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I make both fanart and fanfic. I draw all my cover images myself, and I take art and writing commissions!


A filly waits in a small white room. Waiting for her friends to visit. "Hi! I'm Silver Spoon and I'm the Perfect Patient! What medical symptoms would you like to treat today?"

Winner of the Magic Fades and Science Grows contest on Quills and Sofas.

TW for lots of gore and emotionally cruel treatment of a child. Read with care, and if emotional child abuse is something you've experienced perhaps steer clear of this one. I think my initial trigger warning wasn't extensive enough, so apologies if anyone was disturbed by the content. This is a grimdark look at sentience, souls, and the way people/ponies treat things they perceive to be inhuman.

Chapters (1)
Comments ( 49 )

Christ, this is messed up... I love it, what an absolutely horrible and horrifying concept, I couldn't stop reading and it made me feel revulsion and abject sympathy at the same time and I wanna scoop up Silver Spoon and give her a big ol' hug and adopt her and her symptoms would only ever have to be the feeling of being cherished forever. Excellent work!

Can't wait to read more of this. How much more to go? Is it pre-completed?

I'm always interested in reading more non-traditional takes on horror, and this idea of a "Perfect Patient," with textbook symptoms that can resolve themselves if the doctor messes up...is so horrifying in a way that I can't even really describe. Like something as personal as sickness turned into a heartless robotic execution. To me at least, the story is also making an subtle implication that doctors see people as nameless creatures with symptoms..."imperfect" or "Perfect" patients. And as a patient, that's pretty damn terrifying.

I'm just wondering why you chose Silver Spoon as the Perfect Patient, over any other filly.

I think this story lends itself to becoming a very interesting original fic story, if you're interested in going down that route.

Shaslan #3 · Jan 3rd, 2022 · · 1 ·

It's complete, I think i misclicked when i was publishing! I chose Silver Spoon because I find the dynamic between her and Diamond Tiara really interesting -- it's a toxic friendship and Diamond is a bad friend, but Silver is loyal anyway. To me that makes her both a very loyal person and someone too weak to stand up for themselves. The perfect victim, vulnerable and too loyal to say no. That's why I thought she'd make such an interesting mind to go in the android.

Dang. That's... wow. I can only imagine what this would be like in other scenarios. More so what kinds of scenarios you could make with this concept.

Aside from the deeply disturbing premise of a society developing a general artificial intelligence, giving it the ability to feel pain and the mind of a child, and then inflicting it with various maladies to practice on, it's interesting to see the doctors using this sanitized template for their practice. No false positives, no extenuating circumstances.

Gee, it sure would be nice to practice being a first responder in an emergency situation without having to train myself to deal with distractions and emotional distress. Critique of the doctors not the writing.

While it's 'Complete' it leave many question like the typical "Why? How? When? Who? What?"

Hmmm.. hmmm... really gotta wonder just who came up with this. Why create a fully sapient AI that can actually feel pain and agony instead of an automaton that just simulates it, like they think it actually is? That's just sadistic.

Jesus Christ, Shaslan. Way to knock it out of the damn park.

Best horror fic I've read in ages.

[Added] Shaslan has expanded the content note/trigger warning in the story's description in the time since I wrote this comment. [/added]

For the first time ever I wish there were a warning tag for torture because, if I'd known, I'd have stayed away.

The story is good, it hits all the right beats, and is generally what one wants and expects from a description like that, but that ending . . . I'm sure if one has better mental health than I do, it's perfect, because fuck does it manage to go so much further than what led up to it, even though what came before was already dark and disturbing as can be.

Not something you're gonna see coming, either, since the rest of it operates on entirely different axes of horror and dread. I came in expecting things like the Redheart bit --callous disregard for the patient, treating a thinking feeling being as an object, torment that was incidental rather than an end in itself, and so forth-- which left me entirely unprepared for that end.

Wish I could say I enjoyed it, but the fact I didn't is down to my mental health, not any fault of the story or author. It's well written and well executed. Spot on for the characterization of Starlight and Cozy Glow, too.

“Deactivate vocal chords.” The surgeon’s voice is tight with stress, but suddenly the room is silent.

This seems ill-advised, even on the practice model. Unless there's a surgical-grade ball gag or time for an impromptu tracheotomy, Redheart won't be able to hit mute during an actual procedure.

And, of course, there's the question of why this sort of practice dummy needs what appears to be actual sapience. Do you want an AI revolt? Because this is how you get an AI revolt. Yes, bedside manner is a important as any other skill for a doctor, but in that case, you don't put the psychiatric AI in the body that feels genuine, traumatizing pain.

Don't get me wrong, this is haunting stuff, but in pursuing the reader's horror, it reaches a point of cruelty without justification where I can't maintain my suspension of disbelief. Still, fascinating concept. Thank you for it.

I'd argue that the story does have a justification for this: literally no one in the story is interested in medicine. Starlight wants to have her arrogance validated, Redheart wants to feel like she's still at her peak even though her scalpel is shaky and if she were to operate on a normal pony with the injuries she asked for, that pony would be dead, Diamond wants her friend back, Cozy wants a victim who can never stop being her victim. Silver Spoon wants to be helpful . . . and to not be in pain.

None of them care about whether this project serves a legitimate purpose, and --apart from the perfect patient herself-- none of them care about actually helping anyone.

Is this a terrible idea that serves no medical purpose? Yes. Does it matter? Only if someone with the power to do something about the fact it's a terrible idea cares about the fact it's a terrible idea. If anyone with that power cared, Silver wouldn't be in the situation she's in.

If somebody's rushed to hospital like that, instantly going to surgery, they're going to be given anaesthetics first, general probably. Also likely that in an actual case like that, shock and bloodloss might result in unconsciousness on its own, even without the surgery. Though I'm not a doctor or a medical professional, but I'm really hoping that's what they do. Turning off pain and vocal chords is... a really really bad way to simulate anaesthetics, though.

I'm also guessing they might not realise they have actual sapience in there, if they think it's simulating a personality they aren't going to think 'oh, it's got an actual personality this is wrong' because... it's supposed to simulate one of those. Not actually turn the simulation into the real thing.

Damn, this was a roller coaster, huh? You really feel for all the characters, even Cozy in a way.

But you most of all feel for Silver Spoon, it seems like she's still alive there in a way, or part of her. This is super bittersweet and that's exactly why I think it's so good.

Fluttershy's gonna wring someone's neck...

On that note, I'm pretty sure that giving someone like Cozy an "outlet" for their pshychotic urges doesn't actually help with anything.

Heh... No, no it doesn't, based on any sort of research on the topic. For obvious reasons, a little tricky to do empirically.

But, then, I don't think that's the point either here. None of it about actually doing any good... All about appearing to.

It actually makes her more likely to do the same thing elsewhere, but one could argue that that's part of the horror of the story: this is fractally wrong. No matter how deep you look, there's nothing good in this situation.

Starlight is "learning" that her unprofessional snap diagnoses are spot on, and so will continue to misdiagnose her patients, Redheart has become a monster (unless she already was one, in which case she's just gotten a new and different way to express that), Diamond Tiara has a Silver Spoon she can completely control, yet she still isn't satisfied, and is even more callous toward this one than the original (though that could be because it wasn't possible to do to the original what she can do to this one), which means Silver's only possible ally in this will continue to do the opposite of helping, Silver's life is an absolute unending Hell, and Cozy is being encouraged to take pleasure in outright torture, which makes her far more likely to do the same thing others.

The reason I consistently spoiler that last one, by the way, is because it's not actually something that's in any way implied by the story's description, or the parts that come before it. Insofar as the story has a twist/surprise/whatever you want to call it, it's what happens in that part.

Top-shelf medical horror that isn't about the ailments themselves. A refreshing and all too relevant theme that really pulls everything together.

What an absolutely marvelous story. A novel concept executed wonderfully!

And it provides so much to think on too - does Silver Spoon truly suffer, if its injuries are effectively perfect mimicries that can be done away with at a moment's notice, and it's memories able to wiped away at but a word? Is Silver a philosophical zombie, or are those passages of her running through the grassy fields her dreams, and if so, does that make it sentient? And if so, is it still unethical to use Silver as a tool to train medical professionals, given that no lasting harm is ever done?
Personally, while I deeply empathize with the day-to-day suffering that Silver goes through, I can't bring myself to say that she shouldn't be used as such anymore. Her creation was a cruelty, made to fill the hole left by Diamond's toxic relationship, and have that relationship replicated between Silver and every doctor she meets tenfold. Just as Silver took Diamond's abuse and still viewed her as a friend, Silver takes even more, worse abuse from her visitors, and views them as her friends while they inflict abuse on her. Silver's unfortunate fate, whether as a pony or an android, is to eternally feed the ego and sadism of the narcissistic and cruel. She's damned to a grassy field, running after a friend who left her behind.
But even then, that is her purpose for existing. She can't view anything beyond the symptoms she's told to have for treatment. Much like her real life relationship with Diamond, there can be no relationship beyond the abuse she's given, and her undying hope that she's their friend regardless.
She's Silver Spoon, the Perfect Patient.

I'm the Perfect Patient! What medical symptoms would you like to treat today?”

Chronic acute hug deficiency syndrome.

Well, this thing shouldn't be sentient is all I can really think of. There is no need for it to be, and it's a bear to accomplish and extremely resource-intensive. Unless they couldn't do it otherwise, which would actually make the situation pretty unpleasant. If this is the case is unclear, the 'memories' could be a faulty simulation loop coming from improper maintenance. 'They don't wipe the memory like I ask them to' isn't empathy, it's because the thing overloads and goes on a fritz, and then you have to clean up. Could also bring back bad memories for DT, this is all about the trip down the memory lane for her.

Starlight come in to practice. For her this is purely an intellectual exercise, and she is good at it. At least, unless 'Silver' lied to her, which would be a terrible thing to design.

Redheart comes in to test herself, to be aware of her limits. It's really up in the air if she fails because she's old and bad as others seem to think, or because the sim presented her with a situation with no winning solution. She even remarks on the fact that the sim's output doesn't really match the input but accepts it anyway. We don't ever get to see if she learns from this experience, and failing the sim is undoubtedly vastly superior to failing a living patient, cheating android or not.

Cozy, well, much less scary than canon one, that's for sure. At least here she's definitely a pony. I've no clue if what she does to 'Silver' is healthy, but there's no reason to doubt Starlight on this (having seen her in action exactly once). The alternatives could be worse, for everyone involved. Clearly she believes the sim is purely artificial, if intricate ('They really thought of everything') but it scratches that itch, and that is enough.

Basicly I don't really see this as horror at all. There's no logical reason to expect 'Silver' to be sentient and doubt the interactions' purpose.

Comment posted by Apple Bottoms deleted Jan 4th, 2022
Comment posted by Silent Whisper deleted Jan 4th, 2022
Comment posted by Shaslan deleted Jan 4th, 2022

Well, this one was certainly a treat and a half.

I like it when a horror story makes the characters involved—and us readers in turn—confront what weaknesses that lie within us. The blood, guts and icky stuff here is as violent and visceral as any other, yet where the horror really starts to sink in for me is just how nonchalant everyone here (except Silver Spoon, I guess) is acting towards it. We're seeing all of them in their moments of weakness, and they're don't seem to want to put up any sort of fight against it.

And yet despite it all, we can't help but be sympathetic for them because of their situation. Even Cozy Glow to an extent—which by the way, that ending? Haven't felt squeamish like that in a long time. I mean, it's just so rare for me to read something that makes me feel this helpless, especially on a site filled about tiny colourful horses, which only makes it all the more special when a story like this one comes around, sticks a cyanide-laced scalpel in your gut and twists it for a good measure.

TL;DR, I'm gonna go hug something now. Masterfully done, Shaslan!

It really hits when you realize that Silver Spoon is doomed to do this forever, and that's pretty horrifying in itself. All the doctors having their way with her, and her having no memories of it. She was designed for this, and she feels things, but she just an experiment like any other.

Reminds me of Vault 95 in a way, doomed to repeat the cycle because that's her entire purpose, and as it stands, it does a pretty good job.

Question: what's the difference? A sufficiently accurate simulation of pain and pain responses should be impossible to distinguish for an outside observer.

Deliciously dark.

The memories of the pain shouldn't leave the android crying and shaking after the simulation is over.

Ooooo I do so love fucked up little stories about Silver Spoon.

Oh, wow, that’s pretty f***ed up, in the best way as a story.
But I do have to wonder— why use Silver Spoon as the basis for the AI? Is there something from the show I missed? :rainbowhuh:

Well this concepts gonna stick with me I think, really interesting way to handle the characters but honestly I couldn't stop reading.

Horror with that "what have we become" vibe is pretty rare but this nails it, and god damn it makes me wanna strangle Cozy glow for hurting Silver Spoon

That’s pretty fucked up but in all the best ways. Amazing work on this


Cozy is being encouraged to take pleasure in outright torture,

So I'm going to assume it's your basic psychical torture then? Either way, thanks for reading!

I appreciate the warning.

They probably didn't consider that it was capable to reach sapience. For them it's just an android that you just slap some pain receptors on it and programmed it with a mind of a child(idk, maybe to test some weird mad scientist psychology theories on it). Considering Starlight's poor and unreliable assessment I guarantee they miss the sapient android part. Meanwhile, Nurse "I wanna test my surgical skills" Redheart just goes with the assessment and shows that she hadn't a single idea on how to do surgery. Diamond Tiara just abuses Silver Spoon by trying to make her like the original Silver Spoon. Finally, the doctor who has Cozy Glow's case thought it would be nice for Cozy Glow to use Silver Spoon as an outlet to "let it all out". Ultimately, all these dudes hadn't a single idea on what they're doing and an android who they thought as just an advanced AI that can feel pain and cry but somehow it wouldn't achieve sapience paid for it dearly.

The exact details aren't specified --it's sort of a "fade to black" thing-- so I can't be too specific here, but yeah, physical torture. She even turns Silver Spoon's pain response up so that it'll hurt her more than it would hurt a normal pony. Mind you, there are definite psychological aspects to that, because Cozy is clearly enjoying not just the physical pain she causes but also the psychological trauma she induces.

I mean, I get the psychological component.

It just doesn't feel like Cozy to enjoy carving up a realistic pony facsimile. Remember her reaction to Chrysalis feeding? She's not someone who strikes me as being able to handle something like that.

And if Starlight (with Twilight's and the rest of the Main Six's backing*) decided to train Cozy Glow to be accustom to gore, to give her physical ways to cause pain, then whatever happens next is on them.

*Because let's be real, Starlight is emotionally co-dependent on them. She wouldn't have gone ahead with something this controversial without their say so. Not even just the synth, but letting Cozy out in the first place.

So, I'm about to drop a massive comment about brains, mental health, and sapience, but I figured this should be split off instead of lost in there.

The memories of the pain shouldn't leave the android crying and shaking after the simulation is over.

Technically, they didn't.

Redheart essentially left the simulation running. Until Diamond wiped Silver's memories, Redheart's simulation was still ongoing. And, like, there's arguably a use for that (provided you have no ethics, but that goes for everything here.)

If you're interested in mental health, and they theoretically are, then there's no reason to stop simulating just because of a failure to save Silver. From the patient's point of view, dying and being revived is gonna look identical to temporarily passing out, so having her be revived isn't gonna invalidate the accuracy of the post-surgery psychological trauma.

The fact that she was healed entirely by the reassemble command might invalidate it, but having resetting her body unlinked to resetting her memories also might be useful for studying (and practicing for) cases where a patient experienced physical trauma but for some (presumably magic-related) reason left with no physical aftereffects, if such cases are possible in Equestria.

Continuing to run the simulation while the doctor isn't physically present could also have various uses. Especially with things where you're interested in more than the immediate outcome.

Say Redheart had saved Silver in the short term, but her suture work had been shoddy and Silver died two hours later because of it. If you accept the premise that hurting someone who can be nigh instantly healed from any injury is intrinsically better than hurting someone who can't,* then it's better for Redheart to learn she needs to improve her suture work from that than by having one of her ordinary patients die from it.

* Which you very much should not, by the by. A victim's resilience in no way negates the harm done to them.

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So, given that the question of sapience has come up repeatedly, I feel like there are some things worth bringing up.

The Perfect Patient™ is apparently meant to be able to simulate any symptom for any doctor, which isn't actually the best idea. I'll probably come back to that for a more general thing, but I want to focus on two things.

The first is brain shit. Not psychological stuff, stuff involving a physical brain.

If you make a sufficiently accurate simulation of the brain of a sapient creature, and it's functional, and you leave it running for any length of time, it's going to be sapient. Full stop, it will. It can't not be. Sapience arises naturally out of physical processes, and if you duplicate those processes, you duplicate sapience.

The second is mental health, because it's basically inseparable from sapience, meaning at sufficiently accurate simulation of it as a whole (regardless of what physical processes may or may not be simulated) is likewise going to sapient.

What follows is a lot on the reasoning behind those points.

Historically, we learned about brain function from head injuries. Someone would have this or that part of their brain damaged in a non-fatal kind of way, we'd notice what changed about them, and we'd conclude, "Oh, that part of the brain must govern [whatever]." Now we have things fMRIs and we can see where activity is taking place, which means we don't have to wait for someone to, say, get an iron bar driven through their skull* to make such connections, but it used to be a very much "This part gets broken, then those processes don't work right" thing.

Even with fMRI technology, we can't really know what effect "This specific thing happens right here" will have on a person unless/until it happens. We know whether it's being used in a given process, that doesn't tell us what the effect will be if it stops being used, or if how it's being used changes, because brains are incredibly complex interconnected machines with feedback loops and snowballing processes.

So even with our technology, if you really wanted to know what would happen if you did X instead of Y in the course of brain surgery, you'd have to do both on people. Repeatedly. Ideally with people as similar to one another as possible, to reduce confounding factors.

Enter Silver Spoon, where you can do one, then reset, and do the other, and repeat as many times as you want. She's more useful to an ethically questionable neuroscientist than an infinite supply of clones that lack human pony rights, because you can do the different things to the exact same person. No confounding factors whatsoever.

It only works if she's having actual mental processes, though. If she merely looks like she's having mental processes without having them, that doesn't tell you what your operations are doing, but instead tells you what the person who programmed her thinks your operations will be doing.

So let's talk about swearing. Because it's a lot simpler than, something like the many and varied effects of childhood lead exposure on a person.

If we wanted to fake mental processes, we might program her to swear when she's in sufficient pain or faking sufficient anger and leave it at that. If we want to do medical analysis, that won't do.

We don't necessarily need a prefrontal cortex, cerebellum, striatum, subthalamic nucleus, thalamus, globus pallidus, cingulate cortex and whatever swear-related brain bits I'm leaving out, but we need things that function as they would vis-à-vis swearing because the process of swearing involves complex interchanges between them, and to model that properly you need to treat them as distinct things that do distinct things, contribute to the process in different ways, and react to injuries or other aliments differently.

We don't necessarily need dopamine, serotonin, vasopressin, and testosterone, but we need to have something in our simulation that accounts for their levels and effects on the parts of the brain involved in swearing.

That's just to get Silver to say the word, "Fuck," extemporaneously, which is gonna be necessary if we want practice diagnosing the physical cause of coprolalia or we want to test treatments thereof. (And note well that if we just created what we expected to matter instead of everything, the cerebellum would probably have been left out, which would fuck up everything.)

She's supposed to be for everything though. If you want to simulate every brain injury (be it as the original symptom or the result of the surgical procedure being practiced/analyzed) then suddenly for every single part of the brain we need something that functions the way that part does vis-à-vis everything. Whether you want it to or not, that's necessarily going to function the way a brain does vis-à-vis sapience.

It's not like there's a Sapience Switch you can flip off, sapience naturally arises from the processes you're duplicating. We might not know how many of them it takes to be sapient, but we definitely know that something that has all of them is sapient.

Thing two is shorter. See everything above is about the physical aspects of the diagnosis, treatment, and analysis that Silver exists for, and sapience ultimately arises as a byproduct of that. Thing two, though, it's about thinking and feeling itself, which is pretty directly related to sapience from moment one.

Silver is supposed to simulate psychological problems for practice of diagnosis and treatment. The ailments she's simulating here operate in the realm of thoughts and feelings, which means that the only way to perfectly reproduce them is for there to be thoughts and feelings for them to affect. ​To do otherwise would be like if a surgeon used Silver to practice appendectomy without Silver having an appendix for them to remove.

Like, there is no physical definition of depression, which happens to be the single most common psychological ailment, and there never will be one. Depression is a complex set of interrelated symptoms, and it can have a ton of different causes. By definition, it's all about cognitive processes themselves instead of their physical causes, which means that to simulate it you have to duplicate those cogitative processes every bit as much as you need duplicate flesh and bone to simulate a surgery.

And, again, she's meant to be able to simulate all symptoms/conditions. So it's not just that, say, her executive function needs to be affected by, say, depression and/or ADHD the way and actual person's would, it's that needs to be affected by everything the way an actual person's would. At that point there's no meaningful distinction between her executive function and that of a sapient pony. Repeat for every component of a person's mental functioning, because everything can go wrong, and even when it doesn't go wrong how it interacts with the other components can have major impacts on both diagnosis and treatment whatever did go wrong.

At which point you've created a complete person, with thoughts and feelings and memories, just like the rest of us.

tl;dr: A sufficiently accurate simulation of a physical brain, if allowed to function, will be just as sapient (or non-sapient, depending on the brain) as an actual brain. Sapience thus would necessarily arise as byproduct of making Silver Spoon's physical body mimic that of a normal pony on the level that it does.

Likewise, whether one wants to admit it or not, if one is trying to make a completely accurate simulation of mental health, sapience is the goal, because mental health is defined in terms of the things that define sapience, and when all those things are taken together as a functioning whole, that whole is necessarily sapient.

Silver Spoon being sapient wasn't necessarily intentional, but it was basically inevitable. The focus on accuracy over ethics, when combined with their tech/magic level, couldn't really lead to any other outcome. Not when the accuracy applies to Silver's complete mental and physical health.

Shortest version:
Brains are gonna brain, so if you make a brain, it'll brain.
Mental health is entirely about how brains brain, for a perfect emulation of it, there needs to be braining going on.
Silver has a brain and was made to perfectly emulate mental health.
∴ Silver's ability to brain was inevitable twice over.

* See: Phineas P. Gage (1823–1860) whose injury taught us a good deal about what the left frontal lobe does.

Oh, I don't dispute that brain-like objects will brain given sufficient proximity to brainhood. I just think that the brain doesn't need to be a feature for the people working the liver et al.

Granted, this does lead to a lot of complicated lump/split discussions over which seemingly unrelated procedures actually call for the brain-bearing practice dummy, but I feel like I've missed the actual point of the story enough as it is. :derpytongue2:

Hmmm I was suspecting that it's not really a "built" thing, but the actual Silver Spoon that ended up like this due to some magical mishap in trying to save/revive/something when she died. And then got coopted for this as a lesser evil thing.

Ok this was sweet till that last part… oy!

That was good! A nice bit of thoughtful sci-fi.

Blood? Pfft, let me tell you about color theory 😤.

All joking aside, this was a nice, dark, read and found myself enjoying it on this nice lazy Friday. Keep up the good work.

Wow, this was much better than I thought it would be.
Kinda want some explanation or expansion, but it's a really good story.

A smile spreads across her muzzle as she runs. It’s a brand new day, and she gets to spend it with her best friend in the world.

perfect way to start a story that is undoubtedly going to be horrific

The door swings shut behind that tailored white coat. There is no reply.

great way to subtly introduce the de-equinization here

The mare smiles. “No need.” She reaches into a pocket and produces a pair of small blue glasses, the plastic frames faded with age.

augh, perfection! love the bittersweetness in this section. you could really cut it and eat it with a knife

Cozy Glow smiles wider. “Same as always. My own.”

and, oof. took me a second to parse this… 

loved the structure of the entire piece! the innocence of Silver Spoon’s dreams between the sections, the way each section explores a different attitude and mindset to the Perfect Patient’s use, and the way that the most heartwarming section of Diamond Tiara comes right before the end, which was foreshadowed by Starlight’s very first case, is all just so excellently done. and as any good horror does, it raises questions about the distinction between the simulated and the real, the limits of empathy, and what it means to give impulses toward cruelty an “outlet”. beautiful work!

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