's 2014 Horror Write-off:


Submitted by HISHAM H

Patient ID: 00187934 Name: “John Doe” Age: Unknown

Patient is a male approximately 20-30 years of age, identity currently unknown. Patient is currently subject in ongoing active police investigations

Patient was admitted as case of severe mutilation during prolonged captivity.

History: A man delivering groceries to an elderly homeowner became concerned when the tenant failed to answer the door. Police were contacted, and later broke down the door. Tenant was found dead in his bed, apparently from natural causes. Upon noticing foul odor permeating premises, police searched the house and discovered the patient being held captive in the basement, which was fitted to accommodate him. There were signs of a prolonged captivity. Victim was unable to communicate with officers and was apparently incapable of comprehension. Patient reacted with terror and violence towards officers. He was subdued and placed in physical restraints, and transported to our hospital.

Examination: On admission, patient showed severe mutilations and was in considerable distress. A large dose was required to sedate the patient, which may indicate tolerance due to long term use of sedatives by the captor.

After sedation, patient's vital signs all within normal parameters. Height estimated at 5 feet 10 inches, weight 130 lbs, towards the lower end of normal range. Other than that, patient appears to be well nourished, although slightly dehydrated, and appears to suffer from no deficiencies..

All wounds are healed and show extensive scarring consistent with repeated trauma.

Eyes and associated musculature completely removed, together with a large portion of facial bone bilaterally removed as well; removal extends to the temporal region, both earlobes removed, resulting in a large cavity that extends from the front to the ear on both sides of the head. In each cavity there is a dark, dense object, composed of a synthetic rubberlike material, and covered by a fine hexagonal pattern sculpted into its surface. Each object seems to have been molded to fit in the cavity perfectly and snugly. Imaging studies shows extensive healed tissue damage, but no obvious damage to brain. No electronics or other metallic components detected in both dark objects; they are most likely nonfunctional prosthetics.

Nose has been removed. All teeth in upper jaw extracted; upper lip trimmed and inserted into gums. Lower mandible and tongue removed. There is a large object similar in shape to a showerhead, composed of plastic. Tip expands into large flat surface composed of soft spongy material riddled with tiny holes. Device is inserted into back of throat and down esophagus. Remaining jaw muscles and remnants of tongue are fixed to a pump-like mechanism. Presumably device allows patient to suck up liquids with spongy surface using pump-like mechanism. Due to severe scarring and extensive tissue overgrowth and adhesions, removal of device not possible without extensive surgery.

Both arms modified in an identical way. Starting from the hand, the middle finger is missing, then the entire arm is split into two halves longitudinally. Carpal, radius and ulna bones have been separated, humerus has been split down the middle and repaired with ceramic-like substance, partially resorbed/ replaced by bone. Even head of humerus in socket has been divided into two halves, then smoothed over. Muscles of shoulder, rotator cuff and arm also similarly divided, but restructured surgically in such a way as to preserve nerve connections and as much functionality as possible, then reattached to separate halves. Larger muscles such as biceps remodeled extensively so as to becomes "two" muscles, one for each half. Each half of arm was then covered with skin and muscle grafts. End result is that patient now effectively has "four" arms. Each pair moves more or less in tandem, and do not show true independent movement. Patient retains full strength in upper extremities. Calluses on pressure points of palms indicate extended amount of time spend on hands.

Legs adducted, folded up against body so that knees are against chest. The skin and flesh of each thigh has been grafted into the chest and abdominal wall down its length. Imaging studies show ribs bilaterally have been broken, then fixed with metal bolts directly into the femur. After healing and callus formation, femurs are now fused to ribcage. Imaging studies also showed deformity of spine, due to unnatural posture, as well as bolts inserted into the head of each femur and extending into the acetabulum, effectively locking the head of the femur in place and preventing any rotation or flexion of the pelvic joint.

Scalp missing patches of hair; strips of scalp skin exhibiting black, bristle-like hair grafted into various locations on entire back.

Pelvic musculature atrophied, multiple healed pressure sores and extensive calluses on buttocks. Perineal area inflamed and started to ulcerate, show signs of attempted treatment through application of creams. Perineal irritation most likely due to watery stools of patient, itself due to patient's inability to ingest anything other than liquids.

Unable to assess mental status of patient due to inability to communicate. However, patient most likely has suffered severe mental trauma.


-Do CBC, serum electrolytes, renal function tests, liver function tests.

-Insert IV line.

-Start IVF one-half isotonic saline in 5 percent dextrose, plus KCl 20 meq/liter, at a rate of two liters per day.

-Insert nasogastric tube, and keep NPO until further orders

-Quetiapine 200 mg BID via NGT ongoing

-Quetiapine 50 mg BID via NGT PRN when agitated

-Diazepam 5 mg via NGT PRN if agitated and unresponsive to quetiapine. If cannot be given by NGT, give via IV.

-Refer to psychiatrist for evaluation

-Refer to orthopedics for surgical consultation

-Refer to maxillofacial surgery for surgical consultation

-Refer to ENT regarding device in throat and assessment of patient's airway

-Refer to plastic surgery