"It's not my birthday," she says, apparently talking to the balloon.

The balloon shifts – another whispery crinkle – and drifts to the center of the room. Miriam looks at herself in the mirror. Both eyes are bruised. A rime of crusted blood rings her nostrils.

"This is a dream," she says.

The balloon turns slowly – on the back is another message.

A skull and crossbones are where the cake should be. From the skull's open mouth, emerging through crooked, jaunty teeth, a comic strip word bubble: Happy DEATH-day, Miriam.

"Cute," she says, and she thrusts up with the knife.

The balloon pops.

And it sprays blood everywhere. Black blood. Thick with clots. Miriam wipes it off her face, spitting. It runs down the mirror, globs of rusty treacle. Bits of pale tissue are trapped in the flow like maggots in tree sap. She's seen this before, seen this kind of blood. (On the floor, on the bathroom floor.)

She doesn't know why, but she runs her hand across the mirror, wiping a clear spot away so she can see her reflection.

What she sees surprises her.

It's still her, the reflection. But she's young. Chestnut hair pulled back and tied with a pink scrunchie. No makeup. Eyes wider, fresher, that glimmer of innocence.

Then, movement behind her, in the reflection, obscured by coagulating clumps of gore.

"Nine more pages," says a voice. Louis's voice.

Miriam wheels, but it's too late. He's got a red snow shovel.

He cracks her across the head, laughing. All goes dark. As she's drawn deep into the well of unconsciousness, she hears the squalling cries of a child, and then that fades, too.

She wakes to the antiseptic stink of a hospital. It crawls up her nose. It nests there.

Her hands clutch the sheets. She struggles to get out of bed, to swing her feet over the edges, but the sheets have tangled her, and the bed is edged with a metal rail that she cannot, not for the life of her, seem to overcome. It's as if they form an invisible perimeter. It's hard for her to get air. Her lungs won't draw full breaths. She feels trapped, like in a box, in a coffin. Sucking breath, tight throat, gasp.

Hands reach out suddenly – hard hands, heavy hands – and they grab her ankles and, no matter how hard she struggles, buckle her feet into cold rubber stirrups. The palms feel greasy, wet. A face emerges from the edge of the bed, rising up from between her legs.

It's Louis. He tugs aside a mint-green surgical mask with blood-stained fingers.

"There's been a lot of blood," he says.

Miriam struggles. The sheets have coiled around her hands. "This is a dream."

"Could be." Louis reaches up and scratches the edges of the electrical tape X over his right eye. "Sorry. The tape itches."

"Get my legs out of those stirrups."

"If it's just a dream," he says, "why not just wake up?"