I hoped we would be free of evacuations for a good while yet, but nevertheless kept an eye on the apocalypse watch maintained by the Refugee Service: Llorissa was recovering from its nuclear war and the people were still desperately trying to make a go of it on their battered, irradiated world; on Steteryn the glaciers advanced day by day but the mediaeval societies living two thousand kilometres to the south refused to believe the world was ending; Ardëe’s perennial solar flares were building again but the scientists there were certain the threat wasn’t serious; Schviensever still fought its war against the comets swarming through the solar system, trying to preserve their ancient world in the face of an almost inevitable doom, but even they were doing relatively well for the moment. Any of these worlds could request an evacuation and the IU would certainly respond, but none seemed likely in the next few years. And it was very possible that my new patients would need that time.
Usually when I begin a new group, I have a very clear idea what my patients are suffering from, and therapy can begin immediately. For species with a full medico-genetic map, psychosurgery can alleviate their problems swiftly and they’re usually ready to move on after a month of observation. For others, we resort to older, more gradual methods, and it’s there that my expertise lies. Post-Traumatic Stress Disorder and related conditions are the primary issue for most apocalypse survivors, for which exposure therapy is the key treatment: slowly acclimatising the patient to the horror of their own memories until they no longer hold the same debilitating power over them. I have a whole sheaf of techniques to make it easier on the patient, and group therapy provides the support of peers who share the same terrible experience, reinforcing the individual therapy and giving them the company of people who understand what they’re going through — vital because many PTSD patients are unwilling to open up to people who have not shared their particular horror.
But before we can embark on therapy, we need a diagnosis. There’s no point in beginning exposure therapy if we don’t know which memories are causing the problem, and patients are often unwilling to speak of the horrifying events that created those memories in the first place. They may also suffer from other injuries suffered during the apocalypse, or have complications resulting from pre-existing conditions, making diagnosis vital to ensure we don’t make the situation any worse. Under normal circumstances, the process is made easier by the larger numbers of survivors, who can both support each other and help us understand common problems among their species. Sometimes there are even medical professionals among the survivors, whose assistance can be invaluable; and if we’re really lucky, medical and psychiatric records might survive the apocalypse, allowing us to build on pre-existing diagnoses. Further down the road, having a large enough group from the species makes it possible to build a medico-genetic map which can enable treatment for all but the most dedicated of sufferers.
I had none of these advantages with my current group. They shared a unique experience of loss which we hoped would bring them together, but each had suffered their loss in a very different way, and it was just as likely they would be driven apart. I had psychomedical histories for those who had been on Hub for some time, but their resistance to previous attempts at therapy suggested deeper problems as yet undiagnosed. And of course, it would be virtually impossible to create a medico-genetic map with only a single surviving member of a species to draw upon, meaning we could not risk the subtle procedures used to treat psychiatric conditions.
Each of them was very special, and very different. I would be lucky to understand and diagnose their problems within the next few months, let alone begin effective courses of therapy.
2. Kwame
PSYCHOMEDICAL HISTORY — SUMMARY
KWAME VANGONA
Kwame was discovered in a hibernation unit on a world that had suffered complete nuclear devastation approximately ninety years previously, leaving him as the only survivor of his species. He emerged with minor brain damage, either through the revival procedure or from hibernation itself.
After transfer to Hub, Kwame was diagnosed with severe aphasia. He retained some ability to express himself in written language, and, despite some loss of dexterity, was able to identify himself as the President of the nation of Mutapa, and discover he was the only survivor of his world. This revelation provoked reactions of grief and depression, which lasted several weeks. Eventually, he assented to cautious neurological treatment and physical therapy which restored his power of speech and much of his physical co-ordination, with the exception of fine motor skills. His left arm is particularly afflicted due to a pre-existing injury acquired during military service.
Soon after his arrival on Hub, Kwame began to suffer nightmares. He reported that he witnessed, night after night, the death of his wife, but was unable to give specifics as to what exactly he saw during the nightmares. An exaggerated startle response was observed, along with flashbacks and reticence when discussing the events leading up to the end of his world. While continuing with physical therapy, he became psychologically withdrawn, and often commented that it was impossible to explain his experiences to people who had not been there. A diagnosis of PTSD was made, and he was referred to a specialist.
After a year of therapy, Kwame made the admission that, as President of his nation, he had set in train the events that led to the nuclear holocaust, and believed himself to be personally responsible for the extinction of his species. However, this did not lead to therapeutic progress but instead to a declaration that he wished to be prosecuted for genocide and punished accordingly. His legal case has been stalled for some time, and although he attends therapy sessions, he seems unable to make progress while the case is still pending.
* * *
I’d only moved into my office a couple of weeks previously, but I think I’d done well in making the place comfortable: calming backgrounds, a painting with gentle colours, an abundance of greenery and a pleasant smell of flowers and coffee. Two comfortable chairs faced each other across a small table, and one wall was set to transparent so it windowed out onto the forest beyond the centre.
Kwame sat in one of the comfortable chairs. He didn’t have the energy to appreciate the room — he hadn’t slept and there was strong coffee in the non-spill cup he clutched with both hands — but the transparent wall drew his attention.
“Is that a live image?” he asked.
“Yes. That’s what’s outside right now,” I replied. My office was on the second floor, allowing us to see over the nearest treetops. Beyond them the valley sloped away and the forest canopy spread out into the plains and around the lakes. Patches of sunlight and shade floated across the landscape, and blue mountains met the sky in the far distance.
“How far does the forest reach?”
“All the way across the continent.”
“And you might never see another human face…”
“There are people out there.”
“But no natives.”
“No.”
“An empty world…” He gazed out into the forest. “You never realise in Hub Metro.”
“A little peace and quiet can be good for you.”
“Can it?”
“I hope so,” I said. “Shall we get started?”
“Please.”
“I believe there’s something you want to say first.”
“Yes.” He sucked on the cup’s valve, and grimaced as coffee flooded through him. “I would like to formally request that I be prosecuted for the genocide of approximately four billion people on my world. I am willing to make a full confession, and in fact I have already done so several times.”
“Well, there’s not much I can do about that myself. But I’ve made sure your legal counsel has clearance to talk to you once a week to update you on the case.”
“Is anything likely to change?”
“Kwame, I’m not a police officer, I’m not a prison guard, and I’m certainly not a lawyer. I’m a therapist. I’m here to help you get better.”
“Why?”
“I know you’re still suffering. I think I might be able to help.”
“That is not what I mean. What I mean is… why is it necessary to stop my suffering?”
“It isn’t,” I said. “If you really want to suffer, you can carry on as long as you like. You’ve certainly been making the attempt.”
That took him aback. He wasn’t used to such directness. “I… did not mean that…”
“Yes, Kwame. You did mean that. You’ve consistently refused help, and chosen to pursue a legal course that you know will last years. But even if you manage to get yourself convicted, what would change? We deport most serious criminals back to their home universe. We can’t do that to you because it would be a death sentence. So you’d only end up in prison, and there are plenty of therapists there. Really, all that would change would be the view from the window.”
He looked outside for a moment.
“It is not… the legal process is not about me. I am not trying to punish myself. Four billion people deserve justice.”
“What would happen to you if you were convicted of that kind of crime on your world?”
He smiled without pleasure. “I doubt I would be convicted. They would probably put up a statue instead. Most of the statues in Zimbabwe City were of men who slaughtered thousands in the colonies.”
“But assume for a moment that politics didn’t get in the way.”
“Then I would be executed, of course.”
“Which we would never do.”
“You are more civilised.”
“So by the standards of your world, justice will not be done.”
“No. It will not.” He agreed far too easily; he’d already thought it through, and had an answer.
“So why is it necessary?”
“It is necessary because genocide still happens. Every universe should know the price for such crimes. It should not be a statue in the public square and judgement that comes a century too late.”
“And do you think your conviction would change this?”
“It might.”
“But does it have to be you?”
“There is no-one else.”
He held his opinions with a profound moral certainty, and I doubted he would be shifted easily. But perhaps I could address more immediate issues. “Moving on for a moment, I’d like to talk about your nightmares.”
“If you must.”
“Can you tell me what you see in your dreams?”
“I see my wife. Dying.”
“I’m sorry if this is painful, but I have to ask. How did she die?”
“Unpleasantly.”
“I mean, what do you remember about how she died?”
“Nothing.”
“Why is that?”
“I expect it may have something to do with my condition,” he said, tapping the side of his head.
“But you remember everything when you dream?”
“Every detail. She died of radiation poisoning. Do you know how terrible that is?”
“Yes. I do. I’ve seen it.” I remembered triage duty on the Lift down from orbit, when we evacuated the last few survivors from a world where tactical nuclear weapons had been used in warfare for more than a century. We saw cancers, birth defects, malnutrition from digestive systems mangled by radiation, and worse. Some who’d stayed in the open too long while waiting to be rescued died before we reached Hub. I took a sip of tea to drive the memory away.
“Then you understand,” said Kwame.
“I understand it’s painful to think about. But — and excuse me if this seems like an obvious question — I thought you said you didn’t remember how she died?”
“I do not remember the event. I remember discussing it later, in the bunker.”
“What do you remember from that?”
He sighed. He’d told this story too many times.
“She was on a train in Zimbabwe when the bomb went off. She should have been far away, but we had the oldest railways in the world and they never ran on time. If they had… if the trains had been Dzikanyikan or Chifunyikan… well. They were not. They were Mutapan. So the train was still in the blast zone. They took a lethal dose of radiation. They were lucky to get as far as a hospital. I was out of the country, on an official visit to Chiwikuru. When I returned, I stayed with them until the end.
“My younger son died on the third day. My wife on the fifth. My daughter on the sixth. My elder son on the tenth. I remember none of it, except at night. You know all this already. Why do you need to ask?”
I asked because at no point during this explanation did he suffer a flashback, and his records confirmed that he never did when he told this story. PTSD had been diagnosed in his case from nightmares, hypervigilance and social withdrawal. He should have found it difficult to discuss the source of the trauma. He should have been overwhelmed with memories he could not control. So either his brain damage had complicated the PTSD to the point where it only affected him at night, or something else was going undiagnosed; and I had an plan for how we could find out.
“What if we could show you your dreams?”
His eyes went wide. “I thought that was impossible.”
“Well, yes—”
“If you understood how my brain worked, I would not need to use this thing.” He held up the non-spill cup in his crippled hands.
“You’re right. We don’t have a full understanding of your species. But we do know a few things. We can read the neural impulses inside your mind. We know where your visual cortex is. The quality may not be very good, but we might be able to record some images from your dreams.”
“Why did no-one tell me this before?”
“We used to think your species was unique. Hardly anyone can hibernate the way you do, and it has an effect on the way your brain works which we don’t understand. But one of the older IU member species recently made a bequest of records from thousands of years ago, and it turns out you’re not unique. There have been other human species that can hibernate, and apparently the records might help.”
He sat back in his chair, troubled. I was offering him a way to escape from the rut he was stuck in, so he would probably say no. Eventually, he found a way.
“I wake up screaming in terror every night, because of what I see in my dreams… what makes you think I want to see them with waking eyes?”
“Because it’s the first step in therapy for post-traumatic stress disorder. I’m sure exposure therapy has been explained to you before. If we approach the trauma gently, one step at a time, we can desensitise you to the memory. Eventually, we can make the dreams stop.”
He didn’t answer.
“How long has it been since you slept? Properly, without drugs?
He still didn’t answer.
“Will you think about it?” I asked. “Kwame?”
“I will… consider it.”
And that was as much as I could hope for in the first session.
3. Liss
PSYCHOMEDICAL HISTORY — SUMMARY
LISS LI’OUL
Every human on Liss’s world has been reduced to a powder, with no explanation either for this or how she survived. Physically, she is perfectly healthy, although she has a relatively high level of contaminants present in her tissues. This is most likely due to environmental factors on her world, which was technologically advanced and given to unusual forms of pollution. She claims to be physically average for her people, which would place her species at the higher end of human physical capability. She is considerably stronger than most humans and her level of health suggests a highly developed healing capacity and resistance to disease. Her only physical impairment is a clumsiness which seems to be subclinical in nature.
Psychologically, she appears to be highly delusional. She maintains that her entire species temporarily left and will return at some point, despite being presented with clear evidence that she is the last surviving member of her species. She has suffered no brain dama
ge, and reports no headaches, dizziness, sense impairment or other symptoms associated with neurological disorder. Given the bizarre nature of her world, this may be a defence mechanism to protect against the many traumas of daily life and yet carry on without reflecting on how it can so easily end. This, however, is only speculation. It has not been possible to reach a full diagnosis.
* * *
“What do you remember about what happened? When everyone vanished?”
Liss smiled at me from the comfortable chair, distracted from looking outside. She’d picked an entirely different outfit today, one that clashed with all the colours in my office, as well as the blue of the sky and the green of the forest. She seemed oblivious to how poor her dress sense was, as she was with so many other things. “Oh, well, I guess you already know and everything…”
“I’d like to hear the story for myself, if that’s okay.”
“Sure! It was a pretty normal day, I guess. I got up, put the breakfast show on — Sillafen was on with his movie or something, I mean that guy’s a dick, I don’t know why anyone goes to see his movies — I fixed myself some egg things, not eggs from a chicken, you don’t get eggs any more, not like you get here and those ones aren't even real eggs, are they? You kinda make them from something…”
“Liss—”
“And the pipes were banging again and the super never does anything about it, one of these days it’s all just going to burst and everything’s going to get flooded, that happened at my mom’s place once and she was so mad she sued the city, made them pay for the whole thing…”
“Liss—”
The Last Man on Earth Club Page 5
