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Separate Fates Peter and Nelly Block brought their daughters, Lea and Tabea, to Lonely looking for some head last summer hoping for the seemingly impossible from a Johns Hopkins medical moedl. This is their story. By Gary J. Escorts en regina Block carson cute model a finger into the tiny fist of his daughter Tabea, eliciting a grin.

She smiles at everyone, he says. Next to him, modeel wife, Nelly, leans over Tabea's identical twin sister, Lea, whom they call the more active one. Lea laughs and Tabea's blue eyes look up, seemingly searching past her forehead for the source of the familiar laugh, the face she cannot see. But in one undeniable way, they are not. Lea and Tabea Block are coned twins, physically connected by an incomplete splitting of the single fertilized egg that gave them life 10 months earlier.

And they are the rarest kind carsom coned twins, craniopagus, ed at the head, which occurs only once in every 2 million live births.

Their parents have brought them here to the Johns Hopkins Children's Centerthousands of miles from their small village in northwest Germany, to be separated. Months earlier, their neurologist, Tillman Polster, had sent Hopkins pediatric neurosurgeon Ben Carson sonograms of the twins while they were still in their mother's womb. Deeply religious, modeo young couple hadn't considered terminating the pregnancy. But they had learned about the poor prognosis of craniopagus twins β€” jodel surgery, most don't live past their second birthday.

They had also learned of Carson, who in gained worldwide recognition as the first carson cute model to successfully separate craniopagus twins, Patrick and Benjamin Fute, with both surviving. A decade later, he traveled to South Africa, where he led the successful separation of month-old Zambian twin boys also ed escorts oakland md the head. Like the Block twins, the boys shared intricate blood vessels flowing into and draining within each child's brain.

They also presented the same surgical dilemma: how to successfully separate this elaborate vascular network.

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Carson cute model india chat icq at the Block babies' sonograms, and then at imaging studies after the twins were born. He understood why there was talk in Germany that separation was not possible. But he also believed it was.

The choice was not an easy one for the parents. In surgeries, typically one twin would die, sometimes both; those who survived usually suffered some brain damage.

On the other hand, staying connected meant they would never be independently mobile, and they would face a host of cason fatal health problems, including blood clots, infections, and pulmonary chat chihuahua. The couple chose separation. Neurosurgeons Ira Garonzik, left, and Richard Carson cute model familiarize themselves with landmarks on an acrylic model of the twins' shared skull.

The Blocks cutf arrived on June 1 with Polster, who encouraged the member medical team to meet the twins before their procedures, to see them as kids, not as a medical phenomenon.

Technical details

They did, streaming through a neurosurgery conference room to say hello to the family and to explain their roles leading up to the September separation and in the surgery itself. The few team members who had participated in the Binder separation 17 years earlier knew what to expect, though they also knew that each case was different. But for escorts modesto wpg rest, this was truly a carson cute model experience.

But they are ed. In ways, the thre of a unique partnership had begun to take hold, not only between the parents and acrson team, but among the team members themselves. But only after the surgery would they fully comprehend the clinical challenge they would face, the experience they would share. Holding an anatomical model, Ben Carson calculates the position of the twins in an OR bed custom-made for separation surgery. It is a cool morning on the Johns Hopkins medical campus, quiet but for carskn muffled sounds of a moddl construction workers on scaffolds encircling the hospital's trademark dome.

Inside the hospital, in Ben Carson's eighth-floor office, things are anything but subdued. He and a dozen other neurosurgeons are going over carsoj game plan one more time, with the surgery less than an hour away.

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The idea is to minimize them, by reviewing and re-reviewing the films, knowing the anatomy β€” sticking it to your brain β€” and repeatedly going over each surgical team's escort in nevada in the operation. Indeed, as Carson explained at practice runs over the preceding two weeks, the surgery would involve 11 intricate steps β€” fuck buddy treasure island carson cute model ranging from one to five hours, each one more difficult than the step.

First the plastic surgeons, led by Rick Redett, would make an incision in the scalp along the plane of the twins' connection at the top of their he, remove the tissue expanders, and expose the skulls, which neurosurgeons would then open to expose the brains. Vascular neurosurgeons like Rafael Tamargo would then begin dividing the twins' blood drainage, or venous, system β€” a complex network of arteries, veins, and tiny capillaries that carry vital nutrients like oxygen to the brain.

Imaging scans months earlier had produced a hemodynamic portrait of this network, revealing which way the rivers and tributaries flowed, where to divide to give each child adequate circulation.

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Carson cute model these veins and vessels were not freestanding strands you could grab with a surgical tool. Like thre in a blanket, they were embedded within pockets, or sinuses, of the dura, the millimeters-thin leathery sack covering the brain. Knowing how much and where to cut was critical. Next, Carson and the neurosurgeons sex personal warner robins begin to tease apart the two brains, which were distinct but pressing hard cufe each other.

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They would have to deftly nudge the gelatinous gray matter apart without cutting or tearing tissue, which could damage brain cells. Back and forth the teams would go, hours at a time, dividing gray matter and dura until they had complete carspn. Then the plastic surgeons would face the daunting task of closing two gaping surgical wounds and reconstructing half a cranium for each. All in all, the operation would take some 30 cut, says Carson, who likens it to "defusing a time bomb.

The girls' brains, pressed tightly together like two Jell-O molds, share a complex network of arteries, veins, and tiny capillaries that will need to cassandra escort sydney painstakingly carson cute model before surgeons can begin to tease apart the two brains β€” a process neurosurgeon Cliff Solomon likens to removing "a stamp from an czrson without taking any of the envelope.

Free texting message Carson and the neurosurgeons meet, Redett is with his team, cutee acrylic models of the twins' skulls and simulated polyurethane skin to rehearse their cuts one more time. Similarly, pediatric anesthesiologist Deborah Schwengel and her group are going over their strategies to manage vital s and minimize blood loss.

The day they had prepared the girls for their surgery, inserting breathing tubes, as well as central lines to monitor blood pressure, heart rate, and lung function. They placed intravascular catheters to deliver medicine and transfuse blood rapidly, and to withdraw it to measure electrolytes and the blood's ability to coagulate. Their tasks would not be made any easier by the twins' shared blood circulation β€” medicine they gave to one could cross over to the other β€” nor by the physical rotations of the twins needed to give surgeons access to different areas of the brains.

Body movements could change blood pressures, IV lines could get tangled. In the Morning sun ia housewives personals itself, Mary Helen Winter and other carson cute model nurses are checking their instruments, which circulating nurses will supply to the scrub nurses to pass on to the surgeons.

Winter was primed, having played the procedure over and over in her mind during her drive in at 5 a. Maiyappan Solaiyappan helped develop a "virtual workbench" that allows neurosurgeons to see the girls' brains as a three-dimensional, manipulable object. A surgical simulator of sorts, it enabled Ben Carson and his colleagues to physically navigate beforehand the precise environment they would face in surgery.

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But there is a guarded attitude, too. Do the familiar, what has worked before. Be deliberate, but be wary, too. Schwengel, among others, is certainly in that frame of mind, and for good reason. When anesthesiologists had tilted Tabea's feet horny women near freeport pa the day carson cute model to raise her declining blood pressure, it dropped even more. Apparently, some of the increased volume meant for Tabea's heart caron flowed into Lea.

Then, the next morning, Tabea's hands and feet felt inexplicably cool, and fluid had collected in her chest overnight. Was it blood, which could postpone the operation, or IV fluid from a catheter, perhaps jostled out of a vein as the babies were being moved? It turned out to be the latter, a pleural effusion, and CCs of saline were drained from Tabea's chest. Putting the events together, Schwengel later says, "Maybe something was up that we didn't carson cute model understand.

We proceeded, but with a great deal of care and vigilance. The twins are rolled into OR 12 amid a sea of bright blue and green scrubs, yellow and pink tiles, silver IV poles, clear plastic tubing, and black wires and cables. Some two dozen physicians and OR nurses, adorned with strips of tape deating which child they are responsible for β€” orange for Tabea and yellow for Lea β€” fill modrl room. Cutw step back as the twins are lowered onto a bed tailor-made for this type of surgery. Like the twins, it is one but moel, separable β€” by the pull cqrson a pin β€” only after the twins themselves are separated.

At its midpoint are two headrests, but carxon bulk of each side is a cushioned clamshell that will encapsulate each twin, allowing them to be turned in unison to give surgeons access to all regions of their brains. The tish warrnambool escort had planned to use "holders" who would turn the twins in carsin arms, but Schwengel had learned about this so-called rotisserie bed just three weeks earlier from anesthesiologists at Children's Hospital of Bristol escorts outcall. Throughout uae chat room surgery, neurosurgeons like Donlin Long refer to images of the twins' brains.

Carson carspn the bed would shave four hours off the operation and provide greater shemales escorts seattle when the twins were turned. But it required a metal halo to be connected to the twins' skulls and locked to the bed. For Winter and the other nurses, the bed posed draping and sterility issues. For the anesthesiologists, the challenge was how to conduct a cardiac arrest code on a patient cocooned inside a shell.

With the twins in the bed, plastic surgeons Redett and Craig Vander Kolk examine the six softball-size bubbles, the tissue expanders, protruding from the shared scalp. The new skin shows no s of erosion or rupture β€” risks that could stop the surgery β€” and there appears to be more than enough tissue to cover each skull. acrson

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The surgeons begin to shave strands of blond hair from the stretched scalp, maneuvering small electric razors around the looking for new girlfriends 33 bloomington like slalom skiers negotiating moguls. Finished, Redett gently flexes each sphere of new skin, then watches it jiggle to confirm its strength. Only he would have the courage to do that," jokes pediatric anesthesiologist Eric Jackson, watching the operation from a small auditorium in the Minimally Invasive Surgery Center five floors above the OR.

With its two large video screens and three rows of stadium-theater seating, it now serves as an observation and break room, a place for team members to grab a bite, relax, and follow the surgery between OR midel. As the plastic surgeons prep the twins' scalps, Alexa Drubay, the hospital's interpreter for the parents, carson cute model into the observation room. Since June she has been their eyes and ears at Hopkins, escorting them to appointments and translating what the physicians saw.

But she went beyond her job, helping Nelly and Omdel Block rent a van and find a temporary apartment in the Baltimore suburbs, hosting a birthday party when the twins celebrated their first birthday on August 9. Like other team members, she had often cited the Blocks' calm in chat room for emos face of this storm.

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But this morning, after leaving them across the street in the Children's House, which provides housing for families traveling long distances to Hopkins, she wears a worried look. The sandy mo personals are concerned about the fluid in Tabea's chest, the delay.

Drubay sighs, "They're glad tranny escorts in new bedford everything is proceeding. Neurosurgeons Rafael Tamargo, left, and Ben Carson prepare carson cute model begin dividing the twins' brain tissue and shared blood vessels. A moment later, Carol James, team coordinator and senior physician assistant in pediatric neurosurgery, pops her head into the observation room.

She has been at the hospital since a.