“But I smell things that aren’t real…”

The patient wrung his hands. His face screwed up in frustration; his voice became querulous.

“Like bacon frying or coffee brewing, perhaps blooming honeysuckle flowers?” asked the doctor.

He would try to establish a baseline for this seizure patient’s olfactory hallucinations before attempting an exact diagnosis.

“None of those things. Bad smells. Crazy. Hard to describe.”

In his notebook, the doctor scribbled: Dysosmia.

“Are these odors things you’ve always found unpleasant? Some people can’t stand the smell of wire insulation burning or tires on fire. Others find certain food odors, like garlic or onions, distasteful.”

“I told you, I smell things that can’t be described! Never in my life have I been around odors like these.”

The patient looked down as his pale hands, fingers nervously writhing.

“I know the stench is not just bad. It’s evil.”

This piqued the doctor’s interest. Phantom odorants usually were confined to the individual’s lifetime experiences. The basis for the smells was something the person had encountered and found familiar.

Those who suffered from jamais vu were most interesting in that what they smelled during episodes was not familiar, although they might have been exposed to the odors every day of their lives.

Phantosmia, he wrote on the open page, his expensive fountain pen making flourishes that indicated satisfaction with deducing the patient’s problem.

“How do you mean, evil? Like rotten flesh? Perhaps you mean the smells are sickening. Things you’ve experienced firsthand, like spoiled fish or sour milk.”

Reaction was immediate. The patient bunched up, seeming to collapse into himself. His skin assumed a gray pallor. Sweat beaded on his forehead.

The doctor thought he might be observing the first phase of a temporal-lobe epileptic incident. He leaned forward in his chair, staring avidly, but eventually was disappointed. The patient relaxed after a minute, the knot of his body unraveling to become almost rubbery.

Aura, thought the doctor. The patient had just experienced a perceptual interruption and downshifted out of reality for a few moments. Not rare for this type of seizure patient, one who was obviously trending toward suicidal.

“What just happened? Can you describe it for me?”

The man spoke sluggishly. His fingertips bent and released rapidly, like he was speed typing. The doctor jotted these things in his notebook.

“The smells… came back.”

“Tell me exactly. How did it smell to you? Acrid, sour, burnt, caustic, sickly sweet…”

The patient wrinkled his flaccid face, trying to recall the details of his olfactory hallucination.

“It smells of horrible colors and sounds.”

He moaned and tried to sit up.

“It stinks of things I’ve never seen or imagined. Smells that flash light and darkness, weird colors. Growling and awful shrieking as odors. How can that be? And, it comes from over there.”

He pointed toward the off-white exam room wall, blank and sterile. “Always like it’s on the other side.” The patient shivered. “Something is waiting, just out of sight. I can smell it, not anything that should be… here. With us.”

The fountain pen’s nub scratched busily during the patient’s pause.

“I think it is from another world and trying to squeeze into ours. Those colors and sounds I smell are the thing’s, from its world. Not a nice place.”

If his professional mien had not dictated calm, the doctor would have jumped out of his chair and pumped a fist. Here was a potential case study of a different type of olfactory hallucination. One that associated visual and auditory sensations.

The patient’s fantastic and unbelievable hypothesis notwithstanding, the doctor thought this could be a groundbreaking study involving combined phantom disruptions of mental processes distilled through olfactory imagination, acting as a precursor symptom to an epileptic seizure. He was ecstatic.

“So, you’re saying these strange smells deliver a kaleidoscope of imaginary sensations above and beyond the upsetting odors?”

The patient began to knot up again. “Not… imaginary. Real!”

Now the indicators of a full-blown seizure were apparent. The patient’s lips moved but he spoke only gibberish. Muscles spasmed. His eyes rolled back.

The doctor cursed himself for having not remembered his smartphone. He hurriedly opened his briefcase and extracted the device, pressing the power button and waiting for everything to load. In the meantime, the patient began to judder, his head and neck snapping forward and back like an insane woodpecker.

Although he’d seen such seizures many times, the doctor was still fascinated.

When the phone beeped to indicate his apps were ready, he tapped the camera icon and selected the video function.

Then he smelled the indescribable. It was the chemical plant he had visited as a teenager when his father wanted him to become an engineer, but not like that at all. It was the road-killed dog that he poked with a sharp stick until the rotten carcass expelled a cloud of corruption and hundreds of maggots in his face. But not quite.

It was the dumpster behind his favorite restaurant where homeless people dug for rotten produce and rancid meat—the high, sweet-sour smell of spoilage—but different, too. Not-of-this-world different.

When he began to smell the shocking colors and hear the racket of weird sounds through his nose instead of his ears, he tapped the reverse video function on his phone.

Over his shoulder, the blank wall bulged. Paint peeled and blackened, almost scorching. The drywall beneath crumbled. Now he smelled an abyssal vortex, screaming and carrying the odor of blackest decay, the antipode of human existence.

Somehow, the doctor identified the pervading stench as nightmare effluvium and alien hunger. On the phone’s small screen, he saw the wall burst open, the thrust of gaping jaws wider than his vision could register and transmit to his brain.

The doctor’s last thought was to marvel that a hallucination so real could smell so bad.