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Dr. Stuart Lacey Gives Conjoined Twins Separate Lives
From The Arizona Republic by John Faherty, Jan. 18, 2009
Dr. Stuart Lacey (BS76) stood over the table and looked down at the boys. The operating room at Phoenix Children’s Hospital was a blur—nurses draping the patients, anesthesiologists monitoring their vital signs and scrub techs checking equipment. Lacey stood still, saying goodbye. In the five months since Alex and Angel Mendoza’s birth, their bodies fused together below the chest, Lacey had come to love them, slipping into their room just to hold them. But, he had to put that aside, disassociating himself from his feelings. His wife calls it “when his veil comes down.”
Alex and Angel were no longer babies he loved but patients, and he had work to do. In May 2008, Ashley Frank went to her doctor’s office for an ultrasound to find out the sex of her baby. The technician told her she was having twins. A few moments later, he went to find a doctor.
Conjoined twins are created when a fertilized egg, on its way to becoming identical twins, fails to split completely. Typically, identical twins divide within a day of conception. Conjoined twins’ incomplete split usually happens about two weeks later. Where the split stalls defines the resulting anatomies. The condition is rare. Statistics claim fewer than one in 200,000 live births are conjoined twins with prognosis usually not that good. Only 35 percent of those born survive the first day.
Lacey was there in Aug. when Alex and Angel were born, strong and healthy. They had two beating hearts and four healthy lungs with the proper number of kidneys and bladders, arms and legs. They cried loudly. But the news was not all good. Alex and Angel were joined from their chests all the way to their bottoms. Their pelvises, phalluses and livers were each fused. Their kidneys did not function ideally, their lower intestines were entwined and their hips were splayed at bad angles. Lacey knew that separating the two boys would be complicated, but he knew he could do it.
Surgery began at 7:30 a.m. At 10:48 a.m., the surgeons separated the boys’ combined phalluses and rebuilt one for each boy, leaving each with his own urethra. For two hours, the methodical beep of the boys’ heart monitors beeped in unison. At 12:15 p.m., the boys were re-draped and repositioned. Dr. Lacey began to cut following Alex and Angel’s twisted contours through skin and muscle. At 1:09 p.m. came the next step, the livers.
Stuart Lacey is 54. His flat, country voice reveals a childhood spent in Portales, N.M. He makes jokes about his height, which is lacking, but not about his skill as a surgeon, which is not. Lacey had never before separated conjoined twins. But he had experience doing each of the things he needed to do.
The operation had a master plan. Ten other doctors would complete parts of the procedure. Lacey as head surgeon, would be involved in all of them, in and out of the room all day. Months of preparation, ultrasounds and X-rays could not show the doctors every problem they might find once the operation began. Lacey made the fine cuts into the livers. The organs looked healthy with some shared tissue. The two began to separate. Lacey spent more than 90 minutes untangling their lower intestines. The urologists returned to work on the boys urinary tracts. Ten hours into the operation, Lacey got a good look at the bladders and kidneys where he found a surprise.
Even before the boys were born, Lacey knew they would be a lot of work. But he didn’t foresee how he would be so taken by them. Lacey has four children, all boys. He is also married to an identical twin, and works every day with her sister. That may explain some of why he fell so hard for the boys. The rest is what he calls their captivating personalities. When they were born by Caesarean section, Alex and Angel were facing each other. Lacey was struck by how the brothers started caring for each other on their very first day. Later, he would stand over their crib watching them. When Alex began to cry, Angel raised his tiny hand to rub his brother’s tear-stained cheek. But on the day of the surgery the veil would come down.
Only when they saw inside the boys did doctors see what was wrong. It was known there are four kidneys and they drained into bladders. What they did not know was one of Alex’s two kidneys drained to his own bladder and the other to Angel’s. Angel’s kidneys were the same way, their systems shared and confused. Lacey and the other doctors decided to cleave each bladder in half—and swap the halves so each set of kidneys aligned. Then they would stitch the halves back together. It was an improvisation, but it worked. At 7:21 p.m., it was time to begin the final separation.
There were 17 doctors, nurses and technicians in the room. Lacey started cutting the last bits of bone and soft tissue that were connected. Another operating table was waiting. At 7:48 p.m., Dr. Lacey made the final cut. Ten minutes later Alex and Angel were on separate tables. Hours of work remained. The urologists started again on the reconstruction of the boys’ bladders and phalluses. At 1 a.m., the boys were brought back to the NICU where they were stable, slept and began to recover.
There will be more surgeries ahead, more reconstruction and rehabilitation. Lacey suspects their hips and pelvises and urinary systems will pose challenges, but knows not to what extent. Most of Lacey’s work with the boys is complete, their care now in the hands of neonatologist.
At a press conference, a television reporter asked Lacey how normal the babies will be when they grow up. “They have normal bodies and abilities from the chest up,” Lacey said. Then he allowed the veil to lift, his feelings for the boys to return. “They have marvelous personalities. So in the most important ways, they will be fine.”
