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 glass wall, 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 when the final cut was made, and the twins were separated, they could be moved to separate operating areas for the fitting of the new composite 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 the excitement and the tension starting to build. She worked almost every day, cutting, sewing, cauterizing, diagnosing. This was different.
She thought, Remember to pee. THE RAYNES TWINS were a rare and complicated medical phenomenon. Craniopagus twins comprise only about one percent of conjoined twins. Because of the rarity of the condition, experience with separation surgery was limited. One of the twins, Sara, suffered from defects in the septum of the heart-the wall that divides the right side of the heart from the left side-and the defects were already causing congestion in the circulatory system.
The type of surgery usually favored for craniopagus separation might take place over several months. The most critical part of most operations was doing a staged separation of the brain's blood-drainage system. Each operation would isolate the drainage systems a bit more, and would allow the bodies to create new bypass channels.
In the Rayneses' case, surgeons feared that a protracted series of operations would weaken and possibly kill Sara, which would also threaten the stronger Ellen, especially if Sara were to go into a rapid decline.
The additional factor in the Rayneses' case was that the conjoined area was relatively small-the hole left behind in the babies' skulls after the separation would be no bigger than the diameter of an orange. That meant that a single operation was possible-even with some shared venous drainage, it was thought that one continuous operation would be the best chance for saving both twins.
The surgical team would do the separation, and once separated, the team would break in two, each working on an individual twin. 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 thumb reconstruction, had caught Maret's eye when he began to consider the Raynes twins.
In Weather's case, a young boy had caught his thumb in a hydraulic log-splitter: the thumb had been pulped. After the wound healed, Weather had removed one of the boy's second toes, and used the toe to replace the thumb. Since a thumb represents a full fifty percent of the function of the hand, the reconstruction gave back the kid the use of his hand. As he used the new thumb, it would strengthen and grow, and eventually come to resemble a normal thumb, except for the extra knuckle.
As part of the eleven-hour operation, Weather had hooked up two nerves, two tiny arteries, and two even smaller veins-veins the size of broom straws. The photomicrographs of the sutured veins had particularly attracted Maret's attention. The more veins that could be hooked up, the better off the twins would be-and Weather could do that work, even on the smallest vessels.
He'd also been attracted to her sheer stamina: eleven hours of microsurgery was a super-marathon. He sold her on the idea of joining the team, which also made her available to study the twins, to get to know the parents, and to place the skin expanders under their scalps. WEATHER HAD TURNED away from Maret and the argument-Remember to pee-when they heard a commotion outside the operating room.
"What is that?" Maret asked. Dansk had just come back with a large scalpel, and he turned to look. A few seconds later, an anesthesiologist named Yamaguchi burst into the room. He looked, Weather thought, like someone who'd just come to the emergency 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 pharmacy and cleaned the place out. Everything is shut down. Everything."
Maret's face clicked through a series of expressions, from "Is this a joke?" to astonishment: "What?"
"Some guys with guns," Yamaguchi said. He was flapping his arms, like a loon trying to take off. "Robbers. They robbed the pharmacy. The police are here. There's nothing left, they took everything… That old guy who works there, the one who wears the surgical hat…"
"Don," said Weather.
"Yeah, Don-he's hurt pretty bad. They're taking him into the 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 operating room, mask dangling around his neck, watching the work: the surgeon was cursing at the nurse, who was fumbling the gear, and they were all watching the blood pressure on the old man dropping and 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 lifted the bottle of saline and somebody else said, "Two minutes for the blood." The surgeon said, "I don't think we have the time, I don't think we've got it…" and the anesthesiologist said, "We're losing him, man," and the doc said, "Fuck this, I'm going in," and he cut and cut again and again, going in through the beginning of a brutal black bruise on the old man's belly, and the anesthesiologist said, "Hurry it up, man," and the surgeon said, "Ah, Jesus, I've got no blood, I got no blood here," and he hurled the scalpel into a corner and it clanged around and he said, "It must've been his goddamn kidneys. Let's see if we can roll him," and the nurses moved up to help with the roll and the anesthesiologist said, "Man, he's arresting."
Barakat, standing in the corner, said, "Shit shit shit shit shit shit…"
One minute later, the old man was gone. No point in trying to restart the heart-there was no blood going through it. They all stood around, shell-shocked, and then the surgeon said, "Let's clean up."
One of the nurses said, "We had no time. He was going too quick."
They all looked at the body on the table, worn Adidas sneakers pointed out at forty-five degrees, chest flat and still, the bloody gash on the gut. The anesthesiologist turned to get something and saw Barakat, a tall man, standing in the corner, hands pressed to the sides of his head, and the anesthesiologist said, "Wasn't you, man. You did good. Everybody did good. He was gone when we got him."
And Barakat thought: Now everybody will be here. Now the police will tear the place apart.
Because he really didn't care about the old man. THE SEPARATION TEAM was standing around, repeating what Yamaguchi had said, when Thomas Carlson, the hospital administrator, came hurrying down the hall. Carlson was wearing his white physician's coat, which he often did on public occasions, to remind people that he had an MD in addition to the MBA; but for all 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 be crawling around on the floor trying to find them. The place is completely 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'm sorry, man. But this is an incredible mess. As long as the kids are stable…"