The little boy was five years old. He fidgeted as he lay on the examination table, despite the fact that his every movement seemed to cause pain. Yuri Fedorcenko gently lifted the boy’s bare leg on which was a large, swollen bruise.
“I’m going to bend your knee,” said Yuri. “Tell me the moment it starts to hurt, Vasily, all right?”
“It hurts now,” whimpered Vasily.
Resisting the urge to immediately drop the leg so as not to cause the child further suffering, Yuri let it down slowly, gently. He eyed the older man standing across the table from him.
“So, Prince Fedorcenko, what do you make of the boy’s injury?” asked the man, a tall, husky fellow with small eyes and thinning hair. He looked as if he’d be as comfortable plowing a field as tending a medical clinic for the underprivileged.
“The limited range of motion suggests the possibility of bleeding in the joint. Yet the child says he merely bumped his knee against a table. I see no indication of broken bones besides the marked swelling, which is just not of the type that accompanies fractures.”
“Have you ordered X rays?”
“Of course, Dr. Botkin,” said Yuri, his tone betraying his insult at the implication that he might have overlooked such a routine procedure.
Botkin smiled. “Oh yes, I forgot I am addressing the great physician-to-be, Doctor Fedorcenko.”
“I’m sorry, Dr. Botkin, I didn’t mean—”
“Never mind, young man. Self-confidence is a quality that shouldn’t be lacking in a doctor. However, it ought to be mingled with perhaps a touch of humility.”
“Yes, sir.” Yuri infused his voice with every ounce of humility he could muster. After all, Botkin was not only the head of the clinic, he was also physician to the Court of Nicholas the Second. He was a man in a position of great power and influence in the medical profession, but more than that he was a fine doctor, worthy of respect if only for that.
“Would you care to offer a preliminary diagnosis?” asked Botkin.
“Without the X rays and the other tests I’ve ordered, I’d be taking a stab in the dark.”
“Not to disparage the wonders of modern medicine, Prince Fedorcenko, but it can be risky to rely entirely upon them. A test does not see or feel the actual flesh and blood. It is important that you hone your innate perceptions. Don’t ever let them be made dull by gadgets and machines.” Botkin turned to the patient. “Vasily, we will leave you for a few minutes. I’ll send in your mother and a nurse with something to ease your pain.”
“Thank you, Dr. Botkin,” said the boy, gazing at the older doctor with awe and trust.
“Now, Fedorcenko, step outside with me so we can discuss this further.”
They stepped into the corridor where the mother was waiting. Botkin sent her into the examination room, then told a passing orderly to fetch a nurse. Finally, he returned his attention to Yuri. “There. Now we can talk. Tell me, then, what you think of the boy.”
“Well, Dr. Botkin, I must admit that my ‘innate perceptions’ are quite baffled. There is internal hemorrhaging inconsistent with the severity of the wound. There appear to be no broken bones. If I were to take that stab in the dark, I would almost say this was a case of . . .” He let his words trail off, reluctant to make a fool of himself before this important man.
“Go on, Fedorcenko.”
“You must understand, I am simply extrapolating.”
“You’d be surprised how much of medicine is extrapolation. Now, do continue.”
“In my hematology course, I recall learning of a disease called hemophilia—the bleeding disease. It’s very rare, and thus we didn’t spend a great deal of time studying it. But some of the symptoms are similar to Vasily’s.”
“What do you know of that disease?”
“It is a failure of the blood-clotting mechanism, incurable, and there is little but symptomatic treatment known for it. A hundred and ten years ago an American, John Otto, discovered that hemophilia is a genetically transmitted disease, carried by females but manifested in males only.”
“This is the first case you’ve observed?”
“If, indeed, this is hemophilia, then it is my first case. Have you ever seen it before, Doctor?”
Botkin paused a long moment before answering. “Yes . . . I have seen it.”
“I’ve heard it called the ‘royal disease,’” said Yuri.
“So, you think it impossible for a peasant boy like Vasily to be afflicted with it?”
“No . . . but I think it would probably go far better for a crown prince to have such a disease.”
“Why is that?”
“Royalty can afford to live pampered lives, and pampering is perhaps the best treatment for the illness. Vasily lives on the streets. If he does survive to manhood, he will have to engage in physically taxing manual labor. Look what a mere bump against a table did. Imagine the poor boy in one of our textile factories. Thus, hemophilia is far better suited to one who lives a life of ease.”
“In some respects you are correct. Yet, you haven’t taken into consideration the intense emotional duress of the disease, not only on the patient, but on the family as well. Even royalty are not free of that. And, if a mere inconsequential bump can induce severe symptoms, then even the most sedentary person could be affected.”
“May I ask you a question, Doctor?” When Botkin nodded, Yuri went on. “If Vasily does indeed have this hemophilia, what is his prognosis?”
“Let me clear up one point first. Vasily is indeed a bleeder. He has been in the clinic on two or three previous occasions. I should be surprised if the child celebrates his tenth birthday.”
Yuri shook his head, frowning. He had only a year left of medical school and had engaged in some practical experience, but he was still rather a novice where death was concerned. The only terminal patient he’d ever worked with had been an old man, and when he died, death had come very naturally. A dying child was totally different. Yuri sensed this would be the true test of his mettle, his ability to be a doctor. On most levels, he did not doubt himself. After all, he was at the top of his class at the St. Petersburg University School of Medicine. And he certainly exuded confidence in his medical prowess—so much that he had a reputation for a tendency toward arrogance among his peers and even his professors. If only they knew that on a level unseen by them, and often not even recognized by Yuri himself, he was a mass of doubts and fears. That was his basic nature, which he expended much energy trying to cover.
But now he was conversing with the great Dr. Eugene Botkin; he mustn’t let his thoughts get away from him.
“Does the boy know, Dr. Botkin?”
Botkin shook his head. “How do you tell a mere baby that death lurks for him around any given corner? How do you make him understand that any day might be his last?”
“Even you, Doctor?” Yuri said the words before he realized he had spoken his shock aloud.
“Do you suppose, Prince Fedorcenko, that a physician becomes hard and heartless as he becomes experienced? It has always been my sincere prayer that such is not the case. I hope it never becomes easy for me to inform a patient he is going to die. I hope my heart always aches at the sight of a child, or even a man, in pain. You are one of the best students at the university, Fedorcenko, but you have learned nothing if you cannot grasp this highest lesson of all. Never allow knowledge and know-how to usurp your basic humanity.”
“But, Doctor, how can you come face-to-face with pain and suffering every day without some shell of protection?”
“Trust God, young man. It is the only way.”
At that moment, a nurse carrying a small tray of medication approached.
“Ah, good, sister,” said Botkin. “After you’ve given the boy his injection, find a bed for him. I’d like to keep him overnight for observation.”
“Yes, Doctor.” Then the nurse took a paper from her pocket. “This came a few moments ago. It’s from the tsar.”
“But the tsar is out of town.”
“It’s a telegram.”
With a mumbled word of thanks, Botkin took the telegram, opening it quickly. His high color paled.
“Dr. Botkin,” said Yuri, “is something wrong?”
Botkin made a noticeable attempt to shake away his initial reaction to the message. “No . . . nothing at all, really.” He stuffed the paper into his pocket, then turned to the nurse. “Sister,” he said with more sharpness than Yuri had ever heard from the man, “why aren’t you giving that child his medicine? He’s been waiting too long already.”
“I’m sorry, Doctor.” The nurse hardly finished speaking before she opened the door and hurried into the room.
“I have to go, now,” said Botkin to Yuri, his tone distracted. “See to it that Vasily is made comfortable. Dr. Tevele is familiar with the case and will take over in my absence.”
“Yes, Doctor.”
Botkin started to go, then paused and said, “Fedorcenko, I was about to invite you to my home for dinner. I’d like to talk further with you. Unfortunately, I must go away for a while. But when I return, I hope you will accept my invitation.”
“I would be honored, sir.”
With a sense of awe, Yuri watched the doctor leave. It was no small thing to be invited to Botkin’s home. The man was known to take certain promising students under his wing, acting as a sort of mentor to them. If Yuri should be so honored, it would mean a tremendous boost to his medical career. Too bad the invitation had to be postponed. What if Botkin forgot about it in the ensuing time? He was, after all, a very busy man with many duties on his shoulders—not the least of which was the well-being of the tsar of all the Russias.