As she held Alexei in her arms, all she could think of was the distance that still had to be covered until they reached the hunting lodge – and when they did reach it, what then? The only person who had ever brought Alexei relief from his pain, and put an end to his internal bleeding, had been Father Grigory, and they were in Poland while Father Grigory was thousands of miles away in Siberia.

By the time the hunting lodge came in sight, Alexei was moaning in agony and only semi-conscious. Wrapped in a blanket, he was carried inside and up to his bedroom and Dr Botkin was summoned.

It was a nightmare scenario and one that the very diligent Botkin had lived in dread of. With no other doctor there for support, how could he possibly handle a situation in which the heir to the throne could quite possibly die? A careful examination told him that the previous small swelling in Alexei’s groin – a swelling that had been healing satisfactorily – had ruptured on the bumpy carriage ride and begun bleeding in earnest, the trapped blood forming a swelling the size of a grapefruit in Alexei’s groin.

After ordering for ice-packs to be applied, he sent a telegram to Dr Federov and Alicky’s blood specialist in St Petersburg, Dr Derevenko, telling them of the situation and of how their presence was urgently needed. He sent a similar telegram to Alexei’s paediatrician, Dr Ostrogorsky. Then all he could do was to do what everyone else at Spala was doing, which was pray.

Without Irène, Alicky doubted if she would have been able to get through the next few days. Irène had lost one child to haemophilia, and Sigismund’s older brother, Waldemar, suffered from the disease. If anyone could sympathize with the torment she was suffering, it was her sister, and Irène was also able to stand in for her when it came to acting as a hostess to the many Polish nobles who had descended on Spala. For appearances of normality had to be kept up, regardless of the hideous drama unfolding in secret in the Tsesarevich’s bedroom.

On their arrival at Spala, Dr Derevenko, Dr Fedorov and Dr Ostrogorsky were all in agreement that blood was seeping into Alexei’s groin and lower abdomen and that, with every passing day, it was finding new places in which to form fresh haematomas. The pain Alexei was in was dreadful. As he writhed and thrashed and screamed, Alicky never left him. Day and night she remained by his bed, trying to give him what comfort she could, her red-gold hair turning whiter by the minute.

‘Help me, Mama!’ he gasped time and time again, and then, ‘When I’m dead it won’t hurt any more, will it? I want to die, Mama. I want to die!’