3 October 1881

Professor Sechenov, Pirogov, and three of Russian’s foremost surgeons observed our meticulous antiseptic preparations. The poor governess had tears in her eyes when we placed the small, quivering grand duke on the solid oak table.

I whispered to the boy and dripped ether on gauze over his face. He bravely coughed just once, inhaled deeply, and went under the anaesthetic. Dr. Bell made an incision from the angle of his jaw downward, spilled a few drops of royal blood, and dissected the infected nodes from the nerves and vessels in the neck. We could hear the tsar’s heavy tread in the corridor all through the operation, which lasted over one hour.

There was one particularly ticklish moment after Dr. Bell nicked the external jugular vein with his scalpel. He pressed the bleeding vessel with one finger and adroitly applied a stitch with one hand. There was a collective sigh of relief when he removed the last infected node.

The boy awoke from the anaesthetic but vomited and vomited until there was nothing left in his stomach. Dr. Bell and I maintained the vigil throughout the afternoon and evening. The tsar, with his face set in a rigid mask, held his son in his arms and paced the floor when the poor child whimpered with pain.

After midnight, the tsar retired to his quarters just across the hall, but he returned within half an hour.

“Bah, how can I sleep when my son is near death?”

“Your Majesty, you must rest, for tomorrow may be another trying day. Dr. Doyle will stay with him through the night. Here is a sleeping draught.”

The tsar downed an extravagant dose of laudanum with one gulp and returned to his quarters. A little after midnight, the governess coaxed little George into taking a few sips of milk, and at last, he settled into a light sleep, breathed quietly, and had a strong pulse.

For all my determination to remain alert, I, too, dozed off...