Forty-eight hours after his surgery, Covenant's surgeon pronounced him ready to travel, and sent him to the leprosarium in Louisiana. On their drive to the leprosarium, the doctor who met his plane talked flatly about various superficial aspects of leprosy. Mycobacterium leprae was first identified by Armauer Hansen in 1874, but study of the bacillus has been consistently foiled by the failure of the researchers to meet two of Koch's four steps of analysis: no one had been able to grow the microorganism artificially, and no one had discovered how it is transmitted. However, certain modern research by Dr. O. A. Skinsnes of Hawaii seemed promising. Covenant listened only vaguely. He could hear abstract vibrations of horror in the word leprosy, but they did not carry conviction. They affected him like a threat in a foreign language. Behind the intonation of menace, the words themselves communicated nothing. He watched the doctor's earnest face as if he were staring at Joan's incomprehensible passion, and made no response.
But when Covenant was settled in his room at the leprosarium-a square cell with a white blank bed and antiseptic walls-the doctor took another tack. Abruptly, he said, “Mr. Covenant, you don't seem to understand what's at stake here. Come with me. I want to show you something.”
Covenant followed him out into the corridor. As they walked, the doctor said, "You have what we call a primary case of Hansen's disease-a native case, one that doesn't seem to have a-a genealogy. Eighty percent of the cases we get in this country involve people-immigrants and so on-who were exposed to the disease as children in foreign countries-tropical climates: At least we know where they contracted it, if not why or how.
“Of course, primary or secondary, they can take the same general path. But as a rule people with secondary cases grew up in places where Hansen's disease is less arcane than here. They recognize what they've got when they get it. That means they have a better chance of seeking help in time.
“I want you to meet another of our patients. He's the only other primary case we have here at present. He used to be a sort of hermit-lived alone away from everyone in the West Virginia mountains. He didn't know what was happening to him until the army tried to get in touch with him-tell him his son was killed in the war. When the officer saw this man, he called in the Public Health Service. They sent the man to us.”
The doctor stopped in front of a door like the one to Covenant's cell. He knocked, but did not wait for an answer. He pushed open the door, caught Covenant by the elbow, and steered him into the room.
As he stepped across the threshold, Covenant's nostrils were assaulted by a pungent reek, a smell like that of rotten flesh lying in a latrine. It defied mere carbolic acid and ointments to mask it. It came from a shrunken figure sitting grotesquely on the white bed.
“Good afternoon,” the doctor said. “This is Thomas Covenant. He has a primary case of Hansen's disease, and doesn't seem to understand the danger he's in.”
Slowly, the patient raised his arms as if to embrace Covenant.
His hands were swollen stumps, fingerless lumps of pink, sick meat marked by cracks and ulcerations from which a yellow exudation oozed through the medication. They hung on thin, hooped arms like awkward sticks. And even though his legs were covered by his hospital pyjamas, they looked like gnarled wood. Half of one foot was gone, gnawed away, and in the place of the other was nothing but an unhealable wound.
Then the patient moved his lips to speak, and Covenant looked up at his face. His dull, cataractal eyes sat in his face as if they were the centre of an eruption. The skin of his cheeks was as white-pink as an albino's; it bulged and poured away from his eyes in waves, runnulets, as if it had been heated to the melting point; and these waves were edged with thick tubercular nodules.
“Kill yourself,” he rasped terribly. “Better than this.”
Covenant broke away from the doctor. He rushed out into the hall and the contents of his stomach spattered over the clean walls and floor like a stain of outrage.
In that way, he decided to survive.
Thomas Covenant lived in the leprosarium for more than six months. He spent his time roaming the corridors like an amazed phantasm, practicing his VSE and other survival drills, glaring his way through hours of conferences with the doctors, listening to lectures on leprosy and therapy and rehabilitation. He soon learned that the doctors believed patient psychology to be the key to treating leprosy. They wanted to counsel him. But he refused to talk about himself. Deep within him, a hard core of intransigent fury was growing. He had learned that by some bitter trick of his nerves the two fingers he had lost felt more alive to the rest of his body than did his remaining digits. His right thumb was always reaching for those excised fingers, and finding their scar with an awkward, surprised motion. The help of the doctors seemed to resemble this same trick. Their few sterile images of hope struck him as the gropings of an unfingered imagination. And so the conferences, like the lectures, ended as long speeches by experts on the problems that he, Thomas Covenant, faced.
For weeks the speeches were pounded into him until he began to dream them at night. Admonitions took over the ravaged playground of his mind. Instead of stories and passions, he dreamed perorations.
“Leprosy,” he heard night after night, “is perhaps the most inexplicable of all human afflictions. It is a mystery, just as the strange, thin difference between living and inert matter is a mystery. Oh, we know some things about it: it is not fatal; it is not contagious in any conventional way; it operates by destroying the nerves, typically in the extremities and in the cornea of the eye; it produces deformity, largely because it negates the body's ability to protect itself by feeling and reacting against pain; it may result in complete disability, extreme deformation of the face and limbs, and blindness; and it is irreversible, since the nerves that die cannot be restored. We also know that, in almost all cases, proper treatment using DDS — diamino-diphenyl-sulfone-and some of the new synthetic antibiotics can arrest the spread of the disease, and that, once the neural deterioration has been halted, the proper medication and therapy can keep the affliction under control for the rest of the patient's life. What we do not know is why or how any specific person contracts the illness. As far as we can prove, it comes out of nowhere for no reason. And once you get it, you cannot hope for a cure.”
The words he dreamed were not exaggerated-they could have come verbatim from any one of a score of lectures or conferences-but their tolling sounded like the tread of something so unbearable that it should never have been uttered. The impersonal voice of the doctor went on: "What we have learned from our years of study is that Hansen's disease creates two unique problems for the patient-interrelated difficulties that do not occur with any other illness, and that make the mental aspect of being a leprosy victim more crucial than the physical.
“The first involves your relationships with your fellow human beings. Unlike leukemia today, or tuberculosis in the last century, leprosy is not, and has never been, a “poetic” disease, a disease which can be romanticized. Just the reverse. Even in societies that hate their sick less than we Americans do, the leper has always been despised and feared-outcast even by his most-loved ones because of a rare bacillus no one can predict or control. Leprosy is not fatal, and the average patient can look forward to as much as thirty or fifty years of life as a leper. That fact, combined with the progressive disability which the disease inflicts, makes leprosy patients, of all sick people, the ones most desperately in need of human support. But virtually all societies condemn their lepers to isolation and despair-denounced as criminals and degenerates, as traitors and villains-cast out of the human race because science has failed to unlock the mystery of this affection. In country after country, culture after culture around the world, the leper has been considered the personification of everything people, privately and communally, fear and abhor.