As the Surgeon-in-Chief for Cook Children’s Healthcare System, Eric Hubli, M.D. knows that every surgery needs a backup plan. In many cases, one backup plan is not enough.

“The key to a really good surgeon is the ability to adapt. When operations move in a unique or unexpected direction, you have to be able to create plans b, c, d and e,” Dr. Hubli said.

During the separation procedure for 16-week-old conjoined twins AmieLynn and JamieLynn Finley, multiple layers of plans were considered and vetted in order to give the girls a chance at life on their own. Dr. Hubli has been a colleague and champion for surgeons at Cook Children’s for the past 15 years. Now he is part of a multispecialty team that came together in an effort to understand and manage every nuance of the separation surgery.

Dr. Hubli’s primary role before the surgery was to assist the other surgeons with the organizational process to remove any barriers so their vision could be realized.

“We put our minds together, reviewed all the clinical data and thought about where the challenges would be," Dr. Hubli said. "We then worked to solve them. One person cannot figure it all out, so it was truly a blessing that we had surgeons, anesthesiologists and multiple doctors from different backgrounds. The various viewpoints allowed us to see things from many angles and these collegial interactions were critical to our future success. There were no egos for we were all focused on one goal – a safe and successful surgery.”

Journey to Plastic Surgery

When Dr. Hubli started medical school at Tufts University School of Medicine, he planned to become a pediatrician, but one surgery changed everything.

“During my first clinical rotation, I saw an operation for the first time in my life," Dr. Hubli said. "It was the coolest thing that I had ever seen. The patient went to sleep and woke up ‘fixed.’ I thought the procedure was nothing short of miraculous so right then and there, I decided that I was going to be a surgeon. There are many surgical fields, but I decided on pediatric craniofacial/cleft and plastic surgery because I love working with kids and I enjoy the challenge associated with the uniqueness of every surgery. No two cases are alike, so every operation requires its own unique solution.”

As medical director of Craniofacial and Cleft Services at Cook Children’s, Dr. Hubli brings more than 29 years of craniofacial, cleft and pediatric plastic surgery experience. His focus is exclusively on children with reconstructive craniofacial and cleft issues.

“One of the things I love about pediatric craniofacial surgery is that I get to be with my patients throughout their childhood and teenage years," Dr. Hubli said. "I meet them as a baby and then travel along with them as they grow and develop. Facial structures change as we grow so I monitor my patients and make surgical adjustments when needed. I have two kids of my own, but I consider all these patients to be mine as well.”

Giving the Twins a New Lease on Life

Early on January 23, Dr. Hubli felt more than ready. Gathered outside the Operating Room doors, he joined the twins’ team of 25 medical staff as the group took a moment to pray for the long day ahead. All the hours of planning and replaying different scenarios in their minds would play out in real life.

Once they walked through the Operating Room doors, Dr. Hubli was confident that each team member knew their role and that the group was up to the challenge ahead. He wore green scrubs along with AmieLynn’s team and worked with the pediatric surgeons to perform her closure after the separation. Dr. Hubli said mental nimbleness is an essential part of the surgery – something his team is very familiar with and practices every day. 

“In surgery, you have to expect the unexpected," Dr. Hubli said. "Even the most straightforward case may have a surprise.  On top of that, surgeons who practice in the pediatric realm face the unique challenge of changing patient size. One day you may be operating on a premature baby who weighs less than three pounds and the next day a 300-pound, 16-year-old offensive lineman from the local high school’s football team may be on your OR table. You have to be able to adjust.”

This ability to adjust is demonstrated by all those who participated in this unique surgery. Surgeons, anesthesiologists, scrub techs, nurses, CRNAs, administrators; every member of the Cook Children’s team understands these challenges and each one is uniquely prepared to rise to the occasion.

Milestones Lead to Historic Moment

Many milestones brought Cook Children’s to this historic moment of separating conjoined twins.

“When I think of the milestones of our surgery program, I think more about our milestones as a medical center because we are all connected to accomplish the same goal," Dr. Hubli said. "In my mind, that is what makes Cook Children’s unique. Across the board, from the police officers to the food services and environmental services employees to the Radiology department, from the lab technicians to the CEO and CFO – everyone is all in. The Cook Children’s family has a vocational dedication to caring for these kids and their families. Every person pulls in the same direction – we are here for the kids and their families. This laser focus is why the hospital and our surgery department are top-notch. I have worked in other facilities but Cook Children’s is special – going that extra step is our standard. The caring and kindness you feel at this hospital is genuine. Every patient and family really matters to our staff.”

With every year that passes, Cook Children’s attracts new highly talented people. Dr. Hubli said over the span of 15 years since he began at the hospital, the main campus has expanded from one building to a destination hospital system that covers eight city blocks. New Operating Rooms, new patient rooms, a new NICU and advanced medical devices were brought to Cook Children’s. A new medical center in Prosper opened this month.

“I’ve seen nothing but incredible growth. Every year we enhance our facilities and our staff. In turn, this means that our patients have access to more service lines and care options. The surgery department is a great example of this growth. In the past few years, every surgical service line has added new surgeons. These surgeons have different specialty training which broadens our ability to meet the needs of our community. If your child has a neurosurgical, orthopedic, urological, craniofacial/cleft, ENT, ophthalmologic, pediatric or cardiac surgery issue, we have the staff to assist. In fact, the breadth of the surgery program at Cook Children’s has been recognized by the American College of Surgeons and the medical center has been recognized as a Level One Children’s Surgery Center. This means the hospital rates as a high-end, full-service pediatric facility.” 

By the Numbers

• Surgeries performed at Cook Children’s every year – 20,000
• Sets of conjoined twins born viable in the world each year – 5 to 8
• Percentage of conjoined twins that are female – 70
• Hours spent planning separation surgery – hundreds
• Medical staff in OR for separation surgery – 25
• Total hours in Operating Room for separation surgery – 11
   

‘Every surgeon is potentiated by our wonderful staff'

Dr. Hubli said surgery involves much more than the surgeon. He firmly believes that surgery is a team sport. 

“It’s great to have the best surgeon in the world on your staff, but that surgeon is useless unless the rest of your hospital can meet the challenges presented by complex surgical care. I am happy to say that Cook Children’s has the required talent. From Central Supply to the PICU, from Environmental Services to the C suite, our team is ready, willing and able. This support allows every surgeon to maximize his/her talent as they are all potentiated by this wonderful staff.”

Looking beyond the clinical realm, Dr. Hubli points to the commitment and dedication of the Cook Children’s administration and the surrounding community as key factors in bringing the hospital to this point.

“We can do this case because of the talent we have in the building, the administrators we work with and the community that we serve who supports us unequivocally. I really feel the community is behind us in all we do. The care that we give to children and families when they come in is returned tenfold from the community we serve. Whether it’s time or treasure, the people of our community are 100% behind us. It’s this give and take that makes Cook Children’s great. And that’s why I think we continue to be very successful.”

“I am proud that we have grown to a point where we can meet the challenges presented by the most complex cases.  I am also proud that we have the team right here in Fort Worth. But it’s not personal pride – it’s pride in our team. I am humbled to work with a group of caring, dedicated and giving people. Our Promise speaks to caring for the children and families of our community. I am honored to be able to work with a group of people that bring Our Promise to life.”

It's Personal

Dr. Hubli knows what it feels like to hand over his child to a surgery team. Seven years ago, his son underwent surgery at Cook Children’s – an experience that changed his perspective. 

“I walked into the building that day as a parent, not a surgeon,” Dr. Hubli said. “Before my son’s surgery, I always used to see the clowns walking through the hall and didn’t think much of it. But then the clowns came to my son’s room, and it was the first time I saw him smile in two weeks. That event reminded me that every member of the Cook Children’s team contributes in their own special way. I love those guys.”

Uzoma “Ben” Gbulie,

“I’ve been looking out for these babies since they were in the womb. I spent a lot of time studying intrauterine ultrasounds and MRI images even before they were born. They’re basically like family to me,” Dr. Gbulie said.

Giving Patients a Ray of Hope

In elementary school, Dr. Gbulie realized becoming a doctor was his calling. By the time Dr. Gbulie graduated from medical school, he knew surgery would be his path. He started out in General Surgery but during his second year of training discovered that he wanted to repair instead of remove.

“I have been privileged to train and become a board-certified General Surgeon, board-certified Plastic Surgeon as well as a Pediatric and Craniofacial Plastic Surgeon. Plastic surgery is very rewarding to me because it allows me to fix things and replace whatever was removed so it gives my patients a ray of hope. Filling that void in someone else’s life brings me great fulfillment.”

Finding the Right Facility for the Twins 

This is Dr. Gbulie’s astonishing third time managing a set of conjoined twins. He had already been involved in two prior separation surgeries – one in 2011 where the male twins were joined at the sacrum, and the other in 2016, where the female twins were joined at the hips/pelvis.

“A separation surgery is as complex as it gets. It’s rare to do even one of these cases in one’s career, and a privilege to be invited to take care of a third set of conjoined twins,” Dr. Gbulie said.

When the twins’ mom Amanda Arciniega was only three months pregnant, she reached out to Dr. Gbulie after her mother-in-law’s best friend mentioned she knew a surgeon who had experience with conjoined twins. Amanda and her husband, James Finley, met with him at his office. 

“We had a long talk about where and how it would be best to deliver the babies and eventually separate them," Dr. Gbulie said. "They wanted the assurance that if they stayed in the area, we had a facility where they could be separated. Being a member of the Surgery department at Cook Children’s Medical Center, I was very glad to assure them that Cook Children’s definitely has that capability.”

Expect the best and prepare for the worst 

Dr. Gbulie said it is humbling when you take care of small babies who can’t make decisions for themselves. In the world of pediatrics, it’s really a doctor, parent and patient relationship. 

“As the days became closer to the actual separation, the mother became more emotional," Dr. Gbulie said. "The family has trusted not only me, nor the entire team but also Cook Children’s Medical Center to take care of their precious babies.” 

By reviewing the surgical anatomy, imaging and operative plan enough times that it became second nature, Dr. Gbulie felt that they had reduced the chances of unanticipated surprises. He also planned the original incisions since the way they open affects the way they close. The main challenge for his part would be the complexity of the closure.

The closure could be a complex repair or possibly require a graft or tissue substitute.

“That portion would be a game-time decision depending on what we find and how the babies are doing,” Dr. Gbulie said.

Once the separation is done and closure completed, the twins will be handed over to the Neonatal ICU team. 

“Of everything I have learned from other separations, one of the most important lessons is the importance of the perioperative care," Dr. Gbulie said. "The preparation of the twins by the neonatal unit, making sure they were gaining weight, their electrolytes were normal, their respirations optimal and so forth – all of those allow them to tolerate a very long operation, followed by the hugely important post-operative care. It really does take a village.”

Dr. Gbulie’s motto for surgeries such as this one is to expect the best and plan for the worst. 

“And with God, it will go great.”

Indescribable Joy

On January 23, the day of separation, Dr. Gbulie remained focused. 

“Knowing it is my responsibility to take care of another human being, especially when it is a child, is a huge motivator and keeps me focused no matter how long the surgery takes,” Dr. Gbulie said.

He made the original incisions to be sure the skin flaps were protected for good closure. 

“Once we got into the nitty gritty parts of separating the liver and bowel, I took a step back,” Dr. Gbulie said.

For the next 2.5 hours, Dr. Gbulie took on the role of assisting the pediatric surgeons as the separation of the organs proceeded. Time seemed to stand still as he watched all the hours of meticulous planning by the team fall into place.

Following separation, the pediatric surgery team worked on the diaphragmatic and abdominal fascial repair using mesh. Then it was time for Dr. Gbulie to close JamieLynn which he performed using skin advancement flaps. When it was all done, he stated: “To be able to give this (gift of separation) to the family is an indescribable joy.”

Cautious optimism

Dr. Gbulie said high fives won’t really come until weeks from now. The separation is a major step but is the first part before the recovery truly starts. He will breathe a sigh of relief when the twins go from surviving to thriving.

“The skin is the largest organ in the body and protects our interactions with the environment," Dr. Gbulie said. "It’s really important to get them well healed and a stable wound because without that, more problems could arise such as post-operative infections.”

He feels fortunate for not only the twins’ medical team but Cook Children’s as a whole. 

“There are not many medical centers in the world that have done this procedure," Dr. Gbulie said. "I think this proves that we have a hospital system that literally has every subspecialty and the technology required to pull off something this complex. That’s an amazing achievement and I’m very grateful for that.”

When asked about his work, he stated “I love every bit of what I do, and if given the choice I would always choose to be a plastic surgeon. My training and experience have given me the opportunity to help another set of conjoined twins and I consider that a blessing.”

Background

Dr. Gbulie is a member of the Plastic Surgery Department at Cook Children’s Medical Center. Besides his elective practice, he also provides on-call coverage for facial and hand trauma and has handled many complicated cases including severe dog bite injuries to the face and scalp which require literally putting the child's face back together.

“It's amazing how fulfilling it is to make the child whole and see them smile again, especially when we're able to achieve this with minimal scarring and deformity,” Dr. Gbulie said.

“The Essential Glue”

“My wife Ndidi is an attorney, the love of my life and the essential glue that holds our family together. We're blessed with three wonderful kids – Amaka (14), Sam (11) and Obi (9). During my free time, I love watching soccer and I’m quite sure I’m the biggest Manchester United fan!”

By Jean Yaeger

Marty Knott, D.O., Ph.D. was AmieLynn’s primary surgeon during the historic procedure to separate conjoined twins, AmieLynn and JamieLynn, on Jan. 23, 2023. Although this was his first time separating conjoined twins, Dr. Knott brought experience in operating on chest wall deformities, congenital malformations of the abdomen and chest, abdominal wall defects, tumors, bowels and vascular anomalies. He has worked at Cook Children’s for seven years.

Here are excerpts from a conversation with Dr. Knott prior to the twins’ separation.

It sounds like the area where these girls are joined is where you work quite a bit. Exactly. That's the interesting thing about it.  The actual surgery parts, if you break them down, are things that we do very commonly -- liver surgery and closing abdominal defects in newborn babies. So a lot of the techniques, skills and experience from other places can all be combined into this unique situation. The actual procedures themselves are pretty common.

How did you prepare specifically for this surgery? We have been meeting within our group but also with other subspecialties such as anesthesia and plastic surgery, as well as all of the different components of the operating room team, such as the certified scrub techs, OR nurses and anesthesia techs. It's one of those things where you have a huge team that comes together and everybody plays their role individually to make things happen. And then there's individual preparation by reviewing the scans and charts and the things that they've gone through so far, to just know what things might come up on that day.

Potentially what’s the biggest challenge? The liver separation part's going to be tedious. But the biggest issue is probably going to be getting their abdominal cavities closed and covered safely, because they do have a shared area from their lower sternum down to their belly button area that is open, meaning there's some separation of the muscle and the skin. Just finding effective ways to get that closed once the division has occurred is probably the most hard-to-predict part. For me that feels like the biggest unknown challenge. Everything else is relatively straightforward.

There are different techniques we use. We have babies that are born with other abdominal wall defects that aren't conjoined who still need some sort of either permanent or temporary closure. We'll use some of those techniques we use in other situations for them too. We’re just trying to figure out what's best and preparing for a variety of different options so that once we actually get them separated, we'll be able to know how best to close those abdominal wall defects or those openings so that the intestines, the liver and the heart are all covered safely.

While they're still conjoined, how does everyone who needs to be there fit around the table? There are a lot of people involved, and the table's not very big. To start with, it'll be Dr. Iglesias and I, and then we have two scrub techs that'll be scrubbed into the operation at the beginning. Our plastic surgeons are there as well. It'll be Dr. Iglesias and I until the babies are separated and then we form into two big full teams after that, one for Amie including Drs. Hamner and Hubli, one for Jamie including Drs. Lodwick and Gbulie.  That will be another set of at least four people around the table for each of us.

Someone steps up, someone steps back? Mostly like that, kind of scooting over and leaning. Most of the time we'll stay on our set sides. Typically, Dr. Iglesias will be on the right side and I will be on the left. We'll just work around that and figure out where everybody fits best.

Normally you operate on only one patient at a time and you can position that patient as needed. Can you speak a little bit about the fact that you may not be able to roll Amie the way you want her, because Jamie's there? They've lived most of the time on the sides where, if you're looking from their feet, Amie will be on the left and Jamie will be on the right. That's their baseline or most common position. So that's where we're going to have them during the surgery because that fits best for what they've tolerated so far. There are definitely some limitations. I always say this: In surgery, we try to use other experiences and techniques to fit into unusual situations. There are a lot of different surgeries where positioning has to change throughout the operation for us to be able to get it completed.

We're having to make some modifications within the surgery to where we can move them around a little and use different angles to get portions of the procedure completed safely. We'll use all of our experience and ideas from other situations that are more common to make that happen. But there are definitely some limitations in being able to do things as freely as we want to. Most of what we need to do while they're still joined will be pretty easy to do from the position that is most natural for them.

How long do you think it might take? Longer than expected, just with logistics of everything. Even though we've practiced multiple times, it'll be different on the real day. What I always tell parents when they ask: It'll take as long as it's necessary to get the thing completed safely. I have a timeline in my mind of how things are going to go, but I don't want to put it out there because it doesn't really matter. It's going to take as long as necessary to get them separated and keep them safe the whole time. We're planning for on an all-day event by the time everything's done.

What would you say to your colleagues at Cook Children’s?  This is one of those cool examples where everybody in the hospital gets to come together and participate. A lot of what we do gets kind of divided into little chunks where there's not much interaction between us. This has required a lot of coordination from NICU, to the nurses who know them well, the respiratory therapists, the anesthesiologists, the surgeons, the plastic surgeons and all our staff. Everybody's getting to play a pretty important role, and I hope that everybody sees the importance of what they do on a day-to-day basis.

Anything else? We're all looking forward to it and just asking for prayers that everything goes perfectly and that they recover well.

Jose L. Iglesias, M.D., Medical Director of Pediatric Surgery at Cook Children’s Medical Center, was the lead surgeon during the first separation of conjoined twins, JamieLynn and AmieLynn, in Cook Children's Medical Center's 105-year history.

During his 22 years at Cook Children’s Medical Center, Dr. Iglesias has been instrumental in the advancement of surgical procedures through the use of technology and minimally invasive surgery. He also specializes in chest wall deformities, congenital malformations of the abdomen and chest, vascular anomalies, tumors, gastrointestinal and genitourinary issues.

Here are excerpts from a conversation with Dr. Iglesias prior to the surgery to separate the twins on Jan. 23, 2023.

Did you always want to be a surgeon? My father was a surgeon, and when I was young, he would take me with him to observe patient rounds and surgeries. The thought of one day following in his footsteps was always a dream of mine. I thought working with my hands to help people was awesome. In my General Surgery training, I found my passion to care for the youngest of patients.

Tell me about the growth you have seen in the Cook Children’s Surgery program since your arrival in 2001. Here at Cook Children’s our footprint is constantly evolving. Since my arrival, we have made great strides in laparoscopy and thoracoscopy. Technology and the innovation of video and optics have allowed us to better care for all our patients, even the smallest ones. In addition, we have developed a robust Pectus Program offering the minimally invasive Nuss procedure to our patients with pectus excavatum.

An important part of our program here at Cook Children’s is Quality Improvement. To that end, I helped the hospital become part of the American College of Surgeons National Surgical Quality Improvement Program which measures and tracks the quality of our surgical procedures. This supports our goal to enhance surgical care and patient outcomes.

What is the most rewarding part of your job? For me, it’s the interactions and meaningful relationships that develop because somebody has trusted me with the care of their child. One specific instance involved a mother whose baby was born with a congenital anomaly that required surgical intervention. The mom was so touched by her experience that she ultimately applied for and became a nurse here at Cook Children’s. Another instance that I will never forget involved a young lady with a rare cancer diagnosis. I had the privilege of being her surgeon for several procedures and was involved in her care for over three years. Although she passed, the family invited me to her life celebration where I got to offer my heartfelt condolences to family members in person which meant so much to me. Knowing that I may have an impact on patients and families is both humbling and rewarding, and it is an honor that I will never take for granted.

When did you first meet the twins’ family? A longtime close colleague, and maternal fetal medicine physician, Dr. Bannie Tabor, reached out to me to tell me that he was following a mother with conjoined twins. Surprised by this once-in-a-lifetime phone call, I agreed to meet with mom and dad in our office prenatally. At that time, a fetal MRI showed favorable anatomy for separation.

How long did you plan for surgery to separate the twins? It was an eight-month planning process.

Did you choose the teams for the twins’ separation? Yes. I met with Dr. Chandra Reynolds, lead anesthesiologist, and Valerie Gibbs, director of Perioperative Services, and, together, we assembled the large team consisting of three anesthesiologists, four pediatric surgeons, two plastic surgeons and about a dozen additional OR staff professionals. 

How do you plan for a surgery like this? Months of preparation. Given the complexity of the operation, we held several team meetings and mock-up practice runs to formulate a solid plan knowing that we must prepare for unexpected challenges. We perform complex procedures frequently, but they don’t all have as big of a headline as this one.

What were the next steps? Imaging and growth. We obtained ultrasounds, CT scans, 3D reconstructions and met with radiologists to discuss the anatomy and the neonatologist to address the twins’ development. It was also important to allow the twins to grow to a reasonable size.

What are the plans for surgery? The operative plan involves a step-by-step outline of where to make the incisions in order to optimize the success of closure; we did this with the guidance of our plastic surgeons. Next, we will proceed through the abdominal wall and then on to the division of the liver and lower portion of their sternum, all of which the twins share. We will constantly be assessing any other abnormalities that need to be addressed. Imaging shows the intestines to be separate, but we are prepared for any surprises. Finally, options for abdominal and chest closure are addressed.

What happens once the babies are separated? Once separated, one twin will be transferred to a different bed where teams will split into their green and purple groups and continue operating until completion.

What are the significant risks associated with this surgery? The risks are significant for this type of procedure. Because we are dealing with two abdominal and chest cavities and several vital organs, our main concerns will be bleeding, infection and blood pressure changes. We will also monitor for any heart issues given that their hearts will be in a new position. Closing their abdomens will also be a significant challenge.

Tell me about James and Amanda, the parents of the twins. They are remarkable people. I am amazed by the strength that they have demonstrated throughout this overwhelming process.  They have been eager and willing to learn everything that has been presented to them.

How does it feel that they are entrusting you with their babies? It is always an honor and one that I do not take lightly, when a parent entrusts me with their most prized possession.

What does this surgery mean for you as a pediatric surgeon? The opportunity to separate conjoined twins is an exceptional privilege most pediatric surgeons never get. It is only because we are standing on the shoulders of giants who have trained us, and incredible leaders who have laid the groundwork for this extraordinary institution that we are able to fulfill our Promise.

What does this mean for Cook Children’s? In 105 years, Cook Children’s has never been presented with the opportunity to care for conjoined twins. This will forever be a part of our history, and it is a great honor to all of us that Amanda and James have entrusted us to provide care to AmieLynn and JamieLynn.

What do you anticipate the recovery will look like? The road to recovery will start off slowly. First, we want the large incisions to start healing and for their intestines to start working so that we may feed them. After feeds are started, we will have them work with both dieticians and speech therapists. As time progresses, the twins will likely need physical therapy to address musculoskeletal abnormalities. Other than that, the healthcare team will address any and all issues as they arise. Overall, we are hopeful for a smooth and successful recovery.

What do you think their prognoses will be after surgery? Given their anatomy, I am optimistic that they will recover well and lead happy and healthy lives.

How do you think you will feel once the surgery takes place? Proud of leading a great team to a successful twin separation and humbled by the family who entrusted us. We are a team that has worked countless hours individually, in small departmental groups, multidisciplinary, and now it is time to put all of those pieces together for an operation that will be monumental for all of us here at Cook Children’s Medical Center.

Lastly, I will forever be grateful. Grateful for AmieLynn, JamieLynn, Amanda, James, all of my friends, family and colleagues for supporting and encouraging me throughout this journey. 

Getting to know Dr. Iglesias

Dr. Iglesias is married with two kids. Practicing medicine runs in the family as his wife is a neonatologist, his son will graduate from medical school in June and his daughter is a nurse resident in the NICU at Cook Children’s. “I love having her there.”

Dr. Iglesias started scuba diving during college. His passion was passed onto his son and, together, they earned their master diver certifications. Once or twice a year, they explore new destinations together.

"I moved to Fort Worth and began my career as a Pediatric Surgeon at Cook Children's in 2001 after completing my training at St. Jude & Le Bonheur Children's in Memphis, TN. My wife and two children have loved growing with the city and the medical center ever since. I attended medical school at the University of Texas Southwestern and did my residency training there also, including Parkland and Dallas Children's hospitals. My clinical interests have included minimally invasive surgery, and I was fortunate to be able to expand the technology and procedures during my time at Cook Children's. Other clinical interests include pectus and chest wall deformities, tumors, vascular malformations, and congenital anomalies. Currently, I'm the Medical Director of Pediatric Surgery (since 2014) and previously was Associate Medical Director as well as the Chief of Surgery.

Outside of surgery, I enjoy spending time and traveling with my family. Photography, scuba diving, skiing and performance driving are among my favorite hobbies. My son and I are Master Divers who enjoy exploring new destinations while my daughter and I enjoy perfecting our photography skills with one another."

The medical professionals were separated into two teams, one for each girl. Those in purple scrub hats belong to JamieLynn’s squad, while Team AmieLynn dons the green. Everyone worked together until the babies were separated, then each team focused solely on their assigned baby.

We want to acknowledge and celebrate the individuals who successfully performed this historic surgery at Cook Children's! 

• Chandra Reynolds, M.D., lead anesthesiologist
• Cole Carrillo, CRNA, lead CRNA

Team A (JamieLynn)

• Jose Iglesias, M.D., primary surgeon
• Daniel Lodwick, M.D., first assistant
• Ben Gbulie, M.D., plastic surgeon 
• Syma Monzales, RN, Coordinator
• Sarah Shaabani, RN
• Darrell Wortham, CST
• Claudia Hernandez, CST
• Imad Yamout, M.D., anesthesiologist
• Michael Gonzalez, CRNA
• Raul Guerrero, anesthesia technician

Team B (Amie Lynn

• Marty Knott, D.O., primary surgeon
• Chad Hamner, M.D., first assistant
• Eric Hubli, M.D., plastic surgeon
• Sarah Doyle, RN, coordinator
• Kristen Cherry, RN
• Brittney Fuentes, CST
• Tania Gonzales, CST
• Gavin Fine, M.D., anesthesiologist
• Paul Downing, CRNA
• Daniel Jones, anesthesia technician

Team C (backup on standby)

• Hailey Hanson, RN
• Jamie Gomez, RN
• Rosa Leos, RNFA
• Diana Bravo, CST

Neonatologists

• Chad Barber, M.D.
• Mary Frances Lynch, M.D.

“I loved the game,” Dr. Bowen-Jallow recalled. “I would also play with my doctor kit, and listen to my parents' heartbeats with the stethoscope and take their temperature with my tiny thermometer.”

Just one month into her career at Cook Children’s, Dr. Bowen-Jallow was recently recognized by the American Pediatric Surgical Association (APSA) as the 9th Black female pediatric surgeon in the U.S.

"When the Benjy Brooks committee informed me I’d be recognized for my contributions, I was on cloud nine," Dr. Bowen-Jallow recalled. "When APSA released the recognition to their social media account, it was a wonderful day for everyone to see all of my hard work."

Dr. Benjy Brooks was the first female pediatric surgeon from Texas. Dr. Bowen-Jallow identifies with Brooks' roots and was grateful to receive recognition in her honor. She says credits the recognition to hard work and perseverance.

Hard Work

Dr. Bowen-Jallow attained her undergraduate degree from Texas A&M University and earned a medical degree from the University of Texas Medical Branch.

"I wanted to be a cardiothoracic surgeon and then I desired to be a neurosurgeon," Dr. Bowen-Jallow remembered. "Right before I decided to go into pediatric surgery, I wanted to be a plastic surgeon."

She said becoming a pediatric surgeon was an accident, but it was the best accident that could've happened. She also believes it was worth enduring all 17 years of higher education.

"I'd committed to doing plastic surgery and was lining up interviews," she said. "As I signed up for my acting internship (AI), I wanted to do general surgery and was informed there were no more spots available. My only option was pediatric surgery, and within three days I'd changed my career path. I knew pediatric surgery was what I wanted to do for the rest of my life."

"Working with children is instant gratification," Dr. Bowen-Jallow explained. "If you perform a good operation, perfect your technique and pay attention to detail. Children will recover well."

Dr. Bowen-Jallow also expresses her love for children and admires their resiliency. She enjoys seeing children recover and giving parents peace of mind after an operation.

"It fuels my soul, knowing I’m doing what I’ve been called to do," she said.

Dr. Bowen-Jallow performs surgery on all things from the neck to the pelvis, excluding heart surgery. She also focuses on gastrointestinal surgery and trauma. In her practice, she enjoys researching pediatric health disparities and pediatric obesity. 

Breaking Barriers

Dr. Bowen is proud of her recent recognition. However, she believes it is essential to have minority representation in medicine; being the 9th Black female surgeon is still minimal. 

"There is a sense of sadness knowing how many others like me could have attained more, without implicit bias in the world; and if minority students weren’t underrepresented in medical school," she explained.

Dr. Bowen-Jallow agrees culturally things have changed significantly, but there is still work to be done to get everyone on an equitable playing field. She recalls growing up, seeing very few women surgeons, and not ever seeing a Black pediatric surgeon before residency.

"It is important to have diversity within the medical system, so people know anything you put your mind to is attainable,” Dr. Bowen-Jallow said.

Dr. Bowen-Jallow advises young professionals who want to follow in her footsteps. 

"You have to know where you come from and where you're going. You must set yourself up for success," Dr. Bowen-Jallow explains.

However, for minorities, she believes the advice has to differ because of the adversities they face.

"There is implicit bias. It's not fair and it's not right," Dr. Bowen-Jallow said. "You always have to do better, know more, and perform better so you can stand out among your peers."

Dr. Bowen-Jallow recalls a time in high school where she was written off and told she would never be successful. She remembers that moment being the push she needed any time she wanted to give up.

"My calculus teacher told me I would never be a physician because I wasn't good at math," Dr. Bowen-Jallow said. "That still sticks with me today. Once I got into medical school, I wrote that teacher a note and dropped it off at the school so he could realize the power of his words."

Outside of the Operating Room

When Dr. Bowen-Jallow isn't in the operating room, she enjoys spending time with her husband of 14 years and her children, ages 3 and 5. She credits her husband for standing by her side through numerous years of education and being the family's backbone.

"I couldn't do any of this without the help of my husband," she said. "He has always supported my dreams and supports the late nights and early mornings on the job. My career wouldn't be possible without him."

The family recently relocated to Prosper, Texas, where Dr. Bowen-Jallow will practice full-time once the new Cook Children's Medical Center - Prosper opens next fall.

To decompress, she and her family enjoy running, biking, and other outdoor activities.

"Having young children of my own, I understand the trust and faith that my patients' families place in me every day," Dr. Bowen-Jallow expressed. "Knowing this, I adhere to the golden rule by treating every family the way I would want my own family treated." 

Operation is no longer a game for Dr. Bowen-Jallow. Changing the lives of children, one surgery at a time, is now her reality.

An early advocate for distraction osteogenesis in the facial skeleton, he helped to develop one of the first multi-planner devices used for lengthening the mandible in children. After a brief surgery, the device is used to slowly lengthen bones that are congenitally too small. Over the course of two weeks, daily adjustments actively stretch the native structures so that new bone and soft tissue can be created as the surgeon works to restore facial balance and harmony.

Dr. Hubli has crisscrossed the globe in the name of craniofacial and cleft care, operating and educating from Brazil to Romania and from Finland to Saudi Arabia. He has been asked to speak on the topics of quality in medicine, craniofacial and cleft care and enhancing patient satisfaction at sites, including Harvard University and the Mayo Clinic. His work has been featured on the Oprah Winfrey Show and in Parade Magazine.

But Dr. Hubli is known for more than his skill as a surgeon. It’s the approach to the way he cares for “his kids” that makes him special.

“When I meet new families I like to joke with the moms and dads and tell them, ‘Now, these are my kids too,’” Dr. Hubli said. “I have two wonderful kids of my own. These are my extra kids, my extended family if you will. When I offer advice to parents or make medical or surgical decisions for my patients, I make the same decisions based on what I would do for my own child and trust me … I love my children dearly.”

Dr. Hubli has two children – Alexander, 17, and Sidney, 12, -- and has been married to Joni for 26 years.

It was Dr. Hubli’s brain that Joni says first attracted her to him. No so much his intelligence that would make him a world-class craniofacial surgeon, but his sense of humor.

“He likes to make everybody laugh,” she said. “He’s always been that way. I liked him the first time I met him. He had a great sense of humor. It helps him as a doctor, especially treating children and talking to parents. He has a way of lightening up a situation and that helps them to feel good.”

Dr. Hubli has a unique reason as to why he relates well to his patients – he was once in their shoes. As a child, Dr. Hubli spent many hours in a hospital while he was a youngster in Connecticut. He suffered from complications due to allergy induced asthma.

Things were different back then. Parents were only allowed to visit for a couple of hours a day and there were no parental overnight stays. A week-long stay in a cold-multi-bed pediatric hospital ward left a lasting impression on a 5-year old mind. The facilities were grim, but Dr. Hubli found that the caregivers, the doctor and staff could be rays of sunshine when times were trying. Joni believes that’s what led him into a career as a physician.

And what made him work with kids? More than anything else, Dr. Hubli simply wants to repair a child’s face so he or she can smile. After all, smiles and laughs are so important to the self-professed clown.

Watch him walk down the halls of the medical center and you’ll see him stop and joke with almost anyone he sees, especially the children. Maybe, it’s because he identifies with their sense of humor.

“Pediatrics is a perfect fit for Eric because he can still see the lighter side of life,” Joni said. “Like a kid, he looks to have fun in everything he does and that makes him fun to be around. He has a saying, ‘I have to grow old, but I don’t have to grow up.’ He’s a great doctor and very skilled, but he is not afraid to let his silly side out. We were talking at lunch the other day and he said, ‘Our 12-year old daughter is more grown up than I am.’”

But make no mistake; Dr. Hubli takes his career and the kids he cares for seriously. For him craniofacial and cleft surgery is not just a job, it’s a vocation. Joni will tell you that “he takes his work home. He still studies, he still reviews, he challenges himself to be better every case and we see the distracted dad at home sometimes because he’s thinking about a patient.”

His dedication is energized by the strength of his patients and their families whom he calls “an essay in courage.” Dr. Hubli thought of becoming a priest as a teenager, but felt a stronger calling to becoming a physician. Either way, healing was the goal.

“Would that all of us have the same grace as these kids do! I don’t know if I would,” Dr. Hubli said. “But wow, these kids are cool. If you don’t believe in God, take a look at the kid next to you. It’s a miracle. It’s beyond my comprehension. You can talk to me about DNA and all the wonders of science, but how did these little strands make all of that? I have the degrees. I’ve taken genetics. I’m an educated person. But I say, ‘That it’s still a miracle.’”

Dr. Hubli’s surgical work on children varies. At times, he may be preventing a speech impediment that will stop a lifetime of being made fun or getting bullied. At other times, it’s a matter of performing a surgery that saves a child’s life by giving him or her opportunity to eat or breathe properly.

“Each case is unique because each child is unique. It’s not because of what they look like or why I’m seeing them, but because of who they are,” Dr. Hubli said. “Regardless of the child, the surgical goal is always the same. If I’m successful, their life truly becomes their own to mold and make. Their potential and their future are in their own hands.”

And many times, he’s performing that surgery with Richard Roberts, M.D., a neurosurgeon at Cook Children’s.

“I love working with Eric. We have a great friendship and work well together,” Dr. Roberts said. “The days that we have surgery together are among my most enjoyable. He is a funny guy and great entertainment, but when we step in the operating room it becomes all business. We share a common goal of trying to do the best for the children and we both carry that attitude through surgery until we’re finished.”

So you have two sides of Eric Hubli. The funny guy with hyperactivity issues (his word) … and the other guy, who happens to be a brilliant surgeon.

“I love having fun. In general, I think we all take ourselves too seriously,” Dr. Hubli said. “Don’t get me wrong. This work is not a game and I’m wholly committed to what I do. I work hard and I take my job very seriously. That said, there is healing in humor. I want what’s best for the children I care for, but that’s the thing, they are children and we are a children’s hospital. We should have fun so that our kids, our patients, can have fun even when what we do is some of the most serious and important work that you will ever find.”

“People told me everybody wants to work in pediatrics until you have kids,” Dr. Honeycutt said. “They said, ‘Then you won’t want to work on kids any longer. It will be too much.’ But it was the exact opposite. When I had my own kids I realized even more this was what I wanted. I wanted to help kids like my own. It gave me much more empathy. It made it much easier to take care of them. In my line of work, I’m asking parents to hand their kids off to me and take care of them. They entrust their kids’ lives in my hands and I understand that.”

As a teenager, Dr. Honeycutt saw first-hand the role a surgeon can play in helping a family after a traumatic event.

One afternoon in his hometown of Paragould, Ark., while “horsing around” after football practice, the then 15 year old broke his neck.

A surgical scar remains on Dr. Honeycutt’s neck and so do the memories of his time in the hospital. He describes the scene at the time like what you would see in a bad TV movie as he was placed in traction.

As a patient, he saw physicians changing patient’s lives and making them better. The straight A student now knew what he wanted to be when he grew up.

Then during medical school, Dr. Honeycutt found his specialty.

“When I was doing my neurosurgery rotation, it all just clicked,” he said. “It clearly had all the parts I really enjoyed. I liked being a surgeon. I liked the neurosciences. I liked the workings of the brain. I just loved everything about it.”

While Dr. Honeycutt is now an experienced neurosurgeon, he still strives to be at the forefront of the latest technology and technique. Working on a child’s brain requires not only a steady hand, but the latest in state-of the-art technology.

Dr. Honeycutt and his fellow neurosurgeons use their expertise to perform the most intricate and delicate surgeries, such as deep brain stimulation, iMRI-guided surgery and laser ablation surgery.

“It’s an exciting time right now because we are learning so much about the brain and how it works and at the same time our technology continues to improve with micro instruments, with robotics and computers,” Dr. Honeycutt said. “If I don’t keep learning and keep up with what’s going on, I can get so far behind, rather quickly. One of the great things about Cook Children’s is we are always on the leading edge.”

Another aspect of Cook Children’s that Dr. Honeycutt said makes it unique is the relationship between the neurologists and the neurosciences. As surprising as it may be, Dr. Honeycutt says it’s rare for other hospitals to have the neurologists and neurosurgeons share a clinic together. He calls the working relationship between everyone involved in the Department of Neurosciences at Cook Children’s unbelievable. A lot of it has to do with that communication and the skill of the surgeons and physicians. They push each other constantly to do better.

At Cook Children’s, the neurologists and neurosurgeons can give each other immediate feedback on a patient. “You look at our situation and say, ‘Why doesn’t everyone do this?’ It’s so silly that people don’t do this everywhere,” Dr. Honeycutt said. “It’s one of the things that makes this place so special.”

On behalf of my family, I would like to congratulate you on your retirement and successful career. I know that you changed the lives of many families but I wanted you to know how much you changed ours.

From the very beginning, I trusted you and you never failed William. Maybe it is experience or maybe it is luck; I have nothing but confidence when I think about all the times you were called to consult on his case or help him through surgery. My first memory is when you put in his PD (Peritoneal Dialysis) catheter. So much was at stake for this boy in renal failure. Not only his life, but a family who wanted him to live. I asked to pray with you and the anesthesiologist before the procedure. I still remember the way you took off your surgical cap and bowed your head. Thank you for praying with me even when I could not understand myself through fearful stuttering.

The standard measuring system for a kidney transplant is your fist. I can still see you holding your fist to Will’s tummy to show me how much more he needed to grow. Every month we would work for each advance in height and weight. I remember showing up for a check-up like a student eager to have her project graded. You were as excited as I was for 10.2 kg and a torso that could hold a kidney the size of your fist. At 20 months old, you and your team transplanted a kidney in my son that “pinked up right away.” I can still see your smile and hear you answers to our rapid questions. Our son went into your OR in renal failure and came out with the first normal renal panel in his life. Thank you for guiding us through those months and thank you for all of the beautiful stitches.

William was your patient, but we are his family. Thank you for repeating your opinion over the phone with my husband when he had to be at work. Thank you for letting grandparents ask how a procedure had changed since they had children. Thank you for letting us interrupt your sleep, schedule, and rounds over and over because Lord knows Will loved to do something interesting at 3:45 on a Friday afternoon. Thank you for listening to me. Thank you for looking me in the eye when the news was not the best. Thank you for rejoicing when the news was momentous.

I have no idea how many lives are changed because of your work. But I know how much better the world for our family is because you were in it.

God bless you and keep you, may His face shine upon you.

Katie, Chuck, Will and John Spiekerman

Warren and Lori Carver

Chris, Kathy and Jacob Carver

Charlie and Vicki Spiekerman

Unfortunately, it’s also a troubling trend among today’s high school athletes.

Cook Children’s pediatrician David H. Goff, M.D., FAAP, calls overstressed, busy children a huge problem – both in the classroom and on the playing field. In his Denton office, Dr. Goff sees patients who suffer from a variety of symptoms like chronic abdominal pain, anxiety and depression.

“I see this over and over. I look in the child’s eyes. They are exhausted. I say to the parents, ‘You need to cut back,’” Dr. Goff said. “And it is amazing to me. They say, ‘We can’t. No way. We have a tournament this weekend.’ For any successes we have, we have 100 more burnouts.”

The American Academy of Pediatrics agrees with Dr. Goff. A group of eight organizations, including the AAP, released a consensus statement regarding their concern with today’s high school athlete.

The AAP states, “Student athletes report higher rates of sleep disturbances, loss of appetite, mood disturbances, short tempers and inability to concentrate than non-athletes.”

The recommendations focused on the importance of educating students, parents and coaches on mental disorders in student-athletes; the stress involved with today’s athletes and ways to monitor their behavior.

Concerns of the AAP included the injuries and stress related to student athletes training year round, which doesn’t give them time to rest and recover.

The AAP said these athletes also face stress from poor performance on the playing field, injuries, concerns about getting cut from the team and trouble keeping up with school work, along with their extracurricular activities.

Because of the stress involved, student-athletes may suffer from “a pattern of lack of sleep and under-recovery” and chronic fatigue that puts him or her at risk for anxiety and depression. Other issues include:

• Physical (Physical conditioning, injuries, environmental conditions)
• Mental (Game strategy, meeting coaches’ expectations, attention from media and fellow students, time spent in sport, community-service requirements, and less personal and family time)
• Academic (classes, study time, projects, papers, examinations, attaining and maintaining the required grade point average to remain on the team, and earning and maintaining a collegiate or academic scholarship).

David Gray, M.D., medical director of Cook Children’s Orthopedics and SPORTS, agrees with Dr. Goff that too much activity can simply be harmful to a young person.

With the advent of select sports and recreational leagues, Dr. Gray said children now play the same sport year round without getting a break from those activities. He wants young athletes to have variation in their activities. If not, the repetitive nature of the same sport creates stress and strain especially on growing bones.

Dr. Gray and his colleagues see children who never have a break during the year sometimes playing on two or three different teams during the same season. He said it’s too much stress on their growing skeleton, causing muscle aches, strains and pain.

Both Dr. Gray and Dr. Goff stress children, especially before they reach high school, should focus on participating in several different sports to prevent using the same muscles year round. They say it also helps the child avoid getting burned out on that specific sport.

“For kids, sports are great and you learn a lot from them, but they should be fun,” Dr. Gray said. “Kids need to enjoy them too. You don’t really want a 12 or 13 year old performing to the point where they are having injuries that could actually impact them as an adult.”

Dr. Goff admits this subject quickly places him on his soapbox. But it’s because he sees so many of his patients facing stress and are simply not happy.

He sees them come in with dark circles under their eyes and behind closed doors and just one-on-one with him, they admit to a different story than what they have been telling to their parents.

Far too often, Dr. Goff hears the regrets of parents, but only when it’s too late. The child has gone off to college and the parent wishes they had taken a trip to the Grand Canyon with their family, instead of racing off to another game.

“I ask the parents to leave the room so I can talk to the child,” Dr. Goff said. “I ask, ‘Do you really want to do this?” They say, ‘No I’m tired.”

The scary part of this story is that far too often the parents are trying to do what’s best for their child, but in reality they are doing harm.

Dr. Gray said he is beginning to see injuries in children as young as 8 years old with ACL injuries. Injuries that were once thought not to happen until children were much older.

“Another problem is that the really good, young kids are getting left behind,” Dr. Gray said. “They are burned out because they are pegged to be the superstar and they get over worked, over trained and over pushed. Some get burned out and pushed to the wayside and other kids, who were not as big, catch up by the time they are in middle school. They have more passion and they are not burned out. And they pass them by.”

Both Dr. Gray and Dr. Goff also see phantom injuries – muscle aches or headaches. Anatomically there seems to be nothing wrong with the child. In reality it’s the child hinting he or she needs a break.

So what should a parent do? Here’s a start:

• During the year give the child down time and a chance to recuperate. This is the case physically for sports and mentally for school.

• Vary the child’s routine to avoid burnout

• Give your children an opportunity to tell you if they are enjoying themselves.

“It’s easy to succumb to parental peer pressure,” Dr. Gray said. “Parents are afraid if they don’t do something their child will be left behind. What’s most important is that your children enjoy sports, or enjoy their activities and has a good mental outlook on life. It’s hard for parents to not live vicariously through their children. It’s a hard lesson for parents. You want the best for your child and want your child to be successful. But sometimes less is more.”

Oosthuizen said he was closing the bathroom door Tuesday morning at the place his family is staying for this week's Crowne Plaza Invitational at Colonial. Sophia was on the other side.

"Her finger was on the side of the hinges," Oosthuizen said. "It nearly cut off the finger completely."

Oosthuizen rushed his daughter to the emergency room at Cook Children's, which is located in Fort Worth and is the primary charity for the Crowne Plaza Invitational.

At the hospital, they met with Dr. Pamela Sherman, an orthopedic surgeon and hand specialist. She explained that it was important to repair the nail bed on Sophia's finger and give the new nail a chance to grow in order to save the finger. Dr. Sherman then performed the surgery.

"It was a scary moment," Oosthuizen said. "It was Sophia's first time under anesthesia. You never know what's going to happen.

"Dr. Sherman was great. ... She told us it's important to have the proper people doing it, and they have some of the best there."

Sophia will go to Cook Children's on Sunday for a check-up before the Oosthuizens return home.

Louis Oosthuizen is grateful for the attention his daughter received at Cook Children's.

"If I'm in doubt ever to have any surgery or something for my kids, I'll fly in to see them," Oosthuizen said. "The way they handled it, the way they spoke to us and treated the kids -- it was amazing to us.

"I didn't even know there were hospitals like that."