Kim Serraro's job is to help sick kids cope with the stress of hospitals. Among her most fragile charges are Carl and Clarence Aguirre, 2-year-old boys from the Philippines connected at the tops of their heads.
To comfort and keep them busy, she's given them hand mirrors so they can see each other's faces and dolls with Velcro patches on their heads that can be pulled apart -- to help the boys prepare for their own separation.
But sometimes they just need a few bubbles blown at them.
On the night before their most recent surgery, Carl and Clarence were cranky and impatient for dinner. Serraro pulled out a green bottle of liquid soap and softly blew bubbles over the bed. The boys watched, entranced, then started reaching and giggling.
"What they really need is what we call distraction play, and bubbles are a good distraction," said Serraro. "It helps them cope with pain and discomfort by getting their minds off it."
Serraro is one of a half-dozen child-life specialists at the Children's Hospital at Montefiore Medical Center in the Bronx. These specialists care for children with a range of medical problems, tailoring their care for each. Videos and music soothe and distract. A toy syringe prepares them for real injections. Anesthesia masks, treated to smell like bubble gum, are placed over their faces well before surgery.
The point is to make a scary environment less threatening. Doctors and experts say these specialists are integral to the treatment of children like Carl and Clarence.
In three major operations since October, surgeons have pushed apart the boys' brains and divided the tangle of blood vessels surrounding them. They still share one major vein, which is to be divided in the next procedure. The lead surgeon, James Goodrich, said that if the blood-vessel work goes smoothly, doctors may complete the separation of the brothers' skulls the same day. That surgery could come this summer.
Doctors have taken a gradual approach to separating the boys, rather than doing a single marathon operation, to reduce blood loss and help the twins adapt to rerouted circulatory systems.
The approach has brought an extended hospital stay and repeated visits to the operating room for the boys, who arrived from the Philippines last September. In addition, they have received physical, developmental and nutritional therapy designed to prepare them for independent lives once they're separated, when it is hoped they will finally be able to sit up, stand and walk.
All of which has meant plenty of work for the specialists at Montefiore and at Blythedale Children's Hospital in Valhalla, where Carl, Clarence and their mother stay between surgeries at Montefiore. Both hospitals and the medical team are donating their services.
"I'm very grateful to Kim and the hospitals," said the boys' mother, Arlene Aguirre.
The Aguirre brothers may be Montefiore's best-known patients, but Kim Serraro says other children get the same kind of attention. She works with babies with birth defects, young cancer patients, teenagers on dialysis and their parents.
"Lots of kids just hate the idea of getting hooked up to an IV, and you can force it but then you'll have trouble every time. So we go about it in a calm way," said Serraro, 26. "A kid might be refusing to take pills and that can be dangerous, so you try to find out what's bothering them and you solve the problem.
"It's the sort of things that the doctors and nurses don't really have time for, but it makes a big difference to the kids. It's 100 percent rewarding," she said.
An unfortunate reality of the job is sometimes dealing with the death of a child and its effect on parents, siblings and the specialists themselves.
"You help them get what they need," she said. "We had a death, and the little brother had to come back and see where it all happened. So we took him and the parents through it."
Serraro said it's important not to become too close to her patients, a challenge when children are involved. She knows a delicate case like the conjoined twins is fraught with sad possibilities.
"We love them, of course. How could you not?" she said, gesturing toward the boys as Carl played with a plastic stethoscope and Clarence smiled at his mother. "But we know as well as anybody what's involved. We'll deal with it."
Serraro said of the day the twins will be separated, "That will be such a big day. They're coming to an exciting time, a whole new world."
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