Before the revolution, Derevenko was a physician who served at the court of the last Tsar, Nicholas II. He was a specialist doctor assigned to look after the Tsarevich in 1912, who suffered from haemophilia. His son, Kolya Derevenko, was a friend of Alexei. Nicholas II abdicated in March 1917 and was exiled with his family to the Siberian village of Tobolsk that August, a journey on which Derevenko and his family voluntarily embarked. In May 1918 the Derevenkos accompanied the Imperial family to the Siberian city of Yekaterinburg. Like many others, they were prohibited from staying with the Romanovs inside the Ipatiev House. Instead they stayed in a house across the street, though Derevenko was occasionally allowed to treat Nicholas's son, Alexei Nikolaevich. Early in the morning of 17 July 1918 the former Imperial family and four retainers were murdered by order of the Bolshevik government.