The morning call came at precisely 7:43 AM, as it always did, with Bethany's voice crackling through the intercom like sugar dissolving in weak tea: "Good morning, Mr. Pemberton! Today's shoot is for Anxiolytin. Please report to Soundstage C in your blue cardigan. Remember—you're playing a grandfather who's rediscovered joy!"
Keith Pemberton rolled out of his regulation twin bed and shuffled to the window of Cottage 47-B, where the trade winds carried the perpetual scent of hibiscus and industrial-grade makeup remover. Beyond his postage-stamp garden (maintained by invisible hands during the night shift), the island spread out in its peculiar geography of authentic desperation masquerading as pharmaceutical optimism.
To his left: the sprawling complex of soundstages, each one a hermetically sealed universe where chronic conditions bloomed into thirty-second narratives of redemption. To his right: the village of cottages, arranged in concentric circles like a suburban Panopticon, housing the island's population of 847 professional patients. And there, dominating the horizon like a wedding cake left too long in tropical heat, stood the Director's mansion—all veranda and colonial pretension, its white columns gleaming with an accusatory brightness.
Keith had been on the island for three years, two months, and sixteen days. His contract, printed on paper so thick it felt like skin, guaranteed him a lifetime supply of Tramadol for his degenerative disc disease, plus room and board for himself and his daughter Sarah (who had arrived six months ago to treat her fibromyalgia with a cocktail of experimental compounds). The work was steady: twelve to fifteen commercial shoots per month, playing various iterations of himself—the relieved arthritic, the grateful insomniac, the man whose restless leg syndrome had been conquered by pharmaceutical grace.
The island operated on the principle of perpetual performance. Between takes, Keith had noticed, the other residents never quite dropped character. Mrs. Kowalski from 23-A still wore her "migraine survivor" expression even while shopping for tinned peaches at the company store. Young Tommy Chen maintained his "childhood asthma warrior" posture whether he was filming or playing volleyball on the communal court. It was as if the island's atmosphere itself was laced with method acting techniques, making it impossible to distinguish between therapeutic effect and theatrical imperative.
The Production Assistants moved among them like benevolent shepherds, their clipboards gleaming in the perpetual sunshine. They possessed an unsettling quality of total availability—appearing at the precise moment one needed a tissue, a script revision, or a gentle reminder about medication schedules. Bethany, with her helmet of peroxide curls and smile sharp enough to open letters, had once told Keith, "We're not just making commercials here, Mr. Pemberton. We're creating hope itself!"
But hope, Keith had begun to suspect, was the island's most carefully manufactured product.
Take the matter of the mansion. The Director—known only as "The Director," never by name—could occasionally be glimpsed on her expansive veranda, always dressed in crisp whites that seemed to repel both wrinkles and humidity. She held court with visitors who arrived by private seaplane: pharmaceutical executives, advertising moguls, occasionally what appeared to be government officials with the pallor of people who spent their lives in windowless buildings. Keith had tried to approach the mansion once during a break between shots, only to find himself inexplicably turned around, walking back toward the village with no memory of changing direction.
The island's mythology suggested The Director had once been a patient herself—that she had suffered from a rare condition requiring an even rarer cure, and that her recovery had been so remarkable, so cinematically perfect, that she had transcended her role as subject to become the island's presiding deity. But myths, Keith knew, were just stories that had gotten too comfortable with themselves.
His daughter Sarah worked primarily in the fibromyalgia campaign, a series of spots that required her to progress from pain-wracked despair to cautious optimism to full-bodied joy over the course of a treatment cycle. The progression was filmed out of sequence, naturally—Tuesday might find her shooting "Week Twelve: Dancing Again," while Wednesday called for "Day Three: First Signs of Hope." Sarah had mentioned, during one of their carefully supervised family dinners, that she sometimes forgot which version of herself she was supposed to be.
"Do you think," she had whispered, leaning across the table in the commissary, "that we're getting better or just getting better at pretending?"
Keith had looked around at their fellow diners—hundreds of people whose faces he recognized from television, whose testimonials had become the elevator music of American pharmaceutical anxiety—and realized he had no idea how to answer.
The island's economy ran on a complex system of medical barter. Residents received their medications according to their commercial performance schedules, their dosages calibrated not just to their conditions but to the emotional requirements of their roles. Keith noticed his Tramadol came in different strengths depending on whether he was shooting a "breakthrough pain" sequence (requiring authentic grimaces) or a "back to normal" montage (demanding pharmaceutical-grade contentment).
At night, when the soundstages went dark and the Production Assistants retreated to whatever dimension spawned them, Keith would sometimes walk to the island's edge and stare out at the dark ocean. Other islands dotted the horizon—some said they housed the people who appeared in life insurance commercials, others claimed to see the distant glow of the Depression medication archipelago. But these were rumors, stories traded like contraband during the brief interludes between pharmaceutical performance and pharmaceutical sleep.
The island's most closely guarded secret was not its location (somewhere in the Caribbean, probably, though GPS devices had a way of malfunctioning here) or its funding source (a consortium of pharmaceutical companies that had transcended national boundaries to become something approaching a small nation-state). The secret was simpler and more terrible: the island worked.
Keith's back pain had genuinely improved. Sarah's fibromyalgia had entered a remission so complete it felt miraculous. Mrs. Kowalski's migraines had vanished. Tommy Chen's asthma had all but disappeared. They were living testimonials to the power of pharmaceutical intervention, their bodies transformed into evidence of medical progress.
But Keith had begun to suspect that their improvements had less to do with the medications than with the island itself—its perfect climate, its stress-free environment, its complete absence of the grinding anxieties that had driven them to seek pharmaceutical relief in the first place. They were living in a kind of medical utopia, a place where sickness was treated not just with pills but with purpose, community, and the warm embrace of perpetual summer.
The realization should have been liberating. Instead, it felt like the most sophisticated trap imaginable.
On his 1,200th day on the island, Keith received an unusual request. Instead of his normal grandfather-in-recovery role, he was asked to appear in a different kind of commercial—one for a medication he had never heard of, for a condition that seemed to affect people who had spent too long in pharmaceutical advertising.
"It's experimental," Bethany explained, her smile somehow more pointed than usual. "A treatment for what we're calling 'promotional fatigue syndrome.' You'll be perfect for it, Mr. Pemberton. After all, who better to sell a cure for commercial acting than someone who's been doing it as long as you have?"
Keith looked up at the mansion, where The Director stood on her veranda, a white figure against white columns, fanning herself with what looked like a script. For just a moment, he thought he saw her wave.
The shoot was scheduled for the following morning. The medication, he was told, was delivered in a very special way—not through pills or injections, but through something called "narrative integration therapy." Keith wasn't entirely sure what that meant, but Bethany assured him it would all become clear during filming.
That night, Keith packed a small bag with his few personal possessions and walked to the edge of the island. A small boat was waiting there, its engine running quietly in the darkness. The captain was a woman he had never seen before, wearing clothes that seemed to belong to no particular era.
"Where are we going?" Keith asked as he climbed aboard.
"The mainland," she said simply. "Though I should warn you—the medication wears off once you leave the island. Your back pain will return. Your daughter's fibromyalgia will flare up again. Mrs. Kowalski's migraines will come back with a vengeance."
Keith looked back at the island, its lights twinkling like a pharmaceutical constellation. Somewhere in Cottage 47-C, his daughter was sleeping the deep sleep of the medically managed. Somewhere in the mansion, The Director was probably reviewing scripts for tomorrow's shoots, each one a small story about suffering transformed into hope.
"But we'll be real again?" Keith asked.
The captain started the engine. "As real as pain can make you."
As they pulled away from the dock, Keith saw a figure in white standing on the beach, waving goodbye. It might have been The Director. It might have been just another patient, dressed for an early morning shoot. In the pharmaceutical twilight of the Remedial Isle, it was impossible to tell the difference.
The island grew smaller behind them, its promise of perfect health receding into the distance like the memory of a dream that had lasted too long. Keith felt his back beginning to ache as the first rays of dawn broke across the horizon, and found himself smiling despite the pain.
After all, what was authenticity without a little suffering to prove it was real?
End
Fantastic. You’ve got a future in dystopian fiction.