The Necessary Evil

by André Couvreur

  After serious studies at the Collège Stanislas, Bordier, whose father was then rich, moved by a need for labor and for science, had studied medicine. The first steps on that path had not been without a certain disgust offered to his delicate nature by the dissection of cadavers, but everything can be overcome, everything becomes habit. He had been able to penetrate the amphitheaters of dissection, attach his palpitating intelligence to the study of anatomy, to overcome the fragility of his nerves to the point of suffering, without falling inanimate, the emanations of the thirty or forty fragmented cadavers that lay on the stones, and, above all, to see without dying himself the horror of butchered limbs and open bellies, and the frightful grimaces of physiognomies denatured by death.

  What will-power he had required, too, to support the contact of sick people in the hospitals, place his ear upon the wheezing thoracic cavities, palpate dirty limbs and bandage wounds bathed in fetid pus. Everything had offended the delicate education of his senses: touching sticky flesh, tumors that were deepening frightfully, and breathing in the presence of all that human putrescence, while thinking that the act of breathing was introducing a little of it into oneself.

  Alongside those horrors, which exasperated his physical sensibility, it had also been necessary to vanquish the sentiments they provoked, to support the display of moral lapses and the miseries that causes them. Rich then, cradled in the quietude of fortune and luxury, he had had to assimilate the comprehension of poverty, to get used to the repugnant idea of obscure hovels where numerous families huddled, where maladies and vices were transmitted from parents to children. He calculated those misfortunes; unlike his comrades, who passed them by indifferently, he soothed them with his advice and his purse.

  Later, progressively, he had acquired the habit of those heart-rending contacts; his soul was less bruised by them, less wounded. Then he became as indifferent as his comrades, and isolated himself definitively in the passion of scientific research. With joy, clad in a white smock, he penetrated into the vast wards of patients, following his master’s visits, content to listen at the foot of each bed to the scientific discourse. The sick person became a subject, before whom he made the abstraction of the moral individual.

  Finally, there were the hard hours of the work of preparation in the concourse of the hospital internship, the prolonged period of sleeplessness, during which he accumulated in his active memory the summaries of the questions of examination, a stupid labor of recitation in which no preponderance was accorded to intelligence and personality, in which memory was the only intellectual capacity employed. On, those avid nights on which, alone in his room, in absolute concentration, he had isolated himself in that sterile task, reddening his eyes reading scribbled notes and waiting the first rays of dawn to throw himself, defeated and brutalized, upon his bed, and sometimes continuing his mental overwork in enervated slumber!

  In the first year he had landed on his feet, after having succeeded in the ordeals of admissibility; in the second year he had won the right to wear the black velvet cap, the distinctive sign of interns, an emblem accorded to the conceit of those young scientists, a vestige of the pointed bonnet of old. Only then did he harvest the fruits of the seeds sown, profiting from the accumulation of the questions of internship.

  Every morning for four years he spent hours at the hospital, in collaboration with famous masters. The first year, at the Lariboisière, he entered into the medical service of Professor Cartaux. He had acquired sage principles there under the direction of a master he loved to follow, for his studiousness, his intelligence and the thoughtful limpidity of the blue eyes behind his spectacles. The ward was neat and clean, marvelously maintained by nurses and a supervisor. The external students he had under his orders were serious and hard-working. He gave them lessons, teaching them what he knew himself; he was well-liked by them, and by his patients. In the afternoons he went to study bacteriology in the laboratories of the Faculté or the Institut Pasteur.

  It was a peaceful and happy year—but medicine seemed to him to be fruitless; his delicate nature wanted to accord itself to brutal surgery, whose results appeared to him to be more reliable and more immediate. The other three years of his internship were therefore spent in surgical services. There, the work was more active, incessantly renewed. There was one at the Hôtel-Dieu with an honest and prudent surgeon; one at the Charité with a brilliant and carefree operator; finally, his fourth year was spent with a celebrated professor, much occupied by his clientele and his work, who left his interns an absolute initiative.

  He carried out numerous operations during that final phase of his student life. Fearful at first, his hand became firmer and bolder. In rotation, the interns in a hospital work twenty-four hour shifts; avid for his day on duty, he often took the days of others. In that fashion he learned emergency surgery; his education was complete.

  It was during that final year of internship that his father had died, completely ruined; it never became known how that death had occurred; he kept the secret of frightful death-throes in a wrecked room, on the carpet of which there was a small-caliber revolver in the middle of a sinister pool of blood. That catastrophe had rendered him poor. He was forced to make a trade out of what he had wanted to make an art.

  He had nursed his hard work with the dream of competing for the hospitals, for a professorship, but once his internship was complete he was obliged to install himself in a poor quarter of Paris. The numerous poorly remunerated visits he made were insufficient to nourish him, and, too proud to go complaining of his poverty to his former masters, who would have helped him, he often wept over his foundered fortune, his collapsed illusions.

  In Paris, physicians who want to remain honest need to have enough to live on while waiting for a clientele; he remained honest in spite of his lack of resources—which is to say that he had to struggle bitterly against miserable worries. He was the laborer who, for a problematic reward, climbed up to the sixth floor of houses, who, all day long, traveled the little streets with greasy cobblestones, going past obscure houses whose corridors and shops gave off the damp reek of poverty and alcohol. He was the humble individual who, by reason of his humility, is treated condescendingly and exploited, and whom one does not pay.

  After three years he had competed for a job as a physician in a charitable organization and won. That was twelve hundred francs a year falling into his purse; he began to breathe. At the same time, his reputation for charity and science won him a few rich clients and better-rewarded visits. Success was finally commencing to smile on him when he met Armand Caresco.

  The later was looking for an assistant, the one he had then, Dr. Savre, having notified him, without any plausible reason, that he was leaving. Bordier was seduced by the proposition of the young surgeon, who offered him twenty thousand francs a year, on condition that the occupied himself exclusively with his sanitarium. The surgeon’s reputation was known to him, but he was ignorant of his moral value. He accepted, resigned from the charity, quit his clientele and his quarter, and came to take up residence in a small entresol in the Avenue Hoche, delighted to recover a little of his former luxury and also to devote himself once again to surgery, the science of his predilection.

  And now, here he was, confronted by the sinister list of the operational results of the sanitarium, the so-oft-repeated mourning that darkened the joy of his studies, the operative fury for which, being naïve, simple and good, he had not yet understood the motive, even though he was beginning to divine it. Here he was, gripped by a kind of fear of this sanguinary collaboration, and glimpsing the possibility of an abrupt abandonment of his present situation, as Dr. Savre had done, and a return to his form life of obscure labor, in which, after difficult days in which physical exhaustion was compounded by cerebral fatigue, he was not sure of having earned enough to meet his needs.

  Someone knocked. Caresco shouted an invitation to enter in a voice that still contained a residue of anger. The footman appeared, announcing that Madame de
Mesma, in something of a hurry, was asking to be seen without delay. At a sign from the surgeon, the Vicomtesse was introduced. She entered with a smiling expression, her hands extended toward her young friend. Then, perceiving Bordier, she suspended her enthusiasm.

  “Dr. Bordier, my new assistant,” said Caresco. And, as the presence of that third party threatened to be unwelcome, he added: “Bordier, will you please leave us alone momentarily; I need to talk to Madame la Vicomtesse in private. Go and see Baronne Spirs; give her an injection of serum, and above all, prevent her from receiving visitors.”

  Bordier left, slightly astonished to have been dismissed. Generally, he was present even during the non-medical conversations that took place in the consulting room.

  Left alone with the surgeon, the Vicomtesse de Mesma offered him her hands again. “My dear friend…my savior…how are you?”

  She sat down in a high-backed Cordovan leather armchair, facing the surgeon. She was aristocratic in her bearing, with lively and malicious eyes violently marked with crows’-feet, a pointed and malevolent nose and a jaundiced complexion whose withering clever make-up could not succeed in hiding. Her face gave the impression of a life filled with adventures and bruised by enjoyments. Formidable rumors had run around on her account, and she had been mixed up in the intrigues of the Boulangist movement. She was still received in certain salons, however, by reason of her great name, her marvelous urbanity and the fear she inspired in certain individuals whose secrets she possessed and who wanted her to keep them.

  So, installed in her armchair, at ease, calm and gracious with the man who had cured her, she asked: “Well, how is that young Baronne doing? That’s what I came to see you about.”

  “The Baronne is done for.”

  At that vulgar expression the Vicomtesse started, expressing her astonishment at such language with a significant moue. To repair the disaster, Caresco entered into explanations.

  “You understand, Vicomtesse, that I’m very annoyed by that. The Baronne’s case was particularly grave, and although the operation was carried out with the skill that you know I...”

  “Oh, that’s true—you’re a genius,” the lady thought it appropriate to interject, “and if you haven’t succeeded, who could have?”

  “There were such complications,” Armand continued, “that I was astonished to be able to continue the operation...I’ve never had such a difficult hysterectomy.”

  He was lying shamelessly.

  “Really?” said the Vicomtesse. But what did the complications of the Baronne’s operation matter to her? She straightened the upper part of the body against the back of the armchair and followed the patterns in the carpet with the tip of her umbrella. Then, without looking at her interlocutor, she said: “And…have you been paid?”

  “Yes, immediately after the operation.”

  “I said that that was the custom of the house. Four thousand francs, wasn’t it?”

  “That’s right. By the way, my dear Vicomtesse, permit me to thank you for your obliging aid...”

  He took a envelope out of his pocket containing a thousand-franc bill, which he handed to the tout. The dying woman’s money did not seem unduly heavy in the spare fingers. The fingers in question swiftly buried the envelope in the mysterious depths of a handbag.

  Every time she received similar remunerations for her secret services, Caresco admired the superb, entirely aristocratic ease with which she accepted them. Very observant, he thought that no one of his own race would have had such elegance in prehension, in grabbing something while maintaining the appearance of wanting to let it escape. His conversion to the Catholic religion had not varnished him with such an apparent disinterest in monetary matters. He stored the gesture in his memory.

  “There’s something else,” the Vicomtesse went on. “I’ve brought you—and I mean that they’re in the reception room—the wife and son of a rich farmer from the North. The son has had a coxalgia since birth.5 I ought to tell you that it would be preferable not to talk about the operation immediately. These people are quite backward, you know.” In a lower voice, still in a detached tone, just as she had taken the thousand-franc bill before, she added: “You can ask for two or three thousand, I think. They’re miserly, but rich. He’s their only child. Have them come in—I’ll have to go soon; I have a charity sale at three o’clock.”

  The farmer’s wife was introduced. She was pushing ahead of her a child whose gait was awkwardly contorted. She was red-faced and robust; grease was emerging from the pores of her nose, spreading out in a shiny glaze. Very confused, petrified by the grandiose appearance of the house, the livery of the servants, the luxury of the tapestries and the furniture, by the presence of the Vicomtesse and the cold expression of the surgeon, she became tangled up in explanations. Yes, there had been a fall…not a fall, but a disturbance during the pregnancy. She was lost in confusion.

  Caresco asked her to undress the child. When he was naked, he made him walk back and forth, then said: “Who told you that your child had a coxalgia?”

  “Our local physician.”

  “Well, personally, I don’t believe it is a coxalgia. It’s what is called a congenital dislocation of the hip. It can be cured by.…” He was about to say “an operation,” but the Vicomtesse rolled her steely eyes. He understood and continued: “a method of my own. Would you care to leave your child here for a time under treatment?”

  The rubicund face of the farmer’s wife expanded. The frightening spectacle of the scalpel had not been raised before her eyes, and her child did not have a coxalgia, he only had a dislocation. Her local physician, an obscure officer of health, was mistaken. That news was well worth the trip to Paris and she did not regret having abandoned the cows’ milk and the chickens’ eggs.

  She expressed a desire to remain with the patient. Nothing simpler; two rooms would be put at their disposal; it was just a matter of paying a double fee. The farmer’s wife accepted, and then, at Armand’s invitation, dressed the child again.

  “I’ll go now that my role is complete,” said the Vicomtesse de Mesma. Turning to the weary rustic, she added: “You can see that you’ll be well cared for here, and your son even better.” Aristocratically ceremonious, she extended her hand to the surgeon, who got up to escort her to the door. Before going out, she said: “Look after my young friend Baronne Spirs, and send her back to me cured, won’t you?”

  The two accomplices parted with a glance of tacit understanding. Then, the child being dressed again, Caresco offered to give the farmer’s wife a tour of the house. Ordinarily he left that to Soeur Cunégonde, the supervisor of the eight sisters he had in his service, but as he wanted to go to see the Baronne anyway, whose condition was worsening, he invited the countrywoman to follow him.

  They went up the staircase, whose wrought-iron railings and white marble steps, cutting through an Oriental gallery, influenced the mind of the farmer’s wife, alarming her economy. She would gladly have run back down that luxurious stairway to flee the sum would have to pay out, but the hopping gait of her son, who was climbing up painfully, incited her to continue, and she was torn between the fear of her eroded savings and the lameness of her offspring.

  On the upper floor the luxury became more sober. Two corridors opened to the right and the left, with numbered doors.

  “I have sixty beds,” Caresco said. “Every room has a bathroom, and there are connecting rooms, in case relatives want, as you do, to remain with the patients. I’ll show you one of the rooms; they’re all constructed on the same model.”

  He asked a passing maidservant where there was a vacant room. She indicated number six. Followed by the farmer’s wife and her limping boy, he turned into a corridor, stopped in front of the door in question, knocked, and, when there was no rely, went in. A frightful scene caused him to close the door again abruptly—but not quickly enough, for the farmer’s wife had seen something horribly tragic, and she was gripped by terror.

  Emerging from the curtains of
a bed, a head had appeared to her, waxen in complexion, with hair that descended like a veil over the agony of the face, the prominent cheekbones and eyes veiled by the ashes of death. The mouth that was open to let out gasps and the hand, whose fingers were clutching at an imaginary object, still indicated the final struggle for life.

  Kneeling next to the bed, two sisters were praying, and in the background, Bordier, in a white smock, in the transparency of the window, was gazing by daylight at the coloration of a liquid serum with which he had filled a large syringe, with which he was preparing to make a subcutaneous injection.

  It was a spectacle that struck the farmer’s wife with fear. Greatly embarrassed, the surgeon summoned the maidservant and said, harshly: “I asked you for an empty room—did you not understand?”

  “I meant to say ten,” the maidservant stammered.6

  There was, indeed, no one in number ten. Caresco exhibited a bright, cheerful room overlooking the green foliage of the garden. That sight effaced the earlier scene. The farmer’s wife smiled at the walnut-wood furniture and the onyx clock.

  “And the fees?” she asked, becoming serious again.

  “Oh, I don’t occupy myself with that,” Caresco replied. “Arrange it with Soeur Cunégonde. Here she is now.”

  Indeed, a sister with a white head-dress framing a fat acne-strewn face had slipped silently into the room.

  Soeur Cunégonde was one of the pillars of the surgeon’s sanitarium. Remarkable intelligent and acute, she had had been in Armand Caresco’s service for six years, and possessed all the diplomacy and savoir-faire of her master, for whom she had had a kind of adoration since she had aided, or believed she had aided, his conversion to the Catholic religion. Marvelously endowed with intellectual flexibility, she had quickly adapted to the practices of antiseptic surgery, and by virtue of her activity, her preparatory skills and her zeal during operations, had succeeded in acquiring an authority over Caresco’s mind that was advantageous to both of them.