AFTER | Melissa Cronin
Standing among a circle of physicians, I leaned forward toward the crib, gazing at the three-month-old conjoined twin girls cooing back and forth, speaking their own, intimate language. One twin quietly looked up at the circle of white coats, her mouth open in the shape of a Cheerio, while her sister batted at her face. So it made sense to nickname the laid-back twin Turtle and her active half Turbo.
It was 1999, and I thought I had seen everything in my twelve-year nursing career: burned children, one-eyed babies, twenty-three-week-old preemies. But never conjoined twins. Such cases, I learned, were rare, occurring once in every one hundred thousand live births. For the experienced physicians at this children’s hospital, however, the girls were not an anomaly. They had separated more than a dozen conjoined twins over the previous four decades, and had cared for numerous others whose separation was not possible.
I stepped closer to the attending surgeon in the group as he launched into a listing of statistic: “The stillborn rate for conjoined twins is as high as sixty percent.” Turbo called out, “Boo-oo,” as though she understood what he had just said. Everyone laughed at her uncanny timing. “We go into these surgeries fully aware of the numbers,” the surgeon continued. “About thirty-five percent die on the first day of life, and five to twenty-five percent survive.” I ignored the dire statistics, and reached through the crib slats to touch the girls’ downy skin. I needed to feel what I had only previously seen in nursing journals.
The surgeon explained that, for unknown reasons, females have a better chance at survival than males. I held onto that hopeful statement and envisioned the twins disentangled from one another, unbound from the tug of another being’s needs and wants. But the staggering realm of fission theory trumped my vision for a moment and my mind’s eye rewound to the beginning of the twins’ existence: A single fertilized egg incompletely splitting, developing into two identically fused embryos, those embryos evolving into fetuses, floating together in amniotic brine, exchanging placental nutrients, inhaling and exhaling simultaneously in a buoyant center for nearly forty weeks.
A monitor alarm blared, stirring me from my reverie, bringing me back to the confident voice of the attending physician discussing the fortunate circumstances presented to Turtle and Turbo. Since they were a common twin type – omphalopagus – their likelihood of surviving the separation procedure was promising. And they didn’t share the heart or brain, which would rule out surgery all together. Connected from the lower half of the sternum to the navel, they shared a portion of their ribs, and part of the liver, diaphragm, and the membrane surrounding the heart. My vision of the girls freely running, hopping, and skipping now felt more certain, as certain as parting clouds.
When holding Turtle and Turbo, I’d sit in a rocking chair and prop them against my chest. But when cuddling them – four arms, four legs, and two wobbly heads – I felt more like a referee distracted by another player, my hands busy holding up the twins, unable to stop Turbo from grabbing onto the nose or ear of Turtle. Laying them face up on my lap allowed more freedom of movement: I could easily hold their hands and rewrap them in an oversized blanket when one of them kicked it loose. Their mother, who spent much of her time with them in the hospital, had learned to adapt in the three months she had spent with them at home. She’d hunch her shoulders inward to protect their teetering heads while walking around with them. And if that wasn’t enough, having traveled from Eastern Europe to the United States for the first time, she also had to adapt to the English language. She learned essential phrases like “Where’s the bathroom?” and “Can I use the phone?”
Because of the location of the girls’ connection, their heads were positioned so that they faced one another. I’d shift my eyes from one twin to the other, rubbing their blond heads while talking to them: “Itty bitty cuties … ba, ba … goo, goo.” Since there were no tops large enough to cover the both of them, I dressed the girls in two shirts that snapped together down the middle. Their mother showed me how to change their diapers with speed and proficiency: Lay twins down on bed next to crib, hold back one twin’s set of kicking feet with elbow while un-taping other twin’s diaper. Slip diaper out from under bottom, then toss to floor with free hand. Grab clean diaper from stack within arm’s reach, slide under bottom. Tape diaper closed. Release elbow.
The surgeons had inserted silicone balloon expanders beneath the skin of the twins’ shared chest and abdomen. Each day I cared for them, I slowly injected saline solution into the balloon. Over a period of three months, the skin would stretch long and wide, so each twin would have enough tissue to completely cover her own chest and abdomen after the surgery. When I fed one twin, sometimes the other would vomit. Though it’s possible for omphalopagus twins to share part of their digestive system, this was not the case for the girls. Maybe it was a fluke. Maybe it was a jealous protest, the id of one sister stronger than the other’s: Why are you feeding her first? If one twin was asleep and the other awake babbling – usually Turbo – I’d whisper, “Shhh.” At the same time, I’d be thinking, you won’t have to endure this much longer. Soon you’ll be on your own. I’d give her a pacifier, and stand by the crib watching her watch me until her eyes closed.
The twins’ mother knew she’d be sacrificing months apart from her other children while her husband stayed home to care for them– an ocean away. And the notable reputation of the hospital instilled great confidence in the parents, not to mention the surgeons’ steadfast belief that the twins would go on to live productive lives. But the surgeons, and the parents, knew Turtle was more vulnerable because her heart was in her sister’s chest. I wondered what would happen if Turtle died. Did the girls’ parents really understand what the surgeons meant by vulnerable? Did the parents agonize over their decision to have their daughters separated? Did culture play a role? What would the twins have wanted if they had possessed the cognitive capacity to choose? Maybe they would have wanted to remain together. If Turbo had understood that her sister might die, and she could have voiced her worry, what would she have said? “I refuse to risk losing my sister. We’re staying together.”
As part of a team of nurse practitioners and surgeons, whose goal was to unyoke the twins from one another, I assumed the girls would want the same. Why not? They would eventually be free to form individual friendships, attend different colleges, and choose their own careers. If they were not separated, imagine them dating different partners and having sex while literally joined at the hip. But Chang and Eng Bunker, conjoined twins from Thailand, more than managed. They chose different partners to marry then had nearly two dozen children between the two of them. They proved that it is possible for conjoined twins to live as separate, sentient beings.
The evening before the twins’ surgery, just before I left to go home, I embraced their mother. She pulled me closer to her. When she stood back, she swiped tears dripping down her wintered cheeks. I pointed to my chest, then to the calendar hanging above the nurses’ desk. In block letters, “November” spanned the top of the page. I walked over to the calendar, tapped my fingertip against the third square where it read, “Turbo and Turtle, separation surgery.” I pointed to my chest again, said, “Me. Here. Tomorrow.”
“Yes, yes,” the twins’ mother affirmed. She reached for both of my hands, held them in hers. They trembled. I squeezed them, pressed into her palms an extra dose of assurance. Her brown eyes, as brown as both of her identical daughters’, glimmered. She pulled me close to her again. I’m not sure whose heart was beating faster, hers or mine.
I gave the twins a long hug, inhaling their baby-powdered skin. “Tomorrow’s the big day.” Turbo flapped her arms, calling out, “Oh … Eh … Eee.” Turtle hummed, “Mmmm,” then opened her mouth into a large oval, showing the whitecap of a bottom tooth. After caring for them three days a week for the past three months, they knew my end-of-the-day-voice, the voice that confirmed, “I’ll see you soon. I promise.” At six months old, they had no perception as to how different their lives would be twenty-four hours from then. If they survived, they would be aware of the “after,” but would likely not remember the “before.”
The next afternoon, the twins were surgically separated from one another during a several-hour procedure. An irrevocable separation. While monitoring the wide swings in Turtle’s blood pressure and heart rate throughout the initial post-operative days, I thought, What if she doesn’t survive? Would their parents regret their choice? Would the surgeons regret having made the decision to separate the twins? Would I regret anything I had done to prepare the twins for surgery?
The two cribs seemed out of place. Turtle and Turbo were now not only physically disconnected, but distanced from one another by several feet. One sister could no longer easily touch her sister, reach for her hand. They were both heavily sedated, but I imagined they sensed their corporeal separateness. They had been attached at the chest and abdomen for nine months in utero, then for another six months as infants. How could they not sense the change? Bare chests once kept warm by each other’s beating heart.
Every day, the twins’ mother sat between the two cribs. She learned to split her time between her daughters, but now she had to make choices she hadn’t had to make before, like which twin to hold first when both were crying for attention. During those initial post-operative days, she’d dash over to the more awake twin. She’d slide down the crib rail, take her daughter’s hand and talk softly into her ear, “Mama Jest Tutaj (Mama’s here).”
Several weeks later, after Turtle had stabilized, I carried Turbo to her sister’s crib for a visit. I sat them facing one another. Turbo squirmed, shifted her torso back and forth, as if she were eager to play with her sister. She patted Turtle’s soft belly, grabbed her feet, then her hands. She uttered a string of sounds: “Gi, gi, go.” Turtle mimicked her sister. They giggled at the same time – a musical, singular giggle. Turbo leaned her pudgy face close to her sister’s. They stared at one another, their eyes like wet glass, then brought their faces even closer together, each smelling the other’s familiar breath, feeling remembered warmth on their cheeks.
If our bodies are capable of storing memory, is it possible that both Turtle and Turbo now feel an occasional reminder of their once-upon-a-time physical union? A twinge in the liver, a spasm just below the diaphragm, a skipped heartbeat.
Fifteen years after their separation, long after they had returned to their homeland, a news headline about conjoined twins roused my curiosity. How were the girls doing as fully blossomed teenagers? I searched their names on the Internet and found a You Tube video of them. In it, Turbo chatters while Turtle listens. Turbo takes her hand and flips her long hair out of her face, sharing a full smile. Turtle lets her hair shade her face from view, so all you see is a slice of a grin. Turbo is taller and more muscular than Turtle, and bounces from step to step. But the twins’ arms sway in sync as they walk along, together – holding hands.
Melissa Cronin holds a BS in nursing from Boston University and an MFA in creative nonfiction from Vermont College of Fine Arts. Her work has appeared in The Washington Post, The Jerusalem Post, Narratively Magazine, Chicken Soup for the Soul, Saranac Review, River Teeth Journal, Under the Gum Tree, and Brevity. A journalist, United Way Volunteer, and Irish fiddler, she lives is Vermont with her husband, and is currently completing a memoir.