Troy’s referring to a GUH midwives joke that every birth on the British television show Call the Midwife requires about two minutes of labor before the baby arrives.

Back to work.

Here it comes. The baby’s head crowns, a perfect little yarmulke of jet-black hair. We’re ready to go. Troy gives the “Little breath, little breath, big push” order, and Bella does her best. A pause, and when Troy says so, Bella pushes again. Almost all of the head is out. Good, very good.

Troy asks for “One more big push.” Bella gives it. Then again. Then a pause. Then again. Then a push. Nothing. Bella is crying out now. Then she yells, “Spegni quella maladetta musica!”

“What’s she screaming?” asks Troy.

Bella’s husband translates. “She says ‘Turn off that damn music.’” Marco slaps the laptop closed. The Beatles are gone, but the baby is simply not moving out of Bella.

I put my fingers inside. As I feel around, I realize exactly what’s happening. I tell the assembled that “the baby’s shoulders are just too big for delivery.”

I ask for everyone except the husband and midwife team to leave the room. I urge Bella to extend her legs out from her body, which Marco and Troy help her with. Then we move her onto all fours. But after these less intrusive methods, the baby still won’t budge. I’ve got to perform a “significant” episiotomy. Just like before, nobody moves to leave, but I have more important things to do than police a crowd dispersal.

“Get them out, Troy,” I say. He opens the door. Friends and some family leave. The door closes. An unpleasant nervous silence falls over the room.

After Troy and Marco help Bella onto her back again, I begin cutting, carefully but quickly. Nothing’s moving except the scalpel. The baby’s shoulders are really wide. “Who have you got inside there? A Green Bay Packers linebacker?”

I cut as far as I can sensibly go. There’s some bleeding. I’m not worried, but we can’t cut any more.

“Call obstetrics and pediatrics,” I say, just short of yelling. “We’ve got shoulder dystocia.”

“What is dystocia?” Marco asks.

Troy has an answer for him. “The baby’s shoulders are stuck in your wife’s pelvis.”

Two minutes later Dr. Sarkar appears.

Chapter 66

Chapter 66

THE FIRST THING SARKAR says to me when he enters the room is this: “You’re in charge. I’m just here to help. That will be our understanding and the manner in which we will proceed.”

Somehow I believe him, I trust him. He is, after all, first and foremost a doctor, a doctor involved in one of doctoring’s most precious events. Of course he’s also a colleague and friend who failed to give me an honest update on Dr. Katz.