Identical twins, 1974 - 2003.

The Bijani sisters were born in Tehran, Iran to a poor family which already had 11 other children. Ladan and Laleh were joined at the head (craniopagus twins), a disorder seen in only one out of two million births.

Identical twinning is poorly understood. It is believed to result when the fertilized ovum divides into two separate blastula during early development; conjoined twins, a rarity, are believe to result when this separation is almost, but not quite, complete.

Because of the poverty of their birth family, Ladan and Laleh were raised by doctors, in medical facilities, from birth. They proved to be attractive and talented young women, and both earned law degrees.

The Bijani twins, however, wished to lead separate lives. Ladan was interested in pursuing her law career; Laleh wanted to be a journalist. No one who has not been in this situation can possibly comprehend the difficulties of such forced intimacy.

The twins applied to a medical center in Germany for an operation to separate them, and were refused. Surgery to separate twins conjoined at the head has been performed for some time on infants (with mixed results) but the brains of infants are much more apt to heal than the brains of adults; further, although the brains of Ladan and Laleh were not believed to be conjoined, they shared a large vein which drained blood from both brains, a vein for which a duplicate would have to be grafted in for one twin.

The Bijanis' operation was considered elective because the women likely would live a normal life span without it. However, testing showed the sisters had high intracranial pressure, which, if untreated, could cause frequent debilitating migraines and impaired vision as well as deteriorating brain function. The twins were already suffering from severe headaches. (Was this surgery "elective"? That sounds like surgery for an ingrown toenail. Were these women to live their lives thus unnaturally joined? Were they expected to endure the increasing headaches?)

The Iranian government pledged to cover the cost of the surgery.

Ladan and Laleh were determined, and finally persuaded doctors in at Singapore's Raffles Hospital to perform the operation.

The operation was projected to last some 48 hours, with teams of famous surgeons from all over the world to be involved. The surgery began July 7, 2003.

The bone joining the two heads proved unexpectedly thick, and penetrating that barrier was unexpectedly difficult. The next difficulty was the shared vein. A substitute from the thigh of one sister was grafted in. While that procedure was apparently successful, doctors said the Bijanis' brains were more closely fused than they had expected.

As surgeons toiled to separate the many tiny blood vessels which connected the sisters' brains, however, the twins began to lose blood pressure. By 1:30 p.m. July 8, 2003, local time, doctors had managed to separate them, according to local news reports. Energetic efforts were made to maintain the blood pressure and blood supply of both twins. But Ladan died an hour later. At 4 p.m., Laleh was also pronounced dead.

It makes me want to cry. I'm crying now, as I write this.

The loss of these talented and courageous young women raises a number of ethical questions. The Bijanis were well aware that the operation might result in brain damage or death for either or both of them. One can only try to imagine the agonizing decision-making process between these two young women. (What conversations happened between these two in the night, when there was no one else to hear? Dare we imagine them?) Were the doctors involved motivated by a respect for the self-determination of the patients, or by a desire for fame? Were their motives, as seems probable, mixed? Were these two young women bound together by love, or by hatred, or by both?

Rest in peace, Ladan Bijani.

Rest in peace, Laleh Bijani.

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