| "win The twins 5, decision, Part 2 Now one fights for her life By Donald C. Drake Inauirer Medical Writer ' Baby Girl B, the Siamese twin separated from her sister five weeks earlier, looked strong and healthy as she lay in the crib in the pediatric intensive care unit. ’. She sucked on pacifiers, was alert and moved about easily despite the abnormally large reconstructed chest, which had been attached to her sis- ter. . . But somewhere in the tiny body _ of Baby’ Girl B was a potentially | lethal pocket of infection that had refused.to respond to antibiotics. It ‘was essential to find out where the infection was before it broke loose ‘and overwhelmed the helpless baby. Surgery was the ‘only way to do _ this now, but the surgeons were . afraid that the stress of another op- eration would tip the fragile balance . of life and kill the baby. Tt was one of those tightropes that physicians so often must walk, ‘The threat of infection was only the latest in a series of crises that the sturdy little twin had confronted in the 37 days since she had been sepa- rated from -her sister, wno died in the operation. In that time her kid- neys had stopped making urine. Bio- ‘chemical problems developed that could throw her into convulsions, cause a brain hemorrhage or rob. her of energy., 5 And for a few minutes-her heart stopped. Se Each time the doctors at Children’s Hospital had responded quickly and forcefully. Dialysis was used to clear her body of the toxic wastes created “by the kidney problem. Biochemical Supplements and’ blood transfusions were pumped inte her body. And electricity and drugs jolted her heart back to a. steady beat. - Now, Dr. C.: Everett Koop, the chief of surgery at Children’s Hospi- tal and the man who had separated (See RARV an 14.4). ‘Miracle baby’: The fight for life BABY, From 1-A the twins, was concerned and sad- dened by the growing evidence that the child had an infection. Never before had a Siamese twin with Baby Girl B’s type of problem survived an operation more than 11 hours. She and her sister had been joined at the chest; they had shared a liver and a heart and a half. The surgeons had had to sacrifice the other girl, Bavy Girl A, because the fused heart was not strong enough to support two babies, but they had hoped that Baby Girl B might sur- vive, despite the vast odds against her. (The family has asked to remain anonymous. ) For a while it looked as though the sturdy little baby was overcoming those odds, but then the laboratory figures got worse and worse. The daily tests indicated that the levels of hemoglobin and platelets, needed for clotting, were low, and other blood factors also were abnor- mal. An infection was lurking some- where. Also, her bilirubin levels were high. Bilirubin is the biochemical that the liver-‘makes in getting rid of worn-out red ‘cells. Excess amounts of this substance indicate liver trouble. Dr. Koop and his chief assistant, Dr. Louise Schnaufer, had to decide what to do quickly, because all these things constituted a severe risk to the child. To-operate was a risk, but not to operate was a bigger risk. After meeting with consultants Thursday morning, Dr. Koop decided. ta go ahead with the surgery. An abscess seemed likely, since it would account for the high levels of bilirubin as well as the low levels of platelets and hemoglobin. It would show, up as a spongy bump on the usually smooth liver and then it could be easily drained. The operation probably would take no more than a half hour. It was scheduled for Friday after- noon. Baby Girl B was coming to be known as a miracle baby at Chil- dren’s, because she kept overcoming one crisis after another against all probability. , The first crisis had come only hours after her operation, while she was recovering from the anesthetic. She stopped making urine. This was yery ominous, because in such a smalf baby the toxic wastes could build