Routine Trip Into Uncharted Waters
The story of the high-risk surgery to separate 1-year-old conjoined twins from Guatemala captured the hearts of many around the world last week.
As of Friday, Maria Teresa and Maria de Jesus Quiej Alvarez, who shared a skull and several important blood vessels, were faring well. Doctors say their road to full recovery will be a long one.
During the 22-hour surgery at Mattel Children’s Hospital at UCLA, a team of reconstructive and neurosurgeons cut through their skull, redirected veins and covered their exposed brains with skin.
While the story made international headlines and drew scores of reporters to UCLA’s Westwood campus, Dr. Jorge Lazareff--a pediatric neurosurgeon who paved the way for the twins to come to the hospital for the surgery--tried to maintain his usual routine last Monday.
The day before, he had helped his son, a UCLA student, move into an apartment. The morning of the surgery, he woke at 6:30, drove to work, checked his mail and looked in on patients. Then, at about 8 a.m., he stepped into the operating room with Dr. Henry Kawamoto Jr., a specialist in reconstructive plastic surgery, beginning the twins’ journey toward independence.
Lazareff’s role in coordinating the twins’ care is not the first time he has donated his services. As director of pediatric neurosurgery at Mattel Children’s Hospital at UCLA, Lazareff has made numerous trips to Guatemala and Romania as part of medical teams performing free surgeries on children with neurological diseases.
The 49-year-old says he is motivated by a desire to draw attention to the plight of children suffering from treatable disorders such as cleft palate or pediatric hydrocephalus, a condition that causes the head to swell. In places where it’s a struggle to meet basic medical needs, treating these nonfatal conditions can be a luxury.
He grew up in Argentina, born to a Russian father and Czech mother. He earned his medical degree from the Universidad Nacional de Buenos Aires. Before he joined the UCLA staff in 1993, he was chief of neurosurgery at the Hospital Infantil De Mexico Federico Gomez in Mexico City. A Dante buff, Lazareff is rereading “The Divine Comedy” in Spanish. His UCLA Medical Center office is decorated with snapshots of patients and the Guatemalan children he has treated over the years.
In an interview a couple days after the twins’ surgery, he spoke with a Times reporter about his inspiration and motivation.
Question: How did you prepare for the physical demands of a surgery that lasted 22 hours?
Answer: Personally, nothing. My son will be a sophomore at UCLA. He rented an apartment, and I was helping him move. I will stress, each patient is an individual. The child I’m going to operate on tomorrow is as important as were the twins.
Q: What was running through your mind right before the surgery began?
A: It was blank, nothing: Just let’s go to the car, let’s start the car, park it in the UCLA lot, walk here, answer the mail, go to the O.R., check out how things are doing. One step at a time. In that manner, you start being efficient. [There was] some level of anxiety and some level of uncertainty, but it was overcome by just doing one thing at a time. Let’s go down to the O.R., let’s see where they are
Q: What did you tell the family when you met with them Saturday before the surgery?
A: I talked to them in Spanish. Although my Spanish may have some innuendos that are different from theirs, we went precisely to the point. I told them that we have four possibilities: both of the girls dying, one of them dying, both of them alive and well, and both of them alive but severely impaired. I did not do the statistics--10%, 50% or 70%. There were four possibilities. Each one of them, if it happens, will be 100% for that particular child or for those children. Shall we go, or shall we wait, shall we postpone, what shall we do now? And they said, go ahead, because they had faith in God.... It was a brief, succinct, straight-to-the-point conversation.
Q: From a technical standpoint, how did the surgery on the twin girls compare to other surgeries you’ve performed?
A: It’s not necessarily the most difficult surgery we’ve performed. Certainly, there are surgeries on the brain stem that involve much more sophistication than the actual separation entails. I don’t want to minimize it. This was a difficult surgery because of the unknowns, because we were going into uncharted territory.
Q: What kind of life would the children have had if they remained conjoined?
A: The surgery needed to be done because of quality of life of those children--those children will not be able to walk. They were conjoined in such a manner that they were condemned to roll, if they wanted to roll from one corner of the room to the other. They would never be able to sit at a table, they would never be able to go to a movie.
Some of the conjoined twins are conjoined at the chest. The classical Siamese brothers, everyone knows of them, from the 19th century, they were able to earn a livelihood, and they were able to marry and have a family. They were able to ambulate. They were able to do the most basic human capabilities: walking upright. And the upright walking provides you a three-dimensional perception of space and enhances your motor ability to perform a series of tasks.
They come with a normal brain that receives a constant stimulus from the environment when you are walking upright. And you spread your hands and you go from one point to another point. Those things would have been completely denied to those children.
Q: You devote a lot of your time to assisting children from developing nations. What inspires you to do that?
A: I don’t know exactly. Basically, it is similar to why, when you write, you just try to find the best adverb to remove the dangling participle, why you put a semicolon instead of a colon. You just try to improve what you’re doing. The same principle that drives you to do very good work ... the very best that you can.
Q: You have a family. How do you relate to this situation, having children of your own?
A: My son was born when I was in the last year of my training, and my perception as a physician changed immediately. To have children certainly enhances your understanding of the problems of other parents, particularly when you are going into pediatrics.
That doesn’t mean there aren’t excellent pediatricians or pediatric specialists who do not have children. In my case, having children helped a lot my understanding of the parents of my patients.
