The Physicians of Vilnoc

by Lois McMaster Bujold

  Adelis flicked his gaze aside at Pen’s wince and, perhaps wisely, elected to let this outburst pass unremarked. “Penric, this is Orides’s senior apprentice, Master Rede Licata. Our second medical officer.” First, now, apparently, and by Rede’s indrawn breath he was just realizing the full burden that had fallen upon him. “Master Rede, this is Learned Penric kin Jurald, Duke Jurgo’s Temple sorcerer. He and his demon, Madame Desdemona, have experience in medical matters, and I trust will be able to help us sort out this crisis.”

  Adelis did not, to Pen’s relief, name him a physician outright. Though the general’s touch to the burn scars marring the upper half of his face like red-and-white owl feathers, which framed eyes that could again see out, suggested he was tempted to. Des just preened a trifle at the rare nicety of being separately introduced.

  Only the continuing swipe of his hand through his hair betrayed how harassed Adelis was feeling. With a chin-duck toward the cot, he went on, “When did he pass?”

  “Not half the turning of a glass ago.” Staring down at his late mentor, Rede rubbed the back of his wrist over his reddened eyes, and finally thought to offer, “It was probably already too late by the time you rode into Vilnoc this morning.”

  Adelis hissed through his teeth. “I daresay.”

  The smell of death was a misnomer, and really didn’t apply till a corpse was well along, but the stink of sickness here masked all else, despite the diligent efforts to keep the chamber clean. An orderly glanced up from holding a basin for another patient to weakly vomit into, and called to Rede, “I’ll help you lay him out next, sir.”

  Rede waved him back to his task. “He’ll wait for us now.”

  “That feels so strange. He was always hurrying us along.”

  “Aye,” sighed Rede. He made to draw the stained sheet up over Orides’s face.

  Pen raised a stemming hand. “I had better take a close look at him.”

  “Oh. Yes.” Rede grimaced. “I think he would actually appreciate that.”

  Adelis stood back, arms folded, face grim, as Pen, Rede looking over his shoulder, bent to examine this most notable victim of the mysterious malady. He folded the cover all the way down and studied the corpse systematically from the toes up, neglecting no part.

  Alive, Orides’s skin had been the color of some warm wood or spice. It was darkened all over now to a grayish sort of blotchy purple. No external eruptions or lesions, though his pulpy flesh had started to break down at the pressure points where he’d rested on the cot, the bedsores looking like ones developing for weeks, not days. Eyes, ears, nose, and the inside of his mouth were traced with drying blood but not otherwise markedly different from any other dead man’s. No special tell-tale stenches. The sunken flesh was similar to the parched state of several common diseases that rendered persons unable to keep any fluids down.

  Sight again, please.

  His soul is taken up.

  Yes. But give me everything material you can.

  The room faded away, and the weird, familiar sense of descending like a disembodied eye into a miniature somatic world replaced it. So, the empurpling was bruising, of a sort; not from blows, but as if the tiny blood vessels had disintegrated from the inside out, leaking their contents to coagulate and darken. The effect was apparent all through the body, not just at the skin, including in the lungs and gut. Pen extracted his extended senses as though pulling himself out of a bog. The sense of sticky horrors clinging to his skin was illusory, he reminded himself firmly, though he wanted to wash his hands at his first chance.

  Mindful of the sick men in the beds nearby, Pen lowered his voice. “The victims vomit, cough, and pass blood?”

  “Toward the end, yes. It’s the sign.” Rede’s mouth tightened. “Master Orides knew.”

  “Had he performed any autopsies on the earlier deaths?”

  “Yes, the first two.” Rede’s glance also went to the wary eavesdroppers on the nearby cots. “If you’ve seen all you can, Learned, perhaps we should take this conversation to the courtyard.”

  “Ah. Yes.”

  Rede covered his master’s body once more, and made the holy tally sign with an extra tap to his navel. They shuffled back out to the bright courtyard, Adelis himself holding the curtain aside and exiting with alacrity. He was a brave man, Pen thought, but this wasn’t the sort of enemy he could face with a sword or spear, for all that it was killing his soldiers in front of his eyes.

  Rede sank down on one of the stone benches under the colonnade, squinting through puffy eyelids. In this better light, he looked even more strained, and Pen wondered when he’d last slept. Probably not last night. Adelis leaned against the nearest pillar, head bent with the labor of listening hard—not to their low voices, but to what they conveyed.

  “I suppose I should begin with the obvious questions,” said Pen. “What is the course of this thing? How does it first present?”

  Rede shrugged in frustration. “At first, it appears as a common fever, the sort that passes off on its own with a few days of rest. Headache, and pain in the joints and muscles, loss of appetite. After a day or two, stomach pains start, with loosened bowels, again nothing unusual. The first certain sign is tiny spots under the skin, hard to make out. Then the skin starts to bruise, the spots growing to blotches and coalescing, as you saw. Then bloody or darkened stools and labored breathing. The descent into death is swift after that, three days or less. Altogether, from four days to a week.”

  “Have any men recovered on their own, or had milder cases?”

  “Some are still alive after ten days, though I dare not name it recovered. Half, perhaps?”

  “Hm. So, contagion, or contamination, do you think? Plague, or a poisoned well or the like?”

  Rede’s brows twitched up, as if the latter thought was new. By Adelis’s jerk, it was an unwelcome idea to him, too. “I… Master Orides thought contagion.”

  I think Master Orides was correct, Des put in, thoughtfully. Or at least on the right trail.

  Pen set aside the distracting memory of the famous possibly-poisoned well on the island of Limnos, which had historically destroyed an occupying army.

  “Who were the first to fall ill? Is there any pattern?”

  “Master Orides and I were puzzling over that. The first to die was our chief farrier, who’d been a strong man in excellent health. But the next was a quartermaster’s clerk. Four foot soldiers. A cavalryman. A groom. Just last night, a laundress, the first woman. One of our own orderlies. And, now, our physician.” That last seeming a heavier loss to Rede, and possibly to the fort, than all the rest combined.

  “Any word of outbreaks in the village below?”

  “The laundress was the first. I fear not the last. I’ve not yet had a chance to go down and ask.”

  “Someone should be sent for a census.”

  Adelis frowned, but nodded.

  “So you… you are a sorcerer,” said Rede, looking Pen up and down in perhaps justifiable doubt. “What can you do?”

  So much. So little. Pen muffled a distressed sigh. “Have you ever worked with a sorcerer, or a Temple sorcerer-physician, before?”

  “I’d never even met one. …Master Orides mentioned doing so once, but he didn’t tell me much. Something about destroying the painful stones in the bladder.”

  “Ah. Yes. One of the easiest and safest procedures, and among the first taught. Much better than that thing with inserting the horrible spatula.”

  Rede nodded in a way suggesting he knew that ghastly technique first hand. Adelis, hah, cringed.

  “The first thing you must understand is that my god-gift is chaos magic. It tends, and lends itself, most naturally to destructive procedures—downhill, it’s dubbed. Of which there are more in medicine than one might think. But those can only clear the way for the body to heal itself, as the bladder cleans itself after the obstructing stones are rendered powder. Sometimes tumors can be destroyed.” Sometimes not. “Intestinal worms also, though really, an apothe
cary’s vermifuge does just as well.” The wrenching urgent treatment for the fetuses misplaced outside the womb was the most delicate and advanced of all that downhill roster, and nothing Pen cared to discuss with the army physician. Or anyone else.

  “So… is there then uphill magic?”

  This boy is quick, Des purred in approval.

  Pen nodded. “But it comes with a higher price than the downhill sort. A sorcerer can create order in, well, a number of ways, but then must shed a greater amount of disorder, somehow. If a sorcerer tries to do too much at once, or can’t soon shed the excess of chaos, he or she is afflicted with a sort of heatstroke. Which can be as lethal as any other heatstroke.”

  “Oh. That, I had not heard of.” Although from Rede’s intent look, he understood and had undoubtedly treated heatstroke among the soldiers, no surprise in this climate. But then his nose scrunched up. “How in the world do you shed chaos? What does that even mean?”

  Rede, Pen hoped, wasn’t going to be a man baffled by technical vocabulary. He wouldn’t have to water down his explanations.

  “The area around the sorcerer suffers accelerated deterioration. Ropes fray or break. Metal rusts. Wood rots. Cups slip and spill or shatter. Sparks burn holes or set things alight. Wheels fall off, saddles slip, mounts go lame. The events aren’t, usually, inherently unnatural, just their concentration and speed. Which is why an untrained hedge sorcerer is ill-advised to travel by ship, by the way.” And then there were the tumors arising in the sorcerer’s own body, which probably killed more inept sorcerers, in the long run, than uncanny heatstrokes. “Half my Temple training consisted of learning tricks to direct my demon’s chaos safely outward to theologically allowable targets.”

  Rede was still listening intently, not interrupting this flow. Pen took a deep breath.

  “The first magic my demon ever showed me was how to kill fleas and other insect pests. It turns out that the swiftest, most efficient sink of chaos is killing: the fall from life to death is the steepest slope of order to disorder that exists.”

  And the climb up it, as life built itself freely from matter in the world, its equally miraculous reverse. As Florina had just brought home to Pen most profoundly, but really, miracle was to be found in every breath and every bite of food he took, if he was mindful.

  “So if I’m called upon to do much healing, I’ll soon need to find some better sink for the chaos than a few bedbugs. We can deal with that later. The point is, my uphill magic doesn’t cure or heal in a direct way. It fosters improved order in another’s body so it may more speedily heal itself.

  “So the other limiting factor, besides the need to find a chaos sink and the hazard of heatstroke, is how much help a body can accept at a time. I can no more force an injury to heal all at once than a man can eat a month of meals in a sitting. Repeated small applications are required.

  “It follows that if the sickness is progressing faster than the body can digest my help, my attempt will fail. If the disease has gone past the point of no return, my magic will be wasted.”

  “You healed me,” Adelis protested uncertainly. Rede glanced up at his commander’s sober, scarred face, and his eyes widened in realization.

  “I can heal a man. I can’t heal an army. If many people end up afflicted, rationing my efforts is going to be required.” Pen frowned unhappily at Rede. “We may be forced to choose my patients wisely and cruelly. As a legion’s physician, you must know how that one works.”

  Rede rubbed his brow. By his matching unhappy frown, he was following this better than Adelis. “I’ve not yet attended on a battlefield, but Master Orides would sometimes speak of that problem, yes. If we could get him in his cups.”

  Pen nodded. “From the outside, my results look random, even though they’re not. But when fears and hopes rule in such a hectic mash, it can generate unfortunate misunderstandings about my sorcery.”

  “You sound as if you speak from experience,” said Rede. “Like Master Orides.”

  Pen gave a capitulating wave of his hand. “Two of my demon’s prior riders were active physicians in the Mother’s Order. Counting their whole careers both before and after they were gifted with a Temple demon, it adds up to something like ninety years of medical practice.” Leaving aside his own fruitful, fraught five years of attempting the trade back in Martensbridge. “Given I’m only thirty-three, the effect can sometimes feel… odd.”

  Adelis’s eyebrows rose at this. Had he never done the arithmetic?

  An officer entered the far side of the courtyard, spotted Adelis, and headed determinedly toward him. Adelis shoved himself off the pillar to meet him partway; they conferred in low tones, then the fellow stood aside and waited. Adelis turned back to the pair on the bench.

  “I need to attend to this. I’ll leave you two to get on with it, for now, but report to me as soon as you have something substantive to add, Pen.” For all the world as if Pen were one of his soldiers—score to Nikys.

  Desdemona seized control of Pen’s mouth. “Adelis, a word before you go.”

  “Hm? Is that you, Madame Desdemona?”

  “Aye, boy.”

  Rede looked startled. “The demon speaks through his mouth?”

  “Yes,” sighed Pen.

  Rede looked to his commander. “You can tell them apart? How?”

  “Practice,” said Adelis wryly. “I grant, some days I just give up and think of them as my sibling-in-law.”

  “Howsoever,” said Des, for once unamused. “I’m going to let you conscript him for this, because halting him now would be hard. But you have to make me a promise in return.”

  “Oh?” said Adelis, with due caution.

  “You’ve set him onto this road, so you have to tell him when to step off it. Because he won’t be able to stop, and then we’ll end up having another bloody argument about it. Shut up, Des.” Pen closed his mouth with a snap. But she muscled in for a codicil: “You’re the man in the saddle here, General Arisaydia, which even Pen must concede. This must be your load to lift.”

  “I am not much inclined to let a chaos demon dictate my duty, but I do take your point, Madame Des. We’ll see.”

  “Evader,” she muttered to his back as he trod off.

  “But honest,” said Pen. “One of his better traits, surely.”

  “Hah.”

  Rede had watched this exchange with increasing… not mistrust, exactly, nor disbelief, but maybe the wondering air of a man waiting for more evidence. True to his trade, that.

  Pen clasped his hands between his knees, contemplating what must come next. First. Next-first. “Des, in your two centuries have any of you, physician or not, seen this particular sickness before?”

  “Plagues and contagions, yes, but…” She shrugged with his shoulders. “There are only so many ways disease can break a body down. So the array of symptoms are for the most part familiar. That dire all-over bruising is the one new thing. Very diagnostic.”

  “The most urgent,” Pen began, “no, the most important is to find out how it passes from its source to people, or from person to person if that’s what it’s doing. Right now, I need to test how much simple uphill magic can do. Which we’ll only find out by trying it.” He unfolded to his feet, Rede, after a tired moment, shoving up from the bench likewise. Pen added to him, “When we go back in, don’t introduce me as a sorcerer. Just as a learned divine brought in by their general to pray for them. Which actually won’t be a lie. But it would be very bad to raise false hopes at this stage.” He added after a moment, “Or false fears. Some people have wild ideas about magic. And not just Quadrenes. I’m usually pleased to tutor anyone who will listen, but now isn’t the time.” And after another, “Except for you. You need to know.”

  “Yes,” said Rede heavily, “I do. Show me.”

  Rede led him to the door of the next chamber past where his dead mentor lay. Pen thought to ask, “How many men brought into your care do you have still alive?” How far was he going to have to stretch hims
elf?

  “About thirty, at last report. Two more brought in this morning. Less one, now.” His face set, doing this mortal summing.

  Rede lifted the leather curtain, and Pen took a breath and forced himself across the threshold.

  Six cots, again. One man was still able enough to be helped to the commode chair by two orderlies. Three of the afflicted were quite young soldiers, the others older but not old. Five times Pen knelt by cots and said, “Good day. I’m Learned Penric of the Vilnoc Temple, sent to pray for you,” which was accepted without undue puzzlement, and once with a feeble smile and thanks. He made the tally sign over them, laid a palm on each flushed chest, murmured more rote blessings, and quietly let as much uphill magic as Des could produce wash into them.

  The sixth man, skin purpling, his breathing labored, was bleeding from his nose and swollen eyes, being sponged clean by a worried orderly. He did not react to Pen’s greeting. After a brief glance within his rotting lungs and gut by Sight, Pen just knelt and prayed.

  Sweat was trickling down his back and beading at his hairline when Pen arose and motioned the closely watching Rede to follow him out. He headed straight for the fountain at the end of the court, where he washed his hands with the lump of sharp-scented camphor soap and, after a dubious glance at the much-used towel on its hook, shook them dry. He likewise passed over the common ladle hanging beside it, leaning in to guzzle straight from the bright stream, heedless of the splash on his garments. And then stuck his head under it, letting the flow cool his scalp. He was still panting when he straightened up again.

  “And now,” he wheezed to Rede, “I need to go find something to kill.”

  “I beg your pardon?”

  “Stores. Grain stores would be good, or the stables. Or the midden. Anywhere rats or mice gather, or other vermin. Flies. Crows. Seagulls in a pinch, if any fly in this far from the harbor.”