A flickering pressure-lamp was burning in the surgery. In the little passage leading to the delivery room Aksinya slipped past me carrying a basin. A faint moan came through the door and died away again. I opened the door and went into the delivery room. The small, whitewashed room was brightly lit by a lamp in the ceiling. On a bed alongside the operating table, covered with a blanket up to her chin, lay a young woman. Her face was contorted in a grimace of pain and wet strands of hair were sticking to her forehead. Holding a large thermometer, Anna Nikolaevna was preparing a solution in a graduated jug, while Pelagea Ivanovna was getting clean sheets out of the cupboard. The feldsher was leaning against the wall in a Napoleonic pose. Seeing me, they all jerked into life. The pregnant woman opened her eyes, wrung her hands and renewed her pathetic, long drawn-out groaning.

‘Well now, what seems to be the trouble?’ I asked, sounding confident.

‘Transverse lie,’ Anna Nikolaevna answered promptly as she went on pouring water into the solution.

‘I see-ee,’ I drawled, and added, frowning: ‘Well, let’s have a look …’

‘Aksinya! Wash the doctor’s hands!’ snapped Anna Nikolaevna. Her expression was solemn and serious.

As the water flowed, rinsing away the lather from my hands, reddened from scrubbing, I asked Anna Nikolaevna a few trivial questions, such as when the woman had been brought in, where she was from … Pelagea Ivanovna’s hand turned back the blanket, I sat down on the edge of the bed and began gently feeling the swollen belly. The woman groaned, stretched, dug her fingers into her flesh and crumpled the sheet.

‘There, there, relax … it won’t take long,’ I said as I carefully put my hands to the hot, dry, distended skin.

The fact was that once the experienced Anna Nikolaevna had told me what was wrong, this examination was quite pointless. I could examine the woman as much as I liked, but I would not find out any more than Anna Nikolaevna knew already. Her diagnosis was, of course, correct: transverse lie. It was obvious. Well, what next?

Frowning, I continued palpating the belly on all sides and glanced sidelong at the midwives’ faces. Both were watching with intense concentration and their looks registered approval of what I was doing. But although my movements were confident and correct, I did my best to conceal my unease as thoroughly as possible.

‘Very well,’ I said with a sigh, standing up from the bed, as there was nothing more to be seen from an external examination. ‘Let’s examine her internally.’

Another look of approval from Anna Nikolaevna.

‘Aksinya!’

More water flowed.

‘Oh, if only I could consult Döderlein now!’ I thought miserably as I soaped my hands. Alas, this was quite impossible. In any case, how could Döderlein help me at a moment like this? I washed off the thick lather and painted my fingers with iodine. A clean sheet rustled in Pelagea Ivanovna’s hands and, bending down over the expectant mother, I began cautiously and timidly to carry out an internal examination. Into my mind came an involuntary recollection of the operating theatre in the maternity hospital. Gleaming electric lights in frosted-glass globes, a shining tiled floor, taps and instruments a-glitter everywhere. A junior registrar in a snow-white coat is manipulating the woman, surrounded by three intern assistants, probationers, and a crowd of students doing their practicals. Everything bright, well ordered and safe.

And there was I, all on my own, with a woman in agony on my hands and I was responsible for her. I had no idea, however, what I was supposed to do to help her, because I had seen childbirth at close quarters only twice in my life in a hospital, and both occasions were completely normal. The fact that I was conducting an examination was of no value to me or to the woman; I understood absolutely nothing and could feel nothing of what was inside her.

It was time to make some sort of decision.

‘Transverse lie … since it’s a transverse lie I must … I must …’

‘Turn it round by the foot,’ muttered Anna Nikolaevna as though thinking aloud, unable to restrain herself.

An older, more experienced doctor would have looked askance at her for butting in, but I am not the kind to take offence.

‘Yes,’ I concurred gravely, ‘a podalic version.’

The pages of Döderlein flickered before my eyes. Internal method … Combined method … External method … Page after page, covered in illustrations.