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Two Hearts Beating As One
Comments () | Published February 1, 2006

The hospital's bioengineering department designed computer models of the operating room. It needed more electrical power to support two heart-lung machines in case the girls needed bypass surgery.

Each twin had a medical team, and everyone wore colored badges. Erin's color was purple; Jade's was green.

Kevin asked Dr. Hartman if he could watch the surgery on a closed-circuit monitor. He'd missed the girls' birth, he said, and wasn't squeamish about blood. "That's the closest I could feel to being there for them," Kevin told him. Dr. Hartman said that Kevin's watching would put pressure on the surgeons, so he and Melissa didn't push.

They met with neonatology nurse manager Linda Talley every week the month before surgery. Kevin asked questions; Melissa held the girls and didn't talk much. He wanted to know who would tell them if one or both of the girls didn't make it, and how their bodies would get to the funeral home. Sometimes Melissa started crying.

Two weeks before the separation, Kevin sat in on a meeting with doctors. He thanked everyone for the time they had put in.

"I realize some of you are geniuses, tops in your field," he said. "But my wife and I realize that at the end of the day it really has nothing to do with how smart you are or how many surgeries you've performed. Really--it's not in your hands."

Melissa wanted to be the one holding Erin and Jade before the surgery. She had pictured this moment for months.

As she and Kevin walked down the hospital hallway, Melissa kept thinking she might lose her babies. She and Kevin had talked about what might happen.

If they were ready for the worst, Kevin thought, they wouldn't be as disappointed. Most of the time his realistic attitude was comforting--Melissa called him her rock--but it also got frustrating.

"How can you be so calm," she asked, "when our children may die?"

They had talked about where they'd want the twins buried, what the girls would wear, how they'd tell Taylor. Melissa had said that if something happened, she didn't want cameras there when they found out. Kevin had asked a friend at the barracks to play taps if there was a funeral.

As she walked down the hallway, Melissa wore Jade's baby blanket over her shoulder. Kevin held his arm around her. "You need to be strong and fight," Melissa told the girls.

"It's going to be okay," Kevin said.

He and Melissa had almost reached the surgical suite when Jade started whimpering. They leaned over and kissed the girls. Melissa handed Erin and Jade to the anesthesiologist, who had trouble positioning them.

Melissa thought: That's not how you hold them.

Melissa brought her laptop computer to the playroom where she and Kevin would spend the day waiting. They looked at pictures of the girls while Taylor played. Melissa's mother lit a prayer candle at home in Minnesota. It was June 19, 2004, the day before Father's Day.

Melissa felt calmer than she thought she would. "We'll take good care of them," Dr. Hartman had told her.

In the operating room, surgeons made an incision in the girls' chest and found a thin band of scar tissue connecting their hearts. The tissue was conducting electrical activity: One heart was acting as a pacemaker to the other. What would happen when they cut the band?

There was silence in the room when they did it. Erin and Jade's hearts started beating at different paces. A cardiac surgeon went to talk to Kevin and Melissa. "The hearts themselves are truly functioning separately right now," he said.

Hartman had a margin of error the thickness of a rubber band when it came to separating the liver. He had to avoid hitting a major blood vessel. In surgery, he saw a line of white tissue on the surface of the liver. That's where he would cut.

Cheers filled the room after doctors separated the liver. Dr. Kurt Newman, surgeon-in-chief, told Melissa and Kevin, "We've got two babies that are separate."

Hartman wasn't cheering. There was a lot left to do. Jade was taken to an adjoining room, where doctors worked on closing her skin. They expected to have a harder time with Erin, whose heart stuck up into the air.

Each doctor had a camera on his headlight so one could see what the others were doing during the closures. Jade was taking longer than Erin. The geometry wasn't as straightforward as they'd thought--they had trouble getting the tissue over the opening in her chest. Newman scrubbed out and went to see what Erin's doctors were doing. Boyajian came in to help. They had barely enough skin to close Jade.

Melissa and Kevin didn't know it, but Jade was having trouble breathing. Doctors spent 30 tense minutes stabilizing her, while Erin was wheeled to the newborn intensive care unit, six hours after the first incision.

When Kevin saw Erin, he started crying. He kissed her purple hat. Melissa hugged him as they both touched her. Wow, Melissa thought, maybe he had been afraid.

The doctors brought Jade up from surgery. Kevin stood in the middle of the room and looked back and forth. His daughters were in separate beds.

"Where's Jade?" Taylor asked the first time she saw Erin at the hospital. Kevin and Melissa had told her that her sisters were having surgery and that they wouldn't be "stuck together" anymore.

Kevin and Melissa wanted the twins back in the same bed. They worried they'd miss each other.

Nurses in the intensive care unit put mirrors next to the girls' beds so each girl would think she was looking at her twin. They gave each a blanket with the other's scents on it. They put positioners, similar to sandbags, next to the girls so they'd feel the weight they were used to.

Melissa and Kevin spent their days in the intensive care unit, talking to the twins and reading them Taylor's favorite books.

Doctors thought Erin and Jade would spend at least a month at the hospital, but they were healing quickly. They went home after 13 days.

The first night, Melissa and Kevin kept getting up to look at their daughters sleeping. Melissa assumed they'd look smaller after they were separated, but they seemed bigger.

She could finally hold the girls to feed them. She dressed them in outfits they couldn't wear before. She snuggled with them one at a time.

Erin and Jade couldn't do the things other four-month-olds could do. They were behind because they'd been born six weeks premature and spent the first part of their lives conjoined. Melissa had to get them comfortable lying on their stomachs, to build arm and neck strength.

Bills were adding up. Insurance covered nearly all the medical costs--almost $1.5 million--but Melissa and Kevin had gone from two incomes to one while their family size had doubled.

Strangers sent clothes, cards, small checks. Children's Hospital helped get a donated van. Chevy Chase Bank set up a trust fund and contributed $10,000.

A few people accused the couple of exploiting their children. Someone sent hate mail reacting to the couple's interracial marriage. Police kept watch at their townhouse.

A physical therapist came three times a week to help Erin and Jade catch up. She saw what Melissa and Kevin had already noticed: Erin wasn't kicking as Jade was.

Doctors thought Erin might be having abdominal pain from surgery or a muscular problem. They weren't suspicious of a spinal-cord injury because they hadn't operated near there and there weren't any episodes of shock or low blood pressure.

When Kevin and Melissa took the twins for their six-month shots, Jade screamed; Erin didn't.

An MRI showed a problem with Erin's spine. Surgeons looked at blood-pressure strips and other records. They went through videotapes and their own recollections. Nobody could understand what had caused Erin's injury. They told Kevin and Melissa that blood flow or oxygen to her spine had probably been compromised during the operation, causing nerves to die. They didn't know how it had happened or what it meant for Erin's future.

A few months after the surgery, when the girls still shared a crib, Kevin walked into their room to check on them. He was tired. He saw a baby kicking. This is crazy, he thought--look at her move her legs. He called Melissa: "Erin's moving her legs!"

"Honey," she said. "That's Jade."

Jade started crawling in December 2004, when she was ten months old. Erin could roll from her stomach onto her back.

Melissa wrote down important dates: Jade's first tooth, Erin saying "Mama," Jade clapping for the first time. It was hard when Jade did something Erin might never do, but Melissa and Kevin always celebrated.

They could see Erin's frustration. She'd cry and point as she watched her sisters. If someone was carrying her, she'd throw her body toward whatever she wanted; Melissa had to hold on tight. They were eager to get Erin a "standing frame," which would allow her to be upright, so she could see the world the way Jade did.

When Erin was 11 months old, she fractured the bone above her ankle. Her leg was swollen, but she hadn't cried because she didn't feel the pain. Nobody knew how it had happened. The physical therapist said the cause could have been as simple as Erin's leg being bumped on her crib.

Melissa realized she had more to learn about spinal injuries. She worried about Taylor and Jade jumping and playing near Erin. They'd need to remember how fragile she was.

Erin and Jade were eating finger foods and drinking from cups with straws by the time they turned one. Doctors and nurses came to their first birthday party at the family's new home in Stafford. Dr. Boyajian, their plastic surgeon, brought woodworking gifts he'd made. Kevin, who was away on a seven-week work trip, sent camouflage dresses for the girls.

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