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.

Saturday, July 29, 2017

Chapter 3-3

This concludes Chapter 3. Sorry to be a bit slow about it, but baby arrived the day after I posted the last installment, and somehow even with time off work the first couple weeks after a baby's arrival are not ideal writing time.

Chapter 4 will return to Jozef with the Austro-Hungarian cavalry.



Near Trzeszczany, Galicia. June 22nd, 1915. At normal times, with one surgeon handing off responsibility to another, the transition would have been accomplished away from the nurses’ view, between the two men. These were not normal times, and so Doctor Kalyagin arrived in the middle of the morning routine, escorted by Lieutenant Popov. The two men stood awkwardly in the middle of the ward as the nurses moved from bed to bed, checking dressings and temperatures. The orderlies carried away bedpans and dirty dressings. The housekeeping sisters brought food and changed sheets.

The doctor cut a rather unmilitary appearance next to the infantry lieutenant. His uniform tunic was clearly standard issue rather than the more expensive tailored versions most of the regimental officers wore. Its loose fit only served to accentuate a stomach which bulged above his belt. A rather thin mustache gave no military bearing to his broad, round face, which was boyish in its smoothness, though a receding hairline suggested he was no longer young.

Natalie broke off from her tasks and approached the two men.

“Doctor? We’re very glad to have you here.”

He started to extent a hand, as he would have to a colleague, then stopped himself, withdrew it, and gave a bow instead. Lieutenant Popov made introductions.

“I understand that you’ve been working without a surgeon for several weeks now,” Doctor Kalyagin said. “That must have been difficult.”

“It has. Particularly yesterday, when the fighting became heavy and we received a lot of casualties. There are some cases you’ll want to examine for surgery as soon as you’re settled. The most we could do was trim, stitch, and bandage.”

“Trim and stitch? Who was doing making incisions and performing sutures without a surgeon?”

Perhaps it was reasonable enough that the doctor would be against nurses going beyond their training, but she would at least make sure that any consequences were not unfairly focused on Sister Gorka, who had only been obeying her orders.

“We had casualties pouring in and no idea that we would have a doctor so soon. I gave directions that the minimum be done -- cutting away ruined tissue and suturing wounds before bandaging -- so that the patients would be able to survive the train journey to a regional hospital and receive better care. None of us have any desire to go beyond our training now that you are here.”

She met his gaze and held it. It had been the right thing to do. If he couldn’t see that, well, put that aside. He would have to see it.

He nodded. “Of course. Well, now that the hospital is staffed again, our first priority will be to set procedures and abide by them.”


“Yes, sir.” He was right, of course, but the words stung like a rebuke.

The flatness of her tone brought Doctor Kalyagin up short. He licked his lips. “With no trained staff, I can acknowledge that having nurses perform simple surgeries was the course most likely to save the most lives. Now, perhaps you can take me round the wards?”

The other two nurses joined them as Natalie guided Doctor Kalyagin through the stately rooms which they had so rapidly turned into a hospital. The two operating tables. The gas rings with their kettles for boiling instruments. There were no beds or cots -- the hospital’s had been abandoned along with the patients when they were forced to evacuate their previous field hospital on mere minutes of notice -- but the patients were laid out in neat rows on army blankets.

They finished back where they had started in the main ward. Doctor Kalyagin faced his three nurses, knowing they were waiting for some words -- about their work, about his plans for the hospital. It was these human moments which were so much more complicated than an operation. The clear necessities of saving lives and repairing bodies, works of skill and science, were more rational than the vicissitudes of human interaction.

“I’m glad to be here with you,” he said. That was the person touch. They would like that. It was the personal that he had lacked before when speaking with that lead nurse before. “You have all worked very hard while without leadership, and I salute you for it. My duty now I am here is to show you the most that modern medicine has to offer. There’s so much that science has learned. Proper wound drainage, for instance. Let someone without training suture and bandage a wound, and he might as well stitch a grenade into the poor man’s limb for he will lose it just as surely. But insert a proper drainage tube when suturing, just a little length of rubber pipe, and a man’s limb and livelihood can be saved. Written treatment protocols. Don’t let yourself be deceived into thinking it a mere checklist such as a wife might taking shopping. We are all by our natures forgetful and imprecise creatures. A written protocol saves us from our own failures.”

He let himself wax eloquent on the practices he intended to introduce. To be sure, it was a primitive place. This country house might have been well suited for hosting shooting parties but adapting it to a hospital was a clumsy affair at best for all the nurses’ obvious hard work. Still, there would be flexibility as well. No longer would he need to convince the entire board of senior surgeons about each change he wished to make. In a small hospital such as this real progress could be made.

“With modern procedures,” he concluded, “we can turn this hospital into an institution to be proud of.”

He stood looking back and forth between the three nurses facing him. Their faces were all expressionless. Had he said the wrong thing?

“Perhaps you’ve misunderstood.” He shifted on his feet. “I don’t mean to diminish what you’ve accomplished these last few weeks. You’ve done nothing of which you should be ashamed. You’ve worked without direction, without medical expertise, and without resources. And nonetheless you’ve done yourselves great credit. You should be proud. Really.” He looked around for the warmth this praise was meant to generate and saw none. “As I’ve said, I believe there is much that can be improved by implementing modern medical procedures. I expect your assistance and support, and I know that because you are professional nurses I can expect it.”

There. That would have to do it. With a little bow he turned and left the ward.

“Oh, we’ve nothing to be ashamed of, have we?” Sister Travkin asked. “We have no medical expertise? He’s been in his big city hospital with all the modern conveniences while we’ve traveled hundreds of miles in horse carts, and he would like to tell us that we have nothing to be ashamed of?” She snorted.

“I’ll be glad to have a surgeon back,” said Sister Gorka, her voice low. “Even if he is arrogant. If I never have to use another scalpel or needle I’ll be happy enough.” Natalie remembered the other nurse’s despair the night before, brought on by the work Natalie had told her to do. It didn’t matter what the new doctor was like, Sister Gorka would be glad of his presence.

“If he lasts,” warned Sister Travkin. “You saw that soft round face of his. And if looks are anything to go on he likes his food. We may not have him many weeks. Say what you will of Doctor Sergeyev -- and I have -- but he did have staying power. It took artillery to send him home.”

The morning had begun so well. As they had taken the new surgeon through the wards and showed him the men whom they had treated the day before, the other two nurses had left Natalie to lead, to explain, as if it were the most natural thing for her to be in charge. She had felt a pride of ownership as she pointed out each thing. This was her hospital, her nurses, her patients. And so she had also felt the deepest affront when Doctor Kalyagin began to speak of the need for modern practices, of retraining the staff, of re-organizing the wards to reduce infection. These were not things unfamiliar to her. These modern methods: sewing wounds up with drain tubes, using separate nurses for sterile and unsterile tasks, these and more had been her everyday work at the hospital in Kiev. She hadn’t ignored them in the field hospital out of ignorance. She had done so because here the doctors had scoffed at such practices, and because there had not been the resources to follow them here.

Her fists clenched and anger simmered up as she recalled Kalyagin’s casual superiority.

Looking at the other two nurses she felt balanced on the edge. Sister Travkin was affronted. Sister Gorka was relieved. Both had come to rely on her. Both were as much offended on her behalf as on their own. The three of them had no power to reject the doctor. But with the right words she could make his time in the hospital difficult, perhaps even so frustrating that he would leave.

And yet these practices, which she had known so well in Kiev, would save lives. The doctor might have no instinct for speaking to others, but that did not mean his medical abilities were not sound. If she could set aside her pride, if she put her support fully behind his innovations, he would get the credit, but she would have helped to improve the hospital.

“I’ll go and speak with him,” she said. “I’m sure he doesn’t mean offense. And I’ve seen these practices work in the hospital where I was trained.”

She found Doctor Kalyagin in the butler’s pantry which they had turned into the dispensary. He was examining the quantities of drugs and checking them against the ledger books.

“Who created this tracking system?” He asked the question with no expression, no indication as to whether its creation was a matter of credit or blame.

“I did.”

He turned a page, skimmed down the figures for dosage given and amount withdrawn. “This is very good. Exactly the system we used in my hospital in Vilnius. The fact that you require both an entry for the patient dosage with the date and time, and then a separate entry for the amount withdrawn from the stores, serves as a check against abuse.” He closed the book. “Very good.”

“Thank you. It’s how we managed drugs in the hospital where I was trained in Kiev.”

“Good, good.” His fingers drummed on the ledger for a moment. “Tell me, Sister…”

“Nowakówna.”

“Of course. Nowakówna. What must I do? I can see the staff at this hospital has worked hard. All I want to do is bring modern methods. Save lives. What have I done that offends the other nurses? I can see they aren’t happy with my presence.”

“They’re not unhappy, doctor. Indeed, we are all very relieved to have you here. We did not enjoy having to do work we were not trained but. If there is any hesitation, it is only a feeling that the work we have done and the methods we have followed up till now are being discounted. I’ve seen the modern methods work in Kiev. We’ve just never had the tools. And our previous surgeons were more traditional.”

The doctor was leaning forward, his elbows resting on the drug ledger. “Can you help me? If I can only get the support of all the staff, I know that we can turn this into a modern, model hospital.”

It seemed false to take the credit for supporting his methods when it was loyalty to her, along with their own wounded pride, which held the others back. Yet the others had not stepped forward to talk with the doctor. She had. And she did know the value of the modern techniques.

“Please,” he said. “We can save lives. I know it.”

“Yes. I will help as much as I can.”

***

It was no longer her hospital, but in some sense she still felt the credit for it as she urged the others to accept the new methods which Doctor Kalyagin proposed. The hours were punishing. In order to follow septic protocol, every bandage change now took two nurses instead of one, and so the normal routines of changing bandages and cleaning wounds took twice as long. An orderly who was particularly reliable in matters of spelling and handwriting was assigned to follow Doctor Kalyagin on his rounds and take down the treatment protocol for each patient, which was then pinned to the man’s blanket. While this made the doctor’s paperwork responsibilities manageable, however, it did nothing to relieve the nurses of the additional time required to update the protocol with the date, time and their initials every time they performed any task for a patient. Doctor Kalyagin promised to file a request for more nurses, but in the until this achieved any fruits, they worked more and slept less.

All this became more difficult two weeks later, when after two days of heavy fighting that sent a constant stream of wounded to the hospital the orders came that they must pack up the hospital and withdraw the next morning. The great retreat had resumed.

They were not, at least, forced to once again abandon their patients in order to hasten the retreat. At first they received orders to do so, but Doctor Kalyagin refused to do it. And it proved that he could harangue time and resources from the regimental command nearly as effectively as he could from his own staff. And hour and a half after he had set off in wrath to demand help, a supply sergeant had arrived on the steps of the country house and asked Natalie if this was the mad doctor’s hospital. On being told that it was, he had returned with two dozen hay wagons.

“There’ll be no more room for wounded once we meet up with the rail lines and get the next load of feed,” the sergeant warned her. “But that doctor of yours said his patients could be put on the train at that point.”

And so they began again the itinerant life of the hospital in retreat. Through July they set up hospital nine different times: in schools, in houses, once even in a convent, where the silent nuns in their brown habits moved silently through the bare halls and communicated with each other mainly in hand signals -- so unlike the chatty sisters with their well furnished rooms at the school where Natalie had been brought up. Several of the nuns had some rudimentary medical training, however, and the mother superior had put them at the hospital’s disposal for the length of their stay, allowing the nurses to gain some much needed rest.

They were traveling at angles to the tide now. The Third Army was retreating on a line due north, even as the German armies began to close the salient of Galicia from the west. Refugees streamed east. Lublin was threatened, and those who could not secure places on the overburdened trains had taken to the roads with carts and automobiles, wheelbarrows and baby carriages, all manners of vehicle piled with what possessions they could carry. But while the people followed whatever paths they could fine, the army fell back along lines chosen by the high command. These planners had decreed that the Third Army pass north, between Lublin and Chelm, before the invading armies cut them off, and thence north to Brest-Litovsk before crossing the Bug River. By that route they could avoid the Pripet Marshes, whose unimproved roads and buzzing clouds of midges would have slowed their progress and spread disease among the troops. This gave the army more than a hundred and twenty miles to cover before August, a relentless pace which seldom allowed them the chance to keep their field hospital in one place for more than a day or two.

It was a relief when they at last reached Terespol, and the fortresses guarding the westward approaches to Brest-Litovsk.

The original fortress was over three hundred years old, but there were no picturesque turrets. This was a product of the early gunpowder age, a squat, star-shaped structure with massive walls of stone set in cement and surrounded by a ditch twenty meters across. More modern military design had been at work beyond this. Another fifty yard beyond the ditch, soldiers had dug a trench, the fresh dug earth piled up outside it to form a parapet. Beyond the trench was line after line of barbed wire, strung between posts.

As they approached the fortress, they followed a path that passed through these obstacles in sawtoothed zigzags, blocked every so often by a gate strung with barbed wire and guarded by sentries. None of these seemed built to withstand any solid attack, but perhaps the purpose was simply to slow any would be attacker, making him a target to the soldiers in the trenches of the guns of the fortress. If so, the approach was well designed. It took the hospital staff and their vehicles more than an hour of stops and starts to wind their way through the gates and checkpoints to the fortress itself, where they passed within the big swinging gates of steel-bound wood.

The builds within the fortress walls retained the charm of age. They were assigned a barrack house with whitewashed plaster walls and wide plank floors. Metal bedframes with bare springs were already laid out in rows for the patients.

Doctor Kalyagin went to green the fortress commander. Natalie set the housekeeping sisters to washing down the walls and floors with antiseptic. The orderlies laid blankets across the bedsprings and then carried in the patients from the ambulances one by one.

“Do you think at last we stay in one place for a few days?” Sister Travkin asked as she unpacked the dispensary.

“If the looks of this place are any indication, the army isn’t prepared to retreat any time soon.”

“Surely we’ve had other forts,” said Sister Gorka. “They say Warsaw in surrounded. What good is a fortress if the Germans are on all sides?”

It was more than a year now, since that day in June when Natalie had met her father in his Warsaw house. It seemed even longer than that. Where was he now? Would that grand house with its marble floors and family portraits soon be in German hands?

***

It was a few days that a lone motor ambulance arrived with a screech of tires carrying several wounded men, one an officer with a torn tunic stained dark with blood. “Stomach wound here,” said the stretcher bearer. “A nasty one. Faulty shell exploded in an artillery pit. Killed three of the crew outright. This here is the gun’s commander.”

Natalie took a pair of scissors and began cutting away the tunic as soon as the officer was laid out on the surgical table. Sister Gorka held the rubber tube which dispensed antiseptic solution and reached in by turns to pour it over the exposed wound, washing away the blood. The roles of septic and aseptic nurse, the one who touched the unsterile clothes and fragments and flesh, and the one who only touched what had been disinfected, had already become so natural that they required no instructions.

Doctor Kalyagin asked for a retractor and probed the wound. The officer’s body arched back in pain, a scream breaking through clenched teeth.

“I’ll operate immediately on this one,” he said. “Sister Nowakówna, prepare the the chloroform mask, if you will.”

She counted the drops onto the mask’s filter, pressed it over his face. Was he able to hear and control himself, or was he helpless in the wash of pain? Just in case she leaned close. “This will put you to sleep. Just breath deeply. Count backwards with me. Ten. Nine. Eight.” If he tried to count along with her, she couldn’t distinguish it from the choked moans that were his breathing, but before she reached “One” those too were gone and he breathed deep and evenly.

The operation was extensive. Half burned powder and flecks of metal were scattered among the snaking folds of intestine which in places was torn and punctured. She helped the doctor unpack the coils, and Sister Gorka washed them with antiseptic solution. Then with precise calm Doctor Kalyagin cut and stitched, closing small tears and cutting away badly damaged sections and then suturing the clean ends back together.

As the septic nurse, her work was done first. The cavity was cleaned of dirt and splinters and spilled bile. The coils of entrail were in Sister Gorka’s sterile hands, as she began to carefully fold and pack them back into the stomach.

Natalie went to wash her hands. She scrubbed the dried blood from around her nails. Her apron would have to be changed, it was badly stained. Like a butcher shop. The phrase bubbled up, and of a sudden the enormity of the scene came home. She had been helping to unpack and repair the viscera of another, living human being, and had done so with no real shock or alarm.

She could remember, years ago in the convent school, the feeling of shock clenching at her stomach on the day another girl had fallen from climbing in a tree and broken her arm. She had felt dizzy, with white spots before her vision, at seeing the sick unnatural way the limb bent. And then there had not even been blood.

Had she lost so much natural feeling since that time? Would she still feel a normal revulsion if she saw blood or injury in some normal setting, in a home or on the street, somewhere unexpected and far from the hospital and battlefields? Or were those feelings gone forever?

“I don’t know,” Sister Gorka said, when Natalie asked her about it that night over the samovar. “I think perhaps if I weren’t in the hospital and weren’t wearing my nursing uniform, blood would still shock me. I like to think that there’s a normal life out there that I can go back to, where all these experiences will seem another world.”

For a moment they drank their tea together in silence.

“Would you like to come up on the wall?” Sister Gorka asked.

“What for?”

“I like to look around.”

“It’s dark.”

“You can see the fires. Sometimes artillery and flares. And the stars if it’s clear.”

Their nurse’s uniforms were sufficient pass for the sentry to wave them through.

“There’s a cool breeze tonight, Sisters,” was all the challenge the soldier at the top of the ladder offered. “Keep yourselves warm.”

The breeze was indeed chill enough that Natalie missed her wool coat.

“I’ll show you where I liked to go,” Sister Gorka said. “There’s some shelter from the wind there.”

It was a mortar emplacement, a flat round platform surrounded by a low wall. In the middle of it stood the squat mortar, a short, thick barrel, chest high, with a gaping hole where a ten inch mortar shell would burst forth when fired.

Sister Gorka ignored the artillery piece and went to stand on the stone step that allowed her to look out over the wall. Natalie joined her.

They were facing west. In the distance they could see occasional flashes, German artillery firing at the front with a rumble like far off thunder. There was a strange, round shape, fitfully illuminated by those flashes.

“It’s an observation balloon,” Sister Gorka said, in answer to Natalie’s question. “You can see it clearly in the daylight. It looks like a fat, floating sausage. An officer told me that artillery observers ride up to it with a basket on a pulley and watch to see if their shells are hitting where they are supposed to.”

“They’re filled with hydrogen,” said a male voice. “It’s lighter than air, but it’s a flammable gas. If we need to take away their eyes for at time we send an airplane with aerial torpedoes to shoot it down, and it bursts into flame. Soon enough, however, they send another one.”

Natalie startled and turned to see an officer with the insignia of a lieutenant on the shoulders of his overcoat.

“This is Lieutenant Serafin,” said Sister Gorka. “He also likes to look out over the walls. And he’s interested in photography,” she added. “He has a Bergheil.” She smiled with a softness of expression Natalie had never seen on the reserved nurse before. “Lieutenant, this is Sister Nowakówna.”

The lieutenant bowed. “Good to meet you, Sister.”

Behind them, the moon, just past half, broke from behind one of the scattered clouds and cast its pale light over the lines of trench and wire stretched out between the fort and the still distant enemy.

“How many men defend this fortress?” Natalie asked.

“A division, Sister. Give and take a few battalions here and there. And fortress artillery as well. Perhaps fifteen thousand men in all.”

“Surely here the retreat will stop for a time? That must be enough strength to hold them back.”

“Oh we don’t lack for strength here. Regiments have been falling back across the river for the last two weeks. If we wanted we could have fifty thousand here. But it doesn’t matter. The Germans may not even attack this point. All they have to do is cross the river to the north, get behind us, cut the rail lines. We’d have to fall back before then or we’d be trapped and have to surrender. Once upon a time, when armies were counted in tens or even hundreds of thousands, a fortress like this would have been a threat to the enemy’s rear that he would have been forced to pinch out. But now we count in millions. You’ll hear patriots who’ve read their Tolstoy speak of how we stopped Napoleon, but his army was only a spear, enough to wake the Russian bear and make it angry enough to snap it off and continue fighting. We face an ocean, and it’s more than I know how well this big, clumsy old bear can swim.”

“But if they have millions, don’t we have millions more?”

“We do. We have millions, but with fewer guns, less ammunition, feuding generals, and in the back of their minds the question: Would I, my village, my people be better off if we lost? You’re Polish, aren’t? What do you think? Is Warsaw really any worse off with the Germans and the Austrians than it was with the Tsar?”

These were not the sort of questions the Lutereks -- even Borys with his university ideas -- had discussed, nor the sisters in the hospital. Sister Maria-Grigori, back in the convent, had spoken of the old country as if Poland and Russia were two sides of the same coin. “Do you think it would be better for us to lose the war, Lieutenant?”


“No! No, I said nothing of the kind.” There was an edge to his voice that had not been there before.

Natalie felt Sister Gorka dig an elbow into her side. “He said nothing of the kind,” said the other nurse.

“I’m sorry,” said Natalie. Even in the staid atmosphere of the convent school and its patrons, it had been no great shock in France to hear people speak of the Republic’s illegitimacy, of the need for change. Raised outside the country, she could not know how shocking the turn from hints to plain words was to ears raised under Russian rule.

“All I am speaking of,” said Lieutenant Serafin, “is the necessity of reform, of the recognition of national identities. Surely the Tsar knows this too. If only he can break free of corrupt advisors. I’m sure he wants to give the nationalities a reason to fight.”

***

The officer with the stomach wound was conscious when Natalie made her rounds the next morning, his face pale under a stubble of dark whiskers.

“It’s good to see you awake. How are you feeling?”

He attempted something like a smile. “I don’t remember much, but I imagine it was bad.”

“It was a good surgery, but it will take time for your stomach to heal. You should sleep.”

“I can’t seem to.” This voice was taught but under control.

Natalie looked at the notes on the protocol. Sister Travkin’s initials were next to the approved dosage of morphine, but the time noted was six hours ago. “You poor man. That last dose of morphine must be wearing off. I’ll get you another injection.”

“Thank you, Sestritsa.”

She made the notes in the drug ledgers and drew the dose into a clean syringe.

“I’m putting it directly into the vein. It will take effect more quickly that way.” He looked away as the pressed the needle in. That was good. Still innocent of the desire that made some patients look hungrily at the needle as it delivered the relief to which they had become too much accustomed. “There. In ten or fifteen minutes you should begin to feel the effect. It may also make you sleepy.”

“That would be welcome too.”

He closed his eyes and she turned to go.

“Sestritsa. One more thing.”

“Yes?”

“Some water?”

“I’m sorry, didn’t they tell you?”

He nodded. “But please. Just a little.”

“You need time to heal. The surgeon cut out the torn portions of your intestines and sewed them back together again. Anything that passes through, even water, increases the chance of infection. You have to wait. Tomorrow afternoon, you can have water.”

He ran his tongue over his lips. It would only make him feel worse, but always the patients did it. Forty-eight hours without water. Then another forty-eight with only water, during which they forgot the mercy of being able to drink in the suffering of hunger. By that time, if infection had not set in, broth and other fluids that would at least provide some nourishment. And at last food.

Shocking though it had seemed when she had first seen such operations done, men survived. They had heard back from the regional and base hospitals of patients slowly returned to normality, men who survived having their guts taken out and put back in. It was staggering that modern medicine could accomplish such miracles at all. And yet for those who did not survive, for the nearly half whose wounds became infected despite the attention to antiseptic discipline and the strict diet, those men died raving and feverish, while suffering all the more from the lack of food and water.

“What’s your name, Sestritsa?”

“Sister Nowakówna.”

“Lieutenant Ivan Ovechkin. Sister Nowakówna, would you… Please sit with me. Just for a little while. You said this will make me sleepy when it takes effect.”

“Yes, I’ll sit with you.” She went and got a wooden chair that stood against the wall near the entrance to the ward. His eyes tracked her as she returned and set it next to his bed. Then he closed his eyes.

“Thank you.” He held out a hand and she took it in hers. It was a large hand, but smooth skinned with neatly trimmed nails. A gentleman’s hand. “Our estate is near Odessa,” he said after a moment. “Not a large estate, but comfortable. My father died young. Thrown from a horse. A great rider, they said, but reckless. Now my mother and sister are there to watch over it. She’s a difficult woman, mother. But she cried when I left.”

He continued on, short sentences broken by pauses, speaking of his family and the countryside where he had grown up. At last one pause drew on and became a silence. His breathing was steady. Natalie carefully removed her hand from his and went back to her rounds.

***

“Sister! Sister Nowakówna!”

By the afternoon Lieutenant Ovechkin was calling to her every time he saw her pass.

“Please, Sister Nowakówna. Just a little water. Just enough to wet my mouth.”

“I’m sorry.” Twenty hours since the operation. Twenty-eight more before he could drink.

“Please.” His cheeks were flushed. She felt his forehead. Hot. It could simply be that he was upsetting himself. Or the stress upon the body of blood loss followed by dehydration. But nearly half the time it was infection. As soon as she could she gave him another injection of morphine and he lapsed into sleep again.

By night the fact was clear. He was feverish and sweating, which would only deplete the body’s store of fluid more quickly. She put a cloth soaked in cold water on his forehead, wiped his face to try to cool him down, but when she was called away for a moment she came back to find him sucking at the cloth for what few drops of water he could get from it.

She snatched the cloth away, then saw his jaw tremble. “I’m sorry, Sestritsa. I was just so thirsty.”

Again she wiped his face with the damp cloth. It was simply cruel now. Infection had clearly set it. What good was there in following the forty-eight hour regimen? All it would do is add the pain of thirst to the torture of infection. She had seen this play out in case after case. There was no hope after the infection set in.

“Wait a moment.” She went to the dispensary and drew another injection of morphine. It was an hour early, but what did it matter. Then she took a glass and filled it from the bucket the orderlies refilled from the pump for every shift.

The lieutenant’s eyes followed the glass as she approached him.

“Here. Drink it slowly. Just one glass. And then I have another injection for you to help the pain and let you sleep.”

His hands shook, and she helped him hold the glass so that he would not spill it. Obediently, he took small, slow sips. So slow that she found herself glancing back over her shoulder, wondering if someone would come in and see her breaking the protocol.

There was no reason to be ashamed. She was not hurting him. The infection had already set in. And yet, if she did not have to explain her choice to Doctor Kalyagin, it would be easier.

At last he finished, and setting the glass aside she gave him the injection. Immediately he closed his eyes. “Thank you, Sestritsa. Thank you.”

By morning the fever had Lieutenant Ovechkin deep within its grip. He did not recognize her, but called out to his mother for water. She gave him another glass, then another dose of morphine which left him murmuring in his sleep the rest of the morning. From there he moved into the last stage, the restless fever sleep which preceded death. He was still in that state of near-death when Doctor Kalyagin called her aside.

“Sister Nowakówna, I thought I could rely on you.” His voice was trembling with the effort to keep from shouting.

There was no point in pretending not to know what had angered him or asking how he had found out.

“Doctor, infection had clearly set in. He was dying. I only wanted to make him more comfortable.”

“Sister, we have protocols for a reason. We have them because they save lives. When we disregard our protocols, we kill patients. Is that what you want?”

“He was already dying.”

“That is not for you to decide. It’s not for any of us to decide. Our duty is simply to give care, the best care that we know how. And that is what is written down in our protocols. You, of all people should--” He was shouting, and now he made himself stop. He pressed his lips together, struggling to regain the calm which a doctor should have in front of his staff.

Natalie stood, her shoulders back, teeth clenched. It was the same way she had stood when absorbing a scolding when at school, waiting to see if the nun would strike her or let stinging words do their work alone. If she answered back now, her voice might tremble, and that she did not want to allow. So she stood in silence, and that silence tore at Doctor Kalyagin’s calm since the one thing which seemed like it would quench the betrayal he felt was to see her break down and admit that she had been wrong.

“I trusted you,” he said. “I respected you and I thought that you cared about our patients and our methods.”

She would not cry. She would stand here, with her hands folded, and accept what he said, but she would not speak, because she could not speak without losing control. She tightened her clasped hands until she could feel her nails digging into her palm.

“Get out. Get out for the rest of the day. The other nurses will have to do your work. And when you come back, I will have to watch you since I cannot trust you.”

***

Lieutenant Ovechkin died during the night. Sister Gorka came and told her in the pre dawn light. Since he was an officer, he would not be laid in the common grave where ordinary soldiers were placed in rows and sprinkled with lime. There was no place for new graves in the fortress, so the carpenters would put him in a rough coffin to be shipped by light rail to Brest-Litovsk, where he would join the rows of honored dead in a military cemetery.

His body was already gone when Natalie returned to the hospital the next morning.


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2 comments:

  1. He would have felt the IV morphine within a minute and had pain relief within a few more minutes. That it would take 10-15 minutes is too long - but she can still sit with him until he falls asleep. :)

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  2. Rebekka,

    Thanks. The WW1 nursing diaries I've been able to read cover stuff that struck the authors as unusual (I've got a couple descriptions of intestinal operations like this one) but stuff that seemed routine they don't mention, so I was googling around for how long morphine takes to have an effect and what I found didn't distinguish between oral and IV.

    I'll fix that in revision.

    Always appreciate that kind of detail feedback!

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