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Nightmare would be the first to say he wasn’t an expert on medical issues or how to help those that suffered from chronic illnesses. Sure, he himself had residual pain around his skull from the incident that took his right eye as well as being obviously blind on his right side, but it was different. He was managing himself, not others. He didn’t think he’d ever have to look after another living being with chronic pain and illness.
When he met Error, it changed slightly. The elder God didn’t have chronic pain like Nightmare and wasn’t blind in one eye but he did have vision problems, did suffer from ‘crashes’ when he became overwhelmed or was touched without warning. But these were minor things, problems that were easily managed and worked around. It was when he took in his first mortal, Killer, that he was suddenly put into a position where he had to step up and truly take into account another being's needs.
Killer was loud and obnoxious, a flirt and a jokester. He thrived on causing chaos and was constantly seeing how far he could push Nightmare before the Guardian snapped. He was young too. Not a child or even a teenager, but still young. He was 36 years old when Nightmare took him in, the human equivalent of a young adult in their early twenties, so while he was old enough to know better on certain things he was still a little foolhardy and ignorant on others. That also wasn’t even taking into consideration the amount of trauma that he had gone through and still carried. He hid it well behind sharp words and a blasé smile, but Nightmare was a Guardian of Feelings and could read the other like a book even if his emotions were numb and faded.
It was the first warning sign Nightmare had that something was up with the others SOUL. Or perhaps it was the first confirmation that something was up. After all, Nightmare wasn’t ignorant enough to think merging a monster SOUL with the remnants of a human one wouldn’t have consequences. The muted emotions couldn’t be the only thing going on though, it seemed far too simple a side effect for something so important to a monster's physiology. He knew he was right when, three months after taking the mortal in he started noticing strange behaviours.
At random times throughout the day, Nightmare would feel a spike of pain-pain-annoyance-pain coming from Killer. Other times, he would observe as the mortal would pause in his steps, body swaying from side to side as a seemingly sudden wave of dizziness would overcome him. When he thought Nightmare wasn’t looking, Killer would reach up and rub at his sternum just under his SOUL, breathing hurriedly and quickly. Nightmare would also watch as randomly, the others SOUL would start to pulse and twist quickly and irregularly, almost like a heart palpitation.
Another thing he took note of was the liquid determination that constantly dripped from Killer’s eyesockets. Again, he wasn’t naive enough to think there wouldn’t be repercussions to the others' health, and again, through observations he was proven right. Over the three months he watched as Killer’s vision seemed to get worse and worse, his depth perception becoming increasingly distorted as well as the bone around his eyesockets becoming an angry inflamed red. It was clear the younger was in pain, both from his SOUL and the liquid determination but he also wasn’t speaking up about his issues. He continued to put on a winning smile, continued to throw jokes around and act like everything was fine.
By month 4, Nightmare had had enough.
“Come, we have an appointment today.” The Guardian said as he motioned Killer to follow him towards a portal.
“Ooooh, what AU are we terrorising today?” Killer asked with a skip to his step. He went to twirl a knife around his fingers only to yelp when Nightmare snatched it away with a tentacle.
“This isn’t a mission.” The elder stated firmly.
Killer frowned. He knew they didn’t need anything for the Castle, they went on a supply run just last week so he was unsure what kind of appointment Nightmare could have that would require him if it wasn’t a mission. He narrowed his eyesockets at Nightmare, suspicion sparking through his SOUL. Nightmare stared back, though he did seem to understand why Killer was being reluctant to follow when he didn’t have all the facts.
“The appointment is for you.” The dark God said, tentacle reaching out to wrap around the other's wrist to make sure he didn’t bolt. “More specifically for your health.”
“What?”
Killer is tense, heels dug into the ground and SOUL twisting with agitated uncertainty. It’s a standoff, one Nightmare honestly kinda expected. Killer was still coming to terms with the fact that Nightmare wasn’t just using him for his own gain, that the Guardian genuinely cared for his wellbeing. He’d been manipulated by his world's Chara, had been tortured and driven to the brink of insanity and was still healing from it all, was still learning to trust again. But these things took time and underneath all his charm and his jokes he was still terrified of every hidden meaning behind every action, and was still scared of being manipulated again.
“You are in constant pain.” Nightmare began, slowly and gently. “I can both feel it and see it. Your SOUL and the determination from your eyes are causing you discomfort and are affecting your day to day life. I have made an appointment with Sci to get to the root of the issues and hopefully provide a solution.”
“But why? Why do you care? Don’t you get a free meal from me if I’m in pain? It’s a negative emotion after all.” Killer challenged, still wary.
“When I took you in, you became not just my henchmen, but my charge. That means it is my job to ensure you are happy and healthy. I employed you to help me keep the balance of the multiverse, not to feed my magic with your own suffering. I am the Guardian of Negativity, but that doesn’t mean I wish for others to suffer needlessly.” Nightmare explained.
They stand there staring at one another for a few more moments before Killer reluctantly agrees to let Sci perform some tests on him. It takes a few visits and lots of questions and testing to get a diagnosis, but it’s worth it in the end. Sci diagnoses Killer with Soul-Atrial Fibrillation, or S-AFib for short. As skeletons didn’t possess a heart like humans and flesh monsters do, many heart conditions actually ended affecting their SOUL’s instead. It would seem that merging his SOUL with what remained of Chara’s had caused the magical flow to become disrupted leading to the condition. It explained why he was experiencing soul palpitations, chest pain, dizziness spells, fatigue, shortness of breath and weakness. It also explained why the determination was leaking from his eyes.
The flow of magic was disrupted, so the excess that would normally be released through sweat, tears, breaths and food consumption was instead overflowing in his eyesockets. That overflow was causing vision problems and irritation that could lead to infection if it wasn’t managed properly. Sci ended up prescribing magic beta blockers in the form of eye drops that would reduce the magic and eye pressure as well as slow the SOUL rate down to a normal level. He also prescribed Antiarrhythmic drugs to help control the irregular SOUL rhythms.
Sadly, this was a condition Killer would have to live with for the rest of his life but Sci had said as long as they kept on top of his medication he would be able to live a long and relatively healthy life. It was just something to keep an eye on.
For Nightmare, it was an eye opener. He found himself having to take charge of Killer’s medication as the other wasn’t the best at keeping track of things nor remembering when he needed to take them. It did have the benefit of bringing them closer together though. It helped Killer realise that Nightmare truly did care for him and wanted the best for him. It also had the benefit of helping prepare Nightmare for dealing with complex medical issues as his next mortal also proved to be a handful.
Horror was already in dire trouble when Nightmare picked him up. Severe malnutrition along with a head injury that was never properly healed. It took a while to correct the damage done by the lack of food, but again, Nightmare was quick to note the lasting issues the other was having. Horror would have moments of dizziness, lightheadedness, headaches that could turn into crippling migraines and nausea and blurred vision.
The migraines were a direct consequence of the massive head injury, and perhaps it was also the cause for another strange thing Nightmare noticed. At random moments, Horror would suddenly space out. He could be in the middle of a conversation and suddenly his eyes would go unfocused and he’d stop talking while he stared off into nothingness. It would only last for a few moments before he would snap out of it and carry on like nothing had happened. He’d be incredibly confused if Nightmare or Killer asked him about it, having no recollection of the incident. Other times, when the episodes lasted longer, he’d be confused at having blank gaps in his memory.
Something was seriously wrong and Nightmare was determined to figure out what it was and fix it. Horror was much easier to convince to go have a medical exam than Killer had been. He wasn’t as suspicious as Killer, and while he was guarded he wasn’t paranoid. He also didn’t want to live with constant pain, black outs and fainting spells which had also started popping up.
A few scans from Sci and, like with Killer, they had a diagnosis. Low Magic Pressure was causing the fainting, dizziness, blurred vision, nausea and lightheadedness. The blackouts though, were a different matter. The Low Magic Pressure was caused by the extreme stress Horror’s SOUL had been under during the famine. He’d been denied the correct nutrients for so long that his SOUL was struggling to re-absorb magic properly again. The head injury though was causing a far more serious issue.
There were hundreds of mana lines running through the inside of a skeleton monster's skull. These mana lines helped transfer magic throughout the body, acting like veins that transferred blood throughout the body. The ones in the skull helped carry the magic that allowed their eyelights to work as well as helped with memory and other important brain function. The massive hole in Horror’s skull had snapped and disrupted some of those mana lines causing him to experience Absent Seizures.
Sci prescribed pills to boost Horror’s magic pressure and magic absorption as well as Anticonvulsant drugs for the seizures. The hope was that eventually the Low Magic Pressure would correct itself with the help of the pills and with Horror having access to a steady supply of food again. The seizures though were most likely something he’d live with for the rest of his life with the possibility of them getting worse.
Once again, Nightmare adapted, though this time he also had Killer’s support. The two of them quickly learnt to recognise the signs of a seizure so they could make sure Horror was safe and had ready access to his medication when he needed it.
Dealing with Killer had been an uphill battle, helping Horror was a challenge but surprisingly smooth sailing. Dust was both an uphill battle and a challenge. He was untrusting, paranoid, unstable and filled with anger and guilt. He was filled with high LV that had his Magic practically overflowing at times which made his already unstable emotions even harder to control. His temper was a force to be reckoned with, moments of extreme and intense rage seemingly exploding out of nowhere making him a danger to himself and the others in the castle. This, coupled with his delusions of seeing the ghost of his younger brother led Nightmare to realise Dust would need not just a physical health assessment but a mental health one too.
It was a fight to get Dust to see Sci for his physical. The shorter skeleton had believed that Sci was simply trying to trick them into poisoning him, that they were trying to kill him so he should kill them first. It took the combined strength of Killer, Nightmare and Horror to subdue him with Nightmare using his aura to siphon away the lingering negativity. It took another two days of patient talks and constant reassurance that no, they weren’t trying to trick him and to not listen to the Phantom of his brother.
Unlike with Killer and Horror, Nightmare made a point to stay with Dust the whole way through the physical, though it was mainly for Sci’s safety as Dust was more likely to try and kill the other. At the end, Nightmare had another diagnosis as well as the number of a trusted psychiatrist that could help Dust overcome his psychosis and anger issues.
Whereas Horror had Low Magic Pressure, Dust had High Magic Pressure. He actually had many of the same symptoms as Horror like the dizziness, nausea and blurred vision along with vomiting, chest pains and severe headaches. Dust was also diagnosed with Intermittent Explosive Disorder or IED, a type of anger disorder that explained Dust’s sudden and intense moments of rage. While the psychiatrist would help with his IED and his delusions about his Phantom brother he was also given medication to help lower the amount of magic that was coursing through his body.
Dust took far longer than any of his boys to settle into life in the castle, and while it took a few years for his mental state to settle he eventually became a well adjusted and far happier Monster under Nightmare’s care. Eventually, the hallucination of his brother faded away, his IED grew less intense and frequent and his High Magic Pressure became manageable.
Nightmare learnt to manage his three boys and their medical issues, learnt their tells when they were having bad days and made accommodations when they needed it. He learnt how to manage issues that were a direct cause of trauma and or environmental. Cross had him learning to deal with ones that were always a part of the younger.
Cross was young, Cross was traumatised just like the other boys had been, but Cross was different. He avoided certain foods like the plague, he would become overwhelmed easily in crowded spaces and in turn grow quiet and reserved. His coordination and balance was also poor and he often got pain and stiffness in his joints that would also dislocate much easier than any other skeletons joints did. He would rock in place, hum softly to himself, tap his fingers constantly and had trouble understanding many of Killer’s jokes.
Nightmare had already organised an appointment with Sci to get the recommended supplements Cross would need to get back to a healthy weight as well as regain the magic he’d lost while trapped in the void of his destroyed AU. It hasn’t been difficult to mention his other observations to Sci, to ask him to test and assess for other underlying health conditions. It had been surprising to hear the words Autism and ADHD thrown at him, Nightmare hadn’t known all that much about those terms and was startled to realise that they were conditions a monster was born with and not something that occurred because of an external force. They did explain some of his quirks though as well as a few other conditions he had.
Autism/ADHD often lead to sensory issues and Cross had extreme aversions to certain food textures that had manifested into ARFID or Avoidant Restrictive Food Intake Disorder. Cross would refuse to eat certain foods, even if he was starving and there was nothing anyone could do to get him to eat them. Another condition that was commonly found in those with Autism/ADHD and that Cross had was Hypermobility. It was what caused the stiffness and pain in his joints and why he was so prone to dislocations.
Nightmare took home all the pamphlets he could find on Autism and ADHD and researched late into the night so he could help Cross feel safe and comfortable at the castle. It was clear from talking with his youngest that even in his home AU, no one had ever bothered to understand the struggles he faced or try to help him learn how to navigate a world that wasn’t designed for his needs.
Nightmare wasn’t an expert on medical issues and he wouldn’t claim to be the most kind or compassionate monster. But for his mortals, his boys, he would try. He would read every medical text book there was in the multiverse, would talk to every expert about all the different treatments his boys needed to make sure they were happy and healthy. They were his charges, his to look after, his to care for and protect and he would do so until the end of time.