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Two Hearts Beating As One
Erin and Jade were born attached, with Erin's heart inside her sister's chest. They survived a risky separation, and Erin is now partially paralyzed. Doctors can't say if she'll ever walk, but the twins' parents have reason to hope: They call the girls th By Cindy Rich
Comments () | Published February 1, 2006
Sometimes when she's crying or sitting in her highchair watching Barney, Erin puts her hand over her heart. Her heartbeat soothes her.

For her first four months, doctors didn't know whether Erin's heart would beat on its own--or whether her twin sister Jade's would either. The girls were born joined from chest to navel. Their hearts beat in sync.

Now, with her heart tucked just beneath the surface of her skin, Erin sings "Ring Around the Rosie" with Jade and their older sister, Taylor. She pulls baby wipes from a box and throws them.

Erin likes to ride in her little red car. She has to push the wheels--the car is helping prepare her for a wheelchair. "Ride, ride!" she'll say. Sometimes Jade tries to get in with her. Whatever one of them has, the other wants.

When Erin dances, she lays both arms on the carpet and bounces in place. She's too young to understand why she can't dance the way Jade does. She doesn't know that the same surgery that saved their lives left her partially paralyzed.

Doctors can't tell her mother, Melissa, and father, Kevin, the chances that Erin may walk one day. But odds don't mean much to Melissa anymore. She has two little girls who aren't supposed to be here.

Before her third ultrasound test, Melissa Buckles knew little about conjoined twins. She knew they'd been called Siamese twins. She'd heard they'd been exploited in circuses. She thought there was a stigma.

All photograhs by Matthew Worden.

Melissa, a high-school teacher, and Kevin, a Marine gunnery sergeant, had been married four months when an ultrasound technician told them about their daughters' condition. About one in 50,000 conceptions is a set of conjoined twins, likely a result of a fertilized egg that splits into two embryos but doesn't fully divide. One in 200,000 of those pairs makes it to birth. Most don't live past their first day.

The Northern Virginia couple didn't buy baby clothes because they didn't know if they'd ever meet their daughters. Melissa spent two months in the hospital before an emergency delivery. Then she and Kevin had to teach themselves to care for two babies they couldn't cradle.

When the girls were four months old, their parents waited in a playroom at Children's National Medical Center in DC while doctors performed a six-hour operation to allow Erin and Jade to lead separate lives.

Melissa had always wanted twins, but she thought they had to run in the family. When she was pregnant with their first daughter, Taylor, she hadn't started showing until she was six months along. This time she was bigger much sooner.

"If you really loved me," Kevin joked, "you'd have twins."

Melissa, then 30, was 18 weeks pregnant when she and Kevin went to DeWitt Army Community Hospital in Fort Belvoir, eager to find out if she was having a boy or a girl.

The technician put the wand on Melissa's abdomen and asked, "Does either of you have twins in the family?" They said no. Then Melissa looked at the screen. Was she seeing two heads, or was the technician moving the wand around?

"Am I carrying twins?" she asked.

The technician kept scanning.

"Seriously—am I having twins?"

The technician pointed to the screen: "There's one head. There's the other." Melissa's heart raced, and she started laughing.

"Are you Christians?" the technician asked.

Melissa's throat closed, and she grabbed Kevin's hand. "Why?" she asked.

Melissa called her mother in Minnesota on the way home to Woodbridge. She and her mom talked nearly every day.

Her mother laughed when Melissa told her she was having twins. "But Mom," she said, "there's a problem. They're conjoined."

Melissa got home and turned on the computer. The technician at the army hospital had told her that the girls appeared to share a liver, possibly a diaphragm. Melissa read that the liver is the only organ that regenerates. She learned about Eng and Chang Bunker, twins from Siam who were connected at the chest. She saw pictures of babies who shared limbs, and read about the death rates.

I may never get to hold them, Melissa thought. I may never see them alive.

Kevin turned off the computer and said, "Let's wait before we get upset about something we don't know."

A few minutes after Kevin met Dr. Christian Macedonia in the National Naval Medical Center's prenatal assessment center in Bethesda, they had an understanding.

"If you don't think they're going to make it," Kevin said, "tell us."

It was November 2003, the day after the young couple had learned about the twins.

Kevin owned a copy of Henry Gray's Anatomy of the Human Body and liked researching medical issues. A competitive swimmer, Melissa was versed in how the muscles worked. She'd been a premed student for a year of college. They wanted to hear every detail.

"I'll give it to you straight," Dr. Macedonia told them. As a perinatologist, he'd had a few patients who were pregnant with conjoined twins, but their babies hadn't survived to birth. "When I'm scanning, I don't do a lot of talking; just let me look."

Macedonia studied a volumetric sonogram--a three-dimensional image--and saw that the twins were joined from mid-chest to navel. The liver seemed to be the only major organ system they shared.

"Baby A's heart is in baby B's chest," he said. The twins appeared to have separate cardiovascular systems. If their hearts weren't connected, they would have a much better chance at survival.

Macedonia showed Kevin and Melissa the image of their babies from head to toe. The babies elbowed each other. One looked over the other's shoulder. Macedonia called them dance partners.

"The only thing I can see that's different is they're conjoined," he said. "Everything else looks normal."

He told Kevin and Melissa they could map out a plan for delivery or explore termination options. They didn't want to end the pregnancy.

If one of the twins got sick, Dr. Macedonia told them, they might have to make hard decisions.

"I read on the Internet that most don't make it," Melissa said.


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Posted at 12:00 AM/ET, 02/01/2006 RSS | Print | Permalink | Articles