Mark sat at a high-top table in Shifts Lounge. Shifts was located within walking distance from Saint Stevens Memorial Hospital where Mark held the position of Chief of Medicine. The clientele of the lounge were almost exclusively hospital employees, and the lounge owner accommodated the hospital’s employees work schedule by opening at 7:00 a.m. and not closing till well after 3:00 a.m. each day.

The lounge was decorated intentionally to not include reminders that its patrons would associate with the hospital. Besides a few photographs of Shifts owner posing with some nurses hanging on the narrow hallway leading to the restrooms, there were no other health care industry related pictures or items in the lounge. The owner had even made sure that the soap and cleaning supplies that were used in the lounge didn’t smell like those used in Saint Stevens.

“What do you think is taking them so long?” Doctor Henry Zudak asked.

“They’re not that late,” Mark said. “You have to expect some delays. Traffic can get pretty rough on Long Island, and it isn’t a picnic getting around Chicago this time of day, either. Relax.”

“Relax?” Henry said. “I can’t believe that relaxing is possible.”

Henry Zudak had been an obstetrician for seven years. In those seven years, he had seen plenty of surprises when his pregnant patients were lying on a hospital bed, legs held in stirrups, nervous husbands wondering if they should look south or north. However, what he had witnessed less than twenty-four hours ago was well beyond anything he would describe as a “surprise.”

Ken O’Connell, a successful car dealership owner and entrepreneur, and his wife, Janet, arrived at Saint Stevens at 4:30 yesterday afternoon. They knew, as did their doctor, Henry Zudak, that Jan’s belly was full of not one, but two babies. So while she was just beginning her eighth month of her pregnancy, Henry wasn’t surprised or overly concerned that Jan was in full labor.

Even the discovery that the twins were conjoined – choosing their chests to be their point of connection – didn’t shock Henry, though it was an unexpected development.  Knowing that Jan would not be able to deliver the conjoined twins naturally, Henry had Stanley Mix, a talented surgeon and good friend of his, paged.

“Not sure of their condition, but I could clearly see that the babies are connected at the chest,” Henry reported to Stanley.

“I’ll get ‘em out,” Stanley said.

The Cesarean section was quick. No complications. The neonatal nurse on duty quickly accessed the twins while Stanley closed up the five-inch incision.

“Doctor?” the nurse said in a hushed voice to Stanley who was finishing suturing the baby’s exit passage.

“Yes?” he answered.

“Can you help me with something?”

Stanley thought it was a strange request from a tenured nurse.

As Stanley approached the nurse who stood beside the twins, he could read the concern deeply etched into her face.

“Problem?” he asked.

“I only hear one heart, and I can only get one baby to breathe. APGAR test score is a six. No breathing, no color.”

She turned and gestured to one of the twins.

“This baby has the heart. This one,” she said while placing her hands on the other twin, “is, I think, just going along for the ride.”

Stanley examined the twins carefully, trying hard not to raise the already heightened concerns of the O’Connell’s.

“I don’t think it’s going to be a very long ride,” he whispered. “Heart is too premature to handle one baby, let alone two. This may get ugly.”

The time for quelling the fears of the O’Connell’s was over.

“Ken and Jan,” Stanley said. Though Jan was heavily medicated, her fears made her fully aware. “I believe there’s a problem that we don’t have much time to solve.”

The decision to do an emergency separation was difficult for the parents.  It was not made until both Henry Zudak and Mark Rinaldo were asked to examine the twins and either agree with Stanley’s dire assessment or find a reason the reason to keep the babies joined.

They both agreed with Stanley.

There was no time to wait for a surgeon experienced in the type of surgery needed, so Mark asked Stanley to perform the procedure.

“I’ll assist,” Mark said

“I’ll need the extra hands,” Stanley replied as they scrubbed in.

The procedure only took 40 minutes to separate the twins. Thomas, the twin lucky enough to claim possession of the heart and lungs, was quickly transferred to the Neonatal ICU, while Alexander was carefully and respectfully placed on a gurney and covered with a dazzlingly clean white sheet.

“I’ll go speak with the O’Connell’s,” Mark said as he and Stanley finished the surgery. “Let Henry know what happened and ask him to keep an extra close eye on the other baby.”

As he turned to leave, he felt the strong and sure grip of Stanley’s hand grab hold of his arm. The grip was stronger than Mark thought a grip should be.

“Problem?” Mark asked.

“Look,” Stanley said, gesturing to the baby covered in the white sheet. “It’s moving.”

Mark broke free of Stanley’s grasp and removed the sheet covering the heartless baby. At first, Mark expected that the baby’s nerves were having one last run through the body. However, when Mark saw the child return his stare, it was Mark’s nerves that started running.

“Give me a stethoscope,” Mark ordered.

He checked closely for any signs of life, anything that Stanley and he may have missed.

He found nothing.

“No pulse, no breaths. Nothing,” Mark said.

Mark quickly moved to the windows that separated the operating room from the observation area and drew the curtains closed. Only he and Stanley were in the operating room, the nurses having gone with the healthy twin to the ICU.

“What are you doing?” Stanley asked.

“Making sure that no one sees what the hell is going on in here.”

“Mark, we need to get this baby...”

“Get it where?” Mark interrupted. “Get it to ICU where they can say we screwed up, or get freaked out when they find out that this baby doesn’t have a heart? Or maybe we should bring it out to the O’Connell’s and tell them the good news, that despite not having a heart or lungs that the child they just decided had to be separated in order to save the other baby, is still alive? Where, Stanley? What do you propose we have to do?”