would reflect later only because, in spite of its flawlessness, he could attach it to no specific region or city. ‘But today she complained of pain in her back. On both sides.’
A bit over twenty, the thought flashed through his mind, still considering the possibility (however slight) of an operation. Good solid constitution. There was no frailty about her, no threat of fainting spells. She would not be a nuisance.
‘Rosalia, my dear,’ the countess said. ‘Send everyone away. Let the doctor examine me.’
‘Everyone,’ she added, seeing how her daughter hesitated. ‘Only Rosalia and Dr Lafleur will stay. No one else.’
The countess was, indeed, in the last stages of the disease that had been ravaging her for years: her face a wax mask over the skull; her arms, hands transparent. Thomas could almost see the tendons clinging to her bones. She had prepared herself carefully for this visit. Her clothes were of embroidered velvet, the kind maids were told to be careful with for their wages would never pay for the damage carelessness might inflict on the fabric. He had noted that the dress had been hastily altered to fit a thinning body. The lingering smell of musk and wild roses told him that she had bathed and oiled her body for this encounter.
As she stood up, she tried to hold herself straight, but the effort it required was obvious. Even in her slippers, flat and soft, she rested her arm on the day bed, to steady herself. The nurse jumped forward to hold her, but the countess shook her head.
Her eyes were now following his every move. She was, he decided, studying him very carefully: the way he stood, sat down, opened his bag, assembled his stethoscope.
He began to establish her medical history, the way he had been examining his patients at la Charité. She said she was fifty, but even though traces of obvious beauty were still visible, he could see she was not telling the truth. Closer to sixty, he would say.
‘How many children have you had, Madame?’
‘Ten.’
‘How many are still alive?’
‘Six.’
‘How old were you when your first child was born?’
‘Is it important?’
‘Yes,’ he said. ‘Your medical history is important.’
‘I was seventeen.’
‘Were there any complications?’
‘No, my children came easily to this world. They didn’t cause me trouble then.’
He asked if she remembered her childhood diseases, and she laughed. ‘In my childhood, Doctor, there were two kinds of diseases: those you survived and those you did not.’
‘How many of them did you survive?’
‘My mother told me of two times I was near death with fever. She prayed for me and the fever went away. I also had measles.’
He proceeded to ask her about her diet, her sleeping patterns, the ease of her bodily functions. She was frank and unembarrassed by his questions, a fact he noted with some pleasure for many female patients shied away from telling him about their bowel movements and gas. Many times it was their relatives who had to provide the information he needed for diagnosis. Countess Potocka said she ate very little, having lost her appetite quite some time ago. She was thirsty most of the time but couldn’t drink more than a few sips of water and found the simplest tasks tiring. The nurse was smoothing the folds of her patient’s dress, nodding as if to confirm her words.
‘When did you begin feeling the first symptoms?’
‘Five years ago,’ she said, ‘I was losing weight, but I didn’t think much of it. And blood.’
Blood stained her undergarments, but the Russian doctor maintained that this was normal for a woman of her age, clearly not a point of concern. It was as if her menses returned, she continued, and she felt a slight pain in her belly. At that time it was more of a thought rather than a feeling.
But this pain began bothering her. That mere thought, uneasiness, soon became a constant companion. She woke up aware of it, and it was with her until the time she fell asleep. This pain began interfering with her days, forcing her to come home earlier from a ball, a soirée, or even stay in bed for a day.
‘I’m so tired, Doctor,’ she said. ‘I cannot stand up without feeling faint.’
Thomas ascertained that the first haemorrhage had been almost five years before. The treatments did not work. The dismissed Russian doctor bled her for five consecutive days, told her she had too much heat in her and that she needed cold baths. She was advised to take a water cure in Carlsbad, which she did. The haemorrhaging did not stop.
Thomas turned away as the nurse helped the countess take off her heavy velvet dress.
‘I’m ready,’ she said and when he turned back she was wearing nothing but a light, batiste nightgown. He asked her to lie down on the bed.
All there was to know, the evidence of her life was here, written on her body. He could see stretchmarks from pregnancies, dry patches of skin on her thighs and breasts. In her youth she must have been agile; the muscles, even in their deterioration, still preserved a shadow of their strength.
Her breasts were still relatively full and smooth. Obviously she did not breastfeed her ten children. On her thin thighs there were scars. A series of cuts on one, three burnt patches on the other. Two scars on the inside of her knees clearly were smallpox inoculations—round hollow pockmarks, whiter than the skin around them. He could also see scars on her back, long, white traces of something sharp slashing the skin. She closed her eyes often as he was examining her and breathed with difficulty.
Her disfigured, chafed belly was hardened by the mass growing over her uterus. Fixed. That realization alone was the death sentence. If it were mobile, he might have attempted an operation, but he would never operate on a fixed tumour. He agreed with Le Dran that cancer had commenced locally and was later spread by the lymphatic vessels to the lymph nodes and then into the general circulation. That’s why when he performed mastectomies, Thomas made sure that he dissected the associated lymph nodes in the axilla.
He put no faith whatsoever in various remedies that promised to dissolve the tumour. He had also seen disastrous effects of caustic pastes. As far as research into cancer was concerned he hadn’t seen much of value. Bernard Peyrilhe extracted fluid from a breast cancer and then injected it into a dog. But all he achieved was that the animal howled so much that his housekeeper objected and the dog had to be drowned.
‘The pain,’ the countess whispered. ‘It’s keeping me awake at night.’
He placed the stethoscope to her chest. Her lungs, he could tell, were clear. The difficulty with breathing was a sign of the general weakness of the body. Her pulse was fast and weak.
‘The bleeding,’ the nurse interrupted, ‘has never stopped.’ The pad she removed quickly from between the countess’s legs was stained with dark blood. He asked to see it and noted that the discharge was caked, clotted thick.
The children who died in infancy, Thomas ascertained, had no abnormalities. The countess had had the mercury cure a few times, but he could see
