Vital Signs: Conjoined Twins
PREMIERS MAY 4TH, 2020 AT 6PM
It is the universal feeling of parenthood: incredible joy when your little one is born. And when something goes wrong, you’ll do whatever you can to protect your child. Sometimes, that means making a decision that will forever change the course of their life, a choice often facing the parents of conjoined twins.
Jadon and Anias McDonald were born as craniopagus twins – joined at the head, and it’s incredibly rare. It only happens in one out of every 2.5 million births. Given how rare these cases are, there aren’t many surgeons with the experience to execute such a risky procedure. That’s where Dr. James Goodrich and his team come in. And this time, they’ve partnered with engineers halfway across the U.S., to prepare for this rare surgery like never before.
CNN’s Dr. Sanjay Gupta takes Vital Signs inside the operating room with Jadon, Anias, and the surgical team for a look at what it takes to give these little boys the chance at a normal life.
Vital Sings: Conjoined twines
Premieres: May 4, 2020.
Dr Sanjay Gupta:
00:25 It’s the universal feeling of parenthood, incredible joy when your little one is born. When something goes wrong, you’ll do whatever you can to protect your child. This is Vital Signs. I’m Dr. Sanjay Gupta. Sometimes, that means making a decision that will forever change the course of their life. That’s often the choice facing the parent of conjoined twins. Jaydon and Anias McDonald, they were born as cranial pagus twins, which means joined at the head. That’s incredibly rare, only happens one out of every two and a half million births. 40% of cranial pagus twins are still born and another third live less than 24 hours. Already, these little boys have beaten the odds, but studies show that 80% of twins joined at the head will die of medical complications of they’re not separated by the age of two.Given how rare these cases are, there aren’t many surgeons with the experience to execute the risky procedure. It does take a full team of incredible people to give Jaydon and Alias the best chance for a successful operation and beyond.
Christian McDon:
01:28 You make the craziest faces, man. You want to read them a book, babe?
Nicole McDonald:
01:32 What matters in the end is that they love each other.
Christian McDon:
01:39 When we had the boy, of course, they were normal little boys and just like any other two little babies you see except for being conjoined.
Nicole McDonald:
01:47 I could almost just keep them like this right now because they’re so perfect.
Christian McDon:
01:52 They’re normal little boys.
Nicole McDonald:
01:54 They’re beautiful. They are perfect. They are so funny and they’re-
Christian McDon:
02:04 Happy little boys.
Nicole McDonald:
02:05 Happy.
Christian McDon:
02:05 And crazy.
Nicole McDonald:
02:06 They’re crazy, crazy. Jaydon tries to roll off the bed and drag Anias with him. Anias talks. My favourite thing is to sit here and to hear them talking with each other down the hallway. They talk back and forth and they say … They’re beautiful.
Dr Sanjay Gupta:
02:27 Two boys, Jaydon and Anias. Jaydon is the more rambunctious one. Anias, quiet, inquisitive. He’s also had to struggle more.
Nicole McDonald:
02:40 He’s really bared the brunt of the burden I would say. He’s got breathing issues and feeding issues and he has some vision issues. In the beginning, his hearing was off and he’s gone through heart failure, had seizures. He has had so much happen in the last year and it just rolled right off his back. He just keeps on going.
Nicole McDonald:
03:03 Oh, that’s nice.
Dr Sanjay Gupta:
03:04 I met Nicole and Christian McDonald just days before their twins are to be separated.
Dr Sanjay Gupta:
03:09 At two days out, how you guys feeling?
Christian McDon:
03:15 We’re excited. We’re excited and we’re anxious to finally have the big day here and feeling good.
Dr Sanjay Gupta:
03:25 Anias and Jaydon only know what it’s like to be fused together, sharing one and a half centimetres of their brain tissue. Over the past year, the boys have undergone three operations, each procedure clipping more and more blood vessels and separating more and more of the brain.
Christian McDon:
03:48 We’ve gotten to know them as they are now and there’s always the unknown of how they’re gonna be after this surgery.
Dr Sanjay Gupta:
03:56 How do you work through this in your mind?
Christian McDon:
03:58 There were times when I just didn’t really want to think, go there and think about the fact that one or both of my child’s could maybe have a handicap or something like that after this. I think now I’m at the point where I do know that that is a possibility and if that’s the case, it’s not gonna change anything. We’re still gonna love them. They’re our boys. We’re gonna be a family, we’re gonna have fun, we’re gonna laugh together, we’re gonna do things together.
Nicole McDonald:
04:28 I picture my boys playing soccer in my front yard. They might not play on a team because they’re never gonna hit a ball, but when I see my children, that’s how I see them. For me, it doesn’t matter what the statistics say. The surgery is going to happen and the outcomes are going to be whatever God allows them to be.
Dr Sanjay Gupta:
04:52 With that picture in mind, Nicole, a trained paediatric physical therapist, has worked with the boys tirelessly over the past year.
Nicole McDonald:
05:00 It’s been kind of my mission to prepare them so that when it’s done and they’re separated, they’re not so far behind that they have so much catching up to do. I can get them so that they can push up into the crawling position.
Dr Sanjay Gupta:
05:15 Catching up on milestones for the boys and also for mom and dad. They know what these milestones should look like because of their three year old boy, Aza.
Christian McDon:
05:25 I think as a father with Aza, I was able to just pick him up. When he was about their age, one years old, you as a dad can start rough housing with them a little bit, not too rough or nothing. I miss being able to do that and just being able to hold them. I’m really dying to hold them.
Dr Sanjay Gupta:
05:47 The only way now for the boys to be carried is for both Christian and Nicole to each hold one of the boys and then move together in unison.
Nicole McDonald:
05:58 There’s nothing harder than watching your child cry and not being able to pick them up. I can’t wait until this time it doesn’t matter how hard it is to hear them cry and react to it ina motherly way is something I’m really excited for.
Dr Sanjay Gupta:
06:15 From the day that Nicole learned the fate of her boys, she knew they could be separated but it hasn’t been without sacrifice. Both Christian and Nicole gave up their jobs and moved their family from Illinois to the Bronx to be close to the boys’ surgeon, Dr. James Goodrich at the Children’s Hospital at Montefiore.
Dr. Goodrich:
06:34 Here is a model of our present set of twins. We have this is Anias on this side and this is Jaydon on this side.
Dr Sanjay Gupta:
06:44 No one in the world has operated on more twins like Jaydon and Anias than neurosurgeon Dr. James Goodrich.
Dr Sanjay Gupta:
06:51 Do you get nervous a couple days out?
Dr. Goodrich:
06:54 Any big case you do. It’s part of the equation, secret is not too much.
Dr Sanjay Gupta:
07:00 Get the butterflies lying in formation.
Dr. Goodrich:
07:03 [inaudible 00:07:02] to have a great team, but we’re all set. We’ve worked this one out very well.
Dr Sanjay Gupta:
07:08 When you first met the McDonald’s did you lay out any specific statistics? How did you approach it with them? Was it more of a scientific discussion or an emotional one?
Dr. Goodrich:
07:19 I said the goal is ideally to have both children come out without neurological issues, but one has to be realistic. You cannot separate two brains, particularly if there is fusion without the potential risk of something happening.
Dr Sanjay Gupta:
07:32 Helping improve those chance of a good outcome, 3D models like these, lifelike, anatomically perfect and available in the operating room. They act as a blueprint to practise and review before the operation even begins. Those models mean another team is closely involved with this case. Instead of doctors and nurses, they are engineers and designers as much a part of this operation as the medical professionals and they are half way across the country ready to help Jaydon and Anias. It’s a Monday morning and these printers are already hard at work. Here in this lab in Denver, Colorado, engineers brought Jaydon’s and Anias’s two dimensional scans to life in 3D effectively giving the surgeons an exact model to practise on before ever stepping into the operating room.
Katie Weimer:
08:32 Start with the plates.
Dr Sanjay Gupta:
08:33 Katie [Weimer 00:08:35] is the vice president of medical devices at 3D systems.
Katie Weimer:
08:39 A lot of what we do here is personalised care, precision healthcare. With that comes a basis in a patient’s anatomy. In order to be personalised, you have to start with images of the patient’s anatomy. That comes to us typically in the form of a CT scan, an MR, or in some cases an ultrasound.
Dr Sanjay Gupta:
08:58 Katie’s team converts traditional 2D imaging into complex, lifelike three dimensional models. 3D printing isn’t new in the medical field. It’s being used for everything from splints to implants to models for other operations like heart surgery. For Jaydon and Anias McDonald, conjoined at the head and sharing as much as two inches of brain tissue, the surgeons needed incredibly detailed visuals. For 3D systems, which has collaborated on dozens of conjoined twins operations, the complexity of this case presented a new challenge.
Katie Weimer:
09:34 For the last separation, it really was an all hands on deck approach for us. We worked hand in hand with the neuroradiologist. We online for hours with that team looking for each slice of the imaging data, deciding is this side Jaydon, is this side Anias, what’s happening with this particular set of vessels where they are intersecting, what are the hot points, where are the interesting areas that we need to double check and make sure are created accurately.
Dr. Goodrich:
10:02 The principle behind following the sense of the anatomical planes-
Dr Sanjay Gupta:
10:06 For Dr. Goodrich and his team at Children’s Hospital at Montefiore in New York, it started with a virtual planning session.
Dr. Goodrich:
10:13 It takes the guess factor out. When you’re doing a reconstruction like this, even when we’re working on cranial facial cases, there’s a lot of guessing of trying to guess what you’re doing. You’re no longer guessing. You actually got firm numbers in your mind of what you need to do. For me, it’s firm vasculature. I can look at the size of the vessel, I can calculate it out, I can take it out, I can put it back in.
Dr Sanjay Gupta:
10:35 The virtual look allows the surgeons to practise their approach, what cuts to make, when to make them with the luxury of getting to start all over again if they need to. It provides a level of comfort and reassurance that the surgeons have seen this before they step into the operating room.
Katie Weimer:
10:53 When they approach a case like this, there is no guidebook. They didn’t train, go through their medical training and learn how to separate conjoined twins. What we’re able to do with the three dimensional visualisation and the physical printing of the models is create that guidebook as they go into the operation. They know before they get in there what they’re going to do. By the time they get into the operating room, they’re effectively doing the operation for the second time.
Dr. Goodrich:
11:18 Good morning, Christian. How are you doing? How are the guys? They look pretty.
Dr Sanjay Gupta:
11:24 7:15 AM, this is the day the McDonald’s have been waiting for for the last year. The hope that Jaydon and Anias, 13 month old conjoined twins will be separated at last.
Dr Sanjay Gupta:
11:38 What were you thinking when you were wheeling down the hall this morning? What was going through your mind?
Nicole McDonald:
11:41 It’s just not real. It’s really not even real. To me it’s like another surgery from before.
Dr Sanjay Gupta:
11:47 Wanna give you a little bit of an idea of what happening here. In order to do this operation, they got to continuously move Jaydon and Anias. This is the position that they’re in beforehand and they essentially flipped like this and then like this. Now they’re going to focus on this part of the bone and this part of the brain.
Dr Sanjay Gupta:
12:06 4:30 PM, just about seven hours after the operation began, Nicole, Christian and their entire family are playing the waiting game.
Dr Sanjay Gupta:
12:15 Do you feel anxious? Are you settled? How do you feel?
Christian McDon:
12:24 I think I have a little nervous energy.
Dr Sanjay Gupta:
12:24 What about you, Nicole?
Nicole McDonald:
12:25 What’s waiting in my stomach is for that phone call, okay we’re into … I call it the land of the unknown.
Dr Sanjay Gupta:
12:32 An hour later, the surgical team hits the land of the unknown. Well past midnight, they continue to work through the twins’ brains vein by vein. Then 2:11 AM.
Dr Sanjay Gupta:
12:46 It’s been about 17 hours now since they started operating. You can see for the first time Jaydon and Anias are on two separate operating room tables.
Dr Sanjay Gupta:
12:56 The operation took a total of 27 hours, a really heroic effort by the entire medical team and the little boys but now without difficulty. Despite the detailed visualisations, their brains were fused even more than originally thought. At one point, the surgeons considered stopping. Throughout it all, Katie Weimer from 3D systems was in the operating room to try and help the surgeons. They repeatedly referenced the models that Katie’s team had made as the operation progressed. For Katie, it was an experience she’ll never forget.
Katie Weimer:
13:29 For me, it was a life changing event. We’ve been a part of maybe 75,000 cases and I’ve seen a good majority of those in my 10 years here. This was certainly the most special case I was ever a part of. The use of the technology in the operating room, the visualisations that were created and used and referenced throughout that full 27 hour period was really something I had not seen or experienced before. It really was a testament to how important it is to continue to evolve these technologies to get closer to the hands of the surgeons and the surgical team that use them.
Dr Sanjay Gupta:
14:08 Jaydon and Anias have been successfully separated. It’s the first step, but a big one in the long road to recovery. What could the future look like for these two guys?
Christian McDon:
14:18 Oh my goodness.
Dr Sanjay Gupta:
14:20 We’re checking in to see how they’re doing. That’s next.
Dr Sanjay Gupta:
14:26 When Nicole McDonald got to hold her son Jaydon for the first time, it was as if she saw him for the first time.
Nicole McDonald:
14:33 As a mother, you know when you hold your child, you know every bit of their face. His face also encompassed Anias’s. It was my first moment of relearning his face.
Dr Sanjay Gupta:
14:48 Jaydon and Anias are literally in in two and a half million. They were born cranial pagus twins, conjoined at the head, sharing between one and a half to two inches of brain tissue. After over a year of planning, last month the boys were separated after a 27 hour long operation at Children’s Hospital at Montefiore in Bronx. The McDonald’s have allowed CNN to follow their journey from surgery through rehab exclusively.
Christian McDon:
15:16 Oh my goodness. Oh my goodness. Hi, buddy. Hi.
Christian McDon:
15:25 The last time we were in this room, they were-
Nicole McDonald:
15:27 On one bed.
Christian McDon:
15:29 They were conjoined. I think he’s pretty happy with the outcome.
Nicole McDonald:
15:33 I would say so.
Christian McDon:
15:33 Are yous ticking your tongue out at me.
Nicole McDonald:
15:34 Yeah. It’s a new trick.
Christian McDon:
15:36 You stick your tongue out at me?
Dr Sanjay Gupta:
15:37 For the McDonald’s this entire month has been full of first times, first time in separate beds, first time being held, first time seeing each other. It hasn’t been easy to get here. The boys have battled infections, fevers, and seizures. It’s been particularly trying for Anias.
Nicole McDonald:
16:01 Serious infections close to the brain, skin involvement. They had to take the bone out of Anias. They had to take skin out. For Anias, there’s just never a break.
Dr Sanjay Gupta:
16:15 Despite all of that, the boys’ doctors are so pleased with their progress. Dr. James Goodrich is the boys’ neurosurgeon.
Dr Sanjay Gupta:
16:25 He said he right on or ahead of schedule even. Is there … because it’s so rare, is there a schedule?
Dr. Goodrich:
16:31 Just when we deal with traumatic cases, people with injuries recovery time is months, sometimes year. We’re a month. If you could say this is one month out, this to me is incredibly fast.
Dr Sanjay Gupta:
16:47 Do you feel like you have permission or do you allow yourself, rather, now to think about the future with regard to Jaydon and Anias?
Nicole McDonald:
16:54 I think about their future all the time, all the time. I think about the first time they go to a park and I think about them getting married some day. I’ve thought through their whole future a hundred times over.
Christian McDon:
17:09 It’s not that I’m not optimistic. I’m just more curious what the future holds for them. I guess I don’t want to get my hopes up. I guess I just take it one day at a time.
Dr Sanjay Gupta:
17:24 Each day continues to bring more blessings. The day I visited, Nicole and Christian got to see Jaydon without his head dressings.
Christian McDon:
17:31 I’ve never seen you like that buddy.
Dr Sanjay Gupta:
17:37 For the first time.
Christian McDon:
17:37 The first time without the dressings.
Nicole McDonald:
17:42 It’s amazing! It’s the most amazing thing. I just can’t even believe it. Look at his little hair on top is growing in. Hi, baby.
Nicole McDonald:
17:50 When I look at them and I see them laying in their beds whole and generally healthy and I think mentally with it and moving forward, I don’t just see that miracle, the separation miracles but its been the miracles that took place every step of the way.
Dr Sanjay Gupta:
18:10 Miracles like Jaydon’s first taste of peas.
Christian McDon:
18:14 Are you excited for peas? Hey, we’re learning. There we go.
Dr Sanjay Gupta:
18:20 Or first words.
Speaker 7:
18:27 Dada.
Nicole McDonald:
18:27 Dadada.
Speaker 7:
18:27 Dadadadadada.
Dr Sanjay Gupta:
18:34 And the simple miracle of the entire McDonald family, mom, dad, three year old Aza, and his two little brothers Jaydon and Anias being able to all spent time together as a family. I came to visit them one last time at their hospital before they moved to a children’s rehab facility. Hey guys.
Nicole McDonald:
18:52 Hi.
Christian McDon:
18:52 Dr. Gupta.
Dr Sanjay Gupta:
18:53 Let me give you a hug.
Christian McDon:
18:53 Good to see you. I’m give you a hug too.
Dr Sanjay Gupta:
19:01 Oh yeah. You guys have changed a lot already in just a few weeks. Jaydon was starting to talk/babble before the operation. I remember you mentioning Anias liked to look at those books, to read books and things. Do you think they’re sort of back at that level from before the operation?
Nicole McDonald:
19:20 Yeah, Anias has become my talker.
Dr Sanjay Gupta:
19:23 Is that right?
Nicole McDonald:
19:23 He talks all day.
Dr Sanjay Gupta:
19:25 It is two months to the day that they’ve been separated. Does that surprise you? Christian, did you have any expectations to how long that part was going to take?
Christian McDon:
19:38 I didn’t have any expectations. I knew it was just going to depend on them and depend on God. Dr. Goodrich said they have came back from this quick than any set of twins.
Dr Sanjay Gupta:
19:38 I heard that.
Christian McDon:
19:52 They’ve recovered quicker than any set of twins. He said they’ve defied all the textbooks. He said, “Thankfully they didn’t read the book.” They’re flying. They’re doing really well.
Dr Sanjay Gupta:
20:05 Are you nervous to leave?
Nicole McDonald:
20:07 Yes.
Christian McDon:
20:09 We’re excited.
Nicole McDonald:
20:09 I’m excited. There’s different things, a new set of people to teach all their nuances. I know they’re going to take care of them, but I just have to reinforce the trust with a whole new group of people.
Dr Sanjay Gupta:
20:25 Now this.
Nicole McDonald:
20:25 Now this.
Dr Sanjay Gupta:
20:26 Separated, doing well, breathing, interacting.
Nicole McDonald:
20:30 Yeah, poking each other in eyeballs.
Dr Sanjay Gupta:
20:31 Poking each other in the eye. They’re gonna be true brother. I love how Jaydon smiles after he gives his brother a little poke in the eye.
Nicole McDonald:
20:39 Yeah, yeah. Say, “Yeah.” Can I pick you up?
Dr Sanjay Gupta:
20:42 He like, “Don’t tease me, Mommy.”
Dr Sanjay Gupta:
20:48 When the boys were first born, Nicole and Christian would take them for rides around the hospital in a red waggon. Now, they’re leaving side by side in another red waggon.
Nicole McDonald:
21:01 Alright.
Dr Sanjay Gupta:
21:01 For the McDonalds, goodbye is bittersweet.
Christian McDon:
21:09 Thanks for everything, I’m sure we’re gonna see you again but it’s been great. Y’all been doing a great job.
Dr Sanjay Gupta:
21:15 The whole world is watching you guys, the whole world. I know that for a fact.
Nicole McDonald:
21:18 Hi. Hi, little Jaydon.
Dr Sanjay Gupta:
21:23 Now it is time to say goodbye to their adopted family and adopted home.
Nicole McDonald:
21:27 Are you ready to go for a ride?
Dr Sanjay Gupta:
21:36 It’s also hello to a new home.
Nicole McDonald:
21:37 Do you see your new home?
Dr Sanjay Gupta:
21:40 And hopefully to some more miracles.
Nicole McDonald: 21:51 What do you see? Look at it. Your eyes are everywhere.
Dr Sanjay Gupta:
21:51 It’s so rare that you get to experience something for the first time. That’s exactly what happened here. For Dr. Goodrich, this truly was a first. I’m so grateful that he allowed us to be a part of it and share the amazing story of the McDonald family with all of you. No doubt Jaydon and Anias have a long road ahead of them and we’ll continue to follow their story. For Vital Signs, I’m Dr. Sanjay Supta.
END
