From one to two. In simplest terms, that was the jubilant result Wednesday for conjoined twins Eva and Erika Sandoval, who became two separate toddlers following a 17-hour marathon surgery at the Lucile Packard Children’s Hospital Stanford.
For their parents, Antelope residents Arturo and Aida Sandoval, it was an arduous ordeal, physically and emotionally, that encompassed tears, tension, prayers and hugs, along with the support of about 40 family members who gathered with them at the hospital.
The couple first saw their separated girls, who were born conjoined from the chest down, around midnight Wednesday.
“They look amazing. They’re amazing. They have their hair done, and they’re resting,” said Aida, outside the hospital’s pediatric intensive care unit later that morning. “We’re just going to take it one day at a time and let them catch up on their rest.”
After two years of carrying and caring for Eva and Erika as girls fused from sternum to pelvis, Aida said it was a little surreal seeing her daughters in different beds. “It’s kind of like – ‘Where’s your other half?’ It’s going to take a little getting used to.”
Calling the surgery “a major success,” Arturo said he’s curious to see his daughters’ responses when they wake up. “What are they going to do? How are they going to react?” He marveled that in less than 24 hours, the twins “went from one to two.”
Starting around 8 a.m. Tuesday, Eva spent 17 hours in separation and reconstruction surgery, while Erika spent 18 hours, hospital officials said. The girls are now being monitored in the pediatric intensive care unit, where they are recovering under sedation in adjacent beds. They’re expected to remain in intensive care for up to two weeks.
Lead surgeon Dr. Gary Hartman directed a team of about 50 physicians, nurses and operating room staff during the risky and complex procedure.
“The twins did very well,” Hartman said in a statement Wednesday. “I’m very pleased; this is as good as we could have asked for.”
Going into surgery, the girls shared a bladder, liver, parts of their digestive system and a third leg. The parents said each girl retains portions of the organs they shared. Each still has one leg; their third limb was used for skin grafts to cover their surgical wounds. Stanford surgeons had said before surgery that one or both girls would likely need a prosthetic leg.
As few as one of every 200,000 births results in conjoined twins, making the condition 200 times rarer than Down syndrome. About 50 percent of conjoined twins are born stillborn, and 35 percent survive only one day, according to the University of Maryland Medical Center.
The Sandoval girls, born in August 2014, spent their first seven months at a hospital before coming home to Antelope. They grew into talkative, vivacious girls who danced, jumped and crawled while maneuvering their sprawling, seven-limbed body.
The twins also contracted more than two dozen urinary tract infections, a side effect of their shared bladder that required frequent hospitalizations. Eva grew physically larger than Erika and often dragged the smaller girl around as they played. Doctors worried that the growth disparity would become dangerous as the girls aged and advised the family to opt for separation.
In October, Aida and the twins moved into a Palo Alto apartment to live closer to the medical staff at Lucile Packard, while Arturo stayed in the Sacramento area where he’s employed as a heavy equipment mechanic. The Sandovals had been married 25 years, and had three grown children, when Aida unexpectedly became pregnant with the twins at age 44. The family have hosted fundraisers and started a page on the crowdfunding site YouCaring to raise money for rent and medical expenses.
Only a few hundred surgeries have been performed successfully to separate conjoined twins, and the Stanford doctors had calculated a 30 percent chance that one or both twins wouldn’t make it through Tuesday’s operation.
The first 72 hours are typically the most critical, said Dr. James Goodrich, director of pediatric neurosurgery at Children’s Hospital at Montefiore in New York. Goodrich has successfully performed seven cranial separations of twins joined at the brain.
They look amazing. They’re amazing. They have their hair done, and they’re resting.
Aida Sandoval, mother of twins Erika and Eva
“That’s the window. That’s when the worst stuff happens,” he said, citing infections, bleeding and other complications. “If you make it through without any serious consequences, you’re not out of the woods,” he said, but odds of survival improve.
Goodrich separated conjoined twins in Saudi Arabia last spring and two American 13-month-old boys at the New York hospital in October. He said the frequency of conjoined twin surgeries hasn’t necessarily gone up, but the outcomes have improved, largely due to advancements in surgical techniques and technologies, such as 3-D imaging. In 1952, when the first successful cranial separation of conjoined twins was performed in Chicago, Goodrich said, the surgeon didn’t have CT scans or MRI but likely operated “by the seat of his pants.”
He said the separation itself can be emotionally overwhelming for parents who have spent months or years caring for two children in one body. “It’s like having a death and a newborn child. … I tell parents (their twins) will have two birthdays; the day they were born and the day they were separated.”
For the Sandoval family, that breakthrough came just after 4:30 p.m. Tuesday, when the couple learned that the twins had survived separation. By 6 p.m. the girls were being wheeled to their own operating rooms for hours of reconstruction.
Aida, too overcome with emotion to speak, gave the floor to Arturo, who updated the dozens of family members gathered in the hospital’s auditorium.
“They were split at 4:34,” he said, while his sister translated in Spanish.
“They’ve always been two little people emotionally,” said one of the twins’ sisters, Esmeralda, 25, who was celebrating with a teary-eyed smile. “It’s the physical part that’s difficult to grasp.”
The couple’s oldest daughter, Aniza, credited her parents’ level-headed strength for getting the family to this point. “Despite everything they’ve been told – the percentages of life and death – they stayed positive throughout their whole journey. It only means that the rest of their future, our future as a family, will always be positive and looking at the glass half-full.”