The Book of Maladies Boxset

by D. K. Holmberg

  “Her injury? Three masters examined this patient before—”

  Eckerd nodded. “Exactly. You now can understand the reason I decided to have him join me?”

  Master Helen grunted but said nothing else. She took a towel and began dabbing at the blood seeping from the woman’s wound, saying nothing as she did.

  “You were able to make the diagnosis?”

  Alec turned to the other junior physicker beside him. Jeremy had a plain face and was of average height. Alec was a few inches taller than he and wondered what the young man was be able to see. It was difficult enough for Alec to see the patient from his vantage. If he were any shorter, he would not see anything.

  “I only asked about injury,” Alec said. “There can be a delay in swelling following a head injury.”

  “How is it that a student knows this?”

  “My father is an apothecary in one of the middle sections of the city.”

  He knew that wasn’t a perfect answer, especially considering how few people at the university cared for apothecaries, but honesty was the only way he was going to not be overlooked.

  “Your father must be an impressive apothecary for him to have taught you that diagnostic skill.”

  “He is. He trained at the university.”

  “An apothecary trained in the university? Why did he leave?”

  The masters were simply waiting, holding pressure against the woman’s skull, soaking up the blood. Alec heard them talking quietly to each other, but they weren’t speaking loudly enough for him to hear. The surgery must have been completed, and Alec wondered what they would do next. Now that the section of skull had been removed, where did that leave the woman?

  “I don’t know why he left. I only learned recently that he had trained here.”

  “An apothecary hid that he’d trained at the university?”

  Alec shrugged. “He didn’t think it necessary. I think part of him thought it was better to conceal that than to make it widely known.”

  “Imagine the rates he could have charged had he shared that he trained at the university.”

  Alec chuckled. “My father was never very concerned about how much he could charge.”

  “Seems like a wasted opportunity to me. Why wouldn’t you take an opportunity to make as much as possible?”

  He didn’t need to answer. Master Eckerd spoke up, looking over at Alec. “Tell me, Mr. Stross, if you weren’t able to reach the swelling, what would you do?”

  Alec glanced over and saw the physicker looking at him, a deep frown pulling the corners of his mouth, before turning back to Master Eckerd. “If I opened up the skull and there was no way to reach the swelling?”

  “Yes. What would you do?”

  Alec had no surgical experience. He had stitched wounds closed, but that was the extent. Anything greater than that his father had always sent to the university. Was Master Eckerd asking him a question about a technique that he assumed he would have read about, or learned from his father?

  No. Eckerd would’ve known that Alec had no experience, and the first-year students rarely ventured into the surgical section of the library. Alec hadn’t even considered it, mostly because there was more value in learning various medicinal treatments. He was much more interested in finding various combinations of medicines and liniments that might produce a response. There were few illnesses that required cutting.

  If Master Eckerd didn’t expect him to know some mysterious surgical technique, what was he getting at?

  Maybe it was something as simple as how to find the area of swelling.

  Alec thought about what he knew of anatomy, having studied that for years, and thought about how everything in the brain was interconnected. There seemed to be a way that you could evaluate for pressure, and Alec imagined looking into a patient’s eyes, or possibly in their ears with the right type of implement, but neither of those would give the origin of the swelling.

  “Couldn’t you simply look into her throat?” the other physicker asked.

  Master Eckerd looked over at the man with a hint of disgust. “Throat? Perhaps you need to review your anatomy, Jonas.”

  Master Helen had given some idea, suggesting the discoloration on the skin would reveal where the injury had taken place, but it seemed like even that missed something.

  “I think if you tried to use an instrument within the brain cavity itself, you would run the risk of damaging the tissue,” Alec said.

  “You would,” Master Eckerd agreed.

  “You would need some sort of flexible device to run along the inside of the skull, and use that to allow whatever blood is there to run along it, or, if it’s hollow, through it.”

  Master Eckerd considered him a moment. “Good. Come over here.”

  Alec blinked but did as he was instructed and made his way over to Master Eckerd.

  “Use balsping oil on your hands first.”

  Alec turned to the jar of oil and used the section of cloth that was lying on the table next to it to apply it to his hands, rubbing it in. He was familiar with the oil, having used it when stitching people up. His father had always claimed that application of the oil inhibited infection, but he’d never had any way of proving that. It was simply something his father had taught him. Other things his father taught him were verifiable, and he could apply them to illnesses, or injury, and test whether they were as effective as his father believed.

  The oil tingled on his skin and created a coating.

  “Take the krashole,” Master Eckerd said.

  Alec shook his head. “I’m not sure what that is.”

  Master Helen reached for a thin, long rod. As she held it up, he noted that it was flexible, bending in her hand. “It’s named after the master who created it,” she said, handing it to him.

  Alec took it from her and studied it. It was hollowed out along the length of it, and he marveled at the skill that must’ve been required to make such a thing.

  “Now, you put a slight curvature into the krashole, and you slide along the inside of the skull.”

  “You want me to do this?”

  “Would you prefer Jonas have the opportunity?”

  “I don’t want to take an opportunity from a physicker,” Alec said.

  “Perhaps I was mistaken.”

  Master Eckerd reached for the instrument, but Alec pulled back.

  “No. I’ll do it.”

  Jonas glared at him, but Alec ignored it. He had been invited into the surgical suite, and he needed to take advantage of that opportunity. How often was it that a first-year student was given the opportunity to perform surgery, and brain surgery at that?

  Eckerd smiled tightly. “Now. You will slide this up along the inside, moving slowly and feeling for any change in resistance.”

  Alec followed his instructions, inserting the krashole into the skull and sliding it. It went smoothly, and he pushed toward the back of her skull, feeling no resistance.

  “What am I looking for?” he asked.

  “If you notice bleeding, you’ve either penetrated the tissue, or you found the source of the bleeding.”

  “I thought the source was where the incision was made.”

  “It should be, but you will make another test. Let’s say for the sake of argument that her husband reported that she had struck her head on the railing of the barge as she got off.”

  Alec glanced up, following his train of thought. “Then she’d have hit the back of her head, probably not the side of it.”

  “Indeed. Had she fallen forward, it would have been more likely for her to strike her temple, but if she truly fell backward, we need to ensure that there is no pressure remaining there that needs to be relieved.”

  Alec continued to slide the device along the back of her head. He felt a hint of pressure and stopped.

  “What have you detected?” Master Eckerd asked.

  “There’s resistance.”

  “Then you need to redirect. Withdraw the krashole a slight amou
nt and then push forward again.”

  “What would happen if I pushed forward without withdrawing?” Alec asked.

  “We’ve done experiments on animals and have concluded the risk of penetrating healthy brain tissue is too great. If part of the brain is injured, there are significant detrimental effects. Has your father treated people who’ve hit their head or injured themselves in such a way that they never completely recover?”

  Alec nodded.

  “As I suspected. This would be the same thing you would find were you to push too hard here. You don’t want to penetrate healthy tissue. There’s a good chance she won’t survive this, anyway, but we want to give her every opportunity possible.”

  Alec withdrew the rod slightly and changed the angle, sliding it forward again. He thought he was angling it toward the lower portion of her skull near the back. There was no pressure, and all of a sudden, he felt warmth racing through the rod, and nearly let go of it.

  Master Eckerd grabbed his hand, studying it. “Hold it.”

  A stream of blood began to flow from the end of the krashole. Alec held it in place while the bleeding continued, and it abated slowly.

  “Nice work. Now you’ve done something that very few masters can claim.”

  Alec looked over to Master Helen, and she nodded to him. “How long do we leave this in place?” he asked.

  “There are varying theories. One suggests that we leave it in place until it stops bleeding, and then remove it, allowing the brain matter to settle back into place. Another argues that leaving it in place could provide ongoing drainage of any additional bleeding.”

  “Which one is right?” Alec asked.

  Master Eckerd looked up at him, a hint of a gleam in his eye. “Which do you think it is?”

  “I imagine there is a benefit to leaving it in place only until the bleeding stops. But if the bleeding returns, it could continue to cause pressure, so leaving the krashole in place would be a good alternative, but I would worry about having a wick for infection.”

  “Both are reasonable concerns,” Eckerd said. “You still have not made a choice.”

  Alec stared at the open skull, trying to determine which might be the best option. “Even if we remove this rod, there will still be a tract for drainage, and as long as you don’t replace the bone, or suture too tightly, there will still be a way to relieve pressure. I would favor removing the krashole.”

  “Go ahead then.”

  Alec glanced from Master Helen to Master Eckerd. He hadn’t given him an answer and had simply let Alec talked it through. Which was the right solution?

  Alec had to trust that his analysis was at least close to accurate, or surely, Master Eckerd would not allow him to proceed. He started pulling the rod free, and once it was, he set it on the table next to him.

  “Which was the correct answer?” Alec asked.

  “You’ll know when—if—she survives.”

  22

  A Summons

  The knock at his door drew his attention, and Alec looked up. He had been pacing in the room, his nerves on edge since returning from the surgical suite. The rest of the students had long ago departed, sent back to class, or on to find their evening meal.

  Alec hurried over to the door and pulled it open. Unsurprisingly, Beckah stood on the other side, tapping her foot with her hand held up to knock again.

  “Well?”

  She pushed past him and into his room. She turned back and crossed her arms over her chest. “You didn’t even want to come find me?”

  Alec closed the door and turned to face her. “That’s not it. It’s more that my heart has been racing so fast that I don’t know what to do.”

  “It was that traumatic? I thought that you had some experience watching minor surgery.”

  Alec shook his head. “I’ve stitched plenty of wounds. It wasn’t the observation that was what had my heart racing, it was when Master Eckerd had me insert a flexible rod inside this woman’s head. As I did, all I could think about was penetrating her tissue and leaving her in even worse shape.”

  “You what?”

  “One of the physickers got sick when she watched the removal of the section of bone. Master Eckerd had me take her place, and then started asking questions.”

  “Alec, this doesn’t just happen. First-year students are never allowed into a surgery. And students, in general, are never allowed to actually participate in surgery. What you went in to observe was something that only masters are allowed to assist with. Now you’re telling me that Master Eckerd had you actually perform part of the operation?”

  “I don’t think it was a crucial part. He didn’t let me cut into the bone, or remove the first part of blood.”

  “Still. What you did… that’s amazing. Matthias will be so jealous. Can I be there when you tell him?”

  “You’re terrible.”

  She shrugged. “Why is that terrible? He tried to embarrass you in front of Master Eckerd. I still think it’s great that Master Eckerd invited you into the surgery. Maybe that will teach Matthias to not be such an ass.”

  “You know, you might be the first highborn I’ve ever met who uses such language.”

  “Have you met many highborns like me?”

  Alec chuckled. “I don’t think I’ve met many people like you.”

  “Good. I don’t want you to get too complacent here. I mean, I am the best student in our year, and so far, you’re running a distant second, but more days like today, you might move up.”

  “Is that right? Didn’t you tell me that no first-year students have ever been invited into a surgery?”

  “That doesn’t mean anything. I think Eckerd felt bad for you. It’s probably something that has to do with your father. I imagine he knew him, and maybe he owed him something, some debt, but there’s no way it could have anything to do with your diagnostic acumen.”

  “No way?”

  Beckah shrugged. “Well, maybe there’s some way. But I don’t want you to think too highly of yourself. That’s a sure way to get into trouble.”

  “It doesn’t seem to have gotten you into trouble,” he said.

  “Maybe more than you realize.”

  Before he had a chance to ask her to elaborate, there came a knock at his door.

  Alec looked to Beckah. She was the only person to visit him at the university.

  “Maybe Stefan?” she said.

  “Stefan wouldn’t come here, would he?” Alec said. “Unless…”

  “Unless?”

  Alec shrugged. “Well, I think his Grandma Helen was in the surgery.”

  “You had two masters with you in the surgery? And you still were allowed to perform a part of it?”

  “I had the sense that Grandma Helen wasn’t terribly thrilled with what I was doing,” Alec said.

  “No? I bet Grandma Helen just loved the fact that Master Eckerd invited a first-year student into one of the more interesting surgeries that she would do.”

  Alec made his way to the door and pulled it open, expecting Stefan to be there, maybe having heard that Alec had been in surgery with his grandmother, or maybe he had come for the very same reason that Beckah had come, thinking to hear more about the surgery. He wasn’t surprised that Beckah had come but would be a little bit more surprised by Stefan coming. They got along, but Alec didn’t know him all that well, yet. He had the hope that they would get to know each other, especially as Alec had so few people at the university that he could talk to.

  Instead, a messenger waited for him.

  The university used many messengers, though most of them were meant to run between the masters and the physickers. Occasionally, they were used elsewhere, but he’d never seen them inside the students’ quarters.

  “Can I help you?” Alec asked.

  The messenger frowned. “Are you Alec Stross?”

  “That’s me.”

  The messenger shrugged. “Whatever. I was sent to find you and bring you with me.”

  “Why? Wh
ere are you to take me?”

  “I’m not the one to tell it.”

  The messenger departed, and Alec glanced to Beckah before following him. She went along with him, taking his hand as she did, and once again, he didn’t resist.

  What was he getting himself into here? He liked Beckah well enough, but he shouldn’t be involved with anybody at the university. Especially since he and Sam…

  But there really wasn’t anything with Sam. Even if he wanted there to be, he hadn’t seen her in weeks. Now that she was at the palace, studying with another Kaver, it seemed that she was no longer interested in working with him. Then again, they had no easar paper so there couldn’t be any practice. Without the easar paper, what was the point of them working together?

  The messenger led them to the main entrance of the university. A dangerous-looking man waited there. He had the deeply tanned skin and dark eyes of somebody from the outer sections, but it was the pair of knives that were sheathed at his waist that really gave Alec pause. Something about him was familiar, though he didn’t know what it was.

  The messenger nodded to Alec. “Here’s your man.”

  “I need you to come with me,” the man said.

  “Excuse me, sir, I think you need to be clearer to my friend,” Beckah said.

  “Beckah—” Alec said, raising his hand.

  Beckah shot him a silencing glance.

  “You’re needed,” the man said. “Bastan sends me.”

  “Bastan?” Beckah said. “Who is Bastan? And why would he be sending for Alec?”

  The other man ignored her, and Alec stared at him, realizing then why he recognized him. Alec had seen him in Bastan’s tavern.

  “You’re one of his servers,” Alec said.

  “Among other things. Now. Your friend needs you. Are you willing to come with me?”

  Alec glanced at Beckah and knew that he had to answer some questions, but he nodded. “If Sam needs me, I’m willing to come.”

  “Not Sam. Another. The older one.”

  “What happened?” Alec asked.

  “I’ll let her be the one to tell you. They need your… special abilities.”

  Alec’s heart raced for a moment. If they needed those abilities, that meant they needed him and his Scribing abilities.