them. The last one saved. A molten bundle of burns that the flames have spit out.

[juniperpublisherscasestudies]

Juniper Publishers- Open Access Journal of Case Studies

Late presentation of Two Rare Sacral Spine Tumors challenges of Diagnosis and Treatment in a Low Resource Setting

Authored by Alexis DB Buunaaim

Abstract

Lower back pain with or without an associated mass should be examined thoroughly by physical examination aided with radiological imaging. Described here are two young male adults; 29 and 30 years of age with lower back pain associated with lumbar masses. These patients initially treated themselves with herbal preparations without success. Diagnoses of chordoma and myxopapillary ependymoma were made in the 29 and 30-year old patients respectively after physical examination and imaging. These diagnoses were confirmed by histopathological investigation. Both patients requested discharge against medical advice. Unfortunately, they died at home within one month after discharge.

The diagnosis of chordoma and myxopapillary ependymoma can be very challenging and requires a multidisciplinary approach involving a radiologist, pathologist, oncologist and an orthopedic surgeon.

The poor outcomes in both patients could be attributed to ignorance, entrenched cultural beliefs, late diagnosis from low index of suspicion and lack of requisite diagnostic tools. This indicates that patients are still dying of treatable conditions in low- and middle-income countries especially in Africa. We propose awareness creation among clinicians, and a fund to be established both locally and globally to help with the diagnosis and treatment of sacral tumors.

Keywords:Sacral chordoma; Myxopapillary ependymoma; Late presentation; Spinal tumors

Abbreviations: CT: Computed Tomography; MRI: Magnetic Resonance Imaging; CNS: Central Nervous System; MPE: Myxopapillary Ependymoma; CBC: Complete Blood Count; LFT: Liver Function Test; RFT: Renal Function Test; ESR: Erythrocyte Sedimentation Rate

Introduction

Chordomas are rare slow growing malignant bone tumors that arise from embryonic notochordal remnants [1,2]. They account for 1-4% of all malignant bone neoplasms [3,4]. They occur in various anatomic locations with the sacral region being the most predominant site and lumbar spine being the least (sacrum 60%, spheno-occipital 25%, cervical 10% and thoracolumbar 5%) [5]. Symptoms generally depend on their location but patients typically present with pain at the initial stages [4,6-11]. Some patients may present with constipation, urine and or fecal incontinence due to autonomic nervous system involvement [6].

Chordomas pose diagnostic challenges to physicians [1,4]. However, diagnosis can be made through the use of CT and MRI, but histopathology is the mainstay of establishing diagnosis [1,2,4,6,12]. Surgical resection (marginal en bloc) with or without adjuvant radiotherapy is the treatment of choice [1,2,6,13,14]. Chordomas have poor prognosis because of local recurrence and metastasis [6,12], hence require yearly follow up even after 20-years of surgical resection [12].

Ependymomas are primary central nervous system (CNS) tumours that arise from the ependymal cells of the choroid plexus. They account for 2% of all primary CNS tumors [15]. They are divided into 5 subtypes: sub-ependymoma (grade I), myxopapillary ependymoma (grade I), ependymoma (grade II), RELA fusion-positive ependymoma (grade II or III), and anaplastic ependymoma (grade III) [16]. It is twice as common in men than women with an average age of presentation of 36yrs [16].

Myxopapillary ependymoma (MPE) commonly occur in the conus medullaris, cauda equina and filum terminale of the spinal cord [17]. MPE are grade I tumours and so they tend to grow slowly [18]. They have a high survival rate (98.4%) if early surgical intervention is performed [18].

We present two cases of rare spinal tumours; chordoma and myxopapillary ependymoma in Northern Ghana, who presented late to our institution for care when the initial herbal medical treatment failed. Clinical examination aided by imaging resulted in the suspicion of tumor. Histopathological examination of biopsy samples taken were confirmed as chordoma and myxopapillary ependymoma. We lost both patients a month after discharge against medical advice. This case report illustrates how late presentation and misdiagnosis results in poor outcomes of patients in low and middle resource settings.

Case One

Clinical history and physical examination

A 30-year old male presented with low back pain of 15 months duration. He also had a fungating lower back mass of 6-month duration. The patient initially managed the pain with over the counter analgesics until 10-months prior to presentation when he noticed a mass in his lower back. He went to a traditional healer where he was treated with herbal medications for 6-months because he thought it was a spiritual ailment. During this period, he began to experience a gradual loss of power in the lower limbs and this was associated with urine and faecal incontinence. He was bedridden and thus developed decubitus ulcers and the mass became ulcerated. He reported to a primary health facility because of the fungating mass and inability to move his lower limbs, where he was referred to our facility (tertiary).

On examination, he was a chronically ill looking man who had conjunctiva pallor, anicteric and mildly dehydrated. Systemic examination was essentially normal. He had a fungating lower back mass measuring 9×6cm, hard with irregular edges. The power in his lower limbs was 0/5 with lax anal sphincter tone.

Imaging results

Lumbosacral CT scan showed a heterogenous sacral mass measuring 5.8×6.5×6.2cm with bony distraction of the sacrococcygeal spine (Figures 1A & 1B). Lumbosacral MRI showed a 6.8×7.0×6.8cm lobulated heterogenous T1W hypointense and T2W hyperintense right sided mass involving the vertebral bodies, laminae and pedicles of S1, S2 and S3. The mass extends across the sacroiliac joint and involves the right iliac bone. It encases the right S1-S3 nerve roots with attendant severe canal stenosis. There is also infiltration of the right erector spinatus muscle posteriorly (Figures 1C & 1D).

Hematology and biochemistry results

Complete blood count (CBC) showed a low hemoglobin. Renal function and liver function tests (RFT and LFT) were essentially normal and the erythrocyte sedimentation rate (ESR) was elevated.

Histopathology results

Histopathology from an incision biopsy showed a cellular lesion with bubbly myxochondroid stroma. The cells were illdefined with round oval nuclei. Some of the cells had vacuolated cytoplasm and prominent vesicular nuclei while others had small with inconspicuous nuclei and no visible nucleoli. The stroma was infiltrated with inflammatory cells. The histopathological findings confirmed the diagnosis of Chordoma in line with the clinical diagnosis. Immunohistochemical examination could not be performed by our laboratory.

While conducting a metastatic workup patient requested to be discharged against medical advice for care at home and died a month afterwards.

Case Two

Clinical history and physical examination

A 29-year old male who presented with a 12-month history of low back pain and a slowly growing mass in the lower back. The pain increased in intensity over the period and was associated with lower limb weakness and urine and fecal incontinence. He resorted to herbal medications as well as over the counter drugs for 7 months. He presented to a Primary health facility where he was misdiagnosed as Pott’s disease and treated with antituberculous drugs for 5 months before referral to our facility because of lower limb weakness.

On examination, he was a chronically ill looking man who was moderately dehydrated. Systemic examination was essentially normal. He had a mass in his lower back measuring 7×5cm, it was hard, nodular, tender with irregular edges. The power in his lower limbs was 4/5 and anal sphincter tone was good.

Imaging results

Lumbosacral CT scan showed a heterogenous soft tissue mass involving the sacrococcygeal spine with bony distraction. It invaded the distal spinal canal and the surrounding soft tissue. The lumbar vertebral bodies and their intervertebral disc were normal (Figure 2A, 2B & 2C). Lumbosacral MRI showed an ill-defined sacrococcygeal tumour measuring 11.6×8.9×15.6cm with bony distractions of the sacrum and coccyx, extending to L3 vertebra and invasion of the distal spinal canal. There was severe spinal canal stenosis from L3 to the sacral elements with destruction of the involved vertebral bodies (Figure 2D).

Hematology and biochemistry results

CBC, RFT and LFT were essentially normal with elevated ESR.

Histopathology results

Histology from a core biopsy showed fragments of fibrocollagenous tissue infiltrated by an epithelial lesion with papillary pattern of growth. There were also areas of myxoid changes. This confirmed the diagnosis of myxopapillary ependymoma was made and this agreed with the initial diagnosis made by the clinicians. Immunohistochemical examination could not be performed by our laboratory.

The patient requested discharge against medical advice on financial grounds. He succumbed to the disease after 3 months of discharge.

Discussion

Chordomas are rare slow growing malignant bone tumors accounting for 1-4% of all malignant bone neoplasms [1,6]. Because of their slow growing nature, they are clinically dormant until later in the course of the disease [4]. The symptoms generally depend on their location with commonest being pain and neurologic symptoms [4,6-11]. For these reasons, most patients present to health facilities when the course of the disease is advanced. However, in low resource settings where the hospital is usually not the first point of call for a lot of patients (but the Traditional healer), patients present much later to the hospital when all hope is lost. This leaves the surgeon with very few options to work with. This was demonstrated as it took 15 months from the onset of symptoms, to presenting to a health facility. The patient in this current case report presented with very advanced form of the disease. In poor resource settings, most patients will resort to the Traditional healer whose services are relatively affordable compared to Orthodox health facilities, as illustrated in this case.

Mcmaster et al. [19] in 2001 reported the incidence rate of chordoma as 0.08 per 100,000 in the United States [19]. They also reported that chordomas are uncommon in blacks and people under 40yrs [19]. They observed a male predominance with an incidence rate of 0.10 as compared to females with 0.06 [19]. Murphey et al reported the male to female ratio of 2-3:1 [4]. The current case report from Northern Ghana involved a black male of 39-years of age. Being a male increased his chances of developing a chordoma, but his race and age reduced his risk. This accounts for the rarity of such cases in our settings and sometimes contribute to the low index of suspicion by most physicians. The young age group and the female sex are more likely to develop cranial chordoma [19] which contrast with the sacral presentation of case 1.

Diagnosing chordoma can be very challenging [1,4] but radiological imaging (CT and MRI) play a crucial role in preoperative diagnosis of chordoma [1,2,4,6,12]. Murphy et al illustrated that, most primary tumors of the spine present with characteristic radiologic features on CT and MRI [4]. With the aid of diagnostic images and the appropriate technical human resource, diagnosis can be made easily.

It is worth noting that plain radiographs cannot be used in diagnosing myxopapillary ependymoma (MPE). In low resource settings, primary and secondary health facilities only have access to X rays, hence the reason for misdiagnosis of case 2. The patient was misdiagnosed as Pott’s disease and received tuberculosis treatment regimen for 5 months which delayed time to definitive diagnosis. He was referred from the primary health facility to a tertiary facility for specialist care. A lumbosacral CT and MRI was done and a core biopsy taken for histopathology to confirm the diagnosis.

Both chordoma and MPE have good prognosis when they present early because they can be completely resected [4,18]. Prognosis is largely poor if both chordoma and MPE are left untreated [4,6,18].

In our opinion, poverty and ignorance is the main reason for late presentation of most patients in low resource settings of rural Ghana. Patients are more likely to resort to Traditional healers as their first point of call because their services are cheaper and are more accessible compared to orthodox health services. Also, the bureaucracies in the orthodox health services can be frustrating to patients. Our primary and secondary health services are under resourced both in diagnostic capability and human resource, which accounted for the misdiagnosis.

The lesson from these cases is for clinicians to develop a high index of suspicion and early referral of patients to appropriate centers for treatment especially when there is a suspicion of a cancer. Policy makers in low resource settings should work towards developing the referral and diagnostic capabilities of their primary and secondary health services. They also need to reduce the cost of diagnostic investigations especially for cancer through an established fund to enable patients present early to health facilities for prompt diagnosis and treatment.

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[whump-captain]

No. 26 - You will go down with this ship

fallen | waterfall | trap door

and

No. 11 - Just keep swimming

adrift | drowning | dehydration

(1500 words, OC)

it’s finished! it’s still long as heck but i shaved it down and made it actually make sense. there’s lots of gratuitous descriptions that aren’t even whump here but i like them too much to slash them lol

---

CN: drowning, fall from height, broken bones, internal injuries, paranormal occurrences, (probably wildly inaccurate) resuscitation

---

The job is straightforward: a scaffolding worker from a construction site near the river somewhere down in Greenwich called in strange sounds and movements in the night, silhouettes marching across the half-renovated pier. The foreman said it's nothing, but the worker is worried, see, cause legend is someone died on that pier at some point and it’s possible that their soul is too restless to allow the renovations to be finished.

Cutter listens to all of that while drinking coffee from a metal mug in the temporarily erected break room on the site where the worker asked to meet - late at night. He nods and agrees, makes some small-talk about how those in charge always seem to be the dumbest, which succeeds in bringing the client completely to his side; all the while, he’s casting a careful eye all across the tiny room. There’s a kitchenette in the corner with a kettle and a microwave, a portable radiator that has clearly seen better days, a lamp on the solitary desk, and a metal cabinet filled half with folders and half with the clutter of the workers’ personal belongings. Once he’s happy with what he saw, he lets the client lead him out to the riverbank, where the supposedly haunted pier stands.

The client doesn’t follow him. He hangs back on the bank, sweeping the darkness with the faint beam from his flashlight, while Cutter steps between the metal barriers and onto the pier. It stretches out a good thirty meters into the river and the metal planks that make up its surface creak under his feet. He picks his steps carefully, aware of the gaps between through which the pitch-black, wrinkled waters of the Thames peek. The tide is low - the muddy strip of land under the bank's concrete cliff is visible - but this far in the river is deep and the chill of the wind makes it feel as if the water is radiating cold. 

It doesn't take long for Cutter's eyes to grow accustomed to the dark. He throws one last glance back at the silhouette of the client back on the bank; and then he begins the show. He pulls out his scanner, a clunky metal box dotted with worn buttons and armed with a long, extendable antenna. The machine beeps to life and makes a laboured mechanical clack that then falls into a rhythmical knocking - the story is it will change frequency when it detects something supernatural.

In reality, Cutter has done most of the detecting before the client even stopped talking. There was no gas in the break room, which means it couldn't be a leak. The radiator, though old, seemed up to the standards and the one folder that laid on the desk, not in the mess of the cabinet, was the one labeled "Checks". That brief inspection told him the place is well-built, well-managed and most likely isn't leaking any chemicals, which is where ninety percent of all "hauntings" begin and end - and therefore, what ninety percent of his job is.

The remaining ten percent is intuition. Out on the pier, there is less to observe and more chance to notice the less obvious. The subtle change in the air, the tingling sort of tension one feels when sharing air with something truly out of this world. Cutter got better at noticing it over the past year. What used to be a vague feeling of unease and misbelonging is now a physical sensation, a tightness in his chest that centers itself right over his sternum, where he carries the scar.

He feels that tightness now. There is something on that pier, something beyond the wind and the fog. Under the creaking of swaying metal there is another sound, a barely audible scraping like a rat in the walls. With a sudden breeze, the air swirls, the fog sticks to the handrails and settles on the floor.

The fog which, he realizes, was not there a minute ago. 

Rapidly, like paint staining fabric, a layer of blackened rust spreads over the metal of the pier. The wind picks up and suddenly there's a voice on it, shrieking incomprehensible words with the melody of a hurricane. 

It's time to call for backup.

Cutter takes a step back.

The floorboard snaps under his foot, crumbling away into rust. He plummets, the pier comes down around him; there’s nothing to grab. For a single heartbeat, everything collapses to a pin point directly ahead - and then he hits the water. 

All sound cuts off abruptly. Freezing cold constricts around him and it's like a strike of lightning, shock spears his head in a white flash. Weightless, he feels himself falling. Gravity drags him down slowly, everything feels impossibly heavy. Cold takes over his thoughts too and then slams them into overdrive. Swim. He has to swim.

He kicks up, pushes wide with his arms - and then pain explodes in his shoulder. Miraculously, he forces himself not to cry out, not to lose what air he still has. His shoulder burns like living flame, he can't move it; but he has to, the impossible weight of his own body keeps pulling him down. It's pitch black all around, the pressure rings in his ears. It feels like being bound in ice, squeezed and stabbed from all directions by cold so piercing it's almost numb.

Desperately, he tries to reach up but something else inside him rips, pain tears through him again, bursting out of his chest. A sudden warmth blooms out in front of his face and Cutter realizes it's blood; his own, escaping from between his clenched teeth. His lungs burn now, starved for air and damaged, pressure builds to a flame of pure agony. He thrashes, half fighting and half convulsing, his body can't keep up with the panic that powers it now. The pain, the cold, the dark, it's all racing, all suffocating, he can't-

Something hits the water next to him. The sound is deafening, like a gunshot right by his ear, and the shape blackens the dark even more. It's below him, somehow. It will drag him down. But there's no choice; no time as his lungs scream for air, as pain blinds him to all but the one single goal. With his good arm he grabs at the shadow, his hand locks on it like a vice. The sudden motion sends lightning through his body and this time he shouts, he can't control it. Air bubbles burst out of his mouth in the pitch darkness; immediately there's a blade of pure ice stabbing through his chest as he inhales water. Something yanks him up, his body twitches. Consciousness sizzles and blinks away.

He doesn't feel his head break the surface. His hand is still in a death grip on the life buoy, enough to be dragged up and out towards the muddy bank. The construction worker, his client, wastes no time; he hauls Cutter out onto solid ground and lays him down on his back, crooks his head sideways. Blood pours out of Cutter's mouth, mixed with river water. The client, thanking God that he still had that stupid CPR shield keyring on his keys, powers through what he remembers from first aid training. 

It only takes two rescue breaths. Cutter suddenly convulses and then he's coughing, desperate and painful, sputtering blood and water. Every hungry gasp comes in a stab of pain, setting his broken ribs alight again but he keeps forcing air into his body, breath after impossible breath. Slowly, the violent coughing subsides; he wrestles a fraction of control over his lungs and grabs on to it like a lifeline. His wheezing gasps slowly even out and turn into rasping groans. 

He lets his head drop down into the mud. There's a foul, stale taste in his mouth and so many things in his torso hurt so much that it all blends into one nauseating haze. Wet hair sticks to his face and his clothes weigh down on him like lead. Or maybe it's the exhaustion that suddenly took him. Everything goes blurry again. 

"Hey, mate!" A sudden voice snaps him back to reality and his eyes flutter. The client crouches next to him, his face a mixture of fear and concern. "Don't you pass out on me. I saw you fall, I saw that bloody demon break the pier under you. I pulled you out, but you were gone there for a moment, properly unresponsive. Should I call someone? D'you need an ambulance?" 

The man's frantic chatter fades out into white noise as Cutter, with inhuman effort, reigns in his thoughts and forces his mind to work. Right. Demon. Or, more likely, a decay elemental or something along these lines. Something unquestionably above his pay grade.

A job for Elaine. 

"I need to make a phonecall," he chokes out.

[arushmichael]

Sleeping Sickness (Trypanosomiasis): Symptoms, Diagnosis and Treatment

By Arush Emmanuel Michael

The West African trypanosomiasis (sleeping sickness) is caused by Trypanosoma brucei gambiense and the East African trypanosomiasis (sleeping sickness) is caused by Trypanosoma brucei rhodisiense. Unless treated sleeping sickness is invariably fatal.

Pathogenesis of Sleeping Sickness

The infection spreads to humans by the bite of the Tse-Tse fly. At the site of the bite of the tse-tse fly, a chancre develops. The chancre is hard and tender but it eventually heals. Parasitaemia occurs as the parasite invades the blood circulation. The antibodies against the parasite develop, however antigenic variant surface glycoprotein (VSG) mutants evade the attack being carried out by the antibodies. A new wave of parasitaemia develops due to these VSG mutants. These waves of parasitaemia keep occurring over and over again for months. The central nervous system becomes involved if no treatment is received. Progressive impairment of the central nervous system results in coma and eventually death. In East African sleeping sickness, central nervous system involvement is earlier and disease is more acute, the patient’s death might occur in a year even without the involvement of the central nervous system. West African sleeping sickness may last up to four years and is therefore chronic.

Symptoms of Sleeping Sickness

The usual symptoms of the disease include:

·        Pyrexia (Fever)

·        Weakness

·        Rapid weight loss

·        Fatigue

Signs of CNS involvement and characteristic symptoms include:

·        Headache which is severe nature

·        Difficulty in concentration

·        Changes in behaviour: State of sleeping during day time (Sleeping Sickness) and aggressiveness

·        Patient might fall asleep while standing, sitting or even while eating

·        Coma and eventually death in the final phase of the disease

Since the disease is devastating to life and can lead to death if left untreated it is imperative that you consult a doctor if you notice any symptoms in you or anyone else. Once the doctor prescribed you treatment, you can now buy medicines online in India.

Diagnosis of Sleeping Sickness

After you consult a doctor, the doctor shall ask you your chief complaints and as to what made you come to the hospital. After this, the doctor shall ask relevant questions pertaining to your condition and your symptoms in order to complete your medical history. If you have a travel history to West, East or even Central Africa it can imply the diagnosis of the condition might be sleeping sickness as the condition is found only in those areas. This will be followed by a physical examination to check for any more signs and symptoms that might be important in your case. The doctor will now refer some tests in order to confirm the probable diagnosis so that treatment can be started.

Specimens collected include:

·        Blood

·        Aspirate of lymph node

·        Aspirate of bone marrow

·        Cerebrospinal Fluid

·        The trypanosomal chancre may be aspirated to isolate some fluid

Laboratory diagnostic techniques utilised are listed below:

·        For diagnosis of trypanosomiasis through microscopy, wet unstained preaparations or stained films (Giemsa or Wright stained smears) can be utilised. The aspirate of the lymph node can be utilised to easily demonstrate Trypanosoma brucei gambiense. A blood sample can be utilised for demonstration of Trypanosoma brucei rhodesiense. The parasites might not be visible in a thin blood film as the parasites might be scanty. In such cases, a thick blood film or a concentration method such as buffy coat technique and miniature ion exchange columns can be used.

·        For isolation of Trypanosoma brucei rhodesiense, a rat can be inoculated with the clinical specimen. If the rat also develops the condition, the patient is suffering from sleeping sickness.

·        Detection of antibodies against the parasites can be done by Immunofluorescence, complement fixation test (CFT), Enzyme linked immunosorbent assay (ELISA), and card agglutination tests.Using antigens from blood stage trypanosomes, antibodies in serum can be detected.

·        In trypanosomiasis with CNS involvement, there is a rise in specific IgM in the cerebrospinal fluid.

Treatment of Sleeping Sickness

In early stages of infection without central nervous system involvement, Suramin and Pentamidine are used.

In late stage of infection with central nervous system involvement, Melarsoprol is administered as it can cross the blood brain barrier unlike suramin and pentamidine.

If you are prescribed treatment for sleeping sickness or any other disease, you can order medicines online in India.

Prevention of Sleeping Sickness

To reduce the risk of infections in regions where you can get infected following steps can be taken:

·        Wear protective clothing

·        Use insect repellents

·        Use fly traps and screens impregnated with insecticide