With nurses vying for last-minute hugs and proud doctors snapping keepsake photos, 41/2-month-old Jade and Erin Buckles went home to Woodbridge yesterday, just 13 days after surgeons at Children's Hospital separated the conjoined twins.
"The whole experience is so surreal because everything happened so quickly," said Melissa Buckles, a 30-year-old high school teacher. "We never imagined we'd be taking them home so soon."
As preparations were madefor discharge from the Newborn Intensive Care Unit, Erin snuggled in her mother's arms while Jade pressed her cheek against her father, Kevin Buckles, 35, a Marine gunnery sergeant.
Nurses gathered up the babies' favorite plush yellow ducklings and other belongings while cardiologist Craig Sable and plastic surgeon Michael Boyajian offered final instructions before shyly asking the Buckleses to pose for some farewell pictures.
"Sure!" Melissa agreed, as the twins tracked the commotion around them with dark almond-shaped eyes.
Conjoined from navel to breastbone, the girls spent their lives before the surgery unable to turn their heads much or see the world with anything but a sidelong glance.
"Now they're so smiley," their mother observed.
For the past week, the girls were well enough to share a crib. "They seem a lot happier and calmer in the same bed," Melissa said. Before that, while recovering in separate isolettes, each girl sometimes slept with a soft cloth bearing her sister's scent -- a technique used to comfort a sick twin separated from a sibling.
Dangling over their shared crib was a mobile identical to one waiting for them at home.
"It plays Mozart, Bach and Beethoven," noted Jessica Carmen, a bedside nurse assigned to the girls. "They have a preference for Bach."
Doctors estimate that each girl had more than 100 sutures, some internal, after the six-hour surgery June 19. When they left, only sterile strips remained on the 61/2-inch incision each girl bears.
Other than an occasional dose of Tylenol, neither baby requires pain medication, said Gary Hartman, the lead surgeon. Babies are thought to suffer less pain than adults because "a large amount of pain is learned behavior," Hartman said. "It's not the sensing of pain, it's the interpreting and processing of it."
Of the four conjoined separations he has performed, Hartman noted, the Buckleses were by far the swiftest recovery, something he attributed to "the resiliency of children, the planning and skill of the team and a great deal of good fortune."
Appearing at a brief news conference in the hospital atrium before going home, the Buckleses expressed appreciation for the outpouring of public support: from prayer chains to cards from identical twins around the world.
"The girls look great," Kevin said. The couple had no special homecoming plans. "We're going to disconnect the telephone, disconnect the doorbell and just enjoy our family," he said. The couple also have a daughter, Taylor, 2, and Kevin Buckles shares custody of son Kevin Jr., 11. Also waiting for the twins at home was grandmother Jean Buckles, in town from Louisiana.
"We don't know how to thank everyone for all they've done for our daughters," Melissa said. "It's given them the chance for a new life."
The final cost of the twins' care has not been tallied, but estimates range from $750,000 to $1 million. Their care is covered by Kevin Buckles's health insurance.
Although the surgical team initially thought the girls would face future reconstructive surgery, Hartman said that now looks unlikely.
The girls, however, will still require daily physical and occupational therapy to strengthen and retrain muscles affected by having been conjoined and to develop motor skills that were limited by their deformity.
"The stress of surgery and recovery usually causes some delays in milestones," Hartman said, noting that babies who undergo serious operations generally catch up developmentally by their first birthdays.
Jade and Erin were delivered by Caesarean section Feb. 26 at National Naval Medical Center in Bethesda. The Buckleses had known since an ultrasound during the 18th week of pregnancy that Melissa was carrying conjoined twins.
Fused as one, Jade and Erin had to ride to their medical appointments in a custom car bed. They learned to pluck the pacifier out of each other's mouth and sleep through one another's crying jags. Their parents would often find them sleeping hand in hand.
Even now, their mother said, Jade and Erin seem to recognize each other and retain some secret bond no surgery could change. Side by side in their crib, tiny fingers still sometimes reach out, grasping, until they join together again.