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Even if Susannah doesn't recognize it as such, she's experiencing a visual hallucination. The text style (not italicized) in the book is what clues the reader in on the fact that she doesn't recognize this for what it is; it's just an occurrence that feels like it must be real in her deteriorating mind. Her lack of fear also shows that at this point she still trusts her perceptions, and isn’t able to accept that what she’s seeing might not be really there.