Born joined at the pelvis, Siamese twins Dao and Duan were brought to the United States from Thailand to assess their chances for being separated surgically. NOVA covers the intricate planning and protracted operations that eventually made the two girls into two distinct individuals.
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00:01Tonight on NOVA
00:03Dao and Dwen are celebrating their birthday just like any other little girls.
00:08But they face an uncertain future.
00:11They are Siamese twins.
00:13The sisters are so closely joined that doctors aren't sure if they can separate them safely.
00:19NOVA follows the family as choices are made that will determine how or if Dao and Dwen will live.
00:26A story of love and courage, Siamese twins.
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00:59Committed to discovery.
01:01Improving health.
01:02Extending life.
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01:05Major funding for NOVA is provided by the Corporation for Public Broadcasting
01:10and by annual financial support from viewers like you.
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01:25On April 20, 1993, a plane from Bangkok, Thailand arrived in Philadelphia carrying two small passengers.
01:34My gosh, look how cute!
01:35My gosh!
01:36Dao and Dwen are conjoined twins
01:42born attached at the pelvis.
01:46Orphans since birth,
01:47they have been sent to America
01:49by an international adoption agency
01:51to investigate the chances of separating them.
01:58There to meet them at the airport
02:00are Barbara Headley, a nurse,
02:02and her husband David, a doctor.
02:06The Headleys have agreed
02:08to look after the two little girls
02:10while doctors at the Children's Hospital
02:12of Philadelphia examine them.
02:17Were they in the same orphanage
02:19the whole time until a month ago?
02:21Right.
02:22They were?
02:24Were they happy there, do you think?
02:26They're quite bonded to the workers there.
02:30So this will be their third time
02:31they've been moved, actually.
02:33Yeah.
02:36Do they know that they're coming with me?
02:38Yes.
02:39Okay.
02:39And you think they understand?
02:41Yes.
02:41You tell them.
02:42But they say no.
02:44They don't want to come.
02:46Do you think you should tell them
02:47that it's us?
02:49So they know it's us?
02:50What you will call yourself
02:51for her with her?
02:53She can call me mom.
02:54Mom?
02:55Mom.
02:55Mom.
02:55Mom.
02:55Mom.
02:55Dad, Dad, Dad.
02:57Mommy is here.
02:58Mommy is here.
02:59Mommy is here.
03:00Say hi.
03:03Say hi to Daddy.
03:05Say hi to Daddy.
03:07Daddy is here to go.
03:08Tired after a 26-hour journey,
03:21Tao and Duen, two little girls not yet three years old,
03:25begin a new life in a strange land.
03:28Their future is uncertain and full of risk.
03:36Tao, where do you check this at?
03:38Yeah, see? Carb. We're going to get on a car.
03:47Two days later, Tao and Duen have begun to settle in with the Hedleys,
03:51who have two adopted Asian children.
03:53Come on, guys. Come on. You can do it. Look how pretty.
03:58You're so pretty. You're so pretty.
04:02You're going to get tickled. You're so cute.
04:04So far, they've done really well.
04:10The next morning they woke up and they felt real comfortable here.
04:14And they've been smiling and laughing and they've learned how to say the word dog.
04:18And they've just been enjoying themselves a lot.
04:21And they feel very comfortable.
04:28Thousands of miles from Thailand, Tao and her twin sister, Duen,
04:33are adapting quickly, despite speaking no English.
04:35But later today, they face a crucial test.
04:46How long have you been with the baby?
04:48Two days.
04:49Two days. Well, you're very good at it.
04:50So far.
04:51Okay.
04:51I'm just going to part here.
04:53That's okay.
04:54That's just far.
04:55I'm going to part.
04:55Dr. James O'Neill, head of pediatric surgery,
05:04is one of the world's leading experts on conjoined twins.
05:08Now, what I'm doing now is trying to feel the pelvis.
05:15Conjoined twins are very rare.
05:18The Children's Hospital of Philadelphia,
05:21which has carried out 18 twin separations more than any other center,
05:25only sees one case a year on average.
05:27We have a single, um, a single anus.
05:32But if anyone can separate Tao and Duen,
05:35it is O'Neill and his team.
05:39Conjoined twins rank among the least common disorders
05:45that pediatric surgeons encounter.
05:47It is believed that the occurrence may be anywhere from one in a million,
05:55as a high estimate, to one and a half million.
06:00Conjoined twins were supposed to be identical twins,
06:04whereby a fertilized egg was meant to be completely separated into two sides,
06:10which would then develop into two separate individuals.
06:13Here, the cleavage is not complete,
06:17so you do have identical twins,
06:19but they're connected instead of being two separate individuals.
06:23Depending upon the level at which cleavage is incomplete,
06:29you may have junction at the chest,
06:33the level of the head,
06:36some at the shoulder,
06:38the abdomen,
06:39or the hips.
06:41And it's highly variable,
06:42and there may be combinations of those forms,
06:46and this is why each of these is a very individual circumstance.
06:53Now that I've had a chance to see the babies and their condition,
06:57my next step will be to set up a series of diagnostic studies,
07:02and when you'll come in for the, what we call imaging studies,
07:07then the babies will be seen by other consultants.
07:10For Dow, Dwin, and Barbara,
07:16this is just the first of many visits to Children's Hospital.
07:20Before O'Neill can decide whether or not the twins can be separated,
07:24dozens of tests must be done.
07:31Say hi.
07:32Say hi, Dow.
07:34Say hi.
07:35They only know bye.
07:39Bye-bye.
07:40Bye-bye.
07:42Bye-bye.
07:43Bye-bye.
07:44Bye-bye.
07:44Bye-bye.
07:44Look.
07:45Say hi.
07:50Two weeks after arriving in Philadelphia,
07:53Dow and Dwin are settling into family life,
07:56along with the Hedley's other children,
07:58Lauren and Jennifer.
07:59What do we got here?
08:03You want to get down and walk around?
08:08Do you?
08:09Okay.
08:10Do you want to get down and walk around?
08:10I know.
08:13You want that?
08:16That's all right.
08:18As is quite common in conjoined twins,
08:21one twin, Dow,
08:22is smaller and weaker than her sister.
08:25Even though they share a third leg,
08:30Dwin appears to have more control over it.
08:33Wherever Dwin wants to go,
08:35Dow must follow.
08:36If the twins are not separated,
08:43they face a bleak future.
08:45The middle leg is not growing below the knee,
08:48and soon they will be unable to walk.
08:50Yeah, well, her feet also.
08:52You coming back?
08:53We're not sure.
08:56Dow may continue to get weaker as Dwin grows,
08:59increasingly becoming an appendage on her sister.
09:06They don't like to be left alone still at night,
09:20and they'll sometimes cry for an hour or so before they finally go to sleep.
09:25We're really not communicating in English.
09:28It's more of a sign language type.
09:33The needs, you express your needs in some other means,
09:38and that's the way we convey a lot of what we need to do and what they want done.
09:45When we first got them,
09:49the big one didn't want me picking her up at all,
09:52and when I'd come near her,
09:53she would, you know, wave me away with her arm.
09:55The little one didn't mind,
09:56but the big one,
09:58Dwin,
09:58I guess I should start calling them Dwin and Dow
10:00rather than the little one and the big one.
10:06Right?
10:08There you go.
10:09Now try it.
10:12Whoa.
10:15Whether or not these playful two-year-old girls can be separated
10:22depends on sorting out which organs they share.
10:26And that, unfortunately, will mean many medical examinations.
10:30There you go.
10:31Okay.
10:32Okay.
10:33I guess Alex.
10:35There's going to be an owie, owie, owie, owie, owie.
10:37One, two, three.
10:40Good girl.
10:41Good girl, Dwin.
10:42Kind of rubber bands.
10:43Still speaking only a few words of English,
10:47the twins endure the first of many painful medical procedures.
10:51Today, they've been sedated for a CAT scan.
10:54This test, like all of their care,
10:56is provided by Children's Hospital Pro Bono.
10:59It's okay.
11:00It's okay.
11:01It's okay.
11:01The CAT scan is one of a series of modern imaging techniques
11:10that will allow O'Neill's team to visualize
11:13Dow and Dwin's complex anatomy before contemplating surgery.
11:18Over the next 30 minutes,
11:19the CAT scanner takes hundreds of x-rays of Dow and Dwin
11:22to reveal the position of the tissues and larger organs.
11:31And soon, radiologist Dr. Mabubi sees a problem.
11:35The spinal canals fuse just below the level of the sacrum,
11:39the bone at the base of the spine.
11:40There's a separate spinal canal down here,
11:44but when you're coming down one cm below that,
11:47you can see they're sharing together.
11:49So there's only one spinal canal coming on this baby.
11:55And the other thing you notice...
11:56Barbara is worried.
11:58Inside the bony spinal canals are the delicate spinal cords.
12:02If they are fused also,
12:04then it may be impossible to safely separate the twins.
12:06A CAT scan cannot visualize the spinal cords,
12:12so this crucial question can only be answered with another test.
12:19The radiology reveals several other anomalies about the twins.
12:24Dow and Dwin not only share a third leg,
12:27but have a fused pelvis.
12:31Dow and Dwin each has a colon.
12:33The colons join together just above a common rectum.
12:39Each twin has just one kidney,
12:42and urine drains into a single bladder.
12:50You making up?
12:52You want to get to McDonald's or Mom?
12:54You want to go downstairs?
12:55McDonald's, golden orange.
12:56Until a magnetic resonance imaging can be done
12:59to investigate the spinal cords,
13:01the prospects of separating Dow and Dwin remain uncertain.
13:05Here you go.
13:06Here you go.
13:10Happy birthday to you.
13:14Happy birthday to you.
13:18Happy birthday to you.
13:21Happy birthday to you.
13:23Happy birthday to you.
13:27Yay!
13:28Yay!
13:28Yay!
13:33What, Jen?
13:34Uh-oh.
13:35Look, Dow.
13:36Yay!
13:37Yay!
13:42Look at all these presents.
13:44My God.
13:44On June 6th, Dow and Dwin celebrate their third birthday.
13:48Only six weeks after arriving in Philadelphia,
13:51they are getting the hang of American life.
13:54Good.
13:56Yeah.
13:57Sing it with me, the farmer.
13:59Push.
14:03While they still talk to each other in Thai,
14:05they understand some English,
14:07and can even speak a few words.
14:11I want to see you.
14:12Bye, Dan.
14:13Bye, Dan.
14:14Bye, Dan.
14:15Dao and Dwin are, in a sense,
14:19true Siamese twins.
14:22The land of their birth, Thailand,
14:26used to be called Siam.
14:29Conjoined twins are often called Siamese twins
14:32because of two brothers,
14:33Chang and Ang Bunker,
14:35who lived in the last century.
14:39Chang and Ang,
14:40who were joined at the abdomen
14:41by a wide band of skin,
14:42traveled to America,
14:44where they found work as entertainers.
14:51Chang and Ang Bunker prospered,
14:54bought land in North Carolina,
14:56married two sisters,
14:57and between them,
14:58fathered 22 children.
15:00For all their success,
15:08the Bunker twins wanted more than anything
15:09to be separated,
15:11and toured Europe trying to find a doctor
15:13willing to do the operation.
15:15But none would dare,
15:17suspecting that the tube that connected them
15:19contained part of the liver
15:20and important blood vessels.
15:23Age 63,
15:25they died on the same night,
15:26still joined together.
15:28Today,
15:30a surgeon like O'Neill
15:31would have little difficulty
15:32separating them.
15:34It's interesting.
15:35I think that the risk
15:36probably would have been very small.
15:38It probably would have been handled
15:39by taking a very, very thick ligature
15:44or tie
15:45and tying off the connection.
15:48And then,
15:49after circulation had adapted,
15:53to do a rapid separation.
15:55As most people know,
15:58the Bunker twins were never separated.
16:01And when they died,
16:02they were still together.
16:06Dow and Dwin are fortunate
16:08to be born in the age
16:09of high-tech medicine.
16:12But they are joined
16:13in much more complex ways
16:15than the Bunker twins.
16:17Even in the 1990s,
16:18it may be impossible
16:19to separate them
16:20without killing
16:21or crippling them.
16:34Today,
16:35Dow and Dwin's future
16:36hangs in the balance.
16:38Only magnetic resonance imaging
16:44has the ability
16:45to visualize the spinal cord
16:46and reveal whether
16:48the twins' spinal cords
16:49are joined.
16:54Within a few hours,
17:00Barbara will know
17:00whether or not
17:01the twins can be separated.
17:03after examining
17:17all the films,
17:18radiologist Dr. Larissa Belaniuk
17:21reaches a firm conclusion.
17:24While the bony spinal canals
17:26are fused,
17:27the delicate spinal cords
17:29inside them
17:30are not.
17:31It looks good
17:36because the cords
17:38are not joint.
17:40I saw that.
17:41Yes.
17:43In principle,
17:45Dow and Dwin's spines
17:46can be separated
17:47without damaging
17:48the spinal cords.
17:49The main obstacle
17:50to surgery
17:51has been overcome.
17:53Sally, the camel has
17:55the hump
17:57so right,
17:58Sally, right
17:59Sally, the camel has
18:02three humps
18:03Sally, the camel has
18:05three humps
18:06Sally, the camel has
18:08three humps
18:09so right,
18:10Sally, right
18:11Oh, don't you
18:12Sally, right
18:13The twins pass a wonderful summer.
18:19Here, I have
18:21interrupted only
18:23by examinations
18:24and tests.
18:25I would guess
18:26just from looking at this
18:27that this is not going to be
18:29splittable into two.
18:30No, no.
18:31That you'll have
18:32one baby who could have
18:33the whole
18:34and one baby
18:35who could have
18:35the upper leg.
18:36While Dow and Dwin play,
18:39O'Neill and his team
18:40confront some difficult questions.
18:42Which twin should get
18:44the third leg?
18:45How should the internal organs
18:47be divided up?
18:50Dow and Dwin,
18:51whose union includes
18:52the spine,
18:53pelvis,
18:54intestine,
18:55bladder,
18:56and reproductive organs
18:57present a uniquely complicated
18:59case for the Philadelphia doctors.
19:01O'Neill and his team
19:06worry about whether
19:07they can separate
19:08the twins
19:08in one grand operation
19:10or whether they will need
19:11to do it in stages.
19:15Dr. Louis Schutt,
19:16the neurosurgeon
19:17who will divide the spines,
19:19eventually decides
19:20that it will be
19:21too dangerous
19:21to separate Dow and Dwin
19:23from the front.
19:24There is too much risk
19:25of bacteria from the gut
19:26contaminating
19:27the delicate spinal cord.
19:30Really,
19:31I only need
19:31to be here,
19:32you know.
19:32Schutt thinks
19:33that a preliminary operation
19:34should be done
19:35from the back
19:36to separate
19:36and seal off
19:37the two spines
19:38and partially divide
19:40the sacrum,
19:41the place
19:41where they join.
19:42They call the sac.
19:43The case of Dow and Dwin
19:51has reached the point
20:05of no return.
20:07For while tomorrow's operation
20:08will not separate the twins,
20:10it will weaken
20:11it will weaken
20:11the pelvic ring
20:12that holds them together.
20:18For this reason
20:19the twins will be
20:19confined to bed
20:20after surgery.
20:26This is the last day
20:27on which Dow and Dwin
20:28will walk together.
20:29the other day
20:59The situation here is that we have conjoined twins that have two normal spinal cords.
21:06They are two complete spines, but there's only one sacrum that is at the base of the spine.
21:12So the idea here would be to separate the two spines and give each one of the babies half of the sacrum.
21:20The most difficult part of the operation is going to decide which nerve goes to which leg.
21:25And the second most difficult part is going to reconstruct the tube to make sure that it doesn't leak that fluid that we all have inside our spine called the cerebrospinal fluid.
21:38My decision needs to be...
21:43And then I want to go...
21:55Having planned his incision, Dr. Shute prepares the surgical field.
22:00Despite the information from the imaging studies, Shute is unsure how the nerves leading to the legs exit the spinal cords.
22:07And he will have to be especially careful.
22:12Within an hour, Dr. Shute has exposed the spinal canals.
22:17Viewed from above, they form the shape of a Y.
22:19The two arms of the Y are the spines of each twin.
22:23This is the right twin spinal canal, and you can see it coming down.
22:29This is the left twin spinal canal.
22:32You can see it coming down.
22:33Here is the junction of the two spinal canals and dural sacs.
22:38And here it is, the portion going into the sacrum.
22:41And you clearly can see small nerves here going into the sacral foramina.
22:46So the next challenge is going to be to find out what's inside the tubes and to see where the nerves are going and which one is going to get which nerve.
22:57Lee found it, and now we are cutting it through.
22:59The point of ranger, saccato.
23:02It's working very fine.
23:03You can see one tube now on the right, a tube on the left, completely separated and sutured.
23:16And this is the piece of bone that now has to be split.
23:21Shute and his colleagues begin cutting through the sacrum, the bone at the base of the spine.
23:27They won't cut all the way through today because major blood vessels lie underneath.
23:30They will leave a thin layer of bone in place that will easily come apart when Dr. O'Neill performs the main operation from the front.
23:39After four hours, Dr. Shute is finished.
23:44But for Dow and Dwin, the surgery isn't over.
23:47This operation provides a good opportunity for plastic surgeon Don La Rosa to insert skin expanders.
24:00The main problem in almost all of these spine joints, Dwin, is a lack of skin.
24:05Because when they're separated, there's going to be a big surface to which they're joined where there will be a lack of skin.
24:12And they don't have enough skin to just simply pull it over.
24:16What we're going to do today is essentially put in some balloons under the skin.
24:21They're made of silicone.
24:23And they have a little tube attached to them and a small filling cork.
24:29We'll put one behind this leg and one in front of this leg.
24:36The reason being, this leg is going to go with this baby.
24:39Apparently, this baby has control of this leg.
24:42But we need skin to help resurface this side of this baby after the twins are separated.
24:50So, my plan would be to expand this skin and this skin.
24:54Essentially, build this up so that we then have enough skin to close, to take this area that I've outlined right here.
25:06And bring it back like so to cover this surface.
25:11And have enough skin to then bring this back together.
25:16Can you put another steridrate down here?
25:18Once in place, the plastic balloons will be periodically inflated with saline solution,
25:25slowly stretching the skin over the coming weeks.
25:30And flatten it out.
25:40By 4.30, the first operation is over.
25:43A critical hurdle has been passed.
25:59But Dow and Dwin can't be separated until the skin expanders have grown enough skin to close the wound.
26:05This will take about three months.
26:07Following the operation, Dow and Dwin are placed on forced bed rest.
26:33It is too risky to allow them to move around with the skin expanders in place.
26:42So, they've been placed in a cast with only Barney to pass the time.
26:47Dow has an expander right here that's stretching her skin.
26:51And Dwin has one right here.
26:54And one underneath the center leg.
26:56And she has one on her belly right here.
26:59It hurts when they expand them.
27:01But right now, they don't hurt too much.
27:06They're really bored.
27:08But I'll tell you, they're so patient and understanding.
27:14They really have been real cooperative.
27:18It hasn't been any problems at all.
27:19While the twins remain in the hospital for three months,
27:37David and Barbara go on with their lives as best they can.
27:40David continues working as a gerontologist in his private practice in New Jersey,
27:50where Barbara also works.
27:55How are you, Kat?
27:56But all the time, their thoughts are with Dow and Dwin.
27:59I'm with Dr. Stearns, and I guess they're going to do a cystoscopy.
28:02That was a hard time.
28:06When I would go to the hospital, it was often difficult to leave,
28:09because whenever we would come, they'd become so attached to us
28:12that they would just cry every time we'd leave.
28:17It seems like they've been here from the very beginning.
28:21We don't treat them or think of many differently than we do our others.
28:27Mrs. Warner, would you like to come on back?
28:29Yes.
28:30How are you?
28:31Good.
28:31When they first asked us to find a home for these children,
28:35they were just children, like strangers.
28:38They didn't have a personality.
28:39They didn't have anything.
28:41And since we've gotten to know them, I mean, we really love them.
28:44And we really care about them and want them to do well.
28:48And they think we're their parents.
28:53As the main operation approaches,
28:55Barbara is increasingly worried about the twins, especially Dow.
28:59Physically, Dow is getting weaker
29:01and needs feeding through a tube.
29:04Psychologically, Dow is clearly anxious about the coming separation.
29:09Dow's having a problem a little bit with her identity.
29:11She's been calling Dow and Dow, and she used to call her Dow and until all the surgeries started.
29:18So she's having a problem with where she begins and where she ends.
29:22I think they do understand, and they just say, no, no, you know, don't let the doctors do that.
29:41But then, at times, they seem like they want it, because they'll separate the dolls themselves,
29:47and then tell, well, Dow's going to take a walk, and, you know, Duann's going to play with Jennifer.
29:53So they do have a positive aspect to it, but also I think they're very scared of what the doctors are going to do,
29:59because they don't want any boo-boos, as they say.
30:07As in all the twin separations O'Neill has performed, difficult choices must be made.
30:13Decisions that will critically affect what organs Dow and Duann come away with.
30:18Decisions that will not only determine the success or failure of the operation,
30:22but also the quality of each twin's life afterwards.
30:26To review these difficult choices, Dr. O'Neill gathers his team together the day before surgery.
30:32Radiologists, anesthesiologists, general surgeons,
30:36urological, neurological, and plastic surgeons.
30:40Even for these top pediatric specialists, tomorrow's separation is unusual,
30:45the most complex they have attempted.
30:47Doctors have flown in from Thailand to observe the unusual operation.
30:55Although it's a double femur, I think it would be a great quality to try and make two legs out of this.
30:59You'd end up with two rotten legs.
31:01My thoughts are based on the presumption that the larger twin, which is Duann, gets the leg.
31:10At any rate, the plan, I think, is to go through either through here or through here.
31:14Dr. Drummond, head of orthopedic surgery, has recommended all along that Duann should get the third leg,
31:21as she has most control of it.
31:23This is agreed.
31:24We'll do everything about this tomorrow.
31:25I think eventually...
31:27But where to divide the bone is only one consideration.
31:31Tomorrow, the team must separate the twin's blood vessels as well.
31:34I'll make it a little bit darker here.
31:37Very homespun affair.
31:38But basically, to simplify the arterial anatomy, then, this is just the conjoined aorta over the partially split sacrum.
31:46There's one big iliac going to each leg, and then there are two small vessels going to the...
31:51Perhaps most complicated of all is the urogenital system.
31:54The ureters are right inside the opening as a normal single bladder.
31:58Now, then it bifurcates up here to these two segments.
32:04Dr. Duckett plans to divide the single bladder into two parts, giving Duann the larger part and Dow the smaller.
32:12Although it might seem unfair that Duann, who will get the third leg, also gets most of the bladder,
32:17these decisions are made purely on medical grounds.
32:20The point is not to simply divide the shared organs equally,
32:24but to give the organ to the twin in whom it has the best chance of surviving and growing.
32:29This depends most critically on the nerve and blood supplies.
32:39The meeting breaks up, but the planning continues.
32:42While the doctors ready themselves for a grueling surgical marathon,
32:53David and Barbara Headley spend the last night before surgery at Dow and Duann's bedside.
33:04For three months, the Headleys have been under enormous stress,
33:08spending as much time as possible at the hospital,
33:10while managing home life and work.
33:13They didn't have the beanbag downstairs, did they?
33:16Dow and Duann have been with them for seven months.
33:19The Headleys are thinking about adopting them.
33:22Everybody's worried about them.
33:24Everybody.
33:25We've gotten thousands of phone calls from people just worried about them,
33:28and my kids are home praying when we left.
33:32They're just easy to care about.
33:34As soon as anybody meets them, they love them.
33:36Morning comes, and the twins wake up crying,
33:52fully aware and frightened of the ordeal to come.
33:57Today is the most important day of Dow and Duann's lives.
34:01If all goes well, before the day is out,
34:09each will become a physically separate individual.
34:11I don't think we have to worry too much,
34:21but we'll probably see it.
34:22The family will always be able to see it.
34:25But everyone is aware this is a life-threatening operation.
34:30One or both twins could die.
34:35We will start going right down the midline.
34:41We will open the abdominal cavity
34:43and see if it is reasonable to divide the intestine first.
34:50The overall plan is to attempt to do this in a fashion
34:55where it's like opening the pages of a book,
34:59or a clamshell, if you will.
35:00And that will then give us access to visualize the structures
35:05that we have only visualized radiologically,
35:09but that we know are there.
35:12In the first operation,
35:14the sacrum was partially divided from the back.
35:17Today, O'Neill and his colleagues will operate from the front,
35:21carefully dividing the twins system by system,
35:24reconstructing organs and controlling bleeding.
35:27More than 30 people fill the large operating room.
35:33Many will be on their feet for the next 14 hours.
35:37It should now.
35:43You got it.
35:44The skin expanders have done their work
35:46and are deflated in preparation for the first incision.
35:49This here gives us enough room around the genitalia, I think.
35:56No, I could see it click.
35:58Yeah, you feel it.
36:00And you could see it jump.
36:04What do you say back over here?
36:07Good.
36:08We're going to start here, guys.
36:09Okay.
36:10Okay.
36:10In the first stage of the operation,
36:22O'Neill and his team open the front of the pelvis.
36:30Are you able to reach with a scissor or do you want me to get it?
36:33Once inside, they carefully divide the colons just above the rectum.
36:38Later in the operation,
36:40Dow's colon will be pulled through the skin to make a colostomy.
36:50May I have a small retractor, please?
36:5411.33, four and a half hours after Dow and Duane arrived in the operating room.
36:59Everything is going smoothly, but a difficult challenge lies ahead for urological surgeon Dr. Duckett.
37:07Dow and Duane have a single bladder.
37:09Duckett must find a way to divide it, giving each twin a part,
37:14re-plumbing their urinary systems.
37:16Our situation is we have one bladder in a normal position
37:20with two ureters coming into the base of it
37:23and a bilobar body of the bladder on each side.
37:29We're going to take off about a fourth of the bladder on the right side
37:33and leave that blood supply with dual.
37:37So right now, we just have to decide where to divide that bladder.
37:45Oh, it's not anything much, no.
37:48It's a dry pack.
37:51Due to its position, Duane will get the large part of the bladder
37:55and Dow the smaller part.
37:57But Dr. Duckett hopes the smaller part will grow over time.
38:01And we save this pedicle over here.
38:04You got the pedicle?
38:04You got the pedicle still?
38:05No, a different pedicle.
38:08You'll need to move back a little bit if you wouldn't mind moving.
38:11Yes, thank you.
38:12You got me contaminated, you'll see.
38:15Too close.
38:17Yes.
38:17The bladder divided,
38:19the surgeons continue carving out the boundary
38:21that will physically define Dow and Duane.
38:242.17, more than seven hours into the operation.
38:34If you look up at the diagram over there,
38:37there is a connection between the two aortas.
38:41And we're now dissecting out to see if we can find the right place to divide.
38:46So that's where we are at the moment.
38:48Joining Dow and Duane are a series of major blood vessels,
38:53including a major tributary of the aorta.
38:58Yeah, she does.
39:00All right.
39:01Now, I'm way up there.
39:02I want to put your hand over there.
39:04Tension mounts as O'Neill prepares to divide this critical vessel.
39:07Yeah, go on down.
39:09Corsors, please.
39:14I'll leave a nice little...
39:17Don't hit my hand, I know.
39:27All right.
39:28That stays there for a moment.
39:31Dividing conjoined twins is not about equality or fairness.
39:35O'Neill and his team have given Duane the third leg,
39:38the common rectum,
39:39and the largest part of the bladder,
39:42because the blood and nerves that serve these organs
39:44are principally under Duane's control.
39:47Duane, when separated,
39:48has the best chance of using these parts successfully.
39:515'10".
39:525'10".
40:0410 hours after the twins enter the operating room,
40:08the critical moment approaches.
40:10All that remains holding Dow and Duane together
40:12is a thin layer of bone left in the sacrum
40:15at the base of the spine.
40:20Everyone focuses on O'Neill
40:22as he prepares to sever the last physical link
40:25between Dow and Duane.
40:26Okay.
40:30Yay!
40:31All right.
40:32Get things out.
40:35All right.
40:39Now I have to change...
40:41Now, are we...
40:43Do we need to move this one a bit?
40:45Okay, so let's have a clean sheet.
40:47Let me change...
40:48Activity intensifies as the group divides into two teams,
40:52one for Dow and one for Duane.
40:58Duane's surgical team work quickly to close the wounds.
41:02The skin expanders have done their job well,
41:04and there is enough skin to make the closure.
41:06By 8.30, Duane's surgery is over.
41:22The next 48 hours will be critical for her.
41:25She will be closely watched
41:26for any signs of infection and hemorrhaging.
41:28She's still asleep, but why don't you show her to go on?
41:57All right, come over this time.
42:01All right.
42:01Get y'all off the floor, you fine.
42:03Yeah, we're going to leave her asleep for a while.
42:05Better wake up slowly.
42:07Do you mind if I take a look?
42:09Yeah.
42:12Okay.
42:14Look at the lake.
42:15Where do we want to go?
42:17Barbara and David Headley have been waiting anxiously all day.
42:20We'll give you a call.
42:21If they don't call you, they better get there and call them.
42:23Okay.
42:24Do you know what the number is?
42:25No?
42:25They are relieved to see that Duane has made it this far,
42:29but await news of Tao still undergoing critical surgery
42:32back in the operating room.
42:37At least I've given 20 minutes.
42:43Tao, the smaller and more fragile of the two twins,
42:46now has only one leg,
42:48a partial bladder and half a pelvis.
42:51She will require extensive reconstructive surgery to her bladder and colon.
42:55But today's procedure will leave her with a complete set of reproductive organs.
43:07If she survives, like Dwayne, she will be able to have children when she grows up.
43:12By 10 p.m.
43:18It is all over.
43:19Tao is taken to join Duane in intensive care.
43:29For O'Neill and his team,
43:31it is a satisfying moment.
43:33It's amazing to see two little individuals.
43:36Yeah, I like that.
43:37Yeah.
43:39I like that.
43:44Okay, a little cold right now.
43:46We can go and grab it now.
43:56Yeah, they said to wait here.
43:58While the surgery is over, Tao and Duane are still at high risk.
44:19O'Neill will be watching for signs that the skin grown with the skin expanders
44:22is alive and healthy.
44:25And whether in closing the wounds,
44:26the skin flaps have been drawn too tight,
44:29compromising the function of internal organs
44:31and possibly impairing breathing.
44:42Tao in particular is prone to infection
44:45because she has undergone extensive abdominal surgery.
44:49O'Neill and his team will be watching closely.
44:51Should any of the internal connections rupture and leak abdominal contents,
44:55Tao might be in trouble.
45:00Soon after the operation,
45:02Tao does develop a serious infection
45:04and a raging fever.
45:06But within a few days,
45:08it is under control.
45:12Ten days later,
45:14both twins are doing well physically,
45:16but psychologically,
45:17they're having trouble adjusting.
45:19I'm going to put a pillow under her head, okay?
45:22Yeah.
45:26There, Tao.
45:31No pillow for Tao?
45:34Why?
45:35Why can't you have them?
45:38Tao and Duane are among the oldest conjoined twins to be separated.
45:42And no one's sure
45:43how two sisters joined for three and a half years
45:46will cope with being physically separate individuals.
45:51Yeah.
45:53The two of them won't acknowledge each other.
45:55We've been trying to get them to communicate
45:57or at least say hello.
45:59Once or twice they did talk to each other.
46:01It was really brief.
46:02We haven't had a chance
46:05to put them in the beds together
46:06because of all the equipment
46:07and all the,
46:08that's on their bed
46:10and it just wouldn't be right.
46:11And Tao has a fever
46:12and she doesn't
46:13so they don't want them
46:14to each make each other sick.
46:16But basically,
46:17they seem angry at each other.
46:20When Duane woke up from surgery,
46:21she asked where Tao was
46:23and I showed her.
46:24When Tao woke up from surgery,
46:26it was like
46:27there was a phantom person.
46:30She woke up
46:31and was screaming
46:32and flailing her arm
46:34that was where Duane was.
46:36And she was pounding on the bed
46:38with her arms screaming
46:39and turning in circles
46:40looking for Duane.
46:42So I came in the room
46:43and I quickly oriented her
46:45and showed her where Duane was
46:46and she was okay.
46:48But for about 24 hours,
46:50she would just
46:50fling her arm over
46:52and hit the side of the bed
46:53looking for Duane.
46:57See?
47:00I just wanted to give Tao a kiss.
47:02Can I give you a kiss?
47:04Okay.
47:05Can I give Tao a kiss?
47:06No.
47:09Oh boy.
47:11No.
47:13Okay.
47:15I'll hold your hand too, Tao.
47:16From a Bangkok orphanage
47:22to the surgical unit
47:23at Children's Hospital,
47:25Tao and Duane
47:26have shown remarkable
47:27adaptive powers.
47:29They now face perhaps
47:30their biggest challenge,
47:32learning to live
47:33as individuals.
47:41Within two weeks,
47:43they came to terms with it.
47:45Tao came to terms with it
47:46before Duane.
47:47Duane was still angry
47:48that Tao was around
47:49for a couple weeks.
47:50But eventually,
47:51once they got out
47:52of the intensive care unit
47:53and into their own room,
47:54we could put them together
47:55and eventually we had them
47:56each in a,
47:57we put them in the same bed
47:58and let them touch
47:59and let them see each other.
48:01And then one day
48:01they just hugged each other.
48:03And that was the,
48:03that was it.
48:05And that was the first time
48:06they saw each other
48:06to get like face to face.
48:08This is the way the ladies ride,
48:11ladies ride,
48:12ladies ride.
48:13This is the way the ladies ride,
48:15let these ride,
48:16let these ride,
48:17let these ride,
48:17let these ride,
48:17let these ride.
48:18This is the way the ladies ride,
48:20let these ride,
48:21let these ride.
48:22This is the way the children ride,
48:24tell us about the clock.
48:26This is the way the ladies ride,
48:29ladies ride,
48:30ladies ride.
48:30This is the way the ladies ride,
48:32let these ride,
48:33let these ride,
48:34let these ride,
48:34let these ride,
48:34let these ride,
48:35let these ride,
48:35Dao's gained a lot of weight. She's as tall as Duen now. They're exactly the same height.
48:48Her appetite is better than Duen's.
48:57Her personality is just as strong now as Duen.
49:02She has independence, which she never had before. She talks back to Duen, which she never did before.
49:08She was always the one that was quiet and let Duen dominate.
49:11And today, physically, they look more like height, weight, and appearance.
49:18And emotionally, Dao now has a personality, and she has a separate self, which she never had before.
49:25Duen ruled the roost, and today it's not like that.
49:28Come here. I want to ask you something.
49:32What?
49:33Where was Dao? Where was Dao?
49:36Where was she on you?
49:38Right there? Right there.
49:41Come here. Come here.
49:44I want to ask you something.
49:46Oh, God, take that out.
49:48Get over here.
49:49Do you like having Dao over here?
49:57Do you like it?
49:58Do you like being over here instead of on her?
50:01Do you guys?
50:02Come here. I want to ask you a question.
50:04Could you do me a big favor?
50:06Could you do me a big favor?
50:08Do you guys want to give Dao a big hug?
50:11Aw. Isn't that cute?
50:14Did you give her a hug?
50:16Yeah.
50:17Come here. Come here.
50:19Get over here.
50:20Come on in here.
50:25Thanks.
50:26On Dao and Duen's fourth birthday, the hospital threw them a party.
50:30I'm sad, Mommy.
50:31I'm sad, Mommy.
50:32I'm sad, Mommy.
50:33Over the past year, the twin sisters have won the hearts of all the doctors and nurses.
50:39Is that fun?
50:40When you undertake something like this, your goal is to see that you can, if at all possible,
50:51come out with two complete individuals who can take their place in society and be productive.
50:57I think the other physicians have identical feelings of great gratification in seeing these children grow and develop.
51:10And behave like normal children.
51:13There's no better feeling one can have than seeing that.
51:17The Hedleys did decide to adopt Dao and Duen, a huge responsibility given that the twins will require extensive medical treatment and rehabilitation.
51:29The Hedleys' medical insurance company may not cover these expenses, and so they plan to start a charitable fund to help pay the twins' future medical costs.
51:41Dao is learning to walk with a prosthetic and will require many operations to further repair her urinary system.
51:53Duen also needs an operation on her leg to remove the portion below the knee that is not growing and fit a prosthetic.
52:00Whatever.
52:01Credit!
52:02Of course!
52:03See you later!
52:04Peau!
52:05Do you like that?
52:06Where are you going?
52:07Seal!
52:08There!
52:09Good girl!
52:10Good girl!
52:11Now what about this?
52:12What is this?
52:13A mouse!
52:14Mouth. It looks like a mouse. It has a long, bushy tail. What is it? It's a squirrel. Do you have squirrels in your yard at home? No. No? At my house. At your house? At my house. Let's look at this one. This is a star. Teeth together and blow. Star. Good.
52:38And that's one of your favorite songs that we sing is Twinkle, Twinkle, Little Star. How I wonder what you are. With a family to care for them, these two bright children have started preschool like millions of their peers.
52:53Like the Bunker Twins before them, Dao and Dwen have found a future in America.
53:09And while Dao and Dwen are no longer physically joined together, they, like most twin sisters, will probably be inseparable.
53:34Now.
53:39Now.
54:09You're going to get a new leg. Yeah. Do you think it'll be fun to be able to walk? Yeah. Yeah, I think so too. Isn't that going to be cool? When you get to walk? And you too, Mr. Doctor. What's he going to do? Is the doctor going to fix your foot? What's he going to do?
54:35Yeah, I think so.
54:36He doesn't.
54:37Yeah, it's funny.
54:38You think it's funny?
54:39Yeah, it's funny.
54:40A charm.
54:41It's the perfect present.
54:44Here, is it.
54:45Here it is.
54:46Here it is.
54:47Here it is.
54:48Good job.
54:49Nice job.
55:00There's such hot dogs you like.
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