I asked my mom if she could watch the boys for the weekend while Dave and I tried to figure out what to do. We were barely able to function; tears fell readily and abundantly without provocation.
We talked about our options. We could see our babies through, subject them to testing, possible multiple operations including separation surgery, and at least one heart surgery, and there would be no guarantee that they would survive. Dave and I had looked at the few articles on the web about conjoined twins. Most - let me rephrase - the two of them stated that the condition was extremely rare, most twins being stillborn or dying within a couple of days. The articles went on to state that the majority of surviving conjoined twins were girls, and ultimately there was a 5% chance of survival. Dave did more research than I, though the results were just as heart-breaking and grim. My thinking was that we could bring them here, torture them for a few months as they underwent surgeries, and then we we would watch them helplessly as they went on to be with God; their chances in the grand scheme of survival odds was 5%. This seemed cruel to me. The other option was we could terminate the pregnancy, and let them be with God without subjecting them to pain and suffering. Dave's thinking was that we tear this world apart and do everything we could to save their precious little lives - then we would be able to kiss their eyebrows, and stroke their little heads, and love them as much as we could before letting them go.
We decided to terminate. It seemed humane. Their chances of survivng were abysmally small. I prayed for a miscarriage every night.
Monday morning came. I took the boys to school, but stayed home to mourn for my babies, and to call the dr's office to tearfully let them know of our decision. They gave me the number to a clinic in Oklahoma. I collected my broken heart and called the number to schedule an appointment. The voice I heard through my phone was unsympathetic. She informed me that the first available appointment was not until Thursday and that there was a $100 consultation fee. She asked how far along I would be. By Thursday, I would be 18 weeks. Typically, they only accept patients through 17 weeks because of the size of the fetus, but we could schedule an appointment, pay the fee, and we may have to be referred to a different site.
This was not going to work.
I called the dr's office back and spoke with a kind woman named Mary. I explained the situation. She was understanding, and responded sympathetically to my distress. Mary mailed a book to me about other mothers who had to make hard decisions about their unborn babies. She also gave me a number for a clinic in Dallas, TX. In Texas, abortion can be performed up to 24 weeks. I thanked Mary, hung up, and wept for my babies.
Later that day, I called the Dallas number to schedule an appointment. The woman I spoke with was gentle in her responses. She asked me how many people knew about the pregnancy. I told her everyone knew, I was 17 weeks, and quite obviously pregnant. She asked if the pregnancy was unhealthy, to which I responded that it was. We scheduled the appointment for Thursday at 9. There would be a $125 dollar consult fee and the first day would consist of paperwork and counseling.
I called Dave and choked out the details of the agreed upon plan. Dave's mom came up Wednesday to stay with the boys, and Dave and I headed to Texas.
Thursday morning came quickly. We arrived at the clinic. "Let's rip the bandaid off quickly," Dave said. We walked in and I began filling out the necessary papers. One page asked "Would you like to hear the heartbeat today?" Followed by "Would you like to see the sonogram images today?" I had to sit down. I was weeping again as I checked the boxes for "no."
The clinic was busy. We found the most discreet seats in the waiting room and continued to fill out the paperwork.
I was called back for my consult. The nurse asked if everything was ok. "As ok as it can be right now." Nothing was ok. I cried as she recited the obligatory legal jargon. I cried when the dr came in for the sonogram. "The fetuses are conjoined," he stated. He left, I was sent back out to the waiting room to complete paperwork. The packet had information on the process. It takes 3 days: First day-paperwork and counseling. Second day-implantation of a drug to open the cervix. Third day-removal of the fetus.
A counselor called us back to a private room and told us there was a problem. The dr was concerned that the fetuses were too large and I would require an extra day to dilate. This meant we would have to reschedule for early the following week. In addition, because I have had two prior c-sections, the dr was concerned that the lining to my uterus would tear at the site of the scar, and my "safety was the top most priority." The clinic had scheduled a Doppler sonogram with a dr at a facility about 5 minutes away. We had approximately 10 minutes to get there.
The staff at the next facility was very friendly. News of our situation had traveled prior to our arrival, and we were treated with kindness and discretion. The dr came into the room and asked if we had received any counseling regarding conjoined twins and the options. We admitted that we had received very little, but we were not given any hope. The dr turned on the sonogram and told us that there are several different types of conjoined twins: there are those joined at the head, at the chest, at the abdomen, at the hips, some are only joined by skin, etc. He informed us that in some cases of conjoined twins there is no hope, if they share a heart or even a brain, typically outcomes are grim, but there are other situations that are promising for separation surgery. He viewed my babies on the sonogram and told us that it appeared the twins were conjoined from the xyphoid process to just above the belly button, there was an un-identifiable sack of fluid that they shared, and that it appeared they shared a liver. "Can we separate a liver?" He asked. "Absolutely. But if you would like to see them through, we would need to schedule a fetal MRI to find out more about what they share." He asked if we had any questions. Dave asked about his amount of experience, and about the chances of both of our babies surviving a separation surgery. The dr said that he had seen more than most dr's, and that most dr's don't see any in their entire career. The dr also said that calculating the chances of survival is difficult at best, but that trying was always an option. Dave asked about the babies' hearts, and the holes that were a cause for concern, as well as the hemi vertebra. The dr said that he could not see any defects in their hearts, and that he had noticed a slight bend in the spine, but his opinion was that it was slight scoliosis due to the lack of mobility and the way they were connected. I listened to all of this. The dr. turned to me and asked if I had any questions. "Are there brains developing ok?" Was my first question, to which he responded that they appear to be perfectly developing. "So there is hope?" I asked. "Yes. There is hope."