I wanted to try something different here, and rather than exposit the Nif reports with clunky dialogue, why not show the reader one of the reports that have Ignis and Aranea so agitated. I hope you enjoyed this alternative format and that I was successful in making the reader as uncomfortable as the characters themselves who are reading these reports. Please let me know what you think!


A Study of Blight
By Dorcas Lorran, MD, Parasitologist.

-Place acknowledgements here prior to publication.

Preface:
Per Nifleheim regulation medical notes must contain a preface of all shorthand used.
WBC: white blood count. Tells the number of white blood cells
RBC: Red blood count. Tells the number of red blood cells
Hgb/Hct: Hemoglobin, Hematocrit. Oxygen binding component in blood
CMP: Complete Metabolic Profile. List of electrolytes and other non-cellular blood components.
WNL: Within normal limits
This author will refrain from other shorthand for ease of comprehension

Full breakdown of referenced blood tests can be found Hematology, Modern Vampires. by Collin Arbor MD.

This log for patients 11-30

History from volume 1:
Patient 1: Deceased, Unknown
Patient 2: Deceased, Hemorrhage
Patient 3: Deceased, Unknown
Patient 4: Deceased, Unknown
Patient 5: Deceased, Anemia
Patient 6: Deceased, Suicide
Patient 7: Deceased, Traumatic Brain Injury
Patient 8: Deceased, Unknown
Patient 9: Deceased, Unknown
Patient 10: Deceased, Respiratory Failure

21 April 756

Patient 11 in Stage 1 of Blight. Blood tests show elevated WBC 21.9, low RBC 3.6, low Hct 29.8, low Hgb 9.8 typical for the onset of late-state Blight. Patient may have preexsisting condition of the blood but history is unknown and patient proves to be a poor historian. Prior to infection all CBC results normal for this patient. CMP remains WNL. No signs of active bleeding. Tests of urine and feces have proved negative as sources for blood, and bilirubin levels remain normal. Unknown at this time what is the cause of this abnormality. Patient will have bone marrow study to assess for normal bone marrow.

Patient 12 is in Stage 2 of Blight with onset of external symptoms. Patient has begun to have pallor, fever, body aches. Necrosis noted to left fourth and fifth fingers. Fingers to be amputated and patient assessed for cessation of spread of disease.

Patient 13 in Stage 1 of blight. Patient placed on aggressive cryotherapy to asses effect of low body temperature on spread of disease. All blood tests normal except for microscopic evaluation of blood show evidence of parasites.

22 April 756

Patient 11 has taken unexpected turn in condition. WBC increased 28.1, test re-run to confirm results. RBC, Hgb,Hct continue to decline to 1.9, 17.2, 5.1. New onset of low platelet count. Patient high rist risk for bleeding. Patient placed on supplemental oxygen and vasopressor therapy to improve blood circulation to the heart. Continues to show no evidence of bleeding. Bone marrow biopsy result has revealed normal marrow tissue. Unknown cause for severe destruction of RBC. Patient has begun to show blackening of tissues. Amputation not recommended due to risk of patient death.
-Speculation: does this parasite eat the red blood cells in a manner that does not produce the typical byproducts? Further blood studies needed to assess for byproducts of this metabolic process.

Patient 12

Patient day 1 post-op from three centimeters above left wrist joint per recommendations of Dr. Arbor after consultation. Further tests performed on hand. Results below. Patient continues with chills. Pain medication administered to assess if greater comfort aids in patient self-healing. Started on broad-spectrum antibiotic therapy. Antiparasitic medication administered as well though prognosis is poor as Blight has responded poorly in past. Blood tests show abnormalities for progression into later stages of blight. Samples taken and placed into cryo.

Patient 13
Core body temperature down to 35.1 degrees. Patient placed on sedatives. Cyanosis (blue discoloration – add to preface) observed. Blood tests show no evidence of the chances seen in patients 1-12.
-Speculation, the Blight parasite can only thrive at temperatures greater than 36.
Tissue samples taken for pathology to assess for Blight parasite in tissues.

-Dorcas Lorran, MD

23 April 756

Patient 11
Deceased. Cause, Anemia. Unusual to lose patient in Stage 1 of Blight. (Perhaps reassessment of Stage Categorizations are needed?) Blood tests show RBC, Hgb, Hct, not compatible with life. [ref 2 Arbor] Body to autopsy. Blood placed in cryo.
Summary of Autopsy (-elaborate in separate chapter)
Cardiac function ceased due to poor oxygenation. Blackened areas noted. Further study needed for Blight vs: Necrosis but trademark weblike features not observed.
Bone Marrow study showed patient in early stages of blood cancer, likely cause of such rapid decline of blood cells. Further study on blood cancer patients infected with blight needed. Full autopsy results as well as all medical information to be given to Dr. Arbor . (-apply for grant for further study of Blight with blood cancers)
Microscope exams show normal volume of parasite levels for early-stage Blight. More reason to suspect Blight may attack blood cells. Patient's bone marrow could not produce more blood cells on pace with, or faster than, the destruction. [reference 2 here to Dr. Arbor's book] Still unknown why breakdown of blood cells left no byproduct. Still unknown why abnormal red blood cells were not seen.
Liver: No sign of damage, no sign of working harder than usual, no signs of red cell breakdown in liver.
Spleen: Much smaller than average [ref 3 Arbor], potentially related to the blood cancer. Further study will confirm diagnosis.
Patient 11 to be placed in cryo in morgue in the event of further studies. Good subject for further blood studies. (inform Dr. Arbor)

Patient 12:
Residual limb of left arm beginning with the black web-like appearance now half-way to help. Rapid progress has been seen before in patients. Spread noted form surgical site. ?
-Speculation: Wounds trigger the disease to get worse. If the parasite likes to eat blood cells like speculated above, perhaps the rush of blood to heal a wound causes a high concentration of the parasite?
Left arm to be amputated at shoulder in the event the limb was not severed at a low enough location. While under sedation small wounds to be made, and large laceration to be made on the top of the left foot. Will not be stitched to allow for observation of the disease's reaction to the need to heal the area. Perhaps reach out to nurses who work with Dr. Arbor and specialize in wounds, obtain reports of Blight patients with various wounds. (Patient 24 known to have diabetic wounds. Patient 29 known to have a wound-related-injury. Good subjects. Will discuss in volume 3.)
Patients blood count continues to decline, remains in Stage 2 per current parameters.

Patient 13:
Remains in Stage 1
Patient remains sedated. Core temperature 35.0. Parasite level minimally elevated from previous test. Too soon for conclusions. Will continue to monitor. Other blood tests show abnormalities expected with hypothermia. Chilled intravenous hydration and nutrition initiated. [perhaps Patient 17 will be good subject for nutritional analysis and effect on Blight.]

25 April 756

Patient 14
Former Lucian Military service member. Good candidate for Costlemark Tower trials. In good health, all blood tests WNL, vital signs WNL, no major medical history. Costlemark Tower summarized here, but for full details read report by Officer Godfrey Saeva
Costlemark tower: opens at night with unusually high concentration of daemons. Link between tower and the daemons? Patient 14 to be sent in to investigate in exchange for release from custody.
[Note: Patients 2 and 7 autopsy performed after retrieval of bodies from Costlemark Tower confirm presence of Blight parasites in blood]
Speculation: A link between night, daemons, and Blight. Tower related to origin of disease?

Patient 12
Left arm amputation appears to be successful. No blackened tissue at surgical site. Incisions made to left foot showing signs of the black web-like features. Sutured incision to anterior aspect of foot well approximated 5 sutures in place scant bloody drainage. Open wound to top of food wound base 50% granulation tissue, and already 50% black tissue. Samples taken to assess necrosis and parasite load. Amputation of foot to be done if blood levels stable. Patient currently with post-op anemia 2.1/6.8/21.2. Blood type A- to be transfused with blood taken from patient 5, positive for Blight parasite. Will assess if transfusion transitions patient into Stage 3 of disease.

Patient 13
Showing signs of organ damage, full lab reports in medical record, core temperature 35.0, pulse 40, respirations 30 but decreased to 20 with slight increase in sedation. Blight parasite levels in blood continue to rise at much slower rate than other patients. Requesting report from Dr. Arbor of studies conducted in colder provinces of Nifleheim and Tenebrae from Dr. Franco director of Epidemological studies. [if Lucis would be cooperative with sharing their own studies I could compare the studies of warm and cold regions in Lucis]

28 April 756

Patient 14
Survived night in Costlemark Tower. Lost three MTs retrieving. Showing stage 1 Blight symptoms. Parasitic load low. Unknown if abnormal blood levels due to traumatic injuries, or early-onset metabolism of blood components. Will continue to monitor. Left leg amputated due to severe compound fracture and splintering. Tissue samples taken for pathology. Right leg amputated for presence of bite mark, leg to be dissected to assess bite for signs of Blight. Upon waking from anesthesia patient was combative. Sedated patient. No blackening at surgical wound sites. Patient has multiple abrasions to head and torso with some webbing noted. Will require continued monitoring.

Patient 12
Deceased. Shortly after blood transfusion parasite load levels significantly rose. Blood tests done every 2 hours showed parasite levels doubling every 4 hours. Rapid breakdown of blood cells led to poor oxygenation and cessation. Body prepared for extensive dissection.

Patient 13
Deceased. Body unable to tolerate prolonged hypothermia. Parasite load remained in Stage 1 levels. Blood cell levels also within Stage 1 parameters.
Stipulation—extreme cold may provide clue to controlling Blight.
(But then why was In conflict with common knowledge of Blight being widespread in all provinces. Further study needed.

1 May 756
Word from Gralea to stay put in base. All Costlemark Research to be put on hold. Godfrey Saeva very displeased. But Blight research will continue. (strike this from official report)

Patient 14
Right arm amputated when superficial wounds began webbing. Spread of the black webbing noted from previous amputation sites. Arm sent to lab for dissection.
Results from BLE dissections:
Parasites permeate into each type of tissue. Blood clots noted in capillary tissue (speculation- this is the source of the black webbing?) parasite levels highest in blood vessels but also found in subcutaneous tissue, muscle tissues, and bone tissues.
Patient to have 1 pint of blood removed, blood tests to be performed every hour, splenectomy scheduled for reasons stated below.

Patient 12 and 13
Autopsy results concur with above report on patient 14.
Patient 12: Extreme concentrations of Parasite observed in spleen, perhaps release of this storage to replenish lost blood volume attributes to advancement of disease with the parasites hiding in the healthy blood cells. Further research needed on spleens. Spleen of patient 11 not sufficiently studied. Will need new subject with a blood cancer diagnosis will be needed. Message to be sent to Nifleheim in the morning with compiled report.

2 May 756

Gralea sent message for total radio silence. Damnit. Will continue work with patient 14. Patients 15 and 16 research on hold until travel and radio bans lifted.

Patient 14
Black webbing continues to spread across torso. Has spread from arm amputation site, up the neck, and wrapping around the scalp. Hair falling out in places where scalp has turned black. Closer observations of amputated limbs show patches of hairlessness along black-webbing. Skin sample taken from patient and artificially grown to assess parasite load in skin tissue if removed from patient.

3 May 756
Blackness spreading significally across patient. In places skin has begun to slough away from the patient. Artificial hydration and nutrition started as patient is losing a significant amount of lymphatic fluid. Blood tests comparable with dehydration [full report in medical record] Central line placed for administration of artificial nutrition. 15:45 endoscopy performed. Lesions noted in esophagus, and inside stomach. High risk for esophageal swelling. Will continue to monitor progress for necessity of tracheostomy, but wish to assess if black webbing appears in throat.

4 May 756
Patient with decreased responsiveness. Black webbing has spread to over 50% of skin surface area, 10% skin loss. Continues to lose large volumes of fluids. Edema [swelling- note in beginning to clarify term?] noted to remaining limb. Foul odor noted from former wound sites. Curious development. Most Blight patients terminate in Stage 3 of the disease. Patient is now advancing to what I will now state is Stage 4. Blood tests show severe anemia, but patient is producing adequate volumes of new blood cells to remain compatible with life. 18:30 performed bone marrow biopsy. Site of biopsy already blackened. Results show black tissue inside the marrow. 21:30 [why the hell am I still on duty? I should be paid overtime for this.] bone marrow biopsy performed, this time in left hip. Marrow extracted is healthy. Surprising finding. Very resilient patient. Perhaps something in Costlemark has a new strain of Blight, as this one has progressed in a very unusual fashion.

5 May 756
[Well now I know why we were put on lockdowns. Nifleheim has finally captured Lucis.]
22:00 [another cursed late night. Application for overtime compensation will be filed with Gralea]
Bans on radio and travel lifted. May resume research

6 May 756
Patient 14
Resource proves to be too important to risk death. This is a very different reaction to the Parasite. Blood transfusion performed with artificial blood. Will continue hourly monitoring of blood tests (note to self- stop flip flopping terms of blood test/labs. Find all uses of terms and use one consistently!)
Arificial blood carries lower risk than traditional transfusion [ref 4 Arbor] and zero risk of Blight exposure. Must keep this new strain of Parasite pure. Blood placed in cryo, other samples being studied extensively. With travel ban lifted will send blood samples to Gralea.
Blood samples with positive Parasite presence placed in dish with compatible blood type also positive with Parasite to see if the Parasite is compatible with various strains.
Artificial skin graphs placed over sloughed areas. High risk of rejection, steroids not being used due to risk of worsening Parasite infection.
Full report from dissection of amputated limbs compiled in patient's medical record [include these in chapter referencing autopsies and dissections of amputated tissues]

7 May 756
Day off to celebrate Nifleheim's victory. Insomnian Prince Noctis reported dead in the attack on Altissia.

8 May 756
My request to have blood samples from the Oracle Lunafreya sent to me have been denied. They gave samples to Dr. Arbor but not to me. Perhaps I need to send more detailed reports to justify sending me the samples.

15 May 756
Patient 14
A combination of artificial nutrition, hydration, patient sedation, regular blood transfusions sustaining patient life. Patient sedated due to agitation during periods of lucidity. Skin graphs have been holding but difficult to keep up. Patient at 15% total surface area skin loss. TPN recipe altered to compensate for abnormal protein levels. Will continue routine monitoring.

Patient 22
Bone marrow transplant from patient 14 is proving effective. Patient has begun producing blood cells at a pace to keep with the disease, even with the presence of the familiar stain of this Parasite. Perhaps this patient's bone marrow holds the key to surviving this Blight.

Patient 23
Blood transfusion performed, and as expected patient has contracted Blight. Currently in Stage 1. Blood tests typical for Stage 1. Will synthesize blood from patient 14 for transfusion. Supplement as necessary so patient 23 will survive until transfusion ready. Cannot drain 14 and risk death.

(I don't need the Oracle's blood. I can cure this on my own. I'm making discoveries to even make Dr. Arbor blush and in a fraction of the timeline! I re-submitted an application for a further grant from Gralea. They have to see my potential.)