Conjoined Twins' Process of Separation

Jan. 6, 2005 -- -- On a rainy day in 2003, Kevin and Melissa Buckles began a long and difficult journey when they found out their unborn babies were conjoined.

The couple say they never considered aborting the pregnancy. It was not a matter of religious conviction -- they just felt the girls deserved their shot at life. They had also already come up with names for the babies: Jade and Erin.

At least three out of every 1,000 births worldwide are twins. Only about one in every 40,000 conceptions are conjoined twins. Only one in 200,000 of those survive to birth. And when conjoined twins are born, only a quarter of them survive past their first day.

ABC News' Charlie Gibson followed the Buckles through their daughters' birth and the separation surgery. He also witnessed how this young couple -- one a schoolteacher, the other a Marine -- never lost trust with their goal to have two little girls.

Gibson watched as the experience filled the couple with hope and faith -- the middle names they gave their girls.

What Was Wrong

One of the most difficult days came when Melissa was 18 weeks pregnant, and they were shown their first ultrasound images.

They were told they were having twins, and they laughed, a little surprised. Then the technician offered to show them what was exactly in the pictures. Melissa took Kevin's hand.

"We just asked what was wrong," he said. "And she told us they appear to be conjoined at mid-chest to the abdomen."

The next day, they met with an expert at the National Naval Medical Hospital in Bethesda, Md., who explained that their twins were conjoined at the chest and abdomen. Later, they learned that the girls' shared umbilical cord was wrapped around one girl's neck and Melissa was ordered to the hospital on strict bed rest.

A Hurdle Cleared

Five weeks before Melissa's due date -- 34 weeks into the pregnancy -- contractions began. With each contraction, the babies' heart rates declined. The carefully planned birth suddenly became an emergency.

A Caesarean section was performed before the anesthetic even had a chance to take effect. The babies were out within one minute. "It was probably the most painful thing I've ever gone through," Melissa said.

But Erin and Jade had beaten the odds. Melissa listened with joy as the babies let out hearty, lusty and loud cries. "Seeing them, hearing them, it was just an overwhelming relief," she said. "My heart was bursting."

Still, looming over the Buckles was the operation to separate the girls. Kevin was stoic about what was to come.

However, Melissa said, "I know that I'll have to be there for our children, but I don't think I'll be as accepting."

A Heart-Stopping Moment

The separation surgery took place at Children's National Medical Center in Washington, D.C., when the girls were four months old. Each girl got her own complete medical team. They were color-coded to tell them apart: Jade was tagged in green; Erin got lilac.

Doctors began by making an incision from chest to abdomen on one side. When they opened the sac containing the girls' hearts, they found they were bound by a bridge of connecting tissue. An electrical impulse from the heart of one girl was controlling the heartbeat of the other.

Doctors feared if they cut the connecting tissue, one heart might stop. So, they slowly applied pressure to the connection, watching to see if both hearts would beat on their own.

It was absolutely silent in the operating room when doctors finally cut the connection. When the babies' hearts began beating at a different pace, there was a noticeable release of tension from everyone in the room.

Two Girls

With the hearts separated, doctors turned to the task for which they had planned the most: separation of the liver.

From ultrasound pictures, they had mapped out a line along which they thought they could cut to avoid three major blood vessels -- any one of which could hemorrhage.

But when the liver was exposed, there was a line of white tissue right on the surface of the organ. Doctors later said there might as well have been a sign saying "cut here."

Five hours after the twins were brought to the operating room, the girls were finally free of each other's bodies.

Dr. Kurt Newman, the chief of pediatric surgery, went to the waiting room to tell Melissa and Kevin, "We've got two babies that are separate."

"We always considered them two girls and now we literally have two girls," Melissa said as she and Kevin hugged each other.

But there was still work to be done. Jade was moved to an adjoining operating room, the first time in their lives the girls were in separate rooms.

On the Way Home

Doctors moved on to constructing a new chest wall for each. Erin's heart stuck out 90 degrees up into the air so Dr. Gary Hartman covered it with a Gore-tex patch. "We'll end up with a triangle-shaped defect," he predicted.

It took Dr. Stephen Morrow a little longer to close up Jade, but soon she was also ready to see mom and dad.

Melissa and Kevin couldn't believe how light the girls were. What used to be 18 pounds had become two nine-pound bundles. "I just kind of stood, kind of in the middle of the room and just kept looking back and forth at the beds," Kevin said. "I just had to really catch my breath."

Two weeks after their surgery, the girls went home.

Distinctions

At home, the girls appear to be healing well. There's a bump on Jade's chest from her anomaly. "Her rib cage kind of comes out," Melissa said. But she added, "it may reshape itself as she grows." On the other hand, Erin has a slightly more visible scar.

Jade is turning out to be "very feisty," Melissa said. She demands attention. Meanwhile, she said, "Erin is very laid back. Easygoing."

"They're both very happy," Melissa added. "Smiley all the time. Giggly."

But the Buckles soon found out Erin did not come through the surgery unscathed. When they took their girls to get a flu shot, each girl got a needle in the leg.

"Jade screamed for about three seconds and then she was fine," Kevin said. "And they did Erin and she didn't budge."

Doctors believe that some of the nerve cells in Erin's spinal cord died during the surgery. Though they don't know when, they believe blood flow to her cord may have been interrupted for just a few moments.

"She does have some feelings," Kevin said. "She does have some movement. But on a scale of one to 10 she's probably a two as far as her movement goes."

The Bottom Line

Both babies have physical therapy three times a week. Jade works on preparing to walk. Erin's needs are more fundamental -- therapists want her to get feeling in her legs.

Kevin thinks she will eventually be able to walk as well, but with assistance.

There is hope that the cells will regenerate. Or stem cell research might be able to help.

But the Buckles show no anger. There are no regrets. Medical bills have come to over $1.5 million -- and there is more to come.

They look at the bottom line. They have two little girls who have beaten the odds and who melt your heart.