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To read the novel in start-to-finish order, click the Volume Two link and consult the Table of Contents links at the bottom of the page.
Chapter 7-1
Here we are back with Natalie with the field hospital on the Eastern Front. This installment was originally put up as a part of Chapter 3, but in revisions I re-cut the installments and made this the beginning of Chapter 7, and in the process it's been revised again.
Near Trzeszczany, Galicia. June 22nd, 1915. At normal times, with one surgeon handing off responsibility to another, the transition would have been accomplished away from the nurses' view, between the two men. These were not normal times, and so Doctor Kalyagin arrived in the middle of the morning routine, escorted by Lieutenant Popov. The two men stood awkwardly in the middle of the ward as the nurses moved from bed to bed, checking dressings and temperatures. The orderlies carried away bedpans and dirty dressings. The housekeeping sisters brought food and changed sheets.
The doctor cut a rather unmilitary appearance next to the infantry lieutenant. His uniform tunic was clearly standard issue rather than the more expensive tailored versions most of the regimental officers wore. Its loose fit only served to accentuate a stomach which bulged above his belt. A rather thin mustache gave no military bearing to his broad, round face, which was boyish in its smoothness, though a receding hairline suggested he was no longer young.
Natalie broke off from her tasks and approached the two men.
"Doctor? We're very glad to have you here."
He started to extend a hand, as he would have to a colleague, then stopped himself, withdrew it, and gave a bow instead. Lieutenant Popov made introductions.
"I understand that you've been working without a surgeon for several weeks now," Doctor Kalyagin said. "That must have been difficult."
"It has. Particularly yesterday, when the fighting became heavy and we received a lot of casualties. There are some cases you'll want to examine for surgery as soon as you're settled. The most we could do was trim, stitch, and bandage."
"Trim and stitch? Who was making incisions and performing sutures without a surgeon?"
Perhaps it was reasonable enough that the doctor would be against nurses going beyond their training, but she would at least make sure that any consequences were not unfairly focused on Sister Gorka, who had only been obeying her orders.
"We had casualties pouring in and no idea that we would have a doctor so soon. I gave directions that the minimum be done -- cutting away ruined tissue and suturing wounds before bandaging -- so that the patients would be able to survive the train journey to a regional hospital and receive better care. None of us have any desire to go beyond our training now that you are here."
She met his gaze and held it. It had been the right thing to do. If he couldn't see that… Well, he would have to see it.
He nodded. "Of course. Well, now that the hospital is staffed again, our first priority will be to set procedures and abide by them."
"Yes, sir." He was right, of course, but the words stung like a rebuke.
The flatness of her tone brought Doctor Kalyagin up short. He licked his lips. "With no trained staff, I can acknowledge that having nurses perform simple surgeries was the course likely to save the most lives. Now, perhaps you can take me round the wards?"
The other two nurses joined them as Natalie guided Doctor Kalyagin through the stately rooms which they had so rapidly turned into a hospital. The two operating tables. The gas rings with their kettles for boiling surgical instruments. There were no beds or cots -- the hospital's had been abandoned along with the patients when they were forced to evacuate their previous field hospital on mere minutes of notice -- but the patients were laid out in neat rows on army blankets.
They finished back where they had started in the main ward. Doctor Kalyagin faced his three nurses, knowing they were waiting for some words -- about their work, about his plans for the hospital. It was these human moments which were so much more complicated than an operation. The clear necessities of saving lives and repairing bodies, works of skill and science, were more rational than the vicissitudes of human interaction.
"I'm glad to be here with you," he said. That was the personal touch. They would like that. It was the personal that he had lacked when speaking with that lead nurse before. "You have all worked very hard while without leadership, and I salute you for it. My duty now I am here is to show you the most that modern medicine has to offer. There's so much that science has learned. Proper wound drainage, for instance. Let someone without training suture and bandage a wound, and he might as well stitch a grenade into the poor man's limb for he will lose it just as surely. But insert a proper drainage tube when suturing, just a little length of rubber pipe, and a man's limb and livelihood can be saved. Written treatment protocols. Don't let yourself be deceived into thinking it a mere checklist such as a housewife might take shopping. We are all by our natures forgetful and imprecise creatures. A written protocol saves us from our own failures."
He let himself wax eloquent on the practices he intended to introduce. To be sure, it was a primitive place. This country house might have been well suited for hosting shooting parties but adapting it to a hospital was a clumsy affair at best for all the nurses' obvious hard work. Still, there would be flexibility as well. No longer would he need to convince the entire board of senior surgeons about each change he wished to make. In a small hospital such as this real progress could be made.
"With modern procedures," he concluded, "we can turn this hospital into an institution to be proud of."
He stood looking back and forth between the three nurses facing him. Their faces were all expressionless. Had he said the wrong thing?
"Perhaps you've misunderstood." He shifted on his feet. "I don't mean to diminish what you've accomplished these last few weeks. You've done nothing of which you should be ashamed. You've worked without direction, without medical expertise, and without resources. And nonetheless you've done yourselves great credit. You should be proud. Really." He looked around for the warmth this praise was meant to generate and saw none. "As I've said, I believe there is much that can be improved by implementing modern medical procedures. I expect your assistance and support, and I know that because you are professional nurses I can expect it."
There. That would have to do it. With a little bow he turned and left the ward.
"Oh, we've nothing to be ashamed of, have we?" Sister Travkin asked. "We have no medical expertise? He's been in his big city hospital with all the modern conveniences while we've traveled hundreds of miles in horse carts, and he would like to tell us that we have nothing to be ashamed of?" She snorted.
"I'll be glad to have a surgeon back," said Sister Gorka, her voice low. "Even if he is arrogant. If I never have to use another scalpel or needle I'll be happy enough." Natalie remembered the other nurse's despair the night before, brought on by the work Natalie had told her to do. It didn't matter what the new doctor was like, Sister Gorka would be glad of his presence.
"If he lasts," warned Sister Travkin. "You saw that soft round face of his. And if looks are anything to go on he likes his food. We may not have him many weeks. Say what you will of Doctor Sergeyev -- and I have -- but he did have staying power. It took an artillery shell to send him home."
The morning had begun so well. As they had taken the new surgeon through the wards and showed him the men whom they had treated the day before, the other two nurses had left Natalie to lead, to explain, as if it were the most natural thing for her to be in charge. She had felt a pride of ownership as she pointed out each thing. This was her hospital, her nurses, her patients. And so she had also felt the deepest affront when Doctor Kalyagin began to speak of the need for modern practices, of retraining the staff, of re-organizing the wards to reduce infection. These were not things unfamiliar to her. These modern methods: sewing wounds up with drain tubes, using separate nurses for sterile and unsterile tasks, these and more had been her everyday work at the hospital in Kiev. She hadn't ignored them in the field hospital out of ignorance. She had done so because here the doctors had scoffed at such practices, and because there had not been enough resources to implement them here.
Her fists clenched and anger simmered up as she recalled Kalyagin's casual superiority.
Looking at the other two nurses she felt balanced on the edge. Sister Travkin was affronted. Sister Gorka was relieved. Both had come to rely on her. Both were as much offended on her behalf as on their own. The three of them had no power to reject the doctor. But with the right words she could make his time in the hospital difficult, perhaps even so frustrating that he would leave.
And yet these practices, which she had known so well in Kiev, would save lives. The doctor might have no instinct for speaking to others, but that did not mean his medical abilities were unsound. If she could set aside her pride, if she put her support fully behind his innovations, he would get the credit, but she would have helped to improve the hospital.
"I'll go and speak with him," she said. "I'm sure he doesn't mean offense. And I've seen these practices work in the hospital where I was trained."
She found Doctor Kalyagin in the butler's pantry which they had turned into the dispensary. He was examining the quantities of drugs and checking them against the ledger books.
"Who created this tracking system?" He asked the question with no expression, no indication as to whether its creation was a matter of credit or blame.
He turned a page, skimmed down the figures for dosage given and amount withdrawn. "This is very good. Exactly the system we used in my hospital in Vilnius. The fact that you require both an entry for the patient dosage with the date and time, and then a separate entry for the amount withdrawn from the stores, serves as a check against abuse." He closed the book. "Very good."
"Thank you. It's how we managed drugs in the hospital where I was trained in Kiev."
"Good, good." His fingers drummed on the ledger for a moment. "Tell me, Sister…"
"Nowakówna."
"Of course. Nowakówna. What must I do? I can see that the staff has worked hard. All I want to do is bring modern methods. Save lives. What have I done that offends the other nurses? I can see they aren't happy with my presence."
"They're not unhappy, doctor. Indeed, we are all very relieved to have you here. We did not enjoy having to do work for which we were not trained. If there is any hesitation, it is only a feeling that the work we have done and the methods we have followed up till now are being discounted. I've seen the modern methods work in Kiev. We've just never had the tools. And our previous surgeons were more traditional."
The doctor was leaning forward, his elbows resting on the drug ledger. "Can you help me? If I can only get the support of all the staff, I know that we can turn this into a modern, model hospital."
It seemed false to take the credit for supporting his methods when it was loyalty to her, along with their own wounded pride, which held the others back. Yet the others had not stepped forward to talk with the doctor. She had. And she did know the value of the modern techniques.
"Please," he said. "We can save lives. I know it."
"Yes. I will help as much as I can."
It was no longer her hospital, but in some sense she still felt the credit for it as she urged the others to accept the new methods which Doctor Kalyagin proposed. The hours were punishing. In order to follow septic protocol, every bandage change now took two nurses instead of one, and so the normal routines of changing bandages and cleaning wounds took twice as long. An orderly who was particularly reliable in matters of spelling and handwriting was assigned to follow Doctor Kalyagin on his rounds and take down the treatment protocol for each patient, which was then pinned to the man's blanket. While this made the doctor's paperwork responsibilities manageable, it did nothing to relieve the nurses of the additional time required to update the protocol with the date, time and their initials every time they performed any task for a patient. Doctor Kalyagin promised to file a request for more nurses, but in until this achieved fruits, they worked more and slept less.
All this became more difficult two weeks later, when after two days of heavy fighting that sent a constant stream of wounded to the hospital the orders came that they must pack up the hospital and withdraw the next morning. The great retreat had resumed.
They were not, at least, forced to once again abandon their patients in order to hasten the retreat. At first they received orders to do so, but Doctor Kalyagin refused to do it. And it proved that he could harangue time and resources from the regimental command nearly as effectively as he could from his own staff. An hour and a half after he had set off in wrath to demand help, a supply sergeant had arrived on the steps of the country house and asked Natalie if this was the mad doctor's hospital. On being told that it was, he had returned with two dozen hay wagons.
"There'll be no more room for wounded once we meet up with the rail lines and get the next load of feed," the sergeant warned her. "But that doctor of yours said his patients could be put on the train at that point."
And so they began again the itinerant life of the hospital in retreat. Through July they set up hospital nine different times: in schools, in houses, once even in a convent, where the silent nuns in their brown habits moved through the bare halls and communicated with each other mainly in hand signals -- so unlike the chatty sisters with their well furnished rooms at the school where Natalie had been brought up. Several of the nuns had some rudimentary medical training, however, and the mother superior put them at the hospital's disposal for the length of their stay, allowing the nurses to gain some much needed rest.
They were traveling at angles to the tide now. The Third Army was retreating on a line due north, even as the German armies began to close the salient of Galicia from the west. Refugees streamed east. Lublin was threatened, and those who could not secure places on the overburdened trains had taken to the roads with carts and automobiles, wheelbarrows and baby carriages, all manners of vehicle piled with whatever possessions they could carry. But while the people followed whatever paths they could find, the army fell back along lines chosen by the high command. These planners had decreed that the Third Army pass north, between Lublin and Chelm, before the invading armies cut them off, and thence north to Brest-Litovsk before crossing the Bug River. By that route they could avoid the Pripet Marshes, whose unimproved roads and buzzing clouds of midges would have slowed their progress and spread disease among the troops. This gave the army more than a hundred and twenty miles to cover before August, a relentless pace which seldom allowed them the chance to keep their field hospital in one place for more than a day or two.
It was a relief when they at last reached Terespol, and the fortresses guarding the westward approaches to Brest-Litovsk.
The original fortress was over three hundred years old, but there were no picturesque turrets. This was a product of the early gunpowder age, a squat, star-shaped structure with massive walls of stone set in cement and surrounded by a ditch twenty meters across. More modern military design had been at work beyond this. Another fifty yards beyond the ditch, soldiers had dug a trench, the fresh earth piled up outside it to form a parapet. Beyond the trench was line after line of barbed wire, strung between posts.
As they approached the fortress, they followed a path that passed through these obstacles in sawtoothed zigzags, blocked every so often by a gate strung with barbed wire and guarded by sentries. None of these seemed built to withstand any solid attack, but perhaps the purpose was simply to slow any would be attacker, making him a target to the soldiers in the trenches of the guns of the fortress. If so, the approach was well designed. It took the hospital staff and their vehicles more than an hour of stops and starts to wind their way through the gates and checkpoints to the fortress itself, where they passed within the big swinging gates of steel-bound wood.
The buildings within the fortress walls retained the charm of age. They were assigned a barrack house with whitewashed plaster walls and wide plank floors. Metal bedframes with bare springs were already laid out in rows for the patients.
Doctor Kalyagin went to see the fortress commander. Natalie set the housekeeping sisters to washing down the walls and floors with antiseptic. The orderlies laid blankets across the bedsprings and then carried in the patients from the ambulances one by one.
"Do you think at last we stay in one place for a few days?" Sister Travkin asked as she unpacked the dispensary.
"If the looks of this place are any indication, the army isn't prepared to retreat any time soon."
"They say Warsaw is surrounded," said Sister Gorka. "And they're approaching Lublin to the south and Bialystock to the north. What good is a fortress if the Germans are on all sides?"
It was more than a year now, since that day in June when Natalie had met her father in his Warsaw house. It seemed even longer than that. Where was he now? Would that grand house with its marble floors and family portraits soon be in German hands?
It was a few days later that a lone motor ambulance arrived with a screech of tires, carrying several wounded men, one an officer with a torn tunic stained dark with blood. "Stomach wound here," said the stretcher bearer. "A nasty one. Faulty shell exploded in an artillery pit. Killed three of the crew outright. This here is the gun's commander."
Natalie took a pair of scissors and began cutting away the tunic as soon as the officer was laid out on the surgical table. Sister Gorka held the rubber tube which dispensed antiseptic solution and reached in by turns to pour it over the exposed wound, washing away the blood. The roles of septic and aseptic nurse, the one who touched the unsterile clothes and fragments and flesh, and the one who only touched what had been disinfected, had already become so natural that they required no instructions.
Doctor Kalyagin asked for a retractor and probed the wound. The officer's body arched back in pain, a scream breaking through clenched teeth.
"I'll operate immediately on this one," he said. "Sister Nowakówna, prepare the chloroform mask, if you will."
She counted the drops onto the mask's filter, pressed it over his face. Was he able to hear and control himself, or was he helpless in the wash of pain? Just in case she leaned close. "This will put you to sleep. Just breath deeply. Count backwards with me. Ten. Nine. Eight." If he tried to count along with her, she couldn't distinguish it from the choked moans that were his breathing, but before she reached "One" those too were gone and he breathed deep and evenly.
The operation was extensive. Half burned powder and flecks of metal were scattered among the snaking folds of the patient's intestine, which in places was torn and punctured. Natalie helped the doctor unpack the coils, and Sister Gorka washed them with antiseptic solution. Then with precise calm Doctor Kalyagin cut and stitched, closing small tears and removing badly damaged sections and then suturing the clean ends back together.
As the septic nurse, Natalie's work was done first. The cavity was cleaned of dirt and splinters and spilled bile. The coils of entrail were in Sister Gorka's sterile hands, as she began to carefully fold and pack them back into the stomach.
Natalie went to wash her hands. She scrubbed the dried blood from around her nails. Her apron would have to be changed, it was badly stained. Like a butcher shop. The phrase bubbled up, and of a sudden the enormity of the scene came home. She had been helping to unpack and repair the viscera of another, living human being, and had done so with no real shock or alarm.
She could remember, years ago in the convent school, the feeling of shock clenching at her stomach on the day another girl had fallen from climbing in a tree and broken her arm. She had felt dizzy, with white spots before her vision, at seeing the sick unnatural way the limb bent. And then there had not even been blood.
Had she lost so much natural feeling since that time? Would she still feel revulsion if she saw blood or injury in some normal setting, in a home or on the street, somewhere unexpected and far from the hospital and battlefields? Or were those feelings gone forever?
"I don't know," Sister Gorka said, when Natalie asked her about it that night over the samovar. "I think perhaps if I weren't in the hospital and weren't wearing my nursing uniform, blood would still shock me. I like to think that there's a normal life out there that I can go back to, where all these experiences will seem another world."
For a moment they drank their tea together in silence.
"Would you like to come up on the wall?" Sister Gorka asked.
"I like to look around."
"It's dark."
"You can see the fires. Sometimes artillery and flares. And the stars if it's clear."
Their nurse's uniforms were sufficient pass for the sentry to wave them through.
"There's a cool breeze tonight, Sisters," was all the challenge the soldier at the top of the ladder offered. "Keep yourselves warm."
The breeze was indeed chill enough that Natalie missed her wool coat.
"I'll show you where I liked to go," Sister Gorka said. "There's some shelter from the wind there."
It was a mortar emplacement, a flat round platform surrounded by a low wall. In the middle of it stood the squat mortar, a short, thick barrel, chest high, with a gaping hole where a ten inch mortar shell would burst forth when fired.
Sister Gorka ignored the artillery piece and went to stand on the stone step that allowed her to look out over the wall. Natalie joined her.
They were facing west. In the distance they could see occasional flashes, German artillery firing at the front with a rumble like far off thunder. There was a strange, round shape, fitfully illuminated by those flashes.
"It's a German observation balloon," Sister Gorka said, in answer to Natalie's question. "You can see it clearly in the daylight. It looks like a fat, floating sausage. An officer told me that enemy artillery observers ride up to it with a basket on a pulley and watch to see if their shells are hitting where they are supposed to."
"They're filled with hydrogen," said a male voice. "It's lighter than air, but it's a flammable gas. If we need to take away their eyes for at time we send an airplane with aerial torpedoes to shoot it down, and it bursts into flame. Soon enough, however, they send up another one."
Natalie startled and turned to see an officer with the insignia of a lieutenant on the shoulders of his overcoat.
"This is Lieutenant Serafin," said Sister Gorka. "He also likes to look out over the walls. And he's interested in photography," she added. "He has a Bergheil." She smiled with a softness of expression Natalie had never seen on the reserved nurse before. "Lieutenant, this is Sister Nowakówna."
The lieutenant bowed. "Good to meet you, Sister."
Behind them, the moon, just past half full, broke from behind one of the scattered clouds and cast its pale light over the lines of trench and wire stretched out between the fort and the still distant enemy.
"How many men defend this fortress?" Natalie asked.
"A division, Sister. Give or take a few battalions here and there. And fortress artillery as well. Perhaps fifteen thousand men in all."
"Surely here the retreat will stop for a time? That must be enough strength to hold them back."
"Oh we don't lack for strength here. Regiments have been falling back across the river for the last two weeks. If we wanted we could have fifty thousand here. But it doesn't matter. The Germans may not even attack this point. All they have to do is cross the river to the north, get behind us, cut the rail lines. We'd have to fall back before then or we'd be trapped and have to surrender. Once upon a time, when armies were counted in tens or even hundreds of thousands, a fortress like this would have been a threat to the enemy's rear that he would have been forced to pinch out. But now we count in millions. You'll hear patriots who've read their Tolstoy speak of how we stopped Napoleon, but his army was only a spear, enough to wake the Russian bear and make it angry enough to snap it off and continue fighting. We face an ocean, and it's more than I know how well this big, clumsy old bear can swim."
"But if they have millions, don't we have millions more?"
"We do. We have millions, but with fewer guns, less ammunition, feuding generals, and in the back of their minds the question: Would I, my village, my people be better off if we lost? You're Polish, aren't you? What do you think? Is Warsaw really any worse off with the Germans and the Austrians than it was with the Tsar?"
These were not the sort of questions the Lutereks -- even Borys with his university ideas -- had discussed, nor the sisters in the hospital. Sister Maria-Grigori, back in the convent, had spoken of the old country as if Poland and Russia were two sides of the same coin. "Do you think it would be better for us to lose the war, Lieutenant?"
"No! No, I said nothing of the kind." There was an edge to his voice that had not been there before.
Natalie felt Sister Gorka dig an elbow into her side. "Don't be foolish. He did not mean that," said the other nurse.
"I'm sorry," said Natalie. Even in the staid atmosphere of the convent school and its patrons, it had been no great shock in France to hear people speak of the Republic's illegitimacy, of the need for change. Raised outside the country, she could not know how shocking the turn from hints to plain words was to ears raised under Russian rule.
"All I am speaking of," said Lieutenant Serafin, "is the necessity of reform, of the recognition of national identities. Surely the Tsar knows this too. If only he can break free of corrupt advisors. I'm sure he wants to give the nationalities a reason to fight."
The officer with the stomach wound was conscious when Natalie made her rounds the next morning, his face pale under a stubble of dark whiskers.
"It's good to see you awake. How are you feeling?"
He attempted something like a smile. "I don't remember much, but I imagine it was bad."
"It was a good surgery, but it will take time for your stomach to heal. You should sleep."
"I can't seem to." This voice was taught but under control.
Natalie looked at the notes on the protocol. Sister Travkin's initials were next to the approved dosage of morphine, but the time noted was six hours ago. "You poor man. That last dose of morphine must be wearing off. I'll get you another injection."
"Thank you, Sestritsa."
She made the notes in the drug ledgers and drew the dose into a clean syringe.
"I'm putting it directly into the vein. It will take effect more quickly that way." He looked away as she pressed the needle in. That was good. He was still innocent of the desire that made some patients look hungrily at the needle as it delivered the relief to which they had become too much accustomed. "There. In ten or fifteen minutes you should begin to feel the effect. It may also make you sleepy."
"That would be welcome too."
He closed his eyes and she turned to go.
"Sestritsa. One more thing."
"Some water?"
"I'm sorry, didn't they tell you?"
He nodded. "But please. Just a little."
"You need time to heal. The surgeon cut out the torn portions from your intestines and sewed them back together again. Anything that passes through, even water, increases the chance of infection. You have to wait. Tomorrow afternoon, you can have water."
He ran his tongue over his lips. It would only make him feel worse, but always the patients did it. Forty-eight hours without water. Then another forty-eight with only water, during which they forgot the mercy of being able to drink in the suffering of hunger. After that second forty-eight hours, if infection had not set in, broth and other fluids would be allowed in order to provide some nourishment. Then, when the healing was complete, at last the patient could have solid food.
Shocking though it had seemed when she had first seen such operations done, men survived. They had heard back from the regional and base hospitals of patients slowly returned to normality, men who survived having their guts taken out and put back in. It was staggering that modern medicine could accomplish such miracles at all. And yet for those who did not survive, the half whose wounds became infected despite the attention to antiseptic discipline and the strict diet, those men died raving and feverish, while suffering all the more from the lack of food and water.
"What's your name, Sestritsa?"
"Sister Nowakówna."
"Mine is Lieutenant Ivan Ovechkin. Sister Nowakówna, would you… Please sit with me. Just for a little while. You said this will make me sleepy when it takes effect."
"Yes, I'll sit with you." She went and got a wooden chair that stood against the wall near the entrance to the ward. His eyes tracked her as she returned and set it next to his bed. Then he closed his eyes.
"Thank you." He held out a hand and she took it in hers. It was a large hand, but smooth skinned with neatly trimmed nails. A gentleman's hand. "Our estate is near Odessa," he said after a moment. "Not a large estate, but comfortable. My father died young. Thrown from a horse. A great rider, they said, but reckless. Now my mother and sister are there to watch over it. She's a difficult woman, mother. But she cried when I left."
He continued on, short sentences broken by pauses, speaking of his family and the countryside where he had grown up. At last one pause drew on and became a silence. His breathing was steady. Natalie carefully removed her hand from his and went back to her rounds.
"Sister! Sister Nowakówna!"
By the afternoon Lieutenant Ovechkin was calling to her every time he saw her pass.
"Please, Sister Nowakówna. Just a little water. Just enough to wet my mouth."
"I'm sorry." Twenty hours since the operation. Twenty-eight more before he could drink.
"Please." His cheeks were flushed. She felt his forehead. Hot. It could simply be that he was upsetting himself. Or the stress upon the body of blood loss followed by dehydration. But nearly half the time it was infection. As soon as she could she gave him another injection of morphine and he lapsed into sleep again.
By night the fact was clear. He was feverish and sweating, which would only deplete the body's store of fluid more quickly. She put a cloth soaked in cold water on his forehead, wiped his face to try to cool him down, but when she was called away for a moment she came back to find him sucking at the cloth for what few drops of water he could get from it.
She snatched the cloth away, then saw his jaw tremble. "I'm sorry, Sestritsa. I was just so thirsty."
Again she wiped his face with the damp cloth. It was simply cruel now. Infection had clearly set it. What good was there in following the forty-eight hour regimen? All it would do is add the pain of thirst to the torture of infection. She had seen this play out in case after case. There was no hope after the infection set in.
"Wait a moment." She went to the dispensary and drew another injection of morphine. It was an hour early, but what did it matter? Then she took a glass and filled it from the bucket the orderlies refilled from the pump for every shift.
The lieutenant's eyes followed the glass as she approached him.
"Here. Drink it slowly. Just one glass. And then I have another injection for you to help the pain and let you sleep."
His hands shook, and she helped him hold the glass so that he would not spill it. Obediently, he took small, slow sips. So slow that she found herself glancing back over her shoulder, wondering if someone would come in and see her breaking the protocol.
There was no reason to be ashamed. She was not hurting him. The infection had already set in. And yet, if she did not have to explain her choice to Doctor Kalyagin, it would be easier.
At last he finished, and setting the glass aside she gave him the injection. Immediately he closed his eyes. "Thank you, Sestritsa. Thank you."
By morning the fever had Lieutenant Ovechkin deep within its grip. He did not recognize her, but called out to his mother for water. She gave him another glass, then another dose of morphine which left him murmuring in his sleep the rest of the morning. From there he moved into the last stage, the restless fever sleep which preceded death. He was still in that state of near-death when Doctor Kalyagin called her aside.
"Sister Nowakówna, I thought I could rely on you." His voice was trembling with the effort to keep from shouting.
There was no point in pretending not to know what had angered him or asking how he had found out.
"Doctor, infection had clearly set in. He was dying. I only wanted to make him more comfortable."
"Sister, we have protocols for a reason. We have them because they save lives. When we disregard our protocols, we kill patients. Is that what you want?"
"He was already dying."
"That is not for you to decide. It's not for any of us to decide. Our duty is simply to give care, the best care that we know how. And that is what is written down in our protocols. You, of all people should--" He was shouting, and now he made himself stop. He pressed his lips together, struggling to regain the calm which a doctor should have in front of his staff.
Natalie stood, her shoulders back, teeth clenched. It was the same way she had stood when absorbing a scolding when at school, waiting to see if the nun would strike her or let stinging words do their work alone. If she answered back now, her voice might tremble, and that she did not want to allow. So she stood in silence, and that silence tore at Doctor Kalyagin's calm since the one thing which seemed like it would quench the betrayal he felt was to see her break down and admit that she had been wrong.
"I trusted you," he said. "I respected you and I thought that you cared about our patients and our methods."
She would not cry. She would stand here, with her hands folded, and accept what he said, but she would not speak, because she could not speak without losing control. She tightened her clasped hands until she could feel her nails digging into her palm.
"Get out. Get out for the rest of the day. The other nurses will have to do your work. And when you come back, I will have to watch you since I cannot trust you."
Lieutenant Ovechkin died during the night. Sister Gorka came and told Natalie in the pre dawn light. Since he was an officer, he would not be laid in the common grave where ordinary soldiers were placed in rows and sprinkled with lime. There was no place for new graves in the fortress, so the carpenters would put him in a rough coffin to be shipped by light rail to Brest-Litovsk, where he would join the rows of honored dead in a military cemetery.
His body was already gone when Natalie returned to the hospital the next morning.
UPDATE: I've re-structured the original 3-2 installment into multiple installments, and am moving 3-3 into a later chapter. This is the new Chapter 3-2. April 22nd, 2019.
It's been a long, long time. Some of that is because life intervened in various ways. Baby is due any day now. We finished the school year and the kids began their summer activities. We went to a writing conference at Notre Dame. But also, this section came out far longer than usual. It weighs in at 16,296 words, which is about four times the usual length of a section. There's a lot that happens, though, and I hope you'll find it interesting. I'll only add: all the worst things that happen in these novels are based on real events I found in letters, newspapers, or diaries. My imagination can't rival the darkness of the war itself for sheer invention.
Near Tarnow, Galicia. May 1st, 1915. The sound of artillery began on Saturday, as Natalie was changing Lieutenant Bogdanov's bandages. It rumbled intermittently like a fitful thunderstorm some miles distant.
"Heavy artillery," said the young officer, offering a tight smile to disguise teeth clenched as she sluiced antiseptic solution over the entry and exit wounds in his upper arm.
It was not a bad wound, the sort of neat example which would be drawn on a diagram for lady medical volunteers. The bone had not been touched. No arteries had been severed. The officer had ridden to the field hospital on horseback looking so pleased with himself that Doctor Sergeyev had greeted him with, "This is no time for social calls, young man. You'll have to visit our angels of the sick wards later."
"No, no, doctor, I have a proper calling card," Bodganov had replied, holding up his right arm with a white linen undershirt tied around it as a bandage.
Four days later and the wound was healing nicely. There were some shreds of tissue that had the grey color of death around the edges of the wound, but this was a normal effect of the harsh antiseptics necessary to prevent infection. There was neither sign nor smell of infection or decay.
"Are we attacking the Austrians?" asked Natalie. The well-born officers all considered themselves amateur strategists, and talking would distract him from the wound cleaning process. It was a given that pain killers not be wasted on something as minor as a bandage change, especially for an officer. Soldiers might succumb to emotion when in pain, but an officer was expected to be in control of his reactions.
Bogdanov laughed. "Not with heavy artillery, Sestritsa. We have perhaps two heavy guns for the whole division. No, what you're hearing are the patriotic contributions of the firms of Skoda and Krupp."
"Are they attacking us then?"
"Not by the sound of it. That's just their gunners getting a little bit of exercise. If it were an actual attack, we'd know it."
The lieutenant was right. The evening bombardment was only harassing fire as the artillery zeroed in its guns. At six o'clock the next morning, the guns opened up the real barrage, and they did indeed know it.
At first the hospital braced for a rush of wounded men, but none came. The field artillery rumbled on, a constant growl rather than the sound of separate explosions. At nine o'clock, as Natalie began to make her second round of the wards for the morning, a new deeper note was added to the cacophony. The heavy artillery had joined the field guns in the bombardment.
In the officers' wound ward she found Lieutenant Bogdanov pulling on his tall leather boots in place of his hospital slippers.
"I'm going back to the front," he said, in answer to her question. "I can get by well enough with this arm, and I can't leave them alone in this attack."
"But we've had no one come in wounded. Perhaps things aren't very bad."
"You've had no one come in because that barrage is so constant the men don't want to leave their holes long enough to take their injured comrades to the rear. And did you hear that just now? Those are the heavy artillery coming in. Their infantry will be attacking soon, and I want to be there when they do."
Natalie helped Bogdanov to gather this things. If the wounded of a major offensive were soon to be flooding in, there would be no room for someone as close to recovery as he. Outside, he made an awkward attempt at using his left arm to swing into the saddle but came up short. Then instead he gritted his teeth and did it with the right. Then Natalie handed him his bag, which he draped over the saddle in front of him.
"Leave the bandages on, since you won't have the proper antiseptic for changing them," she told him. "Keep it clean and dry, and don't unwrap it for at least another week."
The lieutenant dipped his head in a sort of bow. "Don't worry, Sestritsa. If the Austrians don't manage to get me, I'll be careful enough that infection doesn't do the job for them."
He was not the only one leaving the hospital. Under Doctor Sergeyev's orders, one group of the ambulance carts set off towards the rail line, bearing away all the patients that could be moved, clearing beds for what was to come. The remaining carts set off in the opposite direction, towards the front in search of wounded who needed to be brought in for treatment. Natalie and the other nurses prepared the operating theaters. The housekeeping sisters scrubbed the floors and walls with antiseptic solution. Doctor Sergeyev paced back and forth on the railed wooden porch which ran the width of the hunting lodge, his eyes always towards the west, waiting for the first sign of the surge of patients which this destruction must bring.
The battle came to the hospital before its victims did. The explosion of the shell sounded like a clap of thunder breaking right overhead, the floor shaking and the windows rattling at the same moment as the boom itself. Natalie saw the steel surgical implements dance on their tray with the vibration. One of the housekeeping sisters screamed, then invoked the saints angrily as she hurried to mop up the bucket of sanitizing solution she had accidentally knocked over.
A second shell exploded, setting the windows rattling and the glass jars and bottles on the shelves clinking.
"Are they trying to destroy the hospital? The monsters!" Sister Travkin was looking out the window at the smoke and dust rising from the newly formed crater near the road, a few hundred meters away.
Natalie ran a last eye over the surgical tools, then laid a sterile cloth over them lest the shelling cause any dust or plaster to sift down upon them.
There was a sound like a train rushing by as a shell passed overhead and then another jarring explosion as it hit to the east of them and on the other side of the road.
"I wonder if they even know the hospital is here. I think they are shelling the road," said Sister Gorka.
They were indeed. These shells marked the time at which the enemy -- mixed regiments of German and Austrian soldiers under German command -- rushed from their trenches to attack the Russian lines. Following the timetable laid out in advance by the German planners, at the moment for attack the gunners shifted their bombardment back several miles and focused upon roads and train tracks. No Russian reinforcements must be allowed to move forward while the assault troops fell upon the front lines.
Shells do not discriminate in their victims. They were sent to prevent fresh troops from rushing forward, but they also fell upon the wounded soldiers and ambulances trying to get away from the lines. It was, thus, not until more than an hour after the ground assault began that the tide of wounded at last swept into the field hospital.
After the morning of waiting in tense readiness, there was now more work than could possibly done. The last moment when the nurses were together and quiet was when Sister Gorka called them to the window. The shelling and obstacles which had slowed the wounded in their escape had also forced them together. Rather than a scattered straggle of men coming down the road, there came a loose column. Some walked arm in arm supporting each other. Some struggled on alone. Some were carried astride horses or laying on carts. As they moved back down the road they formed a broken, ragged mirror image of the ordered columns which often marched up the road towards the front.
As the men reached the field hospital this loose formation began to scatter. They approached in twos and threes, some hurrying, some half carried.
"Sister Travkin, go out to the courtyard and sort the cases as they come in. Gorka and Nowakówna, you'll attend the operating theaters," ordered Doctor Sergeyev. Triage required experience and the willingness to make decisions which might mean life or death. Sister Travkin's seniority suited her for the duty, and if this meant that she and Doctor Sergeyev would not be given the opportunity for strife, so much the better.
Just a few moments anxious waiting, neatening the surgical implements where they stood on their stainless steel trays, and then two orderlies came in bearing their first case upon a stretcher. Natalie waved them to her operating table. The patient shuddered and moaned through clenched teeth as the orderlies slid him off the stretcher and onto the table.
"Careful. Careful," Natalie said, but the two were already leaving and she herself was focused entirely on her new charge.
The soldier's eyes were wide and darted frantically from side to side. "Is it bad, Sestritsa? Will I lose it, Sestritsa? What will become of me? There's no future for a farmer without a leg." The words tumbled forth as soon as he was alone with her, the thoughts which had gnawed at him through the long, jouncing, painful ambulance ride from the front let loose now that he found himself in the comforting presence of a woman.
"We'll do everything that we can. You'll be all right." Even as she spoke practiced words of comfort her eyes and her attention were moving over him, taking in the medical details. A card was pinned to the muddy wool of his overcoat. "Left Leg. Wound. Fracture. Blood loss," it listed in Sister Travkin's neat hand.
She turned to the leg. The blood and fragments of bone were a familiar sight to her now. What horrified her nurse's eye was not these but the mud and gravel so liberally mixed in with the shattered flesh. Cleaning the wound enough for Doctor Sergeyev to operate would take time. Why had Sister Travkin not thought of this? Surely there were wounds more urgently in need of help and quicker to clean.
Looking around in frustration she saw that Doctor Sergeyev had already begun to work on the patient in the other operating theater, assisted by Sister Gorka. There was time, then. She gave the soldier an injection of morphine, noting the dosage on the card beneath Sister Travkin's writing, and then began the process of cutting away the shredded uniform and washing both dirt and blood away from the wound with antiseptic solution.
All other distractions receded as she cleaned the wound, picking out fragments of stone, uniform, and bone with careful forceps. Sister Travkin's choice to send this man for immediate treatment had been perceptive or fortuitous. Somehow the shell fragment which had shattered bone and laid flesh open had missed the femoral artery by the smallest of margins. With the wound clean she could see it pulsing beneath a thin sheen of tissue. Some small misstep, the breaking of this thin arterial wall never meant to be exposed to the outside world, and the man who was still telling her through his morphine haze about the difficulties facing a disabled peasant would bleed away his life here on the table within minutes.
At last the patient was ready, and Doctor Sergeyev began to work, setting bone, cutting away torn flesh and then stitching closed over the wound what skin remained. Afterwards Natalie wrapped the leg in bandages and splinted it.
Orderlies carried the patient away. A housekeeping sister appeared and scrubbed down the operating table. Then another patient arrived, this one with half his jaw torn away by a piece of shrapnel.
The hours passed uncounted. Patients came and went in an endless cycle. The light in the windows changed and dimmed, but the stream of broken bodies was constant.
Sister Travkin appeared in the operating theater, her apron stained with blood and grime, a mark dried to reddish brown on her forehead where she'd used a bloodied hand to wipe sweat away.
Doctor Sergeyev had just finished suturing a wound. He dipped his hands in the basin of antiseptic, dried them, then reached for his brown medicine bottle and took a swig which he rolled around his mouth as if washing away an unpleasant taste before swallowing.
"Are you finished with triage? No more wounded coming in for now, Sister?"
Travkin shook her head. "They're still coming. This one," she nodded to the operating table, "was the thirty-eighth you've taken to operate. I have over a hundred sorted and labeled outside. Those are the stretcher cases. I just told those who can walk to move on to the rail line."
There was silence for a moment. The day gone in operations and still there were twice as many more again needing help. Doctor Sergeyev put his bottle away.
"I came to ask for morphine," Sister Travkin said. "Some of the cases clearly can't be treated till tomorrow, and I want to give them some relief."
Doctor Sergeyev gave permission. Time, personnel, space, even beds -- there were a great many things they were short of, but there was plenty of morphine.
Mamushka stepped forward. "There are more of us housekeeping sisters. I can send a couple of the more experienced ones to help clean wounds and apply bandages to the less severe cases. Then perhaps they could be sent straight on to the trains, or they'd be in a better condition to wait for operation."
The doctor turned to Sister Travkin as the senior nurse. Cleaning and bandaging was nurse's work. In normal times the boundary between housekeeping and nursing sisters' work was strictly observed.
Sister Travkin nodded. "Send them out. I'll supervise them." She took her morphine supplies and left.
Natalie and Sister Gorka returned to their own work. The orderlies carried away the patients who had been operated on and brought in new ones. Through the night the cycle continued.
Some time in the small hours of the morning Doctor Sergeyev told Natalie to go to bed.
"But you are still working." For the last several patients she had felt her fingers becoming clumsy, her vision fogged. She barely knew what words of automatic comfort she offered now as she worked. But how could she leave while so many needed help and while the others still struggled on to provide it.
The doctor shook his head. "I can't go from one surgery to another any more. Sister Gorka will carry on and I can take a brief rest while she prepares each patient. When you've had a few hours rest, you can come back and she'll sleep.
Natalie was on the point of arguing but exhaustion stilled her tongue. Perhaps it was as well. She organized her operating station one last time, putting everything in its place. Then while the housekeeping sister was still wiping down the operating table with cloths soaked in antiseptic solution, Natalie went out into the cool night air.
From the porch she could see Sister Travkin's work, the many patients lying in neat rows across the courtyard, each man labeled with a card listing his condition and priority. The moon, a fat but waning gibbous, hung high in the dark sky, the stars around it gradually becoming visible as her eyes adjusted to the light. There were flashes on the horizon to the west, and as she watched them the rumble of far away artillery which had become an accustomed background to the day made itself present once again. There on the front lines more casualties were being created, men who over the following hours would make their way back to the field hospital and pass through their too few hands before being sent on to the rail line and the hospital trains which carried men to general hospitals in far away cities across Russia.
As from a distant time, memories bubbled forth of the rushes at the Prince Mikhailov Hospital in Kiev when a hospital train arrived. How they had scoffed, there in the well ordered wards, at the work of the field hospitals which had left men in soiled uniforms with bandages roughly applied to wounds that were already turning gangrenous. Now she knew all too well the desperation which had led to such work. Perhaps in a hospital in Lvov, Warsaw or Kiev shift nurses would shake their heads at the men Sister Travkin and the housekeeping sisters would label, bandage, and send walking on to the rail line. They would rebandage the men and see them through their surgeries, and when they were done with their shifts -- perhaps a double or triple shift, but still a shift with an end -- they would leave the hospital and talk about their long day over cup of tea and plate of pastries before taking a tram back to some small flat with its soft bed.
Natalie made her way to the converted stable which served as the women's sleeping quarters. She scrubbed her hands in a water basin, using the harsh brown soap they purchased from the peasants. But even as she rubbed the skin nearly raw the smell of blood still seemed to exhale from every pore when she dried them
Or perhaps it was her uniform she smelled. Looking down she could see the dark stains not only on her apron but on her dark wool nurse's dress. In her bedroom stall she stripped down to her shift. That at least was unstained, even if the smell of blood and antiseptic still seemed to hang everywhere around her. Tomorrow she could wear her second uniform while this would go in to be boiled in the laundry tubs by the housekeeping sisters.
It seemed mere moments filled with fitful dreams before she awoke to one of the housekeeping sisters shaking her.
"Sister Nowakówna. You're needed."
Her body felt leaden as she sat up.
"Here, I brought you some tea."
"Thank you." She held the warm cup in her hands and could smell it, strong and sugary. "Is it morning?"
"Just before dawn. Mamushka said she's sorry you've had only four hours but she wants to send Sister Gorka to get some sleep."
"Are there still more patients coming in?"
"Yes. They just told the orderlies to clear out of their quarters to make more ward space."
"I'll be there as soon as I'm dressed."
The housekeeping sister dropped a slight curtsy and left. Had she been a servant before the war? In this time and place the movement seemed to utterly incongruous.
In the pre-dawn light Natalie found the stable yard and grounds turned into an outdoor receiving ward, with rows of men laid out on the ground with their greatcoats or wool army blankets spread out beneath them. Pairs of housekeeping sisters were moving among them offering sips of water to those who were thirsty.
Sister Travkin was sitting on the stairs leading up to the lodge. Her stained uniform and bloodshot eyes made it clear she had not yet slept.
"Can't you go get a few hours rest?" Natalie asked.
The other nurse shook her head. "Every little while another group of wounded comes down the road. If they can stay on their feet, I can too. In between, I get to rest my feet a little. Sister Gorka needs rest more than I. They've been doing one operation after another. Doctor Sergeyev at least gets to rest during preparation and clean up."
For a moment they were silent together at the foot of the stairs. Then two soldiers appeared coming down the road, supporting a third between them. Sister Travkin roused herself from where she sat, and Natalie went up into the hospital. She found Sister Gorka preparing a man with a stomach wound for operation. The other nurse's expression was one of dull exhaustion.
"I can take over," Natalie said.
Sister Gorka nodded, set aside scissors and forceps, and wiped hands that she could finally allow to tremble on a damp cloth.
"You've done well," said Natalie. "Get some rest." She put a hand for a moment on Sister Gorka's shoulder. It was a slight touch, but all that the formality of the operating theater allowed. That formality was a dam. If they allowed themselves the chance to feel, to cry, to comfort, there would be not stopping the flood let loose.
Sister Gorka gave slight nod, teeth biting against lip. "Thank you."
Natalie too knew the numbness of at last stepping away from the operating table, the tiredness which became absolute only when necessity was no longer there to stave it off. Lying alone in the dark of early morning, in the scant moments before sleep came, she had felt as if she had been drained to the last drop of her humanity. If only there were some comforter to hold her close to give her warmth. But they were the ones who must give out comfort and assurance. There was no one to help them.
Taking up the scissors from the instrument tray where Sister Gorka had laid them down, Natalie resumed the work the other nurse had left off, cutting the mud and blood soaked uniform away from the patient's wounded stomach.
When the fabric of his tunic was pulled back, and she had sopped up the pooled, dark blood with sterile pads of gauze, she could at least see the wound. Pale fat, red flesh, yellow organ tissue, dark blood. The dirt and fragments were gone. The wound was ready for the doctor.
Before she could call to Doctor Sergeyev she felt an unexpected hand on hers. Looking down the patient's eyes were on her, his hand gripping her with unexpected strength.
"Will I be all right, Sestritsa?"
The look which met hers pleaded for truth, but it also asked for comfort. Which should she offer? The prospects of a man with a stomach wound were not good.
"Please. I have a wife and daughter. Will I be all right? Will I see them again?"
She placed a hand on his. "We will do everything we can." Still the eyes seemed to ask the question. "You must be strong. Ask God to help you." A nod, and whether it was the reassurance or the morphine dose which Sister Gorka's neat handwriting listed on the patient card pinned to his tunic, his eyes unfocused and his grip loosened.
She waited while Doctor Sergeyev put the chloroform mask over the patient's face. A brief shudder, a tensing of the muscles, and he breathed more slowly. She moved the soldier's hand, now a limp piece of flesh, off of hers and set to work, handing the doctor the probe with which he began to prod and search the wound.
So many cases had passed across their operating tables over the last day. It was impossible to feel for all of them. In the exhaustion of the work these man became a leg case, a stomach case, a head case. A bone to set and a skin to stitch. Yet each of these cases was in fact a man possessed of fears and hopes, of family and friends, of a home somewhere across this empire which they both in their different ways served though it was a thing so large, so diffuse, that it was as much an idea as a place. All these hopes and fears and loves which must be somehow sewn back into something like a whole body and sent out to whatever far corner of the world they had come from.
All morning they worked and into the afternoon. Sister Gorka returned from a few hours rest and took over the triage work outside the hospital from Sister Travkin. Doctor Sergeyev refused any offer of rest and continued at the surgery, laying his head down on the spare operating table while Natalie prepared the next patient for him.
As evening approached, the tide of soldiers coming down the road from the direction of the front became heavier, but few of them turned in to the field hospital. At first they came in ones and twos, then clumps of men, some with their packs and rifles, some with nothing but the clothes they wore. Carts rumbled by and officers on horses. Whole companies of soldiers came down the road, not marching as they had in days passed, but shuffling, ambling crowds.
"Do you think we are retreating?" Sister Gorka had been making the rounds, giving water and changing bandages.
Doctor Sergeyev joined her at the window, drying antiseptic solution from his hands after his last surgery. "Perhaps some of the spent units are being pulled from the line and replaced with fresh units."
"I haven't seen any units going the other way."
The doctor shrugged. "This road is choked as it is. The staff must be using other roads to send in fresh troops."
"If the enemy breaks through, how will we take all the patients to safety?"
"We'd have the ambulances evacuate the patients to the rail line to catch the next hospital train. We've been here so long, I'm sure if there's any risk of a breakthrough they'll be able to give us plenty of warning."
When the warning came, however, it was last minute and accidental. A regimental staff captain rode into the hospital yard, looked around in obvious dismay, then demanded of Sister Travkin, who was again taking triage duty, "What are you doing here? The order for all support units to fall back was sent four hours ago." When Sister Travkin stared mutely at him for a moment, the full meaning of his words not yet penetrating the physical and emotional exhaustion of the last two days, he swung off his horse. "Do you understand me? Surely you don't intend to give yourselves up to the Germans? Are you alone? Is there other staff here?"
He clattered up the hospital stairs even as Sister Travkin called after him, "We've received no orders."
Natalie heard the sound of riding boots echoing towards them, and instinctively her head turned towards the sound.
"Hold that rib up," Doctor Sergeyev barked.
She fixed her attention on the wounded man on the operating table and pulled upwards with all her strength on the forceps with which she gripped one of his broken ribs.
"Yes, that's right. Now don't move." The doctor reached his own forceps into the wound cavity which the elevated rib exposed and gripped the piece of shrapnel embedded there.
"You need to leave immediately. All of you."
"Wait." Doctor Sergeyev did not look up. He pulled the jagged piece of metal carefully out, trying to avoid cutting the wound channel wider as he did so. For a moment Natalie could see the rising and falling of the lung. Then the wound channel filled with blood. "Gauze pad and apply pressure," the doctor ordered. "Gently. Don't re-compress the rib."
Natalie obeyed. She could feel the blood welling up through her fingers. She added another gauze pad and continued to press it against the wound.
"You must get out immediately or you'll be overrun. Evacuation orders were sent hours ago."
Again Natalie felt blood welling up, slick between her fingers. "Doctor, he's hemorrhaging."
"More gauze. Press hard, never mind the rib."
She added another thick wad of gauze and leaned in with all her weight to try to stem the bleeding. The patient was still unconscious from the chloroform. His breathing was slow. Was it slowing further? His chest sank. A long moment. It rose again.
Back in the hospital in Kiev there would have been a nurse assigned to monitor the patient's blood pressure during an operation like this. She would have called out the two numbers at intervals, allowing all those working on the patient to hear if the Systolic pressure -- the higher number which represented the level when the heart was compressing and pushing blood through the body's arteries -- began to fall down to the meet the Diastolic pressure, a sure sign that that heart was failing.
Here there were not enough staff to devote someone to tracking blood pressure, nor was there any adrenaline injection available for the doctor to try to restart the heart if it gave out. In Kiev she had even once seen a procedure demonstrated by a visiting doctor from St. Petersburg, where he saved a hemorrhaging patient by transferring blood from one of the orderlies directly into the patient through a set of needles and tubes. Doctor Luterek and the other surgeons had been much impressed, and her army nursing identity card had a neatly hand letter notation at the bottom corner "Donor Blood Type III", but there were no such procedures here, and the entire staff would be bled white if they attempted to help a fraction of their cases that way. They could only wait, knowing that the patient's blood was flowing out and unsure if they could stem the hemorrhage in time.
"Doctor!" The officer was standing next to the operating table, shouting.
"I am trying to save a patient, sir!" Doctor Sergeyev said without looking up. "Have the goodness to wait."
"I am trying to save all of you from becoming German prisoners," the officer replied. "Do you understand me, sir? You must leave now."
Natalie's attention was now on the officer. His uniform was the formal dress style favored by the staff, his riding boots were polished leather. But all of these were grimed with dust and spattered with mud.
"Is it as bad as that?" she asked.
"Goddamn it all!" Doctor Sergeyev was shaking the patient by the shoulders. He put his ear to the soldier's chest. For a moment all were silent. Natalie did not feel fresh blood soaking through, but neither did she see the patient's chest rise or fall. She reached out to check his pulse. Nothing.
The three of them looked at each other.
"I hope you're satisfied with your interruption, sir," said Doctor Sergeyev, turning away and reaching for his medicine bottle full of spirits.
"I'm here only to assure your safety," the officer replied, with obvious affront. "If your aim is rather to give yourself up to the advancing enemy…" He left the accusation hanging in the air.
Doctor Sergeyev, leaning against the equipment table, let out a long sigh. "No. You're right of course. If the army is falling back we must do the same. How quickly can you get us carts and support? My staff is reduced and we've spent the last two days overwhelmed. We'll need far more than just the nurses and orderlies to get all the men loaded properly and evacuated to the rail lines. And then there's the equipment to pack up."
The officer shook his head. "You don't understand. There is no time. There are no carts. There is no help. You must take what you can in a quarter of an hour, in the transportation you already have, and fall back as quickly as you can. I'm only just behind the front line. Very soon, the fighting regiments will be withdrawing along the road. And then soon enough it will come the enemy."
"But the patients?" asked Natalie.
"There's nothing to be done for the patients. We'll have to leave them behind and trust ot the Germans providing them with care.""
"Our equipment," said Doctor Sergeyev.
"Gather all that you can, but you must hurry. There is no time."
It was at that moment that Sister Gorka, who had been seeing to the needs of the patients who had already been through surgery, bustled around the corner and into the operating theater. "You're all very grave. Has something happened?"
"The patient died," said Natalie, and then she added the words which still seemed wholly unbelievable. "We have to fall back, and there's no time to load all the patients onto carts and ambulances. We must gather what we can and retreat within fifteen minutes."
With these words she broke free of the shock which had seemed so paralyzing. Taking up a carton which had held bandages sent by some ladies' aid society far away, she began to dump surgical tools into it. No matter, at this moment, what was sterile and what was not. They must have tools wherever they set up the hospital again.
Nurses, housekeeping sister, orderlies, and drivers all moved into feverish activity, loading supplies and equipment on the field hospital's carts and horse drawn ambulances. Equipment, linens, supplies, and personal belongings were assembled.
Patients soon noticed the activity, particularly those -- most of them more lightly injured -- who were laid out on blankets in the open air of the courtyard.
"Where are you going, Sestritsa? What about us? Don't leave us, Sestritsa!"
Several times she felt a hand plucking at her skirts as she walked past the wounded. She would not lie to them, and so she would not speak. She twitched her skirts away without looking. There was no room for patients as they tried to carry away all that they could of the hospital, nor would they have the facilities to care for patients while on the road.
She could brush past these entreaties with something like a good conscience as she oversaw the loading of the medicines and supplies. These were essential if they were to continue to provide their saving care to other soldiers. Guilt stabbed more deeply as she made one more, hurried trip, this time to the women's quarters to collect her few possessions. All these men were being left behind, yet she must take her little suitcase of personal possessions?
It was not as simple as that, of course. She could leave her few treasured things behind -- the wooden doll which had been her companion when she left the Polish estate for the school in France, the little framed photograph of her infant self in her dead mother's arms, the pearls her father the count had given her at their one meeting -- but it would not change the fact that the patients must be left behind. That was a decision beyond her power to change. This was no Tolstoy novel, and she was no Countess Rostova able to save the lives of deserving Russian soldiers by leaving behind her possessions.
The allusion came naturally to mind, and with it the afternoons spent in old Sister Maria-Grigori's room in the convent school, learning Russian and Polish by reading the old nun's novels. How fanciful had seemed Tolstoy's world of battles and retreats and refugees: The Rostovs escaping Moscow, Princess Maria rescued from the French and the rebelling peasants by Nikolai, and at last the great French retreat from Moscow through the wastes of winter.
In some sense it was another world: Fifty years since the novel had been written and a hundred since the French invasion of Russia.
Yet had she not in many ways stepped into the pages of that novel she had read under Sister Maria-Grigori's tutelage? Here she was, the natural daughter of a count, caught up in a great war that surged across the map of Europe: France, Austria, Prussia, and the Russian empire itself. All the elements sprung to life from the novel's pages. Somehow, when she had read about such things, they had not seemed so unpredictable and without plan. There were no forces of history here, only chaos, guilt and fear.
The women's quarters -- the wooden structure built as a stable for thoroughbreds and even that morning still so cozy for the purpose to which they had converted it -- were now in disarray. Some things were taken, others left, and in the process much had been strewn about. As Natalie entered she found Sister Gorka struggling out with her own trunks, not just the usual clothing and personal items but her camera, tripod, and film packed away.
Natalie's own little area was exactly as she had left it that morning. It was a matter of moments to put all of her possessions back into her suitcase. The cot, the little table, the carpet, the washstand -- some items provided by the medical corps and others scavenged from the house -- these would stay behind for whatever use might come next to this structure. Surely the nobleman who had built the stable for his horses could not have imagined it would someday house nurses. She in turn did not know what use it would be put to next.
As she carried her one piece of luggage out to the line of carts, the first of which were already beginning to roll out of the yard, piled high with the hospital's equipment, her eyes were drawn to the landmarks of what had been her world for the past four months. The little forest of crosses under which lay too many men whom she had helped to care for and comfort in their last days; the buildings which had housed sisters, orderlies, and patients; the lodge itself which had served nobly over the last half year as a house of healing.
She handed her suitcase to a Tatar driver, who stowed it among the pile of luggage on his cart. There were shouts and orders and soon the bearded man in his long coat and fur hat clucked to the horses and guided the cart out into the road, among the flow of vehicles and retreating soldiers.
Natalie stood looking back at the hospital. There waited hundreds of men, broken and fearful, waiting to see what would come to them next. There were the cots and operating tables there had been no time or space to load, where they had struggled to mend the wounds of war before life ebbed away. There was so much to leave behind at less than an hour's notice.
She turned to join the stream of hospital staff walking down the road in the wake of the carts and ambulances that carried their possessions. As she did so, she nearly collided with Doctor Sergeyev, who had likewise been looking back at the hunting lodge which for half a year had served as a hospital. There were tears in his eyes which he dashed away with the back of his hand.
"I would never have thought it when I came to this place," he said. "But some of the best hours of my life have been here. And some of the worst."
The Great War, a novel
© 2014 Brendan Hodge
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I've been thinking about what could be Henley's official "position" on Personal Development. If this sounds like a simple question to you, then allow me first to disabuse you of that thought; it's actually quite problematic.
In this post I'd like to try to explain why and then, having addressed that, in the second post I will move on to stating several tentative ideas about PD which, I think, state where we are taking the subject, positioning it not only in relation to the MBA education experience but extending it as a statement of something much bigger.
Many Business Schools have some kind of position on Personal Development. Usually the only way to find out what that is by seeing what they say about it in their marketing material or what they reveal about it via their programme information. Any position on PD could be said, I suppose, to come predominately either from without or from within. 'From without' means that a school has probably surveyed what it considers to be its market and come to the conclusion that this market demands PD, or something like it, be a component of the course (i.e. be one of the course's benefits). Alternatively it could also be that because so many of their competitors seem to be think it so then they, too, must follow suit. This is a compelling position among MBA programmes entangled in rankings battles and it ensures that PD will be pluralistic, plastic and will often rely on non-teaching staff supplemented by "expert" input bought in from outside. There's an overlap with career-related skills development and an advocacy of competency-based frameworks, an extensive use of psychometrics (and resourcing), and advocacy of coaching and mentoring support. Actual integration with the MBA curriculum is minimal when it is mainly the external that influences PD because assessment is expensive and integration of behavioural skills to academic learning outcomes is hard to do without a deeper philosophical intent. The net result of this position is often a strong marketing message but a weak return on an MBA's investment because the intellectual energy of the course is focused on the rest of the curriculum. PD is demoted to a very few measurables, such as how happy the participants were with the CV writing classes, or the presentation courses, or the mock interviews, or the mentor programme, or just simply with the time taken for job placement (and, of course, level of salary). No connection to the education is really needed to measure the effectiveness of the PD in such a case.
The other position for PD, whereby it comes from within, is often driven by the institution's culture, history and type of clientele (i.e. the sort of students and the sorts of organisations they work for). It is also much rarer in the market. Where a School has taken the position on PD that it is intellectually significant there may still be many of the manifestations of career assistance and advice that one finds in externally driven schools, but there is something else, too. PD is part of the curriculum itself. This may be implicit in practice-oriented forms of assessment that require a reflective component, and it may be explicit in PD being a course in its own right. To take this position is to acknowledge not only that PD is not merely 'training' and 'skills-building', but is an epistemic member of the family of domains such as Marketing, Finance, Leadership or Strategy (albeit a much less researched one).
Anyone wondering what the hell I'm talking about can compare and contrast two examples. The first, which I would class as illustrative of the "PD from without" school is an Exec MBA from a little-known institution, London Business School. The second, much closer to my "PD from within" idea, is the Exec MBA at Aston University in Birmingham.
Is Personal Development part of my MBA, or is an MBA part of my Personal Development.
Another thought would be to acknowledge the intellectual and cultural heritage of the business school, i.e. openly state its views on the individual, the scope of free will, and also discuss what good actions are.
@finn, thanks for this thought. Is it all just a question of perspective (two sides, one coin)? Or is one thing sub-ordinate to the other? If the first, then it doesn't really matter which way round. In case of the second, I think some MBA programmes take the first view, but by default the majority assume the second.
@marianne, I agree if you mean 'the business school' in indivdual cases (not if you mean in general as an institution per se), but it often feels as though market forces and instant communication squeeze a School's heritage and, in an over-stocked MBA market, the safe bet is to conform to what everyone is doing. That may be over-stating a homogeneity that in fact isn't there to the degree I'm suggesting, but when success is measured (in ever shortened time periods) by the number of accreditations and ever-higher position in rankings, and where the ambition for careers is to reach a level of seniority before a corresponding level of maturity or wisdom, courses that "go their own way" are much rarer.
Perhaps I was being a little obtuse — I think my question lies at the heart of the matter.
Under this view, a person might decide to do any number of developmental activities, including in some cases an MBA.
In that viewpoint the PD 'module' must surely be the most important module on the course. The MBA is a part of their PD, so the PD module is the one in which they review/reflect on how they are progressing against their initial intentions. And in doing so it is also the place where people learn to become better at the continuous cycle of "understanding who I am and putting it into better practice and understanding who I am and putting it into better practice and…".
A similar dichotomy applies to people's reasons for doing an MBA: either 'extrinsic' ("looks good on my CV, increases my salary") or 'intrinsic' ("learning stuff that will help me become more who I want to be").
These are, I think, two competing world views in our culture. And so I also agree also with Marianne: the way PD is treated is a reflection/manifestation of which worldview is dominant within the business school as a whole.
But ultimately, surely, the most important thing is that the position taken must match (be congruent with) the underlying philosophy being taught by the PD department. Namely, does it teach that the role of PD is to help each person inwardly to find out who they are and become that? Or does it teach that the role of PD is to help each person outwardly to match against a standard that has been defined by someone else?
Henley's official [external] "position" on Personal Development must surely match its own [internal] "position".


text:
flat buyers
Income-Tax Appellate Tribunal
post-dated cheques
LTCG
income-tax return
I-T exemption
Cheque encashed by builder after I-T return deadline? You can still claim tax exemption, says tribunal
Tax experts say this does not apply to post-dated cheques. Builders typically ask for post-dated cheques, if a flat is booked during the construction stageLubna Kably | TNN | June 05, 2017, 07:46 IST
MUMBAI: In a relief to many flat buyers, the Income-tax Appellate Tribunal recently held that if a cheque is encashed by the builder after the deadline for filing income-tax return, it will not debar the taxpayer from claiming I-T exemption available on reinvestment of long term capital gains (LTCGs) in residential property.
Tax experts say this does not apply to post-dated cheques. Builders typically ask for post-dated cheques, if a flat is booked during the construction stage.
If a taxpayer makes a profit on sale of a residential house s/he has held for two years (the 2017-18 budget has reduced the holding period from the earlier three years), it is treated as an LTCG, which is taxable at 20% with an adjustment for inflation, referred to as indexation benefits.
But, if a component of LTCG is reinvested in another house in India within two years of the sale of the original house, the taxpayer can claim a tax exemption under section 54 of the I-T Act. Consequently, the taxable component of LTCGs is reduced to the extent of the reinvestment, which results in a lower tax outgo. In case the amount is not reinvested by the due date of filing I-T return, the taxpayer has to deposit it in a separate bank account under the capital gain account scheme.
The ITAT heard the case of Akansha Ranju Pilani who had earned Rs 1.6 crore on sale of property on August 2, 2011. He purchased another residential property on July 26, 2012 for Rs 2.75 crore and claimed tax exemption. While he had issued several cheques for the purchase price to the builder on the date of the agreement, cheques for Rs 62.21 lakh were encashed by the builder after the expiry of the date for filing the I-T return.
The I-T officer held that as the unutilised amount of Rs 62.21 lakh was not deposited in a separate bank account, to this extent the tax exemption claimed by Pilani should be disallowed. The taxpayer that "once cheques have been issued, his liability is fulfilled and it constitutes utilisation of the sale proceeds of the old house".
He pointed out that the cheques were issued to the builder on July 26, 2012, prior to the due date of filing the I-T return, which fell on August 31. The ITAT thus decided in favour of the taxpayer.
"This decision relies on a tenet set by the Supreme Court that the date of payment in case of a cheque is its date of delivery. On encashment by the recipient the payment is complete, but it relates back to the date of handing over of the cheque (or delivery date)," explains Gautam Nayak, tax partner, CNK & Associates.
However, Nayak sounds a word of caution. "If post-dated cheques have been given to the builder, then the taxpayer should ensure that the unutilised sum is deposited with a separate bank account before the due date of filing the I-T return. In such cases, the date of delivery will be the date mentioned on the cheque."
Top 10 rules for real estate leaders to achieve success
Tags : Regulatory, flat buyers, Supreme Court, Income-Tax Appellate Tribunal, post-dated cheques, LTCG, income-tax return, I-T exemption, Mumbai

redpajama_set_name: RedPajamaCommonCrawl


text:
Visual Rehabilitation – an integral part of eye care
By Sarah Wallace, Public Health Registrar and Prof Hannah Kuper, Director of the International Centre for Evidence in Disability, LSHTM on visual rehabilitation.
We are in a remote area in Morocco, and a woman approaches us, led by her mother. She has heard that a group of ophthalmologists is visiting her village, and grabbed the chance to be examined. She is blind in both eyes from corneal disease, and although the doctors refer her to the local ophthalmology department, they know that a cure won't be possible. She is just one of 80 million people who have permanent vision impairment around the world, most of whom live in low and middle income countries.
Low vision and blindness have profound effects on people's psychological and social wellbeing – people are often left feeling depressed, frustrated and even worthless. Many people who are visually impaired struggle to participate in school, work or their community, and may end up isolated and driven into poverty. So what is to be done for people with incurable sight loss?
Provision of low vision services is the first step. These services require the input of different specialists, and include providing assistive devices, like magnifying glasses, or offering training to improve independent mobility. Sadly, such services are often lacking in low and middle-income countries or, if they do exist, rely on insecure NGO funding. This gap may have arisen because visual rehabilitation is often a low priority in health systems, or because the focus on avoidance of blindness means that the needs of people who can't be cured may be overlooked. Going forward, low vision services need to be scaled up, and ideally fully integrated with a country's eye health services to make them sustainable and part of normal care.
Rehabilitation, however, is broader than low vision services alone. It aims to "optimise functioning and reduce disability in individuals with health conditions in interaction with their environment" (WHO), and so should also focus on improving access to employment and education, or community participation more broadly. These initiatives are offered under the guise of Community Based Rehabilitation, and though often effective, are also limited in availability.
A key constraint in scaling up visual rehabilitation services is that the evidence for effective interventions to improve the quality of life for people who are visually impaired is currently sparse, particularly in low and middle-income country settings. Of 6 Cochrane reviews that have been undertaken around rehabilitation in people with visual impairments, only 2 identified eligible studies, and all were from high-income countries (Virgili et al, 2010, and Virgili et al, 2013). Similarly, a review of the effectiveness of Community Based Rehabilitation programmes didn't identify any studies that included people with visual impairment (Iemmi et al, 2015). Recent increasing interest and research in the area of visual rehabilitation is welcome, but much of it is hi-tech and not currently suitable for resource poor settings.
Eye health services must not neglect the needs of those with irreversible visual impairment, and eye health professionals should be advocates in this area. We need to invest in building the evidence base of effective interventions, and to ensure development of effective, equitable and widespread visual rehabilitation services. These initiatives will help to maximise the quality of life and well-being of people with incurable conditions, like the woman we met in the remote village in Morocco.
Iemmi V, Gibson L, Blanchet K, Kumar S, Rath S, Hartley S, Murthy GVS, Patel V, Weber J, Kuper H. Community-based rehabilitation for people with disabilities in low- and middle-income countries. Campbell Collaboration, 2015, Volume 11.
Virgili G, Acosta R, Grover LL, Bentley SA, Giacomelli G. Reading aids for adults with low vision. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD003303. DOI: 10.1002/14651858.CD003303.pub3.
Virgili G, Rubin G. Orientation and mobility training for adults with low vision. Cochrane Database of Systematic Reviews 2010, Issue 5. Art. No.: CD003925. DOI: 10.1002/14651858.CD003925.pub3.
Top image: Photo courtesy Rajan Shrestha for #EyeCareForAll photo competition
Image in the middle: Photo courtesy David de Wit for #StrongerTogether photo competition
low vision,
Spearheading change in access to assistive technology: the GREAT Repor...
assistive technology,
refractive error,
WHO,
The Kilimanjaro Center for Community Ophthalmology
Benin,
Burundi,
childhood blindness,
Ethiopia,
IAPB Africa newsletter September 2019,
Madagascar,
¿Cuál es la situación y que hacer para mejorar la cultura en rehabi...
Boletín Trimestral Latinoamérica Diciembre 2018,
Latin America,
Low Vision Curriculum
iapb work group,


Whether your cooking is gourmet or on-the-go, closet organizers can make your culinary duties easier, and the professionals at 31-W Insulation are the experts to call. We have provided homeowners like you with quality home improvement services since 1972, so you can rest assured that we have the experience and expertise needed to make your closet renovation dreams a reality.
If your kitchen pantry is in serious need of attention, we will show you how closet organizers can help you utilize every inch of storage space and make items more accessible. For example, you might want to install deep shelves to store seldom-used bulk items, and narrow shelves or baskets for frequently used staples. This attention to detail can make the task of finding what you need to whip up your culinary masterpiece easier than ever.
Additionally, you will be pleased to know that not only can you design the layout of your new closet, but you can also choose from several materials and finishes, such as wood/laminate and wire. Your closet will be just as aesthetically pleasing as it is functional; and because we only use closet organizers from ClosetMaid, you can be assured that it will remain that way for many years to come.
Contact 31-W Insulation today to schedule your complimentary consultation and get started designing your closet organizers for your Middletown, Ohio, home. And don't forget to ask about our other home improvement services, such as the installation of garage doors, fireplace surrounds, stone siding, and more.


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HomeSportsLacrosseWomen's lacrosse finishes regular season at 15-2 to earn second seed in MASCAC
Women's lacrosse finishes regular season at 15-2 to earn second seed in MASCAC
May 3, 2018 Matt Ferris Lacrosse, Sports 0
Framingham hosted Salve Regina on Thursday, April 26 in a nonconference game.
The Rams opened up the scoring just over 4 minutes into play. Kimmy Foley took a pass from Alissa Marino and ripped it by the Seahawks' goalie for the 1-0 lead.
The Seahawks responded, scoring two goals in the next 30 seconds to take a 2-1 lead over the Rams.
Foley scored her second goal of the game just over a minute later, this time off a feed from Grace Gamache, to tie the game up at two.
Salve Regina answered back again, 2 minutes later, to take the lead 3-2.
Framingham scored the next four goals of the game in a 3-minute span to take a 6-3 lead.
The Rams got goals from Hanna McMahon, Gamache and two from Nicole Pacheco.
Just 20 seconds later, the Seahawks cut the Rams' lead to 6-4, scoring unassisted.
Framingham closed the first half, scoring eight unanswered goals to take a commanding 14-4 lead into the break.
On the 8-0 scoring run, Marino contributed three goals for the Rams, Gamache had two goals and Pacheco, Foley and Ashley Gregory all had a goal each.
The Rams started the second half just how they finished the first. Framingham came out and scored the first two goals of the half to stretch the lead to 16-4. Pacheco and Morgan Begley scored the goals, both assisted by Foley.
Salve Regina scored the next three goals of the game to cut their deficit to 16-7.
Framingham added another goal to push the lead back to 10 goals. Gregory scored her second goal of the game off a feed from Begley to make it 17-7.
After another goal from the Seahawks, Begley answered back to extend the lead back to 10. Begley scored her second goal of the day unassisted to make it 18-8.
Salve Regina scored the last two goals of the game to make the final score 18-10.
Pacheco led the Rams with four goals. Foley and Gamache were just behind her, each scoring three. Foley also added five assists in the game while Gamache had three.
Indigo Fox Tree-McGrath played 40 minutes in goal for the Rams, stopping four shots of the eight she faced. Mikayla Seavey played the other 20 minutes in net for FSU, making one save.
With the win, Framingham improves to 13-2 on the season.
On Saturday, April 28, the Framingham State Rams traveled to MCLA to take on the Trailblazers in a MASCAC game.
Framingham dominated MCLA in the first half, scoring the game's first 10 goals before the Trailblazers responded.
On the 10-0 scoring run, the Rams had 10 different goal scorers.
Framingham got goals from Kristen Keenan, Casey Bradley, Emily Burnet, Jenna McMahon, Foley, Marino, McMahon, Begley, Gamache and Gregory. All 10 goals were assisted.
After a goal from MCLA to stop the run and make it 10-1, Framingham closed the half out with two more goals.
Bailey Donnelly and Marino scored the goals to send the game into the break at 12-1.
After scoring the final goal of the first half, Donnelly came out in the second half and scored the first goal to extend the Rams' lead to 13-1.
MCLA would get a goal back, only to see Framingham extend the lead back to 12 goals less than 2 minutes later.
Keenan scored the goal off a feed from Audrey Duhaime to make it 14-2.
The Trailblazers scored another goal 2 minutes later to make it 14-3, but the Rams responded with three unanswered goals to extend the lead to 17-3.
Mallory Fredericks, Gamache and Marino scored the three goals for the Rams.
MCLA would score the last goal of the day to make the final score 17-4.
Marino led the Rams with three goals, while Donnelly led the Rams in assists with four. Donnelly also contributed two goals.
Fox Tree-McGrath and Seavey split the game in net for the Rams. Neither goalkeeper made a save.
With the blowout victory, the Rams moved to 14-2 on the season and 5-1 in the MASCAC.
Framingham hosted Mass Maritime on Sunday, April 29 in a MASCAC game and their last regular season match.
Just over 8 minutes into the game, Framingham found themselves down 3-1.
The only goal from Framingham came from Marino, as she took a pass from Pacheco for the goal.
The Rams responded to the deficit, going on an 8-0 run to take a 9-3 lead.
Framingham had five different goal scorers on the run. McMahon had three goals, Pacheco had two, while Marino, Duhaime and Tess Destino all had one goal.
Mass Maritime would get a goal back with 8 minutes left in the first half, but the Rams responded again, closing out the half with three unanswered goals.
Marino, Gamache and Pacheco all scored goals to make it 12-4.
In the second half, Framingham outscored Mass Maritime 7-5 to take a 19-9 victory.
Framingham had six different goal scorers on their seven second-half goals.
McMahon scored two goals in the second half to lead the way for Framingham.
Marino, Gamache, Duhaime, Jennifer Buckley and Maggie Destino all added a goal apiece for the Rams.
Marino led the Rams in scoring with four goals. Gamache had a team-high three assists.
In net, Fox Tree-McGrath made four stops for Framingham.
With the win, Framingham finishes the regular season with a record of 15-2. They are 6-1 in the MASCAC which earns them a second seed in the conference tournament.
After a first-round bye, the Rams will play the Bridgewater State Bears in the MASCAC semi-finals.


The global rubber tracks for defense and security market is apprehended to follow gradual growth over a 10-year forecast period 2017-2027. According to a recently published research report by Future Market Insights, titled "Rubber Tracks for Defense and Security Market: Global Industry Analysis 2012 – 2016 and Opportunity Assessment 2017-2027," the market is poised for a CAGR of 3.9% over the assessment period and will reach US$ 144.5 Mn by 2027 end, up from US$ 98.4 Mn registered in 2017. Volatile rubber pricing scenario is considered to be a predominant factor restraining rubber sales, ultimately affecting the rubber tracks market performance.
North America currently holds the largest market share of over 31%, followed by MEA with a share of over 20% in terms of value. Europe is another key market for rubber tracks for defense and security. In terms of volume, Future Market Insights identifies dominance of EMEA and North America in the global market in 2017. In terms of basis points, North American and Eastern European markets are projected for a considerable gain, whereas all other regions are expected to see a slight decline in near future. North America will reportedly retain the dominance with a promising CAGR of over 5%; Eastern Europe will be a steadily growing market over the next decade.
North America has been dealing with immense pressure due to internal as well as external terrorism since the past few years. This has been detected as a key factor driving the demand for military vehicles within the North American market. Increasing investment of the US Army in battle tanks and other vehicles is predicted to directly boost the sales of rubber tracks in this region, the US being the leading market in this region.
Soucy International Inc., Ocean Rubber Factory LLC, COECA SA, William Cook Holding Limited (Cook Defense Systems), LS Mtron Ltd., GMT Rubber and Metal Technic Ltd, Martin's Rubber Company Ltd., Cauchos Puntes S.L, Mackay Consolidated Rubber Technology, Northern Plains Track (Camso Group), and TGL SP Industries Ltd. are some of the major companies actively operating in the competitive landscape of the global rubber tracks for defense and security market.
As far as North America-based players are considered, Soucy International Inc. has been the global leader and Camso Group is identified to be striving to enter the military vehicle market for rubber band. Soucy has been the largest rubber tracks supplier for leading OEMs and various Ministry of Defense departments over the years. The company concentrates more on strategic collaborations and is likely to capitalize on opportunities presented by end-users operating in snowy areas and deserts. Camso Groups stands out on account of its expertise in designing, engineering, and manufacturing the most mature technology specifically for mission survivability in hostile environments.


One of my favourite things about Europe has to be its diversity. Last week we were sunbathing in Italy - today we were playing in the snow atop a mountain in the Swiss Alps. After breakfast we took the train to the top of Jungfrau, the highest railway station in Europe. The journey up has some spectacular views over the valley below and the mountain itself.
There's heaps to do at the top of the mountain, and we spent the best part of the day up there. We went up to the viewing platform to get photos and some people ventured out to the plateau in fierce winds and slippery ice - I gave that one a miss! We also walked through the ice palace, which was amazing. There's lots of narrow passages to explore and detailed sculptures of snowy wildlife.
Later on we ventured outside to the snow park, which was a blast. We opted to do sledging and tubing, but there was also skiing and snowboarding available. We had several turns down each run and it was so much fun! It was like being a kid again for a while, and even though I get snow at home (unlike many others) I loved every moment of it.
We headed back down the mountain later in the afternoon, and had a snooze on the way. Dinner was at camp, then we had another party night onsite. However, only around a dozen of group made it (not including myself) because a nasty stomach bug ripped through the group. Hopefully things take a better turn for them all in the morning!