SINGAPORE - A marathon operation to fulfill Ladan and Laleh Bijani's wish for independent lives failed yesterday as doctors managed to separate the conjoined twins, only to see them die.
The 29-year-old Iranian sisters died on separate operating tables at Raffles Hospital after more than 50 hours of surgery that had been marked by some successes, surprises and setbacks.
The twins had been in stable condition before surgeons made the final cuts to detach their brains, doctors said.
But, just as they achieved their long-sought separation, the sisters began losing massive amounts of blood. The medical team battled furiously to save them, but their efforts failed.
Ladan died at 2:30 p.m., (2:30 a.m. EDT), her sister about 90 minutes later.
Warned repeatedly about the risks of the surgery, which had never been attempted on conjoined adults, the twins had said they would rather die than be forced to go on living fused together.
"One of the most impressive things about them was their determination to live separate lives - at all costs," Dr. Benjamin S. Carson of the Johns Hopkins Children's Center, who was one of the twins' lead neurosurgeons, said at a news briefing at the hospital last night.
A collective gasp was heard in the lobby as a spokesman announced the news of Ladan's death in the afternoon. A few of the twins' friends began sobbing and were immediately ushered away.
Several large, colorful bouquets sent earlier in the day from the local Iranian community to the surgeons on the medical team suddenly seemed more like flowers of condolence than flowers of appreciation.
In the twins' native Iran, where the surgery's progress was being followed closely on television and in newspapers, life seemed to stop as news of their deaths spread.
An elder sister of the twins, Zari Bijani, reportedly fainted when state television interrupted normal programming to announce that Ladan had died. Others mourned the twins' passing as a national tragedy.
The Iranian ambassador to Indonesia, Shaban Shahidi-Mo'addab, who had traveled to Singapore to support the twins, noted last night that Ladan and Laleh are the names of flowers - fragile flowers, he said, that bend in the wind but do not break.
"Today these flowers don't exist anymore," he said. "Their destiny wanted them together."
Life of compromise
The twins, who had different interests and personalities, had no choice but to compromise on everything from when to get up in the morning to where to go out to eat.
They both studied law at Tehran University, but only because Ladan wanted to; Laleh had wanted to be a journalist. Many who knew them described them as intelligent, spirited and vibrant.
"These young women grow on you very quickly," said Carson, who met them for the first time just two days before the surgery began.
Dr. Keith Goh of Raffles Hospital, the other lead neurosurgeon, also was taken with the Bijanis. Though he had initially tried to talk the sisters out of the surgery because of the risk that it would leave one or both dead or brain-damaged, he said that, over time, he came to understand their suffering over the past 29 years.
Speaking at the news briefings after the failed surgery, a weary Goh said, "Naturally, I'm very sad, as all of us are."
Many difficulties
The international team of medical specialists from Singapore, the United States, Nepal, Switzerland and Japan experienced difficulties in several phases of the three-day operation.
In the first day of surgery alone, they fell several hours behind schedule. The opening of the skulls, for instance, took a full six hours, much longer than expected because the bones were unusually dense and difficult to cut.
Later, neurosurgeons were slowed by the twins' tightly fused brains, which had to be teased apart one millimeter at a time.
Blood circulation between the twins was unstable at times, causing their brain and blood pressures to fluctuate.
And a newly constructed vein to drain blood from Ladan's head to her heart became blocked.
The twins' journey to separate lives began about 8:30 Sunday morning when, accompanied by seven Iranian friends, they were wheeled in for a final round of CT scans and MRIs of their brains. They were said to be in good spirits, laughing and joking on the way in and out of the tests.
In their last public statement before the surgery, they said, "If God wants us to live the rest of our lives as two separate, independent individuals, we will."
Sleepless night
About 10 a.m., they were taken into the operating room. Originally, they had planned to walk in on their own, but they didn't get much sleep the night before and were tired. They had stayed up most of the night chatting with nurses.
It took two hours to make the final preparations for the surgery, including shaving their heads and making sure that all the intravenous lines and monitoring machines were in place.
Anesthesia began about noon.
