By Adrian Cory

Mr. Chang tensed as the microphones pinned him to the top of the hospital steps.

“Can you tell us why the operation has been cancelled, Doctor Chang?” the same question rang out from a number of different reporters in the melee. The aging surgeon craned his neck to try and see if his car had arrived on the road below them. The dark blue Mercedes was there, plumes of exhaust emissions vaporizing in the cold, November air but he was going nowhere until the hounds had been fed something.

“It’s really nothing significant,” he lied. “The operation has been delayed due to a small, clinical issue that we are looking into.” He lowered his head and dropped a hand into his coat pocket to retrieve a pair of gloves. “I’m confident the matter will be resolved and we will progress with the separation in a day or two. Now, would you excuse me, please?” The physician kept his head down and began to ease through the rank of photographers whose frenzied snapping lit up the descending gloom.

“What has the Emperor said about the delay?” a stocky, intimidating journalist had door-stepped Chang pushing his leathery, pock-marked face within a couple of inches of the surgeon’s. “There really is nothing dramatic to report,” Chang spat out, flustered and eager to leave the mob behind, “the Emperor has been briefed fully regarding his children.” The Mercedes’ rear door was pulled shut and the car had already turned on to Grays Inn Road before the last flash faded.

***

The ward was quiet all but for the sound of the equipment monitoring the children’s vital signs.

Great Ormond Street hospital had seen many children come and go since its formation in the middle of the 19th century. The ailments the children sought recovery from were as diverse as the range of backgrounds they came from. For now though, Daichi and Saemi, the six-year-old twins of the Japanese Emperor, were the children at the centre of attention both clinically and publically. Daichi and Saemi were Craniopagus twins: the top of Daichi’s head attached to the back of Saemi’s. Their bodies separate but their skulls fused together since birth, they lay, as they always did, in a single straight line on the hospital’s crisp white bed sheets. The twins laughed and teased each other with comments and jokes but one never grew irritable with the other: they were getting older yet never further apart.

After initial consultations between the hospital board, a team of surgeons, The Emperor and his young wife, it had been agreed the best course of action was to fly the twins to London for the operation. The children were both in good health and, as no major organs were being shared, the chances of a successful outcome to surgical separation were high. A week later, the twins were comfortably installed in the high-dependency Tiger Ward and it was announced the hospital’s senior Consultant Craniofacial and Plastic Surgeon, David Chang, would lead the multidisciplinary team. As the You Tube video of the twins playing in their new surroundings registered 20 million hits, the world’s interest in the fate of the noble conjoined twins reached feverish proportions as ‘separation day’ approached.

Earlier in the day, Chang and his team were sat in the ward facing a bank of live television cameras. On a bed directly in front of them lay Daichi and Saemi.

“Good Morning, Doctor Chang,” said the BBC breakfast show host, “Are you and your team ready for tomorrow’s operation?”

Mr. Chang studied his team for a moment. Nobody had separated more conjoined twins than he had and the team of neurosurgeons, imaging specialists and nurses that supported him were second to none. “We are thank you,” Chang replied confidently, “we will initiate the first vascular separation at around six a.m. tomorrow and I expect this first part of the procedure to run smoothly enough.”

“How long will the operation take?” the BBC anchor came back.

Chang felt like an Apollo astronaut being scrutinized the day before launch; it wasn’t a good feeling, though. “The initial surgery will be ten hours and we expect to have three more sessions of equivalent length.”

“What is the likelihood of…losing either Daichi or Saemi during the procedure, Doctor Chang?” the presenter trod carefully; news editors liked to deliver happy endings and this story was no different. Chang had lost nine children across fourteen operations but he didn’t flinch. “The twins are strong,” he said, “and this should be a straight forward separation…so it should be a breeze for my team!” His quip broke the tension that had built up in the group of media-shy specialists gathered around the bed and they each afforded themselves a nervous laugh.

“I’ve noticed, Doctor Chang,” a second BBC presenter cut across the interview, “that…I think it’s Daichi…is bigger than Saemi. Will that have a bearing on proceedings at all?”

Chang and his team immediately looked puzzled. “Err…no…” Chang stumbled, unsettled by the question, “the twins are pretty much the same size and weight.” His gaze now studiously fixed on the children’s forms in front of him. “There’s virtually nothing between them.”

White noise filled the interview for a few seconds whilst Chang’s team turned their attention to their patients and the BBC crew paused, unsure as to why a blindingly obvious statement had been refuted so quickly. Chang turned back to the camera and looked visibly troubled.

“Ok, Doctor Chang,” the presenter was under instruction to quickly wind the interview up, “we wish you, the team and Daichi and Saemi all the best for tomorrow. Thank you for your time.”

“Yes. Thank you,” a distracted Chang replied.

Overnight, Daichi had grown noticeably bigger than Saemi.

***

Chang was paged as soon as the call came in from the Japanese Embassy.

Emperor Akita was polite and efficient and accepted Chang’s reassurances that the morning’s drama on the British news channel was nothing to be concerned over. Chang, and his team, knew this was far from the truth, however. Firstly, how had they all missed such a significant change in the twins? Was it their focus? Maybe it was their 747 moment: the analogy drawn from pilots so engrossed with a problem on a plane that they often forget to fly the thing and disaster ensues.

Secondly, and more importantly, what was going on?

The dynamic between the two children had also altered significantly. Daichi was alert and as playful as ever, whilst Saemi had become withdrawn and sullen. Up until now the only way of telling the identical twins apart was the color of their eyes: the boy’s brown and the girl’s blue. Their size and demeanor were now two other distinct differences.

Chang wasted no time in pulling in pediatric specialists from the other hospital departments to determine the cause of Daichi’s increased and sudden growth rate. Most of the morning was spent examining blood and plasma samples and brooding over numerous x-rays and MRI scans. By the time the Emperor and his wife walked into the ward for their afternoon visit, Chang’s team still had no answers.

“What is happening?” The question didn’t need translating as the Emperor looked dumbfounded at the group of expert physicians in front of him; the blood drained from his wife’s face. “We’re not sure,” Chang moved forward from his position beside the twins’ bed. “We know the children are both still healthy, it’s…just…” the surgeon paused, “we’ve not seen anything like this before.”

The royal couple moved closer to the bed.

“Mr. Chang, can I borrow you for a moment, please?” it was his Pediatric Neurosurgeon, Mr. Haas.

“What’s on your mind, Michel?” Chang asked.

“We’ve got another problem,” Haas spoke softly, careful his words didn’t carry to the Emperor, “Saemi is shrinking.”

***

“We need to postpone tomorrow’s operation. Can the PR guys put something out there that doesn’t send everyone gaga?”

The hospital director, Sir Gerald Holmes, wanted to avoid a media scrum outside his building but was more than resigned to the fact that, given the public interest in the twins, this was going to be a tough one to contain. He dismissed the communications team after the briefing and called Chang into his office.

“What have you got for me, David?” Sir Gerald sat forward in his chair, as eager as anyone for some answers.

Chang sighed; unable it seemed, to gather his thoughts. “It’s…incredible really,” he finally said. “We’ve done every single clinical analysis under the sun to substantiate what I’m about to tell you, but the simple truth is there is no rational explanation for what’s happening to the twins.” Chang picked up a glass and took a sip of water. “The facts are Daichi is thriving; growing at a pace hitherto unseen in any controlled environment by us or any of our peers; there’s no research…no data that explains this. While Daichi strengthens, his sister is withering like…like a vine cut off at the root.”

The director was confused. “Has Saemi picked up an illness? Is the prospect of the separation something that’s overwhelming her? Come on, David, you’re not making any sense here!”

“No, Gerald. It’s much more straightforward. Daichi is somehow removing everything out of Saemi. By that I mean he’s taking her blood, her nutrients, her organs, bones, tissue…the imaging doesn’t show how Daichi is managing to do this, or how aware the child is of the process, but he is simply draining the girl’s life force”

The two men faced each in total silence.

Chang eventually spoke. “We’re watching Daichi consume his sister right before our very eyes.”

***

Chang needed a brief change of scene to collect his thoughts and had decided to battle through the press just so as he could get back home for an hour, shower and pick up a fresh set of clothes; it was going to be a long night. If he needed sleep – which seemed unlikely, there were a number of the hospital’s private rooms he could crash in whilst remaining close to the ward and the conundrum within it. Out of the shower, Chang picked up and punched a button on the TV remote. And there he was. Chang watched himself as he avoided the reporters’ questions and made his unconvincing statement about how all was well on the ward and that there wasn’t a six-year-old Japanese kid eating his sister alive in one of his hospital beds. ‘How many times are they going to show this clip?’ the surgeon said to himself as the news channel looped the footage and continued to speculate wildly on the lack of information coming out of Great Ormond Street Hospital.

As he watched, Chang realized he’d made a bad error of judgment going home even for such a short time and allowing his core team to do likewise: he intuitively knew this would end tonight.

Chang jumped back into the Mercedes and drove himself back into the centre of the capital. Once at the hospital, he quickly made his way up to Tiger Ward but things were already going badly wrong as he entered the ward’s reception area.

“We were just about to contact you, Mr. Chang,” a distressed member of the high-dependency support team blurted out when she caught sight of the consultant.

“That’s okay, Josie,” Chang mind was racing, what developments had he missed? “Contact my core team members and get them all back in here quickly, please.” The nurse nodded. “And make sure someone gets hold of Sir Gerald…he’ll need to be here for this.”

Chang pushed steadily through the unit’s swing doors. He could see members of the support team around the twins’ and from their body language he quickly determined that things weren’t good. A strong smell of cooked or burnt meat filled the room; Chang held his breath as he slowly drew up alongside his colleagues. There, on the bed, lay Daichi; a young Japanese boy who was now the size of a ten or eleven-year-old. Attached to him was Saemi, his sister, whose body mass had reduced by about two thirds of what it was just over an hour ago when the surgeon had left. Her skin was blackened and dried and it had split open in many places body but, notably, no blood had escaped. The child’s skeleton could be see through the parched skin; every angle of every joint jutting out from her obscene frame. Saemi’s eyes bulged from their sockets and they wildly scanned from one side of the ward to the next; searching for some release from the torture she was clearly going through. She let out a stifled cry.

“For Christ sake, we need to put her out of her misery,” said a member of the support staff.

“You know we can’t do that,” Chang said steadily, “somebody get on to the Embassy, now.”

Daichi twisted his neck, moving the heads round to face Chang. He held the consultant’s gaze for a moment and then began chuckling quietly to himself. His whole body shook and he was soon in fits of laughter. Boyish giggles; but this was no ordinary boy.

***

Saemi’s inexorable demise took another two hours. The core team of physicians, the support staff, the hospital director, the Japanese Ambassador, the Emperor and his wife all watched the girl succumb to Daichi.

She disappeared right before their eyes; completely. Her body shriveling and contracting into nothing more than a dried husk that was, in the end, no bigger than the size of a fist. Daichi had absorbed her.

The Emperor’s wife wept: twenty-four hours earlier she had two bright, intelligent children whose lives were about to be improved by the brilliance of the people around her. Those people now just stared at her and her misery; no words could possibly be found. The Emperor moved forward towards his son who sat on the edge of the bed facing the floor. Akita gently placed a hand on the side of Daichi’s shaven head and slowly moved it up towards the vestige. As he touched the husk, it fell apart into a cloud of dust particles and Saemi was gone forever.

Daichi lifted his head and opened his eyes to greet his father. A broad smile crossed his face and his eyes sparkled: his beautiful blue eyes.

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