“I can’t incise the episiotomy any larger, and it’s bleeding pretty significantly as it is,” I say, as if he couldn’t see this already.

“Let me take a closer look,” he says as he reaches down and pushes his way through the layers of bloody gauze. He turns to one of the midwife trainees and says, “I need a huge amount of pressure right where my hand is.”

He sees the frightened look on the young intern’s face and reacts. “For God’s sake, if you’re too nervous to do what you’re told, you’d better become a ballerina or a waitress.” I have never seen or heard Sarkar so angry or sarcastic before.

I say, “Let me do it.”

Then the intern says, “No, I’ll do it. Really. I can do it.”

“Very good,” says Sarkar. Then he turns to me and says, “What do you think? Should we get her in for a C-section?”

I have a strong opinion, and I don’t mind sharing it. “No. I’d rather try to get the baby out right now. How do you feel about a clavicular fracture?”

“I’ll do whatever you want. There are pluses and minuses for each approach.”

“Fracture, then,” I say.

In spite of the trainee’s intense pushing, the bleeding has not stopped much. Troy removes saturated gauze and replaces it with new gauze.

Sarkar scrubs and puts on gloves. Then he turns to Marco, Bella’s husband, and says, “Okay, here’s what we’re going to do. Since your baby’s shoulders are not coming out, and we cannot open your wife any farther, what we’re going to do is this: I will go in and gently break the baby’s collarbone.”

Sarkar correctly anticipates Marco’s shock at this information.

“Gently break the shoulder?” Marco says.

Sarkar responds calmly. “It sounds far worse than it actually is. I’ve done it before. The infant’s bones are very, very flexible. They’re not rigid and brittle like our bones. They’re rubbery. The collarbone may not even break. It may actually just bend.”

Now it’s my turn to act. I have three pages of consent forms that Marco must sign. The very fact that I have them and that they must be signed seems to contradict Sarkar’s reassurances. Marco signs them. As soon as Marco dots the i in Morabito, Sarkar turns and leans into Bella.

He places his hands just below the baby’s chin and then inserts his thumbs inside Bella. Sarkar pushes for a few seconds. Then he yells, “Push hard, madam. Big push. Big push.” Then he yells, “Done!”

The baby, a wrinkled, screaming boy with a full head of black hair, is delivered. Immediately Sarkar begins suturing Bella, who is crying and laughing and asking that the music be turned back on.

Sarkar looks at me and says, “Lucy, you’ll please finish the stitching.”