War is declared in July 1914. Lucius does not share his classmates’ patriotism and initially views the war as a disruption to his studies. His cousin Witold enlists, tearfully declaring that the war has made him feel Austrian for the first time; Lucius calls him an idiot. Celebrations fill Vienna—streamers, garlanded soldiers, special cinema programs—but Lucius ignores them. When rumors of physician shortages begin, medical students are offered early graduation and military positions. Kaminski and Feuermann enlist. At Café Landtmann, Feuermann urges Lucius to join, arguing that he will never see such cases again. A girl, he adds, kissed him after a parade. Convinced, Lucius enlists as a medical lieutenant.

His mother, thrilled with his enlistment but worried that medical duties appear cowardly, uses War Ministry contacts to cancel his commission and reassign him to the lancers like his father. Lucius realizes that she needs a patriot to offset the family’s reputation for war profiteering. His father, overjoyed, lectures him on cavalry history and dresses him in full splendor. Together they don suits of winged hussar armor from the family collection. His father teaches him to shoot, having him fire down the grand hallway at a knot in an oak tree visible through an open window.

Professor Zimmer, learning of the enlistment, angrily offers Lucius a safe assistant position in Vienna. The rector follows with a position at the Empress Elisabeth Hospital for the Rehabilitation of the Very Injured. Lucius refuses both. To escape his family’s influence, he travels to Graz and re-enlists, highlighting his ability to speak Polish. His application is instantly accepted due to shortages of doctors and Polish speakers for the Second Army in Galicia.

Reaching the front proves difficult. He is assigned first to Rawa Ruska, then Stanislau, then Lemberg, but each falls to the Russians before he can arrive. The Austrian line collapses. He spends months in Kraków, Poland, billeted in the Natural History Museum’s Room of Large Mammals, trying to study from unhelpful medical manuals. Bureaucratic obstacles prevent him from assisting at the local hospital. He is briefly assigned to delousing duty at a refugee camp, where the camp director uses anti-typhus measures as an excuse to harass Jewish refugees, with staff harshly confiscating ritual garments without explanation. In January, Lucius receives orders for Lemnowice, near Uzhok Pass in the Carpathians. Lucius remembers the name of the pass from family lore: A meteorite once appeared in the sky over Uzhok Pass just before his father was shot in battle.

The night before departure from Debrecen, a child runs into him on an icy street. Lucius trips over his saber and breaks his wrist. Knowing this injury will prevent deployment, he decides not to report it. He finds a blacksmith who sets the fracture, causing immense pain. Lucius steals ampoules of cocaine and morphine from the hospital and fashions a splint, resolving to get proper care at Lemnowice.

The narrative returns to present, with Lucius and his hussar guide riding toward the hospital where he will work. They ride from Nagbocskó through valleys and pine forests. His wrist throbs; he stops to inject cocaine directly into the fracture. They pass a village quarantined for typhus, which the hussar gives wide berth. In a scarred field, they find fifty frozen Austrian horses, executed during retreat. They encounter a refugee family; the hussar confiscates their hidden rabbits despite the woman’s protests, throwing one to Lucius, who tucks it inside his shirt where it urinates on him.

They billet in an abandoned house. The hussar cooks the rabbits but eats little. That night, he tries repeatedly to urinate, groaning and striking himself. Lucius reveals he is a doctor and diagnoses a gonorrheal stricture. With no proper tools, he uses the hussar’s rifle cleaning rod, lubricated with gun oil, to clear the obstruction. The procedure succeeds; the hussar laughs with relief. The next morning, in high spirits, he calls Lucius “Orvos”—doctor.

At dusk, they arrive at Lemnowice, a seemingly deserted village of shuttered huts beneath a wooden church. Lucius knocks at the church door. A nursing sister—a nun who works as a nurse—opens the door, holding a rifle. He introduces himself as a medical lieutenant and asks for the supervising physician. She replies by telling him that he is the supervising physician, since there is no other physician present.

The nurse identifies herself as Sister Margarete. After the hussar rides away, she lets Lucius inside, locking and barring the heavy doors. As his eyes adjust, he realizes the pews have been replaced by rows of blanketed lumps—wounded soldiers. The acrid smell of spoiled meat fills the air. Margarete explains that his predecessor, a Hungarian doctor named Szőkefalvi, ran away two months ago overwhelmed by terror of the lice that infest the hospital.

The hospital, she says, was once a well-equipped casualty clearing station with seven staff: herself and four other sisters (Maria, Libuše, Elizabeth, and Klara) plus two doctors. It was upgraded to a regimental hospital with an X-ray machine and laboratory. But in September, a severe lice infestation began, followed by typhus in December. No amount of lime or cresol could stop it. Sisters Maria, Libuše, and Elizabeth died of typhus. Sister Klara was caught having sex with a patient and sent away. Margarete has been caring for the patients alone for two months.

Overwhelmed, Lucius considers fleeing. He sees the pleading, expectant eyes of the wounded and realizes he cannot abandon them. Signaling his intent to stay, he asks what Szőkefalvi’s custom was at this hour; she tells him it is time for rounds. Relieved and tearful, she asks if he will stay even if he feels the Louse. Lucius agrees, though his skin is already crawling.

She leads him through the church, explaining the layout: lesser injuries in the nave, surgery in the crossing, dying men in the south transept, head wounds in the chancel. They stop at a deep crater in the floor beneath a jagged, patched hole in the ceiling. When Lucius asks what happened, Margarete laughs as if the answer is obvious. She tells him there are approximately 60 patients. Since Szőkefalvi left, she has performed 40 amputations on 23 men, 14 of whom survived. She warns him about the rats—patients have permission to shoot them—and reveals that she bars the doors not because of rats but because of wolves.

They begin rounds, joined by an orderly named Zmudowski. Margarete announces Lucius from the pulpit, then leads him through the nave, proudly showing him her amputation work and stitches. Lucius pretends to appraise them with a studious air. She pauses to remind a patient named Sergeant Czernowitzski how she has taught him proper respect for a nursing sister, implying that he has previously harassed her sexually and that she taught him the consequences of such behavior. When Lucius asks how she did so, she explains that God has given them morphine but also the discretion to withhold it. When Lucius looks uneasy, she explains that she is one woman alone with dozens of men, adding, “It’s either morphine or the Mannlicher [rifle]” (61). She laughs, jokingly reassuring Lucius that she has not shot anyone yet.

As she introduces a comatose Austrian with skull fractures, Margarete asks whether they should perform decompression or wait. Lucius freezes, his inexperience paralyzing him. Margarete prompts him to examine the patient. His hands trembling, he checks the pupillary reflexes and states that the oculomotor nerve seems intact, suggesting that the pressure in his skull is not yet advanced. When Margarete presses for a decision, she whispers that Szőkefalvi would wait. Lucius quietly agrees. She takes over examining the remaining patients while Lucius observes silently.

After rounds, alone in the crossing, Margarete looks at him appraisingly. She tells him they will make do. Then she asks about his wrist.

Margarete leads Lucius to his quarters in the former priest’s house across a snowy courtyard. In the kitchen, they meet Krajniak, the one-handed head cook, who is peeling potatoes. Margarete explains that a supply chain error resulted in the hospital receiving 200 kilos of pickled cucumbers instead of lye. A third man sits in the corner with a shotgun for rats. They pass through a laundry filled with drying uniforms to reach Lucius’s small room. It contains a straw mattress, desk, chair, and stove—it was Szőkefalvi’s room. Margarete inspects the bed for lice, unlocks the door to the courtyard, and advises Lucius not to remove his boots in case he needs to run. He should keep his papers on him to avoid being treated as a spy. She leaves him food and departs.

Lucius examines Szőkefalvi’s casebook, seeing hundreds of cases recorded in careful handwriting. He reflects on his situation, grateful that his broken wrist buys him time to learn from Margarete. That night, she awakens him—new casualties have arrived. In the courtyard, an ambulance is being unloaded. Lucius tries to help but forgets about his wrist and nearly drops a litter. Inside a small quarantine house in the courtyard, Margarete and others triage the wounded around a fire. Of 14 arrivals, eight are already dead, including one frozen in a screaming position with his jaw missing. The six living men are separated and must be warmed and deloused before entering the church to prevent another typhus outbreak.

While Margarete deals with a head wound patient who has risen and is heading for the door, Lucius tries to remove dressings from a soldier with an abdominal wound. When he pulls off the final layer, the man’s intestines spill out in hot, wet rolls. Margarete rushes back, scolds him for removing the final layer before having a new dressing ready, and quickly pushes the intestines back inside. She tells him that the soldier will be dead by morning anyway and that he will get used to such sights.

In the church, Margarete prepares for surgery, washing her hands and drinking horilka—village vodka she calls surgeon’s courage. Lucius watches as she treats two head wounds, performs several amputations, and debrides a shrapnel wound so extensively that she must amputate the leg. After surgery, they immediately begin evening rounds. Margarete detects gangrene in a soldier’s arm stump, and they return to the operating table to amputate the rest of his arm. During rounds, she kills a rat and its babies in a patient’s straw pillow with a shovel.

The grueling routine continues for days: ambulances arriving from the snow, triage, surgery, rounds. By the end of the month, Lucius’s hand has healed enough to assist. He performs his first amputation on the hand of a rifleman. Margarete stands close, guiding him and correcting his technique, telling him that while his method might work in Vienna, in Galicia he needs to cut a larger flap. She hands him the saw. Under her tutelage, Lucius learns. She offers constant, tactful encouragement, noticing but not drawing attention to his lack of experience, telling him his work is good and urging him to be more aggressive in exploring wounds.

February turns to March. Storms continue, fighting slows, and inside the church, darkness deepens. They fashion torches from pitch and rope hemp. Lucius begins taking his meals with Margarete at a table near the bomb crater, breaking officer regulations because he does not want to be alone. Margarete eats quickly and fiercely, always saving her bread to wipe up soup. Their conversations initially focus on cases and dwindling supplies. Soon, however, she shares opinions on everything: the army’s strategic mistakes in fighting in winter, the poor equipment, absorbent puttees, inadequate shoes. She curses a conscription officer who recently took away any man who could still march. Her breathless stories help lighten Lucius’s constant fear.

She asks him numerous questions about medicine and his life in Vienna, fascinated by his knowledge. He enjoys talking to her, finding their conversations similar to his conversations with his friend Feuermann before the war—urgent, important, free from stifling decorum. When her questions turn to his family, Lucius lies, inventing a humble apartment on Schumanngasse and a dentist father who moved from Kraków. He receives letters from his parents; his mother sends Polish toffee and news from a famous doctor friend, while his father encloses a map of old Cossack battles and a list of memorabilia he wants collected. They report the death of Puszek, the family dog. Lucius hides the toffees, regretting his lie but noting that Margarete also reveals nothing of her life before her vows.

They are sometimes joined by the orderlies. Zmudowski, a former postman from outside Kraków, collects stamps and shows Lucius a photo of his infant daughter. Rzedzian, a very large oil field worker from Drohobycz, is proud to share a name with a character from the novel With Fire and Sword. He claims to be able to lift heavy objects through mental strength. Krajniak, the young Ruthenian cook who lost his hand at Lemberg, controls the hospital’s food supply. The other men sing a song teasing Krajniak about his constant sniffles. The final orderly is Second Nowak. His predecessor, also named Nowak, had been vain about his manly hands, avoided corrosive soap, contracted dysentery, and died shortly after Lucius’s arrival. Second Nowak is distinguished by his constantly combed, straw-colored moustache.

The orderlies, trusting Lucius, share the hospital’s mythology. They tell him the story of Zmudowski and the Russian stamps. During a Christmas truce, Zmudowski met a Russian soldier and saw a rare Zemstvo stamp from Astrakhan. He spent the evening steaming stamps off undelivered Russian mail. The soldier offered a trade: Austrian stamps for more Zemstvos. A week later, after fighting resumed, Zmudowski snuck across the frozen river into enemy territory for the rendezvous. They narrowly avoided a patrol and exchanged envelopes. But Zmudowski’s stamps proved worthless—common issues, not rarities. The Astrakhan stamp was actually from Arzamas, also common. He shows Lucius the small, sky-blue stamp in his book, depicting a tiny deer against snow and woods. Second Nowak, stroking his moustache, declares that this is the nature of war.