A pelvis; twisted, crushed babies with enormous heads … a little dangling arm with a loop on it.

Indeed I had read it not long ago and had underlined it, soaking up every word, mentally picturing the interrelationship of every part of the whole and every method. And as I read it I imagined that the entire text was being imprinted on my brain for ever.

Yet now only one sentence of it floated back into my memory:

‘A transverse lie is a wholly unfavourable position.’

Too true. Wholly unfavourable both for the woman and for a doctor who only qualified six months ago.

‘Very well, we’ll do it,’ I said as I stood up.

Anna Nikolaevna’s expression came to life.

‘Demyan Lukich,’ she turned to the feldsher, ‘get the chloroform ready.’

It was a good thing that she had said so, because I was still not certain whether the operation was supposed to be done under anaesthesia or not! Of course, under anaesthesia—how else?

Still, I must have a look at Döderlein …

As I washed my hands I said:

‘All right, then … prepare her for anaesthesia and make her comfortable. I’ll be back in a moment; I must just go to my room and fetch some cigarettes.’

‘Very good, doctor, we’ll be ready by the time you come back,’ replied Anna Nikolaevna.

I dried my hands, the nurse threw my coat over my shoulders and without putting my arms into the sleeves I set off for home at a run.

In my study I lit the lamp and, forgetting to take off my cap, rushed straight to the bookcase.

There it was—Döderlein’s Operative Obstetrics. I began hastily to leaf through the glossy pages.

‘… version is always a dangerous operation for the mother …’

A cold shiver ran down my spine.

‘The chief danger lies in the possibility of a spontaneous rupture of the uterus …’

Spon-tan-e-ous …

‘If in introducing his hand into the uterus the obstetrician encounters any hindrances to penetrating to the foot, whether from lack of space or as a result of a contraction of the uterine wall, he should refrain from further attempts to carry out the version …’

Good. Provided I am able, by some miracle, to recognise these ‘hindrances’ and I refrain from ‘further attempts’, what, might I ask, am I then supposed to do with an anaesthetised woman from the village of Dultsevo?

Further:

‘It is absolutely impermissible to attempt to reach the feet by penetrating behind the back of the foetus …’

Noted.

‘It must be regarded as erroneous to grasp the upper leg, as doing so may easily result in the foetus being revolved too far; this can cause the foetus to suffer a severe blow, which can have the most deplorable consequences …’

‘Deplorable consequences.’ Rather a vague phrase, but how sinister. What if the husband of the woman from Dultsevo is left a widower? I wiped the sweat from my brow, rallied my strength and disregarded all the terrible things that could go wrong, trying only to remember the absolute essentials: what I had to do, where and how to put my hands. But as I ran my eye over the lines of black print, I kept encountering new horrors. They leaped out at me from the page.

‘… in view of the extreme danger of rupture …’

‘… the internal and combined methods must be classified as among the most dangerous obstetric operations to which a mother can be subjected …’

And as a grand finale:

‘… with every hour of delay the danger increases …’

That was enough. My reading had borne fruit: my head was in a complete muddle. For a moment I was convinced that I understood nothing, and above all that I had no idea what sort of version I was going to perform: combined, bi-polar, internal, external …

I abandoned Döderlein and sank into an armchair, struggling to reduce my random thoughts to order. Then I glanced at my watch. Hell! I had already spent twenty minutes in my room, and they were waiting for me.

‘… with every hour of delay …’

Hours are made up of minutes, and at times like this the minutes fly past at insane speed. I threw Döderlein aside and ran back to the hospital.

Everything there was ready. The feldsher was standing over a little table preparing the anaesthetic mask and the chloroform bottle. The expectant mother already lay on the operating table. Her ceaseless moans could be heard all over the hospital.

‘There now, be brave,’ Pelagea Ivanovna muttered consolingly as she bent over the woman, ‘the doctor will help you in a moment.’

‘Oh, no! I haven’t the strength … No … I can’t stand it!’

‘Don’t be afraid,’ whispered the midwife. ‘You’ll stand it. We’ll just give you something to sniff, and then you won’t feel anything.’

Water gushed noisily from the taps as Anna Nikolaevna and I began washing and scrubbing our arms bared to the elbow. Against a background of groans and screams Anna Nikolaevna described to me how my predecessor, an experienced surgeon, had performed versions. I listened avidly to her, trying not to miss a single word. Those ten minutes told me more than everything I had read on obstetrics for my qualifying exams, in which I had actually passed the obstetrics paper ‘with distinction’. From her brief remarks, unfinished sentences and passing hints I learned the essentials which are not to be found in any textbooks. And by the time I had begun to dry the perfect whiteness and cleanliness of my hands with sterile gauze, I was seized with confidence and a firm and absolutely definite plan had formed in my mind. There was simply no need to bother any longer over whether it was to be a combined or bi-polar version.

None of these learned words meant anything at that moment. Only one thing mattered: I had to put one hand inside, assist the version with the other hand from outside and without relying on books but on common sense, without which no doctor is any good, carefully but firmly bring one foot downwards and pull the baby after it.

I had to be calm and cautious yet at the same time utterly decisive and unfaltering.

‘Right, off you go,’ I instructed the feldsher as I began painting my fingers with iodine.

At once Pelagea Ivanovna folded the woman’s arms and the feldsher clamped the mask over her agonised face. Chloroform slowly began to drip out of the dark yellow glass bottle, and the room started to fill with the sweet, nauseous odour. The expressions of the feldsher and midwives hardened with concentration, as though inspired …

‘Haaa! Ah!’ The woman suddenly shrieked. For a few seconds she writhed convulsively, trying to force away the mask.

‘Hold her!’

Pelagea Ivanovna seized her by the arms and lay across her chest. The woman cried out a few more times, jerking her face away from the mask.