The puzzle was thousands of pieces, and it featured a hot air balloon, a slow, meandering river, and a small town. Jenni Ezell sat at a round table, fitting piece into piece. Two nurses stopped by and pitched in, and so did Jenni’s mother. A friend helped for the entire time, in silence.
Jenni sat for 10 hours. She didn’t want hugs. She didn’t want small talk. She wanted to see her sons. Minutes after finishing the puzzle, Jenni and her husband, Dave, got the call from the surgeon that their twins were headed to their rooms. Owen and Emmett—one at the beginning of the day—were now two.
•••
Jenni and Dave met in high school, in Russellville, Arkansas. Years later, after other relationships, they reunited and started a family of their own. Liam was born in May 2012, and six months later they learned they were pregnant again. By January they knew they were having twins, and on March 1, 2013, they visited an obstetrician near their home in Oklahoma. Liam and Ethan, Jenni’s 6-year-old from her first marriage, came along for the appointment; they were all supposed to learn the sexes of the babies.
When the ultrasound popped up on the screen, Jenni and Dave saw their twins, facing each other, smushed together, and moving as one. Jenni asked the nurse if she could tell if they were conjoined; she said she didn’t know. The doctor came into the room and told them what they already knew.
Dave was the rock; Jenni was the wreck. Dave was less confident than he appeared, however, and Jenni’s strength bore itself out over the next four months. But that day, Jenni sobbed in the doctor’s office in front of all four of her sons.
The obstetrician gave the twins little chance of survival. Dave wanted to go through with the pregnancy. Jenni thought about her distant cousin, who gave birth to conjoined twins and eventually lost one not too long after the separation surgery, because of the complications of having been conjoined. She thought about walking around, eight months pregnant, and putting on a happy face while explaining to people that she might lose both of her sons.
Seventeen and a half weeks in, the Ezells made an appointment to end Jenni’s pregnancy. The Oklahoma clinic wouldn’t perform the complicated abortion, so her obstetrician suggested one in Dallas. The Dallas clinic was worried about Jenni’s previous c-section scars (and the size of the boys) and sent her to Medical City Hospital.
At Medical City, they met with Dr. Joshua Weiss, a maternal and fetal medicine specialist. He looked at the twins, then to the Ezells. He gave them a chance, telling them that the twins were good candidates for separation.
“He gave us the tiniest glimmer of hope, and that was all we needed,” Jenni says. “After that we never even considered going through with it.”
The Ezells moved on to Dr. Tom Renard, a pediatric surgeon. His group had performed 12 separation surgeries and had trained under one of the country’s leading separation surgeons. I’m all about preserving life, he told them. They might be born, and then they die, he said. One might live, and one might die. We might have to salvage body parts from one baby to save the other baby, he said. But let’s give them a chance.
At another visit, he asked them to pray. They prayed for safety and strength. They prayed that God would guide Renard’s hands, and that God would give the Ezells peace. But first, they had to wait.
•••
While Owen and Emmett were growing and flipping and spending their days 6 inches from each others’ faces, Renard and the hospital staff were preparing.
The twins were fused at the liver and also shared parts of their intestines and bile ducts. An omphalocele held the intestines and liver outside the boys’ bodies, and sat like a pouch between the two of them. Both organs were visible through the transparent lining.
On July 15, 2013, the twins were delivered. Within 90 seconds, they were transferred from the delivery room to the NICU, where they’d spend the first months of their lives. Jenni was sent to a recovery room, but Dave bulled his way into the NICU. His desktop computer image, still, is that first photo he took of his sons, covered in amniotic fluid and surrounded by nurses and doctors.
“I wasn’t thinking about the fact that they were conjoined. I was thinking about the fact that I was having two sons,” he says. “I wasn’t even processing that there was some abnormal condition until later, when I got to thinking about it. Day One I was just, ‘Look at my babies. They’re beautiful, man. It’s awesome.’ ”
Dave captured one short video, too, of the boys crying. Because of the various breathing tubes the boys have had since birth, it’s the only vocal sound Jenni and Dave have ever heard their boys make.
A day later, they named their sons. Emmett is from German, for powerful. Owen is Celtic, for young fighter. Collectively they weighed in at 11 pounds, 15 ounces; Emmett carried about seven of those. Owen weighed less than five pounds.
Emmett’s strength would show itself in the six weeks between their birth and the separation surgery. Too much blood flowed to Emmett, causing his heart to grow quickly; too little blood made its way to Owen, whose kidneys were not functioning properly. Separation surgeries usually take place six months to a year after birth. But Renard knew the Ezell twins—or at least Owen—wouldn’t make it that long.
He set the date: August 24, 2013, 40 days after their birth.
•••
Ketchup and mustard. Ketchup, red, Owen. Mustard, yellow, Emmett. After the delivery, nurses put red tape on all of Owen’s tubes, and yellow on all of Emmett’s. They flipped the babies every three hours for 40 days, like clockwork, and the ketchup and mustard system was the easiest way to tell them apart. Before the twins headed into surgery, a nurse painted their fingers and toes red and yellow for the same reason.
While Owen and Emmett were growing and flipping and spending their days 6 inches from each others’ faces, Renard and the rest of the hospital staff were preparing. The usual six months or a year had been slashed dramatically. Groups of 30 or 40 hospital staffers would meet at a time, throwing out any and all ideas. Let’s paint their fingernails. Okay. Let’s set up cameras in the staff lounge so doctors and nurses know when to enter the operating room. Perfect.
“I told everyone in the meetings, ‘If you have an idea, I want to hear it. No idea is too small. No one’s going to be ridiculed,’ ” Renard says. “I wanted everyone to have input. I didn’t want anyone in the background later saying, ‘They should’ve done this. I knew this was going to happen.’ ”
•••
Renard and the rest of the staff practiced the choreography of the surgery with dolls and laid out the operating room: tables over here, lights over here, extra power over here. One bed would become two beds, one staging machine would become two. Two separate anesthesia regimens.
While Renard (and an army of nurses, pulmonologists, neonatologists, gastrointestinal specialists, therapists, anesthesiologists, and a bevy of others) planned the surgery, Jenni would take three pictures every day. One of Owen, one of Emmett, and one of them together. She still has every picture of them together.
The night before the surgery, Jenni and Dave tried to sleep but only managed two or three hours of fitful rest. At the same time, Renard was preparing a list of things to pray for:
Our egos will be on the floor. We will function together as a highly functional team. Everything we do will be for the kids. There will be no distractions in the OR. Each of us will be at the top of our game.
Then he went to sleep and woke up for work.
•••
While Jenni worked on the puzzle, Dave walked the halls of the hospital. His family arrived and sang songs, hoping to distract him from his two boys upstairs.
Renard and his team were in the middle of a 10-hour surgery, one that went better than anyone could’ve imagined. The liver and bile ducts and intestines separated cleanly, and the reconstruction went well. Once the separation was complete, the operating room exploded in cheers. Ten hours after they started, Renard went downstairs and told the Ezells they had two boys.
After the surgery, the neonatologist, Dr. Clair Schwendeman, made one order: take off the nail polish. The polish came off, and the nurses slipped on fresh pairs of Batman socks. It was the first time the Ezells saw their sons in separate beds. They still couldn’t touch them—like preemies, their heart rates would spike—but they could move from bed to bed. Jenni was allowed to hold Owen once on September 3, a week and a half after the surgery, but had to wait until September 15 to hold Emmett. Dave couldn’t hold them until mid-November.
“We always thought about one outcome: two babies,” Jenni says. “We’re going to be able to feel two babies’ heads. We’re going to be able to comfort two babies. We really didn’t even dwell on the possibility of losing them. The doctors would tell us about that possibility, and it was like telling it to a brick wall.”
•••
The twins spent the next 10 months at Medical City and a rehab facility before heading home, in June. Once there, Jenni rocked Emmett in the same chair she used to rock Ethan and Liam. She couldn’t see him through her tears.
Nurses rotate through the Grand Prairie house on 12-hour shifts, one for each twin. One of their two living rooms is a makeshift nursery, with two cribs tucked tightly together near a front window. On a recent day in August, Owen sat watching the Disney version of Robin Hood and clapping to the songs. Emmett sat 30 miles away, back at Medical City for a minor infection.
Emmett is the smiler, using his mouth to express himself. Owen, the young fighter, is more expressive with his eyes, opening them wide as Robin Hood leaps onto the screen. Both still have feeding and drainage tubes because of intestinal issues. Doctors think the two will be normal by the time they’re 5, Jenni says, and both are likely to have their trach tubes removed next year.
Once they’re removed, the Ezells will have to deal with the one thing they haven’t yet: crying.
