by Herman Koch
I still pretended to be listening, I pretended to take notes on my prescription pad, but meanwhile I was looking at the clock on the wall behind the comedian’s head. How long was this going to take? Barely four minutes had passed. Even so, I didn’t want to hear any more. No more details. I wanted the comedian to leave my office. To die quickly. Preferably without darkening my door again. Animals go looking for a quiet spot to die. A cat hides behind the bottles of cleaning fluid under the sink. In eight months or so I would read the obituaries in the paper. An entire page of obituaries, most likely. A funeral with more than a thousand attendees, at the cemetery on the bend in the river. Speeches. Music. A posthumous tribute on TV. A special rerun of his best show. Another couple of half-baked anecdotes on a talk show—then, after that, the inevitable silence would settle.
I smiled. A reassuring smile. “Oh, it’s not that bad,” I said. “The chance of infection is relatively minor. And even then, AIDS inhibitors are getting more sophisticated and more effective all the time. Tell me, was there also anal penetration?”
I posed the question as casually as possible. As an unprejudiced general physician. A general physician has to be above all prejudices. I am above all prejudices. There’s no two ways about it. But standing above them is not the same as being able to eliminate them altogether. During anal penetration the tissue is stretched to the utmost. Bleeding occurs more often than not. No one has ever become pregnant from anal penetration. That is not a prejudice. Those are the facts. In biology, everything has a goal and a function. If we were meant to stick our dicks in someone else’s butthole, the opening would have been made bigger. Or, to put it differently, the entrance is as tight as it is in order to warn us not to stick it in there. The way the heat of a flame warns us not to hold our hand above it too long. I looked at the doomed comedian. I could examine him. I could come up with something about swollen glands. The glands in your groin are a little swollen, but that doesn’t necessarily mean anything. On the one hand, I felt like getting rid of him with something that sounded reassuring but sent him home reeling in panic; on the other, today I wanted to see as little of him as possible. No bare skin, no hairy buttocks or—who knows—shaved pubes. As I said, I harbor no prejudices, but there are some things that stretch one’s empathy to the breaking point. I took a blood-test form out of a drawer and checked it off at random. Cholesterol. Blood glucose. Liver function. I looked at my watch. I could have told the time from the clock above my patient’s head, but the glance at my watch sent a signal. “If you go by the lab on your way home, we’ll know more in a few days’ time,” I said. I stood up. I held out my hand. I handed him the form. Three minutes later the patient was out on the street. I dropped down into my chair and closed my eyes. I tried to get the beach back. The blue, cleansing sea. But then there was a knock. My assistant stuck her head into the open doorway. “What did you say to him?” she asked.
“What do you mean?” I asked.
“The patient who was just in here,” she said. “He left in tears. He said he was never coming back. He said you could … well, sorry … I’m only repeating what he said.”
I looked my assistant straight in the eye; I held her gaze. “And what was it he said exactly, Liesbeth?”
My assistant blushed. “He said … he said that you could stuff it up your … well … there, he said you could stuff it up there. I thought that was so rude! I was speechless!”
I took a deep breath. “Liesbeth. The man most probably has AIDS. He got it because he let someone spray semen all over his bleeding gums. When a man drives his motorcycle into a tree without a helmet on, we say it was his own fault. But a person who lets someone else stick their dick in his mouth without any precautions gets no more pity from me than that motorcyclist without a helmet. As far as I’m concerned, he can stuff it up his own ass. What am I saying? That’s exactly what he does!”
I didn’t return Judith’s call. She called me.
“We still have your tent here,” she said.
I felt like saying she could burn it in the backyard, because we would never go camping again.
“I’ll come and pick it up when I have the time,” I said.
It was quiet for a moment at the other end. Then she asked how Julia was doing. I don’t know exactly what it was, but I thought there was something indifferent about the way she asked—something routine, as though there was no way she couldn’t ask. I replied in kind: as briefly as I could. And indeed, she didn’t ask any more questions. Another silence fell. I expected her to say that she missed me. That she wanted to see me. But she didn’t.
“Ralph was sort of listless, those last few weeks of the vacation,” she said. “And he still is. I ask him what’s wrong, but he just shrugs it off. I’m sort of worried, Marc. I thought maybe you could look at him sometime. He doesn’t actually admit it to himself. It’s impossible to get him to see a doctor.”
It seemed an eternity since we had left the summer house. Julia was still unusually subdued. She took a shower two or three times a day—rarely for less than fifteen minutes. Physically she had made a good recovery, as I’d been able to determine firsthand, after emphatically asking her again whether she didn’t mind. Whether she wouldn’t prefer to be examined by another, “neutral” doctor, and not her own father. But she said that she wouldn’t want any other doctor to do that.
Caroline and I had agreed to wait a few months and see how things went. And only after that, if there was no visible improvement, to get outside help. We decided not to inform Julia’s school, either.
“Have him come by sometime,” I said, even though I wasn’t too keen on that. I tried to imagine a listless Ralph. For a split second I considered asking about Alex, whether perhaps he was listless, too, but I decided against it.
“I thought maybe you could come by and pick up the tent and then, sort of in passing, ask whether everything’s okay with him,” Judith said.
“Sure, I could do that.”
I heard Judith take a deep breath.
“It would be nice to see you again,” she said. “I would like to see you again.”
The obvious thing would have been for me to say “Me, too.” But it would have cost me an enormous effort to make it sound sincere.
I closed my eyes. I tried to imagine Judith on the beach, and when that didn’t work, under the outdoor shower beside the pool: how she pulled her wet hair back, and closed her eyes against the sun.
“Me, too,” I said.
A few weeks later, her mother suddenly called me. I hadn’t seen or spoken to Judith’s mother since I saw her come down the steps of the summer house that morning. I hadn’t even thought about her since then, I was almost sure.
She asked how things were. Especially with Julia. I told her. I didn’t tell her everything. I left out, for example, the fact that Julia still remembered nothing about that particular evening. But she didn’t ask about that. I tried to keep the conversation as short as possible, by giving only summary replies to her questions.
“So that’s all there is, more or less,” I said in an attempt to bring things to a close. “We try to live with it, insofar as possible. Julia has to try to live with it.”
I heard myself talking. Sentences were coming out of my mouth, but they weren’t mine. Freestanding sentences are what they were. I was only stringing them together. I thought she was about to say good-bye, when she said instead, “There’s something else, Marc.”
She had called during one of my moments in between; the last patient had already left, the next one still had to arrive. I don’t know whether it was her tone of voice or the fact that for the first time during our conversation she called me by my first name, but now I stood up from my desk and walked to the office door, which was open a crack. I peeked through the crack and saw my assistant sitting at her desk. She was busy writing something on an index card. Quietly, I closed the door.
“Yes?” I said.
“It’s … well, I don’t know how, or even i
f I should be saying it,” said Judith’s mother. “But it’s been bothering me for a long time. Ever since that night, actually.”
All I did was make a little sound. The sort of little sound you make when you want the person at the other end to know that you’re still listening.
“I’ve hesitated until now, because I didn’t want anyone to jump to any conclusions,” she went on. “And I hope you won’t do that. On the other hand, I thought it was irresponsible to simply keep it to myself.”
I nodded—and because I realized at the same moment that she couldn’t see me, I made that little sound again.
“On the night of the fireworks, when all of you went to the beach, I went to bed early. I read for a while first, then turned off the light. I didn’t wake up until much later. I can’t remember exactly what time it was, but I had to get out of bed. That happens to me more often in the middle of the night.” She paused for a moment, then said, “All the lights were out, so I assumed your wife had gone to your tent and that Emmanuelle was in the apartment downstairs. I went to the toilet in the upstairs bathroom. I’d only been sitting there for a minute when I heard a car down below. A car that came up the drive and stopped. I heard the door slam and someone walk up to the house. I don’t remember exactly why, but I flushed quickly, turned off the light, and went back to my room. Someone came into the house. Someone who walked straight through to the bathroom. My room was right next to the door, so I heard the washing machine being opened and closed again. Then the machine started up. And a few minutes later I heard the shower.”
Ralph. Ralph was the first to go home. Alone. In his car. Leaving his family behind. So far, the story Judith’s mother was telling me fitted the facts.
“After a little while I heard sounds coming from the kitchen. I waited a bit, then got up. Ralph was in the kitchen. He was leaning against the counter, drinking a beer. His hair was still wet. When he saw me, it was obvious that he was startled. I told him I had to go to the bathroom, even though I’d just been. But he didn’t know that.”
On the beach, Ralph had been hit in the mouth with a margarita glass. Blood had flowed. After that, the Norwegian girl had punched him a few times in the face. Maybe there was blood on his clothes.
“The washing machine was running in the bathroom,” Judith’s mother went on. “I looked through the glass to see exactly what was in it, but there was too much foam. I couldn’t see very well. I remember that even at that moment I thought it was rather peculiar. I mean, you come home and maybe you want to put on some clean clothes, but then you just throw your dirty stuff in the hamper, don’t you? You don’t do a wash right away? In the middle of the night?”
One morning—it must have been in mid-October—Ralph Meier suddenly walked into my office. Unannounced, as always. He didn’t ask whether he had come at a bad moment. He didn’t ask whether he could sit down. He dropped down into the chair across from my desk and ran his fingers through his hair.
“I … I needed to talk to you,” he said.
I held my breath. I heard my heart begin to pound. Could this really be happening? After two months of uncertainty, could he really be about to come up with a confession? I didn’t know how I would react. Whether I’d grab him by the shirtfront and pull him across my desk. Or start screaming—spit in his face. My assistant would come rushing in. Or would she call the police right away? I could also remain calm. Icy calm, as it was called. I could pull the wool over his eyes. I could act as though I found his confession touching. Then I could give him a lethal injection.
“How are all of you getting along?” he asked.
That was not exactly the question you’d expect from someone who was about to confess to having raped a thirteen-year-old girl. Maybe he was the one pulling the wool over my eyes.
“We’re getting along,” I said.
“Good.” He ran his fingers through his hair again. For a brief moment I wondered whether he had even heard me. Then he said, “I really admire the way you people are dealing with it. Judith told me about it. Judith told me how strong you’ve been.”
I gaped at him. At the same time I tried not to gape too much. I didn’t want him to see my bewilderment.
“I’m faced with something very disturbing that needs to be dealt with in fullest confidence,” he said. “That’s why I came to you.”
I forced myself to stop staring. I tried to adopt an interested expression, insofar as I was able.
“Everything we discuss here remains between these four walls,” I said, waving my hand at my office. I smiled. My heart was still pounding: Smiling, I knew, helps lower your pulse rate.
“Most important of all is that Judith doesn’t find out about it,” he said. “I mean, she insisted that I come and see you, but if it’s something serious, I don’t want her to know.”
I nodded.
“There’s something wrong with me,” he said. “I’m afraid there’s something wrong. Maybe it’s all bullshit, but Judith always goes into a tizzy about terrible diseases. I don’t want her fretting. Over nothing.”
Listless, Judith had said. Ralph was sort of listless, those last few weeks of the vacation.
“It’s good you came in,” I said. “Usually these things turn out to be a storm in a teacup, but it’s better to be safe than sorry. What are the symptoms exactly? What do you feel?”
“For starters, I’m tired all the time. Ever since the summer actually. And I don’t feel like doing anything. I’ve never had that before. But okay, I figured maybe I’ve taken on too much work lately. But about two weeks ago I got this …” He stood up and without further warning unclasped his belt and dropped his pants down around his knees. “This …” He pointed, but even if he hadn’t, it would have been impossible to miss. “Three days ago it was half the size. It’s hard as a rock and when I press against it it hurts.”
I looked. I know my business. At a single glance, in fact, I knew there was only one possibility.
Ralph Meier needed to go to the hospital that week. Preferably that afternoon. Maybe it was too late already, but the earlier you dealt with it, the better your chances were.
I got up out of my chair.
“Let’s go into the other room,” I said.
“What is it, Marc? Is it what I think it is?”
“Come with me. I want to take a better look.”
He pulled up his pants halfway, to just below his buttocks, and shuffled into the examination room beside my office. I asked him to lie down on the table.
Laying a fingertip carefully against the bump, I pressed gently. It didn’t give; it was indeed just as he’d said: hard as a rock.
“Does this hurt?” I asked.
“Not when you press that way, but if you squeeze it I see stars.”
“Then we won’t do that. And there’s no reason to. In ninety-nine percent of all cases, these are just nodes. A sort of growth under the skin. Unpleasant, to be sure, but nothing to get worried about.”
“So it’s not … Not what I thought?”
“Listen, Ralph. We can never be a hundred percent sure. But we want to rule out that one percent, too.”
“What are you going to do?”
He was no longer looking at me. He was looking at my hands, which were pulling on the rubber gloves. At the scalpel I had placed in readiness on a clump of cotton wool, beside his bare thigh on the exam table.
“I’m going to remove a tiny piece of it,” I said. “And we’ll send that to the hospital. In a couple of weeks we should know more.”
I disinfected the area a couple of inches around the bump. Then I stuck the scalpel into it. I cut. First superficially, then deeper. Ralph made a noise; he gasped for air.
“This might hurt a little,” I said. “But it will be over in a second.”
There was almost no blood. That confirmed my initial diagnosis. I pushed the scalpel in until I reached healthy tissue. By cutting into the healthy tissue I established the connection. The cells from the bump would get int
o the bloodstream and be disseminated all over the body. Disseminate … I’ve always found that a nice word. A word that covers all the bases, as they say. At this moment, I was sowing something. Planting something. Within the foreseeable future, the seeds would germinate. In other parts of the body. Parts where they couldn’t be seen with the naked eye.
For the sake of appearances I scraped off a little tissue onto the edge of a glass jar and used the tip of the scalpel to push it in. For the sake of appearances I wrote something on the label, which I then stuck to the jar. I applied a gauze square to the wound and fixed it with two bandages.