Page 61 of The Physician


  Rob held and examined him: slightly smaller than his older brother had been, but not a runt. A lusty, ruddy man-child with round brown eyes and a patch of dark hair that already contained glints of his mother’s redness. He decided that in the eyes and the shape of the head, the wide mouth and the long, narrow little fingers, the new child bore close resemblance to his brothers William Stewart and Jonathan Carter when they were newly born. It was always easy to tell a Cole baby, he told Mary.

  68

  THE DIAGNOSIS

  Qasim had been keeper of the dead for two months when the pain returned to his abdomen.

  “What is it like?” Rob asked him.

  “It is bad, Hakim.”

  But obviously it wasn’t as bad as it had been before. “Is it a dull pain, or sharp?”

  “It is as if a djinn lives within me and claws at my insides, twisting and tearing.” The former drover succeeded in terrifying himself; he gazed beseechingly at Rob for reassurance that this was not indeed the case.

  He wasn’t feverish as he had been during the attack that had brought him to the maristan, nor was his abdomen rigid. Rob prescribed frequent dosing with a honey-and-wine infusion, which Qasim took to eagerly since he was a drinker and had been sorely tried by the enforced religious abstinence.

  Qasim spent several pleasant weeks, slightly inebriated as he lazed about the hospital exchanging views and opinions. There was much to gossip about. The latest news was that Imam Qandrasseh had deserted the city, despite his obvious political and tactical victory over the Shah.

  It was rumored Qandrasseh had fled to the Seljuk Turks, and that when he returned it would be with an attacking Seljuk army to depose Alā and place a strict Islamic religionist—perhaps himself?—on the throne of Persia. In the meantime, life was unchanged and pairs of somber mullahs continued to patrol the streets, for the wily old Imam had left his disciple, Musa Ibn Abbas, as keeper of the faith in Ispahan.

  The Shah remained in the House of Paradise as if in hiding. He didn’t hold audiences. Rob hadn’t heard from Alā since Karim had been put to death. There was no summoning to entertainment, no hunting or games or invitations to the court. When a physician was required at the House of Paradise in place of the indisposed Ibn Sina, al-Juzjani or someone else was demanded, but never Rob.

  But a gift for the new son had come from the Shah.

  It arrived following the Hebrew naming of the baby. This time Rob knew enough to invite the neighbors himself. Reb Asher Jacobi the mohel asked that the child might grow in vigor to a life of good works, and cut off the foreskin. The babe was given suck on a wine sop to quiet his yowl of pain and in the Tongue was declared to be Tam, son of Jesse.

  Alā had bestowed no gift when little Rob J. was born, but now he sent a handsome small rug, light blue wool interwoven with lustrous silk threads of the same shade and embossed in darker blue with the crest of the royal Samanid family.

  Rob thought it a handsome rug and would have laid it on the floor next to the cradle, but Mary, who was pettish following the birth, said she didn’t want it there. Instead, she bought a sandalwood chest that would protect it from moths and put it away.

  Rob participated in an examining board. He knew he was there in Ibn Sina’s absence and it shamed him that someone might think him presumptuous enough to assume he could take the place of the Prince of Physicians.

  But there was no help for it, so he did his best. He prepared for the board as though he were a candidate himself and not an examiner. He asked thoughtful questions designed not to undo a candidate but to bring out knowledge, and he listened attentively to the answers. The board examined four candidates and made three physicians. There was embarrassment over the fourth man. Gabri Beidhawi had been a medical clerk for five years. He had failed the testing twice before, but his father was a rich and powerful man who had flattered and cozened the hadji Davout Hosein, the administrator of the madrassa, and Hosein had requested that Beidhawi be tested again.

  Rob had been a student with Beidhawi and knew him for a lazy wastrel, careless and callous in treating patients. During the third examining he showed himself to be ill prepared.

  Rob knew what Ibn Sina would have done. “I reject the candidate,” he said firmly and with little regret. The other examiners hastened to concur, and the board was adjourned.

  Several days after the examinations, Ibn Sina came to the maristan.

  “Welcome back, Master!” Rob said, gladdened.

  Ibn Sina shook his head. “I haven’t returned.” He appeared tired and worn, and he told Rob he had come for an evaluation which he wished performed by al-Juzjani and Jesse ben Benjamin.

  They sat with him in an examining room and talked with him, gathering the history of his complaint as he had taught them to do.

  He had waited at home, hoping soon to resume his duties, he told them. But he had never recovered from the twin shocks of losing first Reza and then Despina, and he had begun to look and feel poorly.

  He had felt lassitude and weakness, an inability to make the effort required for the simplest of tasks. At first he had attributed his symptoms to acute melancholia. “For we all know well that the spirit can do terrible and strange things to the body.”

  But lately his bowel movements had become explosive and his stools had been besmeared with mucus, pus, and blood; and so he had requested this medical examination.

  They performed the search as though they would never have another chance to inspect a human being. They overlooked nothing. Ibn Sina sat with sweet patience and allowed them to prod and press and thump and listen and question.

  When they were through, al-Juzjani was pale but put on an optimistic face. “It is the bloody flux, Master, brought on by the aggravation of your emotions.”

  But Rob’s intuition had told him something else. He looked at his beloved teacher. “I believe it is schirri, the early stages.”

  Ibn Sina blinked once. “Cancer of the intestine?” he said, as calmly as if talking to a patient he had never met.

  Rob nodded, trying not to think of the slow torture of the disease.

  Al-Juzjani was ruddy with rage at being overruled, but Ibn Sina soothed him. That is why he had asked for the two of them, Rob realized—he had known al-Juzjani would be so blinded with love he would be unable to find a loathsome truth.

  Rob’s legs felt weak. He took Ibn Sina’s hands in his own, and their eyes met and held. “You are still strong, Master. You must keep your bowels open, to guard against the accumulation of black bile that would cause the cancer to grow.”

  The Chief Physician nodded.

  “I pray I’ve made an error in diagnosis,” Rob said.

  Ibn Sina favored him with a small smile. “Prayer can do no hurt.”

  He told Ibn Sina he would like to visit him soon and pass an evening with the Shah’s Game, and the old man said Jesse ben Benjamin would always be welcome in his house.

  69

  GREEN MELONS

  On a dry and dusty day near the end of the summer, out of the haze to the northeast came a caravan of one hundred and sixteen belled camels. The beasts, all in a line and spewing ropy saliva under the exertion of carrying heavy loads of iron ore, wound into Ispahan late in the afternoon. Alā had hoped Dhan Vangalil would use the ore to make many weapons of blue patterned steel. Tests by the swordsmith, alas, subsequently would prove the iron in the ore to be too soft for that purpose, but by nightfall news brought by the caravan had created a stir of excitement among some in the city.

  A man named Khendi, the caravan’s captain of drovers, was summoned to the palace to repeat details of the intelligence for the Shah’s own ears, and then he was taken to the maristan to tell his tale to the doctors there.

  Over a period of months Mahmud, the Sultan of Ghazna, had become gravely ill, with fever and so much pus in his chest that it caused a broad, soft bulge in his back, and his physicians had decided that if Mahmud was to live, this lump would have to be drained.

  One of
the details Khendi brought was that the Sultan’s back had been smeared with a thin wash of potter’s clay.

  “Why was that?” one of the newest physicians asked.

  Khendi shrugged, but al-Juzjani, who served as their leader in Ibn Sina’s absence, knew the answer. “The clay must be watched attentively, for the first patch to dry indicates the hottest part of the skin and is therefore the best place for cutting.”

  When the surgeons opened the Sultan corruption sprang forth, Khendi said, and to rid Mahmud of the remaining pus, they inserted drains.

  “Did the cutting scalpel have a round blade or a pointed one?” al-Juzjani asked.

  “Did they dose him for the pain?”

  “Were the drains fashioned of tin or of linen wicks?”

  “Was the pus dark or white?”

  “Were there traces of blood in it?”

  “Lords! My lords, I am a drovers’ captain and not a hakim!” Khendi exclaimed in anguish. “I have the answers to none of these questions. I know only one thing more, masters.”

  “And what is that?” al-Juzjani asked.

  “Three days after they cut him, lords, the Sultan of Ghazna was dead.”

  They had been two young lions, Alā and Mahmud. Each had come early to his throne to follow a strong father, and each had kept the other in sight while their kingdoms watched, aware that one day they would clash, that Ghazna would eat Persia or Persia would eat Ghazna.

  It had never come to pass. They had circled each other warily and at times their forces had skirmished, but each had waited, sensing the time was not right for total war. Yet Mahmud never was out of Alā’s thoughts. Often the Shah dreamed of him. It was always the same dream, with their armies massed and eager and Alā riding out alone toward Mahmud’s fierce Afghan tribesmen, hurling down the single combat call to the Sultan as Ardashir had roared challenge to Ardewan, the survivor to claim his destiny as the true and proven King of Kings.

  Now Allah had intervened and Alā would never meet Mahmud in combat. In the four days after the arrival of the camel caravan, three experienced and trusted spies rode separately into Ispahan and spent time in the House of Paradise, and from their reports the Shah began to perceive a clear picture of what had occurred in the capital city of Ghazni.

  Immediately following the Sultan’s death, Mahmud’s son Muhammad had attempted to mount the throne but was thwarted by his brother Abu Said Masūd, a young warrior with the firm support of the army. Within hours, Muhammad was a shackled prisoner and Masūd had been declared Sultan. Mahmud’s funeral was a wild affair, part grim leavetaking and part frenzied celebration, and when it was through Masūd had called his chieftains together and declared his intention to do what his father never had done: the army was put on notice that it would march against Ispahan within days.

  It was intelligence that would finally bring Alā out of the House of Paradise.

  The planned invasion was not unwelcome to him, for two reasons. Masūd was impetuous and untried, and Alā was pleased by the chance to pit his generalship against the stripling’s. And because there was something in the Persian soul that loved war, he was shrewd enough to realize that the conflict would be embraced by his people as a foil to the pious restrictions under which the mullahs had forced them to live.

  He held military meetings that were small celebrations, with wine and women making their appearances at the proper times, as in days gone by. Alā and his commanders pored over their charts and saw that from Ghazna there was only one route that was feasible for a large force. Masūd must cross the clay ridges and foothills to the north of the Dasht-i-Kavir, skirting the great desert until his army was deep into Hamadhān. Thence they would turn south.

  But Alā decided that a Persian army would march to Hamadhān and meet them before they could fall upon Ispahan.

  The preparations of Alā’s army was the sole topic of conversation, not to be escaped even in the maristan, though Rob tried. He didn’t think of the impending war because he wished no part of it. His debt to Alā, while it had been considerable, was paid. The raids in India had convinced him he never wanted to go soldiering again.

  So he worried and waited for a royal summons that didn’t come.

  In the meantime he worked hard. Qasim’s abdominal pains had disappeared; to the former drover’s delight Rob continued to prescribe a daily portion of wine and returned him to his duties in the charnel house. Rob was caring for more patients than ever, for al-Juzjani had taken on many of the duties of Chief Physician and had turned over a number of his patients to other physicians, Rob among them.

  He was stunned to hear that Ibn Sina had volunteered to lead the surgeons who would accompany Alā’s army north. Al-Juzjani, who had gotten over his anger or hidden it, told him.

  “A waste, to send such a mind to war.”

  Al-Juzjani shrugged. “The Master wishes one last campaign.”

  “He is old and won’t survive.”

  “He has looked old forever but he hasn’t yet lived sixty years.” Al-Juzjani sighed bitterly. “I believe he hopes an arrow or a spear will find him. It wouldn’t be tragedy to meet a quicker death than now appears to lie in store for him.”

  The Prince of Physicians quickly let it be known that he had chosen a party of eleven to accompany him as surgeons to the Persian army. Four were medical students, three were the newest of the young doctors, and four were veteran physicians.

  Now al-Juzjani became Chief Physician in title as well as in fact. It was a grim promotion in that it caused the medical community to realize that Ibn Sina would not be back as their leader.

  To Rob’s surprise and consternation he was named to fill some of the duties al-Juzjani had performed for Ibn Sina, although there were a number of more experienced physicians al-Juzjani could have selected. Also, since five of the twelve who had gone with the army were teachers, he was told he would be expected to lecture more often and to teach when he visited his patients in the maristan.

  In addition, he was made a permanent member of the examining board and was asked to serve on the committee that oversaw the cooperation between the hospital and the school. His first meeting on the committee was held in the lavish home of Rotun bin Nasr, governor of the school. The title was an honorific and the governor didn’t bother to attend, but he had made his home available and had left orders that a fine meal should be served to the gathered physicians.

  The first course consisted of slices of large green-fleshed melons of singular flavor and melting sweetness. Rob had tasted this type of melon only once before and was about to remark on it when his former teacher, Jalal-ul-Din, grinned widely at him. “We may thank the governor’s new bride for the delicious fruit.”

  Rob didn’t understand.

  The bonesetter winked. “Rotun bin Nasr is a general and the Shah’s cousin, as you may know. Alā visited here last week to plan the war and no doubt met the youngest wife. After royal seeds have been planted, there is always a gift of Alā’s special melons. And if the seeds result in a male crop, then there is a princely gift, a Samanid rug.”

  He didn’t manage to get through the meal but pleaded illness and left the meeting. With his mind in turmoil he rode straight to the house in Yehuddiyyeh. Rob J. was off playing in the garden with his mother but the infant was in the cradle and Rob took Tam into his arms and inspected him.

  Just a small, new baby. The same child he had loved when he left the house that morning.

  He returned the boy and went to the sandalwood chest and removed the carpet bestowed by the Shah. He spread it on the floor next to the cradle.

  When he glanced up, Mary was in the doorway.

  They looked at one another. It became a fact then, and the pain and pity he experienced for her was wrenching.

  He went to her, intending to take her into his arms, but instead he found that both of his hands were gripping her very tightly. He tried to speak but no words came.

  She tore away and kneaded her upper arms.

 
“You have kept us here. I have kept us alive,” she said with contempt. The sadness in her eyes had changed to something cold, the reverse of love.

  That afternoon she moved out of his chamber. She bought a narrow pallet and set it down between the sleeping places of her children, next to the carpet of the Samanid princes.

  70

  QASIM’S ROOM

  Unable to sleep all that night, he felt bewitched, as if the ground had disappeared beneath his feet and he must walk a long way on air. It wasn’t unusual for someone in his situation to kill the mother and the child, he reflected, but he knew Tam and Mary were safe in the next room. He was haunted by mad thoughts but he wasn’t mad.

  In the morning he rose and went to the maristan, where all was not well either. Four of the nurses had been taken into the army by Ibn Sina as litter bearers and collectors of the wounded, and al-Juzjani had not yet found four more who met his standards. The nurses who were left in the maristan were overworked and sullen, and Rob visited his patients and did his physician’s work unassisted, sometimes pausing to clean up what a nurse had not had time to set right, or bathe a feverish face or fetch water to ease a dry and thirsty mouth.

  He came upon Qasim ibn Sahdi lying whey-faced and groaning, the floor next to him soiled with vomitus.

  Ill, Qasim had left his room next to the charnel house and given himself a place as a patient, aware that Rob would find him as he made his way through the maristan.

  He had been afflicted several times within the past week, Qasim said.

  “But why have you not told me!”

  “Lord, I had my wine. I took my wine and the pain went away. But now the wine doesn’t help, Hakim, and I cannot bear it.”

  He felt feverish but not burning, and his abdomen was tender but soft. Sometimes in his pain he panted like a dog; his tongue was coated and his breath was strong.

  “I’ll make you an infusion.”

  “Allah will bless you, lord.”

  Rob went directly to the pharmacy. In the red wine Qasim loved he steeped opiates and buing, then hurried back to his patient. The eyes of the old keeper of the charnel house were filled with fearful portent as he swallowed the potion.