For These Twins, Parting Is Sweet

Julie Cline and her twin sister, April, left Kaiser Permanente Hospital in separate strollers Friday, four months after they came into the world as Siamese twins.

They got a big send-off.

More than 50 physicians, nurses and other hospital staff members threw a party at the hospital on Sunset Boulevard complete with cake, streamers and a paper banner reading “Happy Day April and Julie,” in celebration of the Aug. 19 operation that made it possible for the little girls to lead separate lives.

“This was Kaiser’s first case of conjoined twins,” said hospital spokeswoman Karen Constine, “and we’ve been in Southern California since 1950.”

Julie and April were born joined at the liver, and it took a 29-member surgical team, plus a full-scale dress rehearsal using baby dolls taped together face-to-face, for the surgeons to feel confident of their ability to separate the infants.

“The main thing,” said Dr. Harry Applebaum, the lead pediatric surgeon in the operation, “is that they’ll grow up perfectly normal. The babies have already developed distinct personalities. One is more placid, the other is much more active.”

And sure enough, Julie slept through most of the celebration while her sister was wide awake--and taking it all with a detachment bordering on outright indifference.

Siamese twins occurs in one in every 500,000 births and Applebaum acknowledged that such births also have a 75% mortality rate, primarily depending on how and where they are joined. And parents Milly and Dennis Cline of Chino admitted that they found time passing slowly during the 3 1/2-hour operation.

But Applebaum said he was able to give the Clines “some assurance,” of success before the operation. “And now,” he said, “we can give them full assurance!”

“We want everybody to know that miracles still happen these days,” Milly Cline said.

The twins’ elder sisters, Susan, 7, and Laura, 3, each picked up and held their tiny sisters during the going-home party, kissing them on their foreheads and hugging them as if they were dolls.

“I think the bonding has already begun,” Constine said.

Milly Cline knew she was carrying twins in December, but did not learn that they were conjoined (a condition commonly referred to as Siamese twins) until January. She said she was frightened when she first heard the news, but her religious faith left her “very much at peace.”

“We don’t believe in abortion,” said her husband, a furniture repairman. “We believed the girls deserved a chance. . . . “

Applebaum, the surgeon, said doctors were able to determine that the twins had separate, but fused, livers through the use of a magnetic resonance imaging scan, a new method of examining organs by using magnetic rays.

“This is new technology that has only been available for a year or so,” he said. “The pictures showed that the twins had all separate organs: hearts, gall bladders, blood vessels. Most conjoined twins don’t turn out normal after separation because they often have only one bladder or one rectum between them before separation.”

Most importantly, he said the tests clearly showed that the girls “had two separate bile systems and the liver was actually two livers that were fused.”

Because the surgical team had virtually no experience separating conjoined twins, Applebaum explained, he had to study the matter before attempting the operation.

“They were joined at the liver and the lower part of the sternum and also at their diaphragms,” he said.

“If you look at past results of this operation, there was probably a greater than 50% mortality rate associated with it. But, of course, we had several things working in our favor that made it successful for us,” he said.

He said the imaging techniques that showed the fusion of the two livers also were “actually able to tell us where in the liver to make the incision without much blood loss,” Applebaum said. “We didn’t even have to make any transfusions.”

Applebaum said “Annie” dolls of the infant type used in cardiopulmonary resuscitation classes were taped together in the same way the twins were joined to help the surgical team through a dry run of the operation.