Chapter 15

Bern, September 1913

Rebecca walked into the operating theater with great curiosity. It smelled strongly of having been freshly disinfected with mercuric chloride. There were several tables with basins full of steel instruments, sponges, and gauze around the empty center of the room. Sterilizers were set up off to the side, and another table held cauterizers, suction pumps, and unfamiliar surgical machines. Everything gleamed white, and she wondered how surgeons’ eyes could stand the brightness.

Rebecca searched for a good place to stand. There were four tiered observation rows around the center, but only a few students present so far. She looked toward the door, hopeful that Mark would come in soon. She didn’t have to wait long. He walked in with his confident stride, and she waved to him. She watched his face light up when he saw her, and then he slipped into the stand, touching her fingers lightly.

“You came!”

“Why wouldn’t I?” she asked.

“I thought maybe you weren’t ready to see a surgical procedure yet. Even dissections make you ill.”

“I wouldn’t miss it for the world,” she said defiantly.

“You are brave to stand in the front.”

“I want to be able to observe better.”

“He asks questions of people who stand in the front.”

She paled, but wouldn’t admit her fear. “If you can answer questions, so can I. I studied his textbook on operative techniques. See?” She showed him her brand-new copy of Chirurgische Operationslehre, and he nodded in approval.

Someone tapped her on the shoulder, and she turned to the other side. It was Lara, handing her a handkerchief scented with rose water. “Oh, no need. I think I can handle the smell just fine. Yesterday was a weakness that I shall never repeat. And I’ve smelled ether before.”

“It’s not the ether smell you’re going to be troubled with. You’ll be grateful for this later,” Lara said.

“Why are there so few students observing?” she asked Mark.

“This operation wasn’t announced to all the students. Professor prefers to keep it quiet. It’s the wife of a famous socialist from Russia. They’re exiled.”

Suddenly, the room hushed. She looked toward the door and watched a woman being wheeled in by two nurses in starched aprons. The woman’s body was draped with white sheets, but her face and neck were visible. Rebecca couldn’t help but check for any sign of fear. It wasn’t fear, but rather resignation and fatigue that she observed. She wondered if the woman’s suffering from her goiter was great.

The team of four surgeons and two more nurses walked in minutes later, and Rebecca held her breath as her heart beat faster. She tried to pay attention to everything, from the way Professor Kocher held his hands up for the surgical gloves to the way the anesthetist positioned the ether mask over the patient’s face. She watched the nurses prepare the instruments and clean the woman’s neck.

“Your patient, Dr. Kocher,” the anesthetist announced.

Professor Kocher picked up a surgical knife from a nurse, turned to the students, and spoke. “Does anyone know what is the great advantage of ether over chloroform in general anesthesia?”

Mark answered, “A larger quantity of ether can be administered safely to a patient, Professor.”

“Entirely correct. While both substances can be poisonous to a patient, the toxic dose of ether is much larger than that of chloroform. Therefore, we can use ether more safely for longer surgeries. Now, what would be the contraindications to using ether?”

“It irritates the respiratory tract,” Rebecca heard herself respond.

“It does indeed. Your father is very familiar with this.” Dr. Kocher nodded in approval. “Prolonged uses may cause bronchitis, and you would not wish to use ether with patients who show signs of catarrh.” He continued, “When making an incision, we must avoid unnecessary injury to the adjacent structures. In this case, we’ll make a long transverse incision.”

Mark’s eyes focused on the operation intently. He seemed to be holding his breath.

Rebecca turned to Lara. “What’s the name of this woman? And who is she married to?”

“Her husband is Vladimir Ilyich Lenin, and her name is Nadezhda Krupskaya. He’s the head of the Russian Socialist Party,” Lara whispered.

“Why were they exiled?”

“Anti-Tsar activities. They’re in charge of many protests against the Tsar. They’ve been living abroad to escape being arrested and sent to prison.”

The surgeon continued, “As we’ll be resecting the goiter, ligature of the main vessels above and below on the left side and above on the right side will be necessary.”

Things were moving fast, and a cautery iron was called for to stop the bleeding. Rebecca suddenly felt faint from the smell of burning flesh and was grateful for Lara’s handkerchief. She heard the calls for suction, clamps, and sponges through a haze. Mark’s warm hand covered hers, stroking in small circles, bringing circulation back. The room came back into focus, and she made sure to breathe through her nose.

Kocher’s voice slowly became clearer in her ears. “As you can see, we’re doing a partial removal on both sides to prevent hemorrhage. We must leave a small piece of thyroid tissue intact or the patient will suffer severe physical and mental deterioration—what we term cachexia strumiprivia.”

“Do you and Vlad have to hide from the Tsar as well?” she whispered to Lara.

“Not I, but this is why Vlad came here,” Lara said. “There were police watching him for holding meetings to discuss a newspaper that posted articles about people starving while the Tsar prospered. He knew he was going to be sent to Siberia any day. So he hopped on the train and came here.”

“He doesn’t wish to study law?” Rebecca asked.

“Think of it. What good is Swiss law to him in Ukraine? He’s a journalist. He studies and waits for his chance to return,” Lara said. “If you tell anyone about this, we’ll be in big trouble.”

“You’re wrong about me if you think I’m the kind of person to tell your secrets to anyone,” Rebecca said.

“It’s just that…we have so much at stake.” Lara squeezed her hand. “Please forgive me. I just don’t want to lose him. I love him, you see. If there’s no more threat from the Tsar, maybe one day we can get married.”

“I’m not a child who runs to her parents to tell what she heard all day. You can trust me.”

Kocher worked slowly and meticulously. Rebecca’s legs were tired from standing, but she endured. Mark was called on to answer more than a dozen questions, all correctly. She was as proud of him as if she were the one providing the correct answers.

“And now we must bring the divided tissues into apposition again by means of sutures,” Kocher finally pronounced much later. “Good nursing care will now ensure that our patient will have sufficient recovery. Antiseptic wound treatment is essential for surgical success.” He wiped his forehead and threw the last instrument into the blood-filled basin. The observers stood up and clapped. The nurses wheeled the woman out.

They walked out of the operating theater, careful not to step in the puddles of blood. Rebecca was surprised that the smells no longer bothered her, and her only thoughts were focused on Mark and his friends and the threats they faced in their country. She knew now that the rumors had been correct and these students had been involved in political activities. But was Mark? He sure seemed interested only in medicine. Was he in danger, like Vlad? Should she worry about her heart being given to someone who was in danger from the Tsar’s secret police?

****

“I have the most unusual patient arriving tomorrow morning in my recovery room,” Father announced at supper two weeks later.

“Who is it, dear?” Mother asked, placing her soup spoon down and waving to the cook for the main course.

“Well, my dear. You know that I seldom accept patients for rehabilitation any more, but I find it difficult to reject Theodor. He is most persistent. Not to mention—I do wish for him to teach our Rebecca.”

“Who is it, Papi?” Rebecca interrupted.

“She is the wife of a political refugee from Russia, would you believe it? Her name I really can’t pronounce. But her husband is someone quite known to the socialists here.” Father sliced the beef, and the cook began to serve the steaming slices that smelled of fresh garlic and herbs.

“Professor Kocher allowed me to observe her surgery a few weeks ago.” Rebecca clapped her hands. “I would so much love to help care for her and observe her recovery. May I, please?”

“This is precisely why I have to continue granting him favors. He’ll watch over your education for me.” Father sighed.

Mother sighed as well. “You know, I’m starting to wonder if some of our medical faculty might be socialists themselves, with all the support they’re giving to the Russian political students.”

“I think you may be correct, my dear, but hardly anything like that matters, as long as they give Rebecca good preparation for her medical boards.”

“I just don’t know how you can stand watching them cut into a live person. The blood alone would make me faint on the spot,” Hannah said, wrinkling her nose.

“Don’t worry yourself about it, sister. No one is asking you to observe surgery. You can keep yourself to fashions.” Rebecca rolled her eyes at Hannah. “So can I help you, Papi?”

“Yes, of course. But I do believe one of his surgical students will be coming, as well. And she’ll have my nurse. So I’m not sure how much help will be required.”

“Sounds as if our Rebecca would be rather a nuisance, then,” Hannah said, popping a piece of a fresh roll into her mouth and smirking.

Rebecca ignored her. “Thank you, Papi. May I be excused from dinner? I have some studying to do.”

“Why don’t you finish your meal first? You’re thinner every time I look at you,” Mother pleaded.

“She’s fine. Doctors always eat on the run. You must remember what it was like when I was young, my dear?”

“I do, but she’s a woman, and she’ll ruin her health forever. She’ll catch an illness and it will put an end to her education and to any hope I ever had of having grandchildren.”

“But what about me, Mother?” Hannah’s cheeks puffed in anger.

“Of course, darling. I didn’t mean to forget about you. Speaking of which, I’ve heard of some balls being planned for this winter. We will need to decide which ones you will attend.”

Mother and Hannah bent their heads together and proceeded to discuss winter entertainment as Rebecca gave her father a kiss and went upstairs. She had a great deal to think about. But first, she needed to call and check on Sarah. She hadn’t heard from her in a few weeks, and Father hadn’t made any great progress in speaking with Friedrick about being kinder to Sarah. Her friend continued to look worn, thin, and ghostly pale. Although there hadn’t been any new bruises or broken bones since that awful night, still Rebecca believed that Sarah’s situation was quite desperate. There had to be something she could do to help her. They simply had to meet alone and come up with some solutions. Maybe she could talk to Mark and Lara about this.

Thinking of Mark, tomorrow she’d meet Lenin’s wife and try to find out more about all this socialist talk and how much exactly Mark was involved with the revolutionaries. Mainly, she needed to estimate how much danger he was in. From what she has heard from Lara, she was not entirely optimistic. This woman being in her father’s care was just the perfect opportunity for Rebecca to obtain information.