August tells the reader the story of his birth, prefacing it by saying that he and Via always laugh when Mom tells the story, even though the story itself isn't particularly funny. When Mom was pregnant, nobody knew what August looked like. Via had been an easy and perfect baby, so Mom and Dad declined any special testing. Two months before August was born, the doctors discovered what they thought was a cleft palate, but nothing serious.
The timeline of discovering August's conditions is in line with what's common for babies born with conditions like his—the only way to know for sure if a fetus has these conditions is to specifically test for them. Given how rare these conditions are, many parents choose not to go through with the testing. In this way, the condition isn’t apparent until after birth, much like other identity markers.
On the night of his birth, Mom had two nurses in the delivery room. One was nice, while the other one didn't seem nice at all—and she kept farting. Mom's regular doctor wasn't on duty, so she was assigned a cranky doctor. When August was finally born, the nice nurse whisked him away before Mom could see him. Dad followed, and in his hurry, dropped the video camera. The farting nurse held Mom down so she couldn't follow, and both of them began yelling for the doctor. The farting nurse then discovered that the doctor fainted right there on the floor, and she began scolding him for fainting. Finally, she farted loudly, which woke up the doctor.
As funny as August clearly seems to find the fact that his mom's doctor fainted, it's telling that the first person to see August couldn't stomach how he looked. These first looks are an important and major way that August watches others grapple with his outward identity, and he recognizes that while those first looks usually don't have such dramatic consequences as in the case of this doctor, they seriously inform how people perceive him going forward.
The farting nurse turned out to be very nice. She stayed with Mom for hours and was there when the doctors explained that August was very sick. The farting nurse even told Mom that all of God's children will overcome their circumstances. The next day, she held Mom's hand when they walked to meet August. Mom was struck by how beautiful August's eyes were.
Mom's changing perception of the farting nurse shows that getting to know someone on a deeper level can be far more fulfilling than fixating on easy-to-identify markers, especially since this woman seems to provide some of the best comfort to Mom during this time.