After the marathon 27-hour surgery to remove extra limbs from little Lakshmi Tatma's body, her progress is now being measured in small but significant increments: Saturday, she came off the ventilator; she drank some milk; she wiggled her toes. Sunday, she ate three pieces of bread. These steps of progress indicate that the 2-year-old is recovering very well. But perhaps the most significant indication is that Lakshmi appears to understand what has happened to her.
"Maybe it's my imagination, but I can see her. … She just gives one stare down her limbs and I can see she is saying, 'Where have they gone?'" said Sharan Patil, chief orthopedic surgeon and chairman of Sparsh Hospital, where the surgery was performed.
Patil led the team of 30 surgeons who separated what was essentially a headless parasitic twin joined at the girl's pelvis. Parasitic twins differ from conjoined twins because they are not fully formed and they depend upon the twin on the body functions of the complete fetus.
During the surgery, the spine was cut to remove the extra limbs and the wide gap between the pelvic bones was closed using bone grafts. The closed gap was a significant accomplishment for the surgeons, who had thought they may have to close it over the course of several surgeries.
"She responds extremely well to her parents walking into the ICU. Anybody calls her name, she quickly turns around, which is heartening to see," he said. "She's moving her toes, moving her hands freely."
Lakshmi is stabilized, but the biggest concern right now is infection due to the enormous wounds from her surgery. Doctors hope that she will leave the intensive care unit today.
Outside the hospital, which is surrounded by palm trees, satellite trucks and local media fill the red dirt driveway, awaiting news on the little girl who has captured worldwide attention. Inside, Lakshmi's parents spent about three hours with her Sunday morning. Lakshmi has months of rehabilitation ahead of her, including potential surgery to fix her club feet, as well as an additional surgery due to the repositioning of her organs. But doctors do not expect to do these surgeries soon.
"She's a fantastic child in terms of the speed with the tissue recovering now and she's withstanding the procedure well," said. Patil. "She might surprise all of us with making an attempt at walking within the next six weeks."
In late September, Patil traveled to the family's village in the remote and poor Indian state of Bihar after receiving a call from a social worker seeking help for Lakshmi's condition.
Sparsh Hospital, which is less than 2 years old, was created to help the middle and lower classes of India to receive quality care. The hospital has taken unique approaches to execute this concept by cutting costs, including opening a facility on the outskirts of Bangalore, instead of the high-priced downtown. The hospital's foundation donated the cost of the surgery, estimated at $625,000.
Lakshmi's father, Shambhu, and mother, Poonem, had tried to find medical help for their daughter, but were told surgery was not possible. The family struggled financially, particularly because only one parent could work while the other cared for Lakshmi who was constantly running a fever. Survival rates for conjoined twins can be as low as 5 percent; doctors believed that Lakshmi would likely die in her teens without surgery.
In their village, which has just 150 homes and no electricity, Lakshmi's parents tried to give her in as normal a life as possible. But in the region, villagers considered her to be the reincarnation of Laxmi, the multilimbed goddess of wealth. Some people even tried to buy Lakshmi to put her in the circus.
When. Patil met the 2-year-old, he said he was unprepared for what he saw.
"Even though I'm a medical man and having seen the most grotesque things, it was quite shocking. I'd never seen anything in life like it before," he said. "The way she was moving around with that body, it was quite difficult and it was quite touching. Her older brother was running around and she was envying him."
About a week after the doctor's visit, the family traveled to Bangalore to prepare for the surgery.
For Lakshmi and her parents the trip to the hospital was the longest of their lives. When they arrived in Bangalore, they rode in a car for the first time. And Poonem, who is six months pregnant, received her first ultrasound, which indicated that her unborn child is healthy.
"We have tried to touch their lives, but it's been reversed now. We have become much enriched by having Lakshmi in our hospital," said Patil. "This is probably the best thing that's happened in my career. I'm able to reach out and help somebody who needed it most and nothing could have pleased me more. It's a very nice feeling."