The Cole Trilogy: The Physician, Shaman And Matters Of Choice Part 50

But he had reservations. "Surgery is satisfying so far as it goes. But we're limited to operating on the outside of the bag of skin. The inside of the body is a mystery handed down in books more than a thousand years old. We know almost nothing about the internal body."

"That's the way it must be," Mirdin said placidly, and took a rukh with one of his own foot soldiers. "Christians, Jews, and Muslims agree it is sin to desecrate the human form."

"I don't speak of desecration. I speak of surgery, I speak of dissection. The ancients didn't cripple their science with admonitions of sin, and what little we now know came from the early Greeks, who had the freedom to open the body and study it. They dissected the dead and observed how man is fashioned within. For a brief moment in those long-ago days their brilliance illuminated all of medicine, and then the world fell into darkness." He brooded and the game suffered, so that Mirdin quickly captured the other rukh and one of his camels.

"I think," Rob said at length, almost idly, "that during all these long centuries of dark ignorance, there have been small, secret fires."

Now Mirdin's attention was drawn from the board.

"Men who have had the strength to dissect dead humans in stealth. Defying the priests in order to do the Lord's work as physicians."

Mirdin stared. "Dear G.o.d. They would be treated as witches."

"They would not have been able to report their knowledge, but at least they would have gained it for themselves."

Mirdin now looked alarmed.

Rob smiled at him. "No, I would not," he said gently. "I have enough trouble pretending to be a Jew. I simply do not have the necessary variety of courage."

"We must show grat.i.tude for tiny blessings," Mirdin said drily. He had been made sufficiently uneasy and diverted so that now he played poorly, giving up an elephant and two horses in swift succession, but Rob hadn't yet learned enough about pressing through to victory. Quickly and coolly Mirdin rallied his forces and, within a dozen moves, to Rob's chagrin he was once again forced to experience shahtreng, the anguish of the king.

54.

MARY'S EXPECTATIONS Mary had no female friend other than Fara, but the Jewess was enough. The two women learned to sit for hours and talk to one another, communications devoid of the questions and answers characterizing most social conversation. Sometimes Mary talked and Fara listened to an outpouring of Gaelic she didn't understand, sometimes Fara spoke the Tongue to an uncomprehending Mary.

The words were curiously unimportant. What mattered was the play of emotions across the facial features, the expressions of the hands, what was in the voice, secrets conveyed by the eyes.

Thus they shared their feelings and for Mary it was an advantage, for she spoke of things she wouldn't have mentioned to one she had known so short a time. She revealed her sorrow over the loss of her father; her loneliness for the Christian Ma.s.s; the power of her longing when she awoke from dreaming of the young and beautiful woman Jura Cullen once had been, and then had to lie in the little Yehuddiyyeh house as, like a cold and loathsome creature, the realization crept into her mind that her mother was long dead. And she spoke of things she wouldn't have mentioned no matter how long she and Fara had been friends: of how she loved him so much that sometimes it caused a trembling she couldn't control; of moments when desire flooded her with such warmth that for the first time she understood mares in heat; of how she would never again watch a ram mounting a ewe without thinking of her limbs around Rob, his taste in her mouth, the smell of his firm warm flesh in her nostrils, the hot magical extension of her husband making her one with him as they strove to get him into the core of her body.

She didn't know if Fara spoke of such things but her eyes and ears told her that betimes what Mirdin's wife talked about was intimate and important, and the two dissimilar women became linked by love and high regard, a bond of friendship.

One morning Mirdin laughed and clapped Rob's shoulder in delight. "You've obeyed the commandment to multiply. She's expecting a child, you European ram!"

"It isn't so!"

"It is so," Mirdin said firmly. "You'll see. In this, Fara is never wrong."

Two mornings later Mary paled after eating her breakfast and spewed up the food and drink, requiring Rob to clean and sc.r.a.pe the packed-earth floor and carry in fresh sand. That week she began regularly to be plagued by vomiting, and when her monthly flow was absent, no doubt remained. It should have been no surprise, for they'd been unflagging in their love-making; but she'd long since begun to think that perhaps G.o.d didn't favor the union.

Her periods ordinarily were difficult and painful and she was pleased to be relieved of them, but the frequent nausea made the exchange no great bargain. Rob held her head and cleansed her when she was sick and thought of the coming child with both delight and foreboding, nervously wondering what sort of creature would grow from his seed. Now he unclothed his wife with more ardor than ever, for the scientist in him gloried in the chance to note the changes down to the slightest detail, the widening and purpling in the areolae of her nipples, the greater fullness of her b.r.e.a.s.t.s, the first gentle curving of belly, a rearrangement of expressions caused by the subtle swelling of her mouth and nose. He insisted that she lie on her stomach so he could judge the acc.u.mulation of fat in the hips and b.u.t.tocks, the slight thickening of her legs. At first Mary enjoyed the attention but gradually she lost patience.

"The toes," she grumbled. "What of the toes."

He studied her feet gravely and reported that the toes were unchanged.

The attractions of surgery were spoiled for Rob by a spate of geldings.

The making of eunuchs was a commonplace procedure, and two types of castrations were performed. Handsome men, selected to guard the entrances of harams, where they would have little contact with the women of a house, suffered only the loss of their t.e.s.t.i.c.l.es. For general service inside the harams, ugly men were prized, with premiums paid for such disfigurements as a mashed or naturally repelling nose, a misshapen mouth, thick lips, and black or irregular teeth; in order to render such men completely functionless s.e.xually, their genitalia were entirely removed and they were compelled to carry a quill for use whenever they wished to pa.s.s water.

Often young boys were castrated. Sometimes they were sent to a school for the training of eunuchs in Baghdad, where they were taught to be singers and musicians or thoroughly grounded in the practices of business or in purchasing and administration, turning them into highly prized servants, valuable pieces of property like Ibn Sina's eunuch slave, Wasif.

The technique for gelding was basic. In his left hand the surgeon grasped the object to be amputated. Holding a sharp razor in his right hand, he removed the parts with a single sweep of the blade, for speed was essential. At once a poultice of warm ashes was clapped to the bleeding area, and the male was permanently altered.

Al-Juzjani had explained to him that when castration was performed as a punishment, sometimes the poultice of ashes wasn't administered and the patient was allowed to bleed to death.

Rob came home one evening and looked at his wife and tried not to consider that none of the men or boys he had operated on would ever make a woman swell with life. He put his hand on her warm abdomen, which had not really grown much larger yet.

"Soon it will be like a green melon," she said.

"I want to see it when it is a watermelon."

He had gone to the House of Learning and read about the fetus. Ibn Sina had written that after the womb shuts over the s.e.m.e.n, life is formed in three stages. According to the Master of Physicians, in the first stage, the clot is transformed into a small heart; in the second stage, another clot appears and develops into the liver; and in the third stage, all of the chief organs are formed.

"I've found a church," Mary said.

"A Christian church?" he said, and was amazed when she nodded. He hadn't known of a church in Ispahan.

The week before, she and Fara had gone to the Armenian market to buy wheat. They had made a wrong turn down an alley, narrow and smelling of p.i.s.s, and she had come upon the Church of Archangel Michael.

"Eastern Catholics?"

She nodded again. "It's a tiny, sad church, attended by a handful of the poorest Armenian laborers. Doubtless it is tolerated because it's too weak to be a threat." She'd returned twice, alone, to stand and envy the ragged Armenians who entered and left the church.

"Ma.s.s would be in their language. We couldn't even offer the responses."

"But they celebrate the Eucharist. Christ is present on their altar."

"We would risk my life to attend. Go to the synagogue with Fara to pray, but offer your own silent prayers. When I'm in the synagogue I pray to Jesus and the saints."

She lifted her head and for the first time he saw the smoldering behind her eyes.

"I need no Jews to allow me to pray," she said hotly.

Mirdin agreed with him about rejecting surgery as a profession. "It's not only the gelding, although that is terrible. But in places where there are no medical clerks to service the mullahs' courts, the surgeon is called upon to tend prisoners after punishments. Better to use our knowledge and skills against illness and hurt than to trim the stubs and stumps of what could have been healthy limbs and organs."

Sitting in the early morning sun on the stone steps of the madra.s.sa, Mirdin sighed when Rob told him about Mary and her yearnings for a church. "You must pray your own prayers with her when you're alone. And you must take her to your own people as soon as you're able."

Rob nodded, studying the other man thoughtfully. Mirdin had been bitter and hateful when he had thought Rob a Jew who had rejected his own faith. But since gaining the knowledge that Rob was an Other, he had shown the essence of friendship.

"Have you considered," Rob said slowly, "how each faith claims that it alone has G.o.d's heart and ear? We, you, and Islam-each vows it is the true religion. Can it be that we're all three wrong?"

"Perhaps we're all three right," Mirdin said.

Rob felt a welling of affection. Soon Mirdin would be a physician and return to his family in Masqat and when Rob was hakim he too would go home. Doubtless, they would never meet again.

When he met Mirdin's eyes he was certain his friend shared his thoughts.

"Shall we see each other in Paradise?"

Mirdin stared at him gravely. "I shall meet you in Paradise. Solemn vow?"

Rob smiled. "Solemn vow."

They clasped wrists.

"I think of the separation between life and Paradise as a river," Mirdin said. "If there are many bridges that cross the river, should it be of great concern to G.o.d which bridge the traveler chooses?"

"I believe not," Rob said.

The two friends parted warmly and hurried off, each to his own labor.

Rob sat in the surgery with two other clerks and listened to al-Juzjani warn them of the need for discretion regarding the operation that would follow. He wouldn't give the patient's ident.i.ty in order to protect her reputation, but he let it be known that she was the close relative of a powerful and famous man, and that she had cancer of the breast.

Because of the gravity of the disease, the theological prohibition known as aurat-which forbade any but a woman's husband to look upon her body from neck to knee-would be disregarded to enable them to operate.

The woman had been plied with opiates and wine and was carried in to them unconscious. She was full-formed and heavy, with wisps of gray hair escaping from the cloth that bound her head. She was loosely veiled and fully draped save for her b.r.e.a.s.t.s, which were large, soft, and flaccid, indicating a patient no longer young.

Al-Juzjani ordered each of the clerks in turn to palpate both b.r.e.a.s.t.s gently in order to learn what a breast tumor feels like. It was detectable even without palpation, a visible growth in the side of the left breast, as long as Rob's thumb and three times as thick.

He was very interested in watching; he had never seen a human breast opened before. Blood welled as al-Juzjani pressed the knife into the yielding flesh and cut well below the bottom of the lump, desiring to get it all. The woman moaned and the surgeon worked quickly, eager to finish before she awoke.

Rob saw that the inside of the breast contained muscle, cellular gray flesh, and clumps of yellow fat like that in a dressed chicken. He could clearly make out several pink lactiferous ducts running to join at the nipple like the branches of a river merging at a bay. Perhaps al-Juzjani had nicked one of the ducts; reddened liquid welled from the nipple like a drop of rosy milk.

Al-Juzjani had the tumor out and was sewing rapidly. If such a thing were possible, Rob would have said the surgeon was nervous.

She is related to the Shah, he told himself. Perhaps an aunt; maybe even the very woman of whom the Shah had told him in the cave, the aunt who had inducted Al into s.e.xual life.

Groaning and almost fully awake, she was carried away as soon as the breast was closed.

Al-Juzjani sighed. "There is no cure. The cancer will kill her in the end, but we can attempt to slow its progress." He saw Ibn Sina outside and went to report on the operation while the clerks tidied the surgery.

Soon Ibn Sina entered the surgery and spoke briefly to Rob, patting his shoulder before taking leave of him.

He was dazed by what the Chief Physician had told him. He left the surgery and walked toward the khazanat-ul-sharaf, where Mirdin was working. They met in the corridor leading from the pharmacy. Rob saw in Mirdin's face all the emotions that were churning within him. "You also?"

Mirdin nodded. "In two weeks?"

"Yes." He tasted panic. "I'm not ready for testing, Mirdin. You've been here four years, but I've been here only three years and I'm not yet ready."

Mirdin forgot his own nervousness, and smiled. "You are ready. You've been a barber-surgeon and all who have taught you have come to know what you are. We have two weeks to study together, and then we shall have our examination."

55.

THE PICTURE OF A LIMB.

Ibn Sina was born in a tiny settlement called Afshanah, outside the village of Kharmaythan, and soon after his birth his family moved to the nearby city of Bukhara. While he was still a small boy his father, a tax collector, arranged for him to study with a teacher of Qu'ran and a teacher of literature, and by the time he was ten he had memorized the entire Qu'ran and absorbed much of Muslim culture. His father met a learned vegetable peddler named Mahmud the Mathematician, who taught the child Indian calculation and algebra. Before the gifted youth grew his first facial hairs he had qualified in law and delved into Euclid and geometry, and his teachers begged his father to allow him to devote his life to scholarship.

He began the study of medicine at eleven and by the time he was sixteen he was lecturing to older physicians and spending much of his time in the practice of law. All his life he would be both jurist and philosopher, but he noted that although these learned pursuits were given deference and respect by the Persian world in which he lived, nothing mattered more to an individual than his well-being and whether he would live or die. At an early age, fate made Ibn Sina the servant of a series of rulers who used his genius to guard their health, and though he wrote dozens of volumes on law and philosophy-enough to win him the affectionate sobriquet of Second Teacher (First Teacher being Mohammed)-it was as the Prince of Physicians that he gained the fame and adulation that followed him wherever he traveled.

In Ispahan, where he had gone at once from political refugee to hakimbashi, Chief Physician, he found a city with a large supply of physicians, and more men constantly becoming healers by means of simple declaration. Few of these would-be physicians shared the dogged scholarship or intellectual genius that had marked his own entry into medicine, and he realized that a means was needed to determine who was qualified to practice and who was not. For more than a century, examinations had been given to potential physicians in Baghdad, and Ibn Sina convinced the medical community that in Ispahan the qualifying examination at the madra.s.sa should create or reject physicians, with himself as chief medical examiner.

Ibn Sina was the foremost physician in the Eastern and Western Caliphates, yet he worked in an educational environment that did not have the prestige of the largest facilities. The academy at Toledo had its House of Science, the university in Baghdad had its school for translators, Cairo boasted a rich and solid medical tradition that went back many centuries. Each of these places had a famous and magnificent library. In contrast, in Ispahan there was the small madra.s.sa and a library that depended on the charity of the larger and richer inst.i.tution in Baghdad. The maristan was a smaller, paler version of the great Azudi hospital in Baghdad. The presence of Ibn Sina had to make up for a lack of inst.i.tutional size and grandeur.

Ibn Sina admitted to the sin of pride. While his own reputation was so towering as to be untouchable, he was sensitive about the standing of the physicians he trained.

On the eighth day of the month of Shawwa, a caravan from Baghdad brought him a letter from Ibn Sabur Yqt, the chief medical examiner of Baghdad. Ibn Sabur was coming to Ispahan and would visit the maristan the first half of the month of Zulkadah. Ibn Sina had met Ibn Sabur before and steeled himself to withstand the condescension and constant smug comparisons of his Baghdad rival.

Despite all the costly advantages medicine enjoyed in Baghdad, he knew that the examining there was often notoriously lax. But here at the maristan were two medical clerks as sound as any he had seen. And at once he knew how he could send word back to the Baghdad medical community about the kind of physicians Ibn Sina made in Ispahan.

Thus, because Ibn Sabur Yqt was coming to the maristan, Jesse ben Benjamin and Mirdin Askari were called to the examining that would grant or deny their right to be called hakim.

Ibn Sabur Yqt was as Ibn Sina remembered him. Success had made his eyes slightly imperious beneath his puffy lids. There was more gray in his hair than had been there when the two of them had met in Hamadhn twelve years before, and now he wore a flamboyant, costly costume of particolored stuff that proclaimed his position and prosperity but, despite its exquisite workmanship, couldn't hide the fact that he had added greatly to his girth since his younger days. He toured the madra.s.sa and the maristan with a smile on his lips and lofty good humor, sighing and commenting that it must be luxury to be able to deal with problems on so small a scale.

The distinguished visitor seemed pleased to be asked to sit on the examining board that would question two candidate clerks.

The scholastic community of Ispahan didn't have a depth of excellence but there was sufficient brilliance at the top of most disciplines to make it easy for Ibn Sina to enlist an examining board that would have been respected in Cairo or Toledo. Al-Juzjani would question on surgery. The Imam Yussef Gamali of the Friday Mosque would test on theology. Musa Ibn Abbas, a mullah who was on the staff of the Imam Mirza-aboul Qandra.s.seh, Vizier of Persia, would test on law and jurisprudence. Ibn Sina himself would deal with philosophy; and in medicine, the visitor from Baghdad was subtly encouraged to present his most difficult questions.

Ibn Sina was unbothered by the fact that both his candidates were Jews. Some Hebrews, of course, were dullards who made poor doctors, but in his experience the most intelligent of the Dhimmis who came to medicine had already traveled half the distance, for inquiry and intellectual argument and a delving after truths and proofs were part of their religion, ingrained in them in their study houses long before they became medical clerks.

Mirdin Askari was summoned first. The homely, long-jawed face was alert but calm, and when Musa Ibn Abbas asked a question regarding the laws of property he answered without flamboyance but fully and completely, citing examples and precedents in Fiqh and Shar'a. The other examiners sat a little straighter when Yussef Gamali's questions merged law with theology, but any thought that the candidate was at a disadvantage because he was not a True Believer was dispelled by Mirdin's profundity. He used examples from Mohammed's life and recorded thoughts as his arguments, acknowledging the legal and social differences between Islam and his own religion where they were relevant, and where they were not, weaving Torah into his answers as a shoring up of Qu'ran, or Qu'ran as a b.u.t.tressing of Torah. He used his mind like a sword, Ibn Sina thought, feinting, parrying, now and then sinking a point home as if it were made of cold steel. So many-layered was his scholarship that, although each man who listened shared erudition with him to a greater or lesser degree, nonetheless it numbed them and filled them with an admiration for the revealed mind.

When his chance came, Ibn Sabur loosed question after question like arrows. The answers always were given without hesitation, but they were never the opinion of Mirdin Askari. Instead, they were citations from Ibn Sina or Rhazes or Galen or Hippocrates, and once Mirdin quoted from On Low Fevers by Ibn Sabur Yqut, and the physician from Baghdad kept his face impa.s.sive as he sat and listened to his own words come back at him.

The examining went on far longer than most, until finally the candidate fell silent and looked at them and no more questions came from the seated men.

Ibn Sina dismissed Mirdin gently and sent for Jesse ben Benjamin.

He could feel a subtle change in the atmosphere as the new candidate came in, tall and broad enough to be a visual challenge to older, ascetic men, with skin leathered by the sun of West and East, wide-set brown eyes that held a wary innocence, and a fierce broken nose that made him look more like a spear-carrier than a physician. His large, square hands seemed fashioned to bend iron but Ibn Sina had seen them stroke fevered faces with great gentleness and cut into bleeding flesh with an absolutely controlled knife. His mind had long been a physician's.

Ibn Sina purposely had brought Mirdin to testing first, to set the stage and because Jesse ben Benjamin was different from the clerks to whom these authorities were accustomed, with qualities that couldn't be revealed in an academic examination. He had covered material prodigiously in three years but his scholarship wasn't as deep as Mirdin's. He had presence, even now in his nervousness.

He was staring at Musa Ibn Abbas and appeared white about the mouth, more nervous than Askari had been.

The Imam Qandra.s.seh's aide had noted the stare, which was almost rude, and abruptly the mullah began with a political question whose dangers he didn't bother to hide.

"Does the kingdom belong to the mosque or to the palace?"