To read the novel in start-to-finish order, click the Volume Two link and consult the Table of Contents links at the bottom of the page.

Tuesday, January 12, 2016

Chapter 17-1

It took a week to turn this installment out. My goal is to write two more installments, finishing this chapter, by Monday night next week (which conveniently is a holiday for me.) If I can do that, it's still possible to finish Volume One in January. If not... It's likely to spill into February.

Today's installment returns to Natalie, who is studying to become a Red Cross nurse in Russian Ukraine, despite difficulties both with one of the doctors instructing her and Madame Luterek.

After this chapter, there will be three shorter, one installment chapters to wrap up the volume. Those will take us to the end of 1914. However, keep in mind that this is Volume One of a trilogy. I have the next to volumes, and be assured that there is a clear end. This will not turn into one of those "trilogies" with five and counting volumes. But we have a ways to go. When I close this volume, as preview I'll put up the teaser summary for Volume Two.


Kiev, Russian Ukraine. November 19th, 1914. “Sestritsa, a drink of water.”

The soldier’s face was red and flushed against the white of the pillow case. Natalie pulled back the cuff of her wool dress and pressed the inside of her wrist to his forehead. Hot. Infection was setting in.

“Sestritsa, please!” His voice was hoarse, little more than a whisper.

“I’m sorry.” She took his hand and felt him squeeze back tightly. “It’s still another day until you can have water. I know it feels terrible, but the drip they give you every morning will keep you hydrated.”

This last clearly meant nothing to him. He shook his head and licked already chapped and bleeding lips.

“Water. Please, Sestritsa.”

She felt his forehead again. Yes, very hot. The long ropes of intestine which Doctor Natov had so carefully clamped and stitched at each perforation must still have become infected, and if this soldier was like the others who took infection after such an operation he would likely die within a few days. And yet the instructions were strict: no food or water to be taken for seventy-two hours after the operation to give the intestine time to heal.

The bottles of saline solution would keep his body from dehydrating; it was the lack of something to wet his mouth that was causing his misery. Natalie fetched a few squares of gauze from the bandaging supplies, dipped them in water, and gently wrung them out.

“Here.” She put the little wad of dampened gauze into the soldier’s mouth. “Suck on this. It will help you feel better.”

She sat and held his hand. His mouth and throat were working, drawing what little moisture there was from the gauze.

“I know it’s hard, but try not to lick your lips. It only dries them out more.”

The soldier nodded, continuing to chew and suck on the gauze.

What harm would there be in giving him water if the fever was already setting in? He would feel better now and he would be dead in a few days anyway. But no, she must not allow herself to think that way.

Gradually the soldier subsided and his eyes began to close.

“Let me have it back, soldier. You don’t want to choke on it.”

He turned his head and let the wad of gauze fall from his mouth, then settled back into the pillow. Natalie picked the gauze up and took it to the waste bin, then continued her progress down the line of beds in the enlisted men’s ward. Some needed to use a bedpan. Some needed a drink of water. Some needed to be shifted on their beds to relieve cramps and prevent bedsores. Each man needed some little task for his health or comfort. And all the time she was glancing at the clock, waiting for two-thirty when the time she hoped for and dreaded must come.

The day was divided into sections in the enlisted men’s ward where the Red Cross program was under way. In the morning the nurses-in-training went about their ward duties: cleaning, comforting, feeding, giving medicine, washing, changing dressings. Then, in the afternoon, came the practicum in two-hour shifts. Hers came at two-thirty every afternoon. Under the eyes of Doctor Natov and Sister Levchenko, she had to take her turn practicing the tasks of a fully trained nursing sister. After those two harrowing hours, her final hours of ward work flew by, and she would take a quiet meal with Elena at some cafe or tea shop before attending classroom lectures from eight to ten. Fourteen hours in a day, five days a week, and studying in between.

A hospital train had arrived the night before. The most difficult cases had already been dealt with, but those that remained were deemed ideal for the training of new nurses. When she reported to the surgical room, a meek housekeeping sister was carrying away the bloodied linens from the operating table, and a new soldier was being carried in by two orderlies.

“Sister Nowakówna, are you ready?” the doctor asked.

Natalie nodded.

“All right, process the patient appropriately and explain your actions as you go along. We are here to assist you as needed.”

The soldier’s left leg was a mass of bandages soaked in blood. On his army greatcoat was pinned a tag which she read aloud: “Shrapnel wound to the left leg, including compound fracture.”

She began to unwrap the bandages around his leg. The first part was easy: blood, smell, pus. It was as she got deeper, to the layers of bandage partly stuck to the leg from the several day long journey on the hospital train, that the patient began to moan and struggle.

“Orderly, please hold the patient still,” she directed, forcing her voice to the calm, cool tone which she had learned from Sister Levchenko, a professional voice. The thick-armed orderly gripped the patient’s ankle and thigh and bore his weight down from the other side of the table, keeping the limb still while staying clear of Natalie’s way.

“There’s clearly dirt, gravel and powder residue in the wound,” Natalie said, and the doctor nodded. “Signs of inflammation and discharge. I will begin by irrigating the wound with carbolic solution and removing debris.”

The soldier screamed and the orderly bore down on him, holding the leg still, although Natalie could see the muscle tissue twitch and tremble as she picked and scraped with her tools and then washed antiseptic over the wound.

A month ago her vision might have dimmed or her stomach risen from the smell and appearance of the wound. She would have found it impossible to move when every action provoked screams and shudders from her patient. After she had rushed over to retch in the waste bucket during an operation on a gangrenous foot, Doctor Natov had seemed to take pleasure in saying, “Sister Nowakówna, would you come take a look at this?” whenever some particularly noxious wound was uncovered. But gradually, a familiarity had come, born of the knowledge that without this treatment, the men would die. If she helped a man by shifting him in his bed or getting him a glass of water, she also did so by cleaning his wound and scrubbing or cutting away dirt and putrefaction. Her hands were steady.

“There is clearly infection in some of the flesh, and the exposed end of the bone shows discoloration and discharge from the marrow. The tag was marked by the mobile ambulance three days ago. Given the time the open fracture has gone untreated and the signs of infection in the wound, I would ask the surgeon’s opinion on how to proceed.”

“Why, thank you, sister.” Doctor Natov stepped over and put a hand on her shoulder, giving it a squeeze. “The surgeon will give his opinion.”

His hand lingered on her shoulder for a moment. Natalie wished him to move away, but willed herself to hold still rather than calling attention to it by shrugging off his hand.

Then the interest of the wound took over and he leaned close to the patient instead. “Hand me the bone probe, would you, sister?” He shifted the two halves of the bone slightly, examining the ends. Grateful of the change in attention, she handed him the instrument and he probed at the exposed bone marrow. “All together, the wound is surprisingly healthy. I think that we could remove the infected areas, trim and shape the ends of bone which have been exposed, and quite possibly save the leg. Yes. Sister, prepare a chloroform mask and sedate the patient. I would like to operate immediately now that the wound has been cleaned and exposed.”

Natalie placed a fresh piece of gauze into the mask, measured the chloroform solution to soak it with, and felt her own shoulders relax as well as the soldier’s breathing became more regular and his muscles gradually unclenched.

***

“I was so relieved when I could apply the chloroform and stand back to watch Doctor Natov work,” Natalie told Elena over tea and sandwiches that evening. “I’ve become used to working on wounds and infections and such things in a way I never could have imagined before coming here; but it is the responsibility that leaves me wanting to go away by myself and not speak to anyone afterwards. Giving the orderly his instructions, deciding what to do next, knowing what I should deal with myself without asking the doctor’s opinion. There’s so much that depends on every little thing. That’s what I find hardest.”

Elena laughed. “You must lack my natural imperiousness. ‘A difficult woman,’ that’s what my sister-in-law says of me. But there, I’m sure you’re the nicer for it.”

“But you’re very nice. I’ve seen you taking care of the soldiers. You’re always so kind.”

“Ah, but that’s different. I want to take care of them, so I do it. But you -- you poor, good girl -- you’re taking orders from them. I can see how it hurts you to ever deny them anything.”

“I feel sorry for them. I want to help.”

“With the patients it’s harmless enough, though occasionally what they want isn’t good for them. But I note what you haven’t mentioned: Did Doctor Natov touch you again?”

Natalie folded her arms and looked down at the table. Elena’s angry protectiveness since Natalie had told her of the doctor’s liberties could be as much burden as comfort. “He put his hand on my shoulder for a moment.”

“If you tell him to stop, he will,” Elena said. “When you get that scared rabbit look and say nothing, he’ll think you’re bashfully accepting.”

Easy enough for Elena to say when she was ten years older than the doctor and had never been bothered by him. And when telling people what to do and not to do came naturally to her. Whence came Elena’s confidence that Natalie could tell the doctor to leave her alone and yet still expect to be able to pass the nursing certification in which he taught?

“How can I tell him to stop when he’s in charge?”

“Like every gentleman he’s responsible to propriety. You just have to remind him of it. You mustn’t allow everyone to order you about. Even me. I’m here telling you to do something you find difficult and you’re nodding away and looking guilty just as if you were still a student in that convent under the orders of the sisters. They trained you too well. You’re alway so obedient.”

Natalie laughed. “I wasn’t always so obedient.”

“Oh, tell me about your youthful naughtiness. I’d like to see this Natalie.”

Natalie had made the objection on general principles, not with some particular infraction she was eager to take credit for in mind, and the first things of which she thought, such as lying when asked if she’d taken her bath on Saturday night because it was so cold in the girl’s dormitory that she didn’t want to take off her clothes and run across the stone floor to the metal tub, did not do her any great credit.

“Can’t think of anything?” Elena laughed. “There, what did I say.”

“I can! How about this: One of the older girls told me that it was possible to climb up beyond the choir loft in the chapel, over a gate and further up the spiral stairs, until you got up over the ceiling, under the old Gothic arches. So one night I convinced two other girls to come with me, and we stole a lantern from the groundskeeper’s shed, and climbed up and walked along above the ceiling, scaring each other with ghost stories in the dim light.”

“Do you mean to say that the great crime of your career involved going to a chapel? Ah, child, you’ll never convince me of your wickedness that way.”

“Then watch this. I am taking the last of the tea and the last sandwich.”

Elena grabbed for the sandwich, but Natalie had already reached for it as she spoke and snatched it away to consume with a triumphant bite.

“Now, I see it,” agreed Elena. “You’ve very wicked. All right. As we’ve both now proved our depravity, let us quiz each other for our penance. You will start first, since you have gluttonously stolen the last sandwich, and your task will be: name all the bones in the foot.”

Natalie half closed her eyes and tried to envision the chart which hung in the nursing classroom. “Carcaneus, Talus, Tarsal bones…”

***

The street cars ran less frequently after ten o’clock, and so it was nearly eleven when she returned to the Luterek house. Natalie moved quietly down the entry hall. The house would be asleep by now. She could make herself a cup of tea in the kitchen and then take it up to her room. She had passed today’s review on bones, but on Friday there would be a review on symptoms of infectious diseases.

“Natalie?” Sara had stepped out into the hall, a knit shawl wrapped around her shoulders against the falling evening temperatures which even the house’s modern steam system could not wholly stave off.

“Yes. You’re up late. Is something wrong?”

“A letter from Borys came today and we’re enjoying it again over hot chocolate in the sitting room. Come join us.”

The letters Borys wrote describing his training tended to be both interesting and amusing, and given the rigors of the Red Cross training program, Natalie had not been able to spend much time with the girls of late. But when Sara said ‘we’, did that include Madame Luterek? Though Borys seemed to regard Natalie, with a sort of reverence, as the widow of his older brother, Madame Luterek was easily upset by activities which suggested anything short of complete indifference between her son and Natalie. Still, it was late, and there was a good chance that Madame Luterek had already gone to bed.

Natalie accepted and followed Sara into the sitting room. The room was dim. A single electric lamp was still lit, casting a pool of buttery glow around the loveseat closest to the fireplace. On that seat the girls had constructed an inviting nest out of a pair of afghans, with the pot of hot chocolate sitting on a little table before them.

“I’m so glad,” Lena said. “Come, get in where it’s warm.” She lifted an edge of the banket invitingly and indicated the space next to her on the loveseat. “We hardly see you these days.”

Natalie settled under the blanket, next to Lena, and Sara squeezed in on the other side. There was a moment’s jostling as the three of them packed themselves in tightly, tucked feet up underneath them, and spread the blankets again, but then it began to be cozy despite the encroaching cold of the November evening.

Sara poured Natalie a cup of hot chocolate, and Lena turned back to the first page of the letter and began to read aloud. In Borys’s telling, the process of learning both the geometry which allowed a canon to shell a target on the other side of a hill and the signal codes which allowed spotters to direct the canon’s fire became a series of mishaps enacted by bungling students and overbearing instructors. Scattered through the text were illustrations, some diagrams explaining the geometry of artillery fire, others stick figures acting out the incidents described.

It was as Lena was embarking on a second reading of the letter’s highlights that the door opened and Madame Luterek came in wrapped in a thick quilted dressing gown. She seated herself in a chair opposite them and waited, but Lena’s dramatic reading had fallen silent.

“Well, girls,” Madame Luterek said after the silence had drawn on for several moments. “I see that you had the same instinct as I: to come down and read the letter again before going to sleep.”

“Yes,” said Sara, and Lena got out from the blankets and carried the sheets of writing paper over to her mother.

Madame Luterek tapped the papers into alignment and folded them neatly. “And you, Mademoiselle Nowakówna. You’re up very late.”

“I’m only just back from the hospital, Madame.” Natalie wished desperately that she had refused Sara’s request and hurried directly up to her bed. She had enjoyed her time of closeness with the girls, and also hearing of Borys’s exploits, but to incur in return the anger of Madame Luterek was not a worthwhile exchange. “The girls kindly invited me to have a cup of hot chocolate and listen to the letter.”

“Yes.” Madame Luterek let the word hang in the air for a moment as she looked Natalie slowly up and down. “You certainly seem to be making yourself one of the family.”

“Mother,” said Sara. “Natalie isn’t imposing herself. I asked her to come listen. I know that she cares about Borys too and would like to hear from him.”

Natalie winced as this last, and was not surprised to see the arch smile which it brought to Madame Luterek’s face. “Oh, I am sure that she does. Good night, Mademoiselle Nowakówna. It is time that my girls and I had a little family time together.”

***

If the Luterek house was not always a welcoming place, Natalie did not lack for distractions. Friday marked the culmination of the week: the last practicum session, the last classroom lecture, the last assessment. During the weekend she would have only ward work and study, but today there was little time for musing, comfortable or otherwise.

The initial cases from the hospital train had all been dealt with, and a new train had not yet arrived, but there were complications now from the last two days’ work. The stomach wound case that Natalie had helped the day before was now allowed to drink water, but the infection had set in strongly and he sweated and trembled with fever. Others, who for the first day or two had lain moaning in the semi-stupor of pain after having wounds cleaned and dead tissue cut away, were now rallying and full of fresh demands.

Sister, could you help me sit up? Sister, I’m sorry, a bed pan? Sister, could you help me write a letter home to tell them what’s happened to me? Sister, is there any more food? It’s wonderful to be hungry again.

When these requests had been met, there were linens to change, sponge baths to be given, and bedpans and instruments to sanitize. There was a universality to many of these tasks: women’s work. The folding, cleaning, changing could have taken place in the dormitories at school. Yet when folding linens and making beds at the convent, she could never have imagined these tasks transposed into room after room of battered and broken soldiery.

The morning hours sped by. Then the practicum arrived and she was changing dressings and cleaning wounds under the eyes of Doctor Natov and Sister Levchenko.

The wound she had unwrapped was not healing properly. There were not yet any advanced signs of corruption, but the edges of the flesh were turning a greyish color. She hurried around the surgical table to the tray where instruments were laid out, selecting a retractor and an irrigation bag full of antiseptic. She would pull back the torn edges of the wound and examine them more clearly, then cleanse the wound and seek Doctor Natov’s opinion of whether it should simply be re-wrapped or dying tissue should be removed.

Sister Levchenko cut through Natalie’s internal discourse. “Remember that you are taking the part of the certified nurse. Tell the orderly or aide to fetch things for you so that you need not leave the patient.”

Natalie nodded. She was right of course, but bustling to the table on which things were laid out was so habitual after months as an aid that it was hard to think to ask. “Please hold this bag up and use the tube to irrigate the wound,” she told the young aide, who had stood mutely by, a pained expression on her face after hearing someone corrected.

Yes, with the blood and fluids washed away by antiseptic solution and the retractor to pull back the tattered edges of flesh, she could clearly see that some of the tissue was dying. The question was, should it be removed immediately to prevent it from offering a breeding ground for bacteria, or would it better be left in place while the wound healed itself. She asked Doctor Natov’s opinion, indicating the area with her retractor.

She felt his hand on her shoulder and his body against hers as he leaned in close to see. If Elena was right, this was the moment in which she should speak. Her hesitation felt like a long and painful pause, though it was in fact a time so short that someone not agonizing what to say would not have noticed its passage at all.

“You’ll see more clearly if you step to the side here, Doctor,” she said at last. “If you crowd me like that, I may jostle the patient.”

Instantly she felt Doctor Natov take his hand off her shoulder and move away from her, so quickly indeed that she wondered if to the others in the room he would appear to have jumped back. Motionless, she waited to see if this sudden movement presaged an angry outburst, but the doctor quietly moved to the other side of the patient, leaned forward, and inspected the wound.

“The torn tissue is definitely dying, but I don’t think there are signs of deeper infection. Removing the tissue now will result in renewed inflammation, and it may be difficult to know how much to remove. Keep the wound covered. Irrigate it daily with antiseptic when changing the dressings. Notify me as the first sign of actual gangrene. But unless I am much mistaken I believe that the dying tissue will shrivel away while the rest of the wound heals quite well.”

He turned away from the patient and went to wash his hands in the basin of carbolic solution. “Apply a new dressing and take him back to the ward. I’d like to look at that severe case of trench foot next. Have him brought in. I’ll be back in a few minutes to see how he’s progressing.”

The rest of the practicum passed without incident. Doctor Natov seemed to give her a careful berth but otherwise showed no signs of discomposure.

It was at the end of the day, as Natalie was waiting for Elena in the sitting room, sipping a cup of viciously strong tea drawn from the samovar which had been going all afternoon, that Sister Levchenko entered. She paused when she saw Natalie, as if unsure whether or not to speak, then poured herself a cup of tea as well and sat down next to the younger woman.

“You did well with Doctor Natov today,” Sister Levchenko said after a moment.

Natalie tried to read the older woman’s face, framed by her white nurse’s veil, but it was as calm and expressionless as ever.

“My concern about you, from the beginning, has been whether you have sufficient command to be a nurse. You care deeply about the patients, of course, as we all do. You’re conscientious and hard-working. But in a hospital such as this a certified nurse also carries a responsibility of command. You have to direct the orderlies and aides, and your relationship with the doctors will set the tone for how they and the orderlies treat all the women in the hospital. It’s no place for pretty young things who will meekly accept any familiarity which the doctors try to indulge in. But you handled that very well today. Very tactfully and very professionally. The rest will come. You’ve been fetching things yourself for months now; it will take time to remember that others are here to help you. But I take your conduct this afternoon as a very positive sign, and I hope it is an indicator of things to come.”

Sister Levchenko sipped her tea and fixed Natalie with a steady gaze.

Replies strove with one another. The praise was so unexpected and so welcome, but the standard that she laid out so daunting. Could she do it? Would Sister Levchenko draw close and provide her with advice and encouragement? Did it violate the very tenets of calm and professionalism which the older nurse had outlined to want that kind of nurturing?

There she was, finishing her tea. Natalie must say something before the other nurse was prepared to go.

“Thank you. I’m glad you think I did the right thing.”

Sister Levchenko inclined her head slightly in acknowledgement. She finished her cup of tea.

“I was afraid,” Natalie went on. “That I should not say anything while I was still under evaluation. What if Doctor Natov recommends against my certification? What if he doesn’t like me?”

“Oh, he likes you well enough.” Sister Levchenko gave her something very like a kind of half smile. “And now he respects you a bit more as well. When I was your age, there were doctors in the hospital who would try to push me into a closet and get a good feel, but he’s not that sort, He just likes a pretty face around. He’ll still see that, but he’ll remember that you’re a nurse too.” She pushed back her chair and carried her cup and saucer to the sink. “You’ve begun well, Nowakówna. Continue likewise and things will go well enough with you.”


Read the next installment.

5 comments:

  1. I like the way you've been handling your female characters. Not just in this chapter, but throughout the novel.

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  2. Natalie has so much story left, I am glad there are two more volumes! Can you please explain the use of "sister" for the nurses? I am wondering about the origin of that title.

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    1. As modern professional nursing came into being in the mid-19th century, it seems to have borrowed both terminology and forms of dress from the religious sisters who often provided un-trained nursing care prior to that. "Nursing Sister" was actually a job title used for a senior nurse (and Matron for an even more senior one) in the British health care system until 2010, when it was eliminated in a desire to be more gender neutral.

      During WW1, professional nursing was less than fifty years old as a profession, and although organizations like the International Red Cross helped provide information and standards, the level of training and type of system could vary a lot from country to country. Russia required much less training than Germany or Britain, and during the war allowed women to become certified nurses with only a few months training, as we see with Natalie.

      In Russia in particular, "Sister" was also used as a term of respect (as were Mother and Father in various other circumstances) and one of the memoirs that I read by a Russian nurse said that it was after the revolution, when the solders stopped calling her Sister that she started to worry about her safety being surrounded by men at the front.

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    2. We have a "Sister Kenny Institute" here in Minneapolis named after a prominent Australian nurse who worked and taught here during the polio epidemic. The name confused me at first.

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    3. I knew you'd have the history! :)

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