[The following is the free version of a research paper published six months later in the The American Journal of Medicine.]
American Journal of Medicine, vol. 135, iss. 10, Pg. 13XX-13XX
On Fatal Interdimensional Nervous Derangement Syndrome
by L. Drullers, K. Meshida, A. Whitefield, et al.
Published Oct. 31, 20XX
DOI: https://doi.org/10.1031/j.amjmed.20XX.10.013
1. Introduction
The present epidemic of the infectious disease known currently as Fatal Interdimensional Nervous Derangement Syndrome, aka. FINDS, represents not only humankind's first known encounter with the pathogen itself, but also potentially a profound shift in paradigm for the world at large. It is entirely unlike any disease ever before known to science: it necessitates exotic new physical theories to explain its behavior; poses at present profound ethical quandaries to doctors and their patients; and as an extreme public health hazard, is forcing appropriately strong societal action in an attempt to control the disease. Every known facet of the disease has been or is being explored in great depth by a wide array of scientists, who have produced an enormous and extremely detailed body of literature on the subject in the frenzy to combat the epidemic and contact the Otherworld. This paper will not contribute original research to said body of literature; instead, we wish to summarize and describe said knowledge of FINDS in rigorous and academically accurate fashion, yet in publicly accessible language. References to selected works from this existing body of literature will be liberally distributed throughout this paper for use by the further-inquiring, scientifically literate reader.
2. "Interdimensional Plague" Theory
Developed at first in unscientific settings as an ad-hoc explanation for the behavior of FINDS, this theory's empirical success has since gained it considerable traction among the scientific community and sparked intense and focused research on the topic, though it is still largely rejected as pseudoscientific or in need of considerable revision and elaboration by the community as a whole. [1]
Put simply, the theory asserts the existence of at least one other "parallel universe", which interacts only very weakly with our own. There is believed to be only one of significance to FINDS, which for clarity's sake we shall here name as the "Otherworld". In almost every way it is essentially identical to our own, the largest known differences at present being cultural, especially in regards to gender roles. Interestingly, most persons in our world have a single unique counterpart in the Otherworld, almost always oppositely sexed but similarly situated. Only those who have an Otherworld counterpart are susceptible to FINDS, and this Otherworld counterpart will dramatically affect the effects of FINDS on those infected in our own world [2]. This is believed to be because FINDS is Interdimensional; that is, it somehow exists between our world and the Otherworld and belongs completely to neither, or else exists in both in a linked and entangled state somehow.
This interdimensionality lends FINDS a certain decisive epidemiological advantage: if it infects a person in our world, it will simultaneously infect their counterpart in the Otherworld regardless of said counterpart's previous exposure (or lack of such) to FINDS beforehand, and similarly will infect a person in our world if their counterpart contracts the disease. Not only does this automatically make it effectively twice as infectious as a similar Intradimensional disease, it has also considerably complicated efforts to quarantine, contact trace, and generally control spread of the disease, since such requires considerable coordination with actors in a parallel Universe with which we have very little reliable communication. That being said, currently most scientific support for Interdimensional Plague Theory has derived from the considerably increased success of models which incorporate the action of Otherworld counterparts as compared to efforts which have not [3]; one can hope for the continuance of this success in combatting the worst of the disease, at least.
Said empirical support is of course joined by the testimonies of those infected with FINDS, and cross-examination of such. With no exceptions, all patients are absolutely convinced of the Interdimensionality of FINDS by stage 4 of the disease's development, and some initial unbelievers become convinced of it as early as Stage 2 [4]. At present virtually all our world's knowledge about the Otherworld derives from these patient's testimonies, as unfortunately does the entirety of our communication with the Otherworld. Some doctors [5] dismiss these testimonies as unreliable given the neuropsychological maladies FINDS is responsible for, but the consistency of descriptions of the Otherworld when cross-examined between even estranged, very unrelated patients is remarkable, even in reference to minor details [6]; it is these author's opinion that this lends them a level of credence well above that of the plainly delirious patient. Especially in the mid-stages of the infection, testimonies can usually be trusted as if the patient had actually traveled to the Otherworld (some more imaginative authors [7] even suggest that in a manner of speaking, they have).
3. Symptoms and Mechanism
Despite all the present research focused intensely on elucidating the nature and causes of the FINDS infection, modern science has thus far failed to identify an actual microbial pathogen responsible for FINDS, and satisfactory biomechanical explanations for the behavior of the disease have proved extremely elusive. So severely is this the case that some authors [7] have even put forward the idea that as an interdimensional actor it need not be tied to the physical world in the ways with which the scientific community is most familiar. Whether this is true remains to be seen. Still, its behavior does not wholly exclude description as if it were a physical, microbial pathogen, and broad holistic analyses of what is currently known often conclude with description of it as such.
Currently, most authorities tenuously classify FINDS as an STD, as contact tracing (including of Otherworld counterparts) seems to indicate spread as though it were a particularly infectious one [8]. It's generally agreed that contact need not be as intimate as that required for the spread of other STDs for the transmission of FINDS, but research is mixed on precisely what contact is required. While sustained skin-to-skin contact is generally agreed to be the primary mode of transmission, some studies suggest only light salivary contact is necessary, perhaps even merely as aerosol [9]; these are disputed [10]. FINDS is believed to be contagious through the entire duration of the infection, even in the asymptomatic stage, though it's worth noting that given the rapid progression of the disease this is a far shorter infectious time frame than is typical for STDs [11].
Symptoms very very clearly indicate a disease of the Nervous System, as nearly all of these derive in some way from its misfunction. The cardiovascular disorders present in late-stage FINDS, for example, have all been linked back very clearly to hyperactivity of the Sinoatrial Node. Studies of the brains and nerves of infected persons, however, have yet to reveal many conclusive insights as to the true biomechanical causes of FINDS; it's believed that the technologies needed to examine these in sufficient detail do not yet exist [12].
The actual progression of the disease is detailed in the sections below. FINDS infections can (somewhat roughly) be subdivided into six stages, each with a much greater intensity of symptoms than the last. These are not sharply defined, but instead are marked by smooth and gradual transitions from one to the next. Most such stages last for around 2-5 days, so that the disease in total (if uncured as described in Section 4) results in death 15-25 days after initial contraction [13].
Stage 1: Dormancy
FINDS has a brief, mostly asymptomatic phase early in its development. As it becomes transmissible very swiftly after contraction, and most patients aren't aware they've been infected, this is the phase wherein FINDS is considered most contagious, even though it is no less transmissible in later stages. Especially important is the role of the counterpart of the initially infected individual in the spread of the disease at this stage: Said counterpart contracts FINDS simultaneously with the initial infected, but often has absolutely no idea or any reason at all to suspect anything may be wrong with them, and further often thwart attempts at containing FINDS within social bubbles owing to social differences from the initial infected. One study [14] found that the counterpart of a contracting individual is 2-3 times more likely to be responsible for further spread of the disease than that individual, for said reasons.
Now, it isn't entirely true that FINDS never shows any symptoms during this stage; some (30-40%) patients show a mild and nonspecific immune response after contraction, as if to a weak allergen or passing cold. Their interdimensional counterparts, on the other hand, almost never do (<0.5%) [15] (This, it should be noted, is likely the only symptom of FINDS that shows asymmetry of susceptibility between infected and counterpart regardless of underlying condition). Besides this, there's only one recurring notable symptom sometimes detected in stage 1: abnormally vivid dreams, occasionally featuring elements of the Otherworld or of their interdimensional counterpart's life. Sometimes, they will dream that they are their interdimensional counterpart. These dreams aren't nearly as lucid as those typical of stage 2, nor as purely focussed on the life of their counterpart, but nonetheless can serve as a very early warning sign that an individual has been infected. It is strongly advised that the public be admonished, if any elements pertaining to the Otherworld are recalled from a dream, that they contact a physician immediately.
Stage 2: Early Symptoms
This stage of infection is almost entirely defined by a single symptom: through dreams, the patient will recall days in the life of their Otherworld counterpart with extreme lucidity, often as though they had experienced it firsthand. Most often, this is simply the previous day of their counterpart's life. Other symptoms developed at this time are almost always a consequence of this first, and more commonly first appear during stage 3 of the infection: these include restlessness, mild fatigue, and mild insomnia. Otherwise, patients are almost always entirely healthy during this stage. A few even describe it as an overall pleasant experience, a sort of surreally fun adventure as an opportunity to explore the Otherworld by proxy of their counterpart. That is, if they've managed to avoid such stresses and angsts that come with the knowledge of what follows afterwards, in FINDS' progression as a disease.
Stage 3: Neurological Deterioration
It is in this stage that patients begin to see significant effects of FINDS on their daily lives and everyday behavior. Most disruptively, patients will, at seemingly random times, occasionally experience hallucinations. These can be visual, auditory, tactile, or in short involve any of the major senses in any combination, but following the pattern of the dreams in Stage 2 they usually involve some experience had by the patient's counterpart in the Otherworld. At first brief and sporadic, these will increase both in frequency and severity with the progression of the disease, until the patient reaches the almost fully psychotic states characteristic of Stage 4. Patients begin experiencing notable changes in behavior or personality, sometimes abruptly or temporarily; and stranger still, some patients claim that with focus, they may at will begin to recall memories of their interdimensional counterpart as though they were theirs. Some develop a peculiar form of Dissociative Identity Disorder, and will answer to the name of their Otherworld counterpart if called by that, as well as their own. Insomnia is another distinguishing characteristic of this phase, developing in nearly all patients in a severe form. What sleep patients do get during this time is usually restless and fitful, and dominated almost entirely by REM sleep and extraordinarily vivid, lucid dreams. Some of the symptoms characteristic of Stage 4 may also appear early, in mild form, for some patients; arrhythmia, for example, if the patient had underlying cardiovascular conditions already.
Stage 4: Psychosis
From this stage until death or recovery, patients will constantly remain in a sort of delirium: they'll report feeling as if they're both in this world and the Otherworld simultaneously, suffer from constant and exceptionally vivid hallucinations, have difficulty focusing, report struggles ascertaining which of their memories and behaviors are "correct", often appear and act very distracted even in an utter absence of external stimuli, and are frequently seen mumbling or talking outright to nobody in particular, except perhaps themselves. The insomnia of stage 3 will by now have developed into full-blown agrypnia, rendering patients absolutely unable to fall asleep regardless of fatigue, medication, anesthesia, or all but the most extreme physiological conditions.
Further, patients will begin to develop more bodily afflictions around this time. Most notable and dangerous are brief spells of extreme tachycardia, wherein the heart will beat at double the usual frequency until the episode passes. Other arrhythmias, especially fibrillation, occur less commonly. A number of other maladies come as short but intense episodes similar to the tachycardiac one described above. Patient's body temperature may rise well above its normal level for a brief period; they may suddenly sweat profusely and inexplicably; their breath may suddenly become erratic and difficult; they may suddenly become sexually aroused or orgasmic even in complete absence of stimulus; or experience even rarer symptoms. All of these have been determined to be the result of brief flashes of hyperactivity within the Autonomic Nervous System, which FINDS slowly begins to infect around this time in addition to its conquest of the Central Nervous System. The results, needless to say, are life-threatening as a rule and require immediate medical attention; deaths, however, are rare in this stage. Interestingly, there is some indication that if a patient has an episode as described above, their Otherworld counterpart will experience one of a similar nature simultaneously, and if it proves fatal to one then it will almost always prove fatal to the other. Until an improved means of record-sharing exists between this and the Otherworld, however, this cannot be conclusively confirmed.
Stage 5: Bodily Deterioration
Once FINDS has more fully and completely infected the Autonomic Nervous System, patients' survival rates drop considerably, and those that do survive do so with lingering physiological damage much more often. Left untreated, the episodes of Stage 4 may become chronic conditions and eventually lethal. Organ failure, especially heart failure as a result of protracted tachycardia, may occur. Rarely, the delirium of stage 4 may give way to a deeper sort of dementia, one which is not restricted to hallucinations of the Otherworld or their counterpart, although this is far more uncommon than one might expect given the progress of the disease in the previous stages.
Every known case of FINDS so far has been admitted to a hospital for close medical scrutiny and care during or before stage 5, if it progresses as far as this. This, as a rule, is then where patients will stay until the end.
Stage 6: Coma and Death
The defining feature of stage 6 is that FINDS, once it reaches this point, becomes increasingly incurable. In every prior stage of infection, the cure described in the section below is virtually guaranteed to be successful, but as stage 6 progresses this becomes increasingly unlikely, and the death of both patient and counterpart become increasingly inevitable. This worsening of odds is believed to occur each time a patient's agrypnia is overcome by the severity of their condition and they lose consciousness anyway (this has almost never been observed in stages 4 or 5 except in the event of death). Fainting spells increase in length and depth as the stage progresses, until at last the patient goes entirely comatose. There has never been a patient who has survived once this happens, no matter the intensity of their medical care; multiple organ failure usually follows after.
4. The Cure and the Ethics Thereof
At present, there exists one and only one known cure for FINDS. If not employed, the death of the patient is a certainty, even in intensive care; but nonetheless it's employment remains deeply mired in ethical concerns.
We have mentioned, in section 2, that only those who have an Otherworld counterpart are susceptible to infection by FINDS. It is also the case that if an infected patient loses their Otherworld counterpart -- ie. if they die because of some cause other than FINDS -- in any but the final stages of infection, then that patient will almost always fully recover, usually within hours. In very late stages, adverse physiological effects may persist afterwards, and some high-risk patients may succumb to secondary infections, but these cases are relatively rare; survival rates increase dramatically once the Otherworld counterpart has perished. Patient reports suggest a similar situation in the Otherworld, if one of our own denizens is killed; but at present, there are no recorded cases of a patient and his counterpart both surviving FINDS, once the disease is contracted. [16]
Herein lies the great ethical conundrum proposed by FINDS: If a man and his Otherworld counterpart are infected, is it morally acceptable to decide which of these should live, and to subsequently kill the counterpart? Under what circumstances?
We will not, herein, answer this question except in brief summary. A great many ethicists, philosophers, lawyers, moral psychologists, and so on have written at great length on this controversy already, and rather than repeat said scholars, references to selected works are provided in the bibliography below; for instance, see [17] for deontological perspectives arguing against the above cure, [18] for utilitarian perspectives arguing that the cure's employment is a moral imperative, [19] for legal perspectives on medically-assisted suicide in relation to FINDS, and [20] for a more thorough description of the current standard of care than will be given here.
These authors, however, take the view that as a matter of practicality, the true philosophical resolution of the above conundrum is not nearly so important as the psychological effect of the conundrum itself on FINDS patients. Currently standard medical practice places a great deal of culpability on the patient and his loved ones for decisions regarding the death of the patient himself, and/or his counterpart: Hospitals, being more pragmatically motivated by minimization of legal liability for patient deaths, will routinely arrange for consultations between FINDS patients, their legal representatives, and their physicians to come to and record decisions about the patient's potential death or suicide, which are then carried out in a relatively very short time, before the patient's condition can deteriorate much further. This means that patients who survive commonly feel deeply or ultimately responsible for the expiration of their counterpart, whom many patients feel they have gotten to know rather intimately via the mid and late stages of the FINDS infection.
Adverse effects on mental health tend to linger for far longer and be far more severe than those on patient physiology, and many develop secondary disorders such as PTSD, depression, dissociative disorders, and even DID (the latter being very atypically common in survivors of late-stage FINDS) [21]. Suicidal ideation, being virtually a necessary part of patient treatment under the current paradigm, is extremely common among survivors as well, compared to the general populace.
All told, continuing care of discharged FINDS patients often consists in greatest part of therapy, monitoring, and other psychological care. This, in these authors' opinion, is as it should be: speaking frankly, the experience of a FINDS infection seems at times to be something out of a nightmare. Not only must patients somehow bear the constant spectre of death brought on by diagnosis of such a fatal and fast-progressing disease, they are forced by circumstance to do so very consciously, as they must somehow weigh the value of their own life against another's, then weigh both of those against the moral gravity of what is, in some sense, a murder-suicide. How much smaller and more hollow a consolation must it then be to live thereafter the life of one's choice in the world of one's choice, given the grave consequences required of making such a choice?
5. History of Propagation
The first known case of FINDS was contracted quite suddenly in April of this year, in a small American town named Lake Point. The circumstances surrounding the now notorious first few patients of FINDS are quite remarkable; so much so that a brief recounting of these cases is given below.
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