A narrow doorway stood between two walls with uneven white plaster surfaces, which had been peeling for at least a decade. Visible through the chinks were exposed mud-colored chunks. They slowly crumbled away from timber frames. A pole, striped red and white, protruded just above a shuttered window and rattled with the occasional gale—typical barbershop paraphernalia.
At least it had been on Earth. Dimitry assumed the same was true in this society where life held a remarkable likeness to medieval Europe. That was why being a barber wasn’t his first choice of employment. Although he could shave skin, providing socially presentable haircuts was another beast. The roles of a barber and a surgeon couldn’t have been more different.
Or so Dimitry thought. During the trip from the alley, Milli explained that barber-surgeons dealt in everything from haircuts and amputations to plagues and dentistry.
A terrifying prospect.
In any modern society, the deep complexity within each of those responsibilities required the skills of highly educated professionals with years of training. Even barbers had familiarity with countless minutiae, including dermatology fundamentals and blade safety.
Something like amputation, however, was even more nuanced. Nurses and anesthesiologists worked alongside surgeons who specialized in the organs being removed, followed by the prosthetist, physiotherapist, and psychologist who handled the physical and psychological hurdles of losing flesh.
How the hell was one person supposed to do all that? Was it even plausible for a barber-surgeon to master the basics in a land where tossing raw sewage from a window was the norm for disposing of fecal matter? The survival rates couldn’t have been high.
Following Milli with down-turned eyes, that was all Dimitry could think about.
She stopped upon reaching the barber shop’s protruding doorstep. Her patchy gown flapped in an oncoming gale. “This is the barber who looked at my tiredness and the… the hypnothtrotter gouter years ago. If I tell him how you’re a holy cleric with Zera’s blessing, he’ll definitely consider you, you know?”
Dimitry didn’t mind her assumptions of his holiness. As long as Milli complied with treatment, what she called him didn’t matter. Troubling him more was the prospect of working for a barber-surgeon. However, despite his rationale hinting at imminent disaster, there was hope that in a world where tools, weapons, and walls glowed incandescent, where hushed whispers in the dark gave rise to light, that magic existed to counteract knowledge gaps.
Recalling his time in the dark hall, Dimitry glanced at the light-blue pawn on his wrist. ‘Invisall’. If that was a spell he chanted, and it rendered him unseen, magic could hold possibilities more extravagant than light production.
What if a blood clot disintegrating spell existed? One that cured genetic illness? Regenerated brain tissue from strokes, cerebral aneurysms, or oxygen deprivation? Perhaps in this world, medicine and surgery were merely a ceremonial supplement to healing magic.
There was much Dimitry didn’t know.
He judged the rituals of a mystical people too early. Aiming to investigate spells more thoroughly when he earned a stable living, he focused on basic necessities for now.
Dimitry straightened his back and adjusted his robe, wearing an expression as confident as a barefoot man’s could be. “I’m ready.”
“You’ll do good!” Milli cheered, fresh enthusiasm in her voice. “Zera will see to it.”
“I sure hope so.”
She pushed open the door, which creaked around a rusted metal hinge.
A narrow internal full of ceramic vases and the occasional fluid-filled glass jar came into view, and a self-assured male shouted from further within. “I’m seeing a patient. Wait your turn outside.”
“It’s urgent,” Milli said. “A cleric bearing Zera’s gifts came to rescue us all! He wants to offer his help.”
“…would you please give a moment to deal with this?” the man grunted to someone unseen. Several heavy stomps later, his bushy eyebrows peeked from behind a stone-framed archway. “What?”
Dimitry debated introducing himself but stayed silent instead. To avoid demonstrating his ignorance of this world’s customs, he let Milli handle the greeting.
Her thinning hair flopped when she bowed two overly hasty bows. “Ingram, sir, this is—” Milli glanced back, her pale face filled with the horror of forgetting to learn a crucial detail.
Dimitry briefly bowed. “I’m Dimitry. It’s a pleasure.”
The barber ignored him. “I remember you.” He approached Milli and pulled her head up by the cheekbones. “You’re the one that said her Mark of Devotion was choking her.”
“Y-yes, it’s a little better now. Dimitry is curing—”
“Hold still.” Two of the barber’s fingers jabbed the lump in Milli’s throat.
The woman grasped her neck and knelt into a coughing fit.
Dimitry’s eyes shot open. What did he just witness? Couldn’t the barber just palpate the goiter like a normal person?
Grinding his teeth, Dimitry hid his revulsion. He said nothing. Landing the job and gradually introducing proper examination techniques accomplished more than antagonizing the barber-surgeon ever could. Especially when Milli wasn’t the only victim. In the room ahead, bright light imprinted onto the wall a fourth person’s shadowy silhouette. They were wheezing. Another patient. Were Dimitry to lash out now, would they ever receive proper treatment?
The barber calmly wiped his fingertips on a pink-glowing bloody rag dangling from his back pocket. “The bump is still there, not that anyone expected that to change.”
“But can’t you see? I’m full of energy now,” Milli pleaded. “All because of a holy remedy, you know!”
“What remedy?”
“D-dried seaweed. I ate some yesterday.”
A prolonged laugh barreled from the barber’s gullet. He grinned at Dimitry. “Some are as gullible as ever, eh?”
“You’re wrong,” Milli said. “Dimitry didn’t even ask for money. He did it to honor Zera’s glory.”
“I’m sure he did.”
Dimitry closed the door behind him, locking the freezing wind out of the barbershop. “I can prove my techniques work. You have a patient back there, don’t you?”
The barber’s bushy eyebrows furrowed. “So what?”
“I can help them.”
His glare traveled down Dimitry’s white robes. “Just because you’re a pilgrim doesn’t mean you’ve got Zera’s approval, and it doesn’t mean you can do what I do.” He grabbed a small jar from a nearby shelf. “Take a pinch of salt and be on your way. Brush your teeth with it.”
“How about instead of giving me a paltry handout like everyone else, you let me show you what I can do?”
The barber scanned Dimitry’s eyes like a surgeon hawking an x-ray for cervical spine fractures in a rear-end collision whiplash victim. His hand contemplatively scratched his bald spot and then shoved the salt jar back into place. A sigh escaped his lips. “Just don’t touch my tools. That includes you too, Madalinde.”
“I praise your generosity,” she muttered. “Celeste guide you.”
A short trek past shelves led to another room containing razors and saws and small critters resembling slugs, jiggling turnips, and suction cups. Sat on a barstool in the middle was a young woman no older than twenty. Wheezing beneath her headscarf, the patient cautiously examined Dimitry. Her gasps for breath hastened when she saw his bare feet.
Although her wheezing indicated potentially lethal airway obstruction, that wasn’t enough for a diagnosis. Dimitry knelt to level with her.
She turned away.
“I know, I know.” The barber waved a hand. “Just humor him a while. I’ll give you proper leech therapy after he gives up.”
Leech therapy? This woman could have been dying, and leeches were the barber’s solution? No magical cures? Not even a glowing tool? Fearing the worst, Dimitry locked eyes with the patient. “I know I’m not well-dressed, and my hair’s a bit of a mess, but I promise I won’t do anything to hurt you. I know it’s hard for you to breathe. Will you let me help you?”
After a hesitant nod, she met Dimitry’s gaze.
The floor creaked as Milli slowly approached from the other room. She muttered incomprehensible prayers, and from a wall-mounted stand, a glowing statue of a woman showered the room in overpowering light. It illuminated the patient’s overwhelmingly puffy lips.
Swelling deep in the skin—angioedema. That symptom alongside wheezing led Dimitry to suspect food allergies, but confirmation wasn’t possible without further examination. “Can you open your mouth?”
She did.
“Having fun playing around?” the barber mused.
Ignoring the provocative comment, Dimitry peered to the back of the patient’s mouth. An engorged redness crept beyond her tongue and inflamed uvula to cause pharyngeal swelling that likely traveled down the entire throat. An endoscope was unnecessary to learn that the inflammation reached her respiratory tract. Wheezing was proof enough. But was the source food allergies?
Dimitry leaned back. “Madam, do you feel any itchiness or pain?”
“My mouth is burning,” she croaked after a labored breath. “It feels like I’m chewing a ripe dune pepper. And my stomach hurts so much I feel like throwing up.”
More proof to support his hypothesis.
The barber shook his head. “Whenever Idalia comes in here, I tell her to stop sleeping on her belly. Is it so hard to listen?”
“That’s not what’s causing her stomach pain,” Dimitry said. “I think it’s gastrointestinal anaphylaxis caused by allergies, but without a—”
“Spewing random words to impress me now?”
“You’ve never even heard of allergies? They might kill the poor girl.”
Idalia shot the barber a concerned glance.
He pushed away from the wall. “Of course I know about allergies. And analtraxis!” The barber pointed to a yellow sheet nailed to the wall. “Do you think the guild gives certificates to anyone that comes around?!”
Milli’s muttered prayers grew louder as the patient’s eyes darted across the room, unsure of whom to believe.
Shit. Although the patient might survive today, a severe reaction to an unknown allergen would eventually take her life. This world didn’t have epinephrine injections or antihistamines. There was no room for error.
Dimitry had to provide treatment and appease the barber’s ego. “I admit, you know more than me.”
“That goes without saying!”
“You also know that in order to treat allergies and analtraxis, we need a food challenge to—”
“I know that!” the barber shouted. “I’m just saying that leeches are the better option.”
“The leeches might curb the inflammation, but it’s just a symptom. We need to eliminate the cause.”
“Then how exactly would you extract the cursed blood from her lips, moron?”
Realizing that reason wasn’t working, Dimitry opted for an arrangement that benefited himself, the patient, and a defensive barber-surgeon. “Why not try my way, then prove me wrong with the leeches?”
“I don’t have to prove anything to a bum.” The barber pointed towards the exit. “Leave.”
Desperate, Dimitry’s gaze returned to Idalia. “Tell me, quick. What did you eat this morning? Try to be accurate—this could save your life.”
The girl hesitated. “I… I had pork sausage, and buckwheat soup, and, and some vegetables.”
“Fine.” The barber stomped away. “If you can’t leave, I’ll have someone do it for you.”
The door creaked open, and a harrowing breeze washed across the barbershop.
“Guards!”
With panicked eyes, Milli pulled Dimitry’s arm. “We can’t stay here!”
Her fearful response hinted that Ravenfall’s guards wouldn’t take kindly to two homeless lurkers intruding upon an alleged physician’s establishment, yet every fiber of Dimitry’s being begged him to stay, to help the ailing person in front of him. But he couldn’t stay long. To do so was to risk Milli’s life.
He offered potentially life-saving advice before leaving. “Idalia, you must stay away from all the foods you ate this morning. I know it sounds strange, and I can explain more if you find me in an alley near the Church. I swear to Zera that you’ll never have to wheeze like this again.”
The girl nodded hastily. “C-Celeste guide you.”
As Dimitry dashed away from her, past a fuming barber, and across icy gravel streets, urgency burned within his chest. The people of this city were dying from unnecessarily fatal diseases. And he was starving.
Both issues had a simple solution: cut out the middleman.
Timber chunks and cloth scraps piled against alley walls to make room for an empty storage crate. For the sixth time, it scraped across the dirt floor before hitting another crate with a wooden thunk to produce a poor man’s medical exam table. Nearby was a precarious chair upholding a folded quilt provided by Milli.
Dimitry spread the makeshift table cover and stepped back to appraise his ‘doctor’s office’ from a distance. Here wasn’t good enough either. Although the sun would illuminate a supine patient as long as it remained in the sky, its light would also get in Dimitry’s eyes.
No one would trust a physician who squinted the entire visit.
Kicking away hazardous ceramic shards onto the gravel street, Dimitry went over to the crate and gripped it once more. Pain shot across his thigh as he pulled it through the alley. He winced as the aching in his arms intensified, but thoughts of the lives recklessly squandered spurred him on. A cycle he aimed to end through his efforts. Everything had to be perfect when the patients arrived, which could happen at any moment.
Even now, Milli visited ill acquaintances across Ravenfall in search of potential customers. She did so at Dimitry’s request soon after they fled the barbershop. He planned to treat as many as possible, and he would do so for free.
His decision wasn’t made solely out of a desire to aid the impoverished, but also because building a customer base and a reputation took priority over short-term profits. Although there might have been people willing to pay premiums to a surgeon operating from an alley, there weren’t many. Free admission with excellent outcomes resulted in rapidly propagating word of mouth—the best advertising. Once Dimitry earned a constant stream of patients, he would charge just enough to afford food, equipment, and a sterile workplace. Only then could he provide acceptable care.
No longer would patients like Milli have to suffer from mineral deficiencies.
No longer would patients like Idalia have to die from barbarous barber practices.
Despite his puzzling circumstances, plans of modernizing medicine brought a smile to Dimitry’s face. No surgeon ever had this big of a chance to impact society. He could live with it.
As the final crate scratched against the alley floor, slow footsteps approached from behind.
Dimitry’s head shot back.
A man cautiously stepped in from the streets. Eyes hiding beneath a dirty brown hood, an equally brown and rough tunic wrapped around their torso. They glanced at Dimitry before backing out to reexamine nearby storefronts. “Between the baker’s and the general store,” they loudly announced. “She said the holy cleric Dimitry was here. This is the right place, right?”
Professionally greeting a patient in a torn robe instead of scrubs shot shame into Dimitry’s gut. Refusing to huddle away as his instincts demanded, he confidently strode forward and smiled. “You’re in the right place.”
The patient’s mouth morphed into a shape that held a lifetime of disappointment. “Is that so…”
Dimitry felt his self-esteem plummet, but the primary concern was eroding the source of the tension—his appearance. He looked down at his robe and fabricated a lie using concepts he heard applied to this world.
“Yeah, I know I don’t look like much of a cleric anymore. I was on a simple pilgrimage when heathens attacked my caravan. Now I don’t even have enough to buy proper clothes.” He chuckled. “But could be worse, I guess.”
“Yeah.” The patient cracked a smile. “Better broke than dead.”
A modicum of rapport established, Dimitry slapped the top of the crate beside him. “So, you know, I’d appreciate it if you imagined this was an examination table.”
“They broke that too?”
“I was too terrified to go back and check. I just ran for it.”
“Don’t blame ya.” Arms open and relaxed instead of crossed, the patient sat. “All I’d care about is getting the wife and kids out of there.”
Not one for commitment even in his mid-thirties, Dimitry admired the man’s familial devotion despite a young age. “I’m sure you’ve got a lot going on back home, so let’s get right to it. Mind telling me your name and what’s hurting you?”
“I’m Rowan and…” The patient curled his hands and glanced down at his boots. A piercing wind brushed unnaturally white hair across his forehead. “I think I’m possessed by The Ancient Evil.”
Preparing to hear more of the Church’s deception, Dimitry rolled his neck. “I’m all ears.”
“I’m always tired, and my entire body hurts.”
“Can you be more specific about where it hurts and the type of pain you feel? Is it a crushing pain, or maybe something sharp?”
“My head always hurts,” Rowan said, “like it’s being gently squeezed in a vise, and my lower back and shoulders keep me up at night.” He ran two hands down his leg. “And here, too. My knees, thighs, and ankles. It’s hard to even walk sometimes.”
Although a long list of symptoms, they did little to help Dimitry diagnose the issue. Everything from fibromyalgia to chronic fatigue syndrome caused headaches, joint tenderness, and unlocalized musculoskeletal pain. A world filled with unique phenotypes, like hair color, further complicated treatment. Who knew what novel illnesses plagued peoples’ lives?
Dimitry fell onto his rickety stool, which tilted with the slightest movement, and rested his chin on a fist. “I’m sure the pain makes taking care of your family difficult.”
“You have no idea.”
“Is there anything else I should know about? Anything at all?”
“Well…” Rowan’s voice lowered to a mutter, “Remember I said I’m possessed?”
“Yes.”
Rowan struggled to tug off a boot caked in dry mud and massaged his bruised ankle. “Bishop Marianne says it snaps out of place whenever the spirit inside comes free, but I’ll need to buy regular purifications if I want the pain to stop.”
Charging money for sham treatments—a classic. Dimitry suppressed the urge to click his teeth. “When the spirits come free, what are you doing and what does your ankle look like?”
“Just walking, usually. It gets red and puffy.”
Whenever Dimitry saw an ankle that frequently ‘popped’ or ‘snapped’ before bruising and swelling, he immediately suspected lateral ankle instability. The cause was typically a previously injured ligament that healed incorrectly following an ankle sprain, making future sprains more likely. But that wasn’t always the case. One could never be sure without conducting tests.
Lamenting not having access to imaging machinery to collect diagnostic information, Dimitry knelt. “I’m going to examine you now. Lie down, bend your knee so that your foot lies flat on the crate, and tell me if you feel any pain.”
Rowan complied.
Dimitry set his sights on the anterior talofibular ligament. Of the three that comprised the lateral collateral ligament in the foot, it was the most fragile and therefore the one that usually resulted in recurrent ankle sprains. He would probe its integrity with the anterior drawer test.
However, when Dimitry pulled up the patient’s pant leg, there was something that didn’t belong.
Bruises.
Lots of bruises. Big and small, purple and black, they crawled up the patient’s leg from the shin and calf to the thigh. These weren’t ankle sprain bruises, nor were they the ones seen in fractures.
This was something else.
“What?” Rowan’s torso shot up. “Did you find an evil spirit?”
“These bruises,” Dimitry said. “Where did you get them?”
“Oh, those? I get them all the time. Sometimes, I just wake up with new ones all over. The pain’s not too bad, so they’re no big deal.”
No. It was a big deal. A huge deal. Men in their early twenties like Rowan should not bruise this much and this frequently. They indicated profuse bleeding beneath the skin.
Normally, Dimitry would consider hemophilia or the frequent combination of rheumatoid arthritis and anemia to explain the bruising and widespread joint pain, but that changed when he palpated Rowan’s ankle.
The skin.
It was far too soft—like a newborn’s.
Dimitry’s eyes shot open. Those symptoms: musculoskeletal pain, unstable joints, overly smooth skin, copious internal bruising. They frequently co-occurred within a group of connective tissue disorders that were once thought to be rare but were diagnosed more frequently every year. These days, even surgeons like him knew about them.
“Hold out your hand,” Dimitry commanded.
Rowan’s breathing grew abrupt and rapid. “D-did you find something. Is it bad?”
“I’ll tell you after a few more tests.”
“Okay…”
Dimitry grabbed Rowan’s wrist and pinched the back of their hand. Like loose velvet, the young man’s skin stretched several inches further than any healthy human’s ever should.
Hyperextensive skin.
Although that likely ruled out Loeys-Dietz syndrome, one of several potential genetic disorders, and easy bruising eliminated Marfan syndrome, Dimitry didn’t come to a diagnosis yet. The next step was to test for joint hypermobility with the Beighton Scoring System.
He pulled back Rowan’s pinkies, which bent so far as to almost reach the back of the hand. Then, he tugged the thumbs all the way into the wrist. After also examining the patient’s elbow, knees, and spine with various stretches, Dimitry confirmed the patient had loose and unstable joints.
Rowan said nothing. The wind scattered the long, white hair creeping from under his brown hood past a contemplating frown.
Taking a deep breath of air cold and dry, Dimitry dropped into his chair. He massaged his forehead. There were few things in life more heart-wrenching than delivering a lifelong and painful prognosis to a man with children, and even fewer when the children were likely just as ill with no hope for a cure. Even with Earth’s technology.
The two men sat in silence for a while.
“It’s bad, isn’t it?” Rowan finally asked.
“You said you had kids, right? Do you know if they’re ‘double-jointed’ and bruise easily like you do?”
Rowan’s mouth dropped open. “How did you…” Like a man guilty of committing unforgivable taboos, he squirmed on the crate examination table. “Guess you really are a holy cleric like Milli said you were. You divined all that even though my wife and I have been hiding the kids at home. So, are you gonna tell everyone? That they’re possessed like me?”
“No,” Dimitry said. “I won’t tell anyone anything, and none of you are possessed. You have a disease called Ehlers-Danlos syndrome, and your kids probably have it too. It runs in families with no known cure.”
“How do you mean?”
Pondering the best way to explain genetic illness in a world without toilets, Dimitry leaned back in his chair against a white-plastered wall. “Everyone has this thing in their body called collagen, and it’s responsible for holding flesh together. Unfortunately, your collagen doesn’t work right. That’s why you get so many ankle sprains—the ligaments holding your joints together are unstable. It also explains why your skin is so soft and stretchy and why your blood vessels burst so much that there are bruises all over you. Does that make a little more sense?”
The dumbfounded expression Rowan wore only grew grimmer.
That was all it took Dimitry to omit information on the different Ehlers-Danlos syndrome subtypes and potential complications. Not that he knew enough to speak about them professionally. He wasn’t a rheumatologist nor a geneticist. “What I’m saying is that you and your kids have lifelong conditions. Normally, I’d prescribe you some pain medicine, but I’m afraid I left it back on my caravan far, far away.”
“So you’re saying we’re not possessed?” Rowan jumped up. “It’s just lots of pain?”
Did Dimitry say all that for nothing? Perhaps he included far too much information. “For now, yes. I’m afraid that it’ll probably only get worse with time. You may also start having joint dislocations, sometimes in places no healthy person does.”
All color drained from Rowan’s face. “So that’s what was happening to my father… wait! No, does that mean my kids… oh no.” Eyes to the ground, he paced the alley. “Oh no, oh no, oh no… Celeste guide us.”
Watching a father descend into panic over the life of suffering his children would eventually succumb to was taxing. Dimitry had to turn away lest the gritting teeth showed. There had to be something he could do. Why diagnose a patient and his family with a life of debilitating pain, only to send them on their way?
Still, pills didn’t exist.
And manufacturing them without funds or equipment wasn’t possible.
But there was one thing.
Although Dimitry wasn’t a physical therapist, surgical work involved devising physical rehabilitation programs for patients who had lost freedom of movement in traumatic accidents. The same could work for an Ehlers-Danlos patient. By increasing the strength and endurance of surrounding muscles, joints would become more stable, decreasing the likelihood of dislocations, subluxations, and pain.
“Hey, Rowan!”
Distracted from his musings, the young man looked up. “Ah, sorry about that.” He stumbled closer. “I was just thinking out loud. Thanks for, you know, that.”
“Don’t give me your thanks yet,” Dimitry said. “I’m going to teach you a way to make the pain go away. You’ll be sleeping better, your body won’t hurt anywhere near as much, and you won’t have to pay anyone anything. Not even for purifications from the Church.”
Rowan snapped straight up. “You can do that?”
“No, you’ll be doing it. It’s called aquatic therapy. If you bring your children here, I’ll show all of you how it’s done.”
Revitalized from his slump, the young man prepared to dash away. However, before disappearing into the streets, Rowan turned back. His hand reached into his brown tunic to pluck out a copper coin and slam it onto the examination table with a rough metal clang.
Dimitry fondled the otherworldly money with hungry eyes. “Didn’t… didn’t Milli say I was doing it for free?”
“Yeah.” Rowan grinned widely. “I just don’t want you to starve before I come back. The meat pie lady comes around noon. Celeste guide you, holy cleric.”