Chapter 1
Field hospital
Grand Army of the Sunrise
Near Krakow
An arch of arterial blood sprayed across Isaac Kohen’s blue scrubs, followed by the angry voice of Doctor Oberheuser.
“Keep that hemostat locked, boy!” the army’s chief medical officer shouted, “or I’ll kick your worthless ass back to medical school!”
“I’m sorry, Doctor,” Isaac said, reaching with his forceps into the mangled thigh of the badly wounded soldier. The font of blood, fortunately, helped guide his hand. “These forceps are useless. They keep slipping, tearing the artery, and—”
“Don’t give excuses, boy! Find that artery and clamp it down…now!”
Isaac leaned in despite the blood pouring from the soldier’s leg. He was trying to clamp the femoral artery so that they could amputate the right leg above the knee. A tourniquet had been put in place in the field. It had stopped the bleeding long enough to get the lad back to the hospital, but it wouldn’t do for a removal. Proper anesthesia had been administered. The nurses were standing by with the bone saw. Everything was ready to go, save for Isaac’s task: clamping down the artery before the man bled out.
The sound of artillery echoed in the distance, shaking Isaac’s hands, his nerve, juicing his anxiety. The battle was close. A mile or so at most. General Morris Roth’s Grand Army of the Sunrise locking horns with Polish-Lithuanian forces. This field hospital was closest to General von Mercy’s cavalry, so most of the soldiers being brought in were cavalrymen. The soldier splayed out on the table before them, however, was an artillerist whose leg had taken a nasty bounce from an enemy cannonball. The ball had ripped most of the calf muscle away, leaving nothing but scraps of meaty red flesh, broken bone, and tattered uniform below the knee. The femoral artery itself had been damaged such that a proper ligation was necessary before amputation. He could be saved, if Isaac could just find…that…artery…
“Got it!” he shouted, almost making another mistake of holding up the hand that held the clamp tightly against the artery, just to prove to the old, grumpy, son of a bitch surgeon that he had it. But he kept his hand in place and further supported the clamp with the index finger and thumb of the other hand. “Cut!”
No cutting. He said it again, but the nurse holding the saw just stood there with a sad expression, her eyes cast down toward the bloodstained ground.
“He’s dead, boy,” Oberheuser said, stepping away from the table. “He’s dead.”
The lifeless eyes and pale, sallow face of the soldier confirmed it. Oberheuser ran his hand over the man’s face to close the eyes. He then sighed deeply and wiped his sweat-stained sleeve across his forehead. “Very well. Take him away. Place his body in line outside with the others. Quickly, now. We have other wounded to attend to.”
Isaac stepped away from the table to let the orderlies come up and carry the man away. He stood there holding the forceps, letting blood drip from his hand onto the ground. His heart raced. He was sweating. He felt like weeping.
“My apologies, Doctor. I did the best I could.”
Oberheuser took off his gloves and tossed them into the bucket where all soiled prophylactics were tossed for later sanitation. He pulled his mask down to his chin, shook his head, said, “Don’t worry about it, boy. It’s not your fault. You’re too young and inexperienced to be doing this. Herr Roth put you in the field too soon. You’re not ready.”
Oberheuser was never one to mince words or belay his criticism, especially during times of great stress. Criticize me all you want, Isaac thought as he placed the forceps in a bowl nearby, but you aren’t suited for fieldwork at all, old man. You may be a good surgeon, but you don’t have the proper temperament for this.
The old doctor was, in fact, a very good surgeon. He was in his fifties, Isaac knew, though he wasn’t sure of the man’s exact age.
Karl Oberheuser had been an army physician for the Catholics and Habsburgs before the Ring of Fire, but had quickly aligned himself with the up-timers and their Swedish allies when he had, apparently, seen the writing on the wall. He had received some modern medical training in Jena and had served on Torstensson’s medical staff near Ahrensbök. When General Roth had asked the USE for additional medical support for his own army, Oberheuser had quickly volunteered, which in truth, had come as a complete surprise to Isaac. The old doctor wasn’t an anti-Semite in the strict sense; Isaac had grown up in the ghetto of Prague and knew what true anti-Semitism was. If Oberheuser were, he’d have never volunteered to serve an army comprised primarily of Jewish infantry.
He treated Isaac as if he were a child, something to tolerate, but not to take seriously.
“Doctor Oberheuser,” Isaac said, his voice trembling. “You persist in calling me ‘boy,’ but I will remind you that I am twenty-one years of age. I am trained in up-time medical techniques. I am more than qualified to be here, and I would ask that you refer to me as ‘Doctor’ or ‘Herr Kohen’ or I’ll even accept, ‘Hey, you.’” Isaac swallowed against the strong pulse in his throat, the nervous shake of his hand. “I will no longer answer to ‘boy.’”
The vein on Oberheuser’s forehead grew into a deep purple line that ran to the bridge of his nose. He looked like he was about to explode. Then another report of musket fire echoed through the tent, reminding them both about the matter at hand.
“Then get on outside…Doctor,” Oberheuser said, thumbing toward the open flap of the hospital tent, “and check on the wagonload of wounded that just arrived.” He pointed to a soldier waiting in pain on a stretcher. “I’ll tend to this man’s shoulder.”
Isaac nodded politely. “Yes, Doctor.”
He removed his bloody gloves and mask and affixed a clean apron around his waist. He washed his hands and arms to the elbows; he scrubbed them thoroughly as he had been taught at school. Then he toweled himself off, took a deep breath, and stepped outside the tent.
Inside the tent, all he could ever smell was feces, urine, blood, and body sweat, despite the fact that Doctor Oberheuser understood the value of good ventilation. It was just that, inside the tent, no amount of airflow could staunch the odors that floated up to the canvas ceiling and hung there like a pall over the desperate, but necessary, work being conducted below. Outside, the air was cool and fresh, if not a little sickly-sweet with the smell of sulfur and niter from drifting musket and cannon smoke.
Wounded were lying everywhere, though most were noncritical and could be tended to by nurses. The wounded that Doctor Oberheuser was referring to were Sunrise men who had just arrived from the front.
Nurse Bayer was already tending to them. She addressed Isaac without turning. “All walking wounded here, Isaac. Some more serious than others, but no one a priority, thankfully.”
Devorah Bayer was from the Prague ghetto as well. Her son had been killed at the Battle of the Bridge, and her husband had died a month later from a heart attack. Shortly thereafter, she volunteered her services to Morris Roth’s cause. She did not have as much up-time training as Isaac would like to see in all their nurses, but she was driven and seemingly immune to the sight of blood and suffering. That was always a good skill for a nurse to have.
Her name came from the great prophetess who, in the Book of Judges, led a revolt against the Canaanite king. It meant bee and some even suggested that it meant to speak with kindness. Isaac was all for that right now. The calming voice of a nurse was sometimes the best medicine for a wounded soldier.
“Go ahead and take a respite, Devorah,” Isaac said. “I’ll take care of these men.”
Men! Isaac huffed. Hardly. Oberheuser would be correct in calling these soldiers “boys.” By the innocent look of their faces, they were barely out of their teenage years.
He inspected a sword wound on a young cavalryman’s arm. The slash had cut through the man’s buff coat with one clean swipe. Someone had cleaned the wound and had pulled the lacerated skin together with three strips of surgical tape cut to butterfly. Isaac was pleased to see it. There were a couple field medics near the front, Isaac knew. One of them had probably done this. He inspected the work. He nodded. Nice. I’m having an impact.
“The killing never stops at the front,” Devorah said, helping one of the wounded climb out of the wagon. His left hand was wrapped in a length of his own bloody sleeve. He was in a lot of pain, but he was conscious and could breathe and walk. He was practically ready to return to the field. “You need all the help I can give.”
“Nevertheless…take a break. You’ve been at it nonstop for six hours.”
“So have you,” she threw back.
“Yes”—Isaac winked and shared a sly smile—“but I’m younger than you. Just a boy, remember?”
Devorah got the joke but waved it off. “Fine, fine, Herr Doctor. I’ll give this one some water and a fresh dressing, and then I’ll take a break.”
Isaac nodded his thanks. “Danke, meine Dame.”
It was true that in war, there was always killing at the focal point of the battle. Where exactly that was right now—a mile, two miles, three miles away—Isaac did not know. More casualties would surely come in. They needed every doctor, nurse, orderly, and medic on duty. But fatigue was a devil in a battle situation; just a thirty-minute rest could be the difference between saving a life or losing one.
Isaac turned his ear to the wind. Cannon and musket fire echoed again in the distance. The focal point had either shifted, or the battle itself was winding down. Isaac hoped the latter. The entire staff needed a break, needed to pause for one of those cool drinks of water Devorah’s wounded soldier was about to have. That would be most welcome, indeed.
But not yet.
Isaac climbed into the wagon and inspected the head of a Silesian mercenary leaning exhausted against the railing. Nasty wound. Blunt trauma with deep purple bruising, overlaid by a ragged cut from a serrated edge. Isaac winced. “Serious wound there, my friend.”
The soldier nodded and replied in Polish, “Tak.” He lacked the energy to say anything else.
“Can you walk?” Isaac made his fingers move like they were walking across the ground.
“Tak.”
“Go in there.” He motioned to the tent. “You need stitches for that wound. The head bleeds a lot, you understand, and so if we don’t stitch you up properly, you’ll keep losing blood and then once it does heal, you’ll have terrible scar tissue where no hair will ever grow again. Go in there and tell them ‘stitches.’ You understand…‘stitches.’”
The man seemed to understand. He mouthed the word back a couple times and then crawled to the end of the wagon.
As Isaac was helping the man get out, an argument erupted inside the tent.
Doctor Oberheuser was shouting angrily again.
Isaac held the man back. “Stay here,” he said, taking the man’s hand and placing it over the clean bandage on his head. Isaac pressed down hard and smiled. “Hold it tight over the wound like this. I’ll return shortly.”
Inside, a hussar from the Polish-Lithuanian side of the engagement was laid out on a table. He was fighting two nurses and a field medic trying to hold him down.
“What is going on here?” Isaac asked.
Doctor Oberheuser stopped his vile stream of cursing long enough to answer. “I’m supposed to save der feind here, as per the standing orders of our General Roth. What nonsense! We have neither the time nor the supplies to give aid and comfort to der feind. I won’t do it!”
“Sir,” Isaac said, coming over to assist the nurses with their struggle. The man was out of his mind, mumbling in Polish and casting terrified glances left and right. Isaac could tell right away that he had been given morphine. Too much, in fact. “General Roth’s orders are clear: we are to give aid to enemy soldiers, wherever possible, so long as it does not impede in the care of our own soldiers. We don’t have any serious, pressing cases at the moment, so—”
“He’s lost too much blood!” Oberheuser barked, his frustration and exhaustion on full display. “It’s a ZB-2 Santee wound. The round shattered the right humerus. We’d have to amputate too close to the shoulder. I can’t do it without serious risk and likely failure.”
Isaac looked at the damage despite the man’s writhing. His stomach clenched. It was, indeed, a very nasty wound. The up-time-inspired round had torn through the man’s clothing, pulling fabric deep into the arm and twisting it around the brachial artery. Isaac could see bone fragments peeking out of the muscle tissue, like tiny fangs ready to bite. Luckily, the artery itself was mostly intact. The hussar had lost a lot of blood, but the tourniquet had staunched a full bleed out.
“I can do it,” Isaac said, marking a place on the soldier’s arm with index and middle finger. “You do the ligation and clamping here. You’re more qualified to do those than I am. I’ll do the cutting here.” He moved his fingers to where the bone had been shattered. “There’s no bone left here, so it’ll be an easy amputation. I’ll cut, you clamp. I’ll stitch the flap afterward.”
Oberheuser started to object, but Isaac knew that giving the compliment about the ligation and clamping was just the right amount of butter to spread across the old doctor’s bread. All Isaac wanted was for the foul-mouthed physician to try; that was all. They both needed a little medical redemption for earlier mistakes in the day, and despite such a terrible wound, this hussar was not dead, nor did he have to be.
“Very well,” Oberheuser said, wagging his finger, “but we’ve no time for proper reapplication of PPE or for scrubbing. We’ve got to do it now, or in five minutes, it won’t matter.”
Isaac agreed. “Let’s move him into better light.”
With the nurses’ and medic’s aid, they lifted the table and moved it into the center of the tent where there was light from two oil lamps swinging from the scaffolding. The center of the tent did not offer the best ventilation, but it offered the most space for such a serious surgery.
“Wait… ” the cavalry soldier said, his eyes glossed over in fear and confusion. “What are you going to do?”
“Ah, you speak German.” Oberheuser seemed pleased. “That is good. We don’t have to waste time now trying to figure out what you are saying. Simply put, Mein Herr, we are going to save your life. We’re going to remove your arm to keep you from bleeding to death.”
“No!” the Polish soldier barked. He tried lifting himself up, sliding his legs off the table, but the nurses held them in place. He winced and lay back down. “Don’t take my arm. Please. I’d rather die than lose my arm.”
“You’re going to be fine, young man,” Isaac said. “Trust me. We’re going to take care of you. Get that rolling table over there,” he said to a nurse and pointed to his left, “and get the combat shears and cut off his coat.”
“No, no… ” The hussar struggled. “I won’t let you take my arm.”
“We should give him a shot of morphine,” Oberheuser said, thumbing through a set of scalpels to pick the proper one for ligation of the artery.
Isaac nodded. “You’re probably right, but he’s already loopy with his first dose. I’m loath to give him another.”
“Nevertheless, give him one. Otherwise, we’ll be fighting him the whole time.”
They didn’t have many doses left, but Isaac directed a nurse to fetch him one. For that matter, they had few clean syringes as well. Smaller soiled equipment like syringes and scalpels and clamps were currently being sanitized in one of the pressure cookers that Isaac had snagged in Grantville before answering General Roth’s call. But they still had a few doses ready to go, and at least one of them could be used on der feind.
Isaac pushed out a small stream of morphine to ensure all air bubbles were gone. “Hold down his left arm.”
Isaac moved to the patient’s left side. The hussar was cursing them in Polish—Isaac knew enough of the language to know that—and trying to wrest his arm free from their grasp. He grabbed the man’s wrist and forced the arm down. “Keep him still… ”
He managed to find a vein just below the bicep. He pushed the clear liquid in slowly while Oberheuser waited for the nurse to put the rolling table beside the hussar and carefully lay his wounded arm across it. As she did so, the Polish soldier howled in pain, but Isaac noticed that he was no longer flailing about. That was good. The extra morphine seemed to be doing the trick.
“I’m ready,” Oberheuser said, standing there holding his scalpel.
Isaac accepted two cutting knives from the medic. The bone saw was unnecessary, for there was no bone to saw, just shards that could easily be pushed aside during the procedure. He walked over to the other side of the table and got into position. He nodded to Oberheuser. “Ready.”
“Don’t…don’t take my arm…don’t… ”
The man was fading fast. “Have no fear, young man,” Oberheuser said, leaning over to begin the ligation. “In fifteen minutes, you’re going to be just fine. You’ll fall asleep, and you won’t even remember—”
The hussar moved so fast, Isaac didn’t see him reaching with his good arm into his boot and drawing out a small blade. As soon as Isaac saw it, he howled, dropped his own knife, and reached for it, but failed to knock the soldier’s arm away.
The blade struck Oberheuser’s neck. It was a solid strike, and one that sent the doctor reeling backward and clutching his neck as blood poured from the wound.
“Guards! Guards!” Isaac screamed as he tried grabbing the hussar’s arm. The makeshift blade pierced the shoulder of a nearby nurse before they managed to pile on and knock the weapon from his hand. Isaac was screaming, the soldier was screaming, the nurses were screaming. The guards rushed in. One of them hiked up the butt of his musket and smacked the hussar in the head.
They dragged his limp body away. Isaac recovered and went to Oberheuser immediately.
“I’m so sorry, Herr Oberheuser. I tried to—”
“Herr doctor!”
The new voice was commanding. Isaac turned and saw four men burst into the tent. Two were holding a third between them. The other, carrying no one, was a cavalry officer.
“We have an officer here who needs immediate attention!”
Isaac was about to protest and turn back to Oberheuser, when he felt a hand on his shoulder. He turned. Devorah smiled at him. “Go, and tend to them, Isaac. I’m done with my break. I’ll take care of Herr Oberheuser.”
“Are you sure?”
“Do what she says, boy,” Oberheuser said, using that derogatory term again, but in a weakened, muted voice. Isaac let it go. The wound had not, unfortunately, damaged the old man’s vocal cords. “He didn’t hit the jugular. I’ll be all right. Go do your duty.”
Isaac nodded, mouthed thank you to Devorah, and stood.
“What is the problem?” he asked, helping the two cavalry soldiers carry the officer to a chair. Isaac knelt in front of the man and began checking his wounds. They were serious.
“He took a sword slash across his face and shoulder, and his eye is badly damaged.”
Isaac nodded and looked up. “And who are you, sir?”
“I am Colonel Gerhardt Renz.”
Isaac looked back at his patient. The man was groggy but awake. “And who are you?”
“Christian von Jori.”
“Captain von Jori, to be clear,” Colonel Renz said, “and you have to save him, sir. Please…I beg you.”
Isaac examined the eye. A hastily applied dressing had been wrapped around the man’s head. Isaac lifted the eye patch slowly. Oooh! Ugly!
“It hurts when I blink,” von Jori said.
Isaac put the patch back in place and stood. “Then I’d advise you to stop blinking.”
It was meant as a joke, but no one was laughing. Neither was Isaac, for that matter. It was a bad joke. He just needed to blow off some steam, some tension. Nothing was going right today.
“You’re going to save his eye, aren’t you?”
Isaac had never seen a colonel show so much concern for a lower-ranked officer. The patient did have “von” in his name, so perhaps Christian von Jori was an important person.
Isaac looked across the tent to Doctor Oberheuser. Devorah was still tending to his wound. Isaac then looked at the line of smeared blood and dirt where the Polish hussar had been dragged out of the tent. He shook his head.
What a miserable day.
He turned back to Colonel Renz. “Yes, sir, I will try.” Then he said the quiet part out loud. “But I haven’t been very successful at saving anyone today.”
✧ ✧ ✧
Captain von Jori’s wound was a long saber slash across his forehead, over his eye, down his chin and neck, and into his shoulder. The shoulder cut was the deepest, but the least worrisome to Isaac. The buff coat had prevented the slash from cutting the artery in the arm. They cut away the damaged coat, cleaned the wound, and bandaged it right up.
The neck wound was of more concern. It too hadn’t struck an artery, thank God, but it was deep enough that, with continued movement by the patient, the artery could tear and there’d be nothing Isaac could do about it, being now the only qualified field surgeon still in action.
The most critical wound at present, however, was the right eye. The slash had split the eyelid, although it looked like the eye itself had been spared the cut. A lot of blood had poured into Captain von Jori’s eye and down his face. For some odd reason, small bits of shrapnel and large grain powder had been spread all along the slash line, and one of the most egregious pieces was lodged in the captain’s eye, just under the lid. Isaac had tried extracting it with tweezers. No luck.
“Fetch me that satchel over there,” he said, motioning toward a small leather bag on the ground. “I need my magnet.”
“Magnet?”
Isaac nodded as the nurse fetched his satchel and handed it over. He reached into the bag and drew out a small U-shaped piece of metal, smaller than his palm. He smiled and waved it like a horseshoe. “Courtesy of Imperial Tech in Magdeburg. With this magnet, I’m going to try to extract that little piece of metal you have lodged up under your eyelid. All that painful blinking you’ve been doing has drawn it in too far; can’t get it out by normal means, so we improvise. Now, Captain von—can I call you Christian? Please be still. And don’t blink.”
“Wouldn’t it be best to knock me out first, or give me a sedative, or whatever it is you physicians do to keep your patients calm?”
The question both surprised and impressed Isaac. Most soldiers who came through the white flap were either in too much pain, too weak, or so ignorant of medical procedure that they never asked questions—never said a word, in fact—except scream or grunt or howl in pain. “We’re preparing anesthesia now, but it isn’t ready yet. We can’t wait for it. If I don’t get that bit of metal out of your eye now…well, you just be still. And don’t blink, no matter how painful it is.”
The nurse who had handed Isaac the satchel now leaned over Christian and placed her gloved hands near his eye. With tender thumbs and index fingers, she carefully spread Christian’s eye open. The captain tensed at the pain; she cooed soft words of encouragement to soothe and keep him calm. Blood flowed freely down his face, into his ear, and onto the table. Isaac moved closer, identified the errant piece of metal with a magnifying glass, then slowly moved the magnet toward the eye.
“Still,” Isaac whispered, “still now.”
The metal fragment responded immediately, standing up in its lodged state like a soldier itself. Isaac inched the magnet closer while he mouthed a small thank-you to the duo of Wilhelm Fabry and his wife Marie Colinet who had perfected the practice of using a magnet on pieces of metal in the eye. They were still alive today, somewhere in Germany, and Isaac made a point to one day meet and thank them in person.
Christian lay still and calm, and Isaac drew strength from the man’s courage. If he can show strength and courage in a time like this, Isaac thought, so can I.
He moved the magnet closer until it touched the piece of metal. He let it linger there a few seconds, took a deep breath. Then slowly, slowly, he drew the magnet away to ensure the metal fragment did not slip back into the eye. One…two…three…
The fragment was out. Isaac placed the magnet on a nearby tray. “Very good,” he said with a big, happy sigh. “That’s a relief. Good job holding still, Captain. Your calm demeanor is impressive.”
“Thank you. Please, call me Christian.”
Isaac smiled. “Indeed. There’s still work to be done on your eye, but now we move on to your neck.”
“Anesthesia is ready, Doctor.”
Devorah had taken a moment from treating Doctor Oberheuser to get a morphine shot ready. It was the last full dose they had. Isaac wasn’t sure that Christian even needed it. The man had proven his ability to withstand searing pain, but better safe than sorry, as they said in Grantville. One errant move of his neck while Isaac was stitching the wound might drive the needle right into the artery.
Isaac accepted the syringe. He felt Christian’s hand on his arm.
“Doctor,” the young captain said. Isaac could see tears forming in Christian’s undamaged eye. “If I die, will you ask Colonel Renz to send word to my mother and father in Zurich? Tell them that I was thinking about them in the end, and that I am sorry for leaving without saying goodbye. Will you tell him that?”
Isaac nodded. “I will, Captain, I will. But I won’t have to because you’re not going to die. I promise.”
Christian nodded and then turned his head to the left to expose his mangled neck. Isaac pushed the syringe into Christian’s arm, and then slowly squeezed the plunger until the barrel was empty.
He set aside the empty syringe and grabbed a stitching needle and suture material. He chose to use the good silk thread for this wound. Good quality silk stitching thread was in short supply, but for a wound this delicate and unstable, the best was required. Non-peppermint-flavored dental floss and tennis racket strings from Grantville, sheep gut sutures, and even iodine-treated horsehair were available, but no. Silk all the way.
“Will he live, Doctor?” Devorah’s question was sincere.
“I think so,” Isaac said, making the first puncture on the neck wound and pulling the silk through. “But I don’t know for sure.”