"Come here, Captain!"
shouts Marcos Troast to the black lab chasing
the tennis ball his brother, Geremias, has just
thrown. The 13-year-old twin boys run through
the lush green grass and follow the dog down
to the ocean’s edge. There, they grow distracted
by crabs and snails in the shallow tide pools
until Captain licks Marcos’s face and the game
of fetch resumes.
joined from their chests to their bottoms, the
Troast twins are now happy, active seventh graders.
staff surgeon at Children’s Hospital Boston,
watches the boys play in her back yard overlooking
Quincy Bay, while talking to their adoptive
parents, Nancy and Rich. "They’ve grown
up so much," she says and smiles. Buchmiller
met the Troasts 13 years ago, when she helped
change the twins’ lives. She’d just started
as Children’s chief surgical resident under
Hardy Hendren, MD, who was
chief of surgery. Nancy had called Hendren seeking
his expertise for the boys’ unique problem:
They were extensively joined from their chest
to their bottoms - they were what’s commonly
known as "Siamese twins."
boys were from the mountains of Guatemala and
had been found by Children of the Americas,
a non-profit organization that provides medical
care to under-privileged children throughout
the world. They were born in a rural hospital
in Huehuetenango and because of their condition,
would need more intensive care than any hospital
in their country could provide.
group tracked down Nancy and Rich Troast at
their home in New Jersey through an affiliate
organization called Healing the Children. While
the couple had five children of their own, they
regularly took in children from other countries
who needed a place to stay while undergoing
medical procedures in the United States. When
the group called Nancy about Marcos and Geremias,
she couldn’t refuse. "I knew it would be
a challenge, but I really wanted to help these
boys," she says. So the Troasts took them
in when they were 3 months old and quickly began
to think of them as their own.
twins seldom survive without serious complications
and health problems, so the boys’ best chance
at living long lives was to be separated. But
they would need a surgeon with incredible skill
and experience. A local doctor recommended Hendren,
a renowned surgeon who completed Boston’s first
conjoined twin separation in 1969 and 14 successful
separations during his 55-year career.
June of 1996, Nancy arrived with the twins at
Logan airport. Hendren couldn’t imagine how
she’d manage with the twins and their luggage,
so he and his assistant met them and brought
them to the hospital. The boys spent the next
several days having X-rays, anesthesia evaluations
and other tests before the complicated operation.
in a grueling 23-hour surgery, Hendren, who
was 70 at the time, Buchmiller, and the surgical
team carefully separated the boys - who shared
their livers and colon. "Separating the
boys was amazing and required so much forethought
and planning," Buchmiller says. "It
was my first time working with such an elaborate
team." The twins emerged as two babies
all their own limbs and organs.
Hendren and Buchmiller, on left, with the Troast
Nancy stayed with the boys at
Children’s for four months while they recovered.
During this difficult time, she frequently turned
to Buchmiller. "She was so approachable
and answered our endless questions," says
Nancy. "She’d let us call her at any time
to get advice, for counseling and to quell our
As Nancy recalls the beginning
of their long friendship, Buchmiller laughs
and says it was all just part of being a surgical
resident. "I was there every day and night
and hardly slept," she says. "What
did it matter if they called in the middle of
the night?" Yet even today, Buchmiller
has maintained a close relationship with the
Troasts, who officially adopted the twins shortly
after their separation. While Buchmiller is
no longer their doctor, she continues to be
their consultant, advisor and friend. "I
spent so much time with them that I really got
to know them and build a tight bond and relationship,"
Even though the Troasts lived
in New Jersey, they returned to Children’s many
times over the years for the twins’ ensuing
surgeries, including hip surgery by orthopedic
surgeon John Emans, MD, and
urological procedures with Hendren. "We
trusted Children’s and were attached to the
doctors," Nancy says.
Geremias and Marcos are now
healthy adolescent boys and have transitioned
to local New Jersey doctors. But the Troasts
never let distance keep them from staying close
to Buchmiller over the years. In 2000, when
she left Children’s for a position at Cornell,
the Troasts went to visit Buchmiller there.
And she’s visited them at their home in New
Jersey; in the fall, she brought the boys pumpkins
for Halloween. "There’s a special place
in my heart for the Troasts," she says.
"The family’s commitment to the boys is
Since Buchmiller returned to
Children’s in 2004, the Troasts visit her whenever
they can. The boys jump at the chance to play
with her dog, Captain, or head out on a boat
ride from her home. And of course, they still
call her at any hour. "I pick her brain
all the time," Nancy says. "I trust
her judgement and recommendations."
As Nancy watches the boys chase
Captain, she wonders what their future holds.
They are spitting images of each other, except
Marcos is slightly taller. They’re small for
their age, but their faces show hints of the
young men they are becoming. They have distinct
personalities, but they’re incredibly close
and do most of their activities together, including
year, they’re starting 7th grade. "They’re
becoming more independent all the time,"
Nancy says and watches them run out of sight
to the water’s edge. Because they have slight
language-based learning disabilities, she’s
considering enrolling them in a specialized
high school, perhaps one in which they can embrace
their love for animals.
Geremias and Marcos laugh as
Captain roles over and begs for a treat, which
they readily toss to him. "It’s amazing
to see how far they’ve come," says Buchmiller.
Soon, Hendren and his wife, Eleanor, arrive
at Buchmiller’s house and walk out to see the
boys he separated all those years ago. "I
see a lot of patients that I’ve taken care of,"
Hendren says. "It’s a special privilege
to have people want to come back to see their
surgeons and for us to see them living such
normal lives." He asks the boys if they
remember him. They smile sheepishly, shrug and
then run off to
the dog again.
Nancy certainly remembers. "I have such
an absolute appreciation for Children’s for
everything they have done for the boys,"
Nancy says. "When we visit, it’s like coming
Kerr’s second trip to Children’s Hospital Boston’s
Extracorporeal Membrane Oxygenation (ECMO) program,
which turns 25 this year, was as a video intern
for the Critical Care Division. But her first
visit to ECMO came almost immediately after
she was born, 19 years earlier. "My mother
still hadn’t started labor on her due date,”
says Lauren. “During a check-up, the doctors
saw signs coming from me that they didn’t like."
Her mother was rushed by ambulance to a hospital
in nearby Portland, Maine for an emergency c-section.
It turned out that Lauren wasn’t breathing due
to meconium aspiration syndrome, a condition
in which a baby’s intestinal waste leaks into
the amniotic fluid. This could, in turn, obstruct
her airway and cause inflammation of her lungs.
Chance Reunion: Jay Wilson, MD and Lauren Kerr.
Lauren spent three days receiving
ECMO, getting oxygen therapy to clear the contamination
from her lungs, allowing her to breathe normally.
A week later, she was healthy enough to go home,
only needing to come back every three months.
These check-ups stopped when Lauren was 3, and
she didn’t think much about Children’s over
the years. "I think I came to one of the
annual ECMO reunions, but I only remember it
from the pictures my mom took," she recalls.
"We used to get the invitations, but we’ve
moved since then, so eventually the mail from
Children’s stopped finding us."
That changed in 2008 when Lauren
was preparing to start her freshman year at
Colby College. "Out of the blue, we got
another invitation to an ECMO reunion, just
as I was leaving for school," she says.
Lauren’s mother sent an RSVP to Nancy
Craig, RRT, supervisor for the Children’s
Respiratory Care Unit. Craig remembered working
on Lauren’s case in 1990, and began an email
correspondence with her mother to see how Lauren
"My mom asked Nancy if
she knew of any internships at Children’s,"
Lauren says. Craig recommended that Lauren write
a letter introducing herself to Traci Wolbrink,
MD, clinical fellow in the Critical Care Division,
who is working on a video project called PICU
Without Walls. The videos present hands-on demonstrations
of general critical care procedures by Children’s
nurses, therapists and doctors. The curriculum,
developed for use in developing countries, is
tested at National Pediatric Hospital in Phnom
Penh, Cambodia. The goal is to distribute them
to providers around the world at no charge.
Lauren has spent the last few
months filming and editing these videos, covering
topics like asthma and pharmacology. She’s also
worked on dubbing them into other languages,
beginning with French. "I actually speak
some French, so I’m lucky that was the language
we started with," she says.
One of the highlights of Lauren’s
return to Children’s came when Wolbrink asked
her if she wanted to revisit the ECMO Program.
"It was humbling, and more than a little
mind-blowing," she says. "There was
a baby in ECMO who was born healthy, but contracted
H1N1. And while I was visiting, Dr. Wolbrink
paged a doctor from surgery, who she thought
might have worked on my case." That doctor
turned out to be Jay Wilson, MD,
director of Surgical Critical Care, and director
of ECMO since 1989. "I certainly remember
working on Lauren’s case," says Wilson,
who was the doctor who most likely inserted
Lauren’s catheter when she was a newborn. During
their reunion, Wilson took the opportunity to
check that Lauren’s scar had healed well during
the last two decades. "I'm starting to
hear from a lot of these kids as they grow up,"
"The whole experience has
been fascinating," says Lauren, who returned
to Colby in September. She’s now a sophomore
and International Studies major, but her work
with Wolbrink seems to have sparked other interests.
"I've always loved film, but this has been
my first experience in actually making it,"
she says. "It’s been a cool learning experience."
Lauren is also grateful to have had the chance
to revisit her past at the ECMO Program. "I
don’t know how many babies have been saved by
ECMO in 25 years, but I’m glad to be one of
the ones who got to come back and say thank