That's what you got from the cocaine.

It had helped him through med school, but after that, in Miami, getting cocaine had not been a problem. Once in Minneapolis, for his residency, he'd asked around, found a guy who was recommended as a source for decent marijuana, the imported stuff down from Canada. A guy like that knew where to get cocaine.

So he bought his c.o.ke from a dealer named Lonnie, and then from a redneck named Rick, who took over Lonnie's route when Lonnie moved to Birmingham. Then Rick got hurt in a motorcycle accident, hurt really bad, and Barakat went stone cold sober for a week and a half, and it almost killed him.

One day Joe Mack showed up on his porch with a free baggie of blow.

Like the cocaine Welcome Wagon.

"Our friend Rick said you were one of his best guys, but he's gonna be out of it for a while ..."

At that point, Barakat was spending eight hundred dollars a week on cocaine, with no way to get more money. He hung at eight hundred, until one late night he was waiting at the pharmacy window, the key already in hand, and thought, They've got no protection, and I know the guys who could take it away from them. They've got no protection, and I know the guys who could take it away from them.

It all seemed so simple. And it should have been.

NOW HERE he was, freezing his a.s.s off, trying to set up an a.s.sa.s.sination. Not simple anymore. Not uninteresting, though, if only he'd been working with a competent crew. The whole concept of crime was interesting: the strong taking from the weak, the smart from the stupid. A game, with interesting stakes ... if only he hadn't been working with the Macks.

At twenty minutes after five o'clock, a black Audi convertible rolled up the ramp, headlights bouncing when its tires b.u.mped over expansion joints. The car swooped into a reserved parking place in the physicians' area. Five seconds later, a short blond woman got out and started toward the exit door opposite Barakat.

Had to be her--the same woman he'd seen in the elevator. He let the door close: he couldn't allow her to see him again. Even being in the same part of the building, where she might see him by accident, could trip off a memory.

He waited, nervous, stressed, sweating in the freezing cold, and when she'd gone through the door, went after her. And as he went, the thought crossed his mind: fix it now. Take her. She was a small woman in a deserted building, he could break her neck, who'd know what happened?

Just a thought, but it stayed with him. He might catch her at the elevators ... but when he got there, she was gone. A little feather of disappointment trickled across his heart, his gut. He could have done it.

So now, the question remained. Who was she, and where was she going?

She was early for most docs. They wouldn't normally arrive until sometime after six. On the other hand, the Frenchman's surgical team was supposed to start separating the twins ...

He went that way.

THIRTY PEOPLE milled in the hallway outside the special operating theater. Like most of the other docs, he'd found an excuse to look the place over--the special double operating table, the intricate anesthesia setup, the newly painted, sign-posted floor, an attempt to better ch.o.r.eograph the movements of the ma.s.sive operating team, to keep the sterile and the non-steriles separate, even as they walked among each other.

He saw the blond woman, still in her long winter coat, talking to Gabriel Maret, the Frenchman. Maret was listening closely. She had to be somebody important.

Barakat was an emergency room doc, not on the team, or anything close to it, and all the team members knew each other, so he couldn't risk joining the crowd. What he could do, though, was climb into the small observation theater above the OR. If you wanted a seat, all you had to do was get there early. One of the team members would be narrating the surgical procedures for the observers. The woman, if she were central to the work, would be introduced.

[image]

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 a.s.sistant 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 cl.u.s.tered 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 G.o.d 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-p.u.b.erty 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."

[image]

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 a.s.sociates, 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 a.s.sociate 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.

"d.a.m.nit." 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." eliminators."