Author's note: Several elements in this story come from the mind of one of the masters of modern horror: H.P. Lovecraft. I was inspired by Nyarlathotep and the Dream-Quest of Unknown Kadath, both by Lovecraft, but it does not follow the canon set forth by the either of them. Also, thanks to my beta SnuggleKitten69 for all her suggestions!
Kadath
I looked at the medical report. "So you still can't wake up in the morning?"
My new patient shook his head. His eyes faced the floor. "No."
"And the alarm doesn't help?" I asked.
"No," he repeated. "And I turn it up all the way."
"How are you handling it?"
"I'm not." He looked up at me and gave a contemptuous laugh. "What do I have to get up for, anyway? I'm taking a leave from my program. Just can't do it right now."
"It's a Master's program?" I asked, as my eyes turned to his patient profile.
"Yeah," he nodded. "Biomedical Engineering at NYU. Third year."
"I'm sorry to hear that."
His eyes returned to face the floor. "Thanks," he murmured.
"So, it's still nine hours every night?" I asked.
He let out a long sigh. "Yeah, almost to the second."
I leaned forward slightly. "Without exception? Every night?"
He nodded his head. "Every night."
If I didn't have a medical report submitted by two respected emergency room physicians, I wouldn't have believed it. Three days ago, Devon Porter, the young man sitting in front of me, complained to his roommate that for the past few mornings he had been unable to wake up on time. More specifically, he had been unable to wake up until precisely nine hours had passed. He asked his roommate to try and wake him up early the next morning.
The roommate tried almost everything. It wasn't long before an ambulance took Devon to Bellevue, where it was determined that he was in a coma. Thankfully - and inexplicably - Devon did wake up a few hours later, with no obvious physical impairments. He was kept under observation for the night in the event the symptoms repeated.
They did.
After being kept under observation for two more nights, Devon yet again exhibited the same symptoms and the doctors who examined him were unsurprisingly baffled. Narcolepsy produces symptoms of extreme lethargy, but not to this degree and not on such an exact schedule. I was a sleep specialist and had treated many cases of narcolepsy but nothing quite like this. And although the coma-like symptoms by themselves were disturbing, they weren't what bothered him the most.
"How are the dreams?" I asked.
Devon breathed out a soft gust of air. "The dreams," he said softly as he shook his head in resignation. "Yeah, the dreams." But then he looked at me with a brief surge of hope. "You know, I was looking on the internet and saw something that said that when patients go under anesthesia they don't dream. Can you give me something like that?"
"Using strong sedatives like that is very dangerous unless you're under constant observation," I replied. "I'm not exaggerating when I say they can easily kill you."
He chuckled. "You say it like it's a bad thing."
I suppressed a sigh. This wasn't what I wanted to be hearing. "Are you experiencing suicidal thoughts, Devon?"
"You mean, do I think about all the interesting ways I could off myself?" He replied almost flippantly as he shrugged. "Sure, sometimes."
"And it's because of the dreams?" I probed.
"Yeah," He gave another derisive chuckle. "That and my roommate's new girlfriend."
"Can you tell me about them?" I asked.
He looked at me, his eyes narrowing. "You mean her and him or the dreams?"
"The dreams."
"What do you want to know?"
"Anything you'd like to tell me."
He paused a while and then looked at me intently. "You've had bad dreams, right? I mean real nightmares?"
I shrugged slightly. "On occasion."
"Well, imagine you had a nightmare and it was worse than any nightmare you've ever had, and it happened every single night."
"Doesn't sound pleasant," I replied sincerely.
He leaned forward in his chair, his expression and body language becoming intense. "No, it fucking well isn't."
I shifted in my seat a bit. I wasn't a big fan of my patients cursing, but as long as they weren't abusive, I could tolerate it.
"Now imagine this," he continued. "Imagine that the nightmare is real, as real as being in this room right now, alive and awake. You beg for it to end, but it doesn't. It just keeps going for nine hours straight. Nine hours, on the dot every time. And when you wake up, it's like you weren't actually sleeping, but you were transported to another place...another reality you've just returned from."
My eyes narrowed. "So this nightmare, it's the same every night? The exact same?"
"No," he replied. "It's actually a bit different every night. But it's in the same place."
"What kind of place?"
"A city."
"Where is this city?"
He barked out a laugh and leaned back in his chair. "Where? Fuck if I know. Nowhere on Earth, that's for sure. The sky above it is always changing. Hell, it's not really a sky. I don't know what it is. Sometimes you see black nothingness, or white nothingness, or purple or green nothingness - pick any color. Sometimes you see stars or galaxies, and sometimes you see fucked up geometric shapes floating around - with some that aren't geometric. Other times you see weird flying things...things that are alive...and some things that aren't. But then those things disappear and other things take their place. It's always changing. You look at it too long and you go crazy."
I nodded. "Okay. Can you describe what the city is like?"
He shrugged his shoulders. "Well, it's big. Goes on for miles and miles. But from what I can see, I think the surface just drops off into space, like a flat earth or something. The city just floats wherever it happens to be. There's nothing around it."
"What else can you tell me?" I asked.
He shrugged again. "It's blue."
"Blue?
He nodded. "Blue. The city's blue. Kind of like a silvery blue. And it's made of rock...sometimes it's smooth and sometimes it's craggy. But it just goes on and on...all this blue...shaped into different towers and buildings and streets. It's really intricate. And there's one giant tower in the middle that overlooks the whole thing, as tall as the Empire State Building on steroids, but with weird architecture you've never seen. At the base of the main tower is this giant open stadium, and it's massive...like MetLife stadium...but even bigger...and rounder, and around it there are a bunch of cages on top of these long skinny poles and in one of those cages is where I appear every night."
My eyes widened slightly. "Really? You're a prisoner?"
"Yeah. And it's a good thing I'm not scared of heights. It's like 300 feet down from where I am. And it's not just me, though. There are others there, in other cages. Other humans. One per cage, though some of the cages are empty. But I can't hear them or talk to them. They're too far away."
"And are there people who live in the city...people who are keeping you and the others prisoner?"
"Yeah." He paused and looked down. It was a long time before he answered. "But they're not people."
"What are they?" I asked.
He remained motionless a few moments longer before he slowly returned my gaze.
"They're monsters," he whispered.
"And what do these monsters do...in your dream?"
"What do they do?" he repeated.
"Yes."
He shook his head. "Really fucked up shit."
He didn't seem interested in discussing it anymore, and I thought I'd let things lie. I didn't want to push it. He seemed genuinely fearful of whatever he said he experienced at night. His hands were shaking and once again he wouldn't look me in the eye. Hoping to ease his symptoms, I decided on a prescription of both modafiniland clomipramine. The former would hopefully cure his sleep disorder and the latter was an antidepressant. Antidepressants don't work in a lot of cases, but even if they acted as a placebo and made him believe they were making him feel better, it wouldn't be a bad thing. Also, clomipramine acted as a drug to combat postdormital sleep paralysis. I wasn't sure if it would help in his case, but I was willing to try anything that didn't run the risk of strong side effects.
At the end of the session, we explored ways he could calm himself before bedtime, such as through breathing and meditation exercises. I also urged him to avoid any stimulants after lunch time. Caffeine was known for having a particularly strong effect on some people, and it could have been negatively affecting the quality of his sleep.
I told him to come back in three days. Normally, I liked having a week between sessions, but if he was truly suicidal, I didn't want to wait that long. We also exchanged numbers and I told him that if he had bad thoughts he could call me any time he liked, even if it was nighttime. But then I remembered that the probability of him calling me at nighttime was very low...unless the medication proved successful.
That evening, after I took Molly out for a walk around the block, I explored what kind of diagnosis I should make. To tell the truth, I didn't quite believe that Devon actually dreamed about that nightmarish city in the way he thought he dreamed it. Dreams simply don't take the form of consistent narratives that run night after night as though one is actually living it. Rather, the so-called dreams were likely a delusional disorder of some sort that was brought on by the coma-like symptoms. This seemed like a logical conclusion since the "dreams" and the symptoms began at the same time. Devon likely believed he was dreaming it exactly as he described it, but it was a belief that was shaped by his delusions. The best thing to do was to let the medication I prescribed take effect and hopefully the coma-like symptoms would cease and the delusions would pass.