WEATHER OPENED the operation as she did each day, moving fast now. Moving fast, she was in and out in ten minutes, laying bare the ring of bone that connected Ellen and Sara. Most of the bone had been taken out, and Hanson, at her elbow, was ready to take out all but about a centimeter of the rest of it.
"Anything I can do before I go?" Weather asked him.
"I could use a couple more sterile hands in close," he said.
She stayed, to help hold the babies' heads, six hands in close and tight. Maret asked, through the crowd, "Hearts?"
"Okay so far," somebody answered from the back.
The saw, in cutting through the bone, kicked up the stink of raw blood mixed with something else ... almost a floral scent. Dead peonies, maybe.
Hanson was a half hour, against an estimate of forty minutes. His mask was dotted with sweat when he backed away. "We're good."
The neurosurgeons moved up.
Weather backed out, stripped off the operating gear, dumped it, washed, and walked down to talk to the Rayneses again.
Lucy, anxious, wide-eyed. "Is something wrong? You were gone so long ..."
"I stayed to help with some bone removal. At this point, their hearts are stable, we've got everything but the last half-inch of bone out. Rick can take that out in one minute if he has to."
Larry: "So the neuro guys are working?"
"Yes. Still a way to go," Weather said.
They talked for a couple more minutes; the Rayneses said the overnight crew had reported that the twins had gotten their best sleep since the operation began.
A team nurse popped in, looked at Weather: "Gabe wants you in the OR."
"Something happened?" Larry Raynes asked.
"Looks like it's going okay to me," the nurse said. "I'm not a doctor, though."
WEATHER STEPPED inside the OR and said, "Gabriel?"
Maret looked up from the operating table and said, "Ah, Weather, come around here."
She walked carefully around the edge of the working crew, and Maret pointed at the babies' skulls. "The seven vein," he said, and she nodded.
The seven vein had been difficult to image, but they didn't know why, exactly. It rose close to the edge of the defect, up out of Sara's brain, before apparently edging over to a trough where it dumped the blood.
"It doesn't do that. It actually curled around the edge of the defect and dumps into Ellen's side. So, we can ligate it and forget it. But there's another vein we didn't see--we're calling it fourteen--that comes up beside it. If we could splice seven into fourteen ..."
"How big are they?" Weather asked.
"Not big. But not so small as the ones you did on the toe operation ..."
"I was using the scope for that. If we drop the scope on them, you guys would have to get out of the way."
"I think they might be large enough for you to do with your loupes ... I'm hoping."
"I'll scrub up," she said.
SHE WAS BACK in ten minutes, robed in another five, operating glasses in place. Maret moved sideways, pushing one of the nurses away from the table, and Weather moved in close. The other neurosurgeon continued working on the other side of the babies' heads.
Maret said, "Here," and indicated the two veins with a tip of his scalpel.
Weather's operating glasses were equipped with an LED, and the light illuminated the patch of dura mater as though it were an illustration in a medical text. The veins were small, dark, wire-like--a bit smaller in diameter than the wire in a coat hanger.
Weather looked at them for a full fifteen seconds, until Maret asked, "What do you think?"
"How bad do you need it?"
"Well, it's impossible to know. But the babies are doing okay, so far, we are ahead of schedule, and better to do this now, if we can--we need to move as much blood as possible ..."
"I can do it, but it'll take a while," she said finally. "Sandy might have to stop working every once in a while. I couldn't have the slightest bit of movement."
"How long?"
"Thirty, forty minutes. They're well exposed."
"Thirty minutes?"
"Thirty or forty."
"Thirty minutes. I believe you can do this."
THE VEINS were not especially delicate, but they couldn't be yanked around, either. Weather tied off the smaller fourteen, and began the process of splicing it into the seven. The process was slow: she would be placing four square knots, each smaller than a poppy seed, around the edge of the splice. Ten minutes in, she had one knot; in seventeen minutes, she had two.
An anesthesiologist said, "We've got a gradient showing up."
"I'll be out in ten or fifteen," Weather said. The gradient was the blood pressure in Sara's brain.
"Let's stay with it," Maret said.
Weather did the third knot and asked, "Where's the gradient?"
"Need to move along," the anesthesiologist said.
"We could bleed her for a minute," Weather said. "I think we're tight enough that we won't damage the established sutures."
Maret said, "How long to go ahead and finish?"
"Six or seven minutes, if there're no problems."
"Bleed her just a minute ..."
Weather released a ligature on the fourteen, and blood began seeping out of the incomplete splice. They stood for a minute, then two, soaking up the blood, and the anesthesiologist said, "Better," and Weather closed the vein again.
Six minutes later she was out, removed the ligatures on seven and fourteen, and she and the other neurosurgeon, Sandy, watched the splice for ten seconds, fifteen, and then Sandy said, "Just like shooting free throws."
Weather said, "You should explain surgery to my husband."
Maret: "What does this mean, free throws?"
"Means we're good," Sandy said. "Get your ass back in here. We're coming to the stretch."
"Sometimes, I wish I understood English," Maret said. To Weather: "Thirty-two minutes."
"Best I could do," she said, a little stiff.
He said, "If you'd told me an hour, I would have asked for forty-five minutes. Thirty-two, I hardly believe."
That made it all better.
WEATHER WAS SITTING in the observation theater when Virgil and Lucas squeezed in, and Lucas reached down and tapped her on the shoulder and gave her the thumb. She followed them out into the hall.
"Have you seen a skinhead orderly around?" Lucas asked.
She shook her head. "Not close by. I haven't really noticed one. You mean a guy with a shaved head?"
"Not shaved, just a super-butch. Virgil's seen him around."
"You think?"
"We think. Gotta call Marcy, let her know, see if we can break out the guy's name. It bothers me that Virgil may have seen him here. So I'm sticking close. I'm going to get Jenkins and Shrake over here ..."
"We'll be done this afternoon," Weather said. "We're moving fast now."
18
CAPPY SAID, "I don't see any other way to get her. Has to be inside the hospital, but the cowboy guy is all over her."
A car door slammed close by--the driveway?--and Barakat went to the window, peeked, turned and said, urgently, "They look like police. Man and a woman. Get in the bedroom, and keep quiet."
There were two open twists that'd held cocaine, sitting on the coffee table, and as Cappy disappeared into the back, Barakat snatched them up, looked frantically around the room for other problems, and stuffed the twists in his pants pocket.
Could they smell him? Cappy? He lit a Gauloise, blew some of the acrid smoke around the room, took another quick drag, blew it out, settled in at a desk, turned on the desk lamp, brought up his laptop, threw a couple of medical papers on the floor.
And the doorbell rang.
He took his time, checking the living room once more, and went to the door.
Man and a woman. They held up IDs, and the woman said, "Marilyn Crowe, Minneapolis police. This is Doug Jansen. Are you Dr. Barakat?"
"I am," he said, holding the storm door
open. It was snowing behind the two cops. "What happened?"
"Do you know a Dr. Adnan Shaheen?"
"Yes, of course, very well. We were at school together ..." Thinking: If they found a note, if Adnan had a journal, if they found a letter to my father . . . we should have looked, we should have looked, stupid stupid stupid ...
"I'm sorry to tell you this, Dr. Barakat, but Dr. Shaheen was killed last night."
Barakat had seen this interview coming, had even talked about it with Cappy. He didn't react immediately. He simply froze. Then, "What? Addie ... ?"
The cops waited for him to say something more, and the silence stretched, and then Barakat pushed the storm door fully open and said, "You better come in. Addie's dead? How did this happen? Are you sure, Adnan Shaheen? He has a Lebanese passport? He is a resident at University Hospitals?"
He let himself ramble, now putting himself in a place of shock and sadness, and said, "This ... wasn't drugs?"
"He was hit on the head with a heavy object," Crowe said. "I'm sorry."
"Why did you think it might be drugs?" Jansen asked.
Barakat rubbed his forehead and turned away, wandered to his desk and sat down at the laptop. "He ... I think ... oh, no."
"Street drugs?" Jansen asked.
"I talked to him," Barakat said. "He sometimes used cocaine. I don't know where he got it, I don't know how he learned to get it. He said there was a man who was working his way through medical school by selling cocaine, but I don't know this man ... but that's when he started, you know. Medical school was very hard for Addie, very hard. He had to study very hard. All the time, the cocaine made him ... he thought it helped to concentrate."
"You never reported this to anyone?"
"He was my friend," Barakat said. "I tried to help him. He struggled for twelve years to get his degree. Now, so close ... if I turned him in, it would be the end for him. So I did not. I turned my eyes away."
"All right," Jansen said. "If ... when this is settled, could we call on you to take care of funeral details?"
"Of course. I will call his family--they are still in Beirut. I will call an uncle, who will tell his mother. Addie ... he was the great hope of his family, you know."
"I'm sorry," Crowe said. "Had he ever done anything that, looking back, might make you think that he might have been involved with the pharmacy robbery at the hospital?"
"Addie? No! Not at all. He was ... mmm ... a timid man, really. This is one reason he liked cocaine, because then he was not so timid. He could go to parties and talk with the girls, you know? But a robbery, I can't believe this."
"How was he financially?"
"He had no money ... "
THEY TALKED for ten minutes, and Barakat began developing an irrational fear that Cappy would do something insane, like flush a toilet, or appear with a gun, or even creak a floorboard. None of that happened, and the cops trailed off with a few incidental questions, and left, apparently satisfied.
When the car had gone, Barakat walked back to the bedroom, opened the door: nobody. Then Cappy asked, "They gone?" and sat up from a spot on the floor, behind the bed.
"They know nothing. Still, I am uneasy, you know? This woman ... if she sees Addie's picture in the newspaper, or on the TV, she may remember another man in the elevator. I do not look like Addie, but there is a similarity."
"So, we take her out."
"If possible. Then, we have only Joe Mack. Joe Mack continues to worry me."
"He's gone, man," Cappy said. "I don't think even Joe is dumb enough to come back here, not after all this."
BARAKAT FOLLOWED Cappy to the hospital, up into the ramp, and then past him to the physicians' parking, and into the hospital through a different entrance. Cappy would scout the hallways in his civilian clothes, and then stop by the closet for the scrubs.
Cappy, Barakat thought, could become a problem. He would have to deal with that later, if the police didn't do it first. He doubted that Cappy, from the way he talked, would be taken alive; he was convincing about that, a young man rushing toward death.
AT THREE O'CLOCK in the afternoon, Sandy Groetch looked up from the operating table and said, "I'm done."
There was a rustle of talk both in the operating room and up above, in the observation room, as Rick Hanson moved in with his saws. Up above, Weather stood up and headed for the door, led by Virgil and trailed by Lucas.
In the hall outside, Weather said, "We're almost there."
"What was that talk about Ellen?"
"It's her heart again. The last time they dropped the blood pressure to try to reduce the stress on her heart, it got away from them and Ellen almost arrested. But now they've started treating them separately. Now we've got a chance."
"I thought we always had a chance," Virgil said.
"We liked to think so, but the chance was pretty small," Weather said. They got to the stairway and headed down, Virgil leading. "If both of them live, it'll be pretty much of a miracle."
They took her to the scrub room and waited there, in the hall.
ANOTHER PLASTIC SURGEON, named Tremaine Cooper, was scrubbing when she got there. She joined him, and he asked, "Got any ideas about the fit?"
"Can't tell, but Rick's stayed right on the nominal cut line, as close as I can tell. If he's a little outside it, we're okay. I just hope that he didn't get inside."
A maxio-facial surgeon at the hospital had prepared caps made from a composite material to fit inside the defects in the twins' skulls. Weather and Cooper would fit the caps into the defects, before stretching the expanded scalps over the holes.
Weather added, as they finished scrubbing, "I'll tell you what, Trey. They're gonna want one thing from us, and that won't be neatness. They're gonna want to get the last expanders out, the caps in, and the scalps stitched up, fast as we can do it. They want to get those kids out of here and into the ICU."
"Fast as we can," Tremaine agreed.
"So if you get done before me," Weather said, "don't hesitate to come over and help me out."
"I'll do that," he said.
Weather was faster than Cooper. By making the offer, she diplomatically cleared the way to help him finish, if that were needed.
Inside the OR, they waited while Hanson finished taking out the last bit of the ring of bone. He was sweating profusely, but five or six minutes after they stepped inside, he said, "That's it."
Not unlike drywall repair, Weather thought. Then: Well, yes, it is unlike drywall repair.
Maret: "Okay, everybody, we're doing good, now. Let's move the kids. First thing, check all the lines. We don't want to yank anything out, from clumsiness."
The checks were quick, but not perfunctory. The monitoring, anesthesia, and saline lines going into the children were now separate, but there were a lot of them, and included no-longer-functioning joint lines. The team traced them out, moved a few around, and then Maret said, "Let's make the move. Let's make the move."
Weather was standing in a sterile isolation area, where the non-sterile circulating nurses were not allowed, and had an end-on view of the tables. Hanson, Maret, and one of the anesthesiologists gripped the form-fitting foam cushion on which the twins lay, and carefully, slowly, pulled them apart.
As the cushions moved, the twins slowly, for the first time in their lives, drew apart, an inch at a time, then more quickly, until six feet separated them.
Maret turned to Weather and Cooper: "Quickly, now. Quickly."
WEATHER HAD SARA, Cooper had Ellen. She first took out the two expanders, silicone balloons filled with saline solution--a bloody process because the scalp had to be lifted away from the skull. Once the balloons were out, she worked around the edges of the loosened skin, where it was still attached to Sara's skull.
"Ah, shit," Cooper said. She glanced sideways and saw Cooper with blood spattered on his operating glasses. In cutting the scalp away from the skull, he'd cut through a tiny artery, which squirted blood up into his face and glasses. He cauterized it, and t
he smell of burning blood drifted through the room.
When she thought she was ready, with a little to spare, Weather said, "Cap," and a neurosurgeon moved in with a composite piece marked with tiny orientation grooves. He got it the right way around and placed it in the defect, and Weather saw it almost click into place. The cap would be held down by two tiny stainless-steel screws, and, finally, by the scalp, as it grew back.
The surgeon said, "You do good work, Rick," and, "Drill, please."
Weather stepped back from the table, holding her hands against her stomach to keep from bumping anything non-sterile, and glanced up at the watchers. Only a glance, and then she kept her head resolutely down, for she'd seen, in the glance, the skinhead. Virgil and Lucas had described him, and there was no doubt about it.
"First screw is in," the neurosurgeon said, and behind him, Cooper, working on Ellen, said, "Cap," and a moment later, another neurosurgeon said, "Just like the cap on a Ball jar."
Weather kept her eyes down, thinking. A surgical pen, last used by Hanson, was sitting on an equipment tray. She reached out, picked it up, stepped behind the neurosurgeon, and wrote on the sleeve of her operating gown, "DO NOT LOOK UP. Go in the hallway and tell my husband that the skinhead is in the observation area. DO NOT HURRY."
She said to one of the circulating nurses, whom she'd known for a while, and who knew who Lucas was, "Kristy, could you get me one of the large gauze pads, please?"
The nurse stepped over to a supply cabinet, picked up a pad, slit the packaging without touching the sterile gauze, and brought it over to Weather. Weather held out the arm with the writing on it, still concealed behind the neurosurgeon's back, slowly pulled the gauze pad out of the packaging.
Kristy looked down at the writing on Weather's sleeve, and she almost looked up, but didn't. Her eyes came to Weather's, and she gave a tiny nod. No dummy.
Weather took the gauze pad and moved up beside the neurosurgeon, to watch him place the final screw.