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Twins Stacey Ruby, RN (left), and Tracey Greenwood, RN, are part of the nursing team that is helping twins Ahmed (left) and Mohamed recover from surgery that separated the formerly conjoined brothers.

Robin McCune saw two little boys in her dreams, lying side by side in a bed. So did Tracey Greenwood. Janet Doggett said two of her co-workers told her of visions of the same toddlers sitting up, playing together in the sand.

“I know we’re not supposed to become attached to our patients,” said Doggett, RN, “but these little guys wrap their fists around your heart and they don’t let go.”

Last summer, all three nurses at Medical City at Dallas Hospital were under the spell of a special pair of patients. Two-year-old conjoined twins Ahmed and Mohamed Ibrahim smiled, played and laughed their way into the nurses’ spirits during the 17 months they spent at two Dallas hospitals.

Ahmed and Mohamed realized nothing unique about being craniopagus twins joined at the crown of their skulls. They also knew nothing of life outside hospitals or one void of the extended family of nurses who happily played exciting games of patty-cake and “So Big.”

Nurses were as ingrained as family. Their connection with the boys is what made October so anxious and frightening for the 20 or more nurses at Medical City and the on-campus affiliated North Texas Hospital for Children (NTHC) that took part in some aspect of the twins’ care. As the date for their high-risk separation surgery neared, the shared image of Mohamed and Ahmed—standing apart and looking into each other’s eyes for the first time—was rampant.

“The chances of them surviving this were so slim, and we were so worried and concerned,” said McCune, RN, the pediatric nursing supervisor at NTHC. “And I told Tracey [Greenwood], ‘Don’t think I’m weird, but I had a dream that I walked into the boys’ room and they were separate and they were in the same bed.’ And she said, ‘I had the same dream.’ It was the weirdest thing.”

Two of a kind

It doesn’t take an imagination to see the boys sitting apart these days. But until a few months after their historic separation surgery, it required a security clearance.

With intense media interest in the twins still at a fevered pitch, visitor access to the boys’ ward was restricted to family and a select group of approved hospital personnel.

Among the few to regularly see the twins were Greenwood, RN, and Stacey Ruby, RN, staff nurses at NTHC who came to treasure their unimpeded quality time with their “little guys.” Greenwood is the boys’ favorite playmate for So Big, a game in which she asks, “How big is Mohamed?” or “How big is Ahmed?” It wasn’t long before the sight of Greenwood entering their room prompted Mohamed and Ahmed to instinctively raise their arms.

They don’t do it when Ruby walks into the room, which proves to the nurses just how observant the boys are. Ruby happens to be Greenwood’s own identical twin. While most consider them dead ringers, the boys know Ruby is the “Patty-cake” and “Old MacDonald” sing-along nurse.

“They are normal little boys, and we’ve seen how their personalities have grown after the surgery,” Ruby said. “Separate little personalities that you just didn’t get to see when they were conjoined. That’s really cool.”

In Mohamed, the nurses already spy a fun-loving, mischievous streak. He loves to reach for pagers and cell phones, and tries to get away with usual 2-year-old antics. After being scolded to “be nice” after striking Ahmed, Mohamed quickly learned to start rubbing his cheek and saying “nice” to show he’s learned his lesson.

He’s also a charmer. McCune said Mohamed once grabbed her hand in the hallway, pulled it to his lips and kissed it like a perfect gentleman. “He just smiled,” McCune said, with a laugh.

Ahmed, the nurses said, is more reserved and less bold. He is also, thus far, slightly behind his brother in their rehabilitation efforts. Mohamed is gaining strength and learning to walk, while therapists are still working with Ahmed to strengthen his neck muscles to hold his head straight. Both have years of rehabilitative work ahead, to strengthen muscles that they didn’t use while together. They also face more surgeries, including reconstructive surgery in the spring.

Mohamed has adopted a protective affection for Ahmed, keeping a guarded watch over his brother. They suspect some of it may be in self-interest, the nurses admit.

“If you’re doing something to help Ahmed, like putting down an empty tube or doing something that hurts and upsets him, Mohamed won’t cry ... because he doesn’t want you to do that to him,” Ruby said, with a laugh.