Fiction - Hyssop and Hermetics, The Absinthe Literary Review

Local Malady
a short story by John Tisdale

The taxi ride to the Mayor’s office took me through the center of town. The driver at first performed some sort of monologue. He spoke in Quechua, and he was probably explaining the region’s history, the brief unhappy lives of local patriots, the aborted attempts at paving the dirt road on which we traveled. Probably, too, he mentioned the unusual size of their orchids, the fun-loving nature of the giant otter and the distinctive flavor of the passion fruit. These people, I thought, don’t have too much to brag about.

And there it was: after only a few minutes my driver fell into a dark silence. He interrupted it only once for the rest of the trip, to shout curses at some beggars who’d slowed our snail-like progress through the broken street.

I slouched low in my seat, eyes shut. Concentrating for a moment on a convincing argument for my stomach to settle itself, to find something to do instead of bothering me with all its complaining. I thought of it as a temperamental teenager: sulking quietly one minute, worked into a screaming rage the next, all the time wanting to be noticed or left alone, it could never decide which.

I played my game. The one where I asked: if this town were a human being, what disease would it have?

Munich, for example, was gray, struggling in the thin air. It had tuberculosis. The new kind, the kind that eats the lungs in big fast bites like a child spooning up breakfast cereal.

Sao Paulo had been sick with an indefinite malaise, neurasthenic like an old lady or the way an infant can be when we say it fails to thrive. Unemployment was high, drug abuse rampant. The people there went about their business with empty stares and unconvincing smiles. All of them waiting for the next bad thing.

Los Angeles was the worst. Burned, gutted, its downtown empty, the shops and malls mostly deserted. Alzheimer’s, of course. An easy diagnosis, especially in those days: the city was an old man half-dressed, wandering the highway, his unbarbered yellow-white hair hanging limp around his shoulders. Waiting for someone to tell him—excuse me mister, you are dead, so please lie down and act appropriately.

This little town—Pulcapoto it was called—did not lend itself to a speedy examination. This was partly because in every respect it was the same as the other towns I’d already passed through on this trip, and the others, the villages and settlements I’d seen in other impoverished countries: a single dirt road, open toilets, laundry hanging from the windows of one-story shacks fabricated from broken crates and rusted sheet metal. The superheated air stale and stagnant, filled with eye-stinging brown haze from a few badly maintained autos, the cooking fires, the piles of burning eucalyptus and plastic. The bleating of goats. The endless wailing of hungry infants.

Pulcapoto was different from these other towns in one respect only, and this difference too was in the air. It was over to the north, near the upper jungle where smoke made a greasy charcoal stain in the gray sky, and its smell was most distinct. It cut through the town stench, which was after all just the smell of the living.

But what did this town have? I wondered, and then I was thrown against the near door of the taxi and flung back against the other. The driver cursed again, swung us across the road and only just avoided a collision with a scrawny goat and her kid.

I couldn’t come to a conclusion on the matter. Perhaps what I needed was a consultation, but that hardly was realistic. Colleagues were scarce in those parts. Peer review and grand rounds, they didn’t happen too often. And also the quality of the professionals left something to be desired. A year earlier I’d had a chance meeting with a CARE physician, a morphine addict who spoke in long, slurred sentences and fell asleep at the table before he’d finished his first beer.

I was stumped temporarily, but that was all right, I had great faith in my diagnostic abilities. One time in medical school we had a patient, a man with chronic anemia and nosebleeds. The Chief Resident admitted he knew nothing for certain. Something tropical, he thought, because this man had once worked in Haiti. I’d smiled. A diagnosis can be elusive. The doctor needs to be open-minded, critical, and diligent like a detective, but in this case they hadn’t even looked at the patient’s fingernails. “How long,” I asked him, “have you been picking your nose?”

The Chief Resident had been annoyed, but at the end of the day they tossed the patient on the street because health insurance only covered exotic tropical diseases and other sexy maladies.


We arrived at our destination and my stomach settled, thank God. It had at least ceased its kicking and screaming, apparently having fallen into one of those deep recuperative sleeps, exhausted from all the energy it had expended to maintain its anger. It would be angry again when it awoke, true, but respite was all I sought, a cure being unlikely.

The taxi stopped outside the Mayor’s office, a one-story structure of wood and plaster, and before I could lift my bags, a small, thin fellow scurried out from the building and shook my hand with great energy. He introduced himself, I think, and then abruptly let go of my hand, seized both of my bags and began dragging them back along the dirt toward the entrance.

We entered the office, and the man—who proved to be the Mayor himself—deposited my belongings on the floor, then sat down in a leather chair just behind the desk, beneath a large overhead fan that turned in a slow, sporadic rhythm, pulsing I suppose in accordance with the uneven supply of electrical power.

The Mayor was dressed in long camouflage pants with ragged cuffs, and a faded jacket missing all of its buttons but one, with a shiny lapel and a hole at each elbow. I imagined how the jacket might have looked when it first left the tailor: on the back of a young man playing third cello in the Berlin Philharmonic. Or perhaps adorning some fine fellow dancing a waltz with his mistress on the roof of the Ritz Carlton Hotel in Boston, Massachusetts.

“Please, Doctor,” the Mayor said. He gestured to a cane chair on the opposite side of the desk and nodded in encouragement as I made to sit down. He opened a drawer and removed a large wooden box.

“I can’t tell you how excited I am,” he said. “We’ve been anticipating your arrival for some weeks.” He opened the box, took out two large cigars. “Will you have one?” he asked. “These are the last, until next month.”

“Thank you, Mr. Mayor,” I said, and for a short while we smoked, exchanged some social remarks, and discussed the local wines, about which the Mayor proved reasonably knowledgeable.

“I should tell you,” he said, “I’m not exactly a mayor. I was not elected nor was there any sort of formal appointment. Enverado. More like a chief.” He grinned and leaned back in his chair.

He was a handsome man of about fifty. Handsome for those parts, anyway. His teeth were remarkably good, straight and white. He had thick eyebrows and a mustache that was jet black and well-trimmed. It had been designed, I suspected, to display to best advantage those unusual teeth.

“May I call you ‘Mayor’ just the same?” I asked. I drew on the cigar. “Or do you prefer something else?”

“Mayor is fine,” he said. “I rather like the sound of it.”


I leaned forward, rubbed the tip of my cigar against the rim of the coffee can he’d placed on his desk. The glowing ember, as I had hoped, caught on the metal edge of the can, and this allowed the cigar to go out without attracting the attention of my host, who otherwise would have hastened, I am sure, to light it again.

I hadn’t smoked a good cigar in some time. This one was horribly bad, just abominable. There was something in the tobacco—rubber, perhaps, or tar—it caught at the back of my throat and seemed to stick there.

“I understand you have a medical emergency,” I said. I cleared my throat. “Some sort of infectious disease, I was told. A high mortality rate.”

“Well.” The Mayor smiled. “I don’t know about infectious.”

I shifted in the cane chair. The calls had been recorded, I’d listened to them. Severe bleeding and diarrhea, mucocutaneous lesions. Maybe Dengue hemorrhagic fever, or cholera, and that was okay—good luck to them. But maybe the Speckled Monster, and they might have known: at least one doctor would come, probably a whole team.

“So what is it, Mr. Mayor?” I asked. “The right word?”

“Don’t worry about that.” He knocked the ash from his cigar. “Let me describe the symptoms, then you decide.”

“That’s fine.” I took out my cell phone, placed it on his desk. “I have to call in periodically.”

The Mayor nodded. “A good policy.”

Just then the fan above us groaned to a stop, and the air immediately became thick with smoke from the Mayor’s stinking cigar. He smiled in apology and waved his hand between us. “The power is sporadic.” He held up his cigar. “I can put this out if you like.”

“That’s okay.” I balanced my own cigar on the edge of the desk and removed a notebook from one of my bags. “Let’s talk about the symptoms.”

“Well,” the Mayor said. “There is a bloating of the stomach. That’s the first thing. A loss of appetite. Sleeplessness.” He frowned, looked up at the fan. “After that, vomiting, dizziness. The victim goes into seizures. Death follows within three days, sometimes four or five.”

“Is there much bleeding?”

He nodded. “Sure.”

“And fever?”

“Always. I forgot to mention that.”

“Do you have any ideas yourself? What this might be?”

“I’m no doctor,” the Mayor said. “But we have newspapers, a medical text. Smallpox, eh? Like Los Angeles.”

I shook my head. “That wasn’t smallpox.”

“Really?” He smoothed his mustache with his finger. “The newspaper said smallpox.”

I cleared my throat. “What was the age of the victims?”

“Oh, some were only months old. Others, eight, forty, eighty.”

“And where are they? I’ll want to take a look.”

“Burned. We placed them in a pit a few miles from here. Covered them over with dirt.”

“I meant the living ones, Mr. Mayor.”

“Ah.” He puffed away on his cigar, drawing on it until it emitted a thick wave of smoke. Then he shrugged. “It was two months ago, wasn’t it? When we first asked for your help.”

“A lot of people ask for our help,” I said. And then the thing in my gut woke up. It did a kick turn and sent a wave of acid sloshing against the delicate lining of my esophagus.

“Are you okay?” the Mayor asked.

“Yes.” I rubbed the heels of my hands against my face. Tried to work the fatigue from my eyes. “I’m not aware of any diseases that present themselves in this manner.”

The Mayor squinted at me through the smoke. “I’m sorry?”

“Cholera, I see a great deal of that.” I watched his face as I spoke. “Influenza, measles. The symptoms you describe aren’t consistent with any of those.”

“Why not?”

I shrugged. “Burning the dead is useless, that shouldn’t have helped.”

The Mayor leaned forward, his face red. “I should apologize because we have something you don’t recognize? Maybe not virulent enough?”

“Not at all.” I tried to smile. “I’m here to help.”

“Because mortality was close to eighty percent, I’d say that’s pretty virulent.” He picked up something. Some sort of paper opener, I think. He held it lengthwise, bending it. “Like nothing I’ve ever seen,” he said. The paper opener snapped in half, and he dropped the pieces onto his desk. “One second.” He ducked his head and opened the drawer of his desk.

“You should know,” the Mayor said as he rummaged in his desk, “we’ve been uncooperative with certain of the Communist factions. Perhaps this is one of those monster strains. The Russians develop that; maybe they sent it over.”

I nodded and made an entry in my notebook. Thirty percent was virulent—pretty much a show-stopper. Forget about eighty.

The Mayor straightened, held out a photograph in a silver frame and handed it to me. “My aunt,” he said.

I held the picture, saw it was old, cracked. A portrait of a pretty young girl. “Very nice,” I said.

“Yes,” he nodded, “very nice,” and just then his tone became terse, impatient. Whereas a moment before he had been deferential and phony. “She’s got some kind of bug, Doctor,” he said. “You know, a river bug.”

“I’m sorry to hear that.”

“You’re sorry? Of course you are. That’s why we’re all so happy to have you.” He reached over, waggled his fingers and I handed him back the portrait. “Perhaps you can examine her. That bug, the book says, is not so bad. Here, it’s blindness and death. But in the States, it’s not an issue, is that true?”

“It depends, I suppose, upon the bug.”

He started to say something, ask another question, but I shook my head, grasped the arms of the cane chair and levered myself into a standing position. “I don’t feel well, I’m afraid. Is there a place, someplace where I could be alone for a moment?”

The Mayor dropped the stub of his cigar into the coffee can and stood, his thick eyebrows raised high on his forehead in a show of concern. “I’m so sorry, Doctor, of course. Let me walk with you.” He led me out of the office, and for the first time I saw some of the other people who worked there. They were standing around. Watching.

“Through there,” the Mayor said, pointing. “That’s the bathroom.”

He touched my shoulder as I started toward the door. He handed me the cell phone. “In case you want to make a call.”


One of his people drove me out to the mass grave. He stopped almost a quarter of a mile away and said by way of apology that he had a problem with his lungs.

“Very bad coughing,” he said, and he seized up all at once in a paroxysm of wheezing and hacking, as if to prove his case.

I could have waited for the helicopters. They’d have had the special suits and decontamination units, but from what I’d learned, this thing was dormant or had run its course. People were starving, sure, and there was malaria, measles and whooping cough. One fifth of their babies would die before the age of four, and two years earlier gastroenteritis had killed a third of the village. The Mayor’s man likely had some sort of fungal infestation in his lungs. But that wasn’t plague, that was business as usual.

I soaked my handkerchief in after-shave and wrapped it around my face, and then I followed the trail through the jungle. The grave was a smoking mound of dirt surrounded by barrels of oil and discarded clothing, and in spite of the circumstances, I found myself smiling. Burn the bodies and burn the clothes, that was our mantra, and they often did just fine with the bodies. The clothes were a problem everywhere, because no one wanted to waste.

I circled the mound for a long while. I poked at the corpses lying beneath their thin cover of soil, using the long metal pole the Mayor had found for me. I counted almost a hundred bodies. Mostly adults, some smaller shapes that I took to be children. A few others with narrow skulls and sharp teeth.

They were just bones, all of them. Encased in their charred skin like one of those trout dishes baked in papyrus. Even the animals had left the area alone.


When I returned to the Jeep, I asked my driver if his family had lost anyone to the plague, and he said no, he had three kids, all healthy, thank God. The thing with his lungs though, maybe I could help, he was up all night with the coughing.

“I might have something for that,” I told him, and he smiled.

“Medicines for everything,” he said. He turned the Jeep around and hummed to himself as he drove us back to town.

“Your family was very lucky,” I said.

“Lucky?” He laughed. “I finally save enough to buy a blender, you know? So my wife can make baby food. And guess what, now the power goes out, sometimes a week or more.”

“I meant about the plague.”

“Oh, I understand what you meant.” Then he coughed and coughed, and for a moment I thought he’d drive us right into the jungle. “I’m with the Rondas Campesinas,” he said when his coughing finally subsided. The Peasant Patrol.

I nodded as if his comment made sense, but it didn’t, at least not at the time.


The helicopters came. We worked for weeks distributing food and treating the sick, and I never once heard anyone—medic, pilot, frontline staff or senior officer—complain about how the town of Pulcapoto was not infected with variola major. We did our interviews, of course, collected tissue samples from the gravesite and analyzed them as best we could. But the mysterious disease was never identified.

“I have to leave now,” I told the Mayor. He looked up and smiled, and then he came around from his desk and grasped my hand.

“Thank you so much, Doctor,” he said. “You have done many wonderful things here. And sick yourself the whole time.”

“Well.” He must have seen it in my face because I’d only just told the Captain that morning. “I’m sure I’ll be back.”

The Mayor smiled. “You would be very welcome. My aunt says you’re special. Not quite a saint, because your Spanish is so bad.” He laughed, showing me his bright teeth. “But I thought your work here was complete?”

“Not complete. Not entirely.”

“Ah.” He took a cigar from the box and lit it. “The plague.” He drew on the cigar until the ash glowed. “You’ll figure that out.” He nodded, clapped me on the shoulder. “I have faith.”

“It might help, if I could ask a few more questions.”

“Sure. Shoot.”

I wondered about the sound, a humming noise that filled the room. I looked up. It was the fan, spinning away at high speed, dissipating the foul-smelling smoke from the Mayor’s cigar.

“Why the dogs?” I asked.


“You burned the dogs.”

The Mayor raised his big eyebrows. “That’s a medical question. Zoonotics, right?” He puffed on his cigar. “A theological question, too: why God chooses to harm dumb animals. And guess what? I’m neither a priest nor a doctor.” He smiled. “Lucky for me.”

We walked to the door, and this time he made no attempt to help with my bags. “Although you should know, Doctor, these weren’t German Shepherds or Golden Retrievers. More like coyotes.” He dropped his cigar on the floor and stepped on it. “Barking, right?” He made his hands into pincers, opened and closed them: “Barking, barking.”

“And the others?”

He stared at me. “Others?”

“What were they? Indios? Shining Path sympathizers?”

The Mayor reached into his tuxedo jacket and took out another cigar. “As I said. The ones God has chosen.” He lit the cigar and let the smoke drift out from his mouth. “It’s true, isn’t it? You had your heart set on the smallpox.”


It wasn’t until the ride back to the helicopter that I thought of my unfinished game. What disease does this town have?

There was a famous case, we studied it in school many years ago, that was called a factitious disorder: the mother, it was believed, had injected her little boy with feces. Just to get some attention. His fever, she’d told the doctors, it scares me when it gets so high.

“I’d rather be in Los Angeles,” I said to the driver, and he smiled and pointed out the window.

It was a purple orchid, right there by the road. Easily the biggest I’d ever seen, and very beautiful.


© 2003 John Tisdale

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