Tormina: The Book of Maladies

by D. K. Holmberg

  He started forward. He had a vague idea of where to find Master Eckerd’s rooms, and thought that if he could reach them, and he was there, maybe Alec could get answers. If he wasn’t there, maybe he could find something in his room that would allow Alec to discover those answers on his own.

  As he made his way along the hallway, the sound of voices came from the stairs behind him.

  He had to hurry. He didn’t recognize either of the voices, but neither was the booming voice of Master Carl. His was easy to hear. He never lowered his volume, even when it was unnecessary for him to yell.

  Alec reached the end of the hall and found the door to Master Eckerd’s quarters. He knocked, thinking that it would be better for him to have permission to enter rather than barging in, but there was no answer.

  The voices continued along the hallway. They were louder now, and he thought that he recognized the sound of Master Helen’s voice. He couldn’t be certain. If she found him here, he didn’t want to think of what might happen. She would be unlikely to react well to his presence.

  Alec checked the door, and it was unlocked.

  He flung the door open and stepped inside.

  The room was empty, but a door separating it from another room was cracked, and light glowed from the other side.

  “Master Eckerd?” Alec said, stepping forward.

  No one answered, and Alec took another step forward. Was Master Eckerd even here?

  There was movement in the room; he was certain of it. With the lantern there, he had to believe that Master Eckerd was here, but if he was, why wouldn’t he answer Alec?

  He stepped up to the door and pushed it open a little further.

  When he did, in the faint orange glow of the lantern, he saw a face looking back at him.

  “Master Jessup?”

  Master Jessup took a step forward. His eyes seemed to catch the light from the lantern and almost twinkled. Then a hint of a smile spread across his face. “Mr. Stross.”

  “I… I was looking for Master Eckerd.”

  Master Jessup smiled, and he nodded. “As was I. I don’t know where he is. I haven’t seen him in days.”

  Days? How long had it been since Alec had seen him? Surely, it hadn’t been days. Then again, Alec hadn’t gone looking for him. Maybe it had been days.

  “I didn’t mean to interrupt…” Alec looked around. What was Master Jessup doing in these rooms? A simple knock on the door would have told him Master Eckerd wasn’t here. And if he had any concern, and found the door unlocked as Alec had, a quick look around would have confirmed the man wasn’t in, much less in his other room. There should be no reason for him to be here, not without having Master Eckerd present. It was unlikely that any other master would have gone into another’s quarters without invitation. That seemed strange to Alec.

  Master Jessup smiled broadly. “Ah, I was looking for something we shared. It was a joint project that we were working on.”

  Alec looked around the room. Master Eckerd had a unique set up. It was much like many of the other masters—at least as much as Alec had seen. Within the room, he had rows of shelves on which a variety of books were stacked. Most of them probably had been borrowed from the library, though a man like Master Eckerd would likely have his own collection, and it was that sort of collection which set him apart.

  On a nearby table sat a row of glass jars. Alec conjectured that they contained various medicines and different concoctions that he would have mixed himself. Those alone would have been incredibly valuable, especially if someone knew they had come from a master physicker. Being treated by a physicker was incredibly expensive. Having treatment from one of the master physickers would be even more expensive. Only the richest of the highborns would have been able to afford it, other than those who came with great need to the university.

  There were other assorted items, but none of them was easy to identify in the faint light. What would Master Jessup have been after? What project would he and Master Eckerd have been working on together?

  Something that was none of his business. As a student, especially a low-ranking one, he had no reason to question what they might have been working on together. He could wonder, but neither man was obligated to share what they had been doing.

  “I won’t disturb you, then.”

  Master Jessup smiled again. “You’re not disturbing me at all, Mr. Stross. I was just getting ready to leave.”

  He turned and grabbed something off of one of the nearby tables, slipping it into his pocket. Alec frowned, but when Master Jessup turned back to him, that disarming smile on his face, he bobbed his head. “Now. Would you escort me back down to the ward? I have something that I need to reevaluate, and I would welcome your company.”

  Alec nodded. Even if he had somewhere else to go, or a good reason for his presence here, he couldn’t refuse a request from one of the university masters to accompany him to the ward. Even if he could, Alec wasn’t sure he would want to. There was much for him to see and learn by shadowing him.

  They made their way along the hall, and when voices drifted up to them, Master Jessup tapped him on the arm and guided him down a different hallway, leading him to a narrow stairway that wound around the inside of the university. It was a way that Alec had never gone, and he was surprised to find that it led directly into the student section. From there, it was an easy walk to the ward.

  “Sometimes, I find taking the back way is beneficial.”

  “Beneficial?”

  “There is something to be said about returning to where you first learn. In my case, that is here. Like nearly all students, my first experience with learning about the requirements to be a physicker came from here. It’s something that I recall with fondness.”

  “Why do you say ‘like nearly all students’?”

  Master Jessup glanced over at him with that beaming smile. “Well, there is you. Unlike most of the students who come to the university, you had extensive experience at healing long before you came to learn in these hallowed halls. I even had a place in the lower sections I used to go to as a student.” He smiled at Alec. “There aren’t many places for students to sneak away alone, and a few of us from my time had such a place.”

  They continued past the student section and down the hall until they reached the ward. They passed no one else along the way, and for that, Alec didn’t know whether to be grateful or surprised. At this time of day, it would be normal to find students out in the hall, but there was no one.

  Even once they reached the ward, there was a single junior physicker working, but she only nodded to Master Jessup and otherwise ignored him.

  “Who are you treating? Is it the woman with the thickened blood?”

  “Ah, she is well enough, I suspect. After a single treatment of the covain root, she began to show signs of improvement.” He glanced over at Alec. “And, of course, we had to reduce her sedation. We needed her more alert. The junior physickers always think to treat pain with sedation, but often times, they do so far too aggressively. Pain is beneficial, I think. It shows us signs of what is wrong. Without it, we might never know what more we might need to do.”

  “My father believes that pain is often beneficial. No one ever wants to have pain, but he believes in taking the edge off of it, not masking it completely, not unless there is a good reason.”

  “I think I would like to know more about your father,” Master Jessup said.

  “What’s there to know? He studied here, long ago. I don’t know who he might’ve studied with or who he might have known.”

  “He never talks about it?”

  “I didn’t even know that he had studied here until recently.”

  Master Jessup stopped at a cot in which an older man lay. Sleeping or unconscious, though maybe sedated. He looked to be in his forties or early fifties and had graying hair. His brow was lined, and he took slow breaths, but he appeared comfortable. Alec quickly scanned his body, searching for any sign of visible defects, but there were n
one.

  “Why is this man here?” he asked, beginning to reach for the record.

  Master Jessup grabbed it, pulling it away from him. “I thought that perhaps you might show me exactly how much you know. I haven’t spent much time working with you, though I deserve most of the blame for that. I have been a bit preoccupied,” he said with a smile. “But I hear nothing but good stories about your skill. You are quite well regarded among the masters. I thought that perhaps I should spend little time with you, get a sense of how much you know… Not that I think to test you, Mr. Stross. Consider this a chance for you to demonstrate your knowledge.”

  Alec studied the man. He was accustomed to being tested. It was something his father had taught him from the earliest days. He thought there was value in having him demonstrate what he knew. Somehow, his father always managed to give him things to read that happened to come in around the same time. By having him demonstrate, it helped reinforce what he was reading about and gave him a practical approach to learning that wasn’t practiced even here in the university. Alec had a much different experience from anyone else here.

  “Can you tell me what he presented with?”

  “He presented like this,” Master Jessup said.

  Alec glanced up. “He came in unresponsive?”

  “As I said, he was brought in like this.”

  He smiled to himself. Master Jessup might claim that this wasn’t a test, but that was exactly what it was, and he intended to challenge Alec to see exactly how well he could diagnose a condition without having much information at hand. It was a difficult challenge, and it was the kind of challenge that he would normally be offended by, but there was something about Master Jessup that he was drawn to. He felt compelled to try and please him.

  Alec carefully rolled the sheet back, revealing the man’s gowned form. There was nothing unusual about the skin color of his face or extremities, and by simply observing the rise and fall of his chest and the pulse in his neck, he didn’t detect any visible breathing or circulation issues. He shifted the gown off to the side, giving him full access to evaluate the unconscious man.

  “When you have someone unresponsive, if they are stable, you can take the time to evaluate them thoroughly,” Alec said. Now that he understood that this was a test, he thought about what his father would have expected. His father would’ve expected him to talk his way through what he was doing, detailing each step along the way.

  “And how certain are you that he’s stable?”

  “You told me that he’s been here a few days. I can see that he’s breathing regularly. His coloration is adequate. If he were unstable, more would have been done for him in the meantime.”

  “A reasonable conclusion.”

  “His age limits some of the possibilities, but not so much that it is beneficial.”

  Alec started with checking the man’s pulse. It was strong and steady, supporting his observation of the great artery in his neck. He hadn’t expected anything otherwise, but knowing that was the case, he was reassured by that. He lifted the scope to listen to the man’s heart, and leaned forward, pressing it against his chest and into his ear. As he listened, he heard nothing unusual. Occasionally, when listening to someone’s heart, you can hear an extra beat, or sometimes, a strange rhythm, and less commonly, there might be a strange whooshing sort of sound that could indicate a problem with the function of the heart.

  “And what do you hear?” Master Jessup asked.

  “I don’t hear anything, not clearly.”

  “Do you believe that his heart is responsible for the symptoms?”

  Alec shook his head. “I doubt that this is from his heart. If it were his heart, he would not look quite as healthy as he does.”

  “Then why are you listening?”

  “It’s part of being thorough.”

  “You find that necessary, even when you know that you won’t learn anything from it?”

  “My father taught me that there are times when you think you might know what you’ll discover but be completely wrong.”

  Alec remembered a time when his father had his mind made up about a diagnosis, but it wasn’t until he started examining, listening to the way the body talked to him, that he came up with an alternative diagnosis. That had been the key to healing that person.

  “Go on,” Master Jessup said.

  Alec moved on to listen to the man’s breathing. His breaths were shallow, but they weren’t raspy or wheezing. There was nothing unusual to the lung sounds. He set down the scope and placed his hands on the man’s belly. As he did, the man began to writhe, though not awaken.

  Alec paused, reducing the pressure on the man’s belly, but not removing his hands altogether. It was the only reaction from the man so far, so he focused there for a time.

  Alec moved more carefully, starting at the periphery of the abdomen and pushing slowly inward. After each pressure application of pressure, he lifted off, trying to figure out where inside this man’s stomach that the pain was coming from. As he moved upward, he felt a pulsating beneath his hands.

  He paused. That pulsating was unusual.

  Normally, the stomach was soft. There were parts of it that were firmer than others, and for the most part there was minimal pain when pressing on the stomach. Why would this man have such pain and be unresponsive like this?

  He started checking off ideas in his mind. The first thing that always came to mind when someone was unresponsive and otherwise looked well was the possibility of a poisoning. He had seen that firsthand with the foxglove, but he didn’t think that was the case this time.

  He moved his hands away from the man’s belly. The pulsating was surprising, but he couldn’t allow himself to be distracted. It could be that it was a distraction, a way of pulling his attention from something else that was the true culprit.

  Yet he couldn’t shake the fact that the man had reacted, clearly in pain, when he pressed.

  There were other things that could cause abdominal pain, and he tried thinking of what they might be, keeping his mind off of the possibilities of referred pain, doubting that the severity of the man’s discomfort could be explained in that way. He moved on, looking at his skin, examining his legs and arms, but finding nothing. He propped open his mouth and brought a candle over so that he could look inside. Other than some mild dryness, there was nothing in his mouth that would explain the symptoms. Some poisons could discolor the mouth, and some habitual use of herbs would cause other effects, such as staining on the palate or gums. He saw neither of those. He pinched the man’s nose, and it was unremarkable. He rolled the man over to look at his back. The skin there was no different from anywhere else on his body.

  It was troublesome. Without knowing anything more about this man, it was a mystery. And maybe that was why Master Jessup had challenged him with this case.

  Could it be that the masters didn’t know what was wrong with him?

  Alec frowned. He didn’t want to become so arrogant that he would believe he knew more than the masters, but he had seen things that they had not. It was possible that some of what he had seen allowed him to have a better feel for some of these diagnoses, though again, he did not want to presume that he knew better than the masters.

  “What has been tried on him?”

  Master Jessup shook his head. “What would you try?”

  Alec frowned, biting his lip. He had abdominal pain, and there was the strange pulsation in his belly. It could come from a naturally occurring deformity. There were enough of those that Alec wasn’t beyond believing that they could occur. And there was the pain. Could it be an infection? They could sometimes occur internally. Could it be something else?

  “His reaction to the belly pressure told us he has pain in his abdomen. I imagine he was given something to relieve the pain,” Alec said. “Otherwise, he wouldn’t be resting so comfortably. And there is what you told me about the junior physickers and their desire to treat pain aggressively.”

  Master Jessu
p smiled. “You are exactly what I was led to believe.”

  “What does that mean?”

  “It means that you’re right. The junior physickers have treated his pain. I wasn’t totally forthcoming about how he presented. When he came in, he was moaning and in great discomfort, and they were unable to perform a full assessment. Without doing anything for his discomfort, they couldn’t continue, and they have been unable to provide a diagnosis.”

  Jessup replaced the records at the end of the bed. “As is often the case, it seems they might’ve been a bit aggressive with the dosing to relieve his discomfort. But I feel they are overly aggressive with treatment quite often. Had you not examined his belly, you might not have known that he was having the abdominal discomfort.”

  “And the pulsation?”

  “Pulsation?”

  Alec placed his hands on either side of the central portion of the man’s stomach. He pressed down, collecting the middle section of his stomach between them, and once more felt it. "It's there. I don't recognize it but suspect there might be some reference to it in one of the old patient records on file.”

  The librarians were incredibly skilled at searching the records for symptoms. It was part of what made the university so powerful. They had countless volumes of records, and each of them was cataloged, and those catalogs were tied together, so that the librarians could search them quickly, finding references to various illnesses. It was also a way of searching for symptoms that might be similar to those of another illness. It was time-consuming, but the librarians were skilled at it, and managed to do it much more quickly than Alec could ever imagine.

  Master Jessup stepped next to him and pressed his hands on the man’s stomach. He frowned as he did, holding them in place for a long moment before pulling them back. “Yes. Surprising. He does not appear to have any discomfort when you place your hands there, though.”

  “No, but if you press here”—Alec pressed on the upper right portion of the man’s stomach—“this is where he begins to have pain.”