Next steps for former conjoined twins

In October 2003, 5 weeks after their arrival to New York, the first of a series of surgeries begins. Arlene Aguirre, the courageous Filipino mother who had traveled half way around the world with her conjoined twin boys Carl and Clarence, reluctantly leave them for the first time.

Utilizing state of the art imagery and donning high power magnification lenses, neurosurgeon James Goodrich takes the giant leap — beginning the separation by starting to tease apart the intricate web of tiny veins.

After an intense 3 hour surgery, the relieved doctors emerge to tell an anxious Arlene that everything in the first surgery went according to plan.

There is no apparent neurological damage in either boy, and within days, they delight everyone with their quick recoveries.

With the boys doing so well, therapists at Blythedale Children's hospital introduce them to the unfamiliar sensations of sitting and standing.

In late 2003 and early 2004, doctors perform two more very dangerous surgeries.  Each one designed to delicately pry apart the boys’ brains and further separate the intertwined blood vessels and major veins they share...  and like the first surgery, these next two also go without a hitch. The separation is now 90 percent complete.

Just as significant to the doctors is how well the twins’ circulatory systems have adjusted.  Remember, the challenge is not only separating them, but getting their bodies to fully function without the other.  It’s more than enough to keep Arlene’s dream alive.

Curry: When you think about the positive, what’s the picture in your mind?

Arlene: I saw them running, walking, standing and—playing.

Curry: And smiling at mama.

Arlene: Yeah.  And looking for me. 

On August 4^th, 2004, almost 10 months after the twins’ first operation, doctors decide the time is right for the fourth and final surgery — the actual separation, and the one they say will be the most complicated and risky surgery of all.

It’s a painstaking process. The doctors go millimeter by millimeter, untangling the last of Carl and Clarence’s veins; what they think will be the final steps of the separation.

Dr. Goodrich and his team also start to address the complete splitting of the boys’ sagital sinus, the large vein they share that is crucial part of their drainage system carrying blood from their brains.

While all of this is going on, Arlene goes to the Montefiore hospital chapel to pray, asking god to watch over her boys and help guide the surgeons’ hands.

Afternoon passes into evening;  everything seems to be moving on track.  But then, literally at the 11^th hour into surgery there is a major complication.

The team discovers something that all its advanced technology and planning never revealed.

Contrary to what the doctors thought, Carl and Clarence actually share a small part of the brain.

But now with the boys nearly apart, doctors are at a point of no return.

The minutes tick by.  It now is 12 hours into surgery.  The medical team is dealing with fatigue and working hard to maintain focus.

After 90 minutes of further analysis, Dr. Goodrich feels certain that he has found the natural dividing place between the two brains.  He is ready to make the incision. This final cut will make what was once a fused brain into two.  It’s the kind of dangerous incision the doctors had worked to avoid.  But the Montefiore team believes they got it right.

And it all comes down to this moment.

While Dr. Goodrich continues working, Dr. Staffenberg leaves to deliver the great news to Arlene.

Its almost 4 a.m.,  21 hours after her boys underwent surgery, Arlene sees Carl and Clarence one at a time for the first time ever.

But what will her boys  be like after recovery?  Will they learn to talk and play like other children?  And  will Carl and Clarence finally be able to fulfill their mother’s greatest dream—to walk on their own?

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