Something Else

In which Halley freaks out over differing old-timey blood transfusion techniques.

So I recently had the major revelation that by 1919, blood transfusions (which came into common practice during ww1) could be used to stop hemorrhages in hemophiliacs.  So far I’ve planned The Princess and the Witch under the assumption that at the time there was no real treatment for hemophilia.  I was partially right, because in the early 1910s, several methods of stopping hemorrhages had been developed, but they didn’t always work.  In terms of how that would have worked for the Romanovs (and the back-story for Anna and Pyotr), the failure of these new supposedly miraculous techniques and the success of Rasputin/molester priest’s leave-him-alone-and-pray method would of course reinforce the idea of science has failed and create a general distrust of doctors.  By the time it was established that transfusion was the way to go, Rasputin/molester priest would have been totally in control and any new treatment would be dismissed.

Of course, we also have the whole issue of ww1.  Blood transfusion became a medical thing in the 1890s, but it wasn’t until ww1 that it was perfected, more techniques of it were developed, and it all became common medical practice.  

This is what’s messing me up:

1.  How does Ilya learn that this treatment has been developed?  The most obvious scene for him to learn about it would be the morning after he’s stayed up with Anna, waiting for Pyotr to stop hemorrhaging.  He finds a book about blood disorders in the hospital library, reads about how awful hemophilia is, and comes to a deep understanding about Anna and why she’s so standoffish and over-protective of Pyotr, and he realizes that he’s kind of in love with her.  Needless to say, I am very very very reluctant to mess this scene up.  I guess I could still work it so that the revelation comes later.  The book is an out-of-date basic guide to medicine (like the book that Ilya used to carry with him everywhere before he lost in the robbery), and Ilya wants to learn more but he’s tired and his head needs a break, so he leaves and goes down to have the swim where he realizes that he loves Anna.  Later, after resting, he decides to learn everything he can about hemophilia and blood, remembering that his father told him about the advances made in transfusion during the war.  Then he makes his revelation, runs to tell Anna, but she shoots him down, saying it sounds like a quick way to kill him.  Pyotr is curious about it, but he, too, is suspicious and not super eager to try it unless it looks like he’s going to die, anyway.

My second idea was that in the trip to Omsk, the doctor who fits Pyotr with a brace mentions that new treatments are available.  Pyotr is suspicious, but Ilya is naturally all curious, and the doctor gives him several big books to read.  Part of me is slightly doubtful that an orthopedic specialist who works mostly with braces and prosthesis would be all up on things like transfusion, but given that hemophilia so badly affects the joints, he’d probably be familiar with it and have hemophiliac patients, so idk.  anyway, they go back to Tara, Anna has Ilya over to dinner, and he tells her everything about it, but she and Pyotr come to the same conclusion: not unless it looks like he’s going to die, anyway.

I thought that the scene I’d have the most trouble with would be figuring out how to make the trouble with Roman work, but I’ve kind of got that figured out.  At first, Roman sends his evil toadie Todayev out to rough up Anna and Pyotr (and thus “accidentally” kill Pyotr because “he didn’t know about his condition,” something Ilya accidentally lets slip), and Anna doesn’t let them touch Pyotr.  Ana gets beat, Ilya and Ravchenko are sent for, and Anna goes to the hospital, later she and Ilya bond but she tells him that he loves medicine more than her.  Later, Roman, in a fit of YOU HAD ONE JOB, TODAYEV rage, punches Pyotr in the face and he nearly dies.

This makes everything easier (I guess) by meaning I can combine the two scenes and eliminate a few plot holes in the middle.  Anna and Pyotr are both beat, they get taken to the hospital, where Ilya elects to give his blood, Pyotr stops hemorrhaging and Anna has the big moment when she cries for the first time (something that I was freaking out over getting rid of).  I still have the “you love medicine more than me” later, because it’s kind of important for the ending.

anyway, having that settled comes the big important plan of the MOTHERFUCKING DETAILS.  There are a lot of methods for transfusing blood, and trying to figure out the right method is totally frustrating me right now.  You have A: direct transfusion, where you basically cut a section of blood vessel in the arms of both patients and stick them together with a little metal tube called a cannula.  (it’s actually a bit more complicated than that, but you get the idea).  B: there’s indirect transfusion, which is the method done today, where you take all the blood you need from the donor and then give it to the recipient separately. 

This is what’s frustrating me: direct transfusion was the method perfected in ww1, but in the years immediately afterwards, big advances were made in indirect transfusion, and direct went out because any method that doesn’t involve cutting open a blood vessel is obviously preferable.  HOWEVER, indirect transfusion was made possible by anti-coagulant chemicals, which pretty much defeats the purpose of giving a hemophiliac someone else’s blood because that blood will clot.  Again, I’m not all that sure that all the indirect methods involved anti-coagulants, so there’s that.  And secondly, there’s the issue of what the Tara hospital would have been capable of handling.  One of the best medical books that I’ve found is an illustrated catalogue of medical instruments from 1915.  It has several cannulae for direct transfusions, but none of the equipment for indirect, as they were still being developed in 1915.  Anyway, this may seem irrelevant, but given that Tara is a small town in the middle of Siberia, I don’t really think all their stuff would be terribly cutting edge.  What I’d absolutely be able to kill to do is to go through the old records of the hospital and see if I can find an inventory that lists the equipment available or something.  But that shit is in Siberia and I am in Florida.  ugh.  I’ve asked Alex if maybe he can get me in touch with someone who can search the archives and scan them for me, but this may be asking for too much so ugh.  I’m leaning towards it being a direct transfusion, but even then, I feel like I need to know more about what was available.  Maybe I’m just being obsessive.  Maybe I should just read my books with transfusion information again.  blegh.

So those are my thoughts on this major revelation.  Any ideas, dear readers?