Mason, a cheerful and patient 8-month-old, burst into tears in his sleep one morning this week. For two hours, he could not be consoled. Perhaps it was a very bad baby dream.
Or perhaps, his father wondered, it had something to do with Bradley, Mason's identical twin brother.
While Mason cried Tuesday morning at home, Bradley lay on an operating table at Children's Hospital National Medical Center in Northwest Washington.
Bradley was undergoing surgery for the sixth time since birth, when doctors discovered a rare collection of abnormalities in his body. His esophagus stopped at a dead end and did not connect to his stomach, and his stomach and trachea were connected through an abnormal passage.
Later, doctors found something rarer still: The wall of tissue that is supposed to separate the trachea and esophagus near the larynx and keep food and air from going down the wrong pipe was malformed into an opening or cleft. Instead of a wall, the tissues hung like a curtain.
For Bradley, getting that curtain closed meant breathing, swallowing, eating, even talking normally. It meant an end to his moment-to-moment struggle against choking or asphyxiation. It meant he would cry normally, not like a puppy with a high-pitched whimper.
The curtain was a problem, but it was also the solution. Tuesday, during six hours of tedious surgery through a half-dollar-size opening in Bradley's neck, Dr. Kurt Newman stitched the tissues together and created a wall, thus ending Bradley's eight-month struggle to breathe.
Newman, a pediatric surgeon, put it this way: "He's doing perfect . . . . This was very successful from a surgical, anatomic, creating-the-wall point of view. It couldn't have gone better. The acid test, frankly, is when down the line we see if it works.
"I think it will take months to teach him the tasks that other children have already learned" such as swallowing, vocalizing and breathing, Newman said.
Bradley was in satisfactory condition yesterday, breathing through a tracheal tube connected to a ventilator machine and being fed intravenously.
"We're really happy, I mean he looks pink," said Bradley's mother. "When he had the curtains hanging down, his breathing was always so noisy. He's not noisy anymore."
Bradley's mother, 38 and a writer, and his father, 55, a publishing consultant, requested anonymity but said they hoped others would be helped by learning about Bradley's problems.
There have been only 10 documented cases in the world of combinations of tracheal, esophageal and laryngeal abnormalities such as Bradley's, said Newman, who researched the case extensively. Its cause is not known.
Bradley and Mason were delivered by Cesarean section on March 18, a month prematurely, at Sibley Memorial Hospital. Bradley, the second born, weighed 4 pounds, 12 ounces. Mason weighed 5 pounds, 10 ounces. Almost immediately after their birth, Dr. Christopher Hultzen, the neonatologist who delivered the twins, detected a problem in Bradley's esophagus.
An X-ray confirmed it. Bradley's esophagus ended in a blind pouch. What should have been the lower end of the esophagus had developed into a fistula, or abnormal passage, that was connected to his trachea or windpipe.
Before his mother even saw him, Bradley was transferred to Children's Hospital for surgery and was on the operating table for four hours. Newman opened up the esophagus and joined it to the stomach through the fistula. He severed the fistula from the windpipe. Thus came the end of a condition called "esophageal atresia and tracheoesophageal fistula."
The surgery appeared successful, but a feeding and simultaneous X-ray would be the test.
"The X-ray showed something abnormal," Newman says. "We gave him something to swallow and it would shoot across into his windpipe. This presented a problem."
It was a cleft, or opening, near the larynx, in the wall that separates the esophagus from the trachea. Newman and Dr. Gregory Milmoe performed a bronchoscopy, inserting tiny scopes into Bradley's neck, on April 13 to confirm what the X-ray showed. There it was: a one-inch cleft.
Newman consulted doctors from Massachusetts to Louisiana, and Ohio to Switzerland. There would be more surgery, to repair the laryngeal cleft, but Bradley was too young, and too weak to stand it.
"We wanted to beef him up and get him older," Newman said.
Before Bradley went home from the hospital, Newman wrapped the upper portion of Bradley's stomach around his esophagus to pinch off the canal and prevent stomach acids from traveling up and possibly through the cleft and into the windpipe. Then he inserted a feeding tube into the baby's stomach.
Bradley was ready to go home shortly after the surgery, equipped with monitors, tubes, even special arrangements for helicopter transport to the hospital in case of emergency. Someone had to be with Bradley all the time, or at least within hearing distance of his monitor.
Although he was being fed through a tube, Bradley continued to have swallowing reflexes, which would make him think he was about to choke and would make his breathing labored, which would send Kitri, the dog, running for help even before Bradley's heart monitor would sound off an alarm.
On June 26, he was back at the hospital for surgery for a double hernia and an undescended testicle. On Oct. 20, Newman performed another bronchoscopy and confirmed that the cleft had not closed on its own.
The time for surgery to correct the cleft was near. Newman and his team -- Kathryn Anderson, acting chief of surgery, Milmoe, an ear-nose-and-throat specialist, chief surgical resident Tom Rouse, anesthesiologist Ram Patel and operating room nurse Louise Wilson -- began planning their strategy.
Tuesday, at 8 a.m., Bradley's 21-pound body was hooked up to so many monitors that he looked like an old-fashioned telephone switchboard, his mother said.
The first part of surgery was a tracheotomy in which Newman cut a hole in Bradley's trachea and inserted a tube connected to a ventilator. A relatively simple procedure, Newman said.
Then came the moment of truth. Newman cut through Bradley's neck, aiming toward his pharynx at the back and bottom of his mouth, taking care not to damage the tiny nerves such as those that control the vocal cords.
When he finally had the cleft in sight, he was relieved to find there were no surprises: The cleft was just as it appeared on the X-rays, and the curtain of tissue would indeed be enough to close it.
"There was almost a sense of jubilation among us," he said.
With 20 tiny stitches, Newman connected the hanging tissue. As they heal, the tissues will grow together.
It is expected that Bradley now will develop normally and catch up with other children his age. He will learn how to breathe on his own, how to swallow, how to tell what tastes good or bad. He will live a normal life, his parents hope, with "lots of scars for show-and-tell at school," his father said.
Surgery at birth corrected the problem, but doctors then discovered a more rare abnormality called "laryngeal cleft," at right. The wall of tissue that separates the esophagus from the trachea had a cleft or opening in it near the larynx. Tuesday, surgeaons at Children's Hospital National Medical Center closed the cleft by stiching a curtain of tissue together.