The Physician

by Noah Gordon

  (signed)

  Jesse ben Benjamin Clerk

  They found an established pesthouse in the jail, the prisoners having been freed. It was packed with the dead, the dying, and the newly afflicted, so many it was impossible to comfort any. The air was filled with groans and cries, and heavy with the stench of bloody vomit, unwashed bodies, and human waste.

  After conferring with the other three clerks, Rob went to the kelonter and requested the use of the Citadel, in which soldiers had been housed. This granted, he went from patient to patient in the jail, assessing them, holding their hands.

  The message that flowed into his own hands was generally dreadful: the cup of life turned into a sieve.

  Those close to death were moved to the Citadel. Since this was a large percentage of the victims, those not yet moribund could be nursed in a cleaner and less crowded place.

  It was Persian winter, cold nights, warm afternoons. The peaks of the mountains were dazzling with snow and in the mornings the clerks needed their sheepskin coats. Above the gorge, black vultures soared in growing numbers.

  “Your men are throwing bodies down the pass instead of burning them,” Rob J. told the kelonter.

  Hafiz nodded. “I have forbidden it, but I believe you are right. Wood is scarce.”

  “Every body must be burned. Without exception,” Rob told him firmly, for it was something about which Ibn Sina had been adamant. “You must do what is necessary to make certain.”

  That afternoon three men were beheaded for dumping bodies in the pass, execution adding to the death all around them. It wasn’t what Rob had intended, but Hafiz was resentful.

  “Where are my men to get wood? All our trees are gone.”

  “Send soldiers into the mountains to cut trees,” Rob said.

  “They would not come back.”

  So Rob delegated young Ali to take soldiers into houses that had been deserted. Most of the houses were of stone but they had wooden doors, wooden shutters, stout roof beams. Ali drove the men to rip and tear, and the pyres roared outside the city wall.

  They tried to follow Ibn Sina’s instructions about breathing through vinegar-soaked sponges, but the sponges hampered their work and were soon discarded. Heeding the example of Hakim Isfari Sanjar, each day they choked down vinegar-soaked toast and drank a good deal of wine. Sometimes by nightfall they were as drunk as the old hakim.

  In his cups, Mirdin told them of his wife Fara and his small sons Dawwid and Issachar who awaited his safe return to Ispahan. He spoke with nostalgia of his father’s house by the Arabian Sea, where his family traveled the coast buying seed pearls. “I like you,” he said to Rob. “How can you be friend to my terrible cousin Aryeh?”

  Now Rob understood Mirdin’s initial coolness. “A friend of Aryeh? I am not a friend of Aryeh. Aryeh is a shit!”

  “He is, he is a shit, exactly!” Mirdin cried, and they rocked with laughter.

  Handsome Karim drawled stories of sexual conquest and promised he would find young Ali the most beautiful pair of teats in the Eastern Caliphate when they returned to Ispahan. Karim ran every day, through the city of death. Sometimes he jeered at them until they ran with him, hurling themselves through the empty streets past vacant houses, past houses in which the nervous undiseased huddled, past houses before which bodies had been placed to await the charnel wagon—running from the dreadful sight of reality. For they were touched by more than wine. Surrounded by death, they were young and alive, and they tried to bury their terror by pretending they were immortal and inviolate.

  Records of the Ispahan Medical Party.

  Inscribed on the 28th Day of the Month of Rabia I, in the 413th Year After the Hegira.

  Blood-letting, cupping, and purging appear to have little effect. The relationship of the buboes to dying of this plague is interesting, for it continues to hold true that in the event the bubo bursts or steadily evacuates its green smelly discharge, the patient is likely to survive.

  It may be that many are killed by the terribly high fever that eats the fat from their bodies. But when the buboes suppurate, the fever drops precipitously and recuperation begins.

  Having observed this, we have labored to ripen the buboes that they might open, applying poultices of mustard and lily bulbs; poultices of figs and boiled onions, pounded and mixed with butter; and a variety of drawing plasters. Sometimes we have cut open the buboes and treated them like ulcers, with but little success. Often these swellings, affected partly by the distemper and partly by their being too violently drawn, become so hard no instrument can cut them. These we have attempted to burn with caustics, with poor results. Many died raving mad with the torment and some during the very operation, so that we may be said to have tortured these poor creatures even to death. Yet some are saved. These might have lived without our presence in this place, but it is our comfort to believe we have been of assistance to a few.

  (signed) Jesse ben Benjamin Clerk

  “You bone-pickers!” the man screamed. His two servants dumped him unceremoniously on the pesthouse floor and fled, doubtless to steal his belongings, a commonplace thievery in a plague that appeared to corrupt souls as fast as bodies. Children with buboes were being abandoned without hesitation by their terror-crazed parents. Three men and a woman had been beheaded that morning for looting, and a soldier was flayed for fucking a dying female. Karim, who had led soldiers armed with buckets of limewater to cleanse houses in which there had been pestilence, said every vice was for sale and reported witnessing so much rutting that it was clear many were grasping at life through a wildness of the flesh.

  Just before midday the kelonter, who never entered the pesthouse himself, sent a white and trembling soldier to bring Rob and Mirdin to the street, where they found Kafiz sniffing a spice-studded apple to ward off disease. “Be advised that the count of those who died yesterday was down to thirty-seven,” he told them triumphantly. It was a dramatic improvement, for on the most virulent day, in the third week after the outbreak, 268 had perished.

  Kafiz told them that by his reckoning Shīrāz had lost 801 men, 502 women, 3,193 children, 566 male slaves, 1,417 female slaves, 2 Syrian Christians, and 32 Jews.

  Rob and Mirdin exchanged a knowing glance, neither of them having missed the kelonter’s listing of the victims in their order of importance.

  Young Ali came walking down the street. Something odd, for the boy would have passed them without a sign had not Rob called his name.

  Rob went to him and saw that his eyes were strange. When he touched Ali’s head, the familiar terrible burning chilled his heart.

  Ah, God.

  “Ali,” he said gently. “You must come inside with me now.”

  They had already seen many die, but witnessing the swiftness with which the disease possessed Ali Rashid, it was as if Rob and Karim and Mirdin suffered in the youth’s pain.

  From time to time Ali lurched in sudden spasm, as if something had bitten him in the stomach. Agony made him shudder with convulsion and arch his body into queer, contorted positions. They bathed him with vinegar and in the early afternoon they had hope, for he was almost cool to the touch. But it was as if the fever had gathered itself and when the fresh assault came he was hotter than before, his lips cracked, his eyes rolling up into his head.

  Among all the cries and groans his were almost lost, but the other three clerks heard the terrible sounds clearly because circumstances had made them his family.

  When night came, they took turns sitting by his bed.

  The boy was lying racked on the tumbled pallet when Rob came to relieve Mirdin before dawn. His eyes were dull and unknowing and fever had wasted his body and transformed the round adolescent face, from which high cheekbones and a hawkish beak had emerged to give a glimpse of the Bedouin man he might have become.

  Rob took Ali’s hands and experienced the dwindling.

  Now and again, as an escape from the helplessness of doing nothing, he moved his fingers to Ali’s wrists and felt the pulse be
ats, weak and blurred like the wing strokes of a struggling bird.

  By the time Karim came to relieve Rob, Ali was gone. They could no longer make a pretense of immortality. It was obvious that one of them soon would be next and they began to know the true meaning of fear.

  They accompanied Ali’s body to the pyre and each prayed in his own way as it burned.

  That morning they began to witness the turning; it was obvious that fewer were brought to the pesthouse with the illness. Three days later the kelonter, barely able to suppress the wishfulness in his voice, reported that on the preceding day only eleven persons had died.

  Walking near the pesthouse, Rob noted a large group of dead and dying rats and saw a singular thing when he inspected them: the rodents had the plague, for almost all of them displayed a small but indisputable bubo. Locating one that had died so recently that the warm furry body still crawled with fleas, he laid it on a large flat rock and opened it with his knife as neatly as though al-Juzjani or some other anatomy teacher were peering over his shoulder.

  Records of the Ispahan Medical Party.

  Inscribed on the Fifth Day of the Month of Rabia II, 413th Year After the Hegira.

  Various animals have died as well as men, word having reached us that horses, cows, sheep, camels, dogs, cats, and birds have perished of the pestilence in Anshan.

  Dissections of six plague-killed rats were of interest. External signs were similar to those found in human victims, with staring eyes, contorted muscles, gaping lips, protruding tongue of blackish color, bubo in the groin area or behind an ear.

  Upon dissection of these rats it becomes clear why surgical removal of the bubo is most often unsuccessful. The lesion is likely to have deep, carrot-like roots which, after the main body of the bubo has been removed, remain imbedded in the victim to wreak their havoc.

  On opening the abdomens of the rats I found the lower orifices of all six stomachs and the upper bowels to be quite discolored by green gall. The lower intestines were speckled. The livers of all six rodents were shriveled and in four of the rats the hearts were shrunken.

  In one of the rats the stomach was, so to say, internally peeled.

  Do these effects occur to the organs of human victims of this plague?

  Clerk Karim Harun says Galen wrote that man’s internal anatomy is precisely identical to the pig’s and the ape’s, but dissimilar to the rat’s.

  Thus, while we do not know the causal events of plague death in humans, we may be bitterly certain they are occurring internally and thus are barred from our inspection.

  (signed) Jesse ben Benjamin Clerk

  Working in the pesthouse two days later, Rob felt an uneasiness, a heaviness, a weakness in the knees, a difficulty in breathing, a burning within as though he had eaten heavily of spices, although he hadn’t.

  These sensations stayed with him and grew as he worked all through the afternoon. He fought to ignore them until, looking into a victim’s face

  —inflamed and distorted, the brilliant eyes starting out of the man’s head

  —Rob felt he was seeing himself.

  He went to Mirdin and Karim.

  The answer was in their eyes.

  Before he would allow them to lead him to a pallet he insisted on fetching the Plague Book and his notes and giving them to Mirdin. “If neither of you should survive, these must be left by the last man where they can be found and sent to Ibn Sina.”

  “Yes, Jesse,” Karim said.

  Rob felt calm. A mountain had been moved from his shoulders; the worst had happened and therefore he had been freed from the terrible prison of dread.

  “One of us will stay with you,” good, grieving Mirdin said.

  “No, there are many here who need you.”

  But he could sense them hovering and watching him.

  He determined to note each separate stage of the disease, marking it well in his mind, but got only as far as the onset of high fever and a headache so formidable it made the skin of his entire body sensitive. The covers became heavy and irritating and he threw them off. Sleep overcame him.

  He dreamed he sat and conversed with tall, spare Dick Bukerel, the long-dead Chief Carpenter of his father’s guild. When he awoke he could feel the heat becoming more oppressive, the frenzy within him increasing.

  During a fitful night he was troubled by dreams more violent, in which he wrestled a bear that gradually grew thinner and taller until he was the Black Knight, while everyone who had been taken by the plague stood by and witnessed the thrashing struggle in which neither could pin the other.

  In the morning he was awakened by soldiers dragging their miserable load from the pesthouse out to the charnel wagon. It was a familiar sight to him as medical clerk, but seeing it as one of the afflicted was different. His heart beat throbbingly, there was a far-off buzzing in his ears. The heaviness in all his limbs was worse than before he had gone to bed, and a fire raged within him.

  “Water.”

  Mirdin hastened to fetch some, but as Rob shifted himself to drink, he caught his breath in anguish. He hesitated before looking at the place where he felt the pain. Finally he uncovered it and he and Mirdin exchanged a fearful look. Under his left arm there was a hideous bubo of a livid purple hue.

  He grasped Mirdin’s wrist. “You shan’t cut it! And you mustn’t burn it with caustics. Do you promise?”

  Mirdin ripped his hand free and pushed Rob J. back down onto the pallet. “I promise, Jesse,” he said gently, and hurried away to fetch Karim.

  Mirdin and Karim pulled his hand behind his head and tied it to a post, leaving the bubo exposed. They heated rose water and soaked rags to make compresses, changing the poultices faithfully when they cooled.

  He grew hotter with fever than he had ever been, man or child, and all the pain in his body concentrated in the bubo, until his mind turned away from the unremitting agony and wandered.

  He sought coolness in the shade of a wheat field and kissed her, touched her mouth, kissed her face, the red hair falling over him like a dark mist.

  He heard Karim praying in Persian and Mirdin in Hebrew. When Mirdin came to the Shema, Rob followed along. Hear, O Israel, the Lord our God, the Lord is One. And thou shalt love the Lord thy God with all thy heart …

  He feared to die with Jewish scripture on his lips and strove for a Christian prayer. The one that came to mind was a chant of his boyhood priests.

  Jesus Christus natus est.

  Jesus Christus crucifixus est.

  Jesus Christus sepultus est.

  Amen.

  His brother Samuel sat on the floor close by the pallet, doubtless a guide come to fetch him. Samuel appeared the same, down to the wry and quizzical expression on his face. He scarcely knew what to say to Samuel; Rob had grown to manhood but Samuel was still the boy he had been when he died.

  The pain was even more intense. The pain was terrible.

  “Come, Samuel,” he cried. “Let us be gone!”

  But Samuel only sat and stared at him.

  Presently there was such a sweet and sudden easing of the pain in his arm that the relief was as sharp as a fresh hurt. He could not allow himself false hope, and he forced himself to wait patiently for someone to come.

  After what seemed an inordinately long time, he was aware of Karim leaning over him.

  “Mirdin! Mirdin! All praise to Allah, the bubo has opened!”

  Two grinning faces hovered above him, the one darkly handsome, the other homely with the goodness of saints.

  “I’ll put in a wick so it will drain,” Mirdin said, and for a while they became too busy for thanksgiving.

  It was as if he had come through the stormiest of seas and now drifted in the calmest and most peaceable of backwaters.

  The recovery was as swift and uneventful as he had seen in other survivors. There was a weakness and shakiness, natural following the high fevers; but clarity returned to his mind and there was no further mixing of past and present events.

  He
fretted, wishing to make some small use of himself, but his caretakers would have none of it and kept him supine upon his pallet.

  “It means all to you, this practice of medicine,” Karim observed keenly one morning. “I knew it, and therefore made no objection when you seized leadership of our little party.”

  Rob opened his mouth to protest but closed it quickly, for it was true.

  “I was infuriated when Fadil ibn Parviz was made the leader,” Karim said. “He does well in examinations and is highly regarded by faculty, but as a working physician he is a calamity. Further, he began his apprenticeship two years after I started my own and he is a hakim while I am still a clerk.”

  “Then how could you accept me as leader, who hasn’t yet apprenticed a full year?”

  “You are different, taken out of the competition by your enslavement to healing.”

  Rob smiled. “I’ve seen you, these hard weeks. Aren’t you owned by the same master?”

  “No,” Karim said calmly. “Oh, don’t misunderstand, I desire to be the best of doctors. But at least as strongly, I need to become rich. Wealth isn’t your strongest ambition, is it, Jesse?”

  Rob shook his head.

  “When I was a child in the village of Carsh, which is in the province of Hamadhān, Abdallah Shah, the father of Alā Shah, led a great army across our countryside to move against bands of Seljuk Turks. Wherever Abdallah’s army stopped, misery came, a plague of soldiers. They took crops and animals, food that meant survival or disaster to their own people. When the army moved on, we starved.

  “I was five years old. My mother held her newborn daughter by the feet and dashed her head against the rocks. They say many resorted to cannibalism, and I believe it.

  “First my father died, and then my mother. For a year I lived in the streets with beggars and was a beggar boy. Finally I was taken in by Zaki-Omar, a man who had been my father’s friend. He was a noted athlete. He educated me and taught me to run. And for nine years he fucked my arse.”