Conjoined Twins Survive Risky Separation

Feb. 17, 2009— -- Two-year-old twins Dagian Lee and Danielle have spent the majority of their lives joined at the hip — literally. But two months after a 24-hour surgery separated the conjoined identical sisters, they're recovering at a Pittsburgh hospital while their mother, Catherine Nickson, finds herself pulled in two different directions instead of one.

"I think they're happier because they can actually go to bed without someone punching them in the face," the Cleveland woman said, jokingly. "I think they're happy to get away from each other. I would be."

Nurse Kristen Mancuso, who has taken care of the girls since their birth, said, "Before, they were both right there for her [their mother]. But, now, when she turns to one, the other kind of gets upset."

Beating the Odds

The girls' condition is rare, occurring in one of every 200,000 births. The survival rate is little more than 25 percent, with most conjoined twins being stillborn or dying shortly after delivery.

"I want them to have the best life they can possibly have," said Nickson, who also has a 3-year-old daughter. "I've always read once they're conjoined twins, they don't make it or live to the age of seven. One dies five hours later. I didn't want that to happen. I wanted to have three kids."

The surgeries aren't always successful. Faith Williams, a month-old conjoined twin who survived an 11-hour surgery from her sister, died Christmas Day in London. Her death followed her sister's. Hope Williams died shortly after the separation surgery. The Williams twins were joined from their chests to the lower parts of their stomach and shared a liver and intestines.

But from the beginning, Dagian and Danielle appeared intent to beat the odds. After having her first child, doctors told Nickson she would be unable to have any more children. So, when she learned of the impending birth of not one — but two more daughters — she was surprised.

"They were like, 'Oh I think you're pregnant.' And I was like, 'Ha ha. That's not funny,'" Nickson said. "They did an ultrasound and said, 'I see two heads.' And I went 'Ha, ha that's not funny.' Then they were like, 'They're conjoined.' And I didn't say anything."

The Process of Separation

For two years the girls fused together externally from their chest to their pelvis, and internally they shared vital organs such as the colon and liver.

On Dec. 13, a day before the twins' second birthday, a team of 50 began the 24-hour process of separating Dagian and Danielle at Children's Hospital of Pittsburgh of UPMC.

Twins Like Few Others

The surgery made Dagian and Danielle one of only 20 conjoined twins successfully separated in the world.

"They each have one lower extremity, or one leg, so that can make it challenging for them to walk upright," said Dr. Joseph E. Losee of the Division of Pediatric Plastic Surgery at Children's Hospital. "But other than that, they should have a healthy life."

Mancuso, the hospital nurse who has taken care of the girls, said their personalities are more distinct.

"When they were conjoined, same way, Dagian was more feisty; Danielle goes with the flow," she said. "If one wanted to take a nap and the other didn't, or the other wanted to play. It was kind of difficult."

And Nickson said the toddlers are "typical little kids just hitting each other, stealing each other's pacifiers, popping each other in the head."

Doctors said the twins now are one skin graft away from being released from the hospital, and Nickson said the entire experience has inspired her to go to nursing school.