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"Separating conjoined twins is never standard," says Michael Matlak, MD, one of the surgeons who operated on the Herrin girls. No two sets of twins are joined in quite the same way, and there's always a chance that something will go fatally wrong.
Kendra and Maliyah's team included six surgeons, five other specialists, and more than 25 nurses and technicians. With Dr. Meyers acting as director, they spent 16 hours dividing the girls' torsos, rerouting their circulatory systems, and allotting each twin a share of liver and intestines. Then, just after midnight, they split into two teams-Maliyah's led by W. Bradford Rockwell, MD, and Kendra's by Dr. Matlak-to put each girl back together.
"My God, what have we done?" Dr. Matlak exclaimed when he saw the gaping fissures where the twins had been connected. The pediatric surgeon had performed half a dozen separations in the past, but he'd never encountered wounds as massive as these. He wasn't sure Kendra would have enough extra skin to cover the chasm running half the length of her body.
His colleagues fell silent, and Dr. Matlak walked out to compose himself. In a nearby room, he found the twins' parents and other family members gathered. The surgeon told them of his concerns for Kendra, and the group began to pray. Dr. Matlak returned to the OR, his doubts allayed. "All right," he said as he prepared to move Kendra into an adjoining room. "Let's close her up."
For the next ten hours, the two teams worked simultaneously to rebuild each girl's pelvis and abdominal wall. There was enough extra skin to cover both girls' incisions—in Kendra's case, just barely. At 9:30 the following morning, the twins slept in the ICU, in separate beds for the first time. The nurses pushed their cots together so that when they woke up, they could look at each other and hold hands.
When the Herrins saw their daughters, they held each other and wept. "Everything we'd gone through for the past five years came rushing back," says Jake. "It was such a powerful thing-like they were born again."
The surgeons were moved as well. Dr. Matlak retreated to an empty room, where he broke down in tears. "Joy and gratitude just washed over me," he recalls. Dr. Meyers checked the girls' vital signs; she was astonished to see that their blood pressure and heart rates were still identical. "Twins have a special bond," she said. "There's no doubt about that."
Courtney, then six, was less impressed with the outcome. When she saw her sisters in the hospital, she cried, "Mommy and Daddy, why did you take them apart? I liked them the way they were!"
The twins' ordeal wasn't over. They stayed in the hospital another 12 weeks. Maliyah underwent dialysis three days a week, which often made her so ill that she had hallucinations. Kendra needed surgery for an intestinal blockage. The skin around both twins' incisions began to retract, requiring treatment with "wound vacs" to suction away dead tissue and stimulate new growth.
By April 2007, when Maliyah was ready to receive her mother's kidney, the couple were emotionally drained. "The girls had been to the brink of death and back, and the whole family had gone with them. We had to make one last push, but it was pretty hard for all of us," Erin says.
The transplant was successful, but only time could answer the question that haunted the Herrins: Had all the twins' suffering been worthwhile?
"Kendra, hurry!" Maliyah calls out, tapping at a keyboard in her parents' study. "I'm sending you an e-mail!"
Climbing into a chair nearby, her twin logs on to another computer. "Dear Kendra," says the message in her inbox, "you're my best friend. Love, Maliyah."
As she types a reply, Kendra glances toward her sister. "You can't look yet," she warns Maliyah. "It's a secret."
The six-year-old twins need more surgeries to straighten their spines (which formed a V when they were conjoined), but in most respects they're thriving. They're busy with playdates and swimming lessons and will start first grade in September. By early next year, their parents hope to have them fitted with prosthetic legs. Meanwhile, the girls are learning to use crutches, though Maliyah still prefers scooting around on the floor.
The twins have not forgotten their conjoined days. "Sometimes we still pretend we're stuck together," Kendra says. "But now we can do more things."
They can keep secrets from each other. They can play hide-and-seek with their brothers and Courtney, who has realized that her sisters' separation actually adds to the fun. They can decorate their own bedrooms and choose their own Halloween costumes. "Little things like that have made a huge difference," says Erin. "I want them to grow up thinking that anything is possible."
In one important way, though, the girls haven't changed. Some nights, when Erin and Jake look in on them, they find that one twin has sneaked into the other's room. Kendra and Maliyah are cuddled together in the same bed-side by side, as they've been from the start.
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