Hospital of the Queen's Heart by Ileana, Princess of Romania
Very early one glorious fall morning, even before I had arrived at the hospital, a gypsy family, mother, father, and little daughter, appeared in the hospital courtyard and stood expectantly, waiting to be let in and their needs inquired into. Sister Ginia, the night nurse, brought them into the hospital and established them in the waiting room. Then she went to get Dr. Puscariu, and just as he appeared, a short while later, I arrived, glowing and buoyant from my short brisk walk down from the castle in the crisp, chilly morning. I was full of energy and well-being, eager for my day's work.
The gypsies raised their hands to their lips in a shy peasant gesture as I came in.
"Bine ai venit—welcome to you," I said. "This is your daughter? What is wrong?"
"She is sick with her knee, Highness," answered the mother. "We waited a long time for it to get better, but it did not. So we have brought her to you. We have carried her for many days' journey."
The parents were basketmakers and mushroom gatherers. They were filthy and slovenly. The father was spare and tall, as the gypsy men often are, bearded, and wearing a tattered tunic and trousers which were bound about the calves of his legs with cords. He had thrown a piece of old carpeting about his shoulders for warmth. I cannot describe the mother as being dressed. She was covered with layers of smelly rags from which the colors had long since disappeared, and they were tied with a rope about her spare middle. She looked a hundred years old, so wrinkled and weatherbeaten was she, although I knew she could not have been much older than I.
But the little daughter was one of the most enchanting beings I have ever set eyes upon. She was about twelve years of age, small-boned and delicate; her small oval face was perfectly modeled. She had jet-black hair which was twisted about her head in a braided coronet, and her eyes were large, violet-blue, fringed with black eyelashes as thick as ferns. How she was ever produced by these two I could not imagine. I looked at her, fascinated—one rarely sees such flawless beauty and perfection in flesh and blood. Obviously her parents felt the same way. They completely adored her.
Unlike her parents, she was decently dressed in a red skirt wrapped tightly about her little hips, and a silver embroidered blouse. Around her head was swathed a white scarf, and a dark-blue wool cloak fell from her shoulders. She looked like something that had fallen out of a fairy tale; she was a lost princess thrown in among beggars.
Puscariu and I took her into the dispensary and lifted her onto the examining table. The parents followed and stood near by, their anxious, adoring eyes fixed on their daughter.
We drew up her skirt. The sight that met our eyes was sickening. The knee was swollen to twice its normal size, and from several places at once oozed yellow, evil-smelling matter.
Dr. Puscariu, after a few moments of examination, picked her up and carried her into the X-ray room. We made several plates, the anxious parents standing in the doorway, peering in awe and a little fright at the fearsome machine, yet entrusting their angel confidently to my care and protection.
Then we turned the child over to the nurse to bathe and put to bed, the parents still in close attendance, silent, dignified, watchful yet confident. Puscariu and I studied the X-rays. Without any doubt at all this was tuberculosis of the bone.
"You'll have to tell the parents—not I," he said dryly. "More than likely the girl's leg will have to be amputated."
I was filled with dismay at the prospect of bearing such tidings, but as I turned away from the X-rays I knew that it had to be done. There was no mistake in our diagnosis.
What a way, I thought, to start such a glorious day. I had come with such joy and zest to this day's work, and now I found myself plunged into tragedy, and the news I must give to these simple people would be a crushing blow.
I called them into the waiting room and sat them down. Sit in my presence? Indeed yes—I wished it. They did so, stiff and ill at ease. I explained as well as I could what the matter was with their daughter's knee. Using simple language, I told them about the rottenness of the bone inside the knee, and how the poison of it was seeping into the child's blood, slowly working its way through her body, and that in order to save her life perhaps we would have to take her leg away.
The mother, horrified, covered her mouth with her shaking hands, and then turned to look at her husband sitting impassively beside her, his eyes upon me. Together they shook their heads in stunned silence. After several moments she found her voice.
"No, no, Altetza," she faltered. "Do not cut off her leg. It is not possible to. What would poor people like us do without legs? She must keep her leg. She really needs it very much. She cannot earn a living without it. We cannot keep her without a leg."
How well I understood her—I knew the absolute, utter poverty of the gypsies.Actually, their bodies were all they possessed. To deprive a gypsy of a limb is to deprive him of even more than a necessity or a prized possession. It is to take away a part of his life.
Once more I explained, searching for even simpler language, and I reminded her that after all, it was her child she loved, not her child's leg. Surely, I said, if it was a choice between dying or remaining alive with only one leg, it was better for the girl to live, even though crippled. "Do you not understand," I went on, "that your daughter is going to die if nothing is done for the knee? There is nothing we can do to save her except to operate." "Yes, yes, I do understand you," moaned the mother.
"But please be kind to her and do not cut off her leg!"
I explained patiently that it wasn't that I wanted to cut off her leg. In fact, I greatly wanted not to. I tried to make her understand that it wasn't my idea, nor was the decision mine. It was the result of examinations that the doctor and I had made, and the pictures that the machine had made of the bone inside the knee. It was they that indicated that the leg might have to come off, and I was only telling her what the examination and the X-ray pictures had revealed.
"Surely," I finished, "you and your husband love your child more than you love her leg!"
"Oh, yes," agreed the mother distractedly. "We do. We do understand. Still, Domnitza," she pleaded, "we will be very grateful to you if you will please not cut off her leg."
Tears of desperation sprang into my eyes. How could I ever make her understand that it wasn't dependent upon me whether or not the child would keep her leg. I had nothing to do with it! Once more I went through the entire explanation.
The woman again listened closely and obediently, then she glanced at her husband, sitting mute and observant. He shook his head and she turned back to me. They spoke together, urgently but very respectfully.
"Yes, we understand what you say. We do, and we trust you, Highness. But just the same, please, we would be so grateful if you do not cut off our daughter's leg."
I had run out of arguments. There was nothing more I could add to my explanations. I finally assured them that we would do our best. I told them as plainly as I could that even if we did not amputate they must know that her leg would be stiff, and it would remain that way for the rest of her life.
They rose, looking at me with suffering eyes, saying nothing, accepting my judgment.
The doctor and I made further examination of the girl's knee. She was one of the sweetest creatures I have ever had anything to do with. She was patient and obedient; she did whatever we expected of her without protest, and, in all our study of that unfortunate knee, never once did she cry out although we must have hurt her very much.
Finally, Dr. Puscariu decided there was a very slight chance that the leg might not be amputated, that scraping the diseased bone might be sufficient, and a knitting together of the knee bones thereafter be possible. But we couldn't know certainly until we had opened the knee.
On the day of the operation I explained all this to the mother.
"Please," she said, "may I be with my child while you operate?"
I was disconcerted by the request. My immediate impulse was to say No with great finality. But I caught myself in time and said that I would ask the doctor who was going to do the operation.
I thought the idea was mad, but Puscariu was wiser than I.
"Let her come," he said. "You know, if we don't allow her to stay with us, she may think that we are doing mischief to her daughter. She'll be happier if we let her stay, even if she doesn't understand what is happening."
"But that's just it," I protested. "How will she stand the sight of it? It is going to be horrid to watch."
"Put her far enough away from the table," he advised. "You will find in the end that it is better so."
So I returned to the mother and told her that the doctor had given permission for her to be with her daughter if she would stay quietly in a corner of the room while we operated. I would tell her what was going on, and I promised to tell her the truth.
"That I know, Domnitza," she said simply.
We dressed her up in a sterile gown over her rags, and tied sterile gauze about her head, tucking up her lanky locks. We settled her on a high stool in the corner of the operating room. Then Puscariu, Badillo and I turned to our job of scrubbing. Sister Heidi brought in the little patient and put her on the table. She smiled at the mother and they exchanged a few words, but true to her promise the gypsy woman remained where she was.
Badillo administered the anesthetic, and the child's eyes remained fixed on me, above the ether cone, until they closed in unconsciousness.
I felt dreadfully disturbed. There seemed to be a ridiculous great sob mounting inside me, entirely unprofessional and very upsetting. I had become greatly attached to this beautiful gypsy child, and I felt a kinship, a compassion and respect for the mother who did not understand, who feared for her child, yet trusted me with the blindness of an animal. I caught myself up sternly. This was a job that had to be done, I told myself. I must think of the operation, not of my feelings. Enough of this sentimentality over the little girl lying before me, and her mother sitting like an anxious good child on her stool, her hands in her lap, in the corner over there.
We began. The intense light of the lamp . . . the draped white sheets . . . Puscariu across the table, remote . . . his precise, deliberate hands . . . the shining knives . . . the scalpel that bit deeply into the bone .. . then the knee flexed. A few incisive thrusts and the bones were separated. Matter flowed; there seemed to be quarts of it. Sister Heidi mopped it up. More knives . . . more chiseling, deep, deep in . . . and thank God, we reached healthy bone.
Full of gratitude, I looked up momentarily, my hands still occupied, and called over to the motionless mother.
"The leg is all right. We will not need to cut it off."
Her expressionless waiting face lit up with joy. She uttered no word of relief or thanks to us, but slipping down off the high stool to her knees, she made the sign of the cross and unashamedly addressed herself to God, thanking Him aloud that her child's leg had been saved.
We went on with the operation, listening to her humbly as we worked. She was quite oblivious of us. Then she rose and clambered back onto her stool, folded her hands again in her lap and relapsed once more into immobility, her eyes upon us.
When we finally wheeled the child out of the operating room and took her back to her bed in the ward, the mother followed silently, a little way behind us so as not to be, perhaps, in the way of the great doctors and the wonder-working Domnitza. Quietly, without invitation, she sat herself down beside her daughter's bed. She studied the sleeping girl's face for a moment and then turned to me, and, for the first time in the days I had known her, I saw her smile. Her weatherbeaten face was rapturous, illumined, completely transfigured. I was startled to see shining out at me from beneath the deep-cut, aged network of lines and dullness of expression, her daughter's radiant beauty. Almost shocked, I knew that once—perhaps not too many years ago—she had looked like this fairy child.
Leaving her there beside the bed, I went out of the ward with mixed feelings. I was grateful and glad that the operation had gone so successfully, and I was full of admiration for the devotion of the gypsy mother. But I was suddenly afflicted with sadness that the delicate, unearthly beauty of this young child was destined to be obliterated, that she would become like this crone, her mother, in a few short, aging years of the exposure, physical hardship and continual childbearing of the gypsy woman's life.
The child recovered after long nursing and care, and one day the following spring the three of them, the silent gypsy father, the devoted mother and the daughter who limped painfully now as she walked, but on her two legs, crossed the hospital courtyard and the bridge, turned down the road and vanished back into the mountains whence they had come. I recall the girl's beauty yet with unbelief and pleasure, and instantly thereafter her mother's dull, spiritless, furrowed countenance appears before me, out of which the daughter's beauty had shone incredibly for a moment when she smiled, and then died down again like a flame into its ashes.
The typhoid epidemic broke out soon after we returned to Bran from Cluj, bringing Rosa with us. Life at Spitalul Inima Reginei, in the wards and the operating room, went on as usual. I divided my days between the hospital and the contagious annex, and my trips out into the countryside and the villages. I fell into bed at night almost too tired to sleep.
Whenever there was a free hour in my typhoid warfare, I joined Dr. Puscariu in his study of Rosa's condition. Meanwhile she was being built up for the operation. Puscariu spent most of his scanty free time with her, questioning her, securing every detail of her history, and he and I had endless conferences, discussing what could best be done. So absorbed was he with the problem and the challenge it presented, that I know he took it to bed with him nights, for many mornings he would eagerly greet me:
"I thought of something last night. There is a possibility that we can do thus-and-so—oh, excuse me, Domnitza! Good morning—good morning!"
And I would laugh and press his arm, and say, "Good morning, my friend doctor. What is it you thought of last night? You interrupted yourself!"
Rosa was delighted with her surroundings. The cleanliness of her bed, the colorful curtains at the windows, her pretty striped cotton bedgown and the simple good food we gave her were almost too wonderful to be borne. In no time, she had made friends with everyone in the hospital, not only in her own ward, but also with the ambulatory patients from other wards who came to peep at the new patient from so great a distance and remained to chat; and the staff, who at first were full of curiosity about her, and then full of affection.
My children were as enchanted as the hospital family. Niki, Magi and Herzi visited her every day, bursting with questions and prattle, bringing their treasures for her to admire and handle. When the older children returned from school for their holidays, Stefan from Predeal, the two girls from the Brasov convent school, she and Minola and Sandi spent hours in talk together daily.
The epidemic began to wane in early spring, Rosa was in good condition, and in June we were ready to operate.
I did not assist Puscariu. Badillo took over my usual post, and one of the students assisted, also. As usual, Sister Heidi, the operating room nurse, was with us. My task was a different one this time. I was to attend the patient closely. It was to be a long operation and very difficult for her. Someone must watch her continually, to be sure that she received promptly, as she needed them, the drugs and restoratives necessary to sustain her through it. You must remember that we had no facilities for transfusions, and none of the wonderful equipment which you, here in America, take as casually for granted as you do thermometers and hypodermics. We did not have your wonderful drugs. We had no means for glucose to be fed intravenously during the operation to prevent operative shock. Consequently, a patient's life on the operating table frequently depended upon the keen observation of the nurse in charge, her quick action and administration of the available remedies that the moment demanded.
Puscariu's idea was to cut out a piece of the small intestine and apply part of it to the posterior wall of the bladder—which was all that Rosa had of that organ—sewing it to form a bag which was to be her new bladder. This, and the strange opening on the lower part of her body which had been there from birth, was to be covered with skin lifted from the abdomen and drawn down and across, and the edges joined.
Then the loose, still connected piece of the small intestine, which is like a very flexible and elastic tube, was to be planted in the muscle of her inner thigh, from which he had lifted thin flaps of skin. These would then be replaced, covering the intestinal tube except for a few external inches which would be stoppered. As the intestine was still attached to the mesentery, the peristaltic movements would draw the urine collecting in the new bladder down the passage thus made. While the healing process was taking place the new bladder would be drained by rubber tubes, to be removed when Rosa's new "plumbing," as we called it, was in working order.
The operation was exceedingly interesting to observe. I always liked to watch the quietly moving, fearless precision of Puscariu's hands, but today I was even more absorbed, because the living tissue he was shaping and rebuilding was Rosa.
It went well. When we had finished, and had trundled her off to her bed in the ward, we felt very relieved and not a little triumphant.
Healing was slow, but finally in a few weeks Puscariu was ready to take out the rubber drainage tubes. The process went well until he was removing the last one. To our consternation, it broke, the end remaining inside. You must remember that our rubber materials were scanty and they were old. These tubes were among the supplies I had brought back from Bucharest a year ago, and they had deteriorated. We had used them a little doubtfully, though hoping for the best since they were all we had.
Another operation was performed, the new bladder opened, and the piece of rubber removed.
Alas! from this moment it was impossible to get the wound to heal. We performed one plastic operation after another, but whatever we did, in some spot or other the flesh would refuse to grow together; there was always leakage through the incisions.
We contrived every sort of drainage we could think of. There were no tubes of the right size to be had, and of course we had none of the simple glass bottles and drainage paraphernalia which are used so easily and matter-of-factly here. We used what we had, and when one system failed, someone thought of another and we tried that. We declared that it was an engineering problem as well as a surgical one!
Rosa stood it all valiantly. She took the recurrent plastic operations as wryly and philosophically as one goes to the dentist for the six-monthly hour of pain and discomfort. Only once or twice did she cry hysterically in discouragement when one or another of the operations failed.
She suffered a great deal of pain, and she was one of those unfortunate people whose constitution cannot tolerate narcotics. We had no way of easing her suffering. She liked to have me sit beside her, her hand in mine; sometimes we talked a little, but often not. For hours at a time, day and night for weeks, I was to be found by Rosa's bedside.
I thought a great deal while I sat there. Many things that had hitherto puzzled me or eluded my understanding quietly resolved themselves in my mind. Perhaps those hours were the time that, sooner or later, is always allotted to a searcher after Truth, in which to evaluate experience, observation and pain, to extract from them a few priceless grains of the eternal verities, discarding all the rest as the chaff of living. I think that when we seem the most idle, we may be the most active and productive in the secret, hidden place where lives our Very Self.
These hours, then, were my time to let my processes rest and be still, and Rosa made them possible for me while I gave her the only surcease from pain that she could know.
After many months, in the spring of 1947, we found that the wound was healing. There was no more leakage. The moment Rosa was strong enough she sat up in bed, at first a short while at a time, and then for longer periods. She knitted ceaselessly for all of us with yarn that was brought to her or that came in Red Cross shipments. She made sweaters, socks and mittens for the small children in the hospital, caps, and mittens, socks and mufflers for all six of my children, and for the nurses and other patients. For me, she made a wide, warm shawl, as multicolored as Joseph's coat of many colors, from bits of the best, softest yarns that came to her, in which to wrap my painful arthritic back and shoulders.
She sewed and she embroidered. New babies born in the hospital were always sure of being clothed. She embroidered lovely peasant blouses, lengths of coarse, peasant-woven linen for scarves or cushion covers. Hospital sheets and pillow cases, bedgowns and operating gowns came to the foot of her bed in newly laundered piles to be mended by her quick skillful needle. She seemed tireless. She had endless native vitality—which, indeed, had kept her alive so long—and her mainspring was the need to give and to love.
When she could move about a little she found herself small chores to do about the ward. One day I found her cleaning the corners of the ward that had been overlooked by the maids in their haste or carelessness. She kept the ward tidy; it was "done" in the morning, always, but it didn't stay so, not until Rosa took care of it. Two or three times a day she went from bed to bed, picking up what had fallen to the floor, straightening bedside tables, bringing fresh water. She chatted with the other women patients about needlework or knitting, engaging in long, long earnest and serious conversations—I often wondered about what! Her plain little face was lit by interest in everything and everyone, her great, smoothly plaited braids swung heavily about her, almost dwarfing her.
Later, she loved to work with Maria in the kitchen. She asked Maria to teach her how to cook, and thereupon they became fast friends. Then she begged me to give her regular duties in the hospital for which she could feel herself responsible. I put her in the children's ward with Sister Lorie for a few hours each day. She was wonderful with the small children there and in the day nursery, for her nature was maternal even while it bubbled with a child's own fresh gaiety. While still a patient, she became one of us, almost an unofficial member of the staff. She was hungry to "belong," and I have never known a person so endowed with the ability to win love, perhaps because she gave it so unthinkingly and so spontaneously herself, not even knowing that she was doing so.
Because of the defect she had been born with, Rosa had never gone to school. She wanted to use the long hours of her convalescence learning how to read and write. So I got her an A-B-C book from the village school, and the hospital staff took turns teaching her. When Minola and Sandi came home on their school holidays they, too, helped. She learned her letters quickly and then began to read. One day she wrote her name. She went joyously to everyone in the hospital, from Maria in the kitchen to Dr. Puscariu in the dispensary, and demonstrated triumphantly her new accomplishment. 'We were all as delighted as she, be sure of that.
She could memorize astonishingly and learned poems and whole passages from the Bible with ease. If she was ignorant, it was not from lack of intelligence, that was certain.
Strange are the ways of Fate. . . . Because of her lifelong deformity, because of the happenstance of my finding her in the wards in Cluj—an interesting case to us, a hopeless one to the great overcrowded clinics there —she came to an unknown village hospital tucked away in a mountain valley where her deformed body was made whole by a country surgeon's ingenuity and persistence. And at the same time, the closed windows of her mind were opened, and her horizon began to be pushed back. I am certain that those windows continued to open to horizons ever further and ever more wonderful.
For I never saw Rosa fully healed, or very far on her way educationally. I only saw the promise and the fine beginning. I became a wanderer before she was entirely well. I often wonder where she is now.
Life does not waste people like Rosa. It needs their courage and endurance, their vitality and strength. Perhaps she was being made ready for something that no one could foresee. People like Rosa are never beaten out on the anvil of life, shaped, and then cast aside to live out their lives in uselessness. There is always a reason and a purpose. She has not stood still. If she is alive today she is still vital, and her outstretched hands still find necessary things to do.
Sometimes I hope with all my heart that she stayed in Bran, and that she still moves through the wards and halls of the beloved hospital, doing my work there while we are apart; she understood instinctively and so well the Bran way of life.
In a cottage perched precariously on the side of a mountain, seven miles away from Bran, a woman began to have her labor pains early one morning. The midwife was summoned from the village in the valley below, but she soon discovered that something was going wrong with the birth. She turned from the bedside to the woman's husband.
"There is something I do not understand," she said anxiously. "You must hurry. Take your wife quickly to Spitalul Inima Reginei and get Domnitza to take care of her. But hurry—hurry."
The cottage was at the end of a rough winding path up the steep mountainside. No cart could ever get down —or up—there. The husband saddled his horse with the primitive wooden saddle the peasants use, tied a few cushions on it and lifted his wife onto them. Taking the horse's bridle in his hand they set off down the rocky, precipitous path.
The labor pains continued, and the woman clung to the saddle pommel in agony. After several hours of journeying, nature decided she had delayed long enough, and the child began to be born. The distracted husband dared not stop. He held his wife in the saddle and anxiously urged his horse on.
That is how they reached the hospital that afternoon. We saw them coming over the bridge and hurried into the courtyard to meet them. The woman literally fell off the horse into Badillo's arms, and he carried her into the delivery room. She was hysterical—indeed, almost out of her mind with pain and fright. We put her on the table and gave her a quick whiff of ether to ease and relax her, and then properly administered it. She slipped into a blessed deep sleep, and Ioana and I went to work.
We were horrified to find not only that the birth was well under way, but it was abnormal. Only the arm of the child had appeared. Ioana tried to turn the child around, and after a few minutes looked up at me from the delivery table, her huge brown eyes wide and astonished.
"Why, this is awfully queer, Domnitza," she said. "I can't feel anything. There's all the room in the world inside this woman!"
Then we knew that something was really wrong. I sent for Puscariu posthaste. Before he had time to get there, the child was born—dead, of course. But the afterbirth did not appear. Bewildered and unbelieving, Joanna tried again to find it, searching carefully within the pelvic cavity. Meanwhile we conjectured together; she began to suspect what had happened: that the uterus had ruptured. When she finally located the placenta lying high under the woman's liver we knew that our surmise was correct.
It was then that Puscariu arrived. He grasped the situation at once, ordered the woman taken quickly to the big operating room and we went into action immediately. The operation went well, the woman's condition remained good, and with our small resources we took every conceivable precaution against the infection that seemed almost an inescapable certainty.
The woman withstood her ordeal and the operation with supreme unconcern, not to say indifference. She behaved as a patient would after the simplest sort of surgery. The immensity of her experience never seemed to occur to her—the long trip on horseback to us while giving birth (it was her seventh child), and the major operation which would have prostrated, at least temporarily, any other woman. She, like most peasants, took her bodily functions for granted and knew no fear of them, even when they got out of hand. Her natural endowment of physical strength and fine health seemed actually to act as a preventive of infection, for, miraculously, none appeared.
I often wondered if this boundless strength and vitality of the peasants was perhaps a reason for our exceedingly small mortality in proportion to the amount of surgery we did. They are as vital as trees, as solid with inherent force as the earth. I should not wish to give the impression, however, that the peasant women are as healthy and sound, gynecologically, as is often implied—that they have their children in the fields with the ease of their own domestic farm animals. That is a misconception. We had many women come to us with malformations and difficulties of birth, as well as with the aftermath of malpractice—appallingly crude abortions that did not succeed in their purpose, resulting in injury and infection; and the remaining effects of neglect at childbirth, recent or long since. There were the usual sorts of women's ailments. Lack of attention to themselves and proper care before and after childbirth caused our peasant women their full share of female woes. But they were essentially sturdy and full of astounding endurance. They sorely needed instruction in hygiene, and ever and always they needed to learn the necessity of coming to us at the hospital at the proper time, not when things had gone so far that repair was difficult or, alas! impossible.