The Apothecary Diaries - Volume 11 - Chapter 1

Chapter 1: Dried Fruit

Maomao was at one of the stoves, cooking. Afraid she might poison herself if she didn’t get some air, she took a deep breath in, let it out again, then wrapped a hand towel around her nose and mouth.

It had been five days since the swarm, and they were finally almost rid of the grasshoppers around the medical office. There were a few survivors—at least until Maomao found them, whereupon she would crush them underfoot.

“Do we still need those poisonous plants?” Lihaku asked as he stirred a big pot.

“Yeah. There might be a second wave.” Maomao chopped some of the herbs in question with a cleaver and dumped them in the pot. “You need to make sure you cover your mouth, Master Lihaku.”

“Aw, it’s just a little smoke, isn’t it?” He frowned, not wanting to take the trouble.

“Do we remember what happened when we weren’t careful around the burned-out storehouse? Do we remember singeing our head?”

“Urk...” Lihaku obediently covered his nose and mouth.

“Miss Maomao! Miss Maomaaaao!” Chue appeared, announced by her distinctive tip-tapping footsteps. She was carrying a large box. “I got the extra medicine and bandages you wanted!”

“Thank you,” Maomao said, inspecting the contents of the box. “Is this all?”

“Afraid so,” Chue said with an apologetic look. Despite the box’s size, there wasn’t actually much in it. Certainly not nearly as much as Maomao had asked for. “Supplies are short everywhere. I think we’ll just have to make do.”

“Yes, of course. You’re right.”

The grasshoppers might be gone, but that didn’t mean they could relax. People were on edge, and that sort of anxiety could lead to outbreaks of violence. Some people were hurt, and many more were in poor health. Medicine always seemed to be in short supply already—with a contagion about, of course they wouldn’t have enough.

Maomao passed Chue a mortar and pestle, encouraging her to work too. Chue obligingly but resignedly rolled up her sleeves.

I don’t think we’ll run out of actual food. But there are other problems.

The bugs hadn’t gotten to all of the provisions in the grain silos, but there was a dearth of fruit and vegetables, meaning everyone would have an imbalanced diet for the foreseeable future.

The real trouble is a few months from now. Supplies would need to be closely regulated until the next harvest.

People could be complex and difficult. Just telling them that everything would be fine and to relax wouldn’t do the trick. As soon as they realized there wouldn’t be enough to go around, they would start hoarding. Soon there would be shortages, and then people would start to starve.

Maomao said, “I’m sure our dear acting governor is well aware of all that...”

“When you get right down to it, Master Gyoku-ou is a doer,” Chue replied pointedly.

“A doer?”

For a variety of reasons, Maomao was not personally a big fan of Gyoku-ou’s, but a mark of adulthood was the ability to separate personal animus from objective evaluation.

“He sent provisions and distributed food around the western capital and the surrounding towns, wherever there wasn’t enough to eat. Being quick to act, that’s worth a lot.”

A swift initial response would do much to reassure the populace.

“Started sharing right away, huh? Generous! I thought the powerful were supposed to try to keep everything for themselves,” Lihaku said, impressed.

“Right? But he sent carriages full of provisions, all carefully calculated based on the population and the extent of the damage to each area.” Chue never missed a thing, did she? She seemed to have checked all this out herself.

Wait. Is that... Was it all the stuff Rikuson had been preparing for so long? He’d made plenty of reports to Gyoku-ou. If the ruler had leveraged those, it would all make sense. If that’s true... It would show that Gyoku-ou wasn’t caught up in his pride, was willing to use anything and anyone he could, even those who had come from the central region. Maybe the reason he ordered Rikuson to stay behind in the village rather than coming straight home was precisely so as to get a better picture of what was happening on the ground.

Maomao couldn’t offer Gyoku-ou her unqualified approbation, not when she knew how he had used Jinshi as a convenient foil, hardly treating him like a real Imperial relative. Still, she had to admit that as one of those politicians who felt his first duty was to his homeland, Gyoku-ou was proving quite effective.

I know someone who could stand to learn a thing or two from him. She wondered how Jinshi felt about the way Gyoku-ou was treating him. The audacity of it doesn’t seem to bother him.

He did, however, chafe at his inability to act openly. He wanted to help, but his hands were tied by his status as a guest and visitor. Still, he did what he could, like sending Lihaku with Maomao to the farming village, or getting the freak strategist to form a bug-extermination team. Jinshi was like a duck—paddling like hell underneath.

Jinshi never seemed unduly attached to his power. Yes, he sometimes acted like a man of authority, but when had he really pressed his status as Imperial younger brother?

During the Shi clan rebellion, maybe, but that’s about the only time I can think of.

On that occasion, Jinshi had wielded his status openly. Maomao was in no position to criticize him—she had been one reason he had done what he did—but in any case, that was the moment His Majesty’s younger brother had been most visible to the public, quashing a rebellion.

Maomao knew that after that, Jinshi had begun to fulfill the duties of his station in life. He’d been as busy as he’d been during his time as a “eunuch”—maybe even busier—but much of his work was things that had been foisted upon him. As far as projects he chose to pursue of his own volition...

The preparations to counter the swarm are about the only thing I can think of.

People said he was worrying too much; they said he was raising taxes unreasonably; ordinary people and bureaucrats alike had regarded him with disdain, but still he had done it.

He should have made himself more visible. Like he was when he was a eunuch. Since returning to his position as Imperial younger brother, Jinshi had hardly used his most potent weapon: his looks.

Maybe he’s holding back so he doesn’t get flooded with suitors. Without the buffer of being a “eunuch,” and now with the added inducement of the power of being the Emperor’s younger brother, there would be no shortage of women who wished to become his queen.

Suitors, huh...

Maomao recalled Rikuson’s little joke. She could only assume Chue had reported it to Jinshi along with everything else. What a lot of trouble.

“Miss Chue, did you report everything?” Maomao asked. She deliberately chose not to say what she was thinking of—how Rikuson had asked, back in the village, if he might seek her hand in marriage.

“I’m not sure what report you mean, but don’t worry. It’s all kept top secret from our honored strategist,” Chue said.

Maomao paused. So she had told Jinshi. Lihaku gave them a look—he didn’t know what they were talking about—but he kept stirring the pot.

“If it was just a joke, then no harm done, right?” Chue said.

“Right. And it was just a joke.”

“Right. But some people might take it seriously.”

That was premeditated! Chue knew exactly what she was talking about. Maomao pictured Jinshi at his most troublesome. Boy, was she going to get an earful about this the next time they saw each other. Then again, maybe it would be all right...

“All done, young lady!” said the quack doctor, showing her a big, flat dish filled with rows of pills. Each of the pills was about as large as a grain of rice and very consistent in size, showing that he had used a mold to make them. Maomao remembered when she had first met the quack—she’d been shocked to discover he was producing the balls of medicine by hand, causing each one to be a slightly different size.

“Thank you very much. If you could deal with these next, please.”

“Sure! Don’t mind if I do.” The quack was in fine spirits, although it was hard to tell which of them was the physician and which the assistant.

Not to mention, somewhere along the line, Tianyu had disappeared. When Maomao went to find him to try to get him to help, she discovered him dissecting some former livestock at the cafeteria. In I-sei Province, adults were expected to be able to butcher animals, so a doctor who knew how to do the same didn’t raise any eyebrows. Maomao even started to think that maybe Tianyu had become a doctor precisely because he liked dissecting things.

“This is practice. Wouldn’t want to lose my edge,” he said, dangling one of the animal’s legs teasingly at Maomao. Being a prick, as usual.

Dr. You and the others were busy treating the injured and sick in town. Everyone who had been posted at the main house and the administrative office had their hands full trying to deal with the aftermath of the plague. The freak strategist in particular was always short-staffed, so he appropriated a few people from the annex as reinforcements, leaving the place quieter than usual.

Maomao took stock of the annex as she walked back to the medical office. A minimal handful of people had been left behind to guard Jinshi. The presence of lively souls like the quack and Chue made the place seem boisterous, but they were two of only a few voices to be heard around the annex. The bustling of the marketplace was absent, and there was no laughter of children playing. Occasionally, raised voices might be heard in a minor argument, but that was about all.

Wish I could go out there and get a look at the city, Maomao thought. Unfortunately, this wasn’t the time for a constitutional. Even if the weather was very nice.

The quack doctor, too, gazed out the window as he squeeeeeezed the mold down. He was checking the position of the sun. “I think it’s about snack time,” he mumbled longingly. Normally, snack time would see him off to the kitchen, somehow finagling himself some food.

“Hmm... I’m not sure snack time is on the cards today either,” Chue said with a sniff. “They’re filling up the storehouses and worried about staple foods. I think our little pleasures will have to wait.”

“Sure, sure...” said the quack, who had been enduring life without snacks for several days now.

If missing snack time is the worst of his troubles, he’s pretty lucky, Maomao thought as she started mixing up some medicine.

She was so focused on her concoction that she almost didn’t notice evening falling. She was just cleaning up tools when someone knocked loudly on the office door.

“Who’s there?” Lihaku demanded. He opened the door to find a young woman, white as a sheet. One of the ladies-in-waiting, maybe.

“Wh-Where’s the doctor?” she asked.

“The doctor? You mean me?” The quack trotted up with a blank expression. The woman had obviously come running as hard as she could, and he offered her a cup of water. “C-Come with me!” she cried. “Please! The young... The young mistress!”

Young mistress? Maomao wondered. She hadn’t heard about any mistress. Then again, this was Gyokuen’s home, so she was sure whoever this person was, they must be a relative of his. Even with only a few guards left, no one of suspicious background would be admitted to the annex.

It was obvious from the woman’s behavior that this was an emergency, but Maomao didn’t think dragging the quack doctor to the scene was going to get the poor maid very far. Knowing she couldn’t allow one of Gyokuen’s own relatives to go unattended, Maomao raised her hand. “If you’ll pardon me. The Master Physician is here exclusively to tend to the Moon Prince. We can’t let you just cart him off somewhere. Aren’t there any other doctors in this house?”

It was the most roundabout way of refusing that she could think of.

“They’re all out! Please! If someone doesn’t help her, the young mistress... She’ll...!”

Figured.

A special exception had been made for this annex because a member of the Imperial family was in residence—but the other doctors, including Dr. You, were all pressed into service to treat the commoners in town. If even they had to go serve in the city, how much busier must the local physicians be?

“Could you at least tell us what’s going on with your mistress?” Maomao asked, making the woman drink the water the quack had brought her. She slugged it down in a single gulp, then slowly let out a breath. “For starters, who is your mistress?” Maomao hated how long this was going to take, but she had to start at the beginning.

After a moment, the woman said, “She’s Master Gyokuen’s granddaughter.”

“How old is she?”

“Eight.”

“And her symptoms?”

“Well, she never did eat very much, but ever since the swarm of grasshoppers, she’s nearly stopped taking any food at all. The only thing she’s been willing to eat for days is fruit, but then today she complained her stomach hurt and vomited several times.”

Stomach pains and vomiting? Those symptoms could be almost anything.

“What kind of fruit did she eat today?” Maomao asked. Conceivably, the girl could have gotten food poisoning from consuming bad fruit, but even in an emergency like this, Maomao had trouble picturing a “young mistress” eating something rotten.

“Her mother gave her dried fruit.”

“Raisins, perchance?”

The woman shook her head. “No. Something that had been brought from the capital—I didn’t recognize it.”

“From the capital...” Maomao cocked her head. I-sei Province produced more dried fruit than the capital did. What was there in Kaou Province that they didn’t have here?

“It had reddish-brown skin and looked like it had been dusted in white powder,” the woman said.

Maomao’s eyes went wide. The lady-in-waiting seemed to be describing a dried persimmon. “All right. We’ll see your mistress right away. Where is she?” Maomao scrambled to get tools and medicines from the office shelves, then shoved them into a bag.

“Y-Young lady! You can’t just go running off on your own!” the quack cried.

“If we leave her, in the worst-case scenario, she might die!”

“D-D-Die?!” The quack trembled visibly. Lihaku picked up Maomao’s bag, while Chue seemed to have vanished in the meantime. “But... But I can’t leave the office...”

“I’ll go.” Maomao couldn’t exactly be sure-sure, but she was almost sure that the quack wouldn’t be able to treat the girl. She figured she would have to deal with this herself—but then someone else spoke up.

“Not by yourself you won’t, Niangniang. You’re not even a doctor.”

Who should it be but the man with the indolent grin? Tianyu was leaning against one of the posts in the medical office, a bag full of supplies already in his hand.

“I’ll go with you. At least I have the title of physician.”

He seemed to have gotten very interested in this case, but his presence made Maomao more anxious, not less.

“You’re coming with me?”

“No, Niangniang. You’re coming with me.”

Maomao stood in silence for a moment. He was right that according to the hierarchy, she was just there to help. And she had to admit that Tianyu was better than the quack when it came to actual doctoring.

“Miss Maomao, Miss Maomao!” Chue had reappeared in the meantime. “I reported to the Moon Prince.”

She worked quickly, all right.

“And what did he say?” Maomao asked. Even if she and Tianyu were willing to go see the patient, they wouldn’t be going anywhere without Jinshi’s permission. The lady-in-waiting, too, watched Chue intently.

“He says you can go ahead and go! Just make sure that you discuss the treatment very, verrry thoroughly with the patient!”

Lihaku looked like he was getting ready to accompany them; he was ordering another soldier to look after the quack.

Maomao turned to the worried servant and said, “Show us where we need to go.”

The lady-in-waiting guided them to a house near the annex. When they were ushered into the patient’s room, they found a woman in her mid-twenties by the bed—Maomao took her to be the child’s mother. She quaked violently. The sharply delineated features of her face were the picture of a classic western beauty.

A young girl lay on the bed, her face bloodless. She resembled her mother, but something, maybe the way she was lying there, made her look thin and weak.

Maomao and Tianyu asked Lihaku to wait at the door, then they went into the room. Chue had wanted to come with them, but this time she’d had to stay home.

“M-My daughter! Please, help my daughter!” The mother looked like she hadn’t even had time to brush her hair; it was stuck to her cheeks in messy strands.

“Yes, ma’am,” Tianyu said. He moved to pull the covers back from the patient, but the woman exclaimed, “What are you doing?!”

“I can’t very well examine the patient if I can’t see her,” he said. He was right, as far as it went—but these highborn houses were much concerned about chastity. They resisted the idea of a man looking at a woman’s body, even if the woman was a child of eight.

It was clear from the expression on Tianyu’s face that he had no interest whatsoever in a kid like this, but it was lost on her mother. Some people seemed to think doctors were all-powerful—that they could divine the patient’s condition, whatever it was, just by taking a pulse.

Maomao glanced at Tianyu.

“All right,” he said. “Would there be any issue if my assistant touches the patient?”

“N-No, I suppose that would be all right...”

Maomao bowed, then rolled back the covers. She took a spoon from her bag of tools and checked the inside of the girl’s mouth. She opened the patient’s eyelids and looked at her eyes.

“I’d like to open the patient’s robe. Would that be all right?” Maomao asked. She was speaking to the mother, but she glared at Tianyu, who held up his hands and turned around.

Maomao undid the robe and felt the patient’s abdomen. It was noticeably swollen. She slid her fingers across the skin, and when she found something that felt hard and round, she pressed gently. The girl groaned.

“Wh-What was that?” the mother said.

“Gas is trapped in the stomach. There’s a foreign object in her intestines that’s preventing it from escaping.” Just like I thought. Maomao had guessed the moment the lady-in-waiting said the girl had eaten dried persimmons.

“A foreign object?” The mother’s eyes went wide. She seemed to be searching her memory for anything unusual that her daughter might have swallowed.

“I was told she’s eaten nothing but fruit for the last several days,” Maomao said. “And today she had dried fruit—dried persimmons, yes?”

“That’s right. Even when she didn’t seem to have an appetite, she would eat sweet things. Because of those awful grasshoppers, we haven’t been able to get honey or fresh fruit, so I gave her some dried persimmons that we got as a gift. You don’t think they were poisoned, do you?!”

“No, it’s not poison,” Maomao said, gently rebuffing the mother as she tried to squeeze closer to her daughter. “Eating too many persimmons can cause stones in the stomach. How many persimmons did she eat?”

After a moment, the woman replied, “Three.”

“Three?” Pretty good job for a little kid. But not enough to cause a gastrolith, Maomao suspected. Is it possible? Could three persimmons do that? Maybe they got caught in the fibers from the other fruit?

She thought it through, trying to figure out if there was anything she was missing. A bead of sweat began to roll down the patient’s forehead, and Maomao absently wiped it away with a cloth.

Huh?!

Then she realized why the patient looked so haggard. Unlike her mother’s bountiful head of hair, the child’s hair was thin and scraggly, and it was turning white at the roots.

White hair?

It was said that a terrifying experience could turn the hair white—and there was no question that witnessing a huge swarm of grasshoppers would be a major shock for an eight-year-old child.

Well, now was the time for action, not thinking. But how to explain to the mother? They couldn’t just charge ahead.

“When there’s a foreign object in the stomach, there are three main modes of treatment,” Maomao began.

“Y-Yes?”

Maomao looked at Tianyu. He was still turned around, but even with his back to her she could see him nod. He was going to let her handle this part.

“First, you can give the patient water to help move the object through the insides and eventually evacuate it.”

The mother nodded.

“The second way, by contrast, is to administer liquid medication from below to encourage evacuation.”

From below—in other words, through the anus.

“Water! Bring water!” the panicked mother commanded a servant before even hearing what the third option was.

“I’m afraid in the case of your daughter, I can’t recommend it. It seems likely that she would simply vomit up any water she drank.”

“So you’re going with the second possibility?” the mother asked. She didn’t seem to like the idea of inserting medicine through the behind—but if that would have worked, they could have counted themselves lucky.

“No. Based on what I felt during my examination, I don’t think encouraging evacuation will flush out the object.”

“You can’t do the second thing either? What’s the third thing, then?” The woman fixed her with a look which, while not as potent as Taomei’s, was formidable nonetheless.

“We cut open her stomach and remove the obstruction by hand.”

Instantly the woman’s face hardened and she pounded a nearby table. “You think this is funny?! You want to cut open my daughter’s stomach?! You won’t lay a finger on her!”

The mother, naturally, refused the suggestion. She gave Maomao her most frightening look, eyes flashing.

About what I expected.

“You’re ordering us to attempt the first and second methods repeatedly in order to remove the obstruction?” Maomao said.

“I am, and you’d better do it quickly!”

“I’m afraid I can’t do what you’re asking in good conscience. The patient would most likely only die. If you absolutely must use those methods, you’ll have to do it yourself.”

Maomao kept her voice calm and level. She felt for the young girl lying agonized on the bed, but she couldn’t just administer a random treatment. If the girl died, there would be serious repercussions. If she ignored the mother and simply bulled ahead with a shocking treatment, however, she would get them thrown out.

There was only one choice: she had to persuade the mother.

“I have to warn you, I don’t think there’s time to consult with another doctor. If possible, I want to do the surgery right here, right now.” She looked at the mother, whose eyes darted to Tianyu.

“You’re a real doctor, aren’t you? What this...assistant of yours is saying can’t be right, can it?”

“I concur with her opinion,” Tianyu replied in his most serious tone. “A simple gastrolith could be treated with one of the two methods she described. However, the swelling of the stomach in this case indicates an intestinal blockage. Your daughter needs immediate attention.”

He sounded far more official than he usually did, but Maomao found herself on edge just the same. She was worried that he might slip back into his typical offhanded tone at any moment.

“If you cut into her belly... Won’t that mean she can no longer bear children?” the mother asked.

“We won’t touch the womb. The blockage is located far away from the reproductive organs,” Maomao said, communicating the results of her exam. She was lucky that the physical examination had revealed the location of the problem. If they kept their heads and worked calmly, this would be a relatively easy surgery.

At least, it would be for someone like Dr. Liu.

This wasn’t like attempting to remove lesions, or even extracting a shattered bone. Maomao tried to look steady, to reassure the mother.

“How much harm will you have to do? Whatever this thing is, it’s not small, is it?” the mother asked, looking at Maomao with anxiety all over her face.

“I’ll make a nine-centimeter incision in the skin. Then I’ll cut into the stomach, remove the blockage, and then sew everything up with thread. There will be a scar, but it should fade as she grows.”

Maomao couldn’t guarantee that the scar would disappear—a dire thought for the daughter of a noble family like this one.

“Nine centimeters...” The mother hesitated. But Maomao knew her daughter’s life had to be more important to her.

“That’s how long it will be if I do it.”

“What does that mean?”

Maomao looked at Tianyu. “If you allow the physician here to do the operation, I expect it would be less than half that length.”

Much as it kills me to say it.

Tianyu was, in fact, a gifted surgeon, as Maomao knew from seeing him dissect animals and work with cadavers. She might spend years practicing before she got as good as he was.

Just don’t let it go to your head, you little...

Dr. Liu had warned them repeatedly during the dissections: when they did a real surgery, it wasn’t going to be on a corpse. They were going to have a living, breathing human in front of them. There would be no room for error, he warned them, and they must always seek better surgical techniques. They could not allow themselves to kill a patient because they were caught up in their pride. Instead, they must throw away self-importance and rely on anyone and everyone they could.

So it was that Maomao said to the woman, “A physician bears that title for a reason. If you want the best chance of saving your daughter, then don’t ask a simple assistant like me to do this. You’d be better off trusting the doctor.”

The mother was silent for a long moment, hesitating. She looked at her suffering daughter, then narrowed her eyes and clenched her fist. “Go ahead.”

Maomao let out a sigh of relief. “We’ll need hot water and clean bandages. And could you start a fire for us?”

“Yes.”

“If possible, we also need some ice, but if that’s not available, whatever will most effectively cool the body.”

The mother called a servant and ordered them to prepare everything Maomao and Tianyu would need for the surgery. While they waited, the two opened their bags of tools and took out surgical garments and white aprons, which they put on.

As they got ready, Maomao told Tianyu what she had observed during her examination of the patient, as well as what she suspected the blockage was.

“Seriously? You think it’s...?”

“I can only speculate, but yes.”

She might lag behind him in dissection, but in terms of experience examining patients and assessing symptoms, Maomao was confident that she was ahead. She allowed herself a brief feeling of superiority at Tianyu’s surprise.

“Niangniang, I’m going to do the actual surgery, but maybe you could...”

“I’ll handle the anesthetic. Each of us can do what we’re best at. You have a surgical knife with you?”

“But of course.” Tianyu produced a finely honed knife. Maomao pulled out the medicines she’d brought along.

A child, eight years old, thin.

Yes, they were going to be cutting open her belly, but of course they wanted to minimize the pain as much as possible. Maomao had several analgesics with her. Poppy, thornapple, and henbane were the most well-known of such herbs, but many pain-killing medicines were also poisons. A misjudged dose could have serious consequences.

It was thornapple that Maomao had with her; she was more used to using it than either of the others. It’s often dissolved in wine to administer it, but I’d rather not. Luomen, Maomao’s mentor in all things medical, hadn’t approved of giving medications with wine. True, it would contribute to blunting the pain, but it could also cause changes in the body. It could encourage blood flow and make bleeding harder to stop. It was better avoided, especially with a child who would not be used to it.

Maomao had, in the past, treated a burn without suitable tools or even decent anesthetic, but that had been a special case in which she suspected pain also brought the patient a certain kind of pleasure. She would never normally do that. No, she would never do it again.

She weighed some medicine with a scale. The patient weighs... Let’s call it half what an adult does. She didn’t want to give the girl too much and cause side effects. She would have to work very carefully.

Maomao gently sat the patient up.

“It hurts...”

The girl had been so quiet that Maomao had thought she was asleep, but now she spoke. Maomao smiled a little, then tilted the patient’s chin up. “Take this. It will help.”

She wetted the girl’s lips with the painkiller and helped her drink it. It would take thirty minutes or so for the medicine to take effect. During that time, they could prepare.

“I brought ice,” said the servant, who arrived with ice wrapped in straw. Maomao took it and broke off some chunks, which she put in a leather bag and pressed against the patient’s stomach.

They say you should never chill the abdomen, but there are exceptions to every rule.

Maomao wanted to minimize the amount of painkillers she gave the girl, so instead she numbed the area by making it cold, just as she’d done with Jinshi.

Tianyu polished his little knife, then heated it in the fire. He also had scissors out, as well as something to hold open the incision.

“What do we do about thread?” Maomao asked.

“For the outside, silk. Everything inside, gut,” he replied.

Gut: very literally, thread made from animal intestines. Maomao carefully took out a cloth packet of thread and began inspecting each strand. Ideally, the size should be as consistent as possible, and they wanted to avoid any frayed strands. It was a fraught moment, assessing the implements; they were, after all, about to operate on a young girl.

Finally, Maomao had to make a request of the child’s mother. A cruel request.

“Sometimes the two of us won’t have enough hands during the operation. Could some of your servants help us? Someone who isn’t going to be too disturbed by the sight of blood?”

“What...needs to be done?” the girl’s mother asked.

“We’ve given her anesthetics, but it may not numb all the pain. I tried to go easy on the drugs so there wouldn’t be too many side effects. However, this means that someone may have to hold your daughter down while we work in case she starts thrashing from the pain.”

“Is there any chance I could do it?”

“Do you think you can retain your composure when you see your child in that much pain? Once we start the surgery, we won’t be able to stop.” Maomao gave the woman her most intense look. No matter how much the mother cared about her daughter, if she was going to get in the way, then Maomao needed her out of here.

The mother, however, surprised Maomao with her acquiescence. “All right,” she said. “Will two be enough?”

I thought for sure she would give me a hard time about it. The mother’s face was pale; she must have been near her limit. A servant offered her water.

The mother summoned two more servants, and Maomao instructed them to wash their hands, then dabbed their hands with alcohol. Both of the newcomers were doughty middle-aged women who didn’t look like they would cower at a little blood.

“All right. What say we get started?” said Tianyu, who had wrapped a cloth around his mouth and another around his head. They transferred the patient to an improvised surgical table that the servants had created by putting some long tables together. The patient was breathing much easier; perhaps the painkillers were taking effect. Maomao placed a rag in the girl’s mouth so she wouldn’t bite her tongue.

Then they had the servants hold the girl’s arms and legs. Maomao arranged an apron to cover everything but the operating site.

It was full dark outside, and they had several lights brought so that they could see where they were supposed to cut. To Maomao, it almost looked like the flames danced in answer to the patient’s breathing. In, out.

It was true: working on the living was different from working on the dead. However much they had chilled the skin, there would be blood. The blade of Tianyu’s knife was as fine as a razor.

Tools are an important part of doctoring, Maomao thought. Dr. Liu could exhort them as much as he liked to keep their ego out of it; it still annoyed Maomao that she wasn’t as skilled as Tianyu. If she could get her hands on some tools that might help close the gap, then she wanted to.

The patient was looking pretty out of it from the drugs, her perceptions successfully numbed. That came as a relief to Maomao, who wiped at the blood that poured forth as Tianyu worked.

“Here it is,” Tianyu said, his fingers brushing the swollen small intestine. He gently made an incision with his knife, then plunged a pair of forceps into the opening. Even the servants, who had watched them cut the girl’s stomach open without flinching, recoiled.

“Is there something in there?”

“You called it, Niangniang.”

With the forceps, Tianyu extracted a ball of undigested fruit fibers and a substantial quantity of hair that trailed from the intestine. Out and out it came as he pulled, dangling grotesquely.

Maomao offered Tianyu a tray, and he dropped the hair-and-fiber lump into it. There was still hair in the intestines, so Tianyu went back in with the forceps. Maomao had her mouth and nose covered, but even so the smell was nauseating, an acrid mix of blood and alcohol and stomach juices. The servants turned away as best they could, but they kept hold of the girl’s arms and legs, faithful to the end.

“I didn’t think a gastrolith formed exclusively of persimmon pits would be enough to cause an intestinal blockage,” Maomao said. The patient’s lack of appetite could probably be explained by her habit of eating her own hair. It wasn’t entirely uncommon—some people ate things that weren’t food as a response to stress. In this case, the girl had eaten more of her hair than usual because of the stress of the grasshopper plague, and exacerbated it with fibrous fruits and then persimmons. All of them together had formed the blockage.

Tianyu decided he had extracted all the hair he could and set the forceps aside. There were probably still strands in there, but they weren’t going to be able to get all of them. The rest could be addressed by drinking copious water and maybe taking some laxatives to help work them through.

Maomao passed Tianyu the needle and thread. She used a hook to hold the incision open, making it easier to see the intestines, and wiped up the blood as it continued to flow. Each time Tianyu finished with a stitch, he swapped for the scissors and cut the thread. He stayed stooped over the patient as sweat poured down his brow.

When she was sure they had tied the last knot, Maomao felt a wave of exhaustion. She wished they could just put the patient back in bed, but this wasn’t over yet. She wiped down the surgical site, taking care not to press too hard. Tianyu had been the star of the surgery itself, but it would fall on Maomao to care for the patient now that the procedure was over.

She’ll need more painkillers for sure, and I should prepare some fever medication. Something to stop infection too; that will be crucial. And I have to explain to them what she should eat and how to care for her now that the operation is over.

In other words, there was much to do. At the same time, Maomao wanted to ask the patient’s mother a few questions.

The servants who had been holding the girl down looked almost as spent as the doctors felt. The child had never fought, thankfully, but they were exhausted nonetheless.

“Say, Niangniang,” said Tianyu, who had already scrambled out of his blood-soaked surgical garment. He took the forceps and picked up the object they had extracted. “Do gastric juices make hair change color?” The hairball was discolored in places, brownish.

“Somewhat, maybe. Citrus juice can do it, after all.”

Maomao looked again at the patient’s hair. It was thin because she’d been pulling it out and eating it. The roots were white.

Maomao took the tray with the blockage on it and opened the door.

“Y-You’re finished?!” the girl’s mother asked. She was there, her face devoid of color. She must have been waiting at the door the entire time. Lihaku was simply sitting in a chair; he was used to waiting around.

“Yes, the surgery was a success,” Maomao said. “Would you come inside so we can give you some instructions?”

“Yes, of course.” The mother and a servant entered. The servant was the one who had summoned Maomao and Tianyu. As she and her mistress entered, the other two servants, the ones who had held the girl down, left the room.

“Who do you want to handle the instructions?” Maomao asked Tianyu.

“Hmm... Sounds annoying. You do it. Each of us does what we’re best at, right? Anyway, I get the feeling you’ve noticed something that was lost on me.”

As skilled a surgeon as he was, Tianyu was still Tianyu.

Once the mother and her servant were inside, Maomao made sure the door was closed, then showed them the tray. “This is what was stuck in your daughter’s intestines.”

The other two women cringed when they saw the undigested lump of fruit and hair.

“Why didn’t you tell us that your daughter has a habit of eating her own hair?”

The mother couldn’t quite meet Maomao’s eyes.

Maomao supplied her own answer. “No highborn person could bear the idea of anyone knowing their daughter did something so uncouth, could they? Fine.” She had half a mind to needle them about it a little more, but she would have to leave it at that. The issue was, they couldn’t afford to have something like this happen again. “Abnormal behaviors like eating one’s own hair are frequently caused by stress. Has anything happened to your daughter that might account for that?”

“No,” the woman said slowly. “No, I’ve only brought her up in the way that any...any mother would.”

Liar. Maomao picked up the lump with the forceps. The light and dark hairs formed a mottled pattern. “Your daughter’s hair is naturally auburn, isn’t it? You’ve been dying it black—that’s the source of the stress. Or am I wrong?”

The mother flinched; she pursed her lips and one eye began to twitch. Her lady-in-waiting looked at the ground.

“If we don’t resolve the cause, this will only happen again. How many times do you want your daughter’s stomach to be cut open?”

“It’s not like I enjoy doing it,” the mother said softly. “But the girl has light-brown hair, and her father and I... We both have black hair...”

“Even two parents with black hair can produce a child with brown hair. It must happen fairly often here in I-sei Province. There’s enough foreign blood going around.”

After a long moment the woman said, “My father won’t see it that way.”

Her father? That would be Gyoku-ou. What did he have to do with this?

“My father hates all foreign blood. I-sei Province is part of Li, so he believes it should be ruled by a black-haired Linese. I always thought the same thing.”

Until his own daughter gave birth to a grandchild with light hair.

“My father was distraught by his granddaughter. I had heard, though, that an infant’s hair color can grow darker with age, so I told him she would have black hair eventually. But she never did.”

So the white roots weren’t from hair that had gone white with fear, but because the mother hadn’t had time to redye her daughter’s hair during the swarm. Considering the servant wasn’t saying a thing, Maomao suspected she might be helping to dye the patient’s hair.

Hates foreigners, huh? That was a tough philosophy to get away with when you lived in a nexus of trade. Then again, sometimes familiarity was precisely what bred contempt.

Maomao thought of her red-haired Empress. Gyokuyou and her half-brother might both be Gyokuen’s children, but the family wasn’t monolithic, as this story showed.

“If she won’t stop eating her hair, then I suggest shaving her head until she calms down,” said Maomao. It seemed like the quickest way.

“Shave her head?! What is she, a nun?”

“If you let it keep growing, she’ll just have baldish patches, and will that look better? Besides, if she continues to damage the roots, eventually the hair will stop growing at all.” As she talked, Maomao began taking medicines out of her bag. Anti-infective agents, antipyretics, painkillers. “At the moment, seeing her safely through the hours and days after her surgery is more important. I’m going to give you detailed instructions. If you feel you don’t understand them, I can write down the important points. She needs someone to keep an eye on her postsurgical progress. It doesn’t have to be me and this physician if you don’t like us, but make sure you get some doctor to look at her. I do have to warn you that even if the surgery was a success, she could take a turn for the worse if she doesn’t get proper treatment after.”

If the wound opened or got infected, for example, there would be trouble.

“For now she’s still numb, so she’s calm, but as the painkillers wear off, it’s going to start hurting. Don’t let her touch the surgical site. The pain may keep her awake and she may run a fever. I have medicines here for both those possibilities that you can use as necessary.”

There was a moment as the woman absorbed all this, then she said, “I understand.” Her lip quivered as she approached the bed where her daughter slept. She brushed her thin hair, the faintest hint of relief on her face.

Finally Tianyu spoke up. “I kept the incision to half as long as my assistant said!”

And it was true: he had cut barely half of what Maomao had threatened. What was more, the stitches were as delicate as the incision; if all went well, the scar would be virtually invisible. Maomao couldn’t suppress a flash of annoyance even as she wrote down her instructions.

Wonder if she’ll really follow these.

She had her doubts—but she was very, very eager to get this over with and leave.