Conjoined Sisters Teach Next Generation of University of Minnesota Medical Professionals

The day always begins with a new patient. As a first year pediatric resident, sometimes Timothy Rauschke hears about his cases the day of, when he shows up to work at the University of Minnesota Masonic Children’s Hospital. Others, it’s through an email the night before. Regardless of how he hears, what he is called upon to help with as part the kidney consult service usually isn’t too surprising.

There’s one email, however, that sticks out for Rauschke. It wasn’t the email itself, but rather the once-in-a-lifetime experience that followed.

In February of 2017, Rauschke received an email from Christian Hanna, MD, MS, Assistant Professor of Pediatric Nephrology at the University of Minnesota, which informed Rauschke he was going to be consulting on conjoined twins in the NICU.

“I remember thinking, oh, okay, that sounds great,” remembered Rauschke. “It didn’t really strike me until the next morning that this is something special, something different than we normally do every day.”

February 10, 2017, Paisleigh and Paislyn Martinez were born at University of Minnesota Masonic Children’s Hospital. The girls were thoraco-omphalopagus conjoined twins, connected from the breastbone to the pelvis. Their hearts were connected by a small “bridge,” and their livers were fused in the middle, though they each had their own organs. Complicating matters even further, the care team determined that one of the girls, Paislyn, had a serious heart condition called tricuspid atresia with transposition of the great vessels and a ventricular septal defect.

Hanna and his team were called in to help after experts discovered Paislyn’s heart condition was affecting her kidneys.

“They first contacted me when they realized Paislyn wasn’t urinating,” explained Hanna.

Soon, Hanna and his team noticed something fascinating- Paislyn started to maintain a normal fluid balance, normal serum electrolytes and normal kidney function, because Paisleigh’s kidneys were doing the work for her sister.

“Because of the vascular connection, Baby A’s (Paisleigh’s) kidneys were helping Baby B (Paislyn),” Hanna further explained. “Baby A was acting as a dialysis machine for her sister.”

Hanna and his team were able to handle the unexpected, partially because of weekly meetings they took part in, which included experts spanning multiple specialties throughout the hospital. Rauschke was a part of those meetings.

“One of the things I learned from the conferences with the care team is when to seek the consensus and advice of others,” said Rauschke.

Rauschke pointed out they were all learning together. There wasn’t always a text book answer, and whether veteran or resident, the ability to think on one’s feet and apply and adapt your current knowledge to uncharted territory was invaluable.

“We had to come out of our silos and literally and figuratively get everyone in the same room at the same time,” said Rauschke. “I’ve seen it happen before but never to this degree.”

Weekly meetings weren’t just for the medical staff in this case. The girls’ family was also included.

“Meeting with the family on a weekly basis, and talking to them about the unknown, was challenging” remembered Hanna. “But speaking with them in an honest and sincere way about what could happen has helped with a new aspect of communication with these families, going forward.”

“The biggest blessing to me, is being able to help take care of kids like this, where the families are rallying around them,” said Rauschke.

Rauschke is grateful for so much when it comes to being a part of Paislyn and Paisleigh’s journey, but more than anything he’s grateful for what they taught him.

“We may be able to teach the patients something but really this is a perfect example of how the patients and family teach us - not just medically, but in terms of resiliency.”

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