1 October 1881

Early this morning, with Ivanov administering a few drops of chloroform, I did the operation exactly as Dr. Bell directed. There was a great gush of green pus and, by noon, Katrinka - for that is her name - took some food for the first time in days.

I am elated, literally walking on air, at this small success. Not only that - but the arm stump of young Konstantine has also healed.

I bubbled over with excitement this afternoon when I reported the result to Dr. Bell. A smile flickered over his lips. “Good, good, Doyle. You have been a bit off-color, lately. This is exactly what you needed.”

It is most amazing. His eyes were clear, and there wasn’t the slightest tremor when he knotted a silk cravat that matched his fine, grey, tweed suit.

“It is a fine day. Let us walk to the clinic,” he said.

He set a fast pace and, in high spirits, twirled his new walking stick with a bright silver knob. Once he stopped and eyed a small, round stone, took a stance, swung the cane like a golf club, and sent the stone flying down the road.

“Dr. Nikolay Pirogov will visit the clinic this afternoon. Do you know of his work?” he asked.

I had to dredge through a distant anatomy lesson and finally came up with an answer. “There is Pirogov’s aponeurosis over the biceps muscle. An amputation through the heel of the foot is named for him, is it not?”

He sighted along the cane at a duck rising off the Neva. “Yes, good memory. Pirogov is known for surgical work during the Crimean war and is a first-class scientist. Sadly, he is no longer active in surgery.”

At the clinic, we donned clean, white aprons and carefully washed our hands between each patient. I glowed with happiness as Dr. Bell examined my little patient and said I had done well.

Professor Pirogov arrived just as we commenced a most difficult operation on a ten-year-old boy with infected nodes in his neck. I studied the famous man, hoping for inspiration. He was not the imposing great surgeon I had expected, but was stooped, walked with a limp, and was nearly bald. He sat on a high stool with his chin resting on one hand while Dr. Bell gently dissected nerves and arteries in the neck away from tubercular lymph nodes. Sweat trickled down my brow when he inserted the last stitch and I stopped the chloroform anaesthetic.

“Well done, sir. Well done.” Pirogov said.

Dr. Bell rinsed his hands. “Thank you,” he muttered.

Pirogov pulled at his well-clipped beard. “I must put to you a most difficult situation. The tsar’s son, Grand Duke George Alexandrovitch has tuberculosis of the glands, not unlike this lad. The tsar requested my opinion about surgery but I am no longer operating. Dr. Bell, would you be good enough to see the boy?”

His fatigue dropped away, and he straightened his stooped shoulders. “There are many capable Russian surgeons, aye?” Dr. Bell asked.

“They are all afraid of the consequences if the boy should die.”

“Ah, now that is a challenge I’ll accept. I shall be happy to see young George tomorrow morning.”

And so, in the morning, we will journey to the tsar’s Palace. I dread to think what will happen to Dr. Bell if the surgery fails and the boy dies. But Dr. Bell seems confident in his surgical skills, so I hope all goes well... Certainly, if anyone can save the boy, it is Dr. Bell.