LEXINGTON, Ky. -- The 2-month-old girl doctors hoped to save with a surgical separation from her twin sister has a very good chance for recovery, her doctors say.
But today or tomorrow, or the next day, maybe, as her parents hold her as much as possible, the other twin will die because she has no kidney.
The decision to separate conjoined twins Brittany and Tiffany Lewis -- knowing Tiffany would die as a result -- was gut-wrenching for their parents, Kenneth and Angela Lewis of Corbin. But it was the best option because leaving the girls joined would have placed both of them at risk, doctors said yesterday.
"Nobody likes the cards they were dealt," Dr. Andrew Pulito said of the Lewises, "but I think they're trying to play the hand they were given the best they can."
Dr. Pulito, who helped lead the complex surgery to separate the girls, said Tiffany was not an acceptable candidate for a kidney transplant because she has several other serious medical problems, including severe hydrocephalus, or fluid on the brain, and a markedly abnormal brain.
She would have been severely dysfunctional and might not have survived even if she received a kidney.
Her parents, aided by doctors at the University of Kentucky Medical Center, decided against using life-support systems to keep Tiffany alive.
She will die soon from chemical imbalances in her blood caused by the lack of a kidney. In the meantime, she is being fed and given sedatives and painkillers to make sure she doesn't suffer.
"Our plans now are to keep Tiffany comfortable and allow nature to take its course," Dr. Pulito said. "This is obviously a very difficult situation for the parents."
The Lewises, who are in their late teens, are staying in a hospital room next to Tiffany's so they can see her as much as possible before she dies. After the surgery, they held her and rocked her through the night and through the day Wednesday.
The twins were born May 12, joined at the lower back and buttocks. The bottom parts of their spines were joined, and they shared one pelvis and lower gastrointestinal tract.
Dr. Pulito said Tiffany would have died at birth if she had not been joined to Brittany.
The Lewises knew before they took the twins home to Corbin June 8 that Tiffany would die. They did not have to choose which girl to save.
A team of four surgeons, three anesthesiologists and several nurses and support people worked more than nine hours Tuesday to separate the girls.
Dr. Carol Fowler, who led the surgery with Dr. Pulito, reviewed literature from around the world to prepare for the operation, but the girls' condition was so rare that she found few cases. Doctors planned the procedure for weeks but still had to make adjustments during surgery.
Dr. Fowler said the girls' lower spine was open at birth. Dr. Benjamin Wharf stimulated the nerves during the operation to see which ones went with which girl.
The girls were stable through most of the surgery. Tiffany's blood pressure dropped when they were separated, but doctors quickly fixed that with a transfusion.
Dr. Fowler said doctors did not have to rebuild organs in Brittany. She received the shared organs.
Both girls came through the surgery well. They were in critical condition last night.
Brittany was still on a respirator yesterday, but her condition was better than it had been just after the operation.
"We anticipate, barring unforeseen complications, that she will survive the surgery and do well," Dr. Pulito said.
Dr. Fowler said separating the girls' spines left them with some nerve damage. It is too soon to tell whether Brittany will have problems with walking or bladder and bowel functions.
However, her kidney was working well, and she had moved her legs several times since the surgery, said Dr. Lori Shook.
Doctors must guard against infection and bleeding while Brittany recovers. She might be in the hospital three or four weeks, Dr. Shook said.