Ciera and Tiera Bennett, successfully separated at the UM Medical Center in 1986, are typical 11th graders preparing for college
The Bennett twins meet the Onziga twins in May of 2002.
It was like looking in the mirror for formerly conjoined twins, Ciera and Tiera Bennett. Seventeen years ago the sisters were born joined together and had to be separated in a risky operation performed at University of Maryland Medical Center.
Sixteen years later, the twins wanted to meet their counterparts, Loice and Christine Onziga, conjoined twins from Africa who were separated at the Medical Center on April 19, 2002.
In May, 2002, the teenagers got their wish and met the infants. "It's good to see other babies like us, it's like seeing a reflection of us," said Tiera. "They are beautiful. It's amazing they could make it here and I'm glad they could be successfully separated," said Tiera, smiling, as she held Loice in her arms. They met the infants on May 22, 2002.
In June 1986, a 24-member team led by Medical Center pediatric surgeon Dr. J. Laurance Hill successfully separated Ciera and Tiera when they were 2 months old. Dr. Hill is also a professor of surgery at the University of Maryland School of Medicine.
The premature Baltimore girls shared a liver, diaphragm, chest wall and heart and, just like Loice and Christine, the girls were connected from the chest to the mid-abdomen. Loice and Christine are the second set of conjoined twins to be separated at the Medical Center; Ciera and Tiera were the first.
Today, the Bennett girls are 17 years old and live with their grandmother Laura Weeks. They are in 11th grade in the college-bound program at Carver Vocational High School. Ciera is studying computer science (programming) and Tiera majors in commercial art. The twins consistently rank first or second on their class's honor roll. Both want to attend college.
Meeting Loice and Christine brought back memories for Laura Weeks, Ciera and Tiera's grandmother. "We call it a miracle. Seeing the baby twins makes me want to cry, they are so precious. It's like being here [at the hospital] all over again," said Weeks.
She recalled her own ordeal with her granddaughters when they were conjoined. Although it was a difficult time, Weeks always had faith that everything would turn out well. "We were never worried about them, but Dr. Hill was worried. I told him it's nothing but a package. Cut into it and it will be all right," recalled Weeks. "He said he would try. When he was operating he said he would listen to the voices from the past; he heard voices from the past telling him what to do."
Why was she so calm? "Because I have faith. I believe in medicine and the medicine of prayer."
After surgery, Dr. Hill advised her to take them home and treat them like normal children. "I used to tell them (the twins) 'you're special, but not THAT special,' " recalled Weeks with a smile.
Like Normal Teenagers
These days, the twins behave like any other teenage siblings. Overall, Tiera says she has a good relationship with her sister: "We're close, but sometimes we fuss." Weeks, laughing, chimed in: "like normal teenagers."
Weeks says that although the twins' personalities differ, sometimes they're alike. "Ciera talks all the time. Tiera usually doesn't talk very much, but sometimes they switch around," Weeks said.
Both twins love to read. "They read a book overnight and go to the library and get another one," observed Weeks. The teens both like to read novels written by African-American authors. Tiera likes mystery, crime stories. And Ciera's favorite book? "I'm going to give you a list," she says with a smile. But then she decides on one: Hot Coffee Make You Black. Her favorite author is Eric Jerome.
Both like to dance -- everything from line dancing to the Cha Cha. And they enjoy a variety of music, from rap to Smokey Robinson, the Temptations, and Donnie Hathaway to country music. They got to practice their dance skills when the girls attended their first sophomore dance.
Weeks says physically, the twins are doing great. The only physical problem is that they are hearing impaired, but not severely. Ciera has asthma. Both have scars from chest to navel, and Ciera has scars on both sides.
But that doesn't stop them. They are just like any other 17 year olds.
"We were just separated and live like normal people," said Tiera. "We just have scars. But just because we have a scar, it doesn't mean that stops us from doing anything."
The Doctor Who Made it Happen
Seventeen years ago Dr. Laurence Hill faced the same challenge that his colleagues did with the April, 2002 separation of the Onziga twins. He had to separate Ciera and Tiera, who were born face to face, joined from mid-chest to abdomen. The girls shared a chest wall, diaphragm, heart and liver.
Dr. Hill led a team of doctors in the 1986 operation at the University of Maryland Medical Center. The surgery took over seven hours (with anesthesia time, 12 hours), and it was the first time twins were separated at the Medical Center.
Ciera and Tiera were the first twins Dr. Hill had separated where he was head of the surgical team. When they were born, together they weighed 7 pounds, 9 ounces. But prior to the operation, Dr. Hill had been involved in the management of six other sets of conjoined twins, none doing as well as Ciera and Tiera
Dr. Hill said that Ciera and Tiera are very much like the African twins. "It's almost exactly the same anatomy, so the new twins (the Onziga twins) should be fine."
To this day Dr. Hill still keeps in touch with the teenagers and seems quite charmed by his former patients. "I think Ciera and Tiera are stunning," said Hill. "They're bright, active, bouncy and it's fun to be around them. They have wonderful wits, are very fine students and are going to do good things in their lives."
Dr. Hill sees the twins almost every year. He says the incidental health problems they have are not any different from the average teenager. Although they have some hearing problems, Dr. Hill is not sure if it's congenital or drug related after the surgery.
A Groundbreaking Operation
What was the most difficult aspect of this groundbreaking surgery? Hill says it was at the very beginning. "The most difficult part was starting out, when we were just beginning to make the incision," said Dr. Hill. "The initial separation was challenging. The magnitude of what was being undertaken was a hurdle for everyone at the table," noted Dr. Hill.
The next most startling thing was the position of Ciera's heart -- it stuck straight up and out of her chest. "It was well above the front level of her chest and every time I tried to push it back in the chest, the heart would fail; the blood returning to the heart would be obstructed," Dr. Hill recalled.
To solve the problem, Dr. Hill and the other surgeons resorted to using a sheet of plastic material and made a little tent over the heart. Then they gradually pushed the heart back into the chest. It took the doctors two hours to put her heart back inside Ciera's chest cavity.
This small sheet of plastic then covered the hole in the chest cavity. Side flaps of skin were advanced over the front of her chest plastic patch and sewed together. Thus, the plastic material was left in place but it was covered with Ciera's own skin. "The typical problem with the plastic is that infection can arise and can be life-threatening," said Dr. Hill.
Dr. Hill said that prior to this operation, this prosthetic technique (sliding and shifting pedicles of skin) hadn't been used before successfully for splitting twins to cover defects in the chest and abdomen.
"It was something that came to me as a possible solution," he said. "I was prepared to use this new plastic. It's a technique I had thought of, and we had the plastic material available. The whole key to complex surgery is to consider the worst scenarios."
Once separated, Dr. Hill worked on one twin and Dr. Anne Kolbe, a surgeon who trained earlier under Dr. Hill, worked on the other. Dr. Kolbe was one of the key surgeons and she helped close Tiera.
Voices From the Past
To get through the surgery, Dr. Hill drew upon the wisdom of his teachers.
"A surgeon is sort of standing on the shoulders of previous mentors to see the future," recalled Dr. Hill. "I could visualize or hear my professors of surgery just saying a few words to make everything simple. When you get in a difficult spot you think 'what would my mentor do?' You reflect upon having had enormous support and mentoring during the tough spots. You think about the masters you've been trained under."
After the operation, there wasn't any celebration, because the new twins' conditions were still quite delicate. That's because the tight closure (made during the surgery) not only caused a flow problem for the heart but also compressed the bowel and kidneys in the abdomen and restricts expansion of the lungs. This meant that the twins had to be on ventilators to help them breathe, and their risk of infection was greater.
Once separated, the twins were in the intensive care unit (ICU) for three weeks. During the first week to 10 days, Dr. Hill and other doctors rotated to make sure the girls were okay. "Post-op care is meticulous and intensive and is a major part of success," explained Hill. "The first 10 days are critical. After the first 10 days they were steadily improving, but they're not really set until you get through the first three weeks."
Generally, the statistics are not very encouraging for conjoined twins, according to Dr. Hill. Only 50 percent of delivered twins leave the hospital; 50 percent of conjoined twins do not survive. He also noted that earlier, one half miscarry and never live; then half that are born do not survive.
For the recent Onziga conjoined-twin operation, Dr. Hill was ready just in case the team got into trouble. "My purpose was to stay in the background, observe and make sure certain things were going smoothly, and lend a hand if necessary," stated Dr. Hill.
In fact, Dr. Hill helped the surgeons and nursing team in another way. The surgeons who operated on the Onziga twins (Drs. Eric Strauch, Roger Voigt, Bartley Griffith and Marcelo Cardarelli) studied and followed an instructional videotape Dr. Hill had made of Ciera and Tiera's operation back in 1986.
"The tape helped them to get prepared. The videotape documented Ciera and Tiera's operation, as well as pre- and post-operative care," said Dr. Hill. In fact, the tape was selected by the American College of Surgeons for educational tapes of operations and for the "best and spectacular video" at the 1987 October Annual Congress of the American College of Surgeons.
While he watched this most recent surgery, Dr. Hill experienced some mixed feelings. "It was a little frustrating not doing it (the surgery), but that's what teaching is all about," he said.
And for Dr. Hill, the thrill definitely outweighed the frustration. "It was exciting to watch," he said. "Not only was it exciting, it was very gratifying and I was very proud of the doctors and nurses."
By Michelle Weinstein Murray