When the Dawn Breaks

by Emma Fraser

  ‘The men say they’re more likely to die from pneumonia in our wards than anything else.’ Maud grinned. ‘They’re naughty. Whenever we turn our backs they close the windows. They are simply not used to fresh air. There are more beds in sheds in the courtyard – mainly officers and recuperating patients. The theatre is in the back block. The doctors operate two at a time, but there’s a lull at the moment. There hasn’t been much fighting over the last week, although there’s a rumour that it won’t stay quiet for long.’

  Maud placed her hands on the small of her back and stretched. ‘I’m due on the evening shift. I should get some rest.’

  ‘I’m sorry. I shouldn’t have kept you so long.’ Isabel was instantly contrite.

  ‘I’m just pleased that you’re here,’ Maud replied, with a smile. ‘But you should rest too. You’ll not get much from now on.’

  Chapter 33

  The next day, although Isabel was awake at six, it appeared she was the last to rise. The other beds were made and Alice was nowhere to be seen.

  When her bare feet touched the floor it was as if she were stepping on ice. A plump woman wearing a greatcoat was jabbing furiously at the basin of water with a spoon. She glanced behind her when she heard Isabel’s bed creak. ‘Oh, hello. You must be one of the new doctors. I’m Dr Sylvia Lightfoot. Not so much light of foot as heavy of body, as you might be able to tell. Trained at the London Hospital.’

  Isabel smiled. ‘Dr Isabel MacKenzie, trained at the Edinburgh Royal Infirmary.’

  Dr Lightfoot raised an eyebrow. ‘One of the pioneers? Good for you.’

  ‘What are you doing?’ Isabel asked, throwing her coat around her shoulders.

  ‘The water’s frozen again and there’s no hot to melt it. Mrs Cavendish says she needs it all for breakfast and if I want some I’ll have to wait. She says she’s tired of us all pinching her hot water, and the next time a kettle goes missing, she’ll lock the kitchen door.’ She gave the frozen water another vicious jab. ‘I don’t mind the mud. I don’t mind the hard work. I don’t even mind the straw mattresses with the straw that pokes into one, jabbing and pricking and stopping one from getting to sleep, but I do mind not being able to wash.’ Dr Lightfoot turned to Isabel. ‘Sorry,’ she said. ‘I’m not at my best in the morning.’ She held out her hand. ‘How do you do? I’m delighted you’re here.’

  Isabel smiled, despite chattering teeth. It was so cold in the room that ice had formed on the inside of the windows.

  ‘Most of us don’t bother undressing at night any more,’ Dr Lightfoot said. ‘It’s too damn – excuse my French – cold. If you brought a fur, use it as an extra blanket.’

  ‘How long have you been here?’ Isabel asked, dressing as hurriedly as she could, adding several layers until she knew she resembled a pudding more than a doctor. Perhaps Dr Lightfoot wasn’t as corpulent as she appeared.

  ‘The same as everyone else – a week.’

  ‘How do you find it?’

  ‘I love it. Apart from there not being enough water to bathe.’ Dr Lightfoot flung the spoon onto her bed. ‘I give up. Unless…’ she slid a glance at Isabel, ‘…unless you fancy taking your chances with Mrs Cavendish and fetching us some water. Oh, do say you will. If she catches you, you can tell her you’re new. She can’t blame you.’

  ‘Show me the way!’

  Isabel managed to sneak a kettle of boiling water and once she and Dr Lightfoot had washed, each taking their turn behind a curtain at one end of the room and exposing themselves to the cloth a small area at a time, they made their way to the dining room. As far as Isabel could work out, the nurses were accommodated in their own quarters.

  ‘This used to be the hall when it was a hospital. We use it as the dining room. We run a strict regime here. Breakfast is at seven for those on day shift and seven thirty for those coming off night shift. It’s usually not much more than porridge, bread and tea, but it’s enough to keep us going until lunch.’

  Isabel took a seat beside Dr Lightfoot while an older man in the grey-blue uniform of an Austrian soldier served tea and porridge.

  ‘Johannes looks after us here,’ Dr Lightfoot said. ‘He doesn’t speak much English but we understand one another well enough. We’re blessed to have some good men to help us.’

  Johannes grinned and nodded vigorously.

  There were several nurses at one end of the table, orderlies in the middle and the doctors, including Isabel, at the other end, all keeping up a stream of easy chat as Johannes served them. Dr Lightfoot made introductions but the only name Isabel could remember was that of Margaret Guthrie. She was a sister in her mid-forties, whom Isabel had met when she was working at the Royal Infirmary. Sister Guthrie had been capable if demanding, with a dry sense of humour, and Isabel was pleased to know she would be working alongside her.

  Excited and nervous in equal measure, Isabel tried to ignore the fluttering in her stomach and force herself to eat. Everyone had finished when Maud dashed into the room. Buttoning her cuffs she took the empty chair next to Isabel. ‘I had to wait ages to get some water,’ she hissed. ‘Not that Matron believes that’s any excuse! Now I shall have to do without breakfast.’ She reached over and took a slice of thick dark bread from the centre of the table that no one had touched. When she bit into it, she grimaced. ‘Ugh. But needs must.’

  At seven twenty exactly there was a rapping of a spoon on a plate and the dining room fell silent.

  ‘Matron,’ Dr Lightfoot whispered to Isabel. ‘She allocates the nurses to the wards and then our MO briefs us as to where she thinks we’re needed.’

  The process took less than five minutes. As Dr Bradshaw had promised, Isabel was allocated to dressings and Alice Sinclair to the medical ward. The women all rose and there was a clatter of spoons and cups as they cleared away their breakfast dishes.

  Maud smiled at Isabel. ‘Catch up later?’ With a rustle of her grey uniform, she hurried away.

  ‘Come with me,’ Dr Lightfoot said. ‘You should start in General Surgical. Then I suggest you go to Heads followed by Abdominals. After that you may have to come back to General to do those who are being dressed twice a day.’ She grimaced. ‘I keep hoping they’ll put me on the convalescent wards for a day or two, but no luck so far. They tend to keep Dr Murdoch there as she’s a bit of a menace if she gets too close to actual wounds – she came straight to us from a resident’s post at one of the asylums, poor thing, but it does mean she’s very good with the men suffering from neurasthenia.’

  Isabel had heard rumours about this new and baffling condition that affected men on the front. They couldn’t sleep, couldn’t speak and often had to be fed as if they were children. Some appeared not to be able to move their arms or legs, although their limbs were uninjured. Recently people had started referring to the condition as shell-shock.

  Isabel was allocated a nurse and a decent-sized room off the general surgical ward, with a couch, a dressing-table stocked with bottles and bandages, and a trolley with syringes. The nurse, who introduced herself as Elliot, was a slim, cheerful woman from Australia. ‘We don’t have enough morphine or chloroform to go around at the moment,’ she said. ‘We used it all in the first week just to get the bandages off the men. You should have seen them. Stuck to the wounds like cement, they were. All the anaesthetic we have left is being saved for the worst cases and for theatre. We start with the ambulatory patients to give the sisters on the ward time to get the patients washed, then do the dressings there.’

  Elliot pointed to a man who was mopping the floor. ‘This is Kurt, one of the Austrians. Doesn’t have a word of English, I’m afraid.’

  ‘Sprechen Sie Deutsch?’ Isabel asked.

  Kurt broke into a wide smile and replied in the same language. ‘Yes, of course. My home is only a small distance from here.’

  ‘Crikey, you speak German,’ Elliot said. ‘Wait until the others hear. Most of us haven’t a clue.’

  ‘One of the few benefits of a finishing school in Switzerland,�
� Isabel replied drily.

  They rolled up their sleeves and were soon immersed in a steady stream of dressings. Although none of the soldiers spoke English, Kurt was able to translate Isabel’s German well enough to make the Serbians grin with delight.

  ‘They keep trying to talk to us in Serbian,’ Nurse Elliot said, her quick, gentle hands never pausing as she rebandaged wounds that Isabel had cleaned, ‘even though they know we can’t understand. But don’t you agree that they’re rather handsome?’

  Isabel suspected a reply wasn’t required.

  When they’d cleaned, disinfected and redressed the wounds of all the walking patients they went into the ward, accompanied by Kurt.

  Their first patient was lying in bed, his sheets tented over his right leg. His heavily bandaged left arm was missing below the elbow but when he opened his eyes and saw Isabel he launched into a stream of Serbian that had Kurt grinning widely.

  ‘What’s he saying?’ Nurse Elliot asked, as she undid the dressing on his arm.

  ‘He says that the doctor is the most beautiful woman he has ever seen and he has decided to marry her,’ said Kurt.

  Isabel’s cheeks burned. ‘Something about wanting to marry me.’ Deciding it was better to ignore the comment, she bent her head over the wound on her patient’s arm.

  But Elliot had no such qualms. ‘And you tell him from us that if we have any more of his nonsense he’ll be out of here in two shakes of a monkey’s tail.’

  Kurt looked baffled and Isabel hid a smile. She didn’t think she was going to translate. Her patient continued to smile and chat in Serbian through what must have been a painful few minutes while Isabel cleaned his arm. When she unwrapped his leg, it took all her training to prevent her showing how shocked she was. The stump was hot and swollen, the suppurating flesh turning black at the edges.

  She exchanged a glance with Nurse Elliot, whose cheerful smile had disappeared. Within seconds it was back. ‘No point in letting him know how bad it is, Doctor,’ she murmured. ‘I’ll put his name down on the list for theatre, shall I?’

  Isabel nodded. For a moment she couldn’t speak. One of her first patients and it didn’t look good. She cleared her throat. ‘Could you tell this soldier, Kurt, that we’re going to have to take him back to theatre to try to remove the black bit on his leg? It will probably mean it has to come off above the knee, I’m afraid.’

  As she rewound the bandage, Kurt translated. Her patient looked grim for a moment, then spoke to Kurt. ‘Alexandrovitch says,’ Kurt said, with a glint in his blue eyes, ‘that he will go to the operating room but only if you are with him. He says that if he is going to die, it should be with a beautiful woman looking into his eyes.’

  Isabel managed a smile in return. ‘Tell him I’ll be there. First I have other patients to see.’ She peeled off her gloves. ‘Oh, and tell him I have no intention of letting him die.’

  When Isabel returned to Alexandrovitch, Dr Lightfoot was taking his temperature. There was a look on the doctor’s face that chilled her. ‘This patient is going to theatre, Doctor,’ Isabel said, with a smile at Alexandrovitch.

  ‘I haven’t quite decided.’

  ‘But—’ Isabel started to protest but Dr Lightfoot took her by the arm and led her out of earshot.

  ‘He’s too ill to survive the operation,’ Dr Lightfoot said quietly. ‘He’s already showing signs of sepsis and there are too many who need operations who will survive. I’m going to leave him until the end of my list and then decide. We have barely any anaesthetic as it is.’

  ‘But you must operate! If you leave him he’ll almost certainly die. The gangrene will spread through his body if we don’t stop it.’

  Dr Lightfoot looked regretful. ‘I can’t spare the anaesthesia. And if we go ahead and operate without it, I don’t think he’ll survive the shock in his weakened condition.’

  ‘We could try to give him blood. I watched the American doctors do it in Paris and it worked.’

  ‘It’s been tried before and it’s killed more patients than it’s saved. We can’t risk it.’

  Isabel wasn’t prepared to give up. She’d promised Alexandrovitch he would get better.

  ‘I’d take the chance of operating if it might save him.’

  Dr Lightfoot shook her head. ‘You young doctors are so brave – so willing to try new things.’ She held up her hand when Isabel started to protest again. ‘If the shock doesn’t kill him, the sepsis will. Nevertheless if you wish to operate and he agrees to have the procedure carried out without anaesthesia, you’re welcome to try.’

  The thought of amputating her first limb was bad enough, but to do it with the patient awake made Isabel’s stomach churn. However, Alexandrovitch wouldn’t live if she didn’t take off his leg and it was up to her to make the right decision for her patient. She had no choice. There was no other way to save his life.

  She returned to his bedside and, with Kurt translating, explained what she planned to do.

  ‘He asks what will happen if you don’t take his leg,’ Kurt said.

  Alexandrovitch hadn’t even flinched when he’d been told he’d be fully awake and able to feel every cut of the knife.

  ‘The infection will spread to the rest of his body, and he’ll become increasingly septicaemic and die.’

  ‘This operation – it could kill him anyway?’

  Isabel nodded, and waited until Kurt translated once more.

  ‘He wishes to know if he might still survive without it?’

  ‘It’s possible,’ Isabel admitted, ‘but unlikely.’

  ‘If he were your brother, what would you advise him to do?’

  ‘To have the operation.’

  Alexandrovitch looked thoughtful. He reached under his pillow and brought out a small statue of a blue-robed Madonna. He pressed his lips to the small figurine and mumbled something in rapid Serbian under his breath.

  Kurt looked at Isabel, his dark eyes troubled. ‘He says that the Scottish doctors have served them well. He will take his chances. He prays that Mother Mary will watch over you both.’

  Isabel’s hands were shaking as Sister Elliot helped her put on her rubber gloves.

  Alexandrovitch was lying on the table staring up at her with a half-smile. Dr Lightfoot was carrying out another operation on the other side of the room so at least she wouldn’t be alone for this, her first major unassisted operation.

  Elliot passed Alexandrovitch a piece of sterilised cloth to hold between his teeth and had arranged for four of the Austrian orderlies to be there to hold him down when the pain became too bad.

  Signalling to Elliot that she was ready, Isabel lifted the special amputating knife and prepared to make her first incision. She would have to make it without hesitation and cut deeply. Any other way would hurt Alexandrovitch more. Taking a deep breath, she nodded to the orderlies who had positioned themselves at each corner of the table.

  ‘Hold him tight,’ Isabel said, relieved to hear that her voice wasn’t shaking. ‘Don’t let him move – not even a fraction.’ She lifted the scalpel and sliced through Alexandrovitch’s flesh.

  The operation went better than she could have hoped. Dr Lightfoot left one of the other doctors operating on her patient and came to help. As Isabel cut, Dr Lightfoot used the battery-operated galvaniser to seal off the blood vessels. To everyone’s relief, Alexandrovitch passed out when Isabel started sawing through the bone.

  ‘Well done,’ Dr Lightfoot murmured, when they’d finished. ‘Neat work. Have you done much operating before?’

  ‘A little. No amputations, though. Except the tip of a finger.’

  ‘I’m surprised. You have the hands and cool nerve required of a surgeon.’

  Now that the operation was over Isabel felt sick, but she was thrilled by the praise from the more experienced doctor. ‘It’s what I always wanted to do.’

  Dr Lightfoot smiled. ‘I’ll speak to Dr Bradshaw and see to it that you spend more time in theatre, then. God knows, you’ll get all the
experience you need here to turn you into a first-class surgeon.’

  Chapter 34

  France, February 1915

  Jessie crept back to her ward after dinner. She was so exhausted she could hardly stand, but earlier that day, a young soldier from Skye had been brought in with both legs missing and most of his face bandaged. There had been nothing the doctors could do for him, except clean his wounds and make him comfortable. The soldier wasn’t expected to survive and had been sent to Jessie’s ward to die.

  She’d never met him before, as he came from Sleat in the south of the island and she was from the north, but when he’d heard her speak, he’d clutched her hand. ‘Stay with me, Sister. Please.’ He was terrified and Jessie couldn’t blame him.

  Although the ward was busy, and comforting the soldiers was a task normally left to the orderlies, Jessie pulled up a chair next to his bed.

  ‘Donald, isn’t it?’ she asked softly, in Gaelic. The ward was lit only by paraffin lamps as, in an effort to save power, they kept the electric lighting off when they weren’t expecting casualties. Although the flickering light made it difficult to see what they were doing, at this time of night Jessie preferred it. It was more soothing for those who were awake and in pain.

  ‘Yes, Sister. Donald Stuart.’

  ‘You have the same surname as me,’ Jessie replied, with a smile.

  ‘I’m not going to make it, Sister, am I?’

  ‘Now, where did you get that idea?’ Jessie chided, as her heart constricted. ‘Don’t you know that we have no intention of letting our soldiers die?’

  Donald’s grip tightened. The strength of his fingers almost made Jessie cry out. ‘Whatever you say, Sister.’ He sighed.