Television cameras started following Maria de Jesus and Maria Teresa Alvarez shortly after their 2001 birth in Guatemala. The craniopagus twins — the rarest of all —were brown-haired cherubs fused at the skull, facing opposite directions.
Mending Kids International is a nonprofit that helps provide advanced surgical care to needy children across the globe. In 2002, its organizers prepared to bring the twins to the United States to be surgically separated.
The nonprofit evaluated several hospitals. It ultimately chose UCLA after Jorge Lazareff, MD, director of pediatric neurosurgery, inquired which girl was Maria de Jesus and which was Maria Teresa — the only surgeon who asked.
“That’s how they decided on UCLA,” he says.
But before the twins would begin their medical journey in Los Angeles, Dr. Lazareff needed to have a critical conversation with their parents. He flew to Guatemala City to see them.
“I explained that this doesn’t have to be done; that I presumed the girls could live a long life and this wasn’t a life-saving procedure,” Dr. Lazareff recalls. “I told them the procedure has its risks. There are very few done. I hadn’t done any and UCLA hadn’t done any.”
Parents Wenceslao Quiej and Alba Leticia Alvarez insisted they wanted their girls to have every chance at a normal life, and said they trusted Dr. Lazareff and his colleagues.
On July 25, 2022, Maria de Jesus, known as Josie, and Maria Teresa, or Teresita, celebrated their 21st birthdays.
Saturday, Aug. 6, marks two decades since their 23-hour landmark separation surgery, conducted by a 50-person medical team and followed by people around the world.
From the beginning, Dr. Lazareff — whom Jenny Hull, Josie’s adoptive mother, describes as “a glass-half-full or all-the-way-full” person — never discussed the twins’ odds of survival. He would only say, ‘I’ll be dancing at their weddings.’”
“That was one of the greatest gifts he gave us,” Hull says, “is that he never gave us odds.”
Love and kindness came in unexpected forms throughout the girls’ stay at UCLA, Dr. Lazareff says.
When the twins first arrived in Westwood, nurses on the night shift were taken by surprise because the girls weren’t expected until the following day, he recalls. Yet they sprang into action.
“The nursing team — unknown, anonymous, some of the many beautiful people on staff —put two cots together and dropped the divider in between,” Dr. Lazareff says. “They cushioned with pillows all four sides of the cot so the girls would not bump into each other.
“Maria Teresa was facing one way and Maria de Jesus was facing the other side, almost 180 degrees,” Dr. Lazareff continues. “One of the nurses got a mirror and put the mirror in front of Maria Teresa so she could see her sister. And I think that perhaps was the first time they saw each other’s face.”
Dr. Lazareff was so touched by the moment, he snapped a photo.
Hull, too, says kindness has been the hallmark of the twins’ experience at UCLA. She remains in close contact with several members of the girls’ care team. Dr. Lazareff, for instance, has been to many of the twins’ birthday celebrations.
Hull is also still connected to operations staff members who went out of their way to share kindness. She recalls a couple of custodial workers who’ve been “some of the best people in our lives.”
“They came in every day they were at work,” Hull says. “They were probably the biggest joy in our time being there because they weren't who you expect to be the pick-me-up people.”
One of those workers, Yancy Tate, started working at UCLA shortly before the two Marias arrived. As soon as he saw them, “I knew I had to take care of them,” Tate says. He brought in foam mats so the girls could safely play on the floor.
“From that point on, I was just in there every day,” he says. “Those are my Guatemalan twin babies.”
When they were discharged after their surgeries, Tate didn’t see them for years, but says he often wondered how they fared. Then when he was on his lunch break one day, he heard some commotion — apparently, the two Marias were back at UCLA to visit for their 15th birthday.
Tate quickly finished his lunch and peeked into the room where the twins were talking with medical staff. Hull spotted him and yelled, “Yancy!”
“They remembered me,” he says. “Even talking about it now, it brings tears of joy to me. They remembered me. And they gave me the biggest smile ever.”
Life in Los Angeles
The girls each underwent several more surgeries after their separation, staying with host families in Los Angeles between hospital visits.
After returning to Guatemala, doctors there determined that the twins needed a level of care that local hospitals could not provide. Maria Teresa contracted meningitis and required additional interventions.
Each girl was adopted by her Los Angeles host family. Hull, who’d been caring for Josie, became her adoptive mother. Teresita joined the Cajas family, with their two daughters and two sons.
Originally from Guatemala, the Cajases have hosted 16 children through Mending Kids, though only Teresita has become a permanent part of the family.
Adoptive dad Werner Cajas Dubon describes her as their “center of joy.”
Hull hadn’t intended to become a single mom. A young professional, she was volunteering with Mending Kids and offered to host Josie during her initial stay in Southern California.
“I was so honored and excited to be doing it,” Hull says. “What worried me the most is that she would have to leave. I said, ‘Am I doing this because I’m selfish and I love her so much, or am I doing this because this was supposed to happen?’”
She prayed on it. She talked to her priest. She talked to Josie’s parents, who gave their blessing.
“We’re still very involved in each other’s lives,” Hull says.
Once Teresita was released from the hospital, Hull and the Cajases “made a vow that we would forever be a family, that there would be no separation and we would never leave anybody out,” Hull says.
“In fact, in our adoption agreement, we can’t move further than 20 miles away from each other, from Teresa and Josie,” she says. “It’s really great that we have done that, and also stayed connected with their biological parents.”
Every patient matters
Performing the successful separation procedure brought international acclaim to the UCLA Health medical team, but Dr. Lazareff says every surgery is just as significant as the two Marias’.
“This was not different from the cases done before or the cases after,” he says.
A day or two after the twins’ surgery, Dr. Lazareff remembers, he was meeting with a couple whose child would be having an operation for a brain tumor. The mother said that while they were speaking, she saw the doctor’s face on the TV screen behind him, part of the global media coverage of the separation surgery.
“I explained to the parents, ‘This already happened yesterday. Now what’s important is your child and all the efforts are on your child,’” Dr. Lazareff says.
“I don’t want to say that (the twins’ surgery) didn’t mean anything. It did. But it’s not anything different than the care that UCLA gave to all the other patients. Every case has the same significance as any other.”
The staff’s emotional commitment, too, applies to every patient, he says. He still hears from many families of children he’s treated over the years and regularly attends their Bar Mitzvahs, quinceañeras and graduations.
“That, for me, is a source of joy,” he says. “I go to every party.”
Today, Josie and Teresita are young women. Teresita has faced more health complications than Josie. The bout with meningitis left her non-verbal and reliant on a wheelchair.
“She’s faced a lot of circumstances you could not see her surviving from, but she’s come a long way,” her adopted sister, Vivian Cajas, said at the girls’ quinceañera in 2016.
Josie has graduated from high school and is looking toward college. Though she still contends with health and mobility challenges and uses a specialized scooter to get around, she’s outgoing with an easy smile.
“She sees everything through happiness,” Hull says.
“Sometimes the world doesn’t value you if you’ve got a disability or if you’ve got a mental illness. And these two have done more to change the world and outlook in life than somebody that, quote-unquote, doesn’t have any health challenges going on.”
A return to UCLA
Josie dreams of attending UCLA and becoming a Child Life Specialist — experts who make life more fun and medical treatment less scary for hospitalized children.
She’s been demonstrating her commitment to hospitalized kids for almost a decade already.
At age 12, Josie came up the idea for Once Upon a Room, a nonprofit organization she runs with her best friend, Siena Dancsecs, and Hull that transforms children’s hospital rooms into the kinds of colorful bedrooms they might have at home.
The trio started decorating rooms in Los Angeles. Their work has since expanded to more than 18 hospitals in eight states.
Just before her 21st birthday, Josie returns to UCLA Mattel Children’s Hospital for a day of decorating. One 8-year-old girl’s room goes from plain hospital white to Hello Kitty hot pink, complete with colorful comforters, banners bearing the girl’s name and a spangled cat-shaped purse that the youngster immediately hugs.
‘You definitely put a smile on her face,” the girl’s mother says.
As Josie makes her way down the hall, a star-struck nurse calls out to her. “I know you!”
“All the nurses know me because my sister and I were separated here,” Josie explains nonchalantly.
Josie, Siena and Hull transform half a dozen rooms in just a few hours that day. One is decked out in green with a baseball theme, including a new mitt for the hospitalized child. Another becomes a turquoise unicorn wonderland, with tassels hanging from the ceiling and a plush unicorn toy on the bed. By the time the decorating is done, the child in the room is wearing a unicorn headband and glittery pink wings.
“It makes the kids so happy,” Josie says. “I know how the kids feel when it’s just blank, with no decoration.”
Looking ahead, Josie plans to continue her work with Once Upon a Room and pursue college studies. And Hull plans to be right by her side, supporting her and cheering her on.
“Josie is an exceptional being. She’s strengthened my outlook on humanity,” Hull says of her daughter. “Seeing the world through her eyes is about finding the goodness and focusing on that.”
Learn more about pediatric neurosurgery at UCLA Health.