The ingenuity of OR and PICU nurses was pivotal in the separation surgery of conjoined twins.

For an intricate surgery spanning several days and involving some 150 people, planning for every possibility in the separation of conjoined infants last fall was essential. Although dozens of surgeons and physicians performed what was arguably one of the largest surgical efforts ever undertaken at Hopkins, the ingenuity of nurses like pediatric surgery nurse Mary Helen Winter and pediatric intensive care nurse Marina Dackman was pivotal.

Months earlier, the two had solved a key conundrum: how to keep the twins' sterile drape secure during the 30-hour procedure. The difficulty lay in the final stage, when the special operating bed—custom-built for craniopagus twins (joined at the head)—would rotate upside-down. Winter and other surgery nurses developed a method to wrap each girl in two drapes and secure those drapes with surgical staples.

As a coordinator, Winter compiled and inventoried the massive volume of supplies and equipment the rare surgery would require. Running out of sterile gloves or tracking down special equipment at the last minute wasn't an option. Drawing from her 21 years of experience, Winter estimated the need for each item and placed her orders. By surgery day, hundreds of boxes stood waiting.

For all nurses, the seemingly endless preparations and attention to detail paid off, although the result proved bittersweet. The 13-month-old girls were separated, but despite all heroic efforts, Tabea couldn't be saved. After months of rehabilitation at the Children's Center, however, Lea returned home to Germany with her parents in December.

Winter describes the surgery as "a concert where each person knew where their expertise ended and another's began." But the spirit of teamwork and goodwill left the deepest impression. "I saw a scrub tech holding Tabea's hand when she died," she says. "Someone else was gently cleaning her with a washcloth. It was a sense of humanity I'll never forget."

-From Children's Center News, Winter 2005

PHOTO:  In the historic effort, the experience and creativity of nurses like Mary Helen Winter, left, and Marina Dackman proved crucial.