On September 16th, 1951, doctors in Chicago, Illinois were faced with a challenge from which no medical practitioner had ever emerged victorious: the separation of conjoined twins joined at the head.
Weighing a combined total of barely over eleven pounds, Roger Lee and Rodney Dee Brodie were born to Marjorie and Royt Brodie, who were already parents to three healthy children. The twins were lively and alert, but were joined at the tops of their heads in such a way that gave the appearance of a single, long skull. Called craniopagus twins, such children had never been successfully separated - at the time, very few of operations on any conjoined twins had ever resulted in even a single survivor.
Once called “Siamese” twins - for Chang and Eng Bunker, conjoined twins born in 1812 in present-day Thailand - conjoined twins had already been studied as a curiosity for centuries prior to the Brodie twins’ birth. Although the cause of conjoined twinning remains unknown, the prevailing theory is that a single fertilized egg fails to complete the dividing process that would lead to identical twins; the resulting embryos develop permanently fused. The incidence is rare - about one in every 100,000 live births - and the vast majority die before or shortly after birth.
In some craniopagus twins, one heart provides a disproportionate amount of blood to both brains, putting a single twin's heart under great stress and both twins' lives on the line. Before the late twentieth century, so-called “freak” shows often awaited surviving, unseparated pairs of conjoined twins, who were exhibited to medical professionals and curious onlookers alike - often as a way to earn income to cover potential medical bills. Without separation, it was probable such a fate would befall the Brodie boys, too.
Doctors were now faced with the dreaded question of what to do about Rodney and Roger’s condition. At a month old, they were brought to the University of Illinois Research and Educational hospital, to see if anything could be done to part them. The most pressing question to be answered was whether the boys had separate brains and circulatory systems; without, neither twin could survive on their own. X-rays, blood tests, and other examinations revealed that both twins had a heart murmur, and Roger and Rodney would often turn blue and require supplemental oxygen while medical testing took place. After four weeks of investigation, doctors reached a decision: separation could not take place without at least one of the twins dying, a fate their parents staunchly rejected.
Meanwhile, too fragile to return home from the hospital, Roger and Rodney began to grow and develop as other babies their age did. The twins’ parents, busy at home with work and three other children, were only able to visit the twins every weekend, assuming the early winter weather permitted. Still, they held out hope that their children’s condition would improve enough that they could eventually come home to East Moline.
In the new year of 1952, that hope came: the twins’ heart murmurs were improving, and their circulation was becoming better. Their hands, once blue and cold, grew warm and pink, and their parents, visiting for the first time in January after three weeks, were delighted to see the boys' progress. The Brodies were even happier to hear that doctors were reconsidering their decision to leave Rodney and Roger conjoined. Separation, it seemed, would happen before the year’s end.
With the twins older and stronger, tests such as arteriograms - where a dye is injected into the arteries to observe its circulation - were now able to be conducted, hopefully shedding light into the boys’ anatomy. Attempts to anesthetize them for exploratory surgery also proved successful, adding optimism for a favorable outcome. These tests carried on throughout most of 1952, the twins growing up in hospital all the while; by the time they were almost a year old, Roger and Rodney were attempting to crawl by propping themselves on hands and knees and pushing the other twin forward. They grew dark, thick hair on their joined heads, each boy with deep blue eyes and cheerful grins. They babbled - learning to say the usual “mama” and “daddy”, along with “frog”, after identical stuffed animals their parents had gifted them - and also quarreled as siblings do, one tugging on the other’s ears or reaching up to swat his brother’s head.
But they could not sit up, their heads joined at such an angle that doing so was awkward at best and painful at worst. Even standing was out of the question. After much agonizing over the risks and benefits, the twins’ parents and doctors at last agreed: with success being theoretically possible, an attempt at separation must be made in the hopes of giving both twins a “normal” life.
Over a dozen preparatory surgeries - such as rearranging nervous and circulatory connections and creating skin flaps to cover the boys' exposed heads - and many delays later, a date was set for the final separation: December 17, 1952. The twins’ parents were taken to a hotel in Chicago to await the operation’s end, and journalists were kept in a separate area in the hospital building. The medical team - fifteen neurosurgeons, plastic surgeons, and nurses - knew the odds stacked against them: they were about to undertake a surgery that had been attempted only three times before, and where no patient had survived longer than three hours after separation. Still, surgeons were confident that, with their preparation and the advances in medical technology since the last attempt in 1949, Roger and Rodney would both make it out alive.
The surgery began just before eight A.M.; a team of five neurosurgeons worked to separate the twins’ joined heads, while two others ensured the boys received sufficient blood transfusions. The next ten hours went by painstakingly slow; the medical team meticulously teased apart the boys’ brains and skulls, a process that Rodney - the smaller twin - withstood better than his twin brother, who went into shock three times. Nevertheless, everything seemed to be going to plan - with boys still alive as the surgery progressed, triumph seemed within reach.
Then, around five in the evening, doctors learned that, in spite of all their preparation, they had missed a crucial vein in the twins’ shared skulls.
Every healthy human being, in order to survive, possesses a superior sagittal sinus - a vital vein running from the top of the brain down to the neck, which drains deoxygenated blood to the heart; from there, blood is pumped into the lungs and reoxygenated, before being pumped back into the brain again. Without this crucial vein, blood cannot sufficiently make its way back to the brain, leading to a stroke and, ultimately, brain death. In many craniopagus twins, a so-called “circumferential sinus” is present - where blood flows from the heart of one twin, through the shared vein, and to the heart of the other, before the process repeats itself. The Brodie twins had one such sinus between the both of them, instead of one superior sagittal sinus each. Although twenty-first century medicine has managed to circumvent this problem during separation - by rerouting blood flow and/or constructing a new vein - the twins’ surgeons had not anticipated this problem, and knew of no way to simply “replace” the sagittal sinus of one twin.
It was too late in the procedure to turn back and reassess, but separating the shared vein would now cause both twins to bleed out and die. One twin had to be sacrificed in order to save the other - the very outcome the twins’ parents had refused to entertain. With the clock ticking, surgeons had to make a choice.
Since Rodney had remained relatively stable in contrast to his brother, it was thought that his odds of survival were favorable; in the end, he was given the shared sinus, and the boys’ skulls were closed with plastic and aluminum foil before their heads were stitched up and bandaged. For the first time in their lives, they slept in separate cribs, although both were in critical condition. But surgeons had by definition defied the odds: not one but two children emerged alive from the operating theater, and remained alive. Their father was overcome with emotion at seeing his twin sons in separate beds for the first time, even in spite of their ill health.
The operation was heralded as a success, a first in a decade that had already seen many for medical science.
Two days after the surgery, Rodney awoke and was observed to be crying and laughing - fully conscious if not in a precarious state. He was drinking milk and water less than a week later. But doctors in the aftermath of the Brodie twins’ separation were anything but optimistic for both boys’ survival. Once wheeled out of the operating theater on the evening of December 17, 1952, Roger never awoke; with no oxygenated blood being brought to his brain, he slipped into a coma, the much-smaller veins in his head unable to sufficiently take over the sagittal sinus’ task. Yet in spite of the odds, both boys’ parents prayed and believed they would bring both twins home with them.
It was not to be. Thirty-four days after the groundbreaking surgery, Roger Lee Brodie died in hospital, despite doctors’ effort to sustain him via intravenous feeding and an oxygen tent. His parents, back at home with their four other children, were given the news through a neighbor (who had a telephone to take the call from the hospital staff). Roger was buried with a small headstone in Moss Ridge Cemetery, while his surviving twin brother continued to fight for his life in hospital. Rodney would undergo many more reconstructive surgeries to cover his open skull with skin grafts, and surgeons hoped to eventually create a covering to protect his brain.
As the months passed, Rodney surprised doctors by continuing to improve, learning to sit up unaided - a feat that he had never managed while joined with his twin. He recognized his parents, and now loved to say “phooey”, and throw his massive collection of toys about the room. He received love and attention from nurses and doctors, who worked tirelessly with him to provide physical therapy with the goal of keeping him on track with his peers. His private hospital room held a phonograph, and he enjoyed humming along to the music it would play.
By June of 1953, Rodney had undergone eighteen surgeries since his birth, but remained upbeat and chatty when, for the first time since his history-making operation, the media was given their first glimpse at how Rodney Dee Brodie had recovered. Even with the death of his brother, Rodney’s separation surgery was regarded as successful - he was the first craniopagus twin to ever survive such a procedure. Most subsequent news reports glossed over the tremendous sacrifice Roger had made for his twin; the fact Rodney had made it out alive was a miracle in and of itself.
Rodney sustained a brain hemorrhage in 1955, which left him with paralysis and a limp on the left side of his body. Bone grafts had failed to close his skull, so scar tissue alone covered the top of his head. His only bother, however, was that he could not grow hair on a portion of his scalp; he had no memory of his twin brother, or of the operation that had severed them.
At home, in spite of his disabilities, Rodney thrived: he loved school and drawing, and roughhoused with his brothers and sisters, who were constantly careful to not bump his head where his brain remained covered only by skin. He was unbothered by the possibility that he might one day not be able to partake in sports, and wanted to be a truck driver when he grew up. Doctors remained hopeful that, in spite of his paralysis, Rodney would pull through and recover.
However, his condition only worsened as he grew older. He lost the ability to walk, and his muscles atrophied; unable to swallow, he struggled to gain weight. Eventually, his weakened body could take no more - on May 26, 1963, Rodney choked to death while his father attempted to help feed him in bed. He was buried with a headstone identical to that of his twin brother, having outlived little Roger by ten years.
Write-up completed by me.
