Wrote this over a year ago, tbh. I've been lazy/terrible about crossposting stories to this account, and I apologise.
Warnings: SPOILERS till 2.04: Emilie. Some gore. I go into moderately graphic detail regarding the medical stuff, but there's nothing terribly explicit. As always, my knowledge of 17th century medicine is sketchy; please don't hesitate to point out/correct any mistakes you find.
Title is, of course, Latin for 'first, do no harm'.
primum non nocere
From inability to let well alone;
from too much zeal for the new and contempt for what is old;
from putting knowledge before wisdom, science before art, and cleverness before common sense;
from treating patients as cases;
and from making the cure of the disease more grievous than the endurance of the same, Good Lord, deliver us.
- Sir Robert Hutchinson (1871 – 1960)
Martin Lemay sets up his clinic in Rue Saint-Jacques in the summer of 1623, with the future shining bright in his eyes and a spring in his step. Some say that the shadow of the Sorbonne looms too close, that he still clings to the whispers of his masters from down the street; however, he finds the presence of his alma mater so close by comforting rather than suffocating. It reminds him of where he has come from and what he is still destined to do.
He hires Madame Therese Dubois as his assistant, a hardy widow at least a couple of decades older than him, with large, rough hands and a surprisingly gentle touch, and a sharp beady eye that he tries not to quail under. He quickly learns not to underestimate her experience; in any case, she is more than willing to take matters into her own hands if she thinks that he is making a mistake, no matter what he protests.
(This will change given time, he hopes. He buys her a bottle of brandy and a lace bonnet for every major occasion anyway.)
One of his first patients is a tall, spindly lady of regal disposition, whose name he will forget over the years, but her face, thin and sallow with two sunken eyes burning out of it like two pieces of coal, will forever remain etched behind his eyelids. She has a dry, grating cough, and the air whistles in her narrow chest as though it has been hollowed out, but her concern is the weeping sore at the base of her neck, just above her sternum, that she conceals carefully with a thick scarf.
He examines the unsightly thing, with its irregular borders and undermined edges, and declares jauntily, "Madame, I believe you have what the Greeks called phthisis pulmonale." He eyes his apothecary, mind whirring. "There are not many treatments that have been proved to be—"
She clasps his arm with hot, dry fingers, her grip surprisingly strong. "You misunderstand, doctor," she says, coldly. "I do not need to know what I have; only if you will remove this eyesore."
"Madame—"
"I will double whatever fee you ask."
"Madame, that is not—"
"Please, doctor," she beseeches, and he has already made up his mind before she says, "You are my last hope. I do not care even if it scars."
He sears the ulcer with a hot knife. She bears the pain quietly, returns with the wound scarring over beautifully, and for a moment Lemay is elated. It does not last for long, however: soon, the wound suppurates, and no amount of bleeding treatments stops the infection from laying waste to her body. She is a corpse even before she takes her last breath.
Lemay sits at his table that evening, numb and shaking, the shadow of the Sorbonne looming ever more than before, reaching for him (with those same spindly fingers). Therese sits opposite him and pours him a glass of untouched brandy (that he recognises as one of the bottles he bought her).
"All of us see what we want to see," she says, pushing the glass towards him, "but one man's vision is his and his alone."
He raises an eyebrow, hoping she'll elaborate on that peculiar statement, but she merely gazes steadily back at him. He sighs, downs the brandy in one gulp, and hopes he doesn't dream that night.
Six months into his practice, Lemay is visited by a strapping young gentleman who calls himself Nostradamus.
He seems undeterred by the fact that the real Nostradamus is dead; he believes that he is reincarnated in him. "The devil talks to me, doctor," he tells Lemay, "and he has told me to come here to tell you that the world is sliding towards hell—there will be so much death, so much disease, and the very ground will open beneath us to put us out of our misery."
"A considerate sort of devil, if he's giving us all warning," Lemay says mildly, while Therese shudders, crosses herself, and mutters, "Touched in the head."
Nostradamus gives him a wolfish grin. "The devil is a kind soul, monsieur," he says. "That is why he is so dangerous."
It is a great stroke of fortune, when, merely months later, Lemay is able to secure an apprenticeship with the personal physician of the King himself, Charles Bouvard. Despite his propensity to get lost in his precious greenhouses and his bull-minded insistence that there might still exist a plant in the world that would bring the dead back to life, Bouvard's tutelage proves to be immensely valuable. He scoffs at Lemay's collection of tinctures and pastes and poultices and sends him to Geneva, where he will learn all of the latest in alchemy and the ways these chemicals can be applied in treating the vagaries of the human body.
He comes back with a mind-bogglingly intricate Pharmacopeia, filled with recipes that contain ingredients numbering into the several dozen, required to be measured and mixed with such pain-staking accuracy that Lemay's hands shake at the very thought. He has long since known that medicine walks the twilit line between poison and waste, and with none too steady a gait, but he hasn't ever felt afraid of what he knows until now.
"You'd be doing them a favour either way," Nostradamus tells him, wiping away the last traces of vomit after the last patient had reacted rather… explosively to one of his concoctions. "By purging them of their illness or their life… how does it matter when we are all destined to die in hellfire in mere years?"
"Less philosophising, more working," Therese grunts. Nostradamus is a fairly intelligent, healthy young man when he isn't talking about the devil taking residence in his head; it had been her suggestion to have him make himself useful in Lemay's clinic before he wandered off into the street, rambling, and got his head shot clean off by a trigger-happy Red Guard. Or Musketeer.
"It should matter," Lemay says, "otherwise, why are we here?"
"Oh, don't you go encouraging him now!" Therese cries, throwing a rag at him.
Bouvard is in Florence when the Dauphin falls sick. As his one-time protégé, Lemay is summoned to the Palace to attend on the child. He's nearly sick himself with nerves, but his hands and voice and eye are steady as he examines the infant while the King and Queen look over his shoulder. He is flushed with fever and his chest rises and falls too rapidly, a wheeze trailing every breath.
He already has potions prepared for the child, measured and divided painstakingly, with him spending hours over calculating the weights of each ingredient in proportion to the child's size. To his surprise, one of the Queen's ladies—a Madame Bonacieux, he remembers—protests, saying that the child will only throw up the medicine. He's spared the chore of explaining to her that the purging is the point of the treatment by the King himself stepping to his defence.
Lemay will admit to being just a little gratified at that, even in such dire circumstances.
The goodwill leeches away rather rapidly when the Dauphin does not get better, even after all the purging. If anything, his lungs sound even more congested than before, and the fever has not relented even a notch. It is with a heavy heart that Lemay considers bleeding—the child is so small and so weak already; its skin feels like a rose petal under his large, calloused hands. He is struck by the memory of the stillborn he had delivered just two days past, the lifegiving cord wrapped around its neck like a noose, its body still and grey in his arms while the mother wept and bled and wept.
"We must apply the leeches," he says out loud, before he can lose his nerve.
It's Madame Bonacieux who protests again, voicing his fears that the bleeding just might overtax the poor child's body, and this time, he doesn't have the King and Queen's support. He wonders if he should explain that the leeches are a blessing in themselves—they are clean, easily removable, do not require opening and ligating veins, and leave marks that do not scar and are far less prone to suppurate. But the King—the father—is beyond himself with anger, and the mother's face is twisted in grief, and Lemay decides it would be prudent to be silent.
Madame Bonacieux never leaves the baby's side, and it is this that makes Lemay more nervous than anything.
He takes leave to go to his clinic for rest and to prepare more medicines; when he returns, he learns that much had happened in his absence: the sick baby had been kidnapped—by Madame Bonacieux, no less!—taken to a laundry, of all places, out of some misguided notion that the steam will cure the child when all of his medicines and his leeches could not. He finds out that she is to be executed, but he doesn't spare her another thought before he's running to the Queen's chambers, dread in his every step, expecting to find the child dead already.
He finds the Dauphin sleeping peacefully for the first time since Lemay has seen him, his breathing not only easier, but his fever considerably reduced. He gapes at the child for a few minutes—has Madame Bonacieux used the steam to purge the illness directly out of his lungs?—before he hears a commotion outside the chambers, and thinks he might still save a life, after all.
"As a man of science I must conclude that it was the steam, and not I, that saved his life," he tells the King, even as she is held between two guards, moments away from death, "Madame Bonacieux should receive the credit."
One man's vision is his alone, he knows, but perhaps he has let reason blinker him rather than allow him to see a disease for what it is.
"Perhaps you were right this time, Madame," he tells her when she is freed, for one is not without his pride, "but let me assure you: leeches are generally an infallible cure."
She smiles at him, sweaty and dishevelled and nearly trembling with relief, yet somehow resplendent, and he finds his heart skipping a beat.
And so it is that when Madame Bonacieux personally calls on him for help—with a Musketeer escort, no less!—Lemay is hard-pressed to refuse. Therese shakes her head, but helps pack his saddlebags with his equipment; Nostradamus pales and repeatedly crosses himself at the sight of the wild-haired Musketeer, but mercifully does not say anything else.
He arrives at the garrison not quite knowing what to expect; when Madame hands him a bowl of nearly congealed broth and asks him to determine a kind of hallucinogenic poison that may have been added to it, he wants to laugh. "I am a doctor, not an alchemist," he tells them, and yet, when Madame Bonacieux looks at him with such soft pleading, he relents.
"I will do my best," he says.
He agonises over determining what is inside that thrice-damned broth for hours, until the broth is a hardening sludge and his eyes pulse with pain inside their sockets and he longs for a cup of brandy. He can think of only one way to conclusively determine the effects of the drug for himself, but it is an idea so preposterous, so unscientific, that he instinctively baulks at the thought.
And yet—
He remembers Madame Bonacieux so scared, yet so determined to save the Dauphin at great risk to her own life while he stood like a coward behind his wall of science and reason, and before he can form his next thought, picks up the spoon and forces down a few bites of the broth.
He dreams that he is in the middle of a battlefield—for it is a battlefield, is it not? He is surrounded by bodies piled over each other like the cadavers he's seen in the dank basements of the Sorbonne, drooling sweat and tears and blood and bile. All of them suffer from horrific wounds—great gaping slashes across their abdomen, large suppurating sores that've eaten through flesh and bone, festering gut infections that've laid waste to the entire body—and yet, even as he watches, their eyes open, one by one, and their gazes fix on him.
Bile rises up the back of his throat as he tries to stumble away; however, somebody stops him, and when he turns, it is her—the first patient who'd died at his hands, the living corpse, looking at him with the promise of retribution blazing out of those coal-black eyes and Lemay thinks he is half-dead already when he starts coughing and blood splatters on his hands and his knees start to buckle—
"Doctor Lemay? Doctor Lemay!"
He hears Madame's voice as though from the bottom of a very deep well; he clings to it, allows it to bring him back to the considerably less foggy world of reason. The wild-haired Musketeer—Aramis, he must remember, Aramis—pulls him out the room and Lemay drags in breath after glorious breath of fresh air, even as his dream lingers behind his eyelids. Madame Bonacieux brings him a cup of cold water, and he drinks greedily.
"I believe the broth contains a powerful narcotic drug," he says in between breaths, "derived from a species of wild mushroom."
Aramis' eyes darken as though with understanding, nods and immediately turns to leave, while Madame Bonacieux lingers. "Perhaps you should rest for a bit," she says. "I'm sure I can convince Serge to make something for you—I… I know how terrible this awful thing makes you feel."
He's about to refuse when he the full implications of what she said sinks in. "Madame… you ingested this broth as well?" The horror of it-! Here he is, hardly able to stand after that terrible vision, and he can scarcely imagine this wonderful, beautiful woman undergoing the same.
She smiles at him. "Please—call me Constance," she says. She takes the empty cup from him, but holds his hands for a moment longer. "Thank you, Doctor Lemay," she says. "Once again, I am in your debt."
"On the contrary, Madame Bo—Constance," he says, standing upright and bringing up her hands to kiss them, "you will find that it is I who am truly in your debt. You have my gratitude for more reasons than you know."
Her smile widens into a grin, and his heart lifts at the sight.
Nostradamus greets him when he arrives at his clinic later that afternoon. "Did you see him?" he asks without preamble. "Did you see the devil, like I said?"
"Yes," Lemay says with a sigh, settling heavily into a chair, "I saw him."
A few months later, Lemay is once again summoned to the Queen's chambers.
Constance greets him at the entrance, wringing her hands, her face pinched with worry. "Doctor Lemay," she says, "before I tell you why you have been summoned, I must ask that what you see remains between the both of us, and that you do not divulge it to anyone, including any of the King's men or your assistants." She bites her lip. "One might even consider this an act of treason, and you're my only hope, doctor, but I don't want you to get into trouble that you are not prepared for—"
"Madame," he says. "I promise you—whatever I see, it will be entirely between us. Trust me."
She shoots him a quick, fearful smile, then leads him down a series of winding corridors before finally stopping at a door. He can hear low moaning coming from behind that door. Lemay sweats.
Constance opens the door to reveal a small, if fairly well-appointed room. The space is mostly taken up the bed in the centre, which is now currently occupied by a sweating and writhing young man with a bloody swathe of bandages wrapped around his torso. His wrists and ankles are tied to the bed with strips of linen, and as Lemay watches, he shifts restlessly, contorting his body, even as he moans with some indescribable agony and sweat pours from his brow.
"That's—" he gasps.
"That's d'Artagnan," Constance says quickly. "He's a Musketeer—or I suppose was one, since they've been disbanded and outlawed by the King, though honestly, he's never going to be anything else in his thick head—" She stops, takes a deep breath. "He was shot in the gut by a Red Guard earlier today. Fell at my feet like an idiot because it's become a habit for him, I suppose." When she looks at Lemay now, there are tears in her eyes. "Please—you have to help him. There's nobody else I can trust."
Lemay continues to gape, but his mind is whirring: Musketeer or not, a festering gut shot can only mean one thing—certain death. With his limited equipment, sworn secrecy, and only Constance for assistance, it's going to even more difficult. If it were anybody else, he would've told them to offer the suffering young man the mercy of a swift death, but it's Constance, and he hasn't yet faltered in trying to do the impossible for her.
"I shall do everything I can," he assures her, and is gratified when she smiles tremulously.
He unwraps the bandages around d'Artagnan's torso while Constance prepares hot water and fresh strips of linen—the bullet has entered at a slightly oblique angle in his upper left abdomen, and is still lodged in his body, given the absence of an exit wound. He makes a quick mental inventory of the organs that it could've torn through, and what it could be nestled against—remembers pouring through Vesalius' beautiful, intricate anatomical drawings and watching as his masters pulled apart the human body in the dissection theatre, layer by layer, as though peeling apart a flower. None of the possibilities spells a positive outcome for d'Artagnan, however.
He straddles d'Artagnan's legs and cleans the wound with hot water even as the young man howls and thrashes. "I have to remove the bullet," he says, pouring wine over his scalpel, then widening the wound. It's a struggle, as d'Artagnan arches, such a keening erupting from his throat as Lemay has never heard from a human before; it freezes his heart and numbs his fingers for a few precious seconds before he hears Constance say, "d'Artagnan—d'Artagnan! Ssh, it's all right, I'm here, it'll be over soon, d'Artagnan, it'll be over soon, stay with me…" in an endless litany. He is brought back to the present, and he ploughs on.
His hands are slick with blood and d'Artagnan's struggles have been reduced to mere twitches before he finds the bullet nestled against the diaphragm, having miraculously avoided perforating any major organ. He carefully lifts the bullet out and deposits it on a metal tray, then works furiously, washing and rewashing the wound, ligating bleeding vessels and searching for more, trading speed for thoroughness. When he is satisfied, he begins to stitch together the muscle, the delicate fascia, then finally the skin.
He falls back on his haunches when he is finally done. He is almost surprised to see d'Artagnan's chest rise and fall as he remains deeply unconscious—so focussed had Lemay been on his work that he hadn't even bothered to check if his patient was still alive. However, he sees Constance has taken care of that for him—she still clutches d'Artagnan's hand tightly, as though tethering him to the mortal world by her power of will alone.
Lemay would not be surprised if she could do such a thing.
"You seem to inspire great, impossible things in all the men you meet," he says, "for I do believe, against all odds, that d'Artagnan will survive to see another day."
For a moment, Constance looks like she will say something, but she is too overcome; she turns, buries her face in d'Artagnan's neck, and sobs for the first time since Lemay has met her. He climbs off the bed and busies himself with washing his hands to give her some privacy; he takes the moment to say a quiet prayer as relief settles in his bones, heavy and warm.
It has been a long, long while, but Lemay has finally stepped out of the shadows of his masters.
Finis