Chapter 5: Back Alley Physician

Daylight had escaped Ravenfall. The sun disappeared behind the horizon, and the emerging alien moon’s luminescent green aura crept across a blackening sky. Whatever bustling a city of tens of thousands had at noon dwindled to scattered laughter and whispers—so quiet that any passing howling wind would silence them. However, even as a chill fiercer than this afternoon’s washed across Dimitry’s exposed forearms, it did nothing to quell his restlessness.

Lying in his palm were three coins—copper gadots the people called them. Unlike modern currency, neither was flat nor perfectly round nor uniform. One even had a jagged edge. However, despite the imperfections each possessed, the value they held to a homeless surgeon trapped in an unfamiliar land exceeded a million pennies on Earth.

Ravenous impulses tempted Dimitry to spend them on meat pies as Rowan proposed, but food was a poor investment. At least for now. One of today’s five patients was an out-of-town peasant that, despite free treatment, demonstrated goodwill to a ‘holy pilgrim cleric’ with stale brown bread.

Dimitry graciously accepted her payment.

Not only did starvation flavor dry bread more deliciously than the crunchiest croissant, it also meant Dimitry didn’t have to beg for pottage at the Church. A loathsome proposition for multiple reasons. Among them was morality and pride, yet the foremost was self-preservation.

When Dimitry last visited the priestess, layered grime soaked his rags, masking their identity as pilgrim robes. That made lying about his background simple. However, now that people assumed him a fervent Church zealot on sight, could he do the same? Was it possible to simultaneously keep his ignorance of Zera hidden and assimilate future lies with those of the past without being discovered as a fraud? What punishment was an organization that disguised illness as possession or divine symbolism capable of?

Finding out entailed too much risk.

Even if Dimitry received a pardon, he would lose his identity as a holy cleric, the current source of customers. Food payments allowed him to avoid confrontations with the Church while saving money for two matters even more urgent than insulating clothes, shelter, and hygiene.

The first was electrolyte-rich supplements to stop his muscle spasms and to prevent deadly complications like cardiac arrest. The other was needles.

Simple needles were all Dimitry needed to treat a man who, earlier that afternoon, presented with a deep laceration cutting down his entire thigh. A wound that large and fresh was prone to infection. If only Dimitry had basic surgical tools, if only he had starting funds, he could have avoided a potentially deadly illness before it began.

Fist clamping around the three copper coins they held, Dimitry glanced longingly to his side.

In the hands of a seamstress who hummed a joyful gospel was a needle. Sadly, it wasn’t good enough for surgery. The straight body increased the risk of needlestick injuries, and the rusted iron surface provided crevices for this world’s equivalent of tetanus spores to hide. Even if boiled water sterilization succeeded, the rough edges would irritate internal wounds further.

What Dimitry would do for a half-circle needle made of stainless steel! They were good for everything from ophthalmic to cardiovascular suturing. Even non-rusted iron sufficed. If his three copper gadots were enough to get one custom-made, he would have dashed out from the alley long ago!

He leaned further back against a body-warmed wall and sighed.

Although Milli’s tune came to a halt, her hands continued to sew two rough leather squares together. “Are you still thinking about that? Fremy will be fine. Zera blessed him with the stamina of an ox, you know?”

Dimitry considered explaining the dangers of deep wound infections to her once more, how apparent physical health didn’t guarantee survival, but decided to collect productive information instead. “You said you bought your needles for several copper gadots, right?”

A faint smile that seemed to borrow joy from days long past surfaced on Milli’s face. “Back when I ran my shop, we got really fine bronze needles from the blacksmith for only five coppers.”

He examined his three coins—not enough. “What if I told the blacksmith it was urgent, that I could save lives with a single needle? Do you think he’ll let me pay him back later? Or maybe give me a discount?”

“The only reason my prices were good was because we ordered in bulk. Most people have to pay double for a small job like that. Even if a holy cleric like you begged, you couldn’t convince a blacksmith otherwise. Delaying work just to do a favor for people like us will upset their regulars, you know?”

She shook her head. “They’d rather make money than help a pilgrim fulfill their divine orders. Greed corrupts everyone.”

Despite disdain for the Church’s atrocities, guilt ran rampant in Dimitry’s gut. He never claimed himself to be a holy cleric, but he didn’t correct Milli’s misconceptions either. It was the best way to get her to comply with his seaweed ‘prescription’.

A gust scattered her thinning hair, which would fill in now that she took iodine supplements for hypothyroidism. Her eyes that lay half-closed yesterday were now open and alert. No longer pale, her face had color. Milli was getting better.

He couldn’t risk directly revealing the truth. The lie was keeping her alive. If carrying guilt and listening to religious ramblings meant a woman could rebuild her life, it was guilt worth carrying and mumblings worth listening to.

“What’s wrong?” she asked.

“Just thinking.”

Milli chuckled. “A young man like you shouldn’t worry so much. It’s impossible to help everyone all the time, you know? Not even Celeste could save her entire flock when they trekked across Remora.”

“I suppose she couldn’t.”

Her hand held out the rusty iron needle it was using. “Are you really sure you don’t want this one? I have two more.”

“It’s not the right size, but I appreciate the thought.” Dimitry forced a smile. “I’ll just wait until I get more money.”

Milled sewed the stacked leather patches into a cup shape. “You should rest for tonight. I’m sure you’ll be busy tomorrow.”

“Why’s that?”

“There’s a lot of sick people around, but there aren’t many that’ll listen to me. My old friends yelled at me before I could tell them a miraculous holy cleric was in Ravenfall. I know most of them haven’t seen me in years, but I wish they would’ve listened, you know?”

Dimitry knew the feeling well. Even after laundering his robe, bathing, and shaving, citizens avoided him. A lanky frame spoke volumes in this society, but his youth gave him an advantage. How much worse was the treatment an aged and sickly woman received?

“You’ve done more than enough for me,” he said. “The only reason I had customers today was because you went out of your way to advertise my services.”

She laughed. “You remind me of my youngest. He was always polite, you know? Bringing smiles to be people’s faces, kind of how you’ve done for that boy, Rowan. He’s probably been talking about you all the way up and down the slums. Cora and Saul looked pretty happy, too. You won’t need me anymore. They’ll tell everyone about you, and, unlike me, people will listen to them.”

Relying on word of mouth had been Dimitry’s plan from the start. Short-term profits might not have allowed him even one paying customer today, but working for free provided many stunning reviews that would build the customer-base necessary to lift him out of poverty before winter. A young waitress presenting erythema multiforme rashes on her belly, a stonemason whose blue fingers indicated peripheral cyanosis, and a husband whose wife snored every night.

Dimitry provided them the best treatment possible. He also spent most of the afternoon demonstrating aquatic therapy techniques for Rowan’s family at the river cutting through Ravenfall. Even if they were poor and could only pay a pittance, the work was fulfilling and meaningful, unlike the time he wasted away in a cancer ward bed.

His one regret was that he couldn’t help the girl from the barbershop. Idalia never visited. Although it wouldn’t surprise Dimitry if the pleas of a rushed homeless man didn’t convince her to meet him in a filthy alley, he hoped the spreading rumors of a miracle healer would. For a girl that young to suffocate from common food allergies was a tragedy.

He waited for her even now.

There was no excuse to be unprepared when she arrived.

“I should start getting ready.” Dimitry stretched and stood to straighten the wind-blown quilt covering the examination table. He glanced down at the seamstress who practiced her skills all evening in hopes of working once more. “By the way.”

“Yes?” Milli said without meeting his gaze.

“When business takes off, I want to help fund yours.”

“Oh, please.” She waved a hand. “Don’t worry about me. The duty of the elderly is to guide the young like Celeste did all of Zera’s children. I’ll be fine.”

The sound of crunching gravel from the street coaxed a swift glance from Dimitry. Disappointed it wasn’t a patient, he turned back to Milli. “But don’t you need money to get started? It’ll be hard to do anything with three needles, some thread, and loose fabric.”

“I’m not opening my shop here.”

“Why not?”

After weaving a red string through a leather opening, Milli pushed away from the wall. In her palm was a brand new pouch. She lowered it onto the examination table and knelt. “May it fill further with every life you save.”

Unsure if he was thankful for the gift or guilty of taking more from someone who had little, Dimitry’s eyes furrowed. “That’s for me? Are you sure?”

“It’s my apology for leaving before you can establish your barbershop. I gave it two layers in case someone secretly tries to cut it open and take the coin. Thieves exist even under Zera’s watchful eyes, you know?”

“Are you going somewhere?”

She nodded. “An old friend offered to take me to Worlstock. My youngest lives there. The tavern he runs has its own stable. I have to leave before the snow comes and makes passage by horse impossible.”

A disappointing turn of events. Since treating patients alone proved difficult, Dimitry intended to ask Milli to train as his nurse. Her thoughtful nature was the makings of an excellent health care provider. However, everyone deserved to live life as they pleased. If she felt healthy enough to leave Ravenfall, to reunite with her children, then Dimitry would support her. He knew well the exuberance of a second chance.

“I see.” Dimitry grabbed the pouch from the examination table and smiled. “Thank you for everything.”

Dimitry awoke long before Church bells clanged the next morning. Early winds bit his exposed toes and gray clouds still cast dark shadows over the alley when the first patient arrived. Alone at first, many others soon joined. By the time the savory aroma of meat and baked pastry oozed from pie merchants peddling wares along lively afternoon streets, a tiny crowd of gossipers and patients had formed outside the alley.

The rush of working in the emergency room returned once more. Although Dimitry led a surgical team through life and death encounters no longer, replaced by the basic illnesses of a society without basic hygiene, the pressure of potential lives to save kept him alert. It was the fulfilling, purposeful, and nostalgic adrenaline-rush he yearned for.

Dimitry had purpose. Even if his current lack of equipment didn’t let him help everyone, there were those he could.

Among them was the man rushing closer. His arms carried a child no older than five. The black bags beneath the man’s dilated eyes bespoke the desperation of any concerned father, Earthen or alien.

“Holy Cleric! If the rumors are true, I want you to cure my boy. Make him normal. He needs to take over the farm, and he can’t if he’s like this.”

Milli, who sat against a wall sewing a shirt, glanced up.

“Panic won’t help you, me, or your son,” Dimitry said. “Take a deep breath, and then tell me what’s wrong so I know how to help.”

The father ignored Dimitry’s advice. Breaths erratic and chest heaving, he shoved his child forward. “Look, he doesn’t even walk! How am I supposed to ever retire with him like this?!”

Disappointed that the parental concern was actually self-pity, Dimitry tapped the freshly washed quilt covering the examination table. “Lay him down, and I’ll take a look.”

The boy struggled to wriggle from his father’s arms.

“Try to get away one more time, and I’ll make sure you—”

“Leave me alone!” the boy said.

The father pressed his child into the examination table to keep him from escaping. “My apologies, holy cleric. These past few days Nino’s been so aggressive when normally he’s so calm. Must be getting to that age. I’ll teach him some manners when we get home.”

Sudden yet lasting aggression at such a young age? Dimitry stroked his stubble-covered chin. Although the cause may have been an overly pushy parent, irritable behavior was common in ill children. Nino’s inability to walk supported the latter hypothesis.

Dimitry approached the boy. “Hello, Nino. Do you mind if I take a look at your legs?”

Nino flexed his hips and knees further into his body.

Aversive behavior. The situation was critical.

“Nino!” the father shouted. “If you don’t listen to the holy cleric, I’ll—”

Dimitry held out his hand. “It’s not his fault. There’s something hurting him. Try not to push so hard on his chest.”

“S-sorry. It’s just that the barber said Nino was making it up. We tried everything: spices, star readings, even leeches. Nothing worked.”

Leeches? Again? Dimitry groaned. “I know you’re in pain, and I promise I won’t hurt you or give you leeches. Just a small peek is all I need. Okay?”

Although Nino’s legs didn’t uncurl, his flailing halted.

“Thank you.” Dimitry removed the patient’s boots, then retracted their pant legs.

Small and circular leech bites covered the boy’s swollen ankles and knees. At the site of every puncture was an unhealthily thin and fragile scab, implying impaired wound healing. The skin was pale except for the tiny purple and red dots dotting the surface. They were petechial hemorrhages resulting from burst capillaries. However, out of many symptoms, there was one that stood out.

Corkscrew hairs.

Like desiccated and thin vines, fragile blonde hair sprouted from bleeding follicles across the boy’s shin—a pathognomonic sign few physicians could miss.

Without a wasted moment, Dimitry lowered the boy’s pant leg to avoid them needlessly freezing in the cold. He removed their hood instead.

“W-what’s wrong?” The father leaned further in. “Did you find something?”

“Give me a moment.” Dimitry pushed down on the boy’s overly dry and pale lip.

Nino’s mouth opened, revealing inflamed and purple gums. Gently pressing above the chin was all it took for blood to gush from beneath unsteady teeth. They confirmed Dimitry’s findings without a doubt.

The father looked on with horrified eyes. “B-but we brush our teeth every day. With salt and linens and everything!”

Wincing at the horrors of rubbing salt into a bleeding mouth, Dimitry put the boy’s shoes back on. “Your son has scurvy. It makes it hard for him to walk and also explains why his teeth are bleeding.”

“Scurvy? Is that bad? Can you fix it?!”

Dimitry chose not to explain scurvy’s pathogenesis, nor what vitamin C was or how its lack caused all of Nino’s symptoms from anemia to excruciating leg pain. Patients stared with blank expressions whenever he went into detail. Skipping directly to treatment saved time and prevented headaches. “No need to worry. I’ll fix it. But first, tell me what you eat at home.”

“Uh…” The father froze. “Now that it’s getting cold, mostly pottage.”

If the pottage Nino’s family ate resembled what the Church fed to the poor, the ingredients consisted of water and grain—poor sources of vitamin C. Fortunately, there was a simple remedy. Dimitry saw ample cabbage in the markets while exploring Ravenfall. Their nutritional content made them the perfect supplement.

“Add lots of cabbage to your pottage. Nino will be back to normal in around twenty days.”

“That’s it?” The father asked. “There’s nothing else we have to do? No mantras to chant, no stars to find in the night sky?”

Milli glanced up from the shirt she sewed, her nimble hands continuing to move with unguided precision. “Believe the holy cleric. He was sent by Zera to heal everyone, you know?”

“So the rumors say.” The father held out his hands to lift Nino but stopped halfway. He slapped a copper gadot onto the examination table, and his voice lowered to a whisper. “I’ve heard of your perilous journey here, pilgrim. Be safe.”

Hiding the thrill of another coin, another step towards surgical tools, Dimitry nodded. “Thank you. Stay healthy.”

After the patient left, the gadot fell into Dimitry’s new pouch with a satisfying clang. He didn’t have to look inside to know how many there were. Twelve. The steadily increasing number never left his mind.

But there was little time to savor it. From the gossiping crowd of hesitant patients and curious onlookers beyond the alley, a girl inched closer. Glancing back with every short step forward, hands pressed to a battered tunic, she came to a halt. “E-excuse me…”

Fearing the impression a young girl alone in an alley with two homeless people gave, Dimitry knelt, wearing the kindest smile he could muster. “Hello. Are you lost? Is everything okay?”

She looked back once more before shaking her head. “I’m-I’m looking for the holy cleric.”

“What for?”

“I’m bleeding really a lot.”

Milli’s head shot up.

A myriad of thoughts crashed through Dimitry's mind. A patient with severe bleeding. Was it a laceration? He still lacked tools and saline solution! Boiled river water could suffice to irrigate a contaminated wound, but how quickly could he buy suturing needles from a blacksmith?

Dimitry was getting ahead of himself—there could have been only minutes to work with. Stopping the blood loss took priority. “Everything’ll be okay. Just tell me where the bleeding is, and I’ll handle the rest.”

The girl’s gaze lowered to her pants. “It started two months ago! I-I thought it went away, but it came back again! I promise I stayed away from the forest and fyrhounds!”

Ah.

With a soft chuckle, Milli’s focus returned to her work.

Dimitry’s adrenal glands eased their relentless assault against his pounding heart. Who knew puberty could terrify a man? He massaged his forehead. “That’s quite the problem. I think you should talk to your mother about it. She knows how to handle that better than I do.”

“I don’t want to scare her.”

“I promise she won’t be scared,” Dimitry said.

“Really?”

“I’m sure of it.”

“O-okay…” The girl placed a sweaty stone into Dimitry’s palm. “Celeste guide you.”

Dimitry examined his white-striped gray sedimentary rock ‘payment’. One glance at the alternating iron oxide and chert layers revealed its identity: banded ironstone. They formed on ocean floors, where oxygen from photosynthetic cyanobacteria reacted with dissolved iron to precipitate into underwater oxide layers. How strange that they existed in this world, too.

Reminiscing about similar formations in his mineral collection back home, one Dimitry hoped to continue expanding someday, a nostalgic grin surfaced on his face. “Thank you very much.”

The girl bowed once more before wobbling away.

“Children are Zera’s precious gift,” Milli said.

“I’m sure they are,” he lied.

Before Dimitry could shove the rock into his pocket, another patient approached—the one he waited for since yesterday. A scarf covered her head as it did in the barbershop, yet the young woman’s lips were no longer inflamed. At least for now. One poor dietary decision could have been the difference between normalcy and asphyxiation.

Exhilarated and eager to prevent the worst, Dimitry stood straight. His movements slowed to a confident crawl to exude professionalism despite torn clothes and overgrown hair. This was a patient he couldn’t let escape—not until she learned of her condition.

“Good to see you again, Idalia. I hope you’ve been well.”

The young woman bowed when she got close. “Holy cleric.” Her gaze shifted towards Milli. “And I believe barber Ingram called you Madalinde.”

“Milli is just fine, dear.”

Dimitry pointed to the examination table. “I’m glad you’ve decided to show up. I was worried you wouldn’t.”

“Honestly, I almost didn’t.” Idalia sat. “I was working at the alehouse last evening when I heard rumors about the pilgrim with mysterious pale green eyes who cured every ailment, and I realized it was you.” Obscure yellow-tipped orange hair leaking from under her headscarf, she bowed again. “My apologies for doubting your sacred gifts.”

Although his choice of advertising was effective, Dimitry never expected word of his services to reach so many in two days. He leaned back against a wall. “Well, I’m glad you’ve had a change of heart. You were in a bad spot yesterday. Any worse and your airways may have closed completely. You might have suffocated.”

“Suffocated?” Her gaze lowered to the floor. “I was really scared, I felt like I was going to die, but every time it happened, my brothers and father told me I was worrying for no reason. To think I could suffocate from a burning mouth and a stomachache…”

Full of pity for someone struggling with a mysterious and loathsome illness, Dimitry shook his head. “The burning mouth, stomachache, and wheezing are only signs of a deeper issue. Do you remember what I asked you to do?”

“To stay away from everything I ate that morning, right? Pork sausage, buckwheat soup, and vegetables.”

“Correct. A single ingredient in any one of those dishes is making you ill whenever you eat it. It’s called food allergies. Usually, the discomfort comes on during the meal, but sometimes it can take a while. Did you ever notice something like that happening?”

Idalia watched her hands, which lay folded on her lap. “Now that I think about it, it kinda makes sense. Is that really true, though? I’ve had these… allergies since I was a baby, but they were never this bad.”

The symptoms were worsening with age. Did that mean something? While Dimitry had handled patients with anaphylactic allergic reactions before, to latex or anesthesia during surgery, they were a rare occurrence. Immunoglobulin E-mediated allergies weren’t his specialty. Only a trained allergist would know the full implications of Idalia’s condition. Hell, whether she even suffered from food allergies or something else entirely, like severe food intolerance, was uncertain. And yet, if Dimitry didn’t treat Idalia, a pompous barber with a leech fetish would.

Limited knowledge was shitty, but limited knowledge trumped none at all when the wrong midday snack could kill his patient.

Dimitry spoke with calm and confidence despite uncertainty. “If your allergies are getting worse with time, we need to uncover the source before they become deadly. Think back. Are there any foods in particular that, after eating, make it hard for you to breathe?”

Idalia lifted a shaky hand to fiddle with her faded blue headscarf. “I’m… I’m not sure.”

“I need you to think really hard. It’s important.”

A long silence passed before the girl looked away. “Forgive me, holy cleric. I wish I had been more vigilant.”

Damn.

The worst outcome.

Without knowing the precise substance that pushed Idalia’s immune system into overdrive, a food challenge was necessary. Idalia would sample potential trigger foods from yesterday’s breakfast until one triggered a reaction. Unfortunately, allergic attacks were unpredictable despite general trends. Anything from a mild stomach ache to asphyxiation could result.

Dimitry wished for a less dangerous solution, perhaps an elimination diet encompassing every food Idalia recalled, but avoiding buckwheat, pork, and a plethora of vegetables would cause nutritional deficiencies even if Idalia somehow complied with the draconian dietary restrictions.

He took a deep breath. “Okay, here’s what we’re going to do. Tomorrow, I need you to—”

The enclosing rattling of metal interrupted his train of thought. Dimitry glanced towards the alley’s entrance.

Four rusted iron boots stomped closer. They belonged to two guards, each elbowing citizens as they passed.

A woman with yellow skin and eyes, like that of a jaundice patient, fell to the ground. Not one in the dispersing crowd helped her up.

“That’s him!” a familiar voice shouted. “The charlatan stealing my customers!”