The Little Marias
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who first brought the twins to UCLA's attention, calls the girls'
mother to give a quick update on their condition.
2:38 p.m., Lazareff and the neurosurgery team begin removing a rim
of bone about two-thirds of the circumference of the shared
skull to allow the doctors to see the dura, the fibrous membrane
that envelops the brain. Then the girls are given Mannitol, a medication
to remove water to shrink their brains, a standard procedure in
four hours later, at 6:22 p.m., the neurosurgeons begin to enter
the brain, identifying the veins, collapsing them and rerouting
the blood supply to each of the twins. It is an achingly slow procedure,
but necessary to avoid the possibility of a stroke. For each clamped
vein, the stop-clock on the wall is set for 20 minutes. During that
time, the girls' brain waves are measured; if in that time the EEG
doesn't drop, the team continues on to the next vessel. Throughout
the process, the anesthesiologists keep an especially watchful eye
on Maria Teresa - her blood volume will be replaced 12 times before
the operation is over; her sister's will be replaced three times.
(The medical team had anticipated the need for copious amounts of
blood, and 100 members of the UCLA community had answered a call
to donate blood for the girls.)
that procedure is finished, the neurosurgeons and plastic surgeons
begin to work from underneath the operating tables to remove the
remaining portion of dura and bone.
at 12:56 a.m. the next day just over 11 hours after the first
incision is made a doctor announces, for the record, "They
are separated." A brief moment later, Lazareff, realizing what
has been achieved, adds: "You are looking at two children,
two little girls. There will be two passports, two boyfriends, two
there is no time for celebration. The surgery is only about two-
thirds complete. The twins are still connected by a flap of skin
and it is time for Kawamoto and the plastic-surgery team to make
the final cut and begin the process of reconstruction.