We were basically doing what we always did, the day the woman with the dead baby walked up to us. Not the first time we’d seen a dead baby. Occasionally they die in the line on the way to healing, because even if we set people up to do triage and send the actually dying people to the front of the line, they aren’t perfect, and with babies it can be so hard to tell. They can’t talk to you to tell you they’re dying. So the clerics mess it up, sometimes, and sometimes the babies come to me with their pulses just barely stopped, and instead of regaining their rosy complexion they just lie there, limply, in their mother’s arms. I don’t usually mention it to them. I guess I hope the clerics talk to them about what happened after, about how the baby is dead, but I can’t exactly afford to stop the line to talk to them, not if I don’t want any more babies to die while they’re waiting. There’s nothing for those cases. We do our best, and our best just isn’t good enough.
But this woman knew that the baby she was carrying was dead, and she wasn’t in the line at all. I’m not actually sure how she got past the clerics, although I guess I don’t really expect them to provide very much security. She was in her mid-thirties, probably, older than I was, and she looked at me with so much gravity that I kind of forgot that I was a witch whose time was empirically worth about two or three hundred gold an hour. Maybe her expression wouldn’t have bothered me so much if not for the baby growing inside me, too small to kick. I got all emotional the last time I was pregnant, too, and just because I’m slightly better at handling the motherhood emotions this time around doesn’t mean that they aren’t still there.
“He died yesterday,” she said, holding out the baby to me. I didn’t touch it. I guess I couldn’t have, since my hands were occupied with drawing out the regeneration hex and tapping it into everyone who passed by. Tap tap tap, have to stay at least focused enough that the bottleneck is always moving the line and never that people are waiting on me.
“Jungle fever,” said the apprentice sitting beside me. For a second I thought Frederick was talking about the baby’s cause of death, but of course he wasn’t. He was talking about the person I’d just tapped, so that Dahab could tally one more instance of jungle fever in this city. They’d decided to split things up that way, one person wearing the glasses and identifying illnesses, and the other writing tally marks under the correct labels. When one person tried to do it alone, they ended up missing things.
“I’m sorry I wasn’t here,” I said.
“We didn’t bring him in the day before,” she said. “Didn’t have the eight silver. Not when we scraped together all of the money in the house.”
(“Consumption,” said Frederick.)
“I’m sorry,” I said again, because even I could sense that this was not really the sort of statement that called for any sort of defense from me.
“Are you? I understand why the clerics charge money. They only have so many spells. But you,” she said, and gestured towards the line that extended out of the temple building. “You can heal as many people as you want.”
“ - I mean, I can’t, really?” I said, because I’m an idiot. A very smart idiot. “I can heal as many people as I can touch. Which is - trivial for just one person, or a dozen, but when you’re trying to heal everyone, you actually do run into - I’m sorry, this isn’t what you need to hear, are you sure you wouldn’t rather be talking to one of the clerics?”
“No,” said the woman. Her eyes looked haunted. “I want to talk to you.”
“I don’t - I mean I think that’s understandable, but I don’t really know what you want me to say?”
“I want to know how you live with yourself,” said the woman. “I want you to look me in the eye and explain why you think you need eight silver for ten seconds of work. How you watch people scrape away the last of their savings in a desperate attempt to keep their children alive, and still have the nerve to call yourself Good.”
And - man, what do you even say to that. I feel like even a normal person who was actually good at talking to people would have had trouble with this one. But I’m not even that, so I said, “I mean, I don’t really need the money? I - kind of have all the money I need.”
The woman did not look very impressed with this answer.
“I mean - are you sure you really want to discuss this? I’m sure the Pharasmin temple would arrange a service for the baby, I don’t think they charge for a simple one?”
“I want to discuss this,” said the woman.
(“Sir, you don’t appear to be sick with a disease. Can you go to one of the desks over there for an examination? There’s no charge.”)
“ - okay. Look. I don’t personally need the money. I do have things that I’m using the money for, I’m working on building a research hospital so I can find ways of healing people that aren’t, you know, reliant on me personally sitting here tapping people, and I do think that’s important. I’m also using the money as a very crude way of filtering which people need the treatment the most - “
“ - so that I can spend as little time as possible in each settlement and still hit most of the people who have judged the treatment to be most important to them, worth the largest amount of their savings, either because they think they’re going to die without it or because they’re going to lose a lot of time off work, or - whatever. But it’s very rough and there are lots of people who are going to slip through the cracks at any price, because not everyone has the same amount of money. Obviously.”
“But I’m doing it anyway, because the less time I spend in each settlement, the more time I can spend in other settlements, and there are kind of a lot of settlements in which huge numbers of people routinely die of things? And my best guess is that higher prices in more settlements lead to fewer deaths than lower prices - or no prices - in just a couple cities.”
“That’s how I live with myself. Running the numbers. Counting the living. Thinking about the other babies that didn’t die because I carved out enough time to go heal in Augustana and Katapesh and not just Almas.”
“You could let people in based on how badly they need it,” said the woman.
“Incredibly time-consuming,” I said, immediately. The woman looked like she’d just seen me lash out and hit someone, and was trying not to react, so I guess that was the wrong thing to say, or at least the wrong way to say it. I kept talking out of some vain hope that I could smooth over whatever I’d just said. “I’m not actually sure any more than a handful of people even know how to do that sort of assessment beyond extremely immediate stuff like pulse strength and how generally close to death’s door you look, and most of them live way down south. I’m certainly not going to do it, I could hit ten or twenty people in the time it’d take to carry out one examination. Money’s really lossy, but at least it means that it’s up to people to decide for themselves how badly they need the treatment, and not - “
“We needed it,” said the woman. “And you just sit there talking about - money, like my son’s life was worth less because his father and mother were poor.”
“I don’t think that,” I said. I kind of thought that, though. It sounds so incredibly heartless, I know. Maybe it is heartless. But I was raised in a village whose only temple was the house of the god of trade, so I can’t help it - when I run the numbers, I don’t stop at the lives, I also think about which lives are going to go on and save more lives in turn, or produce more houses to live in or food to eat or ships to transport goods. The dream is a world where almost no children die, not just because it’s a tragedy in its own right - which, to be clear, it is, nobody should die before they’re old enough to be sorted into an afterlife - but because we would all be so much wealthier, so much less hungry, so much less vulnerable. My mother lost two children, and she was lucky; grandmother lost five. I thought sometimes about how much wealthier we might be if the sister between Dahab and myself hadn't died, if nine years of food consumption and growing and learning and brightness hadn't been snuffed out by fever - I didn't even know which fever - and she had lived long enough to begin paying back the investment. Whether she would have done as much good for people as I liked to think that we did.
But none of that’s really the point, when the grief is fresh. Is it.
“Typhoid,” said Frederick.
Dahab hesitated with her quill pen high above the paper. “Sorry, Typhus?”
“What the hell is ‘oid’ - “
“Typhoid,” said Frederick, nearly yelling over the din you get when you have a line of a hundred people who are mostly mothers and their sick children. “And that one’s consumption.”
Dahab marked two tallies. “Okay. Naima, can you please stop talking to her, I can barely hear as it is."
“What am I gonna do, call security on a lady with a dead baby?” I asked, only aware after I’d said it that this was probably a really insensitive way to put it. “Can you guys move?”
“Not unless you want us to lose a bunch of data while moving. Or stop the line.”
“We can’t stop the line,” piped up Frederick. “And, uh, spotted fever.”
“Then we can’t move!” said Dahab, neglecting to write down another tally so that she could aim the full force of her derision at me instead.
We must have looked so stupid to the mother, children squabbling over whether it was worth it to us to get up and move ten feet to a different table. If I had been in her position I would have been disgusted by the level of incompetence on display, by this incredibly rich and mercenary healer not even being able to take five minutes to explain to me why my baby was dead. I wouldn’t have been handling it nearly as well as she was, honestly. She just stood there, looking on coldly, judging us for the weaknesses we were already all too aware of.
“She’s not even paying,” complained Dahab. “You’re supposed to make people pay for appointments with you.”
"That’s all you Osirians think about, isn’t it,” said the woman, and gods, you couldn’t even say that she was wrong, comparatively speaking. She saved us from having to respond by stalking out of the room, head bowed over the corpse of her son.
“Smallpox,” said Frederick.
We worked for ten more hours after that, and hit two more cities. We got home around midnight, like we usually do on days when we visit the medical college in Katheer. I’m genuinely not sure whether the apprentices hate me for the hours or not. In any case, they immediately stalked off to bed to get what they could of a night’s sleep, and I retired to my office to sort through the data and dash off a few garbage sentences to add to a pamphlet about the sanitary benefits of boiling various things in water. (Which is important. Boil your utensils.) Couldn’t really focus, though. I don’t need to eat anymore (although I’ve been doing it lately anyway, since there aren’t a lot of books on how rings of sustenance affect pregnancies), and I don’t need more than two hours of sleep a night, but working around the clock still takes a toll, even when I’m propping up my body’s natural processes with magic. I guess this is probably especially true when pregnant, even if I hit myself with magic every time the nausea comes on.
I probably wasted about an hour shuffling through papers before Elie came in without knocking. He keeps reasonable hours. Or would, if I would.
“It’s one in the morning, Naima,” he said, softly.
“I know. I know.” I was not putting down the papers.
“I find that I do my best academic work after I’ve slept,” he said, after a while. Elie hates telling people what to do, even when they’re being obviously stupid. Well, at least if the person is his friend, or a child, or a peasant, and not, I don’t know, a king or a high priest. I guess this is part of why I married him. “And I wanted to talk to you about the trip to Tian Xia.”
My head snapped up. “What trip to Tian Xia?”
“ - the one you’ve been bothering everyone about ever since we got back from the pyramid? We should do it before the baby arrives. I don’t think I’ll want to leave the newborn alone for - a while. So we should probably do it very soon.”
I was so not in the right headspace to have this conversation, but when has that ever stopped me? “I’m not sure we should do it? I mean - it’s barely even a rumor, it was some aside in a book about some completely different thing. It might not exist at all. And I’ve been thinking about the cost of leaving the work I’m doing here undone, and it would really be kind of unacceptable?”
“Naima, you’ve scarcely stopped talking about the possibilities of inoculation for months.”
“Well, yeah, but I’m finally figuring out how to maximize lives saved over here! And if we leave now - well, I have no idea how many people are going to die, actually, because I’ve just now been working on getting people to keep usable cause of death records at all, but - a thousand, at minimum. Maybe tens of thousands, if we’re gone for more than a month, and I can’t imagine discovering the secrets of whatever they’re doing in Tian Xia much faster than that, especially if we don’t know where to look.”
He looked pained. “Naima, I understand that that’s a cost, but - do you think you’ve uncovered something extraordinary or not?”
“I don’t know,” I said, and I could hear how pathetic I sounded, how unsure. “I have absolutely no idea.”
“Well.” Elie came over to my desk to look at the papers, despite the proclamation about doing his best work in the mornings. “You said they do it with smallpox, right? How many smallpox cases did you see today?”
I glanced over at Dahab’s tally marks and mentally grouped them up. “Three hundred and twelve.”
“Did it say how much inoculation lowers smallpox rates, in the book? Roughly?”
“Not even roughly,” I said, digging through the other papers on my desk in an attempt to unearth the right one. “It sounded like they just didn’t get it, which - is either a wild exaggeration or just, uh, true, I guess.”
“Hm. Well, I guess you can still think about the potential worth in both of those scenarios. If it works as well as the author of your travelogue thinks, and you can lead people in distributing it such that no one gets smallpox anymore, or almost no one, that’s three hundred and twelve more people that you can save from something else, right? Every day, for the rest of your life.”
“The math doesn’t actually work like that - most of the people I see aren’t going to die of their illnesses, and most of them aren’t going to be healed in one go, they’re going to need several treatments before their body is strong enough to successfully fight off the disease,” I cautioned. But of course the thrust of the argument was right. If it worked, if it kept people from ever dying of one disease, inoculation might reduce the total disease burden by - five percent, maybe, if you assumed that all of the diseases listed were about equally likely to kill someone, although of course the actual math was more complicated because different diseases were more or less difficult to recover from. Although that should probably also be reflected in the number of people showing each disease, with something like consumption a far greater percentage of the diseases showing on any given day than it was of all the illnesses that occurred, since consumption cases lasted so long and were so difficult to recover from… whatever, say five percent of total disease burden just to have something to anchor to.
But five percent of the total - that would be an enormous achievement, at the scales we were working at. Five percent of four thousand is two hundred a day is seventy three thousand a year is equivalent to about, what, eighteen days of healing in the first year, which means you’d make up for a month off in the first two years if it worked, except actually if it turns out that inoculation is simple and non-magical then it’s more than that, right, because it would do it at prices that would save even the babies whose parents couldn’t afford to pay eight silver several times until they got better. It would help people who weren’t represented in my current numbers at all. How many smallpox cases went untreated, in the cities I visited? Half? Three quarters? And how many occurred outside them, in rural areas or smaller cities that it wasn’t worth my time to go to?
Whatever that number came out to - you could probably find it with a census, at least for the countries that were functional enough to have taken censuses, and if you could do some adjustment for the higher disease rates in cities - the point is, it would do that forever, no matter what happened to me. It would do it after I was dead. Seventy three thousand times one hundred is equivalent to seven million, three hundred thousand treatments over the course of the next century -
At this point I closed my eyes against the headache that was coming on. I was pretty sure that last bit of math didn’t make sense if we were assuming I would be dead by that point; I wouldn’t be around to treat anyone extra, so the comparison didn’t make a lot of sense. I didn’t have the numbers to determine how many people actually died of smallpox, and frankly it was too late at night to be making guesses with any degree of confidence. We couldn’t count the lives saved as a result of any of these possible measures until we had better data about how many we were losing.
“The potential numbers are staggering,” I admitted. “But the art we’re seeking probably won’t work that well. It might not even exist, like half the things you read about the Far East probably don’t exist. And even if it does exist, the effect could be anywhere from perfect immunity to nothing, and they just - attribute smallpox deaths to other things, because they’ve already decided their system working is something they know.”
“That’s also possible,” said Elie.
Gods. How do you run the numbers on something like that? How do you weigh a legend against a fact? Seven million shadow-people against a thousand children that you know are real? Against a baby you can see who is dead in his mother’s arms, because you were somewhere else at the time?
When I opened my eyes, I had to blink back tears. Elie was kneeling next to me, one hand on my knee, looking like he was trying to come up with something reassuring to say and couldn’t quite think of anything that he thought sounded right.
“I don’t want to be responsible for people dying,” I whispered.
I must have sounded so stupid and childish in that moment, especially talking to Elie, because it’s not like Elie was ever given a choice about whether not to stain his hands with some awful decision or another. Maybe none of us are given a choice, actually, even if we didn’t spend our formative years trapped in countries leading bloody revolutions against diabolism. I don’t know. Maybe once you learn to count the good you’re doing, the good you could do, you can never go back to not deciding, to believing that you’re not responsible for any of the endless and overwhelming bad things that happen in the world. And of course, asking not to be responsible is really asking not to have power, not to get to make choices, not to be allowed to influence the world at all.
I don’t want that. Not really. It’s just overwhelming to think about it, sometimes, how much your decisions sometimes matter. How many people might be depending on you, even the ones who don’t know it. Even the ones who don’t exist yet, the ones who are not yet born.
“I think you have to try things,” said Elie. “You’d never have gotten this far if you hadn’t. Everyone you’ve saved - and it might be more than anyone else in the world, at this point, certainly more than anyone else I know - you’d never have gotten that far if you weren’t willing to take risks. To build on what we already know, and follow it where it leads.”
It’s easy to risk yourself, I wanted to say. Harder to risk other people’s children. I don’t think I used to feel like that. It’s goodness, you know, it seeps into you with exposure, like some bizarre fungus. That’s a bad metaphor. Mold. It’s like mold. Is mold a fungus? Whatever. You start out as plain bread that only cares about itself and its little bread babies, and you figure you'll just care about improving the world because it's the thing to do, and the next thing you know you're full of goodness-mold, and there's no way to get it back out of you.
“And - Naima,” Elie went on, unbearably earnest. “What do you want to do?"
“I want all of the babies to live,” I said, because it was probably one thirty in the morning by now and I didn’t have anything else in me. “I want none of them to have to grow up in the Boneyard, without parents, not understanding what’s going on and hoping that nothing eats them. I want to destroy all of the stupid invisible forces that keep killing them for no apparent reason.”
“And inoculation, if it exists, would get you one step closer to that. It would be - a cure, not a treatment. Destroying your opponent, instead of leaving him to fight another day.”
I thought of my sister, who had died of a disease that I had had no name for, and I thought of the dead baby in his mother’s arms, and I thought of the living baby inside me, the one I was selfishly casting remove disease on every day even though it probably didn’t need it, because it was my baby, and I absolutely refused to lose any of my babies. Even though I knew, on some level, that it wasn’t my choice, that I was not actually stronger than the combined strength of every ghastly spectre that haunted us. I was not going to fight like I knew that.
Above us, on the next level of the tower, a toddler started crying. The older baby, the firstborn, the one whose sickly disposition had moved me to pay whatever price I had to for the power to fight back against the inevitable. One of the apprentices yelled at him in the unmistakable tone of someone who would kill anyone who interrupted their sleep further if the offender were not two years old.
“Let’s go to Tian Xia,” I said. “After I spell the baby to sleep. And go to bed. And warn all of the temples, and arrange childcare while we’re gone, and give the apprentices some minor work to do so they don’t go totally soft while they’re thanking the gods for the chance to take a break. And make sure that the hospital construction team has at least a month of work planned out without needing any further input from me. “
“In the morning,” said Elie, and he tugged me away from the papers.