This story appeared first in the Sunday edition of the Wisconsin State Journal.
When Dr. Frank Greer visited the hospital room of brand-new mother Amy Hurt last month, he came bearing an unusual baby gift: Two boxes of slides from a surgery 27 years earlier that made Wisconsin history.
The June 1984 operation separated the newborn Amy from her conjoined twin sister only days after their birth. It was complex, closely documented, and celebrated in local news headlines.
Over the years, the collection of slides taken at the surgery made their way into Greer's Meriter Hospital office. And Amy went on to live her life — which meant, on Dec. 19, giving birth to a squirmy sweet-faced daughter named Phoenix Rain Hurt.
Several doctors warned against it, saying childbirth could be dangerous for Amy because of all the previous surgeries she endured. But her pregnancy and delivery were so successful that, once again, Amy's story became medical history.
"We're hoping to write the case up" for a medical journal, said Greer, a UW neonatologist who wasn't involved in the conjoined twins' separation surgery in 1984 but remembers all the "hubbub" that surrounded it.
"There are relatively few of these patients that ever go on to deliver — just a handful of cases in the literature."
For many longtime hospital staff who were part of Amy's dramatic first days, the young woman's story also is a personal one.
"This is our reward for doing what we do," said Karen Klemp, a nurse in Meriter's newborn intensive care unit for 36 years, who recalls cradling Amy in her arms, just as she cradled Amy's daughter before the baby and her parents headed home to Antigo to start their new life together.
A first in Wisconsin
Amy and Emily Hasner were born in an Appleton hospital on June 12, 1984, by caesarean section. Their mother knew she was expecting twins but not that the girls were connected at the abdomen and shared a bowel.
After the babies' birth, physicians in Appleton phoned Madison: Were doctors there prepared to separate conjoined twins?
It would be the first known attempt at such an operation in Wisconsin. Another pair of conjoined twins born that year in Madison were surgically separated in Philadelphia.
UW-Madison pediatric surgeon Dr. Munci Kalayoglu would head the Madison team. A native of Turkey, Kalayoglu joined the UW medical staff seven months earlier to help pioneer liver transplants in the city. He also was involved in two operations separating conjoined twins in Turkey and one in Pittsburgh.
"It is a very rare operation," Kalayoglu told the State Journal in 1984. "If you call pediatric surgeons around the U.S., only seven or 10 of them get to perform the operation even once in a lifetime."
Hours after their birth, the Hasner twins arrived by helicopter at Madison General, as Meriter formerly was known. Their mother and father followed by car. Their brothers, ages 2 and 9, stayed with family friends.
The Madison General public relations magazine "In General" documented the operation that occurred 12 days later and the meticulous planning that went into it. Meanwhile, the babies needed particular care. "The girls were turned every hour by special care nurses," the magazine reported. Sometimes, the sisters hugged each other.
Surgery was on a weekend so doctors could reserve two adjoining operating rooms, recall nurses Klemp and Dare Desnoyers, who also still works at Meriter. The operation took place on a Sunday, with Saturday reserved for a four-hour dress rehearsal — using Cabbage Patch dolls taped at the abdomen.
The infants' two surgical teams, which included as many as 30 doctors and nurses working side by side, used the dolls to fine-tune the twins' positioning, from pre-operative scrubbing through surgery. On surgery day, the heat in the room was pumped up to 80 degrees to keep the babies warm. An electrician was standing by in case of power problems.
The twins' names were written on their feet with magic marker, Amy said. "Before they headed into the operating room, they actually turned to my mother and said, 'If we can only save one of them, which one of them do you want us to save?'
"My mother said, 'Whoever will have the better quality of life.'"
Today, looking back on the surgery, "I can really see the hand of God in it," said Amy's mother, Barb Hasner.
Within 13 days after their separation, the "celebrity twins," as local headlines called them, were discharged.
"They actually did very well through the surgery and post-op as well," said retired neonatologist Dr. Gary Gutcher, who coordinated the twins' care before and after their surgery.
"I think most of the time we spent pinching ourselves" that they were connected in a way that made it medically viable to separate them, he said. "It's a wonderful success that (Amy) has had a child of her own."
'Out of the limelight'
After the infants and their parents headed home to Neenah, the reporters went away.
"My parents did an awesome job of keeping us out of the limelight," Amy said. Though being a twin didn't seem unusual (there were two other pairs in her class at school), neither did spending time in doctors' offices.
Both Amy and her sister — who today "is doing fine" and also lives in Wisconsin — underwent many follow-up surgeries.
"We went to practically every major children's hospital in the United States to find someone to help us," Amy said. Her last major intestinal reconstruction, which took place in Boston just before junior high, "basically revamped my life."
By high school, she was riding horses. And power-lifting. In 2003, in a job tending horses at Silver Birch Ranch, a Christian camp in White Lake, she met Aaron Hurt.
Hurt, from Palatine, Ill., was at the camp on an IT internship. He and Amy became friends — after Amy carried him down a hill when he injured his ankle on a hike, the couple recalls.
The following year they were dating, and in 2007 they wed. For nearly three years after they married, the couple agreed to "not even talk about having kids," Amy said.
Eventually, they began discussing options, including adoption. Amy went to visit a series of doctors, all of whom warned that pregnancy could "cause detrimental long-term harm that would result in death," Aaron said.
With that news, the couple was terrified when Amy became pregnant a short time later.
Seven weeks later, she miscarried.
"The hard part about that (miscarriage) was knowing that I hadn't yet found the person who could help me," Amy recalled.
She turned to doctors at Meriter who told her to wait three months to heal and try again.
Risk worth reward
On May 26, their fourth wedding anniversary, Amy and Aaron got their first look at baby Phoenix via ultrasound.
Sara Babcock, a clinical nurse specialist who deals with high-risk obstetrics at Meriter, said the hospital commonly works with women who have complex surgical histories.
Amy's "was a very complicated pregnancy in that she had pretty significant risk factors for a pre-term delivery," Babcock said. "However, we did not feel that those would make it impossible or not recommended for her to at least attempt a pregnancy.
"She's an incredible woman and she's done a lot of wonderful things. She's worked hard for all the things she's attained in her life, and that's to her credit."
During the pregnancy, the couple made frequent four-hour trips to Madison from Antigo, where Aaron works as a credit union information security officer and Amy is a bank teller. Amy was closely monitored and received progesterone shots after 18 weeks. In the weeks leading up to her Jan. 9 due date, she stayed in Madison at the apartment of a friend-of-a-friend she calls "Mama Pat."
Aaron had just driven back to Antigo from Mama Pat's on Dec. 18 when he awoke to a text message from Amy. Contractions had started and she was being admitted for a C-section.
In the pre-dawn dark, Aaron grabbed his still-packed suitcase and a neighbor agreed to drive with him to Madison. Amy watched their progress on the road via Google Latitude on her smartphone.
Five minutes before she headed into the operating room, Aaron arrived.
The couple knew from previous ultrasounds that Phoenix's right hand was not fully developed and had no fingers. The surprise upon delivery was that she did have a right thumb, and the Hurts have been assured by a plastic surgeon that she'll manage fine.
"Of all the things that could go wrong, I'll take it," said Amy, tucking Phoenix into a onesie with flowers in shades of purple, the same colors she picked for her daughter's nursery. "It's not a big deal."