“Check under his rags.”

“Nothin’ there either.”

The prodding came to a halt. Two sets of footsteps moved a short distance away, followed by the distinctive popping of creaky knee joints. An invasive stench akin to stale feces filled the air.

This wasn’t the oncology ward.

Dimitry’s eyes shot open to reveal a discombobulating sight. He lay on a scrap-littered road wedged between two timber-framed walls. They formed a cramped alleyway where, at one end, two men huddled around a small fire, rubbing their hands to stay warm. Dirt, grease, and crimson blots coated their shabby rags. The other end intersected with a gravel street full of pedestrians.

Adrenaline coursed through Dimitry’s veins, shocking him into wakefulness. He pushed off the ground, but a shattering pain in his hands and legs caused him to collapse into body-warmed filth. The unexpected aching caught Dimitry off-guard, but he resolved to try once more. Deliberate movements helped him ease into a standing position. Frigid winds pierced his grimy rags, which wrapped around his torso and left his legs exposed to the elements.

How did Dimitry get here?

Where was he?

What the hell was going on?

All questions Dimitry’s panic did little to answer. What he needed was information, and he needed it now. His gaze turned towards the two men by the fire.

Were they the ones who pickpocketed Dimitry while he slept? Most likely. No one else was around, and they seemed the type to resort to unscrupulous means. The men exuded desperation like stray dogs craving a meal regardless of where it came from. Judging by the blood sprinkled onto their clothes, they were no strangers to struggles of life and death. Dimitry stood no chance if they grew violent.

However, unlike the pedestrians traveling along the main road, Dimitry shared much in common with them. His clothes were ragged like theirs, and they already knew he had nothing to steal. They had nothing to gain from assaulting him. Partially convinced of his safety, Dimitry approached the two men.

A thug with a filth-encrusted beard turned back, eyes full of contempt. “The fuck ya want?”

Dimitry took a reflexive step back and examined both thugs. Neither had a blue pawn imprint on their wrist. His list of questions grew. “I… I just wanted to ask something.”

“Oh, you mean that?” asked an aged man whose gray hair protruded from under stained brown rags. “We were worried that you were dead, so we checked if you were still breathing.”

“Show some damn appreciation that we even decided to check up on ya!”

Since when did checking up on people involve digging through their belongings? Damn savages. Dimitry hid his displeasure, forcing a smile instead. “I appreciate the concern, but I just wanted to know—”

“Weren’t you taught that it’s rude to ask for favors without giving anything in return?” the older man asked.

“Morning prayer ends soon, so ya’d better be quick!”

“Morning prayer?”

“Wellbloom fever clouding your mind, kid?” The older man ran a hand through his gray beard. “Those bullshitters at the Church are giving out free food, and we’re hungry. Get it?”

Dimitry’s stomach groaned at the mention of food. The church the thug referred to was likely to be Baptist, Catholic, or Methodist. All three were known for having soup kitchens. Dimitry wanted nothing more than to eat, to satiate the painful contractions of his stomach, yet the thugs hinted they would exchange information for food.

Widespread uncertainty made knowledge indispensable, but the men’s refusal to get the food themselves fostered doubt. Was the trade worthwhile? Dimitry would decide after he reached the soup kitchen. “Where’s the church?”

The younger thug smirked. “What? Ya never seen a church before?”

“I’m not from around here.”

“What shithole did you crawl out of that you don’t know what a church looks like?” the older man asked.

“Probably some village.” The younger thug waved his hand. “Mine ain’t had much more than a chapel, either.”

“Yeah, but even you knew to look for a big stone tower. If anything, the priestess standing in front is a dead giveaway.”

“Nah. We had a deacon. He was alright.”

“A deacon?” The older man grunted. “Looks like those bitches didn’t take over everywhere yet.”

“They ain’t that bad.”

“That’s because you think with your dick.”

Despite their appearances resembling his own, Dimitry felt out of place watching the two thugs bicker. Long, neglected clumps of hair fell to either side of Dimitry’s shoulders. His beard, which he had shaved his entire life, formed an entwined mesh of grime. He was unrecognizable.

“Hey, you.” The older man nudged Dimitry with a frail elbow. “Since you’re new around here, let me give you a tip. No matter how good they make it sound, don’t join their cult. This is how they treat men.” He turned to reveal a fleshy stump in place of an arm on the other side of his torso.

“Thanks for the warning,” Dimitry said, trying to process their conversation.

“Don’t blame them,” the younger thug said. “That’s your fault.”

“If I was one of their precious ladies, they never would’ve sent me to fight heathens with a fucking toothpick.”

“Yeah, yeah.”

Another extended groan escaped Dimitry’s stomach.

A vision of him biting into a hamburger as its succulent juices spilled into his mouth invaded his mind. The warm imagery lasted but a moment, leaving an emptiness in the pit of his stomach as it faded. Dimitry reached his hand under his rags and traced several ribs that stuck out far beyond the rest of his abdomen. Severe malnutrition.

The younger thug glared at Dimitry. “And what are ya doing wasting time touching yerself? Morning prayer’s ending, and we’re starving!”

Dimitry wasn’t fond of taking orders, especially from suspicious assholes, but food was as urgent a priority as information. He would play along for now. “I’ll be back soon.”

Laughter echoed from behind Dimitry as he left the alleyway and exited onto a gravel-laden street.

Like some backwater Amish town, white-plastered wooden buildings, three stories tall at most, lined an uneven road. There were no cars. No lights. No signs of technology anywhere. Instead, pedestrians in tunics and robes dodged horses and carts as they hurried by. Upon seeing Dimitry, a passing man’s face curled, and he rushed his children along.

Dimitry turned his gaze to the ground to avoid making eye contact. Their reactions were understandable. His hygiene was appalling, and the torn rags he wore probably smelled worse than they looked.

Several hundred meters away, a stumpy spire of stone loomed over the surrounding wooden roofs. If what the older thug said was accurate, that was the church.

And that meant food.

Reinvigorated by the prospect of sating the void in his stomach, Dimitry marched forward.

A building along the way stood out. Behind its open door, an assortment of strange instruments rested on display racks. Hanging above the entrance was a sign with ‘Three Brothers’ Magic’ written across its cracked surface.

Although the characters belonged to a language unfamiliar to Dimitry, not even resembling the hieroglyphics in the ‘invisall’ tome he saw in the dark hall, he read the text as effortlessly as English.

A magic store, huh? Since when did Amish people perform magic tricks? Were they even Amish? Perhaps Dimitry awakened in a place with remnant medieval architecture like Transylvania. But that didn’t explain the lack of cell phones or how he got there. Was he somewhere else or just in a different time period?

Meandering thoughts plagued him until he arrived at a massive building comprised of uniformly chiseled stone bricks.

In front stood a girl in plain gray vestments. Her clothes covered most of her hair except for two blond pigtails resting on her chest. A magnanimous smile decorated her face, its innocence powerful enough to coax protective instincts from the most cowardly man.

Was she the priestess the thug mentioned?

“Are you here for morning mass?” she asked.

Dimitry scanned her person, desperately searching for anything resembling a crucifix, a bible, any symbol reminiscent of Christianity and therefore Earth. There was none. “Excuse me, miss.”

“Yes?”

“What kind of church is this?”

Her smile wavered. “We’re just a normal church.”

“I mean, are you guys Catholic? Protestant?” His breathing grew ragged. “Baptist?”

“Baptist? Is that a village?”

Dimitry’s bare foot tapped the ground restlessly. Although he wasn’t religious, even he knew the different church denominations. So why didn’t a priestess? And weren’t female clergy considered apostasy by the bible? Dimitry suppressed his gut feeling—one warning him he wasn’t where he wished he was—hoping to uncover a more favorable truth. “Do you know Jesus Christ?”

“Who’s that?” the priestess asked.

Shit.

Stores advertising magic devices, oblivious priestesses managing churches, tunics, obscure languages, uneven roads, a lack of electricity, horses as transport, omniscient men, the ability to turn invisible, awakening in an unknown land, overly vivid dreams. All evidence hinted at a warped, medievalesque reality.

Dimitry stepped back, both terrified and desperate to confirm his hypothesis. “Are we… on Earth?”

“We’re…” The girl glanced down at her leather boots. “…on land.” There was sympathy in her eyes, as if watching a hapless child, when she looked back at him.

Dimitry swallowed. The priestess’s confusion told him everything he needed to know. This wasn’t Transylvania. This wasn’t an isolated Amish town within the United States. This wasn’t the Earth he knew.

This was…

This was somewhere else.

“Are you okay?” she whispered, taking a step forward.

Dimitry’s arm shot towards a church wall when a cramp, excruciating like an intestinal blockage, penetrative like a sharp force injury, keeled him over. How long had he been starving?

“What’s wrong? Are you injured?”

“J-just a bit hungry.”

“Get inside.” The priestess pointed towards the church’s doors. “We’ll initiate you, bring the gospel to your ears, and get you some pottage right away!”

Pottage? Was that a dish? Although the promise of food gripped Dimitry, and meeting with the clergy offered a means of edification, the old thug in the alley bemoaned the religion’s deviousness. Before Dimitry allowed a priestess in an alien land to ‘initiate’ him, he needed to know what the process entailed and the ramifications of committing to the ‘Church’. Hasty decisions now could return to haunt him.

Dimitry had only one immediate means for information—the thugs that mugged him. While the men were less than savory, they were the only people he knew that could divulge actionable knowledge about this world in exchange for meager food scraps. No ‘initiation’ required.

Unfortunately, buying their assistance would prove problematic in itself.

The priestess didn’t seem keen on giving away pottage without compliance from Dimitry, and even if he acquired some without joining the Church, he would starve if he traded it to the thugs for information.

But perhaps a solution that fulfilled both criteria existed. A method that earned him enough food to invest into the thugs and himself without commitment to a mysterious religion.

Takeout for two.

“It’s not me I’m worried about,” Dimitry said, swallowing his guilt as he lied to the first person in this world to show him compassion. “Can you spare enough food for another unfortunate soul as well? I have a friend who’s in a bad way. Although I want to hear the gospel and take refuge in the church, I haven’t the time. I need to bring—”

“You know I’m not supposed to take food out of the church.” The priestess wagged her finger as if scolding a petulant toddler. “Your friend must come in person.”

“I would, but you see, we’re from out of town, and we were sleeping on the streets when two thugs attacked us. I managed to get away with only a blow to my head, but—”

“But?”

“My friend wasn’t so lucky…” Dimitry glanced down at the gravel road. “…can’t even walk anymore.”

“I’m sorry.” She looked away. “But the rules are clear.”

Damn. Was there a better way to get her attention? Dimitry thought back on what the thugs in the alleyway said—something about the Church showing preference to women. “My friend really wanted to make morning mass, but no matter how hard she tried, the gash in her leg made it too painful for her to walk.”

“She?”

Dimitry doubled down on his villainy. “I just want her unborn baby to be healthy…”

The priestess’s eyes shot open. “W-wait here!” Her blond pigtails twisted behind her gray vestments as she pivoted away.

When the girl rushed through the church’s entrance, Dimitry collapsed against the wall, attempting to distract his thoughts from the churning in his gut.

A woman across the street dumped a pan of blackened water and various solid bits from a second-story window. The contents plopped to the ground.

Seeing the vile liquid drain into gravel and dirt did nothing to quell Dimitry’s ravenous hunger. Instead, his breaths grew heavier and faster in anticipation of food. He had learned about the starvation process before, seen malnourished patients exhibit its symptoms, but never expected to experience them himself. Food had always been plentiful.

Until now.

After an eternity, the priestess stumbled out of the church carrying two bowls, each containing grainy brown slop and a wooden spoon. “Get this to her right away! I’m not supposed to do this, but every woman is precious to Zera. When you return the utensils, bring your friend as well. I’ll ask Reverend Mother Marianne to look at her wounds.”

Was Zera someone important? Dimitry pushed the concern aside. It already took every ounce of discipline and self-control he had to stop himself from devouring the food in front of the priestess. The details could wait.

“I promise I will.” His trembling hands reached for the gruel-filled bowls. “Thank you for your generosity.”

In an alley near the church, Dimitry trudged past ceramic scrap and piled refuse. He glanced back. People rushed through the adjoining street, but no one followed him.

Good.

There wasn’t anyone to steal his food.

Primal desire flooded Dimitry as he dropped to the ground, cold dirt irritating his exposed legs. He didn’t mind. The only thing he cared about was his haul. His treasure.

Gruel topped one bowl to the brim and the other only halfway. The priestess’s intentions were obvious—the generous portion wasn’t meant for Dimitry but his imaginary female friend. A gesture he intended to take advantage of.

He devoured the glop in the well-portioned bowl and licked it clean. Despite a lack of spices, the murky mixture of beans, grains, and assorted vegetables was nothing short of heaven. Dimitry thanked whatever benevolent entity this world’s Church believed in for food and good-hearted women kind enough to distribute it.

His mouth salivated at the sight of the second portion, but Dimitry stopped himself. Overconsumption could lead to refeeding syndrome—a devious killer that struck any chronically underfed person who overate too soon after prolonged starvation. The sudden influx of calories signaled organs to mass-produce sugars, fats, and proteins, depleting vital minerals in the process. Victims died soon after.

“Something smells good,” a voice croaked from a rag-covered crate across the alley.

Dimitry jumped to his feet, ignoring the crumbling pain in his shins.

An unsteady hand reached from the makeshift home and pulled down a cloth, revealing a woman’s face. Despite what her wrinkled mouth, tired eyes, and sluggish movements suggested, she was forty at most. Not much older than Dimitry. Her pleading eyes stared at the pottage.

He studied the woman’s bony arms. She was starving, too. Dimitry’s gaze traveled from her to the second portion he received from the priestess. Although he originally intended to trade it to the thugs for information regarding this land, never again could he ignore a dying person.

That was why he became a doctor.

Despite gluttonous greed screaming at him, demanding Dimitry guard every grain with his life, he pointed at the bowl. “Would you like some?”

“I want a lot of things,” she said, “but you can’t have everything you want in life, you know?”

“I don’t mind.” He forced a smile. “It seems I overate.”

The woman reciprocated with her own smile—one that abandoned joy long ago. “So young yet so kind. If only my boys were like that, wherever they ran off to.”

So that was who looked after her. There was no way she could care for herself. “Are they coming back soon?”

“Oh, yes.” She looked up at a gray sky illuminated only by scattered rays of sunlight. “One joined the war against heathens in Mettingcrest, the other started a family with an innkeeper’s daughter. They’ve got money, you know? Their own bread oven and all.”

Dimitry knew little about heathens and why they were in Mettingcrest, but neither fighting a war nor starting a family was a temporary task. “How often do your children visit?”

“Well, you know, kids these days are so busy. They have more to deal with than anyone else.”

“But when are they coming back?”

The woman watched Dimitry with hopeful eyes in an otherwise hopeless face. “Any day now. Maybe tomorrow. Definitely tomorrow.”

Realizing an unfortunate truth, Dimitry heaved a heavy sigh. A concerned child would never allow their parent to live in such a pitiful state. No one was coming for her. Not tomorrow, and not the day after. It seemed that kids neglecting their aging parents wasn’t an issue limited to Earth.

Grabbing the bowl of pottage, Dimitry walked towards her. “Patience is a virtue, but there’s no point in waiting with an empty stomach. You should eat.”

“I can’t. Even if I wanted to.” Despite despair oscillating through her words, the woman’s smile never waned. She lowered her torn blanket to uncover a small lump at the base of her throat. “The bishop said it was a mark of devotion from Zera for entrusting such a fine boy with the monastery. He’s a knight by now, you know?”

Dimitry’s eyes furrowed. The ‘mark of devotion’ on her neck resembled a malignant growth more than any holy symbol should. “Do you mind if I take a closer look? I’m a… I was a doctor.”

“A physician?” The woman examined his shoddy clothing. “You lost your job, too?”

“Something like that.” He palpated her neck for nodules and growths with careful strokes from his fingertips.

“I used to be a seamstress, you know? But I’m old now. For a youngster like you, probably never even having children, to—” She coughed violently.

“Did that hurt?”

“N-no. Just felt fuller than usual.”

Dimitry nudged aside her trachea with his right thumb and, with his left, pulled back nearby muscle for higher clarity. “Can you try swallowing your saliva for me?”

The woman complied, and the growth in her neck pulled up.

An enlarged thyroid gland—a goiter.

Alone, that meant nothing. Many illnesses caused goiters, including cancer, excessive thyroid hormone, or even too little thyroid hormone. Fortunately, a simple visual examination could differentiate between them.

Dimitry’s gaze traveled down from the woman’s brown hair—dry and thinning across her scalp—to her puffy face. Along with a hoarse voice and scaly skin, they were classic findings of lacking thyroid function and almost definitely hypothyroidism. But that still wasn’t a diagnosis.

Everything from pituitary disorders and Hashimoto’s disease to viral infection resulted in hypothyroidism. Even malnutrition could have been the culprit. Unfortunately, each had a different remedy.

Were he still on Earth, Dimitry would have decided on treatment only after ordering an array of hormone and antibody tests, but this world doubtless hadn’t such luxuries. The only tools at his disposal were simple examination, rationale, and questioning. Providing standard care was impossible. However, since the lady sat before him was on the verge of starvation, doing nothing wasn’t an option either.

Dimitry cursed his inadequacy but did not let his indecision show. To do so was to lose his guise of composure. Nothing lost a patient’s confidence faster than an unsure physician—especially one in tattered clothes.

Resolving to do his best with what he had, Dimitry would eliminate potential causes for her illness. But first things first. What kind of doctor questioned a patient without even knowing their name?

He leaned back and looked at the woman expectantly. “Mrs…”

“Oh, so formal.” She offered a warm chuckle and a wheeze. “It’s Madalinde, but call me Milli like everyone else.”

“Mrs. Milli, I know your ‘Mark of Devotion’ doesn’t allow you to eat well, but would you tell me about your diet? The more information the better.”

She looked down at her cupped hands, whose fingers quaked in a chilling wind. “There’s not much to say I’m afraid. For many moons, I’ve been getting pottage from the lovely priestesses at the Church. They even mash it for me a bit so I can get some of it down. Then there’s the beef tallow I occasionally get from the butcher… he’s an old friend, you know? From back when I was still mending clothes on tailor’s street. Saulf’d often come by to—”

Although Dimitry nodded amiably while listening to her story, there was only one thing on his mind: Milli survived solely on grain and scraps of beef fat. The poor nutritional diversity astounded him, and it was most likely the cause of her hypothyroidism.

More specifically, iodine.

There wasn’t any in Milli’s diet.

In modern society, producers added potassium iodide to table salt to prevent a plethora of symptoms from cognitive decline to unhealthy weight gain. Milli didn’t have that luxury. Not only was the pottage they ate without salt, but he doubted anyone in this town could identify or treat iodine deficiency.

Without iodine, the thyroid couldn’t produce the hormones necessary for controlling metabolic rate. Even if Milli consumed adequate calories, her body couldn’t sufficiently mobilize the energy. The trembling hands. The damaged hair and skin, among other countless symptoms. They all resulted from poor metabolic control.

But that wasn’t the worst part. Human bodies regulated themselves, allowing for the recognition and amending of internal issues. Milli’s was no different. Attempting to manufacture more thyroid hormone, her thyroid over-activated, growing in size. However, without iodine, the effort was in vain. All her enlarged thyroid did was birth a goiter that starved her further.

The inclusion of iodine in her diet would most likely undo the damage.

Although Dimitry did not know why he was in this world or how to leave, the thought of tending to a patient made him jump to his feet. Some semblance of normalcy. For the first time since he arrived here, a genuine smile surfaced on his face.

“—and the whole family would sit together to help me knit a—” Milli’s prolonged story came to an abrupt end. She looked up at him with dilated pupils. “Did I bore you?”

“No!” Dimitry concealed his exuberant expression to conserve whatever hints of professionalism remained. “No. Not at all, Mrs. Milli. Quite the opposite. It’s just that I think I know how to cure your condition.”

She chuckled once more. “My condition?”

“The mark of devotion.”

“It’s nothing that needs curing, you know. It’s a sign from her holiness Zera that—”

Realizing Dimitry accidentally insulted her religion, he immediately rebounded. An aggrieved patient was unlikely to comply with treatment. “I misspoke. What I meant to say was that I can help you bear the burden. Your children would be delighted to see you eating well and full of energy when you next meet, right?”

Milli paused. A sliver of hope gleamed across her hesitant eyes. “You can do that?”

After a moment spent pondering natural sources of iodine soft enough for a woman with dysphagia to consume, Dimitry spoke. “Can you get fresh cow’s milk? Perhaps from your butcher friend? Two or three cupfuls a day should be enough.”

“Every… every day?” She fished under her rugged gown for a small pouch and looked inside. Several copper coins chimed within. “I have enough for a week.”

That wouldn’t work. Milli needed a daily, affordable source of iodine.

Dimitry’s eyes darted across the alley in search of an answer. The surrounding thatch-roofed buildings didn’t provide a solution. “I’m guessing potatoes are too expensive, too?”

She nodded.

Damn. His foot tapped the filthy alleyway floor, whose callused heel was numb to the scrap-infused dirt below. “How about…” His restless tapping hastened. “How about kelp or seaweed?”

“Seaweed?” Milli uttered. “That’s for pigs, you know?”

“For pigs?”

“The fish peddlers bring dried seaweed from the coasts.”

As if rediscovering hope, Dimitry inhaled a sharp breath. If people used seaweed as pig feed, that meant it was a cheap source of iodine. Cheap enough for a struggling woman to afford.

“It’s not just for pigs,” he said. “Where I come from, there are many who consider it a health food.”

“But… I don’t know anyone that eats it. Are you sure?”

“I’m very sure.” Dimitry cupped his hands as if holding a handball. “You only need this much a day. No more than that or it might make you sick. Can you at least afford that much?”

She nodded with hesitation.

“I know it may sound strange, but promise me you’ll try it.”

“R-right.”

“Great!” Dimitry barely contained the elated grin yearning to spread across his face. “Do you mind if we meet here again tomorrow for a follow-up?”