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Life after Katie

Eilish Holton is Ireland's only surviving separated Siamese twin. Last week, as controversy raged over the future of the world's newest set of conjoined twins, born in a Manchester hospital three weeks ago, she was blowing out the candles on her 12th birthday cake at her home in the village of Donadea, Co Kildare. Gemma O'Doherty meets her and her family and talks to them about what life has been like since she was separated from her sister Katie eight years ago

Eilish Holton blushes shyly, shrugs her shoulders and looks to her mother to help her out. She's not in the mood for talking about the past and doesn't want to think about the future, especially the prospect of a new school year looming in less than 24 hours and just how awful it will be to say goodbye to the carefree days of summer.

A perfectly normal 12-year-old in every respect, and that's how she'd like to be treated, thank you very much.

But last week, as news filtered through to the family about the conjoined twins born in a Manchester hospital, for her parents Mary and Liam it was a poignant reminder of just how special their golden-haired daughter is.

And last Thursday, as she blew out a dozen candles on her birthday cake, the memories of the precious child they lost, the little girl who shared a body with Eilish for the first three years of her life, came flooding back.

It was on August 22, 1988, that Mary Holton was told there was a chance she was expecting conjoined twins. Two days later she held her new-born babies, Katie and Eilish, closely in her arms. They were born with separate heads and necks but their bodies were joined from the shoulders down.

Unlike the Manchester twins who share one heart and one set of lungs, a fact that has ruled out the survival of one of them, the Holton twins had individual hearts and lungs, giving them a normal life expectancy. Although their internal organs were fused at the pelvis, their shared liver would be large enough to sustain both of their young lives.

As babies, they were extremely contented. Eilish was always the quieter of the two, depending on her livelier, more extrovert sister to get things done. She had a bigger appetite than Katie, but unusually Katie was always the plumper of the two. Together, they co-existed in their unique world, but the older they got, the less comfortable it became.

From the start, separation had been a consideration, and as they grew into toddlers, the reality of the future they would share if they stayed together grew more daunting for their parents. They never learned to walk as a pair and the likelihood was that they never would. By the age of three, getting from A to B involved a bumshuffle across the floor. In time, they would be confined to a wheelchair.

After three long years of agonising, Mary and Liam finally decided to go ahead with surgery. The chances of a successful separation were good, as high as 70%. Their parents and the medical team at Great Ormond Street Hospital who performed the operation under paediatric surgeon Professor Lewis Spitz had every reason to hope that the pair would enjoy healthy, independent lives in the future.

With the aid of two Velcro dolls which they stuck together and eased apart, they tried to explain to their three-year-old daughters what the operation hoped to achieve. If anything, it was Katie who grasped the idea of separation more than her sister. She would tell little stories about what she would do if they were apart, but Eilish didn't really seem to take much notice.

And then on an early spring day in 1992, the operation was carried out. It took the best part of 24 hours and was pronounced a success. But four days later, for no apparent reason, the monitors attached to Eilish's heavily sedated body began to behave erratically. Doctors later put it down to the fact that she had reacted in sympathy with her little sister who was dying beside her. She had suffered a coronary arrest.

For almost four weeks, Mary and Liam watched their surviving daughter toss and turn in her bed in intensive care. The massive wound which had been left on her frail body where she was joined to her sister bore the severity of a third degree burn. Apart from the sheer physical pain left in the aftermath of surgery, emotionally she seemed drained. For a long time afterwards, she turned into herself and did not want to speak. When her parents gently broke it to her that Katie had gone to heaven, it was clear they were telling her something she already knew.

Four months later, Eilish came out of hospital, physically stronger and mentally back to her normal, happy self. From time to time she spoke of Katie, but she became more like an imaginary friend to have chats with in the car on the way home from school. Even today, it is hard to know what memories of her sister, if any, linger in her mind.

``What does anyone remember about their lives when they were three?'' asks Mary.

``Maybe in some ways it is better she doesn't remember that much because it might hold her back. She has a picture of the two of them on her bedroom wall and we have loads of film of them together, but she doesn't talk about Katie very often. I suppose she has known no other life.''

At the age of six, Eilish and her family flew to Oklahoma City, where she was fitted with an artificial leg. Within six weeks, she was walking unaccompanied. She called her new limb after her twin sister. Today, she is fit and well and has just returned from another trip to the United States, where she picked up seven Gold Medals in the Irish American Games for the Physically Challenged. Last October, she was presented a National Children's Award for bravery.

Her life today is as much fun as any 12-year-old's should be. Her heroes are Westlife and the Kildare football team, whose defeat last Sunday temporarily removed the smile from her angelic face. She is currently enjoying the novelty of sleepovers in friends' houses, and when she's at home, she has three big sisters to keep her company, Claire (16), Therese (15) and Mairead (13), not forgetting the baby of the family Maeve (4), who has in some ways helped to replace Katie as a little sister. In the eight years since the operation, Eilish has shown a fighting spirit and resilience which has astonished her parents and everyone who knows her.

``She has always had a strong sense of survival more than a sense of loss,'' says Mary. ``She has come through so much, it's only natural that she would. From early on, she took a great command of herself. She is very matter of fact about what happened and that has helped her but she is also very determined. We have never put any barriers in her way because she only would have shattered them.''

On Monday, when Eilish Holton enters her final year of primary school, the parents of the Siamese twins born in Britain three weeks ago will appeal a High Court decision to allow a hospital separate their babies. If they win, both of them will die. But if surgery goes ahead, all medical evidence suggests that one of the babies will survive and lead a healthy life.

The parents, who come from a remote part of southern Europe, are deeply religious and believe that nature should be allowed to take its course. They cannot accept that one of their babies should have to die in order to save the life of the other.

Liam and Mary Holton are extremely grateful that they were never put in that situation. In their case, surgery posed an equal risk for both of their children.

``What those poor people are suffering at the moment is the cruellest form of psychological torture,'' says Liam.

``They are having to let one of their children die so the other can live. There is no worse dilemma a parent could ever find themselves in. We don't feel there is anything we could say to comfort them at this time because we were in a very different situation, but our thoughts are with them and we can sympathise with what they are going through.''

Today, as the Holtons observe the tragic and complex case in Britain and recall the torment they went through as they made the decision to separate their twins, they are convinced they did the right thing.

``If we had known at the time that either child would die, we wouldn't have operated, but in the same set of circumstances, we would do the same thing again. Katie will never be forgotten. We visit her grave every Sunday and sometimes wonder what it would have been like if she had lived. But there is no point in dwelling on the past. We just try to live in the here-and-now and we think in years to come that Eilish will appreciate the decision we made.''