The Brief Life of Angela Lakeberg

She was buried in Roselawn, Indiana, last Monday morning, with three crucifixes pinned to her pink dress and a favorite rattle bracelet lacing her wrist. At the flower-strewn gravesite, her small white casket was placed beside that of her sister, who was laid to rest 10 months earlier.

To most people it seemed the sad but certain end to the saga of the Lakeberg Siamese twins. Born joined at the chest with a fused liver and shared heart, they were separated last August at seven weeks of age in a controversial procedure that sacrificed one sister, Amy, so that the other, Angela, might live. The chance of success -- widely reported to be just 1% -- and the projected $1 million bill for the infants' care ignited a national debate over the limits of medical intervention. Now the Lakeberg girls lay reunited in death. A tragedy, surely, but not a surprise.

And yet to the people who knew best -- her family, doctors and nurses -- Angela's death on June 9 was sudden and unanticipated. In fact, says Dr. Russell Raphaely, director of critical care at Philadelphia's Children's Hospital, until her final respiratory illness, he would have estimated "a better than 95% chance" that she would leave the hospital a healthy child. Says Angela's mother Joey, 25: "We thought she would be home this summer." Far from the tortured existence that many predicted, Angela's brief life was largely free of suffering. Repairs to her heart had rendered it fully functional. Her chest was somewhat misshapen but healing well. Angela did not spend her days entangled in tubes and wires. She needed no sedatives or painkillers or emergency trips to the operating room.

Ensconced in the hospital's cardiothoracic intensive-care unit, the infant recovered quickly from the 5 1/2-hour operation that separated her from her twin. One week later doctors removed the breathing tube that connected her to a respirator. But since her lungs were still weak from surgery and congenital problems, they placed her in a negative-pressure ventilator. The cylindrical device works like an iron lung, enclosing the body from the neck down in a vacuum, so that air flows through the nose and mouth and into the lungs without the effort of inhalation. Over the next months, Angela's caretakers began the process of weaning her from the machine. But in the meantime she was fed her baby formula through a thin nasogastric tube so as not to interfere with her breathing.

By late fall she was able to leave the ventilator for short periods to be held and rocked by nurses. Therapists manipulated her mouth to try to teach her the motions of sucking and eating, and eventually began feeding her tiny ! amounts of pureed food. They played grabbing and reaching games to help her learn to sit up. In January doctors discovered an obstruction in a pulmonary artery and inserted a small tube to widen the passage.

Joey Lakeberg made half a dozen trips to Philadelphia to see her red-haired, blue-eyed daughter, but financial constraints and marital problems kept her in Indiana much of the time. On her most recent four-day visit in April, Joey spent time holding Angela, blowing her kisses and trying to teach her to wink. Angela's father Kenny saw his child only twice.