Published on January 19, 2005

Ahead of a TV special on the case, Singaporean neurosurgeon Dr Keith Goh talks about his failed attempt to separate

30-year-old Iranian conjoined twins Ladan and Laleh Bijani

Growing up in a conservative culture, conjoined Iranian twin sisters Ladan and Laleh Bijani unsurprisingly attracted attention and, in the process, endured much humiliation. With unique personalities and individual dreams, the law majors at Tehran University had wanted to be separated since they were youngsters.

In 2002, at the age of 28, they approached Dr Keith Goh – a Singaporean neurosurgeon who had successfully separated other twins joined at the head. Warned again of the risk, they remained steadfast, even in the midst of a world media frenzy.

After several months, Dr Goh and his team agreed to try. They failed. The Bijani twins did not survive. But the courageous young women left something behind: a resolve among those involved in their case to advance medical science in the field so that other conjoined twins needn’t face the ultimate risk.

The Nation last week spoke with Dr Goh about the Bijanis and the science they pursued together, ahead of a Discovery Channel special airing on January 23 at 8pm.

If you could go back in time, would you still operate on the Bijani twins?

I think if we could reassess the surgical procedure, we would concentrate more this time on how to overcome the problem of the abnormal changes in blood flow that occurred at the end of the surgical separation.

I think the decision to proceed with the surgery – because of what the twins were experiencing in terms of their physical and psychological suffering – would be the same today as it was 18 months ago.

But whether we went ahead in exactly the same manner, I really can’t give you an answer. But I think we know a lot of things now, which we didn’t know then, so we would have to approach the plan of surgery in a slightly different way.

Is separating conjoined twins considered the most difficult operation in the world of neurosurgery?

Yes. Conjoined twins who are joined at the head are generally considered very, very complex cases because the malformed anatomy is so difficult to understand.

Was the Bijanis’ age a factor making it more difficult?

Laleh and Ladan were adult twins – all the previous surgeries had been done on babies or young children – so the changes that had occurred in their anatomy and physiology posed a number of problems.

How did you handle people blaming you for their death? Was you professional integrity compromised?

In heart or brain surgeries, there are often situations like this where blood vessels burst or torrential bleeding occurs, and the surgeons have to react and try to save the patient.

These are the things we spend years training to do. It becomes a reflex. In this case, when things turned bad when we were close to the end of the separation procedure, all of us just started working harder and faster to try and stem the haemorrhage. There was a lot of adrenaline flowing among all the doctors and nurses in the operating theatre, but nobody lost their cool.

You got to know the twins to a certain extent – did that attachment make it more difficult to operate?

I did get to know the twins very well, but although they became friends, it didn’t go beyond the doctor-patient relationship. I was acutely aware of the need to be objective.

But at the same time, you must understand that we doctors are all human beings as well, and ... sometimes when the patients are most unfortunate and they happen to be suffering more than others, you do pay special attention to them.

Knowing the risk was really high, what was it that made you want to proceed?

The decision was not made quickly. It actually took me six months, and that involved many things, but first to try and understand the degree of physical suffering they were going through.

As I began to understand the physical suffering, I also had an insight into the kind of psychological suffering that they had to put up with. These were girls who had to grow up in a conservative culture. They had to overcome tremendous humiliation. Can you imagine what it’s like?

And the way that they were conjoined for so long, we could see from the scans that their brains were being compressed and that it was causing them very bad headaches and so on.

So as a doctor, I felt I had to help them. You see, doctors don’t choose their patients – the patients are the ones who choose their doctors.

The media circus that followed was tremendous. Were you surprised by it, and what did the twins think about it?

I was very disturbed by the media circus – that’s really the correct term – it was a circus. In today’s world, we can’t run away from the media. I was not happy about it, but we had to deal with it the best we could, and the girls knew that they needed to at least try and answer some of the questions raised because they understood that there’s the world out there wanting to hear their story. And there were patients who had similarly severe medical conditions whom they could inspire, so I think they were happy to cooperate in some ways, not a lot of ways.

How are the Nepali twins whom you successfully separated before this case doing now?

The mother keeps me informed by e-mail. The babies are generally doing okay, except for one of them, who is developmentally a bit slower, and that’s baby Ganga.

Now they’re about three years old, coming to four, so we will need to look at how we can help them improve. But generally, their mother seems quite pleased about things.

Kreangsak Suwanpantakul

The Nation

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