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Tuesday, July 08, 2003  

The Bijani operation: A twin interest

I've been following the career of neurosurgeon Ben Carson for years. I first head him speak when he was the featured guest for a banquet for gifted students I attended while in high school. Later, I interviewed him a few times as a reporter. Dr. Carson is currently in the news as one of the surgeons who operated on the craniopagus twins who were willing to risk their lives to be separated. They died during the procedure.

The twins were aware of the operation's high risks but had pressed for the surgery anyway.

Laden, the more talkative of the twins, had wanted to continue studying law and become a lawyer. Laleh, also a law school grad because she had little choice in the matter, had hoped to become a journalist.

On Tuesday, diplomats were arranging for the return of their bodies to Iran for burial in separate caskets.

"At least we helped them achieve their dream of being separated," [Dr. Keith] Goh said.

The operation, the first attempt to separate a pair of adult twins born joined at the head, was fraught with difficulties not seen in infants.

Ben Carson was the lead surgeon for Laden and Dr. Goh led the team for Laleh. The twins did not survive the operation because of uncontrollable bleeding once their heads were apart. The physicians encountered obstacles they had not been able to anticipate from pre-op investigation, including thick skullbone and fused tissues.

The second reason I've been interested in this story is my longterm fascination with twins. It began with my own identical twin sisters as a child. One of my earliest memories is of being punished by my grandmother for telling the twins they came from a single egg that split and produced two people. Gran was not up on her biology and took exception to my 'meddling.' I must have been about five and the twins maybe four.

When the twins started school, I was regularly pulled out of my classes to interpret what they were saying to their teachers. Like many multiples, they had developed their own secret language. Perhaps because we are so close in age, I learned it, too. Eventually, speech therapy ended twin talk.

I remained a fan of multiples and have read most everything written in English about the phenomenon. That has resulted in a head full of arcania, such as:

•Once best friends identical twin advice columnists Ann Landers and Dear Abby did not speak for nearly a decade after having a falling out that seemed to be about mutual jealousy.

•There is a set of twin girls in the Midwest who share nearly everything except their heads. From the waist down they have the body of one person.

•The original Siamese twins could have been separated without injury to either because their connective tissues did not include vital organs and had negligible blood flow.

One of the questions I asked Ben Carson during an interview was how he felt about the criticism he was subjected to after an operation to separate German conjoined twins did not go well. He and other members of the team are subject to similar criticism since the Bijani twins died.

Goh said he had tried to talk the twins out of it but couldn't.

After the deaths, the surgeon said he expected the ethics debate over whether he should have proceeded with the surgery could rage forever.

"This decision of going ahead with surgery which seems so impossible to do was a very difficult one to make," he said.

"But having seen and understood how these girls have suffered over their last 29 years, I and many other world-renowned experts decided to contribute our time and skills to trying to give these girls some measure of a decent, normal life as we know it."

Dr. Benjamin Carson, the other lead surgeon on the operation who has separated three sets of twins fused at the head, agreed.

"These were individuals who were absolutely determined to be separated. The reason I felt compelled to become involved is because I wanted to make sure they had their best chance," said Carson, who is head of Pediatric Neurosurgery at Johns Hopkins in Baltimore.

His response to my question was similar. He believes that the opportunity to lead the normal lives most of us take for granted is a right an individual, or a child's parents, has a right to choose. A quietly religious man, Dr. Carson seemed to be unshaken by the criticism he endured. I suspect his response to any fall-out from this operation will be the same.

I agree with Dr. Carson. My twin sisters do, too.

Carson to speak at Urban League gathering

One of the most respected African-American men in the country, Dr. Carson has long been an advocate of civil rights issues. He will address the topic this month at the Urban League's convention in Pittsburgh.

Conference speakers include internationally renowned surgeon and head of pediatric neurosurgery at Johns Hopkins Medical Institutions Dr. Ben Carson who addresses the guild luncheon on Sunday, July 27. . . .

If you intend to attend the conference or live in or near Pittsburgh, he is a speaker you should try to hear.

5:13 PM