The twins  % '
decision, -Part 2

Now one
fights for
her life

By Donald C. Drake
ZnoLairer Medical Writer

Baby Girl B, the Siamese twin
separated from her sister five weeks
earlier, looked strong and hea!thy as
she lay in the crib ln the pediatric
intensive care unit.
She sucked on pacifiers, was alert
and moved about easily despite the
abnormally large reconstructed chest,
which had been attached to her sis-
ter. '

But somewhere in the tiny body
_ of `Baby * Girl B was a potentially
lethal pocket _ of infection that had
refused I to respond to antibiotics. It
was essential to find out where the
infection was before it broke loose
and overwhelmed the helpless baby.
Surgery was the `only way to do
this now, but the surgeons were
afraid that the stress of another. op-
eration would tip .the fragile balance
of life and kill the baby.
It `was one of those tightropes that
physicians so often must walk,

`The threat of infection was only the
Iatest in a series of crises that the
sturdy little twin had confronted in
the & days since she had been sepa-
rated from ,her sister, wno died in
the operation. In that time her kid-
neys had, stopped making. urine. Bio-
chemical problems developed that
could throw her into convulsions,
cause a brain hemorrhage or rob _
her of energy:        ..
And for a few minutes. her heart
stopped.       4. ,

Eauh time the doctors at Children's
Hospital had responded quickly and
' forcefully. Dialysis was used to clear
her body of' the toxic wastes created
by the kidney problem. Biochemical
supplements and' blood transfusions
were pumped into beer body. And
electricity and drugs jolted her heart
back -to a. steady beat.
Now, Dr. C. Everett Koop, the
chief of surgery at CM&en's Hospi-
tal and the man who had sefiarated
     (See RAPS' nn I&-S%\


iracle ba

e fight for life

    BABY, From 1-A
the iwins, was concerned and sad-
dened by the growing evidence that
the child had an infection.
Never before had a Siamese twin
with Baby Girl B's type of problem
survived an operation more than 11
hours. She and her sister had been
joined at the chest; they had shared
a liver and a heart and a half. The
surgeons had had to sacrifice the
other girl, B:>y Girl A, because the
fused heart was not strong enough to
support two babies, but they had
hoped that Baby Girl B might sur-
vive, despite the vast odds against
her.

(The family has asked to remain
anonymous.)

For a while it looked as though the
sturdy little baby was overcoming
those odds, but then the laboratory
figures got worse and worse.

The daily tests indicated that the
levels of hemoglobin and platelets,
needed for clotting, were low, and
other blood factors also were abnor-
mal.,:Ar, infection was lurking some-
where.

Al& her bilirubin levels were high.
Bilirubin is the biochemical that the
liver ymakes in getting rid of worn-out
red kells. Excess amounts of this
substance indicate liver trouble.

Dr. Koop and his chief assistant,
Dr. Louise Schnaufer, had to decide
what to do quickly, because all these
things constituted a severe risk to the
child.

Toioperate was a risk, but not to
operate was a bigger risk. After
meeting with consultants Thursday
morning, Dr. Koop decided. to go
ahead with the surgery.

An abscess seemed likely, since it
would account for the high levels of
bililtiin as well as the low levels of
platelets and hemoglobin. It would
show. up as a spongy bump on the
usually smooth liver and then it
could be easilv drained.

The opera&n probably would take
nn m&e than a half hour.

It lvas scheduled for Friday after-

noon .-

Baby Girl B was coming to be
known as a miracle baby at Chil-
dren's, because she kept overcoming
one crisis after another against all
probability.

The first crisis had' come only
hours after her operation, while she
was recoverin,g from the anesthetic.
                        -.

She' stoppea making urine. This
was very ominous, because in such a
smalf baby $he toxic wastes could
build:to lethal levels in only 48 hours.
Dr: Michael E. Norman, a kidney
speciAli&, was called. Extra fluids
were given to flush out the kidneys
and, as an added precaution, the
wastes were cleared artifically with
dialysis.
Two days later, more trouble de-
veloped. Lab studies showed a drop
i.n Baby Girl B's calcium and blood
sugai. Calcium deficiencies can
cause: convulsions and low blood
sugar can lead to serious weakness.
Supplements were given, but only a
sligh? improvement was noted.
And the 11 monitoring and fluid
lines: going into her body posed a
constjRnt Threat of infection. The doc-
llors 3egan giving her three anti-
bioti$, and by Oct. 14 her signs had
improved.
But then on Oct. 17 the microbiolo-
gists discovered Pseudomonas in the
girl's:throat.
Thih is a common bacteria that
does :not usually cause problems but
that :can be lethal in a seriously
weakened patient.
Tne.bad news about the Pseudomo-
nas, however, was offset by the fact
that the calcium and glucose levels
in Baby Girl ,B's blood were begin-
ning to stabilize.

to Clearly infection was the big thing
worry about.
The baby was fortified with extra
plate&j, fresh plasma and packed
red c`&. The improvement was only
bmp-orary, but the child appeared
heal&y and there were no outward
signs of infection.
She started eating, and on 0ut. 22
6~ anesthesiologis trieQ to take her

off the ventilator that had been
breathing for her. But her lungs,
weakened by the surgery that had
separated her lungs from her sis-
ter's, could not function unassisted
and she had to be put back on the
machine.

Still she seemed to be doing fairly
well otherwise.
But then on Oct. 28 her hear: stop-
ped.
It happened at 11:30 p.m. when she
vomited and clogged the tube that
had been giving her oxygen. Doctors
and nurses swarmed over her. They
shocked her still heart with electric-
ity to get it beating steadily. They
gave her drugs. Dr. Rulby Godenness,
an anesthesiologist, massaged her
heart with his hands.
Again the sturdy little baby p&kd
through.

On Oct. 29, the day after the car-
diac arrest, Dr. Holzer wrote in the
chart:

"The patient looks much better but
continues to have low urine output.
She has good pulses and appears es-
sentially unchanged from the pre-ar-
rest state."

But there was also bad news &I
this day.

The bilirubin shot up to very high
levels and the platelets started to
plunge. As this happened, the child
started to turn a brilliant orange, in-
dicating severe jaundice.

Hematologist Dr. Charles S. August
was called in. They discussed- the
possibility of taking out all her blbod
and replacing it with fresh blood that
had a lot of platelets and low biliru-
bin levels. But such exchangb trans-
fusions pose risks so this was put off.

By Nov. 10 it was clear that it
would he weeks if not months before
the baby could be weaned off the
breathing machine.

And it is dangerous to keep a
breathing tube in a patient's throat
for more than a month.

They would have to operate and
open a hole in the baby's throat. This
could pose another threat of infec-
Uion, but at least the vocd cords
would not be hurt by the tube.
The surgery was done without
problems. At the same time the doc-
tors cleaned up the old surgical
wound, which had some bacteria in
it, and hoped this might clear up the
mysterious infection.

But it did not work, and by late
last week the surgeons were con-
fronted with the problm of what to
do next.


B&y Girl B lay on the operating
table, her huge chest and belly gro-
tesquely distorted by the fluids that
had been building up in her abdomi-
nal cavity, probably the result of the
problem associated with her liver.
Dr. Koop made me incision at 4:05,
cutting open a hoie about two inches
across. Sticking a suction device into
the hole, he drained out about two
cups of reddish fluid, a huge amount
considering the small size of the
baby (she was not much bigger than
two footballs).
Then he put his finger into the hole
and felt the surface of the liver, look-
ing for the spongy abscess. He could
find nothing.
The liver felt particularly firm, a
bad sign, indicating that it was badly
scarred. This might ,be irreversible if
it were too far advanced.
He cut out a wedge of liver, about
the size of a finger tip, for the patho-
logist to examine. The liver did not
bleed much, another bad sign. This
was another indication of cirrhosis.
Dr. Koop and Dr. Schnaufer looked
sad. They had hoped so much that
the exploratory work would turn up
an abscess and solve the mystery.
But in,stead of that they discovered
what could be a very serious and
possibly irreversible problem.
Over the weekend the biopsy speci-
men would be prepared and on Mon-
day the pathologists would look at it
under the microscope and do other
tricks to learn the secrets the tissue
might contain.
Until then the other doctors could
only support the child and hope that
the miracle baby was aptly named.
                  .,