Leaving Van Gogh

Fifteen





BOTH VINCENT AND THEO seemed convinced that Jo should not know about Theo’s illness, and perhaps they were right to try to protect her. The situation had been different with Blanche and me, because I was a doctor. I could not ignore the signs of consumption, yet when she first became ill, we did not discuss her health. Not long after we married, she became subject to coughs, and sometimes she had a fever at the end of the day. I occasionally saw her watching me as I turned away from her to dampen a cloth with cologne to cool her or to pour some cordial into a glass of water to calm her cough. I never quite caught the expression in her eyes, but I thought it was compassion. I understand now that she saw how her illness would end and pitied me.

I was a doctor; caring for this woman, ill with a weak chest, should have been quite routine. Yet it was not. I called in another physician, my friend Sémerie, but we both knew what ailed Blanche and how little we could do about it.

What we did not know—could not know—was the exact form her sickness would take. Blanche was not gravely ill. Sometimes she was quite pale, and sometimes she needed a great deal of rest. At other times she seemed to be perfectly well. As I had seen in the hospitals, consumption could be swift or slow, could appear to vanish then recur, could develop first in the lungs and spread to the bones or vice versa. Somehow Blanche and I agreed, without speaking of it, to act as if the illness did not exist.

It was a good plan. It allowed us a great deal of happiness. Blanche took a lively interest in my work and in my artistic activities as well. We went together to the Salon of 1870, and I was struck by her taste in paintings, which was remarkably advanced for someone who judged by instinct alone. I wrote a series of reviews of the Salon, incorporating her opinions along with my own. As a compliment to her, I signed it “B. de Mézin.” Mézin was the name of the town near the Pyrenees where her father’s family lived. She was delighted when she held the pamphlet in her hands for the first time.

But Blanche did not get stronger, and once she began coughing blood, we could no longer pretend. In some ways it made life easier, because we could make decisions based on her health without having to invent rationales. I bought the house in Auvers quite simply to get her into the countryside. The air out there was so much cleaner than in Paris that her health improved right away. I continued to travel into town for my practice, staying for two or three nights each week, while Blanche and Marguerite remained in the country. They both loved the garden, and as the summer of 1873 flowed past, I became hopeful. Often the two of them would meet me at the train, and they both seemed to flourish like the blooms on our rosebushes, plumper and pinker each week.

And then, as a culmination of my happiness, my son, Paul, was born that summer. Blanche had been quite well in the previous year or so, and in any event pregnancy often arrests the development of consumption. Blanche feared for Paul, since it is widely believed that tuberculosis runs in families. Because both her mother and her elder brother had died of the disease, she was difficult to reassure. But like his sister, Marguerite, Paul thrived in the healthy atmosphere of Auvers.

As the children flourished, Blanche began to fade. I still wonder what signs I may have missed. Consumption, after all, was such a familiar illness to all of us. Did I overlook a symptom that could have predicted its return: pallor, unusual gaiety, shortness of breath? Was she trying to hide her illness from me, or was she as surprised as I was by what happened on the day Paul fell down the stairs?

Paul walked early, before he was a year old, and he was impossible to restrain. The terraces surrounding the house were a constant danger to the unsteady little fellow, but it was the long flight of stairs outside the front door that tripped him up on that day. The nursemaid whom we had hired to help Madame Chevalier had turned away for a moment only, but that was long enough for the boy to stagger out the door to the top of the steps.

Blanche saw him from the second-story window and called out to the nursemaid, who naturally turned her head toward the house. In that moment, Paul tumbled down the first of the sharp-edged slate steps. Blanche raced down the stairs of the house and flew across the front garden. I heard her from the studio and followed. When I arrived outside, I saw Paul, sobbing, with blood on his pinafore. Marguerite and the nursemaid were sobbing, too. My wife, her face the color of paper, was perfectly still, collapsed on the steps just below the baby. As I darted down the steps to her, Blanche lifted her head, and I saw the brilliant scarlet trickling down her chin, blossoming on her blouse. Her eyes met mine, and I understood instantly. The blood on Paul was not his but hers, coughed up. The baby was angry, and there was a bruise coming up already on his almost hairless head, but he was barely hurt. The real injury lay elsewhere: Blanche’s remission was clearly at an end.

Paul was the first to stop crying, and once his stained clothes were removed, his sister was able to dry her tears. The nursemaid was eventually coaxed into believing that she would not be turned out into the street. Blanche and I could not talk about her health until that evening, and there was little to say in any event. The illness had come back. The cavities formed in her lungs had reached some of the larger blood vessels.

She might still have recovered. I had seen patients who lived for years after hemorrhages. Blanche certainly tried. She drank milk from our goat though she hated it. She rested in the afternoon, swallowed doses of this cordial or that as Sémerie prescribed them—she wanted so very much to get well. But she got steadily worse. On some summer days I am still startled by the light falling in a certain way or the scent of the boxwood in the garden—they prompt in me a sharp burst of misery, an echo from those months when Blanche’s health deteriorated. We did our best to be cheerful for the children. Marguerite was a bright little girl who loved to make out her letters, so Blanche would draw them over and over on a slate. Soon Marguerite could string the letters together into short words: “Mama, Papa, Paul, chat, chien.” Paul seemed to put all of his energies into movement. He still spoke very little but seemed to get exactly what he wanted with gestures and a charming smile. Those hours in the garden spent trying to forget how ill Blanche was were so sweet but so sad.

Her energy faded with the summer sun. By October she tired much more quickly and her cough worsened. The Oise makes winters damp in Auvers. Many tubercular patients seem to improve in the mountains; the dry air is easier to breathe and may arrest the decay of the lungs. I thought of the Alps for Blanche. But she wanted to go south, to Pau, which was at least near her cousins and grandparents.

So Pau it was. We made quite a party, Blanche, Marguerite, Paul, the nursemaid, and I. The children had never been on such a long voyage and Marguerite was enchanted by the train and the landscape flashing by outside the windows. As we traveled farther and farther south, I began to recognize the fellow sufferers among our passengers. Some of them had the telltale pallor, others had the equally characteristic flushed cheeks—it is typical of the disease that two such contradictory appearances should both be symptoms. The consumptives coughed, sometimes with that hopeless, spongy sound that betrays the destruction of the lung tissue. And, if they were accompanied, all of their companions bore the same stricken expression in their eyes.

I had secured a furnished apartment, and I stayed in the little town for a week to see my family settled. I met the doctor who would take care of Blanche and tried to describe my wife’s state with detachment, as if she were any other patient. I know I failed miserably, for as we parted he gripped my hand and my shoulder, saying, “I will do everything I can, Gachet, you may be sure of that.”

I believe he did. Nevertheless I received a letter from him in March 1875 suggesting that I should come to Pau to bring my wife home. I understood what he did not say: If she wanted to die at home, she must be moved soon.

When I arrived in Pau, I was horrified. Blanche was very weak, and in considerable pain. The disease had progressed to her throat, so she could do little more than whisper. Swallowing so much as a mouthful of water hurt her terribly. I was anxious to get her back to Paris as quickly as possible but even more concerned that she was no longer strong enough to travel. I was angry with the Pau doctor, thinking that he should have summoned me sooner, but he explained that my wife had forbidden it. “She wanted so desperately to get well,” he told me. “She did everything I suggested, so eagerly.… She thought the air here did her good.” He paused, and shrugged. “You know how important it is to keep these patients happy.”

I could not blame him. There is no good way to deliver a death sentence. I have often noticed that hope of recovery is among the most powerful medicines we doctors possess, but like every potent dose, it must be administered with care. I will readily admit Blanche was stronger than I in this instance. She persevered without hope for months, protecting me from the truth.

In the end, we sent the nursemaid ahead to Auvers with the children. They were both quiet and frightened, kissing their mother’s cheek lightly before leaving for the station. As they walked out into the hall, it was all too easy to imagine them in the black clothes they would soon be wearing. I have always hated seeing children dressed in mourning, and soon they would be my own.

At first I thought I should take Blanche north in slow stages, sleeping in hotels along the way, but it seemed less tiring for her simply to go straight to Auvers. It was a strange kind of traveling sickroom we created, rattling along the tracks the length of France. There is always a sense, when you are caring for the gravely ill, that the world becomes very small. Life goes on outside—we dimly hear voices and footsteps and bells and clattering dishes—but it matters much less than every hard-won breath and every precious heartbeat.

Blanche had not reached that point—yet. This was not a death watch. It was that much stranger thing, a voyage to the death watch. She was awake, and aware of me as I did my best to make her comfortable. She could still smile. Speaking was difficult, though. The Pau doctor had told me that the disease was attacking her larynx. She would not have a voice for much longer.

On our first night in the train, I ate a proper dinner and tried to feed her some soup. She was very thin, and she worked hard to swallow, to please me. Solid food was out of the question. I removed my coat and put on a dressing gown, then helped her to take off her gray traveling suit. She could still manage the tiny buttons down the front, but she had left off wearing stays while she was in Pau. I suppose the free movement of her rib cage might have made it easier for her to breathe. I folded her clothes and helped her clamber between the sheets the porter had put on the folding bed.

“You won’t come in with me?” she whispered, clasping my wrist as I tucked the blanket beneath her.

“No, my dear, I’ll sleep over there,” I said, pointing to my narrow bed. She didn’t let my arm go but put out her other hand and clasped mine.

“Paul, I know I’m dying,” she said. “This was how my mother died.” She paused, and tried to sit up. Sometimes the pressure of diseased matter in her larynx eased if she were more upright. I put my hands under her armpits and lifted her to lean against the pillows. The lamp by the bed was the only light in the train compartment, though out the window the moon was full. It shone on the ranks of pine trees as we sped through a forest, with the contours of the hills rising and falling outside the window.

“I know it will be painful,” Blanche continued, renewing her clasp on my hand. Her dark eyes burned large in her thin face. “Will you help me?”

“Of course I will,” I promised, puzzled that she should ask. “I will do everything I can. You know that.”

“I don’t mean laudanum,” she whispered, looking up at me. I gazed back, uncomprehending.

“And morphine as well,” I said. “If you need it. You may not.”

She still looked. She shook her head slightly. Then her breath caught, and she was seized by a spasm of coughing. By now this entailed a wretched procedure of basins and spitting and retching, ending with panting exhaustion. As I busied myself, my mind spun. What could Blanche mean?

She lay back now, propped up with her eyes closed. I had turned off the lamp, thinking that she might sleep, but the train tracks had come around so that the moon now shone directly in the window, casting a broad silver ribbon across the table, floor, and bed. I moved over to the window to lower the blind, but her voice came like a thread: “Don’t.”

I went back to the bedside and knelt on the floor beside her. “I thought you might sleep now.”

“Not yet,” she whispered. “The moon is lovely.”

“It is,” I agreed and held her hand. Her skin was dry and hot beneath my fingertips.

“My mother begged me,” she breathed, with her eyes closed. “She begged at the end.” My mind was moving slowly, I could tell. I knew I was supposed to understand what she was saying, but I could not. I was aware of my knees on the thin carpet of the train compartment, the stiff linen sheets, the vibration as we rolled over the tracks. Blanche opened her eyes and sat as upright as she could. She glared at me with a passion that seemed alien to her. My wife had always been sweet and placid, but the disease seemed to have burned away that docility. She willed my eyes to meet hers and willed me to understand.

And suddenly, I did. Blanche’s mother had wanted help dying.

“And did you?” I blurted out, without thinking. Instantly I would have done anything to take the words back. I did not want to know. I did not want to hear, or see—but she nodded again, fierce and proud, a woman I did not know.

A woman who had hastened her mother’s death.

No. A woman who had killed her mother.

I have never been good at hiding my feelings, and that night the moonlight must have revealed my shock, for Blanche took both of my hands in her own and explained like a parent reassuring a child, but with long pauses. “She had only a day or so to live. Perhaps hours. Every breath was a torture. I took from her hours of terrible pain. That was all.”

I did not answer. I was horrified.

“You do the same each time you give me laudanum,” she went on. “You take away the pain.”

“But life itself! To dare!”

This time she shrugged, again a tiny gesture. “What is it then? Life? When it is only agony, why not take it? Is that not the kinder thing?”

“But it’s not for us, there’s always hope,” I babbled. There was no hope in Blanche’s case, we both knew. I turned back to her.

She was looking at me with such pity. For a moment it was as if I were the patient waiting for good news, and she the doctor with the death sentence. “There is no hope,” she whispered. “There is a little bit of time, and a great deal of pain. That is what the rest of my life consists of.” There was no bitterness as she said it, or any effort to convince me, no urging or wheedling. Simply a statement.

“But it is not for us to decide,” I said, aware that I was repeating myself. I thought about the assertion again. Did I believe what I was saying? I stood up and stepped to the window. Trees whipped past, quickly enough to make me dizzy. Their tops were silvered, their bodies black. The moon was so bright that the stars all around it were eclipsed. It was a small, cold sun.

“You don’t believe in God,” came the whisper behind me.

“No,” I answered, without turning around. “I don’t.”

“So you would not be sinning.”

“No,” I had to agree.

“Then?”

“I swore an oath when I became a doctor. We vow to protect life,” I said. I had no idea what I meant.

“When did you ever care for an oath?”

I turned and went back to the bed. “Perhaps this is the only one. Perhaps that is why I feel I must uphold it.” I knelt, my arms on the bed and my head cradled on them. I could feel her fingers in my hair, delicate as moths.

She was waiting, but I could not answer. I could not agree to what she wanted, but I could not explain why. All I knew was that when I began to imagine doing what she asked, I felt a wave of revulsion. I could not contemplate it. My mind flinched away.

“All right” came the thread of her voice. “You cannot do it.”

I looked up at her, and I could feel tears falling onto my hands. My children have always teased me about how easily I weep—much too easily for a man—but it was not always so. It started that night, in the train, in the moonlight. Since then the tears have always been close to the surface. Her fingers wandered over my face, trying to smooth out the furrow between my eyebrows, wiping one cheek and then the other.

“I should not have asked,” she said at length. “Sometimes I forget that you are a doctor.”

“If I cannot heal you, what is that worth? What am I then?” Even I could hear the anguish in my question.

“A good man, Paul. A good husband. A good father. Those are the things you are to me. Other things to other people.”

She fell asleep with the suddenness of the invalid, and said nothing else for several hours. When she woke, the moon was setting on the other side of the train and we had moved into a rocky, irregular landscape that seemed hostile to life. She asked for water, and lay back on her pillow after drinking. I watched her after that, as she lay propped up contemplating the window without expression. She seemed peaceful.

We never spoke again about what she had asked of me. She remained, as she had always been, affectionate and sweet-tempered. She never got bitter or angry, as some patients do when they are in pain. There was something maternal about her attitude toward me during those last weeks. It was as though our whispered conversation in the moonlit train had revealed a weakness in me, a childlike flaw for which she must make allowances.

She spent a month in Auvers, watching April paint the countryside endless variations on green, and drinking in the sight of the children playing with the ducklings and chicks in the garden. But by early May, Blanche was ill enough to become frightening to the children, and I wanted her to be closer to Dr. Sémerie, so I moved her to Paris.

In the last days, the illness moved into her pleura, the sacs encasing her lungs. Each breath was a ragged, agonized torture. None of us slept—not the nurse I’d hired, or Dr. Sémerie, who kept watch with us. Certainly Blanche did not sleep. You could see her eyes fall closed and her entire body relax, then the need for oxygen overcame the exhaustion. Willy-nilly the breath would start again, her eyes would open to an expression of hopeless anguish, and the air would rush into what was left of her windpipe, rattling past the clots of bloody sputum, into her wrecked lungs, and then force its way back out. Agony in, agony out. Thousands of times a day.

We gave her laudanum, though it was difficult for her to swallow it. The doses got higher. It did not seem to relieve the pain, it just made dying easier to bear. I worried about the not-too-distant day when the ruin of her throat would make swallowing impossible. How long after that would she survive?

She had been right, on the train. The last two days of her life were merely dreadful pain. There was nothing else. Nothing for any of us, sitting in chairs beside the bed, holding her clawlike hands, brushing her now-brittle hair off her skull of a face. She didn’t speak. She could not have spoken, there was nothing left of her voice box. I don’t know if she was conscious. I hope she was not. I have hoped that for nearly thirty years.

I did not help her on her way.