The Necessary Evil

by André Couvreur

  It was an explanation of the sort he adapted, with skillful composure, to the assimilation of restricted intelligence. The old woman did not take it aboard immediately. She knew that one can have water in the belly, in the joints and in the lungs, but the rudimentary gossip of common folk had never told her that one could have anything but the brain inside the skull. If she had been told that her granddaughter had a sprained nerve or crumpled flesh, she would have understood that elementary explanation more easily. She had, however, heard mention of trepanning. Her newspaper, the Petit Journal, had related curious operations carried out by means of that instrument; she was even following a feuilleton in which the operation of a trepan had been described at length. But that was very serious; could one even survive it? Tearfully, she asked that question.

  “Can one survive it!” Caresco exclaimed. “But of course—as certainly as two and two make four. It’s an operation I’ve been doing every day for years without ever having had a mishap. The worst that can happen is that the cure will only happen slowly. In any case, the attempt is necessary, if you value your child...”

  If she valued her! The invocation of her eyes to Heaven proved that eloquently. But to decide so rapidly! She had a further moment’s hesitation, moved by obscure impulses in her exhausted brain, and in order to put on a brave face she took a multicolored check handkerchief out of her pocket, with which he mopped her brow. Then, finally making up her mind, she said: “Take her.”

  It was submission, abandonment without revolt. Armand smiled triumphantly. He got up and clapped the old woman on the shoulder. Right! Her little child would be cured. He congratulated her for having understood that it was the only chance of getting out of it. And how happy the child would be on the day when she could return to the aged relative and hold out her arms to her again! It was necessary to operate without delay, the following morning for example, before the malady got any worse. The child had to be brought to his private clinic, where she would be admirably received by Sisters of Charity.

  As for the conditions, it would be sufficient to arrange those with his father; Armand was generous toward the poor and would even operate, if necessary, for nothing; the grandmother would only have to settle the account for the accommodation, medicaments and the maintenance of the surgical equipment.

  The old woman was now looking at him with gratitude. After the doubt, confidence widened her heavy eyelids and a gleam of admiration departed from her eyes to envelop her benefactor. Armand knew that gaze, which he had so often provoked; he was sure that no power on earth could prevent the grandmother from entrusting her child to him; she came to him like a night-flying moth to a light-source, stupidly and blindly.

  No longer having anything to retain him, he stood up and picked up his hat.

  “It’s agreed,” he said. “Arranged for the morning. I start at eight o’clock, You’ll be there, won’t you?”

  He left without saying anything more, without a tender glance at his father’s white hair. He was a stranger to effusion, the warm family embraces that charm the heart so much. He had never experienced the emotion of hugging the old paternal breast to his own, of pressing his lips upon that forehead faded by work, by the cares of existence, and perhaps the education of his son.

  The old physician, it is true, scarcely attracted tenderness; his past of imprecise honor, his lack of altruism, and his soul on sale to all were not made to solicit effusion and left the field free for the abandonment of affection, but even if things had been different, Armand would not have felt his secret fibers stirring. He did not vibrate; his heart was only tickled by the satisfactions of self-esteem or cupidity. Outside of those sentiments, setting aside his aging mistress—but that was another complex sentiment, also formed by vanity, and carnal satisfaction—nothing moved him. His soul was refractory to any surge or impulse.

  Caresco senior, left in the presence of the old woman, took a piece of paper and a pen and absorbed himself in calculations while watching his prey out of the corner of his eye. She was re-swaddling her treasure.

  When she had finished, he said: “That will cost you two hundred francs.”

  Two hundred francs! The old woman shivered n fear.

  “But Monsieur le docteur,” she moaned, “I don’t have two hundred francs! Oh, if I had them I’d gladly give them to you…and the rest too…but I don’t have them, my poor Monsieur. Oh, how unhappy I am!”

  She sobbed, resuming the regular rocking of her child. Caresco senior’s nose moved toward to toothless mouth.

  “One can’t, however, always work for nothing,” he said. “The other day, I lost two hundred francs at that game...” He resumed his original accent: “How much do you earn?”

  “I earn three francs a day for doing housework, and I have eighty francs saved. I don’t have another sou. I’m telling you the truth, my poor Monsieur.”

  Right! All was not lost. The Semite remade his calculations. By adjusting his figures, he estimated that the transaction might yet bring him a hundred francs. His heart was soothed.

  “There!” he said. “You’re going to give me your eighty francs and sign four promissory notes of twenty-five francs each payable over four months. Can things be arranged that way? I’m losing out, personally.”

  The old woman acquiesced. She could have been asked for twelve months hard labor and she would have agreed to it. The physician scribbled on pieces of paper, which the old woman signed awkwardly.

  “Good! You can see that everything is arranged. We have good hearts, my son and I. Take your little girl at three o’clock tomorrow to the operating house in the Avenue Hoche. In the meantime, you can give her this.

  He handed over a prescription, again recommending the neighboring pharmacist, and then let the old woman out through the door to the corridor. He rang for the uniformed domestic and told him to introduce another patient.

  The waiting room was full. He continued his abominable work.

  For his part, Armand, as soon as he left his father’s house, had leapt into his victoria, shouting to the coachman: “Avenue Hoche, and quickly!”

  His consultation period at the Avenue Hoche was from one o’clock until three, and—contrary to habit—he did not intend to be late. Usually, he left the care of the tedious work of consultation to his assistant, Dr. Bordier, and only arrived shortly before three o’clock, at the last minute, to examine a few patients that his aide had reserved for him, either because the diagnosis remained dubious or because his astonishing influence and persuasive talk was required to persuade those who were still hesitant to attempt the throw of the dice of the operation. Today, however, he had a meeting with Vicomtesse de Mesma, an old woman very well connected in society, on whom he had once operated to remove an ovarian cyst, and who was one of his best publicists.

  The weather was radiant. A warm caress was descending from the trees in the Avenue Henri-Martin, refreshed by the water-jets of the municipal water-sprinklers.

  Carriages went past Armand’s victoria; he saluted them with a cheerful gesture and a pearly smile. He was well-known in the Passy quarter. He had a kind of local glory that the passers-by demonstrated.

  After crossing the Place du Trocadéro and the Avenue Kléber, the carriage stopped at one of the houses in the Avenue Hoche, a large building of sumptuous appearance, displaying the luxury of six large windows on the outside. Here again Armand felt content on seeing the file of carriages stationed at his door. One of them bore the Vicomtesse de Mesma’s coat of arms.

  Nimbly, Armand leapt from the footstep before the vehicle had stopped and pulled the sculpted handle of the bell-rope. He was expected, for the massive door opened immediately; the powerful frame of a footman appeared in the gap, and then stood aside to let his master pass.

  He went in quickly, without saying a word, glanced complacently at the large entrance that gave access to carriages, and then escaped briskly to the garden, at the back of which stood the elegant construction of the common.

  Ment
ally, he compared the entrance to his clinic with his father’s. Back there in the Rue Scheffer all was poverty and petty profits. However, he thought, the logic of the commerce was the same here as it was there, deriving from the driving force of disease—only the exploitation differed. Turning left, he climbed five white marble steps to the vestibule. A second footman did not leave him the trouble of opening the door.

  The vestibule, the light of which was filtered by stained-glass windows, was sumptuously decorated with suits of armor and marble statues, outlined against ebony colonnettes. He went through it without bothering with the kindness of attention, only liking beautiful objects for the appearance of wealth that they gave to his house.

  He was about to go into his consulting room, a large room on the first floor overlooking the Avenue Hoche, when the door opened from inside. His aide, Dr. Jean Bordier, appeared, letting out an old gentleman of military bearing, severely dressed in a black coat, on which a large rosette formed a red patch.

  Caresco recognized the visitor; it was General de Rion, one of his former detractors, who had now become an enthusiastic defender since he had treated him.

  “Bonjour, General,” he said “Are you feeling better?”

  The general pulled a face, muttering explanations. Still that damned prostate tormenting him, and swollen legs too.

  In his turn, Dr. Bordier explained: “I’ve examined him. The prostate is still hard and hypertrophic; the general is suffering; medical means are not succeeding.”

  The surgeon leaned against the door-jamb. He seemed to reflect momentarily. The general awaited the master’s words anxiously, seeking his gaze, which fled, annoyed by the smile creasing his lips.

  Caresco understood the old man’s nervousness, seeing him twisting the tip of his white moustache. “You see, General,” he said. “You didn’t want to believe me—it’s necessary to resort to the scalpel.”

  “The scalpel doesn’t frighten me. I’ve already been skewered several times after being wounded, notably in the Crimea—damn it, what a storm that was! What I fear is the after-effects of the scalpel. I’ve been told that the operation you’re proposing—the section…what do you call it?”

  “The resection of the vas deferens.”4

  “That’s it—the resection of the vas difference...”

  “Pardon me,” Caresco interjected, “but it’s deferens…deferens.”

  “I accept correction…out of deference,” the old warrior replied, with a smile. “Well, I’ve been told that that operation won’t change my condition at all. So, you understand...”

  The surgeon protested. The operation, carried out by experienced hands, was indeed quite harmful; but carried out by him, that was something else. In any case, he general had only to seek information from certain patients on which he had undertaken the same operation. Then again, there was nothing else to be done.

  The general was decidedly impossible to convince; he had never encountered anyone who raised so many difficulties before allowing himself to be convinced.

  “Then again,” he said, “if the operation were serious, I’d understand your hesitation—but it’s just a simple little cut here, in the vicinity of the groin.” Sure of himself, he indicated the place with his index fingers, after dropping his trousers. “The consequences are always benign. You ought to understand that, being an intelligent man; you ought to have confidence in what I say, knowing as you do that I don’t operate for the pleasure of operating. All your friends will tell you that…ask the Vicomtesse de Mesma.”

  At the name of the Vicomtesse, the general smiled. Already ill, he had only had a totally platonic intrigue with her, a septuagenarian flirtation, which had surprised him somewhat—but not overmuch—and which had led his making the young surgeon’s acquaintance, when, in despair at seeing the futility of the treatments employed for the cure of his ailment, he had allowed his great friend to bring him to Caresco.

  “Yes,” he said, “the Vicomtesse de Mesma never stops saying good things about you. She confessed to me yesterday that you had carried out an extraordinary operation on her. She’s there now, in your reception room.”

  Caresco held out his hand. “Then I must hurry, because she doesn’t like to be kept hanging around. Au revoir, General.”

  The general left, as if regretfully. The surgeon went into his consulting room, followed by Bordier. It was a rectangular room with two large windows overlooking the avenue, furnished with a more sober taste than the vestibule, but nevertheless very luxurious. Gobelins tapestries representing mythological scenes covered the walls, causing two marvelously expensive and elegant bookshelves to stand out even more. Like the work-table, they were made of solid mahogany encrusted with copper. In a corner, near a window, was a chaise-longue covered with antique Oriental upholstery.

  As soon as Bordier had closed the door, Caresco sat down at his desk. Mechanically, he riffled through a numerous accumulation of letters that Bordier had already unsealed: emotional letters of thanks; dry letters veiling anger, which contained the settlement of bills on behalf of individuals on who he had operated—and killed; and respectful letters from provincial colleagues asking for meetings or advertising patients, commencing with the words “Cher maître…” a phrase that always tickled the ambitious eyes of the surgeon agreeably. The letters had been summarized by Bordier in a couple of lines, sometimes with a single word.

  “Nothing new, then,” said Caresco, finally, having run through his assistant’s blue-penciled notes.

  “Nothing.”

  “How is the patient I operated on yesterday doing?”

  “Which one? Three women had operations yesterday.”

  Armand shrugged his shoulders. Bordier knew perfectly well that when he referred to the person he had operated on the previous day he meant Baronne Spirs, on whom he had carried out a hysterectomy. The other two women did not count; only the Baronne had commercial value.

  “Well,” said Bordier, adjusting his gold-rimmed spectacles, yesterday evening she was doing well, but she had a bad night, and at ten o’clock, she started shivering.”

  “Is she on her way out?”

  “It’s probable.”

  Caresco shook the table with a violent blow of his fist; his brow furrowed. In front of his assistant he did not suppress his gestures or his words.

  “That’s annoying, Bordier, you know—the Baronne! That’s going to lose me several operations. Something’s been the matter with the recovery rooms for some time. There was the twelve—you know, the suppurating kidney cyst. The five and the seven died of infection—infection, you hear, my dear chap!—and now the Baronne, a miserable hysterectomy, who’s going to croak too. What’s going on in there? I’ll need to have the place disinfected, you know. The walls are putrid with microbes. It’s annoying!”

  He meditated for a moment, but without a hunt of concern. For some time, his scalpel appeared to have been subject to a streak of bad luck. He was going through one of those inexplicable black patches that, without any apparent reason, follow happier sequences—but never before had one been so prolonged.

  He searched for a cause, in vain. It would have been comprehensible once, in his father’s house, the wretched and insalubrious lodgings in the Rue Scheffer, but here, in the most sumptuous clinic in Paris, where all the rooms were well-ventilated, where the gleaming parquets could not conceal the slightest grain of dust without it being perceived, where everything was arranged according to the most absolute regime of antisepsis, and where everything, from the depths of the cellar to the eaves was swept, dusted, scrubbed and polished in a constant war against infectious germs—here, in this veritable palace, the mere sight of which excited the laudatory exclamations of visitors, in this purified environment—it was truly inexplicable.

  Was it because, wanting to maintain his reputation as a brilliant operator, he went too quickly, doing too many operations at a time, and not taking, in that flesh race, the extremely scrupulous care and infinite precautions with w
hich every surgeon had to surround himself? No—he carefully maintained his reputation as the most hygienic practitioner in Paris as well as the most skillful. Each of his operating sessions was monitored by too many eyes, often malevolent—the eyes of colleagues who would have been glad of an opportunity to criticize—for him not to observe himself rigorously.

  It was necessary, then, to attribute these astonishing series of successes or failures down to chance, to the organization of hazard thanks to which bad operations presented themselves simultaneously, as did the good ones: the petty secondary circumstances that, in combination, could decide the fate of the operation being favorable at some times and unfavorable at others.

  Yes, his judgment stopped at such an astonishing appreciation. He did not want to admit it; unlike many of his colleagues, who only cut into the flesh if success was evidently probable, he operated on all those who came to his scalpel.

  Sitting at the desk, with his head supported in a hand to delicate to be that of a surgeon, his forehead intelligent and his eyes thoughtful and candid behind the mirror of his spectacles, Bordier, leaving the young master to his meditations, was reflecting on his own account. Yes, decidedly, too many people were dying in the clinic. In the three months since he had accepted the functions, envied by so many others, of being Armand Caresco’s collaborator, the back door of the house had already opened to coffins on many occasions. Why had he come to take his place beside the celebrated surgeon? How had he let himself be convinced by the persuasive and enveloping speech of that skillful seducer?

  He would, alas, have been able to make the same reply and give the same reason as others, his predecessors, notably the last of them, Dr. Savre: the urgent need to live. How, when the plethora of physicians and the exaggerated development of gratuitous care and mutual societies made money scarce, when he had no personal fortune and parents who had bled themselves dry in supplying a dowry for a rich marriage, when the landlord held out his hand, the butcher complained and the tailor refused to deliver for lack of money, could one not listen with a grateful ear to the propositions of a colleague who had arrived and become famous—and who would bring you, by the simple fact of collaboration, along with any easy life, a relative celebrity?