12 August 1881

This morning, I couldn’t shake my sick feeling about my fellow scientists. I was thinking that I should go home, give up medicine, and focus on my dream of becoming a writer. After further inner debate, though, I decided that, alas, I was too desperately poor to try anything else, especially a riskier career such as writing, so there was no alternative for me but the practice of medicine.

Thus, this morning, I dragged myself through the streets of St. Petersburg to attend lectures on chemistry and bacteriology given by two scientists with German accents. I understood most of the lectures and tried not to fall asleep.

At noon, I met Vera Nayechev for lunch. “Fyodor has spoken of your kindness to him and wishes to consult with you about his lung congestion,” she said, while we ate delicious small pancakes, called blini, topped with caviar and hot soup.

I did a bit of sightseeing and, at four o’clock, reached Dostoevsky’s small flat. I opened the door to the odor of decay and sickness mingled with stale beer and cabbage. A subdued group of students, writers, and a publisher was eating and drinking. Sviazhky, with the red beard, gave me an immense bear hug. He wore a grave expression on his face. “Fyodor’s health is deteriorating. He is near the end,” he said.

“When I saw him on the Servia, he appeared to have epilepsy,” I said.

“It all started when he was arrested, then shackled hand and foot in the St. Peter and Paul fortress years ago. For months, he ate nothing but stale crusts of bread.”

“What was his crime?”

“There was no crime. The secret police accused him of plotting against the tsar and sentenced him to death by firing squad. A priest insisted he confess his sins and kiss the cross as they led him into Semyonovsky Square. The tsar’s men put a hood over his head and tied his hands, but at the last minute, Tsar Nicholas I commuted his sentence to eight years in Siberia.”

“How terrible.”

“Yes, and his story is not uncommon. That is why so many people want to see the end of the tsars.”

After perhaps a half-hour of pleasant conversation and drinking vodka, Sviazhky flung his arms around a middle-aged man who appeared from an adjacent room. “Doyle, this is Golovinsky, the son of a man who was in Siberia with Fyodor. He is now one of Fyodor’s most trusted friends.”

Golovinsky gestured to me. “He is ready for you.”

He took my arm and led the way into the author’s small study. Dostoevsky, reclining on a chaise lounge, raised himself and languidly offered a thin, pale hand, criss-crossed by blue veins. “Ah, my young Scottish doctor. Welcome to St. Petersburg. I am glad to see you.”

His face was pallid, with just a hint of freckles over his cheeks, and his beard was matted with a yellowish scum. He lay back on the lounge, covering his mouth with a soiled, blood-stained handkerchief and was convulsed with a moist, gurgling cough.

I spent a moment looking at the shelves of his books. I could not read Cyrillic but recognized many of his novels and stories. He had lived a writer’s life, a life I had always dreamed about but never had the courage to pursue. This man was pure bravery, yet look at where it had gotten him - frail and sickly and dying in a hovel.

I vowed to do whatever I could with my limited skills and the meager supply of medicines in my instrument bag. Several students crowded into the room, as if expecting a miracle from the foreign doctor. There was no way that I, a recent graduate, could meet their expectations. I tried to comfort him by putting my hand on his shoulder. “So Fyodor, tell me how you are feeling.”

“My cough has become insufferable and my doctors can do nothing.”

“I will try to alleviate your suffering.”

With my best, assumed, professional manner, I counted his pulse at the wrist. The beats were rapid and erratic, not a good sign. He had another paroxysm of coughing while I removed his shirt to percuss and auscultate his lungs. His thin chest was sunken and the ribs were prominent. There was no subcutaneous fat and only a few strands of muscle. I placed the middle finger of my left hand on his chest wall and tapped it with my right index finger. The percussion note sounded like a hammer striking an empty drum, except at the apex, where the note was flat and dull.

This was a sign of a fluid-filled cavity. One hardly needed a stethoscope to hear the gurgling rales in both lungs. I surmised that Dostoevsky was in the end stage of pulmonary tuberculosis, aggravated by years of smoking cigarettes, poor diet, and general ill health. I guessed his ailment originated in the ordeal of imprisonment and Siberian exile while he was a young man. There was little to be done except to palliate his symptoms. I poured a strong dose of laudanum into his bedside cup and wrote a prescription for menthol.

“Take as much laudanum as you wish to decrease the cough, and get this from your chemist. Place a tablespoonful in a kettle of boiling water, and inhale the steam with a towel or blanket over your head twice a day.”

It was a useless nostrum, but I had learned from Dr. Bell to always prescribe something to give the patient hope - no matter what.

Dostoevsky thanked me. I lingered a while, talking with Golovinsky and Vera at the window as a half-dozen students from the flat sauntered toward the main street. Suddenly, a troop of mounted police, the Okhrana, cantered into Kuznechney Alley and, with no warning, began to beat the students with their rifle butts. “Disperse, disperse! No meetings allowed!” the policemen barked.

Two students fell with bleeding heads. Others cowed under the blows and meekly submitted to the shackles and chains. An older, stout woman - what the Russians called a babushka - showed great courage and dashed her handbag in the face of one of the officers who was beating a frail young man on the ground.

She attempted to run, but to my horror, the captain of the troop took deliberate aim with his pistol and brought the fleeing woman down with one shot. Blood spurted from her chest as she lay on the cobblestones. Then, the police dragged the shackled students away, leaving the dead woman under a dispersing cloud of gun smoke.

“This happens every day,” Vera whispered. “It is the great tragedy of our lives. These horrible Okhrana round up suspects and take them away to the fortress - the ones that they have not already killed, that is.”

“Is there no justice in this forsaken place?” I shouted, without thought of my hosts.

Dostoevsky finished a wracking, gurgling coughing spasm. “Watch out, my young Scottish doctor. This is not Edinburgh. If you are too loud, they will come for you, too,” he said.

“Thank you, my friend,” I answered.

Then, with a glance to Golovinsky, I thought I heard Dostoevsky speak. “Only one more, then I will be at peace. Now go,” he whispered.

Vera took both of my hands with a firm grip. “Doyle, we should leave, but be very careful, please. I don’t want you to come to harm. Keep your eyes open and your mouth shut.”

I thanked her for the advice, which sounded like what Dr. Bell had said all through medical school.

It was near dusk when we left Dostoevsky’s flat. Bright red sprays of light reflected from western clouds but the day had turned gloomy. Vera tucked her arm through mine and we cautiously walked out onto the street. Ah, I felt a growing warmth for this strange, but delicious young woman who was concerned for my well-being.

“Come, Dr. Doyle, we will not allow the secret police to spoil our day.”

She held me so close that an observer might have thought we were lovers. Was she, like Penelope, playing me for another purpose? She was a sensuous, full-bodied woman with a scent of roses. I was attracted to her bosom thrusting against a thin blouse.

We lingered at the Bronze Horseman - the bigger than life statue of Peter the Great astride a magnificent horse - and watched the Neva peacefully flow into the Gulf. I loved the way she thrust herself against my body and enjoyed inhaling her scent.

She pulled me towards her. “I must leave, but let us meet again at the Beranger, let us say, at three o’clock,” she said. The brush of my mouth on her face soon turned into a very satisfactory lip-bruising kiss.

“Yes, tomorrow at three o’clock.”

Upon my return, Bell was jittery, nervous, and poised with a syringe and a needle over his bared left arm. “Ah, good! Doyle, you are just in time to witness a great surgical advance. I shall inject three cubic centimeters of cocaine and water into my skin.”

He inserted the needle, depressed the plunger, and immediately relaxed.

“Now Doyle, plunge the point of your penknife into the area of injection.”

“Sir, I couldn’t do that. The pain would be intense.”

“Nonsense. Cocaine renders the area pain free. Think what this means to the future of surgery.”

With that, he stabbed the needle deep into his arm. “Look, there is no pain.”

I was worried and perplexed. Since he first tried cocaine at the lecture, Dr. Bell’s behavior had alternated between bouts of euphoric hyperactivity and dreamy lethargy. I was sorry about his use of cocaine and yearned for the old caustic, cutting Bell.

I excused myself and went to my room to study and mull over the day’s events. My thoughts, as they seemed to inevitably do, soon turned to Penelope. Where was she now? Was she in the clutches of the secret police in some horrid prison cell? What was the role of our mysterious Mr. Tatum? He posed as our valet, but went off on mysterious errands, and once, I heard him speak of the ‘embassy men.’ Was he watching over us or pursuing his own affairs?