The first floor of the new care-house was almost finished, and all but five of the beds were in place; most of those beds were already occupied by men in the grip of illness, and by nightfall, there would be three more patients to care for, according to the Watchmen who patrolled the levees and dykes where the work-gangs labored, and where the supervisors struggled to keep up with the demands of the Czar. Already there were isolated groups of tents in the drained part of the marshes where members of the work-gangs were sent when they became too ill to function-the stricken supervisors were brought to the care-house.
Little though anyone said so aloud, the whole of the populace of the new city was terrified of epidemic disease breaking out among the gangs, for surely once that happened no one would be safe. Dread hung over the Neva as surely as mosquitoes did, and stung as pertinaciously. The weather did not encourage hope for improvement: the last heat of summer lay over Sankt Piterburkh; the brassy sky reflected in the river and the standing water in the marsh; the air itself seemed enervated by the dreadful humidity. Activity lagged on this day, as it had for a week: validating the deepest fears of the populace, Swamp Fever was slowly spreading from the work-gangs to the other residents of the city even as the insistence for more and faster building was emphasized by the supervisors, who strove to get as much done as possible before the cold closed in.
"The Watchmen are coming shortly," said van Hoek to the five male nurses he and Ludmilla had received thus far: two were monks; the other three had served aboard ships as their crews' medical officers. All five men maintained stoic demeanors as the number of their patients increased. "The messenger said he has collapsed from his injuries, including a ragged puncture in his side." They were in the largest of the care-rooms, which just now was darkened by closed shutters and oppressively hot.
"More Swamp Fever, and a fall while sick, like Szymon Victrovich?" she said, sounding tired. "That is twenty-six we have seen and treated, and it's only mid-September." She turned toward the rear window. "I wish they would finish the out-buildings. We need a real mortuary, not just a rear porch, especially in this weather."
"Of those twenty-six, we've lost four, with two more failing," van Hoek said as if reciting a necessary but unpleasant fact. "So far."
"Will this be another?" Ludmilla asked. "How badly is he affected?"
"No; you misunderstood me, Ludmilla Borisevna. This one isn't Swamp Fever, for a change, or so the Watchmen's messenger reported. This one was injured when the dredging-barge was rammed this morning by the Danish ship while the fog was low," said van Hoek. "They say he's badly hurt."
"Broken bones, or worse," Ludmilla thought aloud.
"Worse, I fear. The messenger said the man had frothy blood coming from a tear in his side."
"That's dangerous, then. He shouldn't be around Swamp Fever, that may settle in his wounds and cause putrefaction." Ludmilla sighed, her face showing her worry. "Still, we must be ready to help him. The Hercegek is upstairs working on more medicaments. Shall I tell him we will need the surgery this afternoon, finished or not? I need to get some more of that tincture of willow-bark and pansy in any case."
It was a chore for Kyril Yureivich, but neither of them mentioned it. Van Hoek looked around the room. "Go ahead. Jascha and Klavdye will do your work for a short while."
To confirm this assurance, Jascha and Klavdye both said, "Da," and went on offering small cups of lemon-flavored water to the men in the beds.
"There-you see?" Van Hoek motioned her out of the room. "Go up to the Hercegek and tell him what is coming. Tell him I'll join him as soon as the patient arrives."
"I will," she said, wiping her hands on the apron she wore over her European clothes. She hurried up the stairs, taking care not to risk getting splinters in her hands from the unsanded railing. As she reached the top of the flight, she saw four carpenters working on the surgery area, their iron-cored leather mallets hammering out a regular rhythm tap-POUND, tap-POUND, tap-POUND, like the steady beating of hearts. Ludmilla averted her face as she went into the side-room where Saint-Germain had set up his laboratory, and found him with Hroger filling up a book-case.
"Ludmilla Borisevna," said Saint-Germain, turning at the sound of her footsteps. He wiped his hands on a length of cotton that was draped over the end of a small trestle-table. "What may I do for you?"
"We have an injured man being brought in. He's probably going to need to have bones set and may need some kind of surgery, as well. Heer van Hoek can tell you more; he received the report from the messenger." She spoke quickly, but with the kind of certainty that kept her from sounding too hasty. "From the messenger's report, his lung may be damaged."
"That's unfortunate," said Saint-Germain. "How soon will he be here?"
"As soon as he can be brought here," she answered. "My guess would be in less than an hour."
"Then we should make ready now." He motioned to Hroger. "If you will ask the carpenters to come in here and work on filling the space between the outer walls and the paneling with packed sawdust? That way van Hoek can attend to the man without distraction, and the carpenters need not witness what the injured man requires to have done."
Hroger put down the stack of books he carried. "I'll attend to the mattress," he said at his unflustered best. With a nod he left the room.
"All right," said Saint-Germain. "I will go in as soon as the carpenters are out of the place and put a thin mattress on the surgery-bed, and set out the tray for Heer van Hoek's use."
"Thank you for attending to it so quickly." She stared at him. "You know how to treat these sorts of injuries, don't you? You've treated them before, not just studied them."
"I have some experience along such lines, yes," he said, curious to know what was on her mind. "I learned most of what I know in Egypt, some time ago." He had learned many things during his centuries at the Temple of Imhotep: treating injuries was among them.
"So you've mentioned," she said, still concentrating on him as the carpenters filed into the room, their supervisor bringing a wheelbarrow filled with packed sawdust. "Should we leave this to them?"
"It is probably for the best." He bowed her through the door, saying as he did, "Have you had your mid-day meal yet, Ludmilla Borisevna?"
"There hasn't been time," she said, noticing that Hroger was already putting the surgery room into as much order as he could achieve.
"You would be wise to make time. You must protect your health if you are to care for the sick. Have a bowl of strong broth with marrow within the hour, and take a dish of tea with it." He picked up a stiff-bristled broom and began to sweep away the chips and shavings that remained on the floor. "We do not want a bad footing."
She made a gesture of agreement. "A good precaution." She saw that Hroger had slipped away. "He has other work you require?"
"He is getting a mattress for the surgery-table," said Saint-Germain. "An injured man needs something softer than bare boards to lie upon." He patted the surgery-table, not wanting to add that the mattress would soak up more blood than planks could do. "This will be ready in ten minutes."
"I'll inform Heer van Hoek, and then I'll go heat some strong broth with marrow. I haven't much of an appetite, but I'll eat." She remembered to curtsy before she hurried back down the stairs.
"She's wearing herself out with work," said Hroger as he pulled in one of the rolled surgery-mattresses. "You can see it in her face."
"I know," said Saint-Germain, taking the mattress from Hroger and spreading it on the surgery-table.
"She values what you tell her," Hroger went on in his indirect manner.
Saint-Germain said nothing in response to that. "We'll need the silk twine, the curved needles, the magnifying lens, the irrigation syringe, the Blue Lotus ointment for numbing the skin, and two vials of syrup of poppies, to stop the man's pain."
"Very good," said Hroger, and went off to fetch them.
Fifteen minutes later, Heer van Hoek came up the stairs, pulling on his long smock as he climbed. "Hercegek, thank you for doing this." He removed his wig and hung it on a wooden peg near the stairs.
"It is part of my duties here, I believe." Saint-Germain had already donned his smock and handed his wig to Hroger; he finished tucking up the ruffles at his cuffs, and said, "If you would like my assistance, it is yours to command."
"You appear prepared," said van Hoek. "You might as well remain, in case the injuries are severe. If there is a bad break in a bone, both of us will be needed to set it."
Saint-Germain pointed to his tools. "Would you want to use any of these?"
"I have my own, thank you," said van Hoek, indicating a rolled leather case lying at the end of the surgery-table; he was showing more signs of nervousness as he studied what he had brought with him. "Not that you don't have an excellent collection. Where did you get them? Padova?"
Although he had been at the Universita there in the past, most recently before his voyage to the Audiencia de Peru about sixty years ago, he had acquired the surgical tools over a number of centuries and in a number of places including Padova. "As well as Bologna, Praha, and Alexandria," he answered.
"That's right-you're widely traveled, aren't you?" Van Hoek was beginning to look nervous; he cracked his knuckles and started to pace.
"I have been about a fair part of the world," Saint-Germain answered. "I hope I am sufficiently prepared," said Saint-Germain, hearing the door open below, and a hurried conversation before the footsteps of at least three persons indicated that the Livonian Watchmen were bringing the injured man up to the surgery-room; their efforts were accompanied by slow, persistent moaning.
The lead Watchman was showing his teeth, his breath coming heavily, a look in his eyes that hinted at his distress about the man he and his two comrades carried on the pallet. The man they bore had a sheet thrown over him, much of it stained red; blood dripped off the ends of the sheet, leaving a trail of droplets, and the metallic odor of blood surrounded the man. The Watchman looked around the surgery-room. "Where-?"
"Here. On the table," said van Hoek. "Lift him up and roll him off."
"I don't think that's a good idea," said one of the Watchmen in Swedish. "He's in pretty bad shape."
"I'll help you," Saint-Germain volunteered in the same language. "If you raise the pallet, then I'll do what I can to shift him without rolling." He had learned that trick almost three thousand years ago, during his centuries in Egypt.
The three Watchmen grunted as they strove to lift the pallet, trying to keep it level. At last they had it as high as their waists, and that was about all they were able to do. The Watchmen were sweating, muscles straining, one of them pale with fright. "No higher," said the lead Watchman.
Saint-Germain stepped in next to the pallet, and in a quick, powerful move, slipped his arms under the injured man and, as if swinging an armload of grain-sacks, shifted him onto the surgery-table. As he withdrew his arms, the sleeves of his smock, and its front, came away red. "All right. You may put the pallet down."
The lead Watchman stared at Saint-Germain. "The man's no lightweight, but you-"
"It depends on rapid, steady movement. It is not as hard to do as it looks." For living men, it was harder, but he kept this observation to himself.
The Watchmen regarded him uneasily, but their leader only said, "Foreign tricks, that's what it is."
"Of course." Saint-Germain paid no attention to the blood on his clothes as he leaned over the man and pulled back the sheet. He froze, seeing the color of the man's face and the lacerations that began just below his shoulder and ran down his left side to the middle of his thigh; the deepest wounds were in the side of his torso, where the blood that welled was frothy and pink, a sure sign that the lung was damaged. There was nothing he or Heer van Hoek could do to save him: the physical damage was too catastrophic. He stepped back from the surgery-table and looked directly at van Hoek. "I have syrup of poppies-that will ease the pain."
"He's been shivering as if he were cold-in this weather," said the leader of the Watchmen, looking a bit pale himself.
The youngest of the Watchmen retched as he caught sight of the dreadful wounds. "I … I must … leave …" With that he bolted down the stairs. His footsteps crossed the main room beneath and took him out of the care-house.
The remaining Watchmen looked sheepish. The leader cleared his throat, then said, "Do you need our services any longer? We have more men to remove from the …" He made a vague motion of his hand to imply some service he anticipated providing.
"You mean there are more injuries?" van Hoek asked.
"None as bad as this one. Four men have drowned that we know of, but there may be more. The rest are nothing like this." He pointed to the man on the surgery-table.
"Will you need beds for anyone else downstairs? Should we alert the nurses?" Van Hoek tried to concentrate on the patient, taking up bandages and trying to deploy them about the body in an attempt to lessen his bleeding.
The Watchmen stood as far from the injured man as they could; they winced whenever the patient groaned or shuddered. Finally the leader said, "The others are work-gang men. They're not our concern. Their supervisors will have them removed to their camps."
Saint-Germain had filled a small cup with a cloudy amber liquid. "If he can get this down, it will ease him." He moistened a bandage and put it on the man's mouth, then poured a little of the syrup of poppies on it, and was relieved to see the man swallow. He added more to the bandage. "He will take this anodyne; that is to the good."
Van Hoek started wrapping the huge tear in the patient's side, working with determined haste. "I think the bleeding is slowing down."
"It seems that way," said Saint-Germain, and there was no hint of satisfaction in his tone. He gave the man more syrup of poppies.
The leader of the Watchmen bowed slightly. "Well, then, we'll leave. He's in your hands now."
The other Watchman muttered something about God, and left quickly, his leader not far behind him. Their pace increased down the stairs until they all but ran out the door.
They had been speaking in Russian, but now van Hoek changed to Dutch. "How much longer, do you think?" It was as if the departure of the Watchmen freed him to address the reality of the injured man's dying; his question was accompanied by an uncanny wail as their patient began to tremble from a seizure.
"Not long: fifteen, twenty minutes at most." Saint-Germain gently pressed the patient to keep him from falling off the surgery-table. Satisfied that the spasm had passed, he offered more syrup of poppies, making sure the man swallowed the thick liquid before offering more.
"Won't that hasten his death?" Van Hoek frowned his disapproval.
"By a few minutes, perhaps, but that changes nothing," said Saint-Germain. "At least he will not have to be in such agony as he has been."
Van Hoek nodded once. "You're probably right. With the greatest anatomists in Europe, this man could not have been saved. A punctured lung, and the hip looks shattered."
"He probably raised his arm to fend off the ramming ship, a useless gesture, but an understandable one," said Saint-Germain, as he looked over the wounds. "If he were not so torn up, I would recommend putting a blanket over him, to help him regain a little warmth, but he would not be able to stand the pain it would cause."
"I see that," said van Hoek. "Is he conscious enough for a confessor?"
"I doubt it; his eyes are glazed and he hears almost nothing," said Saint-Germain. "A priest would not be here in time, in any case. Do we know what faith he follows?"
"On a dredging-barge, he'll probably be Dutch, or English," said van Hoek. "Protestant, in any case."
"Or Scottish or Irish, and Catholic," said Saint-Germain.
Van Hoek shrugged. "As you say, there isn't enough time." He put his hands together and began the Lord's Prayer.
Saint-Germain provided another bit of syrup of poppies, and noticed that the patient hardly swallowed anything. He stepped away from the surgery-table, and poured the remaining syrup back into the vial from which he had taken it. This done, he wiped out the small cup and put it back with his other supplies. When van Hoek ended his prayer, Saint-Germain joined in the "Amen."
"Whom should we notify?" Van Hoek touched the man's neck, trying to determine if he still had a pulse.
"The supervisor on the dredging-barge, I would suppose," said Saint-Germain, his own, keen senses telling him that the man was slipping away into death.
There was a long, awkward pause, and then van Hoek drew the sheet back over the man. "Would you be willing to do that for me? I find such notifications distressing."
Saint-Germain took a moment to consider. "I will," he said, "providing I can find his supervisor." He glanced at the covered body. "Shall I also ask Jascha and Klavdye to come and move this?"
Van Hoek swallowed hard. "It would probably be best. Then this room can be cleaned, and the surgery-table mattress taken away. And the blood needs to be washed off the stairs." He heard someone coming up those stairs, and fell silent.
Ludmilla appeared in the stairwell. "Is it over?" she asked, crossing herself.
"Yes," said Saint-Germain. "I will go shortly to speak to this man's supervisor. I will find out who he was and what manner of burial he may require."
"In the meantime, he should be removed from this room and taken down to the rear porch to be washed and laid out," Ludmilla reminded them. "It isn't wise to keep bodies within doors when there is sickness in the air."
"True," said van Hoek. "Very well, then. As soon as the Hercegek returns from making the required notifications, we'll send Kyril to the burial work-gang and have him inform them to which cemetery he's to be taken." He leaned against his standing tray of surgical supplies, distress in every aspect of his being. "And there will be more-many more."
"Not like this one," said Saint-Germain.
"No-the Swamp Fever doesn't leave bodies so ravaged. But their numbers will rise before they fall." Van Hoek tightened his hands and closed his eyes. "We must prepare. We must prepare," he said, more to himself than to Ludmilla or Saint-Germain.
"So we must," said Saint-Germain, and raised his voice to summon Hroger. As soon as he arrived, Saint-Germain said, "Do we still have any of that solution that removes bloodstains?"
"Yes," said Hroger.
"Would you be good enough to make it available to Jascha and Klavdye?" He could see the concern in Hroger's eyes, and he added, "We will need a fire outside to burn the surgery-table mattress and the sheet. Bring another drape from my store of them, so the body need not lie under all that gore."
"It will stiffen, and stink," said Hroger, unwilling to present an optimistic view on the death. "For the sake of the other patients, the sooner he is moved, the better. At least a new drape will keep it fairly neat and make preparation for burial less unpleasant." Without waiting for dismissal, he went back into the room that would be Saint-Germain's laboratory to open the large wooden chest which contained all the medical equipment and supplies.
Ludmilla crossed herself again. "Your manservant spoke in kindness, of a sort, but it's still upsetting." Her steady gaze was directed on Saint-Germain and there were unshed tears in her eyes.
"We must become more accustomed to dealing with the dead," said van Hoek with a resigned apathy that he wanted to serve as a shield against what lay ahead. "Swamp Fever is going to keep providing bodies until the cold sets in, and then cough and ague will come, and we will have more men in our beds." He was doing his best to match Hroger's pragmatic tone, but his voice broke on his last words.
"I am aware of that," said Ludmilla.
"We will need to steady ourselves, not only to take care of the patients, but to keep ourselves from succumbing to despair." Van Hoek straightened up. "Despair can be as deadly as fever."
Saint-Germain had a sudden, intense memory of Nicoris and her suffering in her attempts to live as those of his blood must-how she had fallen into dejection and hopelessness, "Despair is a great killer," he agreed quietly.
"I have had the broth you recommended, and the marrow," Ludmilla said, aware that something more than their immediate conversation was bothering him, and wanting him to know that his skills were valued. "You are right-I have let myself become over-tired."
"Which is what we must avoid," Saint-Germain concurred. "If there is anything that will compromise the care we provide, it is exhaustion. I have seen it happen before." Every time those giving care lapsed into exhaustion, their ability to look after those stricken diminished and their own risk of becoming ill increased sharply. From Egypt to Siberia, from China to Mexico he had seen the pattern repeated, and he had come to understand how dangerous debilitation could be.
There was a long moment of quiet among the three, when the sound of the carpenters came through the walls, and the noise from the road outside penetrated the double-paned windows. Then, just as Hroger returned, Ludmilla said, "Then we must make a schedule for resting as well as work, not just for us, but for the nurses and the servants. If we all collapse, the Hercegek is once again right: we will lose our ability to give any care at all."
Hroger took the bloody sheet off the body and wrapped it in a long linen drape, working steadily and without any outward signs of repugnance. When the man was swathed, he said, "I'll go summon Kyril Yureivich to assist me; we'll carry him to the porch."
"No," said Ludmilla. "I'll go get him."
"You needn't," said Hroger.
"But I do need," Ludmilla countered. "This is my obligation, and it's my duty to act." She nodded to Hroger. "You're most helpful, but Kyril will want to receive his orders from me, especially when it comes to a body that isn't Russian."
Saint-Germain signaled to Hroger. "Why not go with her, so that you and Kyril may work out the best way to transport the dead man to the porch? Leave Jascha and Klavdye to tend the ailing in the main care-room."
The smile that Ludmilla offered was so genuine that Saint-Germain was surprised by it. "If you're willing to accompany me, Hroger, I would thank you for your help."
Hroger bowed. "I am at your service, Madame."
Ludmilla shook her head in polite disbelief. "To find a manservant who is also a gentleman." She started down the stairs. "I'll warn our monks that the body is coming. They'll want to make sure the lower floor is cleansed before another patient is admitted, so that death does not blight them all." As she descended, Hroger followed her down.
"Whatever they think best," said van Hoek as the two disappeared from view. "Much as I have reservations about the Orthodox faith, it is necessary that we accommodate the monks: we need their help and their good-will."
Thinking back to his discussion with the Metropolitan Matvei, Saint-Germain said, "The Orthodox Church has the final authority regarding the dead of Sankt Piterburkh. Not even the army can contravene an interment order from the Metropolitan. Once I establish the man's identity, I will file a report with the Metropolitan's office about the dead man, so that they may decide what the Church will accept."
"Russian Orthodoxy!-it is laden with traditions and rituals that are worse than the Catholics," said van Hoek with Protestant austerity. "But as we are guests here, we must comply with the customs of the country." He closed up his instrument case and unfastened the front of his smock and began to pull it off. "This should be burned. Yours as well."
"I'll see it's done," said Saint-Germain as he began to remove his smock, taking care not to brush his clothes with the drying blood that soaked into the smock.
"Before you notify the Metropolitan, let me know what you plan to tell him." Van Hoek dropped his smock on the floor. "I don't want this man to be neglected because he wasn't one of the Orthodox Christians, as has happened to others. And I don't want the care-house to come under his disapproval for mistreatment of the dead."
"I will," said Saint-Germain, thinking as he spoke that van Hoek's unease was more reasonable than he wanted to admit. He pulled his cuff-ruffles out of his sleeves and shook them, then he inspected the front of his clothes. "There seems to be a spot of blood on my neckcloth," he remarked.
"And no doubt on your leg-hose and shoes," said van Hoek. "I always find blood on my shoes after treating so much bleeding."
"Hroger will attend to it," said Saint-Germain, knowing he would be unable to clean the spot himself, lacking a reflection to guide him.
"How long do you anticipate being gone?"
"An hour, perhaps two," said Saint-Germain. "I will be as quick as possible." He decided to order Saari to fetch one of his horses, saddled and bridled, to lend him a little speed; earlier he had seen Saari patrolling the other side of the street.
"Keep your own advice in mind, Hercegek," van Hoek recommended. "Don't wear yourself out. You, too, need to be rested."
"I would like to be more … restored," Saint-Germain admitted, and wished again there were women he could visit, unknown, in dreams. He went to get his wig, saying to van Hoek as he went, "I will send word if I am delayed more than two hours."
"Thank you," said van Hoek with an odd catch in his throat. "I confess I find such errands difficult."
"As do we all," said Saint-Germain, tugging his wig into place before setting out down the stairs to inform Ludmilla and Hroger of his plan, and then to summon Saari, to explain what the afternoon required.
Text of a letter from Mungo Laurie in Sankt Piterburkh to his wife, Hepzibah, in Edinburgh.
To my most sorely missed mouselet, my dear wife,
As much as I long to see you again, I can be grateful that you are not here just at present. Three days ago, the Danish ship Redeemer, lost in the fog, rammed into our dredging-barge, drowning nine men and injuring twenty-three. One of the men, Hamish Andrews, died as a result of his injuries. I have been occupied these last two days with making arrangements for his burial. There is a small Protestant cemetery at the far end of this island, and I am almost finished with the arrangements for his funeral, which of necessity will be simple; for the Russian Church limits the formalities approved for those not of their congregations, and there are only three Protestant clergymen in the city. I am informed that Andrews' coffin must be laden with stones, or there is a risk that it will pop out of the earth when the tide is high. Such things have happened before. The rising water is why so few buildings in this place have cellars of any kind: they flood.
I have been dealing with Harald Nyland, Graf Horsens, one of the Danes helping to create the harbor here. He has promised to negotiate with the Captain of the Redeemer regarding the level of repair the ship will need, and I will supply Nyland with information on the degree of repairs our dredging-barge needs. Between us, we should arrive at a settlement that will be fair to us all, and permit the dredging to continue until winter comes, as the Czar has demanded.
Speaking of the Czar, he and his associates are expected here within ten days. He has ordered a grand banquet and has invited more than a hundred guests-almost the entire Foreign Quarter. All the households in the city are scrambling to make sure there is sufficient food and drink for him and his Court. They say his capacity for eating and drinking is prodigious, and therefore his celebration may well exhaust the pantries of Sankt Piterburkh, not a comforting thought with winter coming.
The weather has broken at last, and instead of still, hot, damp days, there is now a sharp wind out of the northwest, and although the sun is warm during the day, it is becoming cold at night. Some of the sailors say there is a storm brewing, but they say that every time the weather changes. I mention this because I may not be able to send you letters for much longer this year. I should have at least one more chance to put a note in the hands of a Captain bound for Edinburgh before the ice comes, but if the autumn is stormy, I may have to wait until spring, or risk not getting it to you at all.
I have read your letter of May 10th, my mouselet, until it is almost in tatters. I see your writing, and I am overcome with missing you. I have already asked the Czar's deputy, the man Alexander Menshikov, if he could designate a house for me next spring, so I might bring you to this place and we will not have to be so long apart. I will be glad to have your nephew accompany you, for young as he is, he should not once again be cast upon the rest of your family as the orphan he is. Six may be young for a long voyage, but it is better to travel than to be abandoned.
If this is the last I can send to you this year, remember that you are in my thoughts every day, that I keep you in my prayers every night, that I long to embrace you, that I am yours to the end of the world.
Your devoted husband,
September 21st, 1704
entrusted to Captain Arcangelo Montesque of The Star of Genova