The mother had been in labor seven hours and because twins were expected, two doctors were in attendance, the family doctor and a local obstetrician. The delivery was difficult, the cord wound around one baby's head. When the baby at last was born, it was "bruised and blue," as a nurse would later say in court.
"Ventilate," the anesthesiologist said and the nurse, glancing up quickly, saw only one child. But the obstetrician, seeing what the nurse had not seen, quickly gave another order. "Don't reusciate, let's just cover the babies," she heard him say. The father, also a doctor, at his wife's side in the delivery room, seemed to agree. Seeing that his wife had just delivered Siamese twins -- joined at the waist with a deformed third leg -- he moved his hands, palms outward, across his chest. "Enough," the gesture said, "no more."
Later, according to a petition of neglect filed by the Illinois Department of Children and Family Services, the parents and the doctor would both ask that the boys be given no food or water and only "palliative" medical care. The orders, to some degree, were allowed. While the twins, at birth, weighed 9 pounds, 12 ounces, by the time family services stepped in and removed the children from the nursery's intensive care unit, the children were down to six pounds.
"They were lethargic, weak and passive," a family services caseworker testified in court. I saw their ribs sticking out -- which indicated to me that they had not been fed."
The parents and the Illinois Department of Children and Family Services are now locked in a custody battle over the children, the parents denying charges that they abused them and fighting to get them back. A hearing to determine whether the children were "neglected" is being held this week in the Vermilion County Courthouse. At the same time, a grand jury is investigating the case. Thirteen hospital personnel have been called and a decision on whether criminal charges will be returned, perhaps against the hospital, doctors or parents, is expected by the end of the week.
This is, however, no ordinary custody fight or criminal investigation, for it raises important questions about who should live and who should die. It takes the public behind the closed doors of the nursery intensive care unit, giving a rare glimpse of the secret decisions that are often made when severely deformed children are born.
The case is also complicated by a number of other factors: the father, Robert Mueller, happens to be a physician; the mother, Pamela Schopp Mueller, a registered nurse. Both the Muellers work in the hospital, the Lakeview Medical Center, where the twins were born. Dr. Mueller is an emergency room physician; Mrs. Mueller works in the surgical and general wards.
Besides that, Danville, a relentlessly flat city of 47,000 persons about 150 miles south of Chicago, is a place where most of the people knew who the parents of the twins were long before the Danville Commercial News published their names, knew it was Dr. Mueller, polite and soft-spoken with a beautiful ranch house and all the trees out back, and Pam Mueller, a slightly older woman, and that the birth was their first. It was not an anonymous tragedy, it is their tragedy. Maybe this sort of thing goes on all the time in the big cities, people said, but not here, not in Danville.
And of course, pending the outcome of the criminal investigation, there will be the larger questions. Is it more "abusive" to allow a deformed child to die or is it more cruel to allow such a child to live, perhaps to go through life as a joined twin, sharing, as in the case of the Danville twins, one lower body, with three legs and one intestinal tract.
And if both Siamese twins are in the same health, but only one would likely survive separation, who makes the decision which will live and which will die? It's a decision that is Solomonic, a question that perhaps no one can decide.
In the case of the Mueller twins, first identified in court papers only as twins A and B until their parents petitioned to give them names, the court first appointed one lawyer, Fred Underhill, to represent the children. But because, as Underhill explained, the twins' "interests could conflict," that is, one twin might have to be sacrificed to save the other, the court appointed a second lawyer, one for each twin. Underhill admits that the decisions that may have to be made are perplexing. "We're all kind of just guessing," he says.
Meanwhile, in the city of Danville, while there seems to be a certain amount of sympathy for the parents, there is also a feeling that there's going to be a hanging, at least in the figurative sense. Vermillion County State Attorney Edward Litak, forbidden by law from commenting on the criminal investigation, nonetheless makes his feelings on the case perfectly clear.
"The state of Illinois defines murder as the taking of a human life without justification, the only justification is self-defense," he says. "The quality of human life or the lack of it is not the issue. . . . Most terrible crimes are often committed for lofty ideals. . . . John Brown's raid was for lofty ideals. He wanted to free the slaves, but he hung for it, and quite properly."
Others in town, particularly nurses who saw Pam Mueller come into the nursery to pick up her babies, and have seen the extent of the twins' deformity, view this differently.
"They're horrible," one nurse says, describing the twins. "It's got three legs, one a half-foot with seven toes -- two legs are sticking out of one side, one on the other . . . I love children, but God forgive me, it should have died right there . . . and the mother comes in and holds them in her arms and cries and cries. . . . I've been in this business for 20 years, but it's the first time I've ever broke down. . . . This woman wasn't the type who would abuse children . . . this was the type who was dedicated to children."
The nurse said this only under the protection of anonymity, for fear runs very high in this case. Two key medical figures have already refused to testify at the custody hearing here this week and a number of nurses -- visibly unhappy to be taking the stand, have agreed to testify only with a waiver of immunity from criminal charges. (Even with such immunity, their licenses technically could still be lifted by the state medical board.)
The parents of the twins -- she a pale, plump woman with no make-up and a simple haircut; he taller, pale and soft-spoken -- have also maintained an extremely low profile.
Protected by three defense attorneys, they shrink back when reporters approach, refuse to allow even such information as their age or schooling to be given to the press.
In the small wood-paneled courtroom here, they sit holding hands, she with her back to the reporters. When the slides of her babies were shown Wednesday, with the expert from Children's Memorial Hospital in Chicago pointing out the withered third leg, the second, imcomplete set of genitals, she looked away from the slides, clutching her husband's hand, and putting her hand over her mouth, as if she was afraid she would cry out.
When this morning, her attorney, cross-examining a nurse, asked if Mrs. Mueller had ever told the nurse not to feed the infants or give them oxygen, she cried, openly, her tears falling over the defense table.
The nurse, also tearing, said no, she has never received orders from the mother that the children not be fed.
But she was prevented, by objections from the defense, from saying precisely what the orders of the attending physician had been. And she suggested, as did a number of other nurses, that the orders had in fact been not to feed the children, and that when the nurses did so, the feeding was often surreptitious. The babies were given only a mixture of sugar and water, sometimes on the end of a pacifier, and those feedings had not been entered -- as is normal -- on the children's charts.
The story of the Siamese twins, as it emerges from testimony of several Lakeview Medical Center nurses, and a state social worker is as follows:
Marian Seidler, a general staff nurse with 25 years' experience, told the court, before the parent's defense attorney could insist that her comments be struck from the record, as were most other nurses' comments about any doctor's orders, that the twins' physician had ordered "palliative care." She also said that she had questioned the doctor's orders, without divulging precisely what those orders were and that a number of nurses on the floor were unhappy.
"I talked to Dr. [Petra] Warren [the family doctor] and he told her that some of the girls were uncomfortable being on duty with the babies . . . that the situation was volatible, that maybe something should be done. . . ."
Yet another nurse testified that she had seen no one give the twins medication or oxygen. She also had an emotional description of the twins' mother.
On May 7, two days after the twins were born, the nurse testified, the day Mrs. Mueller went home, "she came into the nursery and she said she thought she might not see these twins again. She picked them up . . . a very difficult thing to do. . . .She had tears in her eyes . . . and she left. . . ."
On May 10, according to the nurse, Mrs. Mueller once again came to see her children.
"She said it was very hard not having babies at home," the nurse testified. "She said the house seemed so empty . . . she woke up in the morning expecting to hear babies crying and there were no babies. . . ."
Three days later, the Illinois Department of Children and Family Services received an anonymous telephone call that a pair of Siamese twins at Lakeview Medical was being neglected and abused. A social worker investigated. The next day the children were removed to Children's Memorial Hospital in Chicago, accompanied by their mother and Nancy Conrad, supervising nurse at the delivery. On May 15 Family Services filled its petition of neglect.
Now the twins remains in Chicago, the parents are in Danville, and the matter is finally being settled by the courts in hearings that continue Friday.
Shirley Sloop, a nurse at Lakeview, was the last witness to day. She testified that she twice fed the babies but didn't put it on the chart "because it was against doctor's orders." She also delivered the most damaging testimony of the day against Mrs. Mueller: "She said after seeing the X-rays, seeing that the twins shared a common pelvis, bowel and stomach, she was sure they were doing the right thing."