Sunday, September 13, 2015

Cojoined Twins

As a young scrub nurse, I did many cases with a Chicago neurosurgeon that was the first to separate twins joined at the head where one survived. The neuro residents always made a big point of this, pointing out the length of the procedure (10+ hours) and the fact that 6 Liters of blood were replaced.

Nurses were not so easily impressed, raising the issue that one twin never regained consciousness and died 34 days post op. The other twin was mentally and physically retarded living to age 11. The surgery was done when the twins were 15 months old and certainly not able to provide informed consent. We wondered how the twins would have done without the epic surgery. Maybe they could have adjusted to life as conjoined twins. Maybe our values of having separate bodies were being forced on people that were happy to be joined. The issue provided lots of fodder for philosophizing in the break room between cases.

Recently, I came across a much earlier and primitive attempt to separate twins joined at the sternum that raised some issues in my mind. Radica and Hodica, two  Hindoo  girls that were a part of The Barnum and Bailey Circuus.  Hindoo is an old reference to being Indian and today considered an ethnic slur.

One of the girls developed a respiratory problem and the circus physician recommended they be separated. (I did not realize that a circus had a dedicated physician, but it sounds like an interesting job.) On 2/10/1902 Dr. Eugene Doyen separated them at a Paris Hospital.

Paradoxically, the weaker twin, Radica survived the procedure, but soon died. Here are some notes from the surgeon: "In severing the membrane connecting their bodies, 3 arteries were cut and blood in the amount of 30 to 40 grams was lost." It sounds to me like the good doctor failed to recognize that the twins shared components of their circulatory system and went in wily- nily chopping away. In nature things don't exist in odd numbers so who knows what he cut.

That the patients are still alive, says Dr. Doyton is due to the "rapidity of the operation." Aside from the lack of aseptic technique this photo raised a couple of questions in my mind.

Where is the scrub nurse? Who do they have to yell and scream at?  How can you keep things neat and orderly without a scrub nurse?  Same sex groups always get into trouble acting on their own. Remember the Taliban or criminals in the NFL. Some women are needed here to balance things out.

Historically, women have always been superior to men in tasks like sewing and putting things back together. Remember Betsy Ross? Putting things back together and suturing is a more advanced skill set than taking things apart.

Five men working with sharp metal objects on undefined anatomy is not a good idea.

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