'So what can I do for you today, Mr Johnson?' Dr Ellerby asked, leaning forward in his swivel chair towards the middleaged man sat in his consulting room. Mr Johnson was dressed in tweeds and was of average build; bushy greying sideburns framed his rather gaunt features and his sunken eyes stared unblinkingly back at Dr Ellerby.

 

'I need you to operate on my stomach and remove the spider that's living in there,' said Mr Johnson matter of factly. There was an intensity to his statement that quite unnerved the doctor, but he was used to Mr Johnson's demeanour. A diagnosed delusional paranoiac, Mr Johnnson was a regular in his surgery. Dr Ellerby sat back in his chair, crossed his legs and looked intently at Mr Johnson.

 

'I see, and what makes you think there's a spider living in your stomach?' Dr Ellerby had found in the past that if he went with the delusion, although he had to be careful not to feed it, that he could invariably get to the bottom of his patient's ailments and then suitably prescribe care for them. Either that or he had to inform the mental health team that Mr Johnson was close to a new episode and that they needed to consider another intervention.

 

'I woke suddenly in the night and felt it crawling into my mouth, I could feel the hairs of its legs tickling the insides of my cheeks and its pin like feet stabbing into my tongue as it clambered into my open mouth as I slept. I coughed trying to spit it out, but it was too tenacious and depite trying to claw it out of my mouth it had slithered into my throat before I could grab it and then I felt it walking down my throat, pressing into my chest and finally plopping into my stomach.' Mr Johnson's already bulbous eyes were now wild, the inherent fear clear for Ellerby to see as the man relived the horror his mind had projected onto him of a fat, furry spider making a nest in his body. Ellerby shuddered slightly, he was no fan of spiders himself and just the illusion of Mr Johnson's description was enough to make him feel queasy. The hairs on his arms rose as goose pimples engorged expressing his disquiet at the description, bringing to bear his own irrational fear of spiders.

 

'I see,' Dr Ellerby replied, taking a deep breath and trying to centre himself. 'Right, well perhaps I should examine you and see if I can determine the exact point of the issue. It maybe,' he went on as he thought Mr Johnson was going to object, 'that some form of medication would do the trick, rather than surgery, something to dissolve the spider. Surgery is always a last chance kind of approach, as there are often issues and potential additional hazards with even the simplest of surgeries. You understand, Mr Johnson?' He held the man's gaze, who then nodded reluctantly.

 

Dr Ellerby waited whilst Mr Johnson stripped to the waist and then proceeded to make his examination. He made suitable oo and aa noises as he prodded and poked. Inspecting the mouth and throat and then pressing and tapping on the man's abdomen and stomach. Finally checking the areas around the appendix. He stood back from Mr Johnson and said 'Hmm'.

 

Mr Johnson didn't fail to pick up the slight crease of Dr Ellerby's brow, a hint of concern maybe? So the doctor had confirmed his tale, as far as Mr Johnson was concerned. Dr Ellerby on the other hand had detected a lump where it shouldn't be in Mr Johnson's belly. There were signs of soreness in his throat, quite mild, so probably just an aspect of a cold coming on. But the lump was interesting, it wasn't an issue with his appendix, and he didn't think that an ulcer would express in such a manner. The lump had tumouresque qualities to its feel, so a biopsy was definitely on the cards. More tests were required. Dr Ellerby always had to hand it to Mr Johnson's delusions, they were great premonitions for his continuing good health. His subconscious mind was highly in tune with his physical body and had never once failed to pinpoint something before it became a major issue. However, the idea of a spider camping in Mr Johnson's intestines still made Ellerby shiver.

 

'Yes, there's definitely something there, Mr Johnson. Quite what it is I'm not sure, but further tests will diagnose it promptly.'

 

'It's a spider.' Mr Johnson said emphatically, 'I've already told you.'

 

'Yes, sorry, Mr Johnson,' Ellerby mollified, 'I know, but we will still need to do some further tests to determine the best course of action and how to rid you of your.. spider.' He turned back to his desk, 'you can get dressed again now, Mr Johnson.'

 

Ellerby sat down at his desk and thought for a moment, biopsy seemed reasonable, basic run of bloods to determine any hidden side effects of whatever might be in the lump and there was always the probability that surgery was on the cards. He explained as much to Mr Johnson. 'In the meantime are your feeling any discomfort or pain from your.. spider?'

 

'Apart from when it entered me, no. It seems to be fairly dormant at the moment.'

 

'Good. Right I'm going to refer you to St Mary's, they will send you an appointment for a biopsy.' He paused then said, 'Have you eaten at all this morning, Mr Johnson?'

 

'No,' his patient replied, 'not since I ate the spider. Not been remotely hungry.'

 

'Hmm, loss of appetite,' of course, he thought, that could just be the symptoms of an incoming cold, but... 'Good, in which case, if you'd like to wait outside I'll get one of the nurses to take some bloods. We can then determine if your lump, I mean your spider, is leaking anything untoward into the rest of your system.'

 

Mr Johnson stood up, in response to Dr Ellerby's move from his chair. He took Ellerby's hand and shook it. 'Thank you, doctor, you've always been there for me when I needed help.' Ellerby felt his hand was being crushed in a vice, Johnson's grip was so tight. He wondered if Johnson had been working out as previous handshakes had always been rather limp.

 

Mr Johnson left his room and Ellerby made some calls, primarily to the mental health unit to update them on Johnson's potential physical diminishment and to St Mary’s to organise a biopsy. Unfortunately the earliest was going to be the end of next week. Still, in the grand scheme of things this was pretty good and still gave Mr Johnson a good head start on whatever kind of tumour it was. It was still fifty fifty at this point as to whether it was benign or not and Ellerby’s experience of Mr Johnson’s subconscious tended to suggest that whatever it was had been caught with enough time to resolve it to everyone’s satisfaction.

 

*

 

Dr Ellerby didn’t always attend his patient’s procedures, generally there just wasn’t the time in his schedule, and ultimately it was unnecessary. But with Mr Johnson he often attempted to make the effort to attend. There was something enigmatic about Mr Johnson’s ailments that piqued the doctor’s professional interest and, as such, he liked to follow the whole process of care. In the last year he had had a number of discussions with Mr Johnson’s clinical psychologist, Matt Dawson. Together they had been discussing writing a book based on Mr Johnson’s presenting psychosis and the nature of his subconscious’ ability to forewarn of any detrimental diagnosis to his actual physical being. It was just a shame, Matt had joked, that his psychosis couldn’t fix his psychosis.

 

Ellerby was at St Mary’s early the following Friday for Mr Johnson’s biopsy and he had already had the opportunity to speak with his patient prior to him entering surgery. As much to help allay any concerns as to find out how the man was feeling with his ‘spider’ living inside of him. Mr Johnson’s appetite had returned, if anything it had increased and a brief inspection of his anatomy had shown him that the initial signs of an oncoming cold had gone, he also noted that Mr Johnson’s overall health seemed to be much improved. He appeared more robust than his naturally sinewy body normally suggested and Ellerby had remarked as much to him, his patient had merely shrugged, unable to supply an answer for this apparent anomaly in his physicality. Ellerby wondered if it had anything to do with the blood test results, which had shown elevated levels of certain alien toxins coursing through his vessels. He had remarked as much to Mr Collins, the surgeon, when in consultation with him earlier and the general consensus was that the tumour could well be cancerous and that it was leaking toxins into Mr Johnson’s bloodstream, elevating certain aspects of his endocrine and adrenal production. It would certainly account for his increased appetite.

 

Ellerby was now in the viewing chamber next to the surgical unit, where he was accompanied by a number of student doctors who would also be watching the procedure. Mr Collins, had just entered and done the prechecks with his team to ensure everything was set to continue safely and efficiently. He was employing an image assisted needle biopsy procedure; the needle in question had a small cutting edge to it, which he promptly used to make an incision in Mr Johnson’s abdomen, over the swelling, which had grown alarmingly over the last two weeks, and proceeded to insert the needle into the lump. The x-ray of the area was woefully inadequate in Mr Collins’ opinion as it merely determined the area that he was working on, but provided no detail of the tumour itself. He was further disconcerted when the needle punctured the swelling and the whole mass seemed to completely deflate. This was not normal and he removed the needle almost immediately and without withdrawing any sample tissue. He spoke briefly with his assistants and ordered an imaging scope and endoscopy to be brought in. He also looked over at the anaesthetist as Mr Johnson had given forth an audible sigh as the swelling burst. The anaesthetist checked his instruments and then checked Mr Johnson, but then merely shrugged at Mr Collins suggesting that there was nothing untoward with either the patient or the set up.

 

With an endoscope now in hand Mr Collins proceeded to investigate the tumour by inserting in through the original incision. He felt Mr Johnson move as he did so, just the slightest quiver, but it was enough for him to know the anaesthesia wasn’t doing its job. He looked over at the anaesthetist, who was already investigating his instruments, eventually adjusting one of the dials and increasing the flow of gases into the patient. He went back to the endoscope, but was once again disconcerted as he felt the tip of it move of its own volition. He looked up at his monitor and could see a mass of dark matter just ahead of the camera, a number of other smaller dark masses scattered around the whole. This was not normal for a cancerous tumour, nor was it normal that a tumour would deflate in the manner that had just occurred. He advanced the probe, but as he did so the large mass started to disintegrate.

 

‘What the Hell?’ Mr Collins exclaimed, looking more closely at his monitor. He noted in his peripheral vision the anaesthetist was once again animated and seemed rather agitated. As for Mr Johnson, he was visibly moving on the table and starting to moan. Mr Collins wanted to know more about the mass, but at the same time was aware that his patient was entering a zone of discomfort that should not be happening. He made an instant decision to extract some sample tissue from the largest black mass, before it completely disintegrated and would then withdraw from the procedure. The endoscope pressed into the mass, which completely broke apart in a most unnerving manner, flowing away from the tip of the endoscope almost like water. On the screen Mr Collins got the impression of bulbous black sacks and thousands of legs. He stepped back in horror as Mr Johnson suddenly sat bolt upright on the gurney and screamed. The sound was muffled and eerie in its emanation because despite his mouth jutting wide open, it appeared to be clogged by myriad strands of white fluff. His eyes bulged open as those around the gurney were drawn to the sight of the writhing skin across his abdomen. As if living creatures were wriggling and squirming just under the skin. Mr Johnson gripped the metal side of his bed and continued to scream, white fluff spewing from his distorting mouth. His back arched, his belly being propelled upward, the skin rippling with hundreds of tiny wriggling movements distorting the abdomen, the rods of the bed collapsed with the crushing grip Mr Johnson employed. His entire form tensed, solidified and contorted, holding its position for several moments before Mr Johnson collapsed back onto the gurney and appeared to fall unconscious.

 

The surgical team had all leapt back from the silently screaming man, horrified by the scene in front of them. As Mr Johnson finally became still, the team watched as bulbous growths formed on the surface of his flesh, which then violently erupted like pustulant buboes, spewing forth a tenebrous swarm of spiders that consumed their host in a splendid gorging feast of excess. The team to a man screamed aloud and fled the surgical room.