Hema makes her incision and has no time to think about tying off bleeders; there is very little bleeding, in any case, and that is not a positive sign. She positions the retractors to hold the wound open. Then something amazing happens: the abdomen seems to expand and glow with a heavenly luminescence. She is stunned and puzzled at the sight until she realizes it is simply the sunlight coming through the frosted operating theater window. Nevertheless, Hema cannot remember such a thing happening before now. She sees the worst of her fears and knows she will have to perform a hysterectomy once the twins have been removed. There is so much blood, including a massive blood clot practically surging up at her, and there has been so much trauma. Hema knows all her familiar landmarks and guidelines for such a procedure will be nonexistent.

Numerology is important to Hema; she quickly tries to ascertain the bad luck of this day’s numbers. She recalls having to repair a child’s broken leg and gripping the testicles of a crazy Frenchman earlier in the day, and she wonders what is next. Thomas Stone is fumbling around with an oozing vessel. Hema gets his attention back to the more important work ahead of them. After she incises the uterus, she reaches for the baby located at the top of the uterus. He is head down and upside down, and he would have been the second child delivered in a natural birth. Now, though, he will be the firstborn. This twin has his hand jammed against his cheek, however, and he will not move. Hema extends the cut and suctions the infant’s mouth, but he will still not move. Then she sees the problem: the twins are joined at the head.

The connection is not complete; a small tube of flesh, darker than an umbilical cord, tethers them together. Blood is flowing from the tube, probably caused by one of the probes made by Dr. Stone, and Hema hopes the loss of blood is from a vessel rather than something more substantial. She begins speaking aloud all the potential problems that could occur once these babies are removed from their uterine home. This is a strategy she often uses to organize her own thoughts and prepare her assistants for all possible contingencies. It has a secondary advantage of allowing other people to help her find any flaws in her thinking or reasoning. Her commentary is met with silence, and she prays both babies will live as she cuts the tube that connects them.

Nothing happens. Hema ties off the stumps and removes the first child, a boy, and hands it to the waiting nurse. She pulls out the second child, also a boy and an identical twin, and sees the damage to the top of his head. Both of the boys are tiny, perhaps three pounds each; they are at least a month premature. Neither child cries. Hema returns to her patient and begins to work frantically to save the life of Sister Mary Joseph Praise. As she works, Hema wonders why the nurse probationer who took the first child was still standing there, dumbstruck, when she turned to hand her the second child. But her first priority now is the woman on the table.