Carson's pivotal surgery

For months, a team of physicians and nurses had rehearsed for the delicate surgery. For hours they had prepped the two tiny bodies perilously joined at the head. And when it came time on that day in 1987 to put a knife to the large vein connecting them - the most fraught step in the groundbreaking operation to separate infant conjoined twins - Dr. Benjamin Solomon Carson, the brilliant young pediatric neurologist who had overseen the babies' case from the start, offered his scalpel to his boss.

It was a sign of deference and respect - and perhaps, a measure of caution. But Dr. Donlin Long, head of neurosurgery at Johns Hopkins Hospital, refused the gesture. Carson, he had already decided, should make the crucial cut.

"Part of me thought, maybe I should take the knife. If things go badly it would be terrible for the young doctor's career," Long recalled this month. "But I also know that if this was a success, if things go well, it would make his reputation, would make him famous, that people would grow up trying to emulate him."

More than any other moment, it was the separation of the Binder twins that launched the stardom of Ben Carson.

But while Carson frequently deploys anecdotes from his compelling life story after a hardscrabble childhood in Detroit, he only occasionally cites and never dwells on the story of Benjamin and Patrick Binder.

While Carson and his team achieved something unprecedented, with long-term benefits for science, it did not result in a happy ending for the Binders.

"In a technological 'star wars' sort of way, the operation was a fantastic success," Carson said in an Associated Press article from 1989. "But as far as having normal children, I don't think it was all that successful." He declined to comment for this story.

Updates on the children were limited after the surgery. A German magazine, Bunte, signed an exclusivity deal with the family until the boys turned 18. A search through its archives, in addition to new interviews with members of the family and Carson's medical colleagues, shows a more complete and complicated portrait of an event that shaped the lives of those involved.

"I will never get over this. . . . Why did I have them separated?" the boys' mother, Theresia Binder, told the Freizeit Revue, a Bunte sister publication, in 1993.

In January 1987, Theresia Binder was eight months pregnant and suicidal.

"I wanted to kill them and myself as well," she said, according to Carson's best-selling book Gifted Hands. She had just learned that her babies were stuck together and felt like "a sick, ugly monster" was writhing inside of her.

She debated taking pills. She considered jumping from a window. Instead, on Feb. 2, 1987, she gave birth to her boys. They weighed a combined 8 pounds, 14 ounces. They shared a head, but Theresia's fear was replaced with a new emotion.

"Not once did we ever not love them," her husband, Josef, was quoted by Carson as saying in Gifted Hands.

Doctors told the parents that if the pudgy babies remained joined, they would never be able to sit, crawl, or turn over. But Johns Hopkins was world-renowned for taking on difficult cases.

"I tentatively agreed to do the surgery knowing it would be the riskiest and most demanding thing I had ever done," Carson wrote. "But I also knew it would give the boys a chance - their only chance - to live normally."

The Binder twins were lucky in that they had two brains. It meant that the surgery was at least feasible.

On Labor Day 1987, the 7-month-old twins - who, according to Newsweek, had been "giggling and kicking since entering Hopkins" - went in for surgery.

After Long gave him back his scalpel at the pivotal moment, Carson severed the primary thin vein that linked the twins.

Separated for the first time in their lives, Benjamin and Patrick were placed in medically induced comas. The magnitude of this precarious success was lost on no one; a massive media scrum awaited the doctors as they emerged from the operation.

The babies' early recovery was closely charted in subsequent headlines.

And they did go home to Germany, seven months later. And then, news of the Binders stopped. Even Carson lost track of them, noting that he had written letters and never heard back.

It soon became apparent that the boys were hopelessly delayed, according to a 1993 interview with the Revue. Benjamin would moan occasionally but Patrick remained completely silent.

When Freizeit Revue caught up with Theresia in 1993, she said her children's brain damage had destroyed her marriage. Josef, who has since died, according to her brother, became an alcoholic and lost his job.

Patrick Binder died sometime in the last decade, Theresia's brother Peter Parlagi said. Benjamin is 28 and still cannot speak. "But you can tell by the way he looks at you that he's happy to see you."