Can Zombies Feel Pain?

Dr. Dratoc is having a nice, relaxing cup of coffee in his favorite café, Sodium. He likes the place because it doesn’t get a lot of business, probably because of its name. He’s often alone in there, and has his choice of seats. Usually he sits in the back, away from the windows. Working in a hospital gives him plenty of opportunities for people watching, so when he’s at Sodium, he likes to face the wall and zone out, just forget everything for a while.

Today he’s thinking about as little as possible as he sips his cinnamon mocha. Caffeine and L-theanine, good for what ails you, and what ails Dr. Dratoc is overabundance of stimulation.

“Ouch!” he says suddenly, before he evenly realizes his hand is burning. He looks down at the spilled coffee on the table. Man, that smarts. Afferent nerves working as evolved, he thinks, looking up. He sees a man shuffling away, the one who bumped into his table. “Excuse you,” Dratoc says, a little peeved.

The man turns around, eyes glazed, a deep, bleeding gash in his forehead, blood running over broken teeth and dripping on the floor. He reaches a hand up, mumbles “braaiii” and takes a step towards Dratoc.

“Damn it,” Dratoc mutters. And Sodium used to be such a nice place.

~~~

Congenital analgesia, or congenital insensitivity to pain (CIP), is a very rare condition that afflicts only a handful of people in the world at any one time. People with CIP don’t experience pain, although they can feel heat, cold, and pressure on their skin. This is opposed to CIP with anhidrosis, where the sufferer feels almost nothing except pressure on the skin.

Science still isn’t sure exactly how nerve endings send different signals for pain, temperature, pressure, and other sensations, although CIP does appear to be an affliction of the brain, and not of the nerve endings themselves. In a sense, people with CIP do have pain, they just don’t know it.

Congenital analgesia is usually an inherited condition, although there are cases reported where it was theorized that a malfunctioning excess of endorphins mitigated pain reception. It can be very dangerous to have, since feeling pain is an evolved survival technique, and suffers are at risk of sustaining life ending injuries without being aware of it.

Fortunately, people with CIP do not usually suffer from any other defects; while they don’t feel pain, they do grow and heal as normal.

~~~

Dr. Dratoc kneels over the now recumbent man, listening to the distant but approaching wail of an ambulance. He reads the man’s medical bracelet. “Congenital Analgesia. Please alert a medical professional if I am bleeding freely.” Well no duh.

The barista, dreads, goatee, ironic t-shirt and all, emerges from the bathroom with a green face. “Blood everywhere, man. Not cool, not cool. It’s all over the sink, all over the Dyson Airblade hand dryer, man.”

“He probably slipped on the wet tiles, poor guy. Banged his head pretty good, put him in a daze. I’m surprised he was able to walk out of there at all.”

“Aw geez, ya think he’s going to sue?”

Dr Dratoc shrugs. “If he even remembers what happened,” he says, looking at the burn on his own hand and wincing. “They say experiencing pain can enhance the making of memories. This guy probably won’t remember a thing.” Dratoc blows on his hand, although the pain won’t go away. “Must be nice.”

So Many Undead It Will Drive You Batty

Halloween is Dr. Dratoc’s least favorite time of year. He’s as enthusiastic about costumes and parties as he is about draining abscesses, which he did most of the day. A guy in is twenties, who’d been bitten by a dog, had foregone medical treatment, and gotten a nice bag of neutrophils for his trouble.

Still, Dr. Dratoc tries to make an effort, and agrees to attend a friend’s party. He decides to go dressed up as doctor. Who will know? He considers helping out in the ER for a day, to get his lab coat nice and splattered. He dismisses the idea immediately, of course—Typhoid Mary was bad enough; he’d hate to be remembered as Staph-Infection Steve.

The party is thumping, packed with Miley Cyruses and government-shutdown-pun costumes. Dratoc is standing next to the punch bowl, marveling at a party in the modern era that even bothers with a punch bowl, nevermind the vectors for bacteria transmission it presents. Still, it’s full of alcohol, so there’s that. He’s talking to Greg Seibar, the party’s host's roommate, who’s dressed, of course, like a zombie.

“So, dude. Get this. Later? Doug? You remember Doug? Crazy Doug? He’s coming as a vampire. With bats, dude. With bats.”

“I see,” says Dr. Dratoc, trying to ignore Seibar’s attempt at lividity. Is that guacamole spread on his face?

“Real live bats dude. Seriously, it’s going to be—“

There’s a scream, and the crowd parts as a man stumbles into the room, falling over and crashing through coffee table. He’s dressed in dark red, a tattered cape on his back. He manages to stand up, and there’s more screams. The makeup on his face is incredibly realistic. Red welts all over, foam running from his mouth. His eyes are wild and rolling as he staggers towards a girl dressed like an undead postal worker, grinding his teeth.

“Dude!” Greg, sloshing a cupful of punch and taking it to the new arrival. “Freaking awesome dude! Have a—“

At the sight of the cup the man goes into a rage, bellowing at an ungodly volume, knocking the cup to one side, and lunging for Greg’s throat. Dr Dratoc leaps forward and pulls the man back before he can sink his teeth into Greg’s flesh.

~~~

Rabies, or hydrophobia, or lyssavirus, has been around for most of recorded history, and probably predates civilization. Since it’s naming, some 4000 years ago, the disease has always been associated with animals, which is why, when symptoms show in someone without the presentation of zootic contexts, diagnoses can be varied. This makes “zombie!” an easy way to describe someone afflicted with late-stage rabies.

Symptoms can be similar to what is seen in your “fast and angry” type zombie movies, such as World War Z and 28 Days Later. In fact, fans of these popular zombie vehicles will recall that at the start of the outbreaks in these films, rabies is believed to be the cause of the violence that humanity witnesses.

Rabies can be transmitted via the saliva, which is why biting is often the means by which new victims become infected. Modern treatments now include some protocols that have shown limited success even in post-symptomatic patients.

~~~

While Dr. Dratoc struggles with the enraged man, Greg scoots himself backwards and hides behind a table. “What the damn hell! He thinks he’s a zombie! He thinks—“

Moving quickly, Dratoc pulls his wallet out and shoves it into the man’s mouth. The man clamps down on it hard enough to make his jaw bulge.

Everyone’s staring. A girl dressed like slutty Gloria Steinem says, “Is he having a stroke?”

“No, he has rabies. The wallet’s for him to bite on instead of me." The man struggles, but Dratoc holds on. "Someone call 911. And get them to send animal control to this idiot’s house. He’s probably got a pile of dead bats in his basement.”

Half a dozen people pull out cell phones and start poking. One takes a picture. “Is he going to be alright?” the girl says.

Dr. Dratoc tightens his grip, even as the man begins to relax, easing from mania into lethargy. “Probably not. I say he’s got an eight percent chance. But stupider things have happened.”

It's All Fun and Games until your Flesh Starts Rotting Away

Things are bustling at Lidokork General, a hospital right in the heart of the city. The ER is hopping (rash of food poisoning from a raw-foods bistro), the pharmacy is backed up (one too many pharmacist at home sick with strep) and the jocks in Ortho are horsing around, as usual. One of them, Dr. Crank, is giving Dr. Dratoc a hard time.

“So, Dratoc, heard you cured a zombie last week.”

Dratoc sighs. He doesn’t have time for this. He’s got a patient in 14B who isn’t responding to antibiotics, and her necrotizing fasciitis may require debridement, and he is not looking forward to his consult with the resident otolaryngologist. Talk about the walking dead. The guy’s breath could knock a buzzard off an offal wagon.

“Did you say zombie?” A police officer, walking by the nurse’s station, stops for a second.

The ortho surgeons burst out laughing. Dr. Crank claps Dr. Dratoc on the back. “Here’s your man, sergeant!”

The cop glares at Dr. Crank, who doesn’t seem to notice, then turns to Dr. Dratoc. “I just brought a guy in, caught him trying to break into a pill-lab on the east side. The doc in ER doesn’t know what to make of him. Teeth all busted, eyes bloodshot, running sores on his arms and legs. I swear he looks like an honest to god zombie.”

Dr. Dratoc takes a deep breath, sighs again. “Show me.”

###

It’s called Krokodil, a mixture of codeine, paint thinner, gasoline, and whatever else the pushers who make it can find in their garages. The high has been described as comparable to heroin, although it can be more intense, and much briefer. As an opiate-based drug, it’s terribly addictive, and abusers wind up taking more not just because it’s so cheap, but because they want to avoid the excruciating withdrawl.

But the worst part is the toxic effect it has on the body. People who shoot up krokodil develop green spots at the sight of injection almost immediately, and subsequently gangrene. Their flesh starts to literally rot away in places, which means they have to choose a different spot on their body for the next injection. More exposure to the corrosive chemicals: more gangrene. Abusers don’t last more than a few years.

If they’re lucky. The drug doesn’t just effect the skin, but any major organ, every major organ. Including an especially the brain. Imagine someone shuffling towards you with rotting skin, groaning through a decaying larynx, eyes vacant from brain damage. Sound familiar?

###

Dr. Dratoc follows the police officer into one of the ER examination rooms, where a young man sits, handcuffed to the bed. It’s just as the cop described: open wounds on the kid’s arms and legs, skin turning green, blackened in places. Dratoc does a cursory examination, and finds track marks in the few places where the skin is still more or less clean.

The doctor shakes his head. “Krokodil. Not very common in the US. In fact, I think there have been less than ten reported cases this year.” So far, he doesn’t say out loud.

The police officer makes a face. “I figured he was on meth. What’s Krokodil?”

“Let me put it this way,” Dr. Dratoc says, grabbing forms to admit the junkie into intensive care. “If you had to choose between Breaking Bad and The Walking Dead, which TV show would you rather live in?”

The cop makes another face. The junkie gurgles

Dr. Dratoc nods. “Yeah. This is like both.”

Real Life Zombies (Sort of)

Dr. Dratoc is almost done with another 18 hour shift. He’s tired. He’s bleary-eyed. He’s already spent five hours in the OR patching up a drunk with bite-shaped wounds on his legs (“I think it was a dog or some kind of wild cat,” the drunk kept saying) and another two hours on a code in the geriatric wing. They managed ot save the old guy, but Dr. Dratoc is tired. He’s heading for the locker room, to drop of his lab coat, grab jacket, and head home.

He turns the corner, taking a short cut through ER, and standing there, just staring at him, is a zombie.

A walking corpse, to be precise. Middle-aged man, dressed in a filthy shirt underneath two jackets and a coat. Cold sores open and oozing around his mouth. His pants are in tatters, stained with blood, and as Dr. Dratoc stands there, trying to decide if he’s hallucinating, the man (thankfully?) collapses.

###

Cotard’s Syndrome was named for a French neurologist who, back in 1880, met a woman who insisted she had no brain. Since then, although it’s not common, several cases have emerged with similar symptoms. Sufferers describe themselves as dead, or invisible, or having limbs that don’t belong to them. People with Cotard’s will seem to be obsessed with death, take no pleasure in any stimuli, and will sometimes forego normal hygiene.

PET scans have shown a link between Cotard’s and subdued activity in the front and paratiel regions of the brain, like that of someone in a deep coma. This can be the result of depressive episodes or drug induced metabolic imbalances.

Recently, meta-analysis of drug databases and hospital admissions have suggested that in patients with renal failure, some drugs aren’t broken down adequately, and increased levels of 9-carboxymethoxymethylguanine (CMMG) can cause obstructions in certain cerebral arteries. In some people, this can have disturbing psychiatric effects. Dialysis is often the only way to clear CMMG from the brain.

###

As tired as he is, Dr. Dratoc leaps forward, checking for a pulse. He calls for an orderly, and together they get the man up on a table. He opens his eyes, pupils surrounded by a sickly yellow and shrunk to pinpricks. “I’m a dead man,” he says. His breath is awful. “I’m dead. Put me in the ground. I am dead.”

Dr. Dratoc checks the man for ID, and finds a bottle of pills—Zovirax. Probably for the cold sores. Dratoc does his best to stabilize the man. He does a quick examination. Swollen kidneys. Skin under his fingernails, matching deep scratches in the rash on his legs. Bruising on his arms, especially between the wrist and elbow.

Dratoc is exhausted. Think, think. Swollen kidneys, itching, rash, the coats could indicate he feels cold, the bruising, from falling several times, due to dizziness? Could this be renal failure? Dratoc makes a decision. “Get this man on dialysis, right now.”