NEW YORK NURSE: March 2008
by Joely Johnson
The nurses on the neurosurgical team at the Children’s Hospital at Montefiore Medical Center in the Bronx know what it feels like to achieve the impossible.
In 2004, Mary Speranza, Esther Kho Uy, and Katie Thompson were on the team of experts who successfully separated Carl and Clarence Aguirre, conjoined twin boys attached at the head. The boys and their mother had come to New York from the Philippines just a year earlier, seeking a miracle.
Surgical attempts to separate such twins often result in tragedy for one or both children. For the Montefiore RNs, however, failure was not an option. “We never go into surgery without completely believing the procedure is going to work,” said Speranza, who retired from the facility in June 2007 after 43 years of nursing. “We’re very good at what we do, and it was truly a team effort.”
Prior to the Aguirre case, surgery to separate conjoined twins had been done in one marathon-like session, often resulting in the death of one patient and leaving the surviving twin with severe handicaps. The Montefiore procedure was performed gradually, in four procedures over 10 months. Spacing the surgeries allowed time for the delicate separation of shared veins, including the large sagittal sinus vein the boys shared at the back of their skulls. This staged approach has become the recommended standard of care in such cases.
Arlene Aguirre, the boys’ mother, was the nursing team’s third focus of care, according to Esther Kho Uy, surgical nurse on the case. During the final separation, Arlene had a number of religious instructions for the RNs, including the placement of a statue of the Virgin Mary in the OR facing Clarence, who was in more critical condition.
The nurses also supported Arlene’s cultural values. “The boys came with red threads on their ankles,” said Kho Uy. “In the Philippines, this is the color of hope, and was very touching to all of us. We made sure the threads were not cut.” She described the patient advocacy and family support the RNs offered as, “very emotional and pure nursing.”
The nursing team needed a plan to move the two-year-old twins during the fourth and final procedure. This was extremely challenging and required real ingenuity to map out – there were no references on the subject.
“During our brainstorming sessions, I took two of my daughter’s dolls and pinned them together at the heads to help us visualize how to drape the children and how to position all the lines,” said Kho Uy. It ultimately took two hours for the nurses and other team members to prepare the room and the twins for the final surgery.
A pair of OR beds were attached at the head area and draped sterilely. The children, already washed and shaved on a nearby stretcher, were moved onto the beds in a prone position, carefully supported with bolsters and padding, and covered with more sterile drapes.
When it came time to turn the boys onto their backs, the RNs removed the top layer of draping and, together with the anesthesiologists, used the opportunity to do a mid-surgery check on IV lines and pressure points. They then carefully repositioned and redraped the twins in anticipation of the procedure’s end.
On Aug. 5, 2004, after a successful 17-hour surgery, Clarence and Carl were out of the OR and on their way to recovery, finally resting in separate beds.
Today, the five-year-old twins are doing remarkably well by all measures. They continue to visit Montefiore for periodic checkups and surprise everyone with their energy and health.
In 2007, Kho Uy and fellow surgical nurse Katie Thompson were invited to deliver a presentation on their experience of the Aguirre separation. The women spoke at the first conference of the Pediatric Neurosurgical Nursing Group, which was held during a meeting of the International Society of Pediatric Neurosurgeons in Liverpool, England. More than 80 RNs were in attendance, many of them pediatric ICU nurses. Thompson, a Montefiore RN for 23 years, said, “We were proud to share the story of how nurses played such an important role in this historic surgery.”