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 no other evidence of syphilis than her weakened heart. When he pressed a fingernail on her index finger, he could see a pulsating vein, a sign of dilated aorta. This, however, was not what was killing her.
‘The pain,’ the countess repeated.
It was this pain that had made the journey impossible to continue and had forced them to stop here, in this Berlin palace so kindly offered by an old family friend. This pain took up all her thoughts, made travelling impossible.
‘It’s in my bones, Doctor. It is in my womb. I cannot move without crying.’
Carefully he disassembled his stethoscope, and put it back inside its leather case. He wished Ignacy had not been ordered out of the room with the others, leaving him alone to pronounce his diagnosis. The nurse, no matter how capable, would not be of much help at the moment of truth. He expected a fainting spell, a fit of screaming. This was the time to talk of God, of afterlife, of grace and repentance. Of fate and resignation. Not his kind of talk.
‘Please, Doctor,’ the countess said. ‘I want to know.’
Ignacy would not agree with me, Thomas thought. What right do we have to take hope away, he would ask. Why cut off the flow of the vital force? Deprive the body of its only defence. But hope, as far as Thomas was concerned, was a fickle notion. He had come to value facts over feelings and so far, he had had little reason to doubt the wisdom of such an approach.
‘I cannot offer you any hope, Madame la Comtesse,’ he said, finally, defying Ignacy’s voice in his head. ‘The tumour emerges out of the womb. It feeds on your body. It is fixed. I cannot operate.’
She was silent. Her eyes followed the movement of his lips. The nurse, he had noticed, grasped the countess’s hand in hers. Two hands, one strong and smooth, the other like a claw of some starving bird.
‘Cancer is like an invasion,’ he went on. ‘Your body has fought bravely, but the battle