LUCY AND LARRY RAYNES were with the children, who were still awake, but about to be moved to the operating theater. Sara saw Weather and her eyes misted up. She was still a baby, but she recognized the woman who’d caused her pain in the past. She began to cry, softly, and then Ellen started, not yet knowing why.
Lucy Raines bent over them, comforting them. Larry flapped his hands around, helplessly, and said to Weather, “They’re about to give them something.”
Weather nodded: “We’re not the only ones who feel the stress. They’re babies, but they know something is happening.”
Ellen pushed against the sides of the hospital bed, and that torqued Sara, who stopped crying and thrashed with her hands. The babies could hear each other talking, but had never seen each other.
Larry said, “We just talked to Gabriel, he said everything was going smoothly.”
“Yesterday was like a freak accident,” Weather said. “Everything now is just like it was yesterday—maybe better. Maybe some of the nervousness got burned off.”
“I felt terrible about that guy,” Lucy said.
“So do I.” Weather bent forward and kissed Sara on the forehead. “It’s hard, baby,” she said.
AN HOUR LATER, the twins were rolled into the OR, sedated, but not yet fully anesthetized. As the two anesthesiologists worked to position them, to rig them with the drip lines and to take a final look at the blood chemistry, to check their monitors, Maret wandered over to Weather and said, “It’s time. No problems with the pharmacy this morning.”
Weather nodded and followed him into the scrub room. A few seconds later, Hanson, the bone-cutter, followed them in, with his resident; the surgical assistant stood waiting behind Weather. They scrubbed silently, until Maret said, “That first day of practice, we started with Vivaldi. If no one objects . . .”
“Perfect,” Weather said. She’d always had music in her ORs. “Start with ‘Primavera.’ ”
“Your choice,” Maret said, smiling at her. “You’re okay?”
“Anxious to get going,” she said. Her part, her first part, would be routine, nothing more than she did every day: cutting down to bone, cauterizing the bleeders, rolling back the scalp. Then, she’d get out of the way until the bone-cutter was done.
An anesthesiologist stuck his head in: “We’re set. You want to say go?”
Maret looked at the team members in the scrub room, pursed his lips, smiled, nodded and said, “Go.”
THE OBSERVATION THEATER was packed: team members had the first choice of seats, but after that, it was first-come first-seated, as long as you had the right ID. Barakat looked around: the watchers weren’t just residents, but included a lot of senior docs on their own time. He was at the back, in the highest row of seats.
Down below, three nurses and two anesthesiologists clustered around the two small bodies joined at the skull; so close to perfection, and yet so far. Each was an attractive child—if there’d been another inch of separation, they’d have been just fine. Now they lay on the special table, brilliantly lit, cradled in plastic, asleep, their eyes covered and taped, the bottoms of their faces isolated in breathing masks.
The scrub room doors opened in, and a small woman led a first group into the OR. A man sitting in the first row of the observation theater said into a microphone, “Doctors Gabriel Maret, Weather Karkinnen, Richard Hanson. Dr. Karkinnen will begin ...”
She was masked, hatted, robed, gloved and slippered, wearing an operating shield over her eyes; but she was the woman from the elevator and the Audi, Barakat thought. Right size, right shape. Now that he knew her name, he could Google her, just to be sure.
The narrator said, “For those who just got here, the first procedure will be to open the scalp at the point of conjoin, to remove the first expander, and to prepare the bed for the initial craniotomy.”
The surgical lights were miked. Barakat could hear Karkinnen talking with her surgical tech as they prepared the tools on a tray at her left hand. Karkinnen bent over the babies, with a surgical pen, her head blocking Barakat’s view of what she was doing. Then Karkinnen straightened and asked an anesthesiologist, “Where are we?” and the anesthesiologist took a few seconds and then said, “We’re good. Sara’s heart looks good.”
Karkinnen: “Dr. Maret?”
Maret looked around and said, “Everybody ... may God bless us all, especially the little children. Weather, go ahead.”
With Vivaldi playing quietly in the background, Weather took the scalpel from the surgical tech, leaned over the skulls of the two babies. She’d used a surgical pen to indicate the path of the incision, and now drew the scalpel along it, the black line turning scarlet behind the blade.
ALL SKIN has its own toughness and flexibility, and from post-puberty to old age, there was so much variation that you never knew quite what you’d get when you made the first cut. Sometimes it was saddle leather, sometimes tissue paper. Older people often had papery skin, and so did the young, though it was different.
Cutting into the twins was like cutting into a piece of Brie; Weather had noted that in earlier operations and no longer really paid attention to it. There was almost no separation between scalp and bone. She cut the first jigsaw pattern, got one little arterial bleeder, burned it, then slowly peeled the skin away from the incision. The room was suffused with the scent of burning blood, not unlike the smell of burning hair.
Her first part had taken twenty minutes.
She hadn’t done much, but at the same time, she thought, everything: they were under way. They could still turn back, but the bone-cutter was right there, with his custom surgical jigs. Once they were in, turning back would be more complicated.
“I’m out,” she said.
“Looks good,” Maret said. “Perfect.”
SEPARATING THE TWINS was not a matter of simply cutting bone and then snapping them apart. The venous drainage inside the skull had to be carefully managed, or blood pressure would build in the babies’ skulls and damage their brains, and likely kill them.
The brains themselves were covered by a sheath of thin, tough tissue called the dura mater, which acted like a seal between the brain and the skull, and channeled the blood away from the brain. The dura mater, in most places, was thick enough that it could actually be split apart—like pulling a self-stick stamp off its backing—leaving each brain covered with a sheet of dura mater.
However, the imaging had shown that there were a number of veins that penetrated the dura mater, and rather than returning to the original twin, instead drained to the other twin. Those veins had to be tied off, and, in the case of several of the larger ones, redirected and spliced into other veins that drained to the appropriate twin.
To get inside, Hanson would fit a custom-made jig, or template, around the join between the twins’ skulls. During the course of the operation, he would cut out a ring of bone, with what amounted to a tiny electric jigsaw. When the twins were taken apart, the holes in their skulls should be precisely the shape and thickness of pre-made skull pieces made of a plastic composite material.
Before that could happen, Hanson had to take out the bone, and then Maret, a neurosurgeon, and a couple of associates, would probe the physiology right at the brain, to make sure there was no entanglement of the brains themselves. Imaging said that there was not; if there had been, the shorter operation would have been impossible. When they’d confirmed the imaging, and that the dura mater stretched across the defect, they would begin separating the tissue, and splicing veins.
Weather’s surgical tech started giggling at the scrub sink and said, “I was so scared. I did three little things and I was completely freaked out.”
“I was a little nervous myself,” Weather said. “Are you okay?”
“Oh, sure. It’s just that everybody’s up there watching. Everybody important. What if I dropped a scalpel on your foot?”
“I’d have to have you killed,” Weather said.
The nurse started giggling again, and it
was infectious, and Weather started, though it was unsurgeon-like. They’d just stopped when Weather said, “Couldn’t you see it? Sticking out from between a couple toes? What would I say? Ouch?”
They started again.
WEATHER STRIPPED out of the sterile gown, head-covering, shoe covers, and surgical gloves, and tossed it all into disposal baskets and walked down to the lounge where the twins’ parents were waiting.
They both stood up when Weather walked in, and she smiled and said, “It’s going. I made the first incisions, and Hanson is getting started on the entry.”
“How are the girls?” Larry asked.
“They’re strong. Sara’s heart is fine. This next part will take a while ...” The parents nodded. They had a time line, knew about what each procedure would take. The bone-cutter would be working for a couple of hours, followed by the neurosurgeons.
After talking with the parents, Weather left them in the lounge and walked down to the cafeteria for a cup of coffee and a roll. Several members of the team were there, called or waved to her when she came in; she went to the line for a roll, then joined them.
Barakat had come in well behind her, watching, got a slice of pizza and a cup of coffee, careful to keep his back turned when she might look his way. When she was seated, he carried his tray to a table behind her, his back to her. A few minutes later, after some chatter about the twins, she was telling her friends about doing an artist sketch for the police, of the man coming out of the parking structure.
Barakat finished his coffee, checked the time. Too early for a civilized call, but the Macks weren’t civilized, and Lyle Mack said to call as soon as he knew who she was.
WEATHER WAS IN the gallery when the operation started going sour. The first indication was simple enough, when the anesthesiologist said, “We’re looking at a little thing with Sara’s heart, here.”
Maret nodded to an associate and backed away from the table. “What can we do?”
He and the anesthesiologist began talking about it, and the cardiologist came in and looked at all the numbers on all the machines. He wasn’t sterile, so he stayed back, watching.
The anomalies continued to develop. The cardiologist ordered medication to steady the rhythm of Sara’s heart, but the medication began to slow Ellen’s, and finally the cardiologist told Maret that they needed to move the children to intensive care, where they could be taken off the anesthesia and treated for the heart problems.
“You see no alternative?” Maret asked.
“We could go a little longer, but then, if Sara really gets into trouble, it could take longer to bring them both back ... we could wind up with an emergency.” An emergency most likely meant Sara would die.
“Damnit.” But Maret acceded, looked up: “Weather, we’ll need to close up here.”
“ANOTHER FIVE THOUSAND, and all you have to do is make the one ride,” Lyle Mack told Cappy. They were back in Cherries, Cappy an hour out of bed. “We’ve got a bike spotted for you, a Yamaha sports bike. Almost new, perfect condition. Owner keeps a spare key in a magnet box shoved up under a flap behind the seat. Joe will drop you at his garage. The guy doesn’t come home until eight o’clock. You ditch the bike after the ride, Joe’ll pick you up. Clean, quick.”
Cappy’s eyes slid over to Joe Mack. “Saw your picture on TV Like you used to look.”
“I saw it; it don’t look like me. Like I used to look,” Joe Mack said.
“Not exactly, but it had all the right parts in the right place,” Cappy said.
“Once this woman’s gone, it’s no problem. Can’t identify somebody on the basis of a drawing-thing if the witness is gone,” Lyle Mack said.
“The thing that bothers me, a little bit, is the spotter,” Cappy said. “You know ... that’s another guy. I thought we were cutting down on the number of guys who know.”
“Well ... maybe we can talk about that sometime,” Lyle Mack said.
Cappy smiled his minimalist smile, a slight widening of his narrow lips. “I was thinking about it at work. This could be like a job. I could be, like, you know, one of those eliminators.”
“You could be,” Lyle Mack said. He scratched his head, and like any small-business man, got thinking about the bureaucracy of it. Nobody ever thought about the bureaucracy, but that’s most of what any small business was. He said, “I don’t know how you’d set it up. You know, find guys who need the work. If any one of them folded up, you’d go down with them. But we ought to think about it. If there was some way to do it, you could sure make some bucks.”
“I wish ...” Joe began. Then, “I’m not sure we oughta be doing this. This is like, remember that Walt Disney cartoon with the tar baby? It’s like we’re getting more stuck in the tar baby.”
Lyle Mack took a quick circular pace, his jowls shaking, and he said, “Joe ... She saw ya, goddamnit. We gotta do something about it, while we got the chance.” He looked at Cappy: “By the way, I got a question. That goddamn shotgun, even cut down ... how you gonna manage that?”
“Not using the shotgun,” Cappy said. He took a revolver from his pocket, wrapped in Saran Wrap, turned it sideways so the Macks could look at it. “Got it in Berdoo. Perfect bike gun. Can’t touch it, because I wiped it.”
“What the hell is that?” Lyle Mack asked.
“It’s the Judge,” Cappy said. “Three .410 shells with Four-O buckshot, that’s five pellets the size of a .38 in each shell. And two .45 Colts in the other two chambers. Gotta get close, but I won’t do it unless the barrel’s touching her window glass.”
“Dude,” Lyle said, “you got the equipment.”
As HE AND JOE went over to get the bike, Cappy thought about killing people for money. Well, what was the difference between that and killing a guy for his bike? Maybe that was when he crossed some kind of line—the first guy he killed, he did almost out of self-protection. Later on, he did it because it was interesting.
He’d seen all kinds of killing on TV, ever since he could remember—crime movies and war movies, cop shows, people being killed every way you could think of. Machine-gunned and executed and shot with long-range rifles and stabbed and strangled and poisoned and electrocuted and beat with baseball bats, everything. Real airplanes flying into real buildings, guys blowing themselves up on the news.
You’d always get some news chick telling you how bad you should feel about it, but Cappy didn’t feel much of anything, except interested, and neither, he thought, did the news chick. Or anybody else. It was entertainment, was what it was, and in real life, it was kind of more entertaining.
Like riding a bike too fast: you didn’t know exactly what was going to happen. It was almost like he was killing people in a movie, except more. Like you see Bruce Willis cap somebody, that’s how much he felt it, times ten. Times a hundred. He liked rerunning it, when he’d pulled one off, but he liked rerunning Bruce Willis movies, too.
The thing is, it was intense.
But, Lyle Mack was right. How would you get in touch with the people who needed the work done? Maybe you could find some big Mafia guy and contract out for it. Have to think about it.
“HERE WE GO,” Joe Mack said, as they turned down an alley. He pointed out the garage: “The white one with the red doors. I’ll drop you off right in front of it. Nobody can see us, unless they’re right in the alley. Got to get in and out quick, though.”
Cappy nodded. “I can do that.” He reached under the seat and pulled out a Penney’s bag with the handgun in it. “See ya.”
He seemed really calm, Joe Mack thought, as he dropped him. Joe Mack could hardly hold on to the steering wheel, and every time he closed his eyes, he saw the smiling faces of Mikey and Shooter, followed by a fade-in of the dead faces. It was creeping him out. He planned to drink a lot that night, so he’d get some sleep.
In fact ...
He fished a pint of bourbon out from under the seat and took a pull. Looked both ways for cops, and took another one.
AT THREE O’CLOCK in the
afternoon, the sun was already dipping toward the horizon. Weather came out of the parking garage, looked both ways, took a left, down toward the I-94 entrance. She’d take it only a mile or so to the Cretin Avenue exit, then head south.
She was tired. She needed to get home and take a nap. The surgery she’d done hadn’t been difficult, but the stress around the operation was taking a toll that she really hadn’t expected. It wasn’t the work, it was the talk afterward. The fact was, they could go in and dissect the dura mater from Sara’s brain in a half hour or so; they could finish the bone cutting, take out the dura mater, leave it with Ellen, close up, and Ellen would be good.
Sara would die. In medical papers, they would say that a patient was sacrificed so the other could live. Sacrificed. Nice. The idea of making that decision made her skin crawl. Separating the dura mater, so that each baby could drain blood back into the venous system, was the time-eater. The neurosurgeons were advancing toward each other a millimeter at a time, sorting veins, saving everything they could.
But if something went too wrong ...
JUST NEEDED A NAP, she thought. The surgery could resume in the middle of the night, if Sara’s heart function improved. Or, if it worsened enough that they were compelled to let Sara go, and attempt to rescue Ellen.
As she came out of the parking garage, she glanced in her rearview mirror and saw the biker break away from the curb a block behind her; paid no attention, saw the stoplight ahead turn yellow, and floored the accelerator, clipping the red light as she went through. She kept the speed up down the block to the next light, and caught an odd motion in her rearview mirror; the biker had flat run the red light, and had almost been taken out by a car coming through.