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I will refer to the patient I am about to describe for you as Mr. N. I do this not only to protect his privacy, as is my professional responsibility, but also as a safeguard against those whose secrets are jealously kept, and whose displeasure at any indiscretion could risk my own life.

Mr. N. is diminutive in stature despite his elevator shoes, with a capacious, balding head and a commensurately prodigious intellect. His sky blue eyes and notably direct gaze strike many in his social circles as off putting, even unnerving. I can say personally that under his inspection one gets the sense one has been push-pinned to a cork board and is being scrutinized by an icy intelligence indifferent to trifling matters like an individual life or death. In public he is a noted neurologist, well-respected by his peers here in England and abroad. In private he is something considerably darker.

He came to my London offices a little more than one year ago and I diagnosed him with moderate to severe melancholia that waxed and waned irregularly. He lacked suicidal ideations and that of course I initially deemed a good thing, though in this particular case I have since had good reason to rethink that judgment.

I began with my usual dream analysis which quickly revealed distinct ego inflation. This I concluded to be compensatory for a personal mythology harshly negative and relentlessly self-judging. That in turn seemed to me rooted in profound guilt over the death of his younger brother S. in a childhood drowning incident. A sad event for which Mr. N. held himself responsible.

Treatment was proceeding along typical lines and with a slight but positive response in affect when new symptoms suddenly and inexplicably introduced themselves. Photophobia, to begin with. So severe that our weekly sessions had to be moved to evenings only. The patient took to sleeping days in a heavily curtained room and avoiding the sun at all costs. This was soon followed by a more disturbing development. Hemophilia in its most literal sense: an intense and overpowering love of blood.

This initially presented as a newfound taste for rare steaks, chops, and liver (he had previously taken his meats well done). It all progressed rather quickly to the point that N. made arrangements with his local butcher for meat to come delivered to his home in metal tubs and virtually swimming in blood. Eventually he made some disturbing inquiries to the end of procuring live farm animals which, one surmises, he intended to butcher by himself. In this request he was blessedly refused. Unfortunately that closed door led to him adopting more extreme methods intended to satiate his new and unnatural thirst, methods that involved stray animals and about which common decency precludes my going into detail.

It would be fair to say that his new fear of sunlight and strong affection for blood disturbed Mr. N deeply, and in fact it struck him personally as “ghoulish.” He may have become a slave to these passions, but he held no affection for his new masters. In a word he was afraid.

“What on earth is happening to me, doctor?” he asked me in a session that my notes date to three months ago. “I fear I am losing my mind.”

He had grown noticeably paler over the preceding weeks, more quickly and strikingly than a mere absence of sunlight could reasonably account for. Indeed I was on the verge of referring him to a colleague of mine, a medical doctor, when Mr. N. made his own new diagnosis.

“Or if I’m not losing my mind,” he said, “then this is something infinitely worse. I think I am becoming a vampire.”

It is not seemly for an alienist to show unchecked emotion at even the most outlandish outburst from a patient. I literally had to bite my tongue and exhale slowly before replying with a calm question meant to uncover the psychological truth beneath his absurd speculation.

“If you were to become a vampire,” I asked, “what part of you would you have to leave behind? What part of you would end?”

He rubbed his face with his hands and considered for a long moment. “I don’t know. The part of me that’s human, I suppose. The part of me that’s decent and cares about my moral reputation, that is, my estimation, good or evil, in the eyes of my fellows.”

“And if you were free from all such moral judgments?”

He shook his head. “You think it has something to do with my guilt complex. Well, that’s all very interesting, but how does it explain this?”

And with that he bared his teeth at me with a loud and startling hiss.

I fell back into my chair in shock before I could get a grip on myself. I was looking at his canines and my first thought was that he had filed them to points. An instant later I rejected that as it was obvious that the teeth were noticeably longer as well as dagger-like.

“Are those artificial?” I asked.

At this he laughed mirthlessly, and the sound of it fairly curdled my blood.

“Oh, doctor. Do you really imagine I would choose to do this to myself? No. This is all happening of its own accord. It doesn’t seem there’s anything I could do to stop it. Apart from paying someone to drive a stake through my heart and decapitate my corpse. If the legends hold true, that is.”

I sat a moment in silence gathering my wits. Despite his denial I had to believe that he had engaged some orthodontist to create the fangs. The alternative he suggested wasn’t remotely possible in my mind.

“What,” I finally asked, “do you think caused this?”

“Well, I thought it was a dream at first, a nightmare. Glowing yellow eyes in the darkness of my bedroom. A bite that was painful and somehow ... delicious at the same time. This scene repeated I don’t know how many times. And then the changes began. Cause and effect are clear enough in my mind. I was bitten by another vampire. It’s as simple as that.”

I do not favor confrontational therapy with my patients. However, instincts told me that if this fantasy managed to root itself any deeper in Mr. N. that this psychosis could well become permanent. I had an idea.

“I want you to lie back on the couch and close your eyes,” I said.

He did so without reply.

I then reached around to the back of my neck and unclasped the chain that holds a gold cross I wear beneath my shirt. I cupped the cross and chain in my left hand. “Keep your eyes closed and hold out your right hand, palm up, please.”

He followed my instructions obediently, and I gently placed the cross in his hand. There immediately came a sound of sizzling, like bacon in a frying pan. He shook his hand violently and let out a terrible scream. The cross and chain flew across the room and hit the wall.

He had sat up and was looking at his hand in fear and confusion. “What the hell did you do?”

He turned his palm toward me and I could see his skin had reddened and that a blister was forming. A blister in the shape of a cross. The sickening smell of burning flesh had already permeated the room.

I was unable to calm him or regain his trust that day and the truncated session ended there.

To my surprise he telephoned the following week and set up another appointment. This time I did not challenge his incredible assertion. I could not. For as the time for his session came around he arrived punctually. In the form of a bat. He then transmogrified into human shape before my very eyes.

I had no choice then but to accept the seemingly impossible. I did so by reminding myself that whatever he was, he was still a patient. He was a patient who was coping with a trauma as extreme as one could ever imagine. And so I did what I do. I listened and offered what I could to aid in his psyche surviving this awful transition.

Did I succeed? I would have to say so, yes. And proof of that was the stream of pale men who followed Mr. N. to my door for treatment over the following months. I have a full calendar these days, or should I say these nights? The undead have their neuroses too, it appears. And I have become their only solace in this world. God help me.

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