Possum and Nugget were the names Chris and Sarah gave their identical twins in a moment of crisis.
The news that they were having twins came as a shock, especially identical twins, but they were excited about the lovely chaos that twins would bring. Their daughter, Claudia, was looking forward to the birth of her siblings, but she did not know what ‘double trouble’ meant just yet!
When Sarah and Chris welcomed their identical twin girls into the world, they were known only as Twin 1 and Twin 2. They had assumed they had many more weeks to choose names.
Sarah went into labour at just 26 weeks (14 weeks early). To the untrained eye, she presented as a calm expectant mother – but I had seen the look she had before. That look of fear and dread, buried deep away from worried family, is only visible to those who have seen it before. It is a look seen in the eyes of many parents going through the hell of extremely pre-term birth.
We set up the delivery suite in preparation for two extremely premature babies. After birth, the twins were very sick and needed immediate stabilisation. Chris and Sarah only got a brief cuddle before they were whisked away to the Royal Darwin Hospital Neonatal Intensive Care Unit (NICU).
They were very unstable in those first 48 hours. Chris and Sarah would not leave their bedsides, watching with determined horror as the medical team worked on their precious baby girls. They were too sick for their parents to hold. All they could do was watch and hope that their daughters’ vital signs flashing on the monitors conveyed good news and not bad.
Twin 1 started to turn the corner after about day three. She came off the ventilator and was able to breathe with minimal assistance. She was stable. The medical team’s attention was more focused on her sister.
The twins had twin-twin transfusion syndrome, a life-threatening complication of identical twins who share a placenta. One twin, the donor, becomes anaemic due to a lack of blood flow, and the other twin, the recipient, can go into heart failure due to too much blood flow. Babies with this condition are often born early and have a high mortality rate, particularly for the recipient twin.
Twin 2 was the recipient twin. She was very unstable after birth, bleeding from her lungs and then into her brain. The team worked hard to stop her bleeding, but it was not enough. Most babies with severe brain haemorrhaging do not survive, and the ones that do survive are often severely disabled.
As the hours passed when Twin 2 did not show signs of improvement, one of the medical team kindly suggested it may be time to name her. They called Twin 2 Audrey, and her parents refused to give up, with Chris eventually telling us, ‘She was a tough little Nugget.’
With Twin 1 stable, Sarah and Chris quickly decided she was to be referred to as Possum until they could find a ‘proper name’. The following day, Possum was formally named Constance. Chris and Sarah were determined to take both twins home, no matter what the future held.
Nugget had a stormy course through the NICU, with multiple neurosurgical procedures in Darwin and then medical transport to Brisbane for further neurosurgery. The family were briefly separated across two states, as Possum was too unwell to leave the NICU in Darwin when Nugget had to go to Brisbane. The family were reunited in Brisbane a week later when Possum was transported to Brisbane to be with her sister.
I remember how strong Chris and Sarah’s relationship was over those difficult days, which stretched into weeks, and then months. The kind of stress they were under was unimaginable, but they held fast and supported not only each other, but also the medical team caring for their babies.
Sarah and Chris were eventually able to take both girls home 4 months after that harrowing day in November.
They are now 14 months old. They have had some challenges along the way but are going from strength to strength. Constance (AKA Possum) is happy, healthy, and very cheeky. She is almost walking and is causing her older sister grief. Despite being on home oxygen for a few months, she has had minimal problems with her lungs and is developing normally.
Audrey (AKA Nugget) is determined not to be left behind. She is crawling and starting to talk. She has poor vision but is able to see well enough to steal toys from her sisters! Her parents feel that her vision is improving every day. She has defied the odds and has almost normal development, despite the severity of her brain haemorrhage.
I learn so much from my patients and their families. Chris and Sarah have taught me never to give up hope because miracles can happen; we just need to give them a chance.
The Humpty Dumpty Foundation donated the majority of the sophisticated equipment used by the staff at the Royal Darwin Hospital NICU to save Constance and Audrey's lives. Without the generosity of the donors to the Humpty Dumpty Foundation, we would not be able to make these miracles happen.
By Dr Louise Woodward
Paediatrician and Director of Neonatal Transport, Royal Darwin Hospital