As they got to the door, it popped open, and a fourth man,who’d been on the other end of the cell-phone call, let themthrough. The fourth man was tall and thin, dark-complected,with a black brush mustache. He wore a knee-length black raincoatthat he’d bought at a Goodwill store two days earlier, andblack pants. He scanned the parking structure, saw nothing moving,pulled the door shut, made sure of the lock.
“This way,” he snapped.
Inside, they moved fast, reducing their exposure, should someoneunexpectedly come along. No one should, at the ass-end ofthe hospital, at fifteen minutes after five o’clock on a bitterly coldwinter morning. They threaded through a maze of service corridorsuntil the tall man said, “Here.”
Here was a storage closet. He opened it with a key. Inside, a pileof blue, double-extra-large orderly uniforms sat on a medical cart.
The hard men dumped their coats on the floor and pulled theuniforms over their street clothes. Not a big disguise, but theyweren’t meant to be seen close-up—just enough to slip past avideo camera. One of them, the biggest one, hopped up on thecart, lay down and said, “Look, I’m dead,” and laughed at his joke.The tall man could smell the bourbon on the joker’s breath.
“Shut the fuck up,” said one of the others, but not in an unkindlyway.
The tall man said, “Don’t be stupid,” and there was nothingkind in his voice. When they were ready, they looked at eachother and the tall man pulled a white cotton blanket over the manon the cart, and one of the men said, “Let’s do it.”
“Check yourself . . .”
“We don’t hurt anyone,” the tall man said. The sentiment reflectednot compassion, but calculation: robbery got X amount ofattention, injuries got X-cubed.
“Yeah, yeah . . .” One of the men pulled a semiautomatic pistolfrom his belt, a heavy, blued, no-bullshit Beretta, stolen fromthe Army National Guard in Milwaukee, checked it, stuck it backin his belt. He said, “Okay? Everybody got his mask? Okay.Let’s go.”
They stuffed the ski masks into their belts and two hard menpushed the cart into the corridor. The tall man led them fartherthrough the narrow, tiled hallways, then said, “Here’s the camera.”
The two men pushing the cart turned sideways, as the tall mantold them to, and went through a cross-corridor. A security camerapeered down the hall at them. If a guard happened to belooking at the monitor at that moment, he would have seen onlythe backs of two orderlies, and a lump on the cart. The tall manin the raincoat scrambled along, on his hands and knees, on thefar side of the cart.
The big man on the cart, looking at the ceiling tiles go by,giggled, “It’s like ridin’ the Tilt-A-Whirl.”
When they were out of the camera’s sight line, the tall manstood up and led them deeper into the hospital—the three outsiderswould never have found the way by themselves. After twominutes, the tall man handed one of the outsiders a key, indicateda yellow steel door, with no identification.
“This is it?” The leader of the three was skeptical—the doorlooked like nothing.
“Yes,” said the tall man. “This is the side door. When you goin, you’ll be right among them. One or two. The front door andservice window is closed until six. I’ll be around the corner untilyou call, watching.”
He’d be around the corner where he could slip out of sight, ifsomething went wrong.
The other man nodded, asked, “Everybody ready?” The othertwo muttered, “Yeah,” tense now, pulled on the masks, took theirpistols out. The leader put the key in the lock and yanked openthe door.
Weather Karkinnen had taken a half-pill at nine o’clock, knowingthat she wouldn’t sleep without it. Too much to do, too muchto think about. The procedure had been researched, rehearsed,debated, and undoubtedly prayed over. Now the time had come.
Sleep came hard. She kept imagining that first moment, thefirst cut, the commitment, the parting of the flesh beneaththe edge of her scalpel, on a nearly circular path between theskulls of the two babies—but sometime before nine-thirty, sheslip ped away.
She didn’t feel her husband come to bed at one o’clock in themorning. He took care not to disturb her, undressing in the dark,lying as unmoving as he could, listening to her breathing, untilhe, too, slipped away.
And then her eyes opened.
Pop.
Dark, not quite silent—the furnace running in the winternight. She lifted her head to the clock. Four-thirty. She’d beenasleep for seven hours. Eight would have been the theoreticalideal, but she never slept eight. She closed her eyes again, organizingherself, stepping through the upcoming day. At twenty minutesto five, she got out of bed, stretched, and headed to theen suite bathroom, checking herself: she felt sharp. Excellent. Shebrushed her teeth, showered, washed and dried her short-cutblond hair.
She’d laid out her clothes the night before. She walked acrossthe bedroom barefoot, in the light of the two digital clocks, pickedthem up: a thick black-silk jersey and gray wool slacks, and dressy,black-leather square-toed shoes. She would have preferred towear soft-soled cross-training shoes, like the nurses did, but surgeonsdidn’t dress like nurses. She’d never even told anyone aboutthe gel innersoles.
She carried her clothes back to the bathroom, shut the door,turned on the light again, and dressed. When she was ready, shelooked at herself in the mirror. Not bad.
Weather might have wished to have been a little taller, for theauthority given by height; she might have wished for a chiselednose. But her husband pointed out that she’d never had a problemgiving orders, or having them followed; and that he thought hernose, which she saw as lumpy, was devastatingly attractive, andthat any number of men had chased after her, nose and all.
So, not bad.
She grinned at herself, turned to make sure the slacks didn’tmake her ass look fat—they didn’t—switched off the light, openedthe bathroom door and tiptoed across the bedroom. Her husbandsaid, in the dark, “Good luck, babe.”
“I didn’t know you were awake.”
“I’m probably more nervous than you are,” he said.
She went back to the bed and kissed him on the forehead. “Goback to sleep.”
Downstairs in the kitchen, she had two pieces of toast, a cupof instant coffee, and a yogurt, got her bag, went out to the car,backed out of the garage, and headed downtown, on the snowystreets, across the river to the Minnesota Medical Research Center.She might be first in, she thought, but maybe not: there wereforty people on the surgical team. Somebody had to be more nervousthan she was.
At the hospital, the yellow door popped open and the threebig men swarmed through.
Two people were working in the pharmacy—a short, slender,older man, who might once in the sixties have been a dancer, butno longer had the muscle tone. He wore a scuzzy beard on hischeeks, a soul patch under his lower lip. First thing, when he cameto work, he tied a paper surgeon’s cap on his head, for the rushhe got when people looked at him in the cafeteria. The otherperson was a busy, intent, heavyset woman in a nurse’s uniform,who did the end-of-shift inventory, making sure it was all there,the stacks and rows and lockers full of drugs.
Some of it, put on the street, was worthless. Nobody paysstreet prices to cure the heartbreak of psoriasis.
Most of it, put on the street—on more than one street, actually;there was the old-age street, the uninsured street, the junkiestreet—was worth a lot. Half-million dollars? A million? Maybe.
The three hard men burst through the door and were on topof the two pharmacy workers in a half-second. The woman hadenough time to whimper, “Don’t,” before one of the men pushedher to the floor, gun in her face, so close she could smell the oilon it, and said, “Shutta fuck up. Shut up.” Soul-patch huddled intoa corner with his hands up, then sank to his butt.
The leader of the three waved a pistol at the two on the floorand said, “Flat on the floor. Roll over, put your hands behind yourback. We don’t want to hurt you.”
The two did, and another of the men hurriedly taped theirhands behind them with gray duct tape, and then bound their feettogether. That done, he tore off short strips of tape and pastedthem over the victims’ eyes, and then their mouths.
He stood up: “Okay.”
The leader pushed the door open again and signaled with afingertip. The tall man stepped in from the hallway, said, “These,”and pointed at a series of locked, glass-doored cupboards. And,“Over here . . .”
A row of metal-covered lockers. The leader of the big menwent to the man on the floor, who looked more ineffectual thanthe woman, and ripped the tape from his mouth.
“Where are the keys?” For one second, the man on the floorseemed inclined to prevaricate, so the big man dropped to hisknees and said, “If you don’t tell me this minute, I will break yourfuckin’ skull as an example. Then you will be dead, and I will askthe fat chick.”
“In the drawer under the telephone,” Soul-patch said.
“Good answer.”
As the big man retaped Soul-patch’s mouth, the tall man gotthe keys and began popping open the lockers. All kinds of goodstuff here, every opiate and man-made opiate except heroin;lots of hot-rock stimulants, worth a fortune with the big-namelabels.
“Got enough Viagra to stock a whorehouse,” one of the mengrunted.
Another one: “Take this Tamiflu shit?”
“Fifty bucks a box in California . . . Take it.”
Five minutes of fast work, the tall man pointing them at thegood stuff, sorting out the bad.
Then the old guy on the floor made a peculiar wiggle.
One of the holdup men happened to see it, frowned, thenwent over, half-rolled him. The old guy’s hands were loose—he’dpulled one out of the tape, had had a cell phone in a belt clipunder his sweater, had worked it loose, and had been trying tomake a call. The big man grunted and looked at the face of thephone. One number had been pressed successfully: a nine.
“Sonofabitch was trying to call nine-one-one,” he said, holdingup the phone to the others. The old man tried to roll away, butthe man who’d taken the phone punted him in the back once,twice, three times, kicking hard with steel-toed work boots.
“Sonofabitch . . . sonofabitch.” The boot hit with the sound ofa meat hammer striking a steak.
“Let him be,” the leader said after the third kick.
But the old man had rolled back toward his tormentor andgrasped him by the ankle, and the guy tried to shake him looseand the old man moaned something against the tape and held on,his fingernails raking the big guy’s calf.
“Let go of me, you old fuck.” The guy shook him off his legand kicked him again, hard, in the chest.
The leader said, “Quit screwing around. Tape him up againand let’s get this stuff out of here.”
The old man, his hands taped again, was still groaning as theyloaded the bags. That done, they went to the door, glanced downthe hallway. All clear. The bags went under the blanket on the cart,and the three big men pushed the cart past the security-cameraintersection, back through the rabbit warren to the utility closet,replaced the orderly uniforms with their winter coats, picked upthe bags.
The leader said, “Gotta move, now. Gotta move. Don’t knowhow much time we got.”
Another of the men said, “Shooter—dropped your glove.”
“Ah, man, don’t need that.” He picked it up, and the tall manled them out, his heart thumping against his rib cage. Almost out.When they could see the security door, he stopped, and they wenton and out. The tall man watched until the door re-latched,turned, and headed back into the complex.
There were no cameras looking at the security door, or betweenthe door and their van. The hard men hustled through thecold, threw the nylon bags in the back, and one of them climbedin with them, behind tinted windows, while the leader took thewheel and the big man climbed in the passenger seat.
“Goddamn, we did it,” said the passenger. He felt under hisseat, found a paper bag with a bottle of bourbon in it. He wasunscrewing the top as they rolled down the ramp; an Audi A5convertible, moving too fast, swept across the front of the vanand caught the passenger, mouth open, who squinted against thelight. For just a moment, he was face-to-face with a blond woman,who then swung past them into the garage.
“Goddamnit!”
The leader braked and looked back, but the A5 had alreadyturned up the next level on the ramp. He thought they might turnaround and find the woman . . . but then what? Kill her?
“She see you guys?” asked the man in the back, who’d seenonly the flash of the woman’s face.
The guy with the bottle said, “She was looking right at me.Goddamnit.”
“Nothing to do,” the leader said. “Nothing to do. Get out ofsight. Shit, it was only one second . . .”
And they went on.
Weather had seen the man with the bottle, but paid no attention.Too much going through her head. She went on to the physicians’parking, got a spot close to the door, parked, and hurriedinside.
The tall man got back to the utility closet, pulled off the raincoatand pants, which he’d used to conceal his physician’s scrubs: ifthey’d been seen in the hallway, the three big men with a doc,somebody would have remembered. He gathered up the scrubsabandoned by the big men, stuffed them in a gym bag, along withthe raincoat and pants, took a moment to catch his breath, toneaten up.
Listened, heard nothing. Turned off the closet light, peekedinto the empty hallway, then strode off, a circuitous route, avoidingcameras, to an elevator. Pushed the button, waited impatiently.
When the door opened, he found a short, attractive blondwoman inside, who nodded at him. He nodded back, poked “1,”and they started down, standing a polite distance apart, with justthe trifle of awkwardness of a single man and a single woman,unacquainted, in an elevator.
The woman said, after a few seconds, “Still hard to come towork in the dark.”
“Can’t wait for summer,” the tall man said. They got to “2,”and she stepped off and said, “Summer always comes,” and shewas gone.
Weather thought, as she walked away from the elevator, Nopoint looking at the kids. They’d be asleep in the temporary ICUthey’d set up down the hall from the operating room. She wentinstead to the locker room and traded her street clothes for surgicalscrubs. Another woman came in, and Weather nodded toher and the other woman asked, “Couldn’t sleep?”
“Got a few hours,” Weather said. “Are we the only two here?”
The woman, a radiologist named Regan, laughed: “No. John’sgot the doll on the table and he’s talking about making somechanges to the table, for God’s sakes. Rick’s here, he’s messingwith his saws. Gabriel was down in the ICU, he just got here, he’scomplaining about the cold. A bunch of nurses . . .”
“Nerves,” Weather said. “See you down there.”
She was cool in her scrubs, but comfortably so: she’d beendoing this for nearly fifteen years, and the smell of a hospital, thealcohol, the cleaners, even the odor of burning blood, smelledlike fresh air to her.
No point in looking at the kids, but she’d do it anyway. Therewere two nurses outside the temporary ICU, and they noddedand asked quietly, “Are you going in?”
“Just a peek.”
“They’ve been quiet,” one of the nurses said. “Dr. Maretjust left.”
Moving as silently as she could, in the semi-dark, she movednext to the babies’ special bed. When you didn’t look closely, theylooked like any other toddlers, who happened to be sleepinghead-to-head; small hands across their chests, eyes softly closed,small chests rising up and down. The first irregularity that avisitor might notice was the ridges in their skulls: Weather hadplaced a series of skin expanders under their scalps, to increasethe amount of skin available to cover the skull defects—theholes—when they were separated.
There was really no need for her to look at them: she simplywanted to. Two babies, innocent, silent, feeling no pain; theirworld was about to change. She watched them for a minute. Theone named Ellen sighed, and one foot moved, and then she subsidedagain.
Weather tiptoed out.
The old man in the pharmacy was moaning, the woman tryingto talk, and the old man heard the woman fall down against a chair,after trying to get up, and then somebody was rapping at the servicewindow and they both tried to scream, and they were loud butmuffled. He was chewing at the duct tape on his mouth, and finallyit came loose from one side and he spat it away from his face.
“Dorothy, can you hear me?”
A muffled “Yes.”
“I think I’m hurt bad. If I don’t make it, tell the police that Iscratched one of the robbers. I should have blood on my hand.”She replied, but the reply was unintelligible. He’d been workingon the tape on his wrists, and eventually pulled one free . . .He tried to get up, but was too weak. He couldn’t orient himself;nothing seemed to be working. He fumbled at the tape over hiseyes, failed to get it free, moaned, moaned . . .
More time went by and the old man felt himself going dark;didn’t know what was happening, but his heart was pounding andhe told himself, calm down, calm down. He’d had heart and circulatoryproblems, clots, and he didn’t need a clot breaking free,but his heart was pounding and he was sweating and somethingwas going more wrong than it should be, more wrong than rollingaround on a tile floor gagged and blinded and beaten. Hurt bad.
Then the door rattled and he shouted and he heard an answeringshout, and he shouted again and Dorothy tried to screamthrough her gag, and some time later the door rattled again, andhe heard it open, and somebody cried out, and then more peoplewere there.
He blacked out for a moment, then came back, realized he wason a gurney, that they’d put a board on him, they were movingdown a hallway. Somebody said, a few inches from his face, “We’removing you down to the ER, we’re moving you.”
He said, as loud as he could as the world faded, “I scratchedhim. I scratched him. Tell the police, I scratched him . . .”
The operating room had been reworked for the separationoperation. Maret had stripped out all the general surgery stuff,put in more lights, brought in the custom table. The table hadbeen made in Germany, and lined with a magic memory foamthat would adapt to the kids as their bodies were moved this wayand that.
Sara and Ellen Raynes were joined at the skull, vertically, butslightly turned from each other. If an observer was standing atSara’s feet, looking at her face, and Sara was looking straight up,then Ellen’s face was upside down and rotated to the observer’sleft. Imaging studies, done by Regan and her associates, indicatedthat their brains were separate, but they shared a portion of thedura mater under the skull, a kind of fibrous lining that protectedand facilitated the drainage of venous blood from the brain.
The incoming blood in the arterial system was good in bothbabies; but if the blood couldn’t be drained away, and recirculated,it would put increasing pressure on the brains, eventuallykilling them.
Sara and Ellen were eighteen months old. Their parents hadknown the babies were conjoined before birth. The option ofabortion had been proposed but rejected by the parents, Lucy andLarry Raynes, for religious and emotional reasons. The childrenhad been delivered by cesarean section at seven and a half months.Sara had been born with a congenital heart defect, which furthercomplicated matters.
Weather pushed into the OR and found three surgeons workingwith the baby doll—a life-sized, actual-weight dense-foammodel of the Raynes twins. They had it on the table and wererolling it against the foam.
“So . . . no change,” Gabriel Maret said.
Maret was a short man, with a head slightly too large for hisbody, the size emphasized by a wild thatch of curly black hair,shot through with silver. He was dark-eyed, olive-complected,with a chipped front tooth. He favored cashmere in his carefullytailored, French-cut winter suits, and the women around thehospital paid close attention to him: he was French, and the observingwomen agreed that his accent, in English, was perfect.
Maret had come to dinner with Lucas and Weather every weekor so over the winter, enjoying the kids and the family life. He wasdivorced, with four children of his own. He and his wife still sharedan apartment in Paris, and, sometimes, he said, a bed. “It’s insane,”he said. “She is more stubborn than one of your mules.”
“More stubborn than you?” Weather had asked.
He considered the question: “Maybe not that stubborn,”he said.
He and her husband, Lucas, who got along improbably well,once spent an hour talking about men’s fashion, nearly drivingWeather crazy with the inanity of it. She’d said, “Fifteen minuteson loafers? Loafers?”
“We were just getting started,” Lucas said. She wasn’t sure hewas joking.
“So . . . no change,” Maret said.
“Not as long as everything goes right,” said John Dansk, a neurosurgeon.
“If we run into trouble splicing the six vein, if we loseit, we may have to take out another piece and that means rollingSara this way and Ellen will torque back to the right.”The six vein was a vein shared by the twins. They’d tie it offon Ellen’s side, and attempt to splice it into the five vein on Sara’s,the better to move blood out of Sara’s brain. The vein numberssimply came from imaging charts prepared by the radiologists.
“So what are you suggesting?” Maret asked. He glanced atWeather: “You are gorgeous this morning.”
“I know,” she said, to make him laugh. As did the other womenaround him, she liked to make him laugh.
Dansk scowled at them and said, “I’m suggesting that we slicea few wedges out of the base of the mold, so that we can usethem as shims if we have to brace one of the kids.”
“Why not have a nurse hold her?” Maret asked.
“Because we might be talking a couple hours, if worse comesto worse.”
“You know how much that mold cost?” Maret asked.
“About one nine-thousandth of your annual salary,” Dansk said.
Maret shrugged. “So, we cut a few wedges. Why not? If weneed them, we have them, and if we don’t, it won’t matter.”
“Should have thought of this before now,” said Rick Hanson,an orthopedic surgeon who would make the bone cuts throughthe kids’ shared skull. He seemed shaky; he’d invented a halfdozenlittle saws for this operation and would be the focus of alot of attention. Because of the way the children’s skulls intersected,they formed a complex three-dimensional jigsaw puzzle—basically, an oval ring of bone—of which he’d be removing onlya few pieces at a time. Normally the cutting would have beendone by the neurosurgeon, with drills and flexible wire saws.Hanson, from Washington University in St. Louis, had developedhis own set of electric saws matched to jigs—cutting templates—for complicated bone cuts. Maret had decided that Hanson’s techniquewould be ideal, and would make it possible to prepareperfectly fitted composite plates to cover the holes in the babies’skulls.
“We’re just nervous,” Maret said now. “That’s normal.” Maretwas the team leader, the one with all the experience. He’d donetwo other craniopagus separations, one in France, one in Miami.Of the four children involved, two had survived—one from eachoperation. When he talked about the work, he talked mostlyabout the children who’d died.
Another doc pushed into the room, followed by a secondone. They had all kinds—anesthesiologists, radiologists, neurosurgeons,cardiologists, plastic and orthopedic surgeons, and amedical professor who specialized in anatomical structures of theskull, as it pertained to craniofacial reconstruction. They hadtwenty nurses and surgical assistants.
Weather said to Dansk, the neurosurgeon, “If you want to cutthose wedges, you better get it done: they’ve got to start cleaningthe place up.”
Dansk said, “I’m on it,” and, “I need a scalpel or something.Anybody got an X-Acto knife?”
Above the table, in an observation room behind a canted glasswall, people were beginning to filter into the stadium seating.
A nurse came into the OR—one of the sterile nurses—and said,“I wanted to see if we could make the move one more time.”
She wanted to practice breaking the tables apart, so that whenthe final cut was made, and the twins were separated, they couldbe moved to separate operating areas for the fitting of the newcomposite skull shells.
“Why don’t we visually check the linkage . . .” Maret began.
It was starting; Weather didn’t think it, but she felt it, felt theexcitement and the tension starting to build. She worked almostevery day, cutting, sewing, cauterizing, diagnosing. This wasdifferent.
She thought, Remember to pee.
The Raynes twins were a rare and complicated medicalphenomenon. Craniopagus twins comprise only about one percentof conjoined twins. Because of the rarity of the condition,ex perience with separation surgery was limited. One of thetwins, Sara, suffered from defects in the septum of the heart—thewall that divides the right side of the heart from the left side—and the defects were already causing congestion in the circulatorysystem.
The type of surgery usually favored for craniopagus separationmight take place over several months. The most critical partof most operations was doing a staged separation of the brain’sblood-drainage system. Each operation would isolate the drainagesystems a bit more, and would allow the bodies to create newbypass channels.
In the Rayneses’ case, surgeons feared that a protracted seriesof operations would weaken and possibly kill Sara, which wouldalso threaten the stronger Ellen, especially if Sara were to go intoa rapid decline.
The additional factor in the Rayneses’ case was that the conjoinedarea was relatively small—the hole left behind in the babies’skulls after the separation would be no bigger than thediameter of an orange. That meant that a single operation waspossible—even with some shared venous drainage, it was thoughtthat one continuous operation would be the best chance for savingboth twins.
The surgical team would do the separation, and once separated,the team would break in two, each working on an individualtwin. The joint surgery was expected to last up to twenty hours.
The team was committed to saving both twins.Weather did aesthetic, reconstructive, and microsurgery.Her availability in Minnesota, and a paper she’d done on a thumbreconstruction, had caught Maret’s eye when he began to considerthe Raynes twins.
In Weather’s case, a young boy had caught his thumb in a hydrauliclog-splitter: the thumb had been pulped. After the woundhealed, Weather had removed one of the boy’s second toes, andused the toe to replace the thumb. Since a thumb represents a fullfifty percent of the function of the hand, the reconstruction gaveback the kid the use of his hand. As he used the new thumb, itwould strengthen and grow, and eventually come to resemble anormal thumb, except for the extra knuckle.
As part of the eleven-hour operation, Weather had hooked uptwo nerves, two tiny arteries, and two even smaller veins—veinsthe size of broom straws. The photomicrographs of the suturedveins had particularly attracted Maret’s attention. The more veinsthat could be hooked up, the better off the twins would be—andWeather could do that work, even on the smallest vessels.
He’d also been attracted to her sheer stamina: eleven hours ofmicrosurgery was a super-marathon. He sold her on the idea ofjoining the team, which also made her available to study thetwins, to get to know the parents, and to place the skin expandersunder their scalps.
Weather had turned away from Maret and the argument—Remember to pee—when they heard a commotion outside the operatingroom.
“What is that?” Maret asked. Dansk had just come back witha large scalpel, and he turned to look. A few seconds later, ananesthesiologist named Yamaguchi burst into the room. Helooked, Weather thought, like someone who’d just come to theemergency room to see his child: panicked.
He said, urgently, to Maret, Weather, and the others, “It’s off.The operation’s off. We’ve got, we’ve got . . .”
Weather caught his sleeve and said, “Slow down, slow down.”
“It’s off,” Yamaguchi said. “Some guys just raided the pharmacyand cleaned the place out. Everything is shut down.Everything.”
Maret’s face clicked through a series of expressions, from “Isthis a joke?” to astonishment: “What?”
“Some guys with guns,” Yamaguchi said. He was flapping hisarms, like a loon trying to take off. “Robbers. They robbed thepharmacy. The police are here. There’s nothing left, they tookeverything . . . That old guy who works there, the one who wearsthe surgical hat . . .”
“Don,” said Weather.
“Yeah, Don—he’s hurt pretty bad. They’re taking him intothe ER.”
“You must be shitting me,” Maret said with a non-Gallic precision,looking around at his astonished crew.
Alain Barakat stood at the back of the emergency operatingroom, mask dangling around his neck, watching the work: thesurgeon was cursing at the nurse, who was fumbling the gear, andthey were all watching the blood pressure on the old man droppingand the surgeon was saying, “Get it in there, get it in there,get some pressure on it,” and the nurse stood on a chair and liftedthe bottle of saline and somebody else said, “Two minutes for theblood.” The surgeon said, “I don’t think we have the time, I don’tthink we’ve got it . . .” and the anesthesiologist said, “We’re losinghim, man,” and the doc said, “Fuck this, I’m going in,” and he cutand cut again and again, going in through the beginning of abrutal black bruise on the old man’s belly, and the anesthesiologistsaid, “Hurry it up, man,” and the surgeon said, “Ah, Jesus, I’ve gotno blood, I got no blood here,” and he hurled the scalpel into acorner and it clanged around and he said, “It must’ve been hisgoddamn kidneys. Let’s see if we can roll him,” and the nursesmoved up to help with the roll and the anesthesiologist said,“Man, he’s arresting.”
Barakat, standing in the corner, said, “Shit shit shit shitshit shit . . .”
One minute later, the old man was gone. No point in trying torestart the heart—there was no blood going through it. They allstood around, shell-shocked, and then the surgeon said, “Let’sclean up.”
One of the nurses said, “We had no time. He was going tooquick.”
They all looked at the body on the table, worn Adidas sneakerspointed out at forty-five degrees, chest flat and still, the bloodygash on the gut. The anesthesiologist turned to get somethingand saw Barakat, a tall man, standing in the corner, hands pressedto the sides of his head, and the anesthesiologist said, “Wasn’tyou, man. You did good. Everybody did good. He was gone whenwe got him.”
And Barakat thought: Now everybody will be here. Now the policewill tear the place apart.
Because he really didn’t care about the old man.
The separation team was standing around, repeating whatYamaguchi had said, when Thomas Carlson, the hospital administrator,came hurrying down the hall. Carlson was wearing hiswhite physician’s coat, which he often did on public occasions, toremind people that he had an MD in addition to the MBA; but forall that, not a bad guy, Weather thought.
He went straight to Maret: “Gabe, you’ve heard.”
“I’ve heard there was a robbery.”
“Unfortunately. The problem is, we’ve also got a man down.He’s hurt pretty badly, and we won’t have access to your drugs—any drugs, except in an absolute emergency, and then we’ll becrawling around on the floor trying to find them. The place iscompletely wrecked. They threw everything out of the lockers,what they didn’t take.”
“So: everybody is here,” Maret said.
“But you’re going to have to wait,” Carlson said. “God, I’msorry, man. But this is an incredible mess. As long as the kids arestable . . .”
Maret nodded: “Well. I guess we can wait.”
Weather and Maret went together to tell the Rayneses. Theparents were waiting in what the team called the “separationlounge,” once a meditation room, which had been converted forfamily use and for team conferences.
The Rayneses were sitting on a couch, looking out over atable full of magazines: neither one was reading. They were intheir early thirties, and except for their sex, as alike as new marbles:honey-blond, tall, slender, from the small town of New Ulmin southern Minnesota. Larry worked in a heating and airconditioningbusiness owned by his father; Lucy worked at thepost office. Neither had lived outside of New Ulm. Both of themspoke fluent German, and went to Germany every summer, tohike. They had no other children.
They’d conferred with Maret on the separation process, buthad worked more with Weather than any other physician, becauseof Weather’s involvement in the preliminary surgery.
They were astonished by the news. “What does it mean? It’soff ? For how long?” Lucy Raynes blurted. “I mean . . . ?”
“We’ll go tomorrow,” Weather said, patting her arm. “Sametime. This whole thing is so bizarre . . . there are police everywhere,I guess. The girls are fine, no change for them.”
“I can’t believe it,” Larry Raynes said. “After we got thisfar . . .”
His wife put an arm around his waist and squeezed him: “We’llbe okay. It’ll be all right.”
Of the two Rayneses, Lucy was the most demanding of information,had studied the details of the separation, used terms like“superior sagittal sinus” and “calvaria,” read medical papers onother separations. She’d spoken to the media on a number of occasions,both televised and print. Larry, on the other hand, mostlytalked about timing, and the children’s development, and often,to Weather, seemed to simply want to get it over with. He wasn’tstupid, but swept along in a current too strong for him, partmedical science, part circus. He wanted to go home.
Maret had warned everybody about the circus. “Wheneverthis is done, we get the media, because of the drama and thesympathetic aspects. You have to be prepared. In Miami, we hadreporters following the surgeons home, knocking on doors, waitingin the streets.”
Now he said to the Rayneses, “I’ll talk to the media in tenminutes or so. I’d like you to be with me.”
Larry Raynes said to his wife, “You go. I’ll go sit with thekids.”
Weather left them talking, and went back to the locker roomto change back into her street clothes.
By the time she got back, most of the team had drifted away.The OR nurses were shutting the place down. Weather stoppedto talk with her surgical assistant, when one of the team’s cardiologists,Alan Seitz, who’d been called to the ER, came amblingdown the hall, looking distracted. “What?” Weather asked.
“That Don guy died,” Seitz said. “One of the robbers kickedhim to death. Broke up his kidneys. He was soaked in Coumadin.He bled out before we could get anything going. We were dumpingfluid into him fast as we could, nothing to do.”
Weather stepped up and gave him a squeeze. Seitz was an oldfriend. “Nothing to do. You only do what you can.”
“Yeah.” Seitz looked around and said, “I mean, Jesus Christ:kicked to death. In the hospital.”
As they got to the door, it popped open, and a fourth man,who’d been on the other end of the cell-phone call, let themthrough. The fourth man was tall and thin, dark-complected,with a black brush mustache. He wore a knee-length black raincoatthat he’d bought at a Goodwill store two days earlier, andblack pants. He scanned the parking structure, saw nothing moving,pulled the door shut, made sure of the lock.
“This way,” he snapped.
Inside, they moved fast, reducing their exposure, should someoneunexpectedly come along. No one should, at the ass-end ofthe hospital, at fifteen minutes after five o’clock on a bitterly coldwinter morning. They threaded through a maze of service corridorsuntil the tall man said, “Here.”
Here was a storage closet. He opened it with a key. Inside, a pileof blue, double-extra-large orderly uniforms sat on a medical cart.
The hard men dumped their coats on the floor and pulled theuniforms over their street clothes. Not a big disguise, but theyweren’t meant to be seen close-up—just enough to slip past avideo camera. One of them, the biggest one, hopped up on thecart, lay down and said, “Look, I’m dead,” and laughed at his joke.The tall man could smell the bourbon on the joker’s breath.
“Shut the fuck up,” said one of the others, but not in an unkindlyway.
The tall man said, “Don’t be stupid,” and there was nothingkind in his voice. When they were ready, they looked at eachother and the tall man pulled a white cotton blanket over the manon the cart, and one of the men said, “Let’s do it.”
“Check yourself . . .”
“We don’t hurt anyone,” the tall man said. The sentiment reflectednot compassion, but calculation: robbery got X amount ofattention, injuries got X-cubed.
“Yeah, yeah . . .” One of the men pulled a semiautomatic pistolfrom his belt, a heavy, blued, no-bullshit Beretta, stolen fromthe Army National Guard in Milwaukee, checked it, stuck it backin his belt. He said, “Okay? Everybody got his mask? Okay.Let’s go.”
They stuffed the ski masks into their belts and two hard menpushed the cart into the corridor. The tall man led them fartherthrough the narrow, tiled hallways, then said, “Here’s the camera.”
The two men pushing the cart turned sideways, as the tall mantold them to, and went through a cross-corridor. A security camerapeered down the hall at them. If a guard happened to belooking at the monitor at that moment, he would have seen onlythe backs of two orderlies, and a lump on the cart. The tall manin the raincoat scrambled along, on his hands and knees, on thefar side of the cart.
The big man on the cart, looking at the ceiling tiles go by,giggled, “It’s like ridin’ the Tilt-A-Whirl.”
When they were out of the camera’s sight line, the tall manstood up and led them deeper into the hospital—the three outsiderswould never have found the way by themselves. After twominutes, the tall man handed one of the outsiders a key, indicateda yellow steel door, with no identification.
“This is it?” The leader of the three was skeptical—the doorlooked like nothing.
“Yes,” said the tall man. “This is the side door. When you goin, you’ll be right among them. One or two. The front door andservice window is closed until six. I’ll be around the corner untilyou call, watching.”
He’d be around the corner where he could slip out of sight, ifsomething went wrong.
The other man nodded, asked, “Everybody ready?” The othertwo muttered, “Yeah,” tense now, pulled on the masks, took theirpistols out. The leader put the key in the lock and yanked openthe door.
Weather Karkinnen had taken a half-pill at nine o’clock, knowingthat she wouldn’t sleep without it. Too much to do, too muchto think about. The procedure had been researched, rehearsed,debated, and undoubtedly prayed over. Now the time had come.
Sleep came hard. She kept imagining that first moment, thefirst cut, the commitment, the parting of the flesh beneaththe edge of her scalpel, on a nearly circular path between theskulls of the two babies—but sometime before nine-thirty, sheslip ped away.
She didn’t feel her husband come to bed at one o’clock in themorning. He took care not to disturb her, undressing in the dark,lying as unmoving as he could, listening to her breathing, untilhe, too, slipped away.
And then her eyes opened.
Pop.
Dark, not quite silent—the furnace running in the winternight. She lifted her head to the clock. Four-thirty. She’d beenasleep for seven hours. Eight would have been the theoreticalideal, but she never slept eight. She closed her eyes again, organizingherself, stepping through the upcoming day. At twenty minutesto five, she got out of bed, stretched, and headed to theen suite bathroom, checking herself: she felt sharp. Excellent. Shebrushed her teeth, showered, washed and dried her short-cutblond hair.
She’d laid out her clothes the night before. She walked acrossthe bedroom barefoot, in the light of the two digital clocks, pickedthem up: a thick black-silk jersey and gray wool slacks, and dressy,black-leather square-toed shoes. She would have preferred towear soft-soled cross-training shoes, like the nurses did, but surgeonsdidn’t dress like nurses. She’d never even told anyone aboutthe gel innersoles.
She carried her clothes back to the bathroom, shut the door,turned on the light again, and dressed. When she was ready, shelooked at herself in the mirror. Not bad.
Weather might have wished to have been a little taller, for theauthority given by height; she might have wished for a chiselednose. But her husband pointed out that she’d never had a problemgiving orders, or having them followed; and that he thought hernose, which she saw as lumpy, was devastatingly attractive, andthat any number of men had chased after her, nose and all.
So, not bad.
She grinned at herself, turned to make sure the slacks didn’tmake her ass look fat—they didn’t—switched off the light, openedthe bathroom door and tiptoed across the bedroom. Her husbandsaid, in the dark, “Good luck, babe.”
“I didn’t know you were awake.”
“I’m probably more nervous than you are,” he said.
She went back to the bed and kissed him on the forehead. “Goback to sleep.”
Downstairs in the kitchen, she had two pieces of toast, a cupof instant coffee, and a yogurt, got her bag, went out to the car,backed out of the garage, and headed downtown, on the snowystreets, across the river to the Minnesota Medical Research Center.She might be first in, she thought, but maybe not: there wereforty people on the surgical team. Somebody had to be more nervousthan she was.
At the hospital, the yellow door popped open and the threebig men swarmed through.
Two people were working in the pharmacy—a short, slender,older man, who might once in the sixties have been a dancer, butno longer had the muscle tone. He wore a scuzzy beard on hischeeks, a soul patch under his lower lip. First thing, when he cameto work, he tied a paper surgeon’s cap on his head, for the rushhe got when people looked at him in the cafeteria. The otherperson was a busy, intent, heavyset woman in a nurse’s uniform,who did the end-of-shift inventory, making sure it was all there,the stacks and rows and lockers full of drugs.
Some of it, put on the street, was worthless. Nobody paysstreet prices to cure the heartbreak of psoriasis.
Most of it, put on the street—on more than one street, actually;there was the old-age street, the uninsured street, the junkiestreet—was worth a lot. Half-million dollars? A million? Maybe.
The three hard men burst through the door and were on topof the two pharmacy workers in a half-second. The woman hadenough time to whimper, “Don’t,” before one of the men pushedher to the floor, gun in her face, so close she could smell the oilon it, and said, “Shutta fuck up. Shut up.” Soul-patch huddled intoa corner with his hands up, then sank to his butt.
The leader of the three waved a pistol at the two on the floorand said, “Flat on the floor. Roll over, put your hands behind yourback. We don’t want to hurt you.”
The two did, and another of the men hurriedly taped theirhands behind them with gray duct tape, and then bound their feettogether. That done, he tore off short strips of tape and pastedthem over the victims’ eyes, and then their mouths.
He stood up: “Okay.”
The leader pushed the door open again and signaled with afingertip. The tall man stepped in from the hallway, said, “These,”and pointed at a series of locked, glass-doored cupboards. And,“Over here . . .”
A row of metal-covered lockers. The leader of the big menwent to the man on the floor, who looked more ineffectual thanthe woman, and ripped the tape from his mouth.
“Where are the keys?” For one second, the man on the floorseemed inclined to prevaricate, so the big man dropped to hisknees and said, “If you don’t tell me this minute, I will break yourfuckin’ skull as an example. Then you will be dead, and I will askthe fat chick.”
“In the drawer under the telephone,” Soul-patch said.
“Good answer.”
As the big man retaped Soul-patch’s mouth, the tall man gotthe keys and began popping open the lockers. All kinds of goodstuff here, every opiate and man-made opiate except heroin;lots of hot-rock stimulants, worth a fortune with the big-namelabels.
“Got enough Viagra to stock a whorehouse,” one of the mengrunted.
Another one: “Take this Tamiflu shit?”
“Fifty bucks a box in California . . . Take it.”
Five minutes of fast work, the tall man pointing them at thegood stuff, sorting out the bad.
Then the old guy on the floor made a peculiar wiggle.
One of the holdup men happened to see it, frowned, thenwent over, half-rolled him. The old guy’s hands were loose—he’dpulled one out of the tape, had had a cell phone in a belt clipunder his sweater, had worked it loose, and had been trying tomake a call. The big man grunted and looked at the face of thephone. One number had been pressed successfully: a nine.
“Sonofabitch was trying to call nine-one-one,” he said, holdingup the phone to the others. The old man tried to roll away, butthe man who’d taken the phone punted him in the back once,twice, three times, kicking hard with steel-toed work boots.
“Sonofabitch . . . sonofabitch.” The boot hit with the sound ofa meat hammer striking a steak.
“Let him be,” the leader said after the third kick.
But the old man had rolled back toward his tormentor andgrasped him by the ankle, and the guy tried to shake him looseand the old man moaned something against the tape and held on,his fingernails raking the big guy’s calf.
“Let go of me, you old fuck.” The guy shook him off his legand kicked him again, hard, in the chest.
The leader said, “Quit screwing around. Tape him up againand let’s get this stuff out of here.”
The old man, his hands taped again, was still groaning as theyloaded the bags. That done, they went to the door, glanced downthe hallway. All clear. The bags went under the blanket on the cart,and the three big men pushed the cart past the security-cameraintersection, back through the rabbit warren to the utility closet,replaced the orderly uniforms with their winter coats, picked upthe bags.
The leader said, “Gotta move, now. Gotta move. Don’t knowhow much time we got.”
Another of the men said, “Shooter—dropped your glove.”
“Ah, man, don’t need that.” He picked it up, and the tall manled them out, his heart thumping against his rib cage. Almost out.When they could see the security door, he stopped, and they wenton and out. The tall man watched until the door re-latched,turned, and headed back into the complex.
There were no cameras looking at the security door, or betweenthe door and their van. The hard men hustled through thecold, threw the nylon bags in the back, and one of them climbedin with them, behind tinted windows, while the leader took thewheel and the big man climbed in the passenger seat.
“Goddamn, we did it,” said the passenger. He felt under hisseat, found a paper bag with a bottle of bourbon in it. He wasunscrewing the top as they rolled down the ramp; an Audi A5convertible, moving too fast, swept across the front of the vanand caught the passenger, mouth open, who squinted against thelight. For just a moment, he was face-to-face with a blond woman,who then swung past them into the garage.
“Goddamnit!”
The leader braked and looked back, but the A5 had alreadyturned up the next level on the ramp. He thought they might turnaround and find the woman . . . but then what? Kill her?
“She see you guys?” asked the man in the back, who’d seenonly the flash of the woman’s face.
The guy with the bottle said, “She was looking right at me.Goddamnit.”
“Nothing to do,” the leader said. “Nothing to do. Get out ofsight. Shit, it was only one second . . .”
And they went on.
Weather had seen the man with the bottle, but paid no attention.Too much going through her head. She went on to the physicians’parking, got a spot close to the door, parked, and hurriedinside.
The tall man got back to the utility closet, pulled off the raincoatand pants, which he’d used to conceal his physician’s scrubs: ifthey’d been seen in the hallway, the three big men with a doc,somebody would have remembered. He gathered up the scrubsabandoned by the big men, stuffed them in a gym bag, along withthe raincoat and pants, took a moment to catch his breath, toneaten up.
Listened, heard nothing. Turned off the closet light, peekedinto the empty hallway, then strode off, a circuitous route, avoidingcameras, to an elevator. Pushed the button, waited impatiently.
When the door opened, he found a short, attractive blondwoman inside, who nodded at him. He nodded back, poked “1,”and they started down, standing a polite distance apart, with justthe trifle of awkwardness of a single man and a single woman,unacquainted, in an elevator.
The woman said, after a few seconds, “Still hard to come towork in the dark.”
“Can’t wait for summer,” the tall man said. They got to “2,”and she stepped off and said, “Summer always comes,” and shewas gone.
Weather thought, as she walked away from the elevator, Nopoint looking at the kids. They’d be asleep in the temporary ICUthey’d set up down the hall from the operating room. She wentinstead to the locker room and traded her street clothes for surgicalscrubs. Another woman came in, and Weather nodded toher and the other woman asked, “Couldn’t sleep?”
“Got a few hours,” Weather said. “Are we the only two here?”
The woman, a radiologist named Regan, laughed: “No. John’sgot the doll on the table and he’s talking about making somechanges to the table, for God’s sakes. Rick’s here, he’s messingwith his saws. Gabriel was down in the ICU, he just got here, he’scomplaining about the cold. A bunch of nurses . . .”
“Nerves,” Weather said. “See you down there.”
She was cool in her scrubs, but comfortably so: she’d beendoing this for nearly fifteen years, and the smell of a hospital, thealcohol, the cleaners, even the odor of burning blood, smelledlike fresh air to her.
No point in looking at the kids, but she’d do it anyway. Therewere two nurses outside the temporary ICU, and they noddedand asked quietly, “Are you going in?”
“Just a peek.”
“They’ve been quiet,” one of the nurses said. “Dr. Maretjust left.”
Moving as silently as she could, in the semi-dark, she movednext to the babies’ special bed. When you didn’t look closely, theylooked like any other toddlers, who happened to be sleepinghead-to-head; small hands across their chests, eyes softly closed,small chests rising up and down. The first irregularity that avisitor might notice was the ridges in their skulls: Weather hadplaced a series of skin expanders under their scalps, to increasethe amount of skin available to cover the skull defects—theholes—when they were separated.
There was really no need for her to look at them: she simplywanted to. Two babies, innocent, silent, feeling no pain; theirworld was about to change. She watched them for a minute. Theone named Ellen sighed, and one foot moved, and then she subsidedagain.
Weather tiptoed out.
The old man in the pharmacy was moaning, the woman tryingto talk, and the old man heard the woman fall down against a chair,after trying to get up, and then somebody was rapping at the servicewindow and they both tried to scream, and they were loud butmuffled. He was chewing at the duct tape on his mouth, and finallyit came loose from one side and he spat it away from his face.
“Dorothy, can you hear me?”
A muffled “Yes.”
“I think I’m hurt bad. If I don’t make it, tell the police that Iscratched one of the robbers. I should have blood on my hand.”She replied, but the reply was unintelligible. He’d been workingon the tape on his wrists, and eventually pulled one free . . .He tried to get up, but was too weak. He couldn’t orient himself;nothing seemed to be working. He fumbled at the tape over hiseyes, failed to get it free, moaned, moaned . . .
More time went by and the old man felt himself going dark;didn’t know what was happening, but his heart was pounding andhe told himself, calm down, calm down. He’d had heart and circulatoryproblems, clots, and he didn’t need a clot breaking free,but his heart was pounding and he was sweating and somethingwas going more wrong than it should be, more wrong than rollingaround on a tile floor gagged and blinded and beaten. Hurt bad.
Then the door rattled and he shouted and he heard an answeringshout, and he shouted again and Dorothy tried to screamthrough her gag, and some time later the door rattled again, andhe heard it open, and somebody cried out, and then more peoplewere there.
He blacked out for a moment, then came back, realized he wason a gurney, that they’d put a board on him, they were movingdown a hallway. Somebody said, a few inches from his face, “We’removing you down to the ER, we’re moving you.”
He said, as loud as he could as the world faded, “I scratchedhim. I scratched him. Tell the police, I scratched him . . .”
The operating room had been reworked for the separationoperation. Maret had stripped out all the general surgery stuff,put in more lights, brought in the custom table. The table hadbeen made in Germany, and lined with a magic memory foamthat would adapt to the kids as their bodies were moved this wayand that.
Sara and Ellen Raynes were joined at the skull, vertically, butslightly turned from each other. If an observer was standing atSara’s feet, looking at her face, and Sara was looking straight up,then Ellen’s face was upside down and rotated to the observer’sleft. Imaging studies, done by Regan and her associates, indicatedthat their brains were separate, but they shared a portion of thedura mater under the skull, a kind of fibrous lining that protectedand facilitated the drainage of venous blood from the brain.
The incoming blood in the arterial system was good in bothbabies; but if the blood couldn’t be drained away, and recirculated,it would put increasing pressure on the brains, eventuallykilling them.
Sara and Ellen were eighteen months old. Their parents hadknown the babies were conjoined before birth. The option ofabortion had been proposed but rejected by the parents, Lucy andLarry Raynes, for religious and emotional reasons. The childrenhad been delivered by cesarean section at seven and a half months.Sara had been born with a congenital heart defect, which furthercomplicated matters.
Weather pushed into the OR and found three surgeons workingwith the baby doll—a life-sized, actual-weight dense-foammodel of the Raynes twins. They had it on the table and wererolling it against the foam.
“So . . . no change,” Gabriel Maret said.
Maret was a short man, with a head slightly too large for hisbody, the size emphasized by a wild thatch of curly black hair,shot through with silver. He was dark-eyed, olive-complected,with a chipped front tooth. He favored cashmere in his carefullytailored, French-cut winter suits, and the women around thehospital paid close attention to him: he was French, and the observingwomen agreed that his accent, in English, was perfect.
Maret had come to dinner with Lucas and Weather every weekor so over the winter, enjoying the kids and the family life. He wasdivorced, with four children of his own. He and his wife still sharedan apartment in Paris, and, sometimes, he said, a bed. “It’s insane,”he said. “She is more stubborn than one of your mules.”
“More stubborn than you?” Weather had asked.
He considered the question: “Maybe not that stubborn,”he said.
He and her husband, Lucas, who got along improbably well,once spent an hour talking about men’s fashion, nearly drivingWeather crazy with the inanity of it. She’d said, “Fifteen minuteson loafers? Loafers?”
“We were just getting started,” Lucas said. She wasn’t sure hewas joking.
“So . . . no change,” Maret said.
“Not as long as everything goes right,” said John Dansk, a neurosurgeon.
“If we run into trouble splicing the six vein, if we loseit, we may have to take out another piece and that means rollingSara this way and Ellen will torque back to the right.”The six vein was a vein shared by the twins. They’d tie it offon Ellen’s side, and attempt to splice it into the five vein on Sara’s,the better to move blood out of Sara’s brain. The vein numberssimply came from imaging charts prepared by the radiologists.
“So what are you suggesting?” Maret asked. He glanced atWeather: “You are gorgeous this morning.”
“I know,” she said, to make him laugh. As did the other womenaround him, she liked to make him laugh.
Dansk scowled at them and said, “I’m suggesting that we slicea few wedges out of the base of the mold, so that we can usethem as shims if we have to brace one of the kids.”
“Why not have a nurse hold her?” Maret asked.
“Because we might be talking a couple hours, if worse comesto worse.”
“You know how much that mold cost?” Maret asked.
“About one nine-thousandth of your annual salary,” Dansk said.
Maret shrugged. “So, we cut a few wedges. Why not? If weneed them, we have them, and if we don’t, it won’t matter.”
“Should have thought of this before now,” said Rick Hanson,an orthopedic surgeon who would make the bone cuts throughthe kids’ shared skull. He seemed shaky; he’d invented a halfdozenlittle saws for this operation and would be the focus of alot of attention. Because of the way the children’s skulls intersected,they formed a complex three-dimensional jigsaw puzzle—basically, an oval ring of bone—of which he’d be removing onlya few pieces at a time. Normally the cutting would have beendone by the neurosurgeon, with drills and flexible wire saws.Hanson, from Washington University in St. Louis, had developedhis own set of electric saws matched to jigs—cutting templates—for complicated bone cuts. Maret had decided that Hanson’s techniquewould be ideal, and would make it possible to prepareperfectly fitted composite plates to cover the holes in the babies’skulls.
“We’re just nervous,” Maret said now. “That’s normal.” Maretwas the team leader, the one with all the experience. He’d donetwo other craniopagus separations, one in France, one in Miami.Of the four children involved, two had survived—one from eachoperation. When he talked about the work, he talked mostlyabout the children who’d died.
Another doc pushed into the room, followed by a secondone. They had all kinds—anesthesiologists, radiologists, neurosurgeons,cardiologists, plastic and orthopedic surgeons, and amedical professor who specialized in anatomical structures of theskull, as it pertained to craniofacial reconstruction. They hadtwenty nurses and surgical assistants.
Weather said to Dansk, the neurosurgeon, “If you want to cutthose wedges, you better get it done: they’ve got to start cleaningthe place up.”
Dansk said, “I’m on it,” and, “I need a scalpel or something.Anybody got an X-Acto knife?”
Above the table, in an observation room behind a canted glasswall, people were beginning to filter into the stadium seating.
A nurse came into the OR—one of the sterile nurses—and said,“I wanted to see if we could make the move one more time.”
She wanted to practice breaking the tables apart, so that whenthe final cut was made, and the twins were separated, they couldbe moved to separate operating areas for the fitting of the newcomposite skull shells.
“Why don’t we visually check the linkage . . .” Maret began.
It was starting; Weather didn’t think it, but she felt it, felt theexcitement and the tension starting to build. She worked almostevery day, cutting, sewing, cauterizing, diagnosing. This wasdifferent.
She thought, Remember to pee.
The Raynes twins were a rare and complicated medicalphenomenon. Craniopagus twins comprise only about one percentof conjoined twins. Because of the rarity of the condition,ex perience with separation surgery was limited. One of thetwins, Sara, suffered from defects in the septum of the heart—thewall that divides the right side of the heart from the left side—and the defects were already causing congestion in the circulatorysystem.
The type of surgery usually favored for craniopagus separationmight take place over several months. The most critical partof most operations was doing a staged separation of the brain’sblood-drainage system. Each operation would isolate the drainagesystems a bit more, and would allow the bodies to create newbypass channels.
In the Rayneses’ case, surgeons feared that a protracted seriesof operations would weaken and possibly kill Sara, which wouldalso threaten the stronger Ellen, especially if Sara were to go intoa rapid decline.
The additional factor in the Rayneses’ case was that the conjoinedarea was relatively small—the hole left behind in the babies’skulls after the separation would be no bigger than thediameter of an orange. That meant that a single operation waspossible—even with some shared venous drainage, it was thoughtthat one continuous operation would be the best chance for savingboth twins.
The surgical team would do the separation, and once separated,the team would break in two, each working on an individualtwin. The joint surgery was expected to last up to twenty hours.
The team was committed to saving both twins.Weather did aesthetic, reconstructive, and microsurgery.Her availability in Minnesota, and a paper she’d done on a thumbreconstruction, had caught Maret’s eye when he began to considerthe Raynes twins.
In Weather’s case, a young boy had caught his thumb in a hydrauliclog-splitter: the thumb had been pulped. After the woundhealed, Weather had removed one of the boy’s second toes, andused the toe to replace the thumb. Since a thumb represents a fullfifty percent of the function of the hand, the reconstruction gaveback the kid the use of his hand. As he used the new thumb, itwould strengthen and grow, and eventually come to resemble anormal thumb, except for the extra knuckle.
As part of the eleven-hour operation, Weather had hooked uptwo nerves, two tiny arteries, and two even smaller veins—veinsthe size of broom straws. The photomicrographs of the suturedveins had particularly attracted Maret’s attention. The more veinsthat could be hooked up, the better off the twins would be—andWeather could do that work, even on the smallest vessels.
He’d also been attracted to her sheer stamina: eleven hours ofmicrosurgery was a super-marathon. He sold her on the idea ofjoining the team, which also made her available to study thetwins, to get to know the parents, and to place the skin expandersunder their scalps.
Weather had turned away from Maret and the argument—Remember to pee—when they heard a commotion outside the operatingroom.
“What is that?” Maret asked. Dansk had just come back witha large scalpel, and he turned to look. A few seconds later, ananesthesiologist named Yamaguchi burst into the room. Helooked, Weather thought, like someone who’d just come to theemergency room to see his child: panicked.
He said, urgently, to Maret, Weather, and the others, “It’s off.The operation’s off. We’ve got, we’ve got . . .”
Weather caught his sleeve and said, “Slow down, slow down.”
“It’s off,” Yamaguchi said. “Some guys just raided the pharmacyand cleaned the place out. Everything is shut down.Everything.”
Maret’s face clicked through a series of expressions, from “Isthis a joke?” to astonishment: “What?”
“Some guys with guns,” Yamaguchi said. He was flapping hisarms, like a loon trying to take off. “Robbers. They robbed thepharmacy. The police are here. There’s nothing left, they tookeverything . . . That old guy who works there, the one who wearsthe surgical hat . . .”
“Don,” said Weather.
“Yeah, Don—he’s hurt pretty bad. They’re taking him intothe ER.”
“You must be shitting me,” Maret said with a non-Gallic precision,looking around at his astonished crew.
Alain Barakat stood at the back of the emergency operatingroom, mask dangling around his neck, watching the work: thesurgeon was cursing at the nurse, who was fumbling the gear, andthey were all watching the blood pressure on the old man droppingand the surgeon was saying, “Get it in there, get it in there,get some pressure on it,” and the nurse stood on a chair and liftedthe bottle of saline and somebody else said, “Two minutes for theblood.” The surgeon said, “I don’t think we have the time, I don’tthink we’ve got it . . .” and the anesthesiologist said, “We’re losinghim, man,” and the doc said, “Fuck this, I’m going in,” and he cutand cut again and again, going in through the beginning of abrutal black bruise on the old man’s belly, and the anesthesiologistsaid, “Hurry it up, man,” and the surgeon said, “Ah, Jesus, I’ve gotno blood, I got no blood here,” and he hurled the scalpel into acorner and it clanged around and he said, “It must’ve been hisgoddamn kidneys. Let’s see if we can roll him,” and the nursesmoved up to help with the roll and the anesthesiologist said,“Man, he’s arresting.”
Barakat, standing in the corner, said, “Shit shit shit shitshit shit . . .”
One minute later, the old man was gone. No point in trying torestart the heart—there was no blood going through it. They allstood around, shell-shocked, and then the surgeon said, “Let’sclean up.”
One of the nurses said, “We had no time. He was going tooquick.”
They all looked at the body on the table, worn Adidas sneakerspointed out at forty-five degrees, chest flat and still, the bloodygash on the gut. The anesthesiologist turned to get somethingand saw Barakat, a tall man, standing in the corner, hands pressedto the sides of his head, and the anesthesiologist said, “Wasn’tyou, man. You did good. Everybody did good. He was gone whenwe got him.”
And Barakat thought: Now everybody will be here. Now the policewill tear the place apart.
Because he really didn’t care about the old man.
The separation team was standing around, repeating whatYamaguchi had said, when Thomas Carlson, the hospital administrator,came hurrying down the hall. Carlson was wearing hiswhite physician’s coat, which he often did on public occasions, toremind people that he had an MD in addition to the MBA; but forall that, not a bad guy, Weather thought.
He went straight to Maret: “Gabe, you’ve heard.”
“I’ve heard there was a robbery.”
“Unfortunately. The problem is, we’ve also got a man down.He’s hurt pretty badly, and we won’t have access to your drugs—any drugs, except in an absolute emergency, and then we’ll becrawling around on the floor trying to find them. The place iscompletely wrecked. They threw everything out of the lockers,what they didn’t take.”
“So: everybody is here,” Maret said.
“But you’re going to have to wait,” Carlson said. “God, I’msorry, man. But this is an incredible mess. As long as the kids arestable . . .”
Maret nodded: “Well. I guess we can wait.”
Weather and Maret went together to tell the Rayneses. Theparents were waiting in what the team called the “separationlounge,” once a meditation room, which had been converted forfamily use and for team conferences.
The Rayneses were sitting on a couch, looking out over atable full of magazines: neither one was reading. They were intheir early thirties, and except for their sex, as alike as new marbles:honey-blond, tall, slender, from the small town of New Ulmin southern Minnesota. Larry worked in a heating and airconditioningbusiness owned by his father; Lucy worked at thepost office. Neither had lived outside of New Ulm. Both of themspoke fluent German, and went to Germany every summer, tohike. They had no other children.
They’d conferred with Maret on the separation process, buthad worked more with Weather than any other physician, becauseof Weather’s involvement in the preliminary surgery.
They were astonished by the news. “What does it mean? It’soff ? For how long?” Lucy Raynes blurted. “I mean . . . ?”
“We’ll go tomorrow,” Weather said, patting her arm. “Sametime. This whole thing is so bizarre . . . there are police everywhere,I guess. The girls are fine, no change for them.”
“I can’t believe it,” Larry Raynes said. “After we got thisfar . . .”
His wife put an arm around his waist and squeezed him: “We’llbe okay. It’ll be all right.”
Of the two Rayneses, Lucy was the most demanding of information,had studied the details of the separation, used terms like“superior sagittal sinus” and “calvaria,” read medical papers onother separations. She’d spoken to the media on a number of occasions,both televised and print. Larry, on the other hand, mostlytalked about timing, and the children’s development, and often,to Weather, seemed to simply want to get it over with. He wasn’tstupid, but swept along in a current too strong for him, partmedical science, part circus. He wanted to go home.
Maret had warned everybody about the circus. “Wheneverthis is done, we get the media, because of the drama and thesympathetic aspects. You have to be prepared. In Miami, we hadreporters following the surgeons home, knocking on doors, waitingin the streets.”
Now he said to the Rayneses, “I’ll talk to the media in tenminutes or so. I’d like you to be with me.”
Larry Raynes said to his wife, “You go. I’ll go sit with thekids.”
Weather left them talking, and went back to the locker roomto change back into her street clothes.
By the time she got back, most of the team had drifted away.The OR nurses were shutting the place down. Weather stoppedto talk with her surgical assistant, when one of the team’s cardiologists,Alan Seitz, who’d been called to the ER, came amblingdown the hall, looking distracted. “What?” Weather asked.
“That Don guy died,” Seitz said. “One of the robbers kickedhim to death. Broke up his kidneys. He was soaked in Coumadin.He bled out before we could get anything going. We were dumpingfluid into him fast as we could, nothing to do.”
Weather stepped up and gave him a squeeze. Seitz was an oldfriend. “Nothing to do. You only do what you can.”
“Yeah.” Seitz looked around and said, “I mean, Jesus Christ:kicked to death. In the hospital.”