SEATTLE, Wash. — Twin toddlers El and Ally are a handful and a blessing.

When their mom, Sam Albalushi, was pregnant, she was overjoyed to learn she was having twins. But scans revealed potential complications.

Her babies were growing but not moving in utero.

“I was not happy. I was sick most of the time. I was crying and stressed,” Sam said of her third trimester. “We had no clue what was going on.”

It only became clear when the girls were born.

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“All the doctors, they ran to a corner, and everyone was so shocked in that room,” Sam said.

El and Ally were conjoined – attached at the pelvis. Medical staff whisked them away before Sam could see or hold them.

She described being in shock.

“I was not able to accept it suddenly when this happened,” Sam said. “But then I came to my senses, like, you know, where are my kids? I want to see them. ”

She went to visit her girls in the NICU.

“I’ve never seen conjoined twins before, but they were looking so beautiful, so incredible,” Sam said. “I started crying, and I was so happy.”

It was daunting, overwhelming, and medically challenging, but Sam was happy because El and Ally were so happy. They were joyful babies.

But their parents believed their best life would come through a separation surgery.

“For my kids, I was really concerned about their growth, about their life,” Sam said. “We were not able to go outside. If we go outside, it was so hard to explain to people around us. It was so hard to keep our privacy. Everybody wanted to take pictures, to ask questions.”

There were health issues as well. If one of the girls was so sick she had to be hospitalized, the other did too. If one was awake, the other twin couldn’t sleep. And their parents knew, as they got older, they would want to be able to walk, run, and play.

The family was living in the Middle East, and Sam searched the world for the best doctors.

“I just took my laptop, and I started looking for all the hospitals, articles, and research papers,” Sam said. “How many conjoined twins are there in the world? What kind of conjoined twins exist?”

The family moved to Seattle, and within days, Sam wheeled the girls into Seattle Children’s Hospital.

“You know, it’s not often we get these patients dropping into our clinic in this way,” Dr. Caitlin A. Smith said. Smith is the co-director of the Reconstructive Pelvic Medicine Program at Seattle Children’s.

“I obviously knew there was going to be a lot of work involved to evaluate them and make sure that we could separate them,” Smith said. “A lot of conjoined twins have organs or blood supply that cannot be separated. It’s not safe. One of them won’t be able to survive being separated because of their anatomy. We needed to establish that their pelvic organs could be separated safely. And each of them has, you know, bladder, bowel, and gynecologic function. And so that was the main question.”

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Children’s assembled a team including urologists, gynecologists, plastic surgeons, and neurosurgeons. “The team was ultimately about 30 people,” Smith said. Counting our anesthesia team, our nursing staff. We had great scrub techs and circulators in the OR that day that we’re lucky to work with.”

Over the course of six months, they met monthly to plan. They ran a practice session.

And finally, when the girls were 15 months old, they went into the operating room for an 18-hour surgery.

“We think about surgery all the time, and we have very focused plans. Patients are very complex, but I’ve never thought about an operation for six months before,” Smith said. “The relief, I think, that they were separated safely was really rewarding for me.”

Today, months later, El and Ally are quickly learning to use their new mobility. Sarah Lewis and Maya King are physical therapists at Seattle Children’s, working with the girls since they were discharged from the hospital.

“Since we’ve seen them, they’ve been able to pull themselves up into standing positions and work on standing for the first time,” Lewis said. “We try to make it fun for them, to entice them to do what we’re trying to get them to do. So what we’re working on is some sitting to standing so that they build strength in their leg muscles and prepare their hip muscles for standing and walking.

Another piece of their development is more emotional. For more than a year, the twins only knew life together – then one day woke up to this dramatic change.

“They were smiling and they were also confused, like ‘What’s going on and why is she in another crib?” Sam said of the girls’ post-operation.

“They have different personalities, different likes and dislikes. But there’s some way they’re still connected with their emotions. They start noticing, ‘Where’s my sister and why am I here alone,’ so I think they always want to be together.”

They can be together, but now it’s by choice. And Sam has something she initially missed out on as a new mom. When the girls were conjoined, it was very difficult just to hold them. Now, she can finally get her cuddles. “I’m hugging them, and I’m kissing them every time,” Sam said.

Despite all their progress, El and Ally have a long road ahead.

“They still have a lot of appointments with the kidney doctors, with urology, with the plastic surgeons, and the developmental doctors. Also, the therapies. They are getting all the therapies like feeding, speech therapy, and physiotherapy. So we still have a lot of appointments going on, we have future surgeries,” Sam said.

The family established a GoFundMe for anyone who would like to help.