Since birth, Maliyah and Kendra Herrin have been together, but Tuesday morning they entered the newest phase of their young lives separately and on a different schedule.
About 8:30 a.m., about 25 hours after doctors at Primary Children's Medical Center began surgery to separate the girls, who were born joined mid-torso, Maliyah was moved into the pediatric intensive-care unit, where she began the earliest part of her recovery. Surgeons finished closing skin over Kendra's surgery wounds about an hour later and placed her bed next to her sister's.
The twins, 4, are both critically ill. Even though the surgery went "really, really well," according to pediatric surgeon Dr. Rebecka Meyers, who coordinated the complex separation, the girls are very swollen, in pain and have had a lot of stress placed on their small bodies. They are under heavy sedation to control the pain "imagine someone just came and took away half your body," Meyers said.
They are also on ventilators to support their breathing and will be monitored closely in the intensive-care unit for at least a week. They are expected to stay in the hospital for about a month.
Like the surgery itself, doctors can only predict how long initial recovery will take. "They could have the (ventilation) tube out in two or three days or two or three weeks, and neither would surprise me," Meyers said.
They also have to heal from a massive wound. And many of their internal organs have been cut and stitched and stapled and rearranged.
The hours following the separation were emotional. Meyers cried, she said, when her colleague Dr. Michael Matlak carried Kendra to a different operating room right after the girls were separated. She cried again when she told the twins' parents, Jake and Erin Herrin, of North Salt Lake, how well things went. And the mid-morning reunion of the parents and the twins was filled with "happy tears and sad tears," said Bonnie Midget, hospital spokeswoman.
Each girl now has one leg, and further surgery is needed to prepare them for prosthetic legs. How well they will maneuver on them is unknown, dependent in part on "how hard they want to to work. They will be able to walk, but it will require a lot of effort. How much motivation each has is not something I can decide," Meyers said. "Kids are very motivated by nature."
The girls have used Kendra's one kidney, accessed by Maliyah through the liver they shared. Once that was divided, Maliyah lost that access and will need dialysis until she has a kidney transplant. Erin Herrin hopes she'll be able to donate a kidney to Maliyah in a few months, but first the little girl has to heal. The surgeons also split the twins' intestines and rebuilt their bladders and pelvic rings.
There were no major surprises during the surgery, the doctors said, and the girls required very little blood.
"We were hoping and praying for the best," said Jake Herrin. He and his wife, who also have three other children, credited their faith in God with helping them through the tough decision about whether to separate the twins.
Throughout the long wait, they said, they had a sense of peace, although they were anxious for it to be over. "Who thinks the prayers are working? I do," the father said when they were told the girls had been physically separated Monday night.
As for the long recovery and future, the mother said: "We're up for it. We're always up for a good challenge."
The girls, she said, "will get married. They will have families of their own."
Kendra and Maliyah will have extensive rehabilitation and more reconstructive surgeries. But that, too, has been planned for by a lot of people.
Play has and will continue to be a big part of the preparation for the twins' new life, PCMC child life specialist Holly Moss-Rosen said. "It helps kids process and explore issues."
They used play to help "normalize" the hospital experience during the long weeks as in-patients leading up to the surgery. Play provided a distraction during the ride to the operating room Monday morning. And it will help them heal."They are so cute," said Meyers, who laughed describing a day when the girls were "scaring" each other. They didn't see her, because they were too busy giggling and going "whoooo" to each other. "They are cute, adorable little girls."