"One of the babies is alive, but the other baby doesn't exist as an individual," Patil said. "The two bodies are fused together. ... The entire parasitic part of Lakshmi's body was feeding on Lakshmi for nutrition, for oxygen, for energy, for everything else. That's typically how a parasite is described … a parasite which is dependent on the host."
Because of the parasite, Lakshmi's health and possibly her survival were in danger. Patil believed the parasitic twin should be surgically removed. Without surgery, Patil estimated that Lakshmi's chances of surviving past her teenage years were minimal.
But in Lakshmi's case, he faced something more than a medical issue. A local fair to celebrate the holy day of the goddess Lakshmi coincided with Patil's visit. Once the little girl who was the image of Lakshmi entered the crowd, it was clear that she had a profound effect on the villagers.
"She was thought to be bringing a lot of good things to the village and the people around," Patil said. "Some of them even folded their hands in respect for the little girl, which was quite amazing."
Because she was considered a good omen to the village, Patil worried that some villagers might be against surgery to change her form into that of an typical 2-year-old.
"I'm sure a lot of the people in the village had those ideas in their minds, that if something was done to Lakshmi, things might turn around, and things might not be so good for them anymore," Patil said.
Privately, Lakshmi's parents had heard many negative opinions -- that some villagers feared the Tatmas could not return if they left; and that Patil might say one thing and do another.
"They had the genuine love and concern … that any parents would have for the child," Patil said.
To reassure the parents, Patil arranged for all of the family's medical expenses to be paid through his hospital. Recognizing that medical care is out of the reach of millions of people in India, Sparsh Hospital in Bangalore has a foundation whose mission is to extend orthopedic and reconstructive surgical care to those who need it, regardless of income.
Every day was different for the Tatma family because of fluctuations in Lakshmi's health. "So she really was living on the edge," Patil said.
Having weighed their options carefully, Lakshmi's parents finally decided to travel more than 1,000 miles from their village to Sparsh Hospital, a state-of-the-art facility where doctors performed a battery of tests to see whether surgery was even possible.
The first X-rays revealed complications. Lakshmi's spine was joined to that of her parasitic twin, and doctors had to determine how to separate the spine without affecting Lakshmi neurologically. They also discovered that Lakshmi had only one functioning kidney. A second functioning kidney was in the parasitic twin.
"The team itself [included] 37 people as part of the surgical procedure," Patil said. "We had five sets of surgeons who operated on the little girl."
On Nov. 6, 2007, Lakshmi was wheeled away from her parents, and the surgery began.
Pediatric surgeons made the first incision, to identify her internal structures -- "which of them belonged to the parasite and which belonged to Lakshmi," Patil said.