CHAPTER TWENTY-NINE

THE PHYSICIAN’S APPRENTICE

Now when Yonah rode out with Nuño to treat a patient he no longer waited idly for the physician to complete his task. Instead he stood at the bedside as Nuño spoke in a low voice throughout the examination and treatment. “Do you see the dampness of the sheets? Do you detect the acidity of his breath?” Yonah listened closely as Nuño told the sick man’s wife that her husband was stricken with fever and colic and prescribed a light diet free of spices, and infusions to be taken for seven days.

On the ride from house to house they kept their mounts to a businesslike canter, but on the slow ride home Yonah usually had a question or two that he had gleaned from the day’s work. “How do the symptoms of colic vary?”

“Sometimes colic is accompanied by fever and sweating, but other times, not. It may be caused by acute constipation, for which a good remedy is figs boiled in olive oil and honey until they are a thick paste. Or by diarrhea, for which rice may be parched until it is perfectly brown, and then boiled down and eaten slowly.”

Nuño always had a question or two of his own. “How does what we have seen today match what Avicenna says regarding the detection of illness?”

“He has written that often illness may be recognized by what the body produces and expels, such as sputum, stools, sweat, and urine.”

He continued to work at his translation of the Avicenna book, which buttressed Nuño’s lessons:

Symptoms are obtained through physical examination of the body. There are visible ones, such as jaundice and edema; some are perceptible to the ear, such as the gurgling of the abdomen in dropsy; the foul odor strikes at the sense of smell, for example, that of purulent ulcers; there are some accessible to taste, such as the acidity of the mouth; touch recognizes certain ones: the firmness of …

When he found a word he couldn’t identify, he had to go to Nuño. “It says, ‘the firmness of … the Hebrew word is sartán. I’m sorry, I don’t know what sartán means.”

Nuño read the transcribed passage and smiled. “It almost certainly means cancer. Touch recognizes the firmness of cancer.”

In itself the process of translating such a book was educational, but Yonah found he had limited time to devote to Avicenna, because Nuño Fierro was a demanding teacher who set him straightaway to reading other books. The physician owned several classical works of medicine in the Spanish language, and Yonah became responsible for the knowledge imparted by Teodorico Borgognoni writing on surgery, Isaac’s work on fevers, and Galen on the pulse.

“Don’t just read them,” Nuño warned. “Learn them. Learn them so completely that you will not have to consult them in the future. A book may be burned or lost, but if you really have learned, the book is part of you and the knowledge will last as long as you do.”

Opportunities to perform additional dissections in the barn were rare and widely spaced, but they studied the corpse of a woman of the town who had thrown herself into the Ebro and drowned. When they cut into her womb Nuño showed him a fetus, not fully formed and the size of a fish that any angler would have thrown back.

“Life is engendered from the sperm, the issue of the penis,” Nuño told him. “It is not understood what occurs in the woman’s body to make the transformation. Some believe that seeds in the expelled male liquid are quickened into growth by the natural warmth of the female tunnel. Others suggest it might be helped by the additional heat of friction during repeated thrusting of the male member.”

They dissected a breast, Nuño pointing out that the spongelike inner tissue was sometimes the site of tumors. “In addition to delivering mother’s milk to the babe, the nipples are sensitive sexual areas. Indeed, a woman can be readied for intercourse by means of stimulation of several areas by the hands or mouth of the male, but it is a secret ignored even by many anatomists that the seat of female arousal is here,” he said, and showed Yonah the tiny organ, the size of a small pea, hidden in twin folds of skin like a wrapped jewel at the top of the vagina.

It reminded Nuño of another lesson he wished to teach. “There are women in good number in the town, more than enough of them for any man’s needs to be discreetly satisfied. But stay away from whores since many have the pox, a disease to be avoided for its terrible consequences.”

A week later, he fixed that lesson firmly in Yonah’s mind by bringing him to the home of Lucía Porta, in the center of the city. “Señora, it is the physician come to see little José and Fernando,” he called, and a woman shuffled to the door.

“Hola, Señora,” Nuño said. She looked at them without greeting but gave them entrance. A thin, small boy stood against the wall, snuffling and regarding them dully.

“Hola, Fernando. Fernando has nine years,” he said, and Yonah felt a stir of pity, for the boy seemed four or five years old. His legs were underdeveloped and terribly bowed. He made no protest when they examined him. Nuño pointed out that he had a clump of dark growths on his scrotum and another on his anus, like small grapes. “We sometimes see this, but not often,” he said. He led Fernando to the window where the light was better, and held the child’s mouth open wide so Yonah could see that the palate was perforated. It was a strange mouth in other ways; the two upper front teeth were gapped like pegs, narrower at the bottom than the top. “The hole in the palate is very commonly seen, and so are the malformed teeth.”

A crying infant lay on a pallet, and Yonah and Nuño knelt over him.

“Hola, José,” Nuño murmured. The baby had sores and blebs on his mouth and about his nose.

“You have enough salve, Señora?”

“No. All gone.”

Nuño nodded. “Then you must go to Fray Medina’s shop. I shall tell him to expect you, and to give you more.”

Yonah was glad when they were in the bright sunshine again, and walking away. “The salve will do very little,” Nuño said. “Nothing will do much for them. The baby’s sores will go away, but his front teeth no doubt will come in like his brother’s. And there may be far darker complications. I have noted that several of my patients who have gone mad—two men and a woman—had suffered from the pox while younger.” He shrugged. “The connection between the two diseases is nothing I can prove, but it is interesting that the combination appears,” he said, and for a long time that was all he taught Yonah about pox.

*   *   *

Nuño said his apprentice was required to attend church regularly, although at first Yonah struggled against this rule. It had been one thing to attempt an illusion of Christian piety in Gibraltar, where he was under constant scrutiny, but he rebelled against hypocritically performing the mechanics of Catholicism while living in Nuño Fierro’s household, where he sensed there was no threat to a nonbeliever.

But Nuño was unyielding. “When your apprenticeship is completed you will go before the town officials, a candidate for licensing as a physician. I must go with you. Unless they know you as a practicing Christian, you will not be licensed.” Then he delivered his decisive argument. “If you are discovered and destroyed, Reyna and I shall be destroyed with you.”

“I have been to some services of the church only a few times, when attendance was a necessity. I was able to mimic those who sat nearby, kneeling when they knelt, sitting when they remained seated. But church attendance is dangerous for me, because I am unskilled in the subtleties of churchly behavior.”

“It is easily taught,” Nuño replied calmly, and for a time along with the lessons in medicine there was instruction about when to rise and when to kneel, how to recite Latin prayers as though they were as familiar as the Shema, and even how to genuflect upon entering the church as if Yonah had done it all the Sundays and saint’s days of his life.

*   *   *

Spring came to Saragossa later than it had arrived in Gibraltar, but eventually the days grew longer and warmer. The trees he had pruned and fertilized in the orchard bloomed prodigiously, and he watched as the fragrant pink petals fell and were replaced within weeks by the first small fruits, both apples and peaches, hard and green.

On a day of soft rain a widow named Loretta Cavalier came to the infirmary and complained that in the past two years her monthly flows had all but disappeared, replaced by severe cramps. Small and fair skinned, with hair the color of a mouse’s fur, she described her problems haltingly, her close-set eyes looking only at the wall and never at Yonah or Nuño. She had been to two midwives, she said, and had been given salves and nostrums but nothing had availed.

“Are your bowels open?” Nuño asked.

“Sometimes they are not.”

For when they were not he prescribed flaxseed in cold water to be drunk seeds and all. Outside the dispensary her horse and cart waited, but Nuño told her that for a time she must leave the cart at home when she went on errands, and ride on horseback. For increasing her monthly bleeding he instructed her to boil in water cherry bark and purslane and leaves of raspberry and to sip the resulting infusion four times each day, continuing this treatment until thirty days after her flow became regulated.

“I am not certain where to find the ingredients,” she said, and Nuño told her they might be purchased at the apothecary’s shop in Saragossa.

But the next afternoon Yonah collected strips of bark from a wild cherry tree and gathered purslane and new leaves from a berry bush, and that evening he carried them, along with a bottle of wine, to the woman’s small house by the Ebro River. Her feet were bare when she answered his knocking at the door, but she invited him in and thanked him for the bark and the leaves. She gave him a mug of his own wine and poured a mug for herself, and they sat by the fire on two beautifully carved chairs. When Yonah complimented them she said they had been made by her late husband Jiménez Reverte, who had been a master carpenter.

“How long has it been since your husband died?” Yonah asked, and the woman said it was two years and two months since Jiménez had been stricken by the thrush and carried off, and that she prayed daily for his immortal soul.

They never knew ease with one another but conversed awkwardly, separated by silences. Yonah was aware of what he wanted to occur but unversed in the kind of conversation that might bring it about. Finally when he stood she rose too; he knew he would have to leave unless he acted, and he put his arms around her and bent to touch his lips to her mouth.

Loretta Cavalier remained very still in his embrace before she disengaged and took the oil lamp and led him across the room, to where he followed her bare feet up the steep, narrow stairway. In her chamber he had only the briefest opportunity to see that Jiménez had carved her bedstead more cunningly than the chairs, all oaken grapes and figs and pomegranates, and then she carried the lamp from the chamber and left it on the floor of the hall. When she returned there was the quick rasp of material drawn against flesh as they divested themselves of clothing and dropped it onto the floor.

They fell against each other then like a pair of long-parched travelers in a dry desert, as if each of them expected sweet water; yet the union brought Yonah only relief, and not the rich pleasure for which he yearned. Presently, lying in the dark room scented by what they had been doing, he explored with his hands flaccid breasts, sharp hipbones, and knobby knees.

She put on her shift before reclaiming the lamp. Yonah was never to see her naked. Though he came back to her house to lie with her three more times their joinings lacked passion, as if he were committing an act of onanism with her borrowed body. They had almost nothing to say to one another; awkward conversation was followed by release in the fine bed, followed by spare and clumsy words as he took his leave. The fourth time he came to her house, when she answered his knocking she didn’t invite him in, and he could see past her to where Roque Arellano, the Saragossa butcher, sat at her table with his shoes off, drinking wine Yonah had given her.

Several Sundays later Yonah was in the church when the banns of Loretta Cavalier and Roque Arellano were read by the priest. After they were married Loretta Cavalier began to work in her husband’s butcher shop, a prosperous business. Nuño kept chickens but didn’t raise beef or pork and several times Reyna asked Yonah to go to the butcher’s to buy meat or the fish which Arellano sometimes also carried. Loretta had become skilled; he admired the swift, sure way she cut and trimmed meat. Arellano’s prices were high, but Loretta always greeted him cordially, her close-set eyes beaming, and often she gave him marrow bones that Reyna used when she made soup or potted a fowl.

*   *   *

Both Nuño and Reyna had come to live in the hacienda when the maestro of the house was Gabriel ben Nissim Sporanis, and it had been the Jewish physician’s custom to bathe before sundown each Friday, preparing himself for the Sabbath. Nuño and Reyna had fallen into the habit of weekly bathing, Nuño taking to the bath on Mondays and Reyna on Wednesdays, so water would need to be heated for only one bath in the course of an evening. The bathing was done in a copper tub placed before the fire, where a kettle of additional water was kept heating.

It was great luxury for Yonah to bathe each Friday as Montesa had done, though he had to scrunch his large body into the confines of the tub. On Wednesday evenings sometimes he would walk outside while Reyna bathed, but more often he stayed in his room, playing his guitar or working on the Avicenna by lamplight. It was hard to concentrate on memorizing the drugs that had astringent uses on sores and those that warmed and did not purge, while trying to imagine how she looked.

When the water cooled, he could hear Nuño going to her, taking the kettle off the fire and adding hot water to the tub, as she did for the maestro on Mondays. Nuño also provided this act of courtesy for his apprentice on Fridays, moving slowly and with exertion as he lifted the kettle, warned Yonah to swing his legs out of the way lest he be burned, and poured the hot water, his breathing labored.

“He does too much. He is no longer young,” Reyna said to Yonah one morning when Nuño was occupied in the barn.

“I try to lighten his load,” Yonah said, feeling guilt.

“I know. I asked him why he must lavish so much of his strength in teaching you,” she told him frankly. “He said, ‘I do it because he is worth it.’” She shrugged and sighed.

Yonah could offer her no comfort. Nuño forced himself to ride out even when the cases were so ordinary that follow-up calls could be made by the apprentice alone. It wasn’t enough for Nuño that Yonah had read Rhazes, who pointed out that superfluities and poisons were eliminated from the body each time urine was voided; the maestro must point out to Yonah at bedside the lemony color in the void of the patient who had a long-lasting fever, the pinkish urine occurring at the start of malarial fevers that recurred every seventy-two hours, the white spumous urine that sometimes came with pus-filled boils. He taught Yonah to detect the varied stink of disease in piss.

Nuño also demonstrated an excellent grasp of the art and science of apothecary. He knew how to dry and grind herbs to powder, and how to make unguents and perfusions, but he sacrificed the convenience of making his own medicines. Instead, he patronized an aged Franciscan, Fray Luis Guerra Medina, a skilled apothecary who also had provided medications for Sporanis.

“There is much suspicion of poisonings, especially when a member of royalty dies. Sometimes the supposition is well grounded, but often they are not,” Nuño told Yonah. “For a long time the Church forbade all Christians from taking medications prepared by Jews, lest they be poisoned. Some Jewish physicians prepared their own remedies anyway, but a number of physicians, Old Christians as well as Jews, have been accused of attempted poisonings by patients who didn’t wish to pay their medical debts. Gabriel Sporanis felt safer using an apothecary who was a friar, and I use Fray Guerra also. I have found that he well knows the difference between hemp agrimony and cassia fistula.”

Yonah saw what he had risked by supplying medicinal herbs to Loretta Cavalier and understood he must never do it again. Thus he learned from the older man and listened as Nuño Fierro sought to prepare him for life as a physician, both in professional knowledge and in the homely matters that composed a successful practice.

*   *   *

One day, when Yonah had been an apprentice physician little more than a year, he realized that in that time, eleven of their patients had died.

He had learned enough medicine to understand that Nuño Fierro was an exceptionally good physician and to recognize his good fortune to be in the hands of such a teacher; yet it weighed on him that he was entering a profession in which the practitioner so often failed.

Nuño Fierro watched his pupil the way a good horse trainer studies a promising horse. He saw Yonah fight bitterly against the gathering darkness when a patient lay dying, and noted the gravity that settled into the younger man’s being with every death.

He waited until one evening when teacher and student sat by the fire in weary rest, mugs of wine in hand.

“You killed the man who slew my brother. Have you taken other lives, Ramón?”

“I have.”

Nuño took a sip of wine, studying him as the apprentice told of how he had arranged for the murders of two relic dealers.

“If these incidents could be lived again, would you behave differently?” Nuño asked.

“No, because all three men would have killed me. But the thought that I have taken human life is a burden.”

“And do you wish to practice medicine as a chance to atone for the lives you have taken, by saving other lives?”

“It wasn’t the reason I asked you to teach me to be a physician. Yet perhaps lately I have had similar thoughts,” he admitted.

“Then you must see the powers of the medical art more clearly. A physician is able to ease the suffering of a small number of people. We fight their diseases, we bind their wounds and set their broken bones and deliver their young. Yet every living creature eventually must come to an end. So despite our learning and skill and passion, some of our patients die, and we must not overly mourn or feel guilt that we are not gods who are able to grant eternity. Instead, if they used their time well, we must be grateful they had experienced the blessing of life.”

Yonah nodded. “I understand.”

“I hope so,” Nuño said. “Because if you lack this understanding you will be a poor physician indeed, for you will go mad.”