Bright Stars, Old bones
Author: Anoop Sheshadri
The story was originally for an ACP contest to write a story of 1,000 words or fewer with the theme “compassion in medicine.” At the time I’d been reading about the history of medicine and the dual role played in many cultures of the physician as both doctor and shaman. I’d also been studying some of the key figures that advanced medicine as a science and an art, and how some past techniques would seem at best superstitious and at worst barbaric to the modern physician but yet others are still in use, more or less unchanged. I tried to take what I’d been learning about and shape it in some way to fit the theme—and, just to keep things interesting, add a touch of the surreal.
The elder threw another bark on the embers and shuffled the stones in the pit to let the breeze flare the coals to orange life. The child lay prone on the soft furs next to him, coughing weakly, spittle sticking to pale lips. The small body poured sweat, and the markings that the elder had swirled across his brow, cheeks, and chest were streaking bluish-black and green across a swollen stomach. The old man tamped down his pipe and, lighting a handful of straw on the glowing embers, touched it to the wooden bowl. He breathed deeply: pungent, fresh, a suitable offering. Ripe for prayer.
The fire shed its light from here to the cliffside, playing across the bottom of a small ramp that ran in short stitches from the floor to the hollows above. Around him, other fires, some with simmering pots or meat smoking above them, stretching across the base of the cliff by other chiseled stairways, splashing sunset colors across the cleared ground. Where the light ended, men held spears to fend off the night. The night stared back with green glowing eyes.
The old man exhaled, smoke puffing out, cleaving and collapsing. He stared up at the stars, and they swirled together, pooled and rippled, circles flowing around and within each other but not touching. The center grew dark, and to the elder the stars seemed like the eye of some giant skyspun god, and it blinked, and the circles never touched.
A man in a loose-spun robe shimmered in front of him, seeming to ripple himself. A veil hung round his head to a bare chest, hiding already blurred features. He leaned over the boy. “Demons,” he said. “The child is possessed. I will take a sharp file and cut a circle here,” he pointed, “and here. Withdraw the skull-flap and we will pack in sweet-smelling herbs to drive out the spirits.”
“He needs a change of diet!” A second figure appeared: duskier, clad in a garment wrapped about his waist with a necklace of beads draped over a black bag he held. “This illness is caused by animalcules, minute creatures, entering from air and food. See here, his heart beats faintly; his blood, thickened. His water runs through his pores. The boy needs to avoid foods and be kept cool. When he is balanced, we chant over him and give him black sulfur and mint in a compounded alkali; this will help the body heal.”
A shrill voice joined the chorus: “Bollocks!” An elderly woman, gray hair drifting over a white tunica. “Drain his blood to balance his humors. The boy has excess phlegm, a winter humor in summer months. See how moist he is? His lungs fill with fluids. With the bad blood gone, the liver will balance the yellow and black bile and he will be right as rain.”
Another dark man, this one wrapped in garish cloths, metal glinting from various pockets and recesses in a hundred designs, twisted and bladed, hollow-tubed and hooked. “Nonsense,” he said. “He has fever. I will supply a purgative and then incise the abdomen to search for suppuration. You will boil some catgut, then we stitch the wound and apply a dressing. The boy will get worse before convalescing. I have seen this in the young.”
“You lack faith!” A woman in a black homespun habit appeared next to the growing circle. “Our Lord gave this illness to the child for a reason, and if we stay strong, then he will overcome it. We will watch over him and keep him safe and dry, so our prayers may be heard. In the meantime, a tincture of hyssop, thyme, and licorice will blunt his fever’s edge.”
Then spoke a man in a tall, black coat, wearing a wide-brimmed hat over a flowing wig, its straps hitched behind a sharp-pointed beard. “You’re only seeing the surface. His blood is thinned by infection. His body harbors swarms of microorganisms; fever will drive these out. We must ensure he stays well-fed and supplied with healing draughts to help kill the infusoria. Willow-bark, or ginger.”
Still more voices spoke through the smoke and haze to chide or advise the elder. A spectacled man in a brown suit: “Small wonder it’s come to this. The place is filthy! These cups need to be sterilized, those utensils boiled! And you there, what do you mean by walking around with those rusty bits of iron?”
Another, holding wires and pads: “Ve vill connect him to the machine, ja? This tells us the underlying pathology!”
A man in loose-fitting blues, holding a syringe: “Never would have happened if he’d had his shots. Don’t suppose he’s allergic to penicillin, is he?”
A shock of white hair connected to a blurred body: “Sepsis. He’ll need positive pressure. We’ll hook him up to the vent. Nurse!”
A woman wearing a white coat: “First thing, we’ll need his electrolytes, CBC, the whole work-up—Mary, can you swab him? It’s not serious, really—Mary? She’ll fill you in. Let’s see the next case.”
The child shivered, caught in the center of twelve gauzy shadows. The elder coughed and the stars blinked shut and lidded. He shook his head and the voices spun away and the shadows became shadows again, the stars, just cold points of light. The boy shivered on the furs, hands fluttering. The elder wiped the boy off with a moist cloth, dipped a ladle into water, poured it down the child’s throat. He swallowed greedily. A woman approached in a simple dress. The elder puffed his pipe while she wrung her hands. Finally: “The gods speak. Keep him drinking, and dry.” He handed her the boy and watched as she rocked him, crooning softly. He looked at his pipe’s dying ashes and then, impulsively, embraced them. “He will be fine. I know this.” She smiled through warm tears. The boy slept quietly through the night, his fever breaking before dawn. The elder smoked at the stars, dreamed, and wondered.
About the Author: Anoop Sheshadri
Anoop is an Internal Medicine intern at UTSW.