"...the surgery came at an inopportune time; not only were tensions in the Samoa Islands spiking and soon to turn hot, but the reforms spearheaded by Frederick had stalled out, and the rivalries between Bennigsen, Hohenlohe and Eulenberg were intensifying as the Reichstag, Bundesrat and Prussian Landtag each flexed their independent muscles and stymied the projects of one another. [1] After the initial spurt of liberal reforms after the Waldersee putsch, efforts to further entrench power under the "triad" of Kaiser, Chancellor and Vice-Chancellor in Berlin were harder to pursue. The successful battle to eliminate Prussia's parallel Foreign Office and consolidate it within the Imperial diplomatic service was long and arduous; further attempts to rein in the Landtag ran into problems as Eulenberg's conservative bloc began to make more noise about blocking reforms in the Bundesrat if its privileges were not maintained. Bennigsen and Hohenlohe did not work as well together as Frederick had hoped upon their initial appointments; Bennigsen, for his part, had grown accustomed to deference from not only the Kaiser but his bloc in the Reichstag and grew increasingly autocratic in how he controlled the legislature, and despite the soft agreement that ministries would be staffed by mutual consent, Hohenlohe and the Vice-Chancellor often sparred over even minor appointments as a form of regional or personal patronage, in no small part over Bennigsen's suspicions towards Hohenlohe's Catholic faith.
By 1887, when Frederick went under the knife to have a full laryngectomy performed at the Royal Palace, only the Caprivi reforms consolidating power with the General Staff over the armies of the individual kingdoms and creating a more uniform command structure was still moving along, and even that was only due to the removal of much of the Prussian old guard during the post-Waldersee purges. Even there, Prussia, Bavaria, Saxony and Wurttemburg would maintain separate armies; but staff colleges became streamlined and uniform, setting up a cold war within the War Office between appointments made by the Kaiser as "Imperial commandants," Prussian and Bavarian officers of the noble class, and staff officers who were generally drawn from the middle classes but would never see the more prestigious appointments reserved for aristocrats, as opposed to the egalitarian Navy which quickly earned favor with the liberal Reichstag.
Victoria, of course, was strongly opposed to Fritz's cancer operation, relying heavily on the British specialists who assured her it was benign; in the end, and perhaps in one of the first times in their marriage, Frederick dismissed his wife's counsel as his voice grew so weak he could barely speak and he coughed frequently. He deferred to Dr. Bergmann and the advice of both his heir and his Chancellor to proceed, even at the risk of death on the operating table. [2] The planned surgery was kept secret and the Kaiser vanished from public view for months, with Henry on leave from his Naval duties to handle the most critical matters of the German state and leaving all royal Prussian matters in the hands of Kaiserine Victoria, which boiled the blood of Eulenberg and other Prussian nobles who loathed the Empress. The fairly new and innovative procedure of a laryngectomy was successful - the cancer of the throat was removed and later revealed to be highly malignant in a later biopsy, but it came at the cost of the Kaiser's voice. For the next two years, until a device was designed and surgically inserted as a prosthetic larynx, he was unable to speak, communicating only via handwritten missive or tapped Morse code on a table with a large black stone he kept tucked in his pocket, and he was forced to kick his longtime smoking habit. Both the life-prolonging surgery and the manufacture of a prosthetic larynx with which Frederick was slowly able to re-learn to speak and make sound - very faint and odd-sounding, but words nevertheless - caught the royal courts of Europe by surprise and were hailed continent-wide as marvels of modern science..."
- Frederick and Victoria: Consorts of Germany
[1] We see here now the downside of the German Imperial constitution when there's not a singular figure like Bismarck to dominate the machinery of government
[2] Of course, IOTL, Frederick listened to the British doctor who told him he was fine at Victoria's urging and did not have the surgery after Bismarck intervened. Here, he listens instead to his original German doctor, Bergmann, who aggressively advocated the surgery, and Crown Prince Henry and Chancellor Hohenlohe (not Bismarck) accede to his proceeding with it. My head-canon is that Frederick does this having already been on the throne nearly a decade and trusting that Henry will be a more able Kaiser should he die than William, whom he did not particularly love