Kendra loves to play games on the computer, while Maliyah would rather play with her Barbies. But the Herrin twins have had to form a cooperative team not often found in 4-year-olds.
When Kendra wants to dance, Maliyah pitches in to help her. When Maliyah wants to go outside, Kendra's usually happy to go along. They have to work together to get up and down the stairs or play video games or put on their shoes.
They are conjoined, their small bodies uniting at the abdomen. They share a pelvis and each controls one leg. While they are always together, their parents, Jake and Erin Herrin, say the twins are not always doing the same thing. Kendra might dress up while Maliyah plays with her beloved Barbie dolls.Ask the bright, inquisitive Herrin twins how they picture themselves as adults, and they see two separate girls, each living her own life although there will always be time for each other.
On Monday, two large teams of specialists at Primary Children's Medical Center will separate the twins in an operation that could last anywhere from 12 to 36 hours. It's a prospect their parents approach with both excitement and anxiety.
"This is wearing on us," says Erin Herrin of the hospitalization that began several weeks ago, when doctors placed 17 small bags under the girls' skin to expand it. The bags are slowly stretching as doctors add saline.
"We're doing this because we love them so much," their mother says. "I would really like to get it over with.
"It was a difficult decision to make," the North Salt Lake mother adds. "I like them like this. I'm kind of mourning them being separated. But I know they want to live their own lives. I know it will be better for them."
Conjoined twins occur in one in 50,000 to 100,000 births, and many of them die before or shortly after birth. There are five different types of conjoinment, each with different challenges. Some twins are joined at the head, for instance, and some at the chest or pelvis. Like most conjoined twins, Kendra and Maliyah share some organs, including a kidney and liver.
Their parents and the medical staff have tried to prepare the girls for the coming surgery, but on a level they can understand. Child-life specialist Holly Moss-Rosen made each of the girls a conjoined-twin doll that they could separate when they were ready.
Kendra cut her dolls apart early on. Then they were sewn back together so she could do it again. Maliyah started to cut hers a couple of times, but decided to wait until she and Kendra were separated. Tuesday night, she changed her mind and cut them apart.
"Shhhh," she told hospital spokeswoman Bonnie Midget, pointing proudly to the dolls. "They had a really big operation and now they have to sleep for a while."
When the girls were born Feb. 26, 2002, their mom says, "We were told such a bleak picture. They would never walk. (They do, with a walker.) They would never do this or that."
The Herrins researched other conjoined twins on the Internet and called many of the families, even getting an interpreter to help them talk to a couple from Mexico. The Herrins' children the twins, older sister Courtney, 6, and twin boys Austin and Justin, now 13 months "can be whatever they want," she says. "When they say they can't do something, I tell them, 'Just try. Maybe you can.' "
"We've explained enough that they seem to understand pretty well. For their age, they're extremely intelligent and extremely headstrong," Jake Herrin says. As for being in the hospital, "They haven't seemed surprised by any of this process."
Filling the expanders under their skin was painful at first, but it has become almost routine. Their mother says the twins only cry when they're in pain. What has been tough, though, is the need for the girls to lie on their tummies and not move around too much because of the skin expanders. It's hard, mom and dad agree, to keep two busy girls relatively still when they're not sick.
The twins have been remarkably healthy, says Dr. Rebecka Meyers, chief of the Division of Pediatric Surgery at University Hospital and Primary Children's, who was first consulted on the case when their mother was still pregnant with them. Meyers will serve as the coordinating surgeon, orchestrating the teams who will separate the girls.
Once they're separated, one of the twins will be moved to an adjacent operating room for necessary reconstructions. And while CT scans and MRIs have given the doctors great information about the girls' anatomies, they won't be surprised to be surprised, Meyers says. They may find anomalies they didn't expect that will need to be fixed, and that will determine how long the complex operation takes.
The Herrin girls are being separated at a much older age than most conjoined twins because they both use Kendra's kidney. Maliyah's blood gets to Kendra's kidney through the liver they share, Meyers says.
Dividing the liver will be simple, because they are both connected to it. Still, Meyers hopes they can do that part of the surgery near the end of the separation, because once the liver is divided, Maliyah will no longer have access to a kidney. In a few months, her mom will give Maliyah a kidney, but doctors decided to separate the girls first because the massive operation could put enough strain on a donor kidney to destroy it.If all goes well, the girls will spend a week in intensive care, and then at least a couple of weeks more in the hospital. And there will be other reconstructive surgeries in the future.