This is a story about science. It's also about heart.
For nearly 40 years at Toronto's Hospital for Sick Children, Canadian doctors have made medical history -- by separating conjoined twins.
These surgeons have reconstructed bile-duct systems, performed a sex-change operation, blocked off blood vessels to the brain and switched kidneys between twins. In one recent case that has seldom been mentioned in public, they transplanted a leg from a dying twin to her survivor. Canada has become famous for these miraculous operations. During surgery, doctors sometimes must play God, deciding which baby gets, for example, the single set of genitalia. But in each case they rescue human beings who would otherwise be doomed to living half-lives.
And what they do for Canadians they also do for the rest of the world. Sick Kids, as it is universally known, covers medical costs for foreign twins, possibly the only hospital in the world to do so. And each time, ordinary Canadians cover the other expenses, from plane tickets to lodgings.
Conjoined twins are rare -- an estimated 1 in 200,000 births. To use detached medical jargon, many aren't compatible with life. In four decades, Sick Kids has separated only 10 sets, six Canadian and four foreign. But each time, the public is fascinated. Such twins pose the question of what it is to be a person. What do privacy, autonomy, free will, individuality and identity mean when two people are stuck together? "Conjoined twins capture people's imagination. There are issues about self," says Dr. Jacob Langer, chief surgeon at Sick Kids.
But then the twins return home. The headlines fade, and the children seemingly vanish. Recently, The Globe and Mail decided to find out what's become of these extraordinary infants, to put faces to the names and gain some insight into life after separation. The newspaper spent several months tracking down five sets of twins. These are their stories. You will meet the unfortunate mother of the first set of Canadian girls separated, in 1966, and the much luckier mother of the only set of Canadian boys. Among the foreign twins, The Globe tracked down a long-vanished pair from Myanmar, formerly Burma, and met other twins who have gratefully made Canada their new home.
Theirs are stories of scientific triumph. But they're really stories about compassion.
THE TWINS FROM TRINIDAD
At 20 years of age, Heera and Shiva Ramkhalawan could be poster boys for togetherness.
"We're Siamese twins," says Shiva, lounging on a white brocade sofa covered in plastic at their family's townhouse in Toronto's Chinatown.
"When we were babies, we went through a lot," Heera adds.
"Doctors didn't think we would walk," Shiva says. "It was, like, really messed up. We couldn't see each other. We had four legs underneath. But everything's cool now."
The brothers aren't just cool -- they're a menace. They were separated at nine months, didn't walk until they were 3, moved to Canada and still sleep together in the same double bed. But when it comes to pickup basketball games, their friends never let them play on the same team.
"They think we're a threat. They think we can communicate," says Heera, with a grin that shows off brace-perfect white teeth.
The brothers also have active social lives. "If we were stuck together, we'd have to find another set of twins stuck together," says Shiva, flashing identical white teeth.
They are watching a hip-hop video on a TV beside the Hindu shrine in their living room. The twins adore rap and dream of recording their own CD. They wear the requisite oversized fake diamonds in their ears, and baggy clothes to match. Their outfits just happen to hide misshapen torsos.
They were born in 1985 in Trinidad, joined at the hip, and practically everywhere else, including the pelvis, chest, liver, intestines and urinary tract. The twins had two testicles each, but shared a single penis. Their single colon ended blindly in one's baby's urethra.
The gynecologist, a Chinese Trinidadian, was so shocked when he saw them that he called his sister in Toronto. She told him Sick Kids had just separated twins from Burma. And so, on their third day of life, the Ramkhalawan twins were flown to Canada. Doctors performed an emergency colostomy, creating an opening in their shared abdomen.
The newborns returned to Trinidad, but the main hospital in Port of Spain could not separate them. However, the plastic surgeon there had trained at Sick Kids, and contacted his counterpart there, Ronald Zuker.
"He called Zuker. Zuker called me," says Dr. Robert Filler, then chief surgeon. "We said we'd take them."
Meanwhile, Dr. Zuker considered how to close the gaping wounds caused by separation surgery. Previous twins had recovered agonizingly slowly with a synthetic patch. Then the plastic surgeon had a eureka moment: If a woman's belly expands during pregnancy, why couldn't a baby's?
"I thought: I could put balloons in there and stretch the tissue." A Toronto company named Cox Uphoff International manufactured tissue-expander pouches to be used in breast implants -- and Dr. Zuker knew the salesman. "He donated tissue expanders. I took a suitcase full of them to Trinidad."
In Port of Spain, he and Dr. Filler, the chief surgeon, successfully implanted seven balloons under the babies' chest, abdomen and buttocks. Every two weeks, the local plastic surgeon would inject more saline solution. "It worked beautifully," says Dr. Zuker, who later published a paper about it in the Journal of Pediatric Surgery.
The Rotary Club of Trinidad raised $130,000 toward the twins' medical care in Canada. British West Indian International Airline provided plane tickets. Doctors and nurses at Sick Kids pledged to donate their time. The Herbie Fund, the hospital's special fund for foreign children, would cover the rest.
Nine months later, in a marathon 22-hour operation, a record-sized team of 73 doctors and nurses at Sick Kids separated the twins. Their father, Latchman Ramkhalawan, a carpenter, remembers sitting in the waiting room. "Complete strangers dropped by to say hi, and talk to us."
He and his wife, Evelyn, a medical receptionist, begged Dr. Filler to construct a normal bowel opening for each of their sons. "We could have, but they were missing the sphincter muscle," Dr. Filler says. "Without any kind of control, they'd be a mess down there. We advised against it."
But the surgeon thought he might be able to solve another problem. From the start, the parents had been told only one of their sons could remain a boy. So they had named one Shiva, which means Lord of Destruction, and the other Meera, after the Hindu goddess who transformed poison into nectar. They used the names interchangeably because they dreaded choosing which would become the "girl."
During surgery, Dr. Filler managed to split the penis lengthwise. "There was just enough urethra to separate them," he says happily. "Each got half."
And so Meera became Heera, a boy's name that means "precious diamond."
In response to a delicate question about the functioning of their private parts, Shiva says easily, "Everything there is good."
Heera adds, "Yeah, we're perfect right now. We lead really normal lives."
The only thing that mortifies them is their colostomy bags. They have never removed their shirts in public. Nor have they told friends.
"I feel if they know, they'll stop being our friends," Shiva says.
Heera adds, "Or they'll try to help us out, or ask us, 'Are you okay?' "
They especially dreaded telling girlfriends. When Heera lost his virginity a couple of years ago, he kept his shirt on the whole time. He and his girlfriend soon broke up.
A year ago, when Shiva started dating, he couldn't bring himself to tell the young woman either. "For six months, we'd get intimate, I would push away."
Not long ago, Shiva announced he had "something important" to tell her. She saw him shaking with nervousness, and blurted, "You're a woman!"
He told her he had been born "different," and had had many operations. Then he handed her a pamphlet on colostomies and fled. That night, she called. "This doesn't seem bad," she told him. "Why are you worrying?"
Heera had watched this drama unfold and decided pamphlets were a good idea. His friend scanned the one he handed her. "This is nothing," she declared. "I thought you were going to tell me you were dying."
Both young women had a million questions about colostomies. Do you have to wear it all the time? (Yes.) How often do you have to change it? (Every day or two.) What happens during sex? (You put on a clean bag.)
Each girlfriend wanted to wear a colostomy bag for a few days, to understand what it was like. When they removed the adhesive pouch, they likened it to getting waxed.
SOLVING THE PUZZLES
P.T. Barnum coined the term "Siamese twins" when he displayed a pair of conjoined twins as sideshow freaks in his circus. Born in 1811 in Siam, now Thailand, Eng and Chang Bunker were joined at the abdomen by a 10-centimetre band of tissue. They shared a liver, but had separate personalities. One drank; the other never touched a drop. One played poker, the other didn't. They married, bought houses next to each other and alternated where they slept. Between them, they fathered more than 20 children.
With their circus earnings, they bought a plantation in South Carolina, where they owned many slaves. By the time of the Civil War, anesthetic was available and medicine had advanced so that they could have been separated. But even when Chang died at 63 of pneumonia in 1874, Eng wouldn't contemplate separation. His single heart couldn't keep their common circulatory system going, and he died a few hours later as blood pooled in his dead brother's body.
Doctors believe conjoined twins occur when a fertilized egg fails to split completely. That's why the twins are always the same sex and genetically identical. They sometimes share a spleen or a heart or an artery to the brain. Their small intestines might be intertwined. They might have only three legs, or two heads on a single body.
For surgeons, this is the medical equivalent of a Rubik's Cube. They must probe, poke and take MRIs to discover how the twins are joined and how to separate them. Bob Filler had already performed two conjoined-twin surgeries by the time he arrived at Sick Kids. He would perform four more in Toronto, and consult on a seventh.
Dr. Filler already had an outsized reputation before he joined Sick Kids from Boston. In military service in Vietnam, he had operated on local children with cleft palates whom he had sneaked into the base hospital. When army brass tried to shut him down, he complained on national television. They backed off -- and eventually awarded him a Bronze Star.
The surgeon was also famous for pioneering an operation for esophageal atresia, a rare condition in which the esophagus and windpipe aren't properly connected. In 1979, a baby in New York was born with the condition and the attending pediatrician called Dr. Filler. He offered to donate his services, but the family didn't have enough money to cover the other costs and U.S. Medicaid refused to fund a foreign operation.
Enter a crusading newspaper. Stories in the Toronto Star about the undernourished baby, Herbie Quinones Jr., galvanized the city. Air Canada gave plane tickets. The Sheraton Centre donated a room to Herbie's parents. Paul Godfrey, then chairman of Metro Toronto, launched a fundraising drive.
"Metro government gave money, people pledged more, and we got enough to bring Herbie Quinones here," Dr. Filler says.
The state of New York was shamed into paying the medical bills, and the $16,000 Canadians had donated became the Herbie Fund. Dependent on annual fundraising, it has allowed Sick Kids to treat 470 children from 80 countries for everything from heart operations to separation surgery for conjoined twins.
"We're the only hospital to have funding dedicated to foreign patients who can't pay for their care," says Dr. Langer, who succeeded Dr. Fuller. "That's something I think is kind of Canadian. We help children from other places who would otherwise die or have a horrible life."
Dr. Zuker notes that operations for foreign children at Sick Kids are done when operating rooms are normally closed. "We never do it at the expense of our own population. It never impacts on Ontario patients."
The complex international cases, Dr. Langer adds, give Sick Kids the expertise to better take care of Canadian patients.
Dr. Filler, now retired, a dual citizen and as blunt as ever, also sees a benefit for the hospital itself. "It helps their marketing," he says. "People think: 'Astounding! You have the skills to do that?' "
For all its expertise, Sick Kids doesn't hold the record for numbers of conjoined surgeries. Great Ormond Street in London and Children's Hospital of Philadelphia have operated on more. But Dr. Zuker, who holds the Canadian record at eight sets, measures not by quantity but by complexity.
"It's not just that the surgeons can separate them. You need a very advanced team that can deliver state-of-the-art care. What makes us special is the very high degree of multidisciplinary care that I don't think other institutions can match," he says, citing expert anesthetists, a top intensive-care unit and a crack nursing team to handle wounds, pain control and hydration.
Gruff with adults, Dr. Zuker, 60, does his best to put his young patients at ease, to the point of donning a Superman-print surgical cap.
He says the puzzles posed by conjoined twins frequently lead to new medical innovations, such as the use of the tissue expanders, or transplanting a leg from one dying twin to the survivor.
"All of those things had never been done before. . . . We write it up, present it at national and international meetings so that other people can learn from our experiences."
Of all his twins, Dr. Zuker says, his most challenging set was his first -- two little brothers from Burma.
THE BOYS FROM BURMA
In 1982, the wife of a young railway engineer in northern Burma gave birth to a set of conjoined boys. Joined in a Y-shape, the Htut twins couldn't even see one another. Their mother was told that they were dead.
"When Lin wanted to sit up, Win would have to lie down. For my own opinion, it was better to let them die," said their father, Nyi Htut, a practising Buddhist. "Maybe in the previous life we did something wrong, and the kids also did something wrong."
Joined from chest to abdomen, the twins had only two good legs between them. A withered third leg dangled off to the side. They had one testicle each, and a single penis. They also shared a pelvis, liver, bladder, large intestine, an entwined small intestine and a fused urethra.
At six days old, the twins were whisked 650 kilometres south to the Children's Hospital in Rangoon, founded by a Burmese doctor named Pe Nyun who was trained at Sick Kids in 1963 as part of the Colombo Plan, a post-war international aid program.
There, the twins languished, with no one taking them outside for sun or air.
In 1983, Dr. Alan Conn, a Sick Kids anesthetist, happened to drop by to visit a Burmese anesthetist who also had trained at Sick Kids. Dr. Conn spied Lin and Win marooned in their crib. The staff begged him to take the boys. The Rangoon hospital, which lacked everything from a ventilator to a pathology lab, could do nothing for them.
"Those kids wouldn't have lasted a day on the operating table," says Dr. Conn, who somehow found himself agreeing to help.
"I wondered how I'd dug myself in that hole," says the doctor, now 79 and retired in Guelph, Ont. "Only eight twins joined like Lin and Win have ever been separated, and only half of them survived."
Back in Toronto, he approached the chief surgeon. "Dr. Conn said to me, 'What do you think?' " Dr. Filler recalls. "I said, 'Seems to me worth a whirl.' "
The Herbie Fund agreed to pay medical expenses. Dr. Conn also leaned on senior politicians in Ottawa -- friends he still won't name -- who persuaded Canada's aid agency to provide more money. Unbeknownst to Dr. Conn, his Dutch-Canadian travel agent approached KLM Royal Dutch Airlines, which promised to fly the Htut twins, their parents and any medical staff back and forth as often as needed -- business class.
Fifteen months later, on July 18, 1984, the twins arrived in Toronto. They were accompanied by an uncle (who happened to be a family doctor) and Dulcie Yin, a nurse who had also been a member of the Colombo team at Sick Kids.
The twins' parents, preoccupied with a new baby girl, stayed home.
"The mom and dad didn't expect the children to survive," Ms. Yin recalls in a phone interview from her current home in Surrey, B.C. "They dared not hope."
Doctors faced an excruciating decision: Which boy would become a girl? Groping their way through a minefield of gender stereotypes, some staff felt Win should remain a boy because he was bigger. Others thought Lin was more "aggressive." Dr. Wai Lwin, the twins' uncle, refused to make the choice.
Dr. Filler asked Ms. Yin to consult the parents. She was unable to reach them, and the flummoxed doctors ended up asking her to choose.
"I said Lin was more dominant," Ms. Yin says. "He was the first to get up, and the other one had to follow. The other one had the nature of a little girl, so clean and tidy. If there was a wrinkle, she'd smooth the sheet."
The operation involved eight surgeons, five anesthetists, 14 nurses and 16 residents and took 17 hours. Dr. Zuker made the first incision. Dr. Filler sliced through their abdomen wall. The twins were aged 2 and underweight. Their shared bladder, separated by a lining only three cells thick, was "like trying to separate wet tissue paper," one doctor said later.
To calculate blood loss, nurses weighed each surgical sponge. One of the two-year-old, underweight twins lost six times his blood supply; the other, eight. Lin got more of the pelvis -- and all the extra skin and muscle from the useless third leg to close his wound. Lin also got the penis, and kept his one testicle.
Dr. Filler castrated Win. Using a piece of their shared large intestine, "we made her a vagina," Dr. Zuker says. "It was another first. It was very exciting."
At a press conference, Dr. Filler made the mistake of repeating the idea that Lin remained a boy because he was the "more aggressive" one.
"I got all sorts of grief," he says. "But I didn't decide which one was which."
Lin healed first. The Bloorview MacMillan Children's Centre, Canada's largest children's rehabilitation hospital, fitted him with a state-of-the art prosthesis and taught him to take his first steps.
By the time he returned to Burma a year later, Lin had spent the first four years of his life in institutions. He spoke only English and liked burgers and fries. When he spied his baby sister for the first time, he burst into tears. He wailed that Win was his only sister.
But Win remained at Sick Kids. Her wound, covered with a synthetic patch, took months to heal. When she finally arrived at Bloorview MacMillan for a prosthetic leg, her natural leg was twisted out and up, like an upraised arm, and scoliosis had bent her spine into a "J."
The technicians made her a full-body bucket with an attached brace that pressed her leg down. It looked -- and must have felt -- like a medieval torture instrument. By the time she left in late 1985, Win still couldn't walk. She was dressed like a girl, in a pink dress with puffy sleeves, her long silky hair pinned up with a barrette.
The twins returned twice, in 1987 and 1994, for follow-up care. On the final visit, it was clear Win had not been receiving hormone therapy in Myanmar.
"She looked like a boy again," says Linh Le, an orthotist at Bloorview MacMillan who fitted the twins. "Her hair was cut like a boy. She played like a boy."
After that visit, Mr. Le sent photos and letters. "I never heard from them," he said. Burma's military junta, which first seized power in 1962, had formally changed the country's name to Myanmar and had become more oppressive, incarcerating democrats such as Nobel laureate Aung San Suu Kyi.
The twins should have returned every two years for new prosthesis. But contact was lost for more than a decade.
Dr. Pe Nyun, the founder of the Rangoon Children's Hospital, offers a clue: On the twins' final trip, their attendant, an uncle's chauffeur, defected. After that, Dr. Nyun guesses, "The Burmese government said: 'No more going.' "
When The Globe and Mail found out this spring that a Canadian businessman named John McBride was going to Myanmar, he was asked if he would help find the Htut twins. He didn't hesitate.
"I see it as part adventure, part Good Samaritan," says Mr. McBride, managing director of CC Capital Partners Group, a private investment company in Toronto.
Starting with the address of the twins' aunt and uncle, Mr. McBride was able to track down the Htut family, who now divide their time between Yangon (formerly Rangoon) and Sagaing, a town on the Irrawaddy River north of the ancient Burmese capital of Mandalay.
The twins share a bungalow there with their mother, a successful businesswoman who runs a sesame-seed oil plant. Their younger sister Moe Moe lives with their father in Yangon, where she attends hotel-management school and he is now deputy general manager of the Ministry of Railroads. His senior position means that when the twins make the long journey to Yangon, they invariably get an entire rail car to themselves.
Armed with a video camera, a list of questions from The Globe and his own curiosity, Mr. McBride asked about the twins' health and happiness.
The most dramatic news was that Win was a male once again. He made his choice of gender at 10 when he told his mother he was in fact a boy, and would always be a boy.
"Since I first had knowledge I was born a boy, maybe when I was five years old, I really wanted to be a boy," Win said in a soft voice pitched low enough to be of either gender. He said he has had no problems going from a boy to a girl and back to a boy again, and was never teased at school. The only trouble comes when he boards a train. The military government restricts movement by checking travellers' ID cards, and his still classifies him as a female.
Unlike Lin, who had a shadow of a mustache on his upper lip, Win's face was hairless, his eyebrows more delicate. At 23, they looked 13.
Their sarongs masked their missing legs. Like Heera and Shiva, Lin and Win seemed to sit the same way they were born -- Lin, who has no left leg, on the right; and Win, who has no right leg, on the left.
Lin had wanted to go to university, but when Win -- who dropped out before his final year of high school -- couldn't qualify, both went to trade school and became silversmiths. They supported themselves earning piecework wages of about $1.50 a day as craftsmen, hammering designs into ceremonial metal trays and pots for Buddhist temples.
To relax, the twins said they visited tea houses to watch satellite TV and cheer their favourite team, Chelsea Football Club.
Slender and gentle-natured, Win still has digestive problems, a curved spine and a left shoulder that spikes upward. Lin is in good health, and has become the bigger twin. His mother said he would like to marry, but he hasn't yet had a girlfriend. Doctors here say there is no reason he couldn't father children.
"These guys are completely self-sufficient," Mr. McBride says. "You've never met two more well-adjusted, content individuals in your life."
Both twins rejected their prosthetics about six months after their final trip to Toronto, as too uncomfortable in their country's suffocating heat, and took to whizzing around using one crutch each. Lin told Mr. McBride that he now yearns for a proper artificial leg, his parents speculating that it was because he wanted to start dating.
(A spokeswoman for Bloorview MacMillan said it could make them new prosthetics at a discount, if funds could be found to bring him back.)
Win said he had no interest in girlfriends. But neither he nor his family had any resentment for the doctors who performed the sex-change operation. "They were doing the best for Win," said their mother, Daw Tin Tin Myint.
For his part, Mr. Htut, who once had thought his sons would be better off dead, was profoundly grateful. "I shall always remember the kindness of the Canadian people," he said. "For us, it is unbelievable that the Canadian people are still interested in our kids."
Before leaving Myanmar, Mr. McBride gave Win and Lin a Canadian flag. The twins had forgotten virtually all their English, but looking straight at the video camera, they said: "Thank you, Dr. Conn. Thank you, Dr. Filler."
THE QUIET CANADIANS
All of the foreign twins at Sick Kids have been separated in a blaze of publicity. In addition to the twins from Burma and Trinidad, Hira and Nida Jamal from Pakistan received intense coverage. During their 1995 operation, doctors discovered they couldn't split the girls' shared vein to the brain. Nida received a smaller portion, suffered a stroke and died one month later.
Kamla Sharma, director of the international patients program, says that giving up anonymity isn't a condition of the Herbie Fund. "When an international child comes, we tell them, 'You have a choice,' " she says. "But a lot of them say, 'Who do I thank?' Their one shot on TV is their chance to say thanks."
Meanwhile, all but the first set of Canadian twins have remained anonymous.
"The Canadian ones don't want anyone to know," Dr. Filler says. "They don't want to be thought of as freaks."
The second pair of twins separated at Sick Kids, in 1971, were known only as Kristen and Heather. Hospital sources say they later died. Margaret and Susana, the daughters of Mennonite migrant labourers, were separated in 1994 and now reportedly live in a farming community west of London, Ont.
In 1996, Sick Kids separated Faith and Hope from Chatham, Ont. One later died of bile-duct problems. Another set was separated in 2003, and the surviving twin received a leg transplant from the dying sibling. Their names and gender were never disclosed, although one source told The Globe that they were sisters.
When doctors at Sick Kids separated their first set of Canadian boys in 1996, they even assigned the family a code name, the Williams. At the time, the hospital released the sparsest information: the twins were male, born at Mount Sinai hospital and shared a liver.
After nine years, with the boys thriving, their mother, Homi Karrys, agreed to her first interview.
She says she and her husband, Dean, already had an infant daughter when her obstetrician phoned after a routine ultrasound. "He told me, 'You are carrying Siamese twins. I've scheduled you for an abortion on Thursday at York Region Hospital. Be there at 9 a.m.' "
Mrs. Karrys, who runs two daycare centres, collapsed at her office. More tests confirmed the original results. She called her sister, who had once organized a telethon at Sick Kids and mentioned the chief surgeon.
Dr. Filler showed them a photo album of various twins he had already separated and ordered a battery of new tests.
"There's something about Dr. Filler," Mrs. Karrys says. "He calms you down. He gives you hope."
On April 23, 1996, after a difficult pregnancy, Mrs. Karrys gave birth to Artamis and Alexi. They weighed a combined nine pounds. Eight days later, Artamis's kidneys began to fail, so Dr. Filler and Dr. Zuker operated to separate the twins.
The boys had been joined in the same uncomplicated way as Chang and Eng -- a shared liver and a small bridge of flesh. "Whack, bam -- a two-hour surgery," Dr. Filler recalls.
Mrs. Karrys remembers that when the twins regained consciousness, they stretched their arms out, reaching for each other. "Each had a hand on the other one's ear."
Today, her sons suffer from croup, but are otherwise healthy. They bike, rollerblade and play hockey. And they get injured. Artamis has had two broken arms and more than 60 stitches from playground accidents.
"I wonder which time period gave us more grey hair," Mrs. Karrys says.
UNHAPPY FIRSTS
Canadian families with conjoined twins want privacy for good reason. Just ask Myrna McGee, the mother of the first twins Sick Kids ever separated, nearly 40 years ago.
The media staked out her home, even chased her husband down the hall when he arrived bearing a bouquet at St. Joseph's Hospital in Guelph, Ont. For years, on Mrs. McGee's daughters' birthday, reporters called for comment, but she was always too sad to talk. Indeed, she has never talked about her daughters to a reporter until now.
A fragile redhead with blue eyes and pale skin, the memories are hard and her thoughts come slowly. At 63, she sits in a steno chair that she uses to wheel herself around her bungalow. She suffered a crippling stroke nearly 20 years ago and no longer walks.
In 1966, Mrs. McGee and her husband, Leonard McGee, already had a three-year-old daughter. He was a long-distance truck driver. She worked at the Imperial Tobacco factory down the road. Her second pregnancy was uneventful until her doctor informed her, two weeks before her due date, that she was having twins. "I remember being shocked at the fact that I was having twins," she says quietly.
During her labour, as doctors prepped her for a cesarean section, she heard the nurses talking. "I remember them saying, 'Oh my god, they're Siamese.' At the time, I didn't have a clue. I just thought, 'Siamese kittens.' "
Like the Htuts in Burma, no one dared show the mother her babies. Instead, Sherri Lee and Crystal Ann McGee were rushed to Sick Kids. They arrived struggling, blue and on the verge of death.
The McGees visited them three times a week, but could look at them only through a window. Mrs. McGee wasn't allowed to breast-feed. Only once, she remembers, she was allowed to don a mask and go on the other side of the glass. "We could touch their heads. They were covered up, so we never saw how they were attached."
Like most conjoined twins, Sherri Lee and Crystal Ann faced each other. Joined from chest to navel, their livers were fused. A single pericardial sac wrapped around their overlapping hearts, which protruded into each other's chest cavities. The doctors didn't ask Mrs. McGee if they could operate. "They said there was no choice."
By the 1960s, Sick Kids was already performing open-heart surgery. But separating conjoined twins would be a first. Doctors were unsure how much anesthetic two joined babies would need, or how much blood they might lose. During a similar operation 16 years earlier in Edmonton, both babies had died during surgery.
Sick Kids rehearsed with dolls and flow charts. On the morning of their daughters' operation, Mr. and Mrs. McGee arrived early, but fled soon after because the tension was too great. At 5 p.m., they were told the operation had been a success.
In fact, however, Sherri Lee's heart was a problem. The doctors could not push it back into her chest cavity as they had done with Crystal Ann. "When we tried to put it back in," Dr. Conn recalls, "it would fibrillate, quiver and stop."
Just before midnight, Sherri Lee died. She was three months old. Mrs. McGee had never once held or kissed her.
To thwart the media, the McGees avoided their family plot in Guelph and found a spot in a quiet rural cemetery. "Surely, the reporters wouldn't know," she recalls thinking. "But a car pulled up right behind us, and two reporters got out, snapping pictures of the baby in the hearse." Enraged, Mr. McGee grabbed the camera and ripped out the film. Later, Mrs. McGee made him return it. "They might charge you with theft."
Months later, when Crystal Ann came home, Mrs. McGee's life became a blur of bandages, sleepless nights and doctors' appointments. After her factory shift, she would rock her daughter for hours. It seemed as though Crystal Ann cried non-stop. Her wound never fully healed. "Mind you, the doctors said she wasn't in any pain, but who knows? She never walked. She could never even sit up. She never even ever smiled. She didn't have any life, really."
Crystal Ann was 2 when the doctor advised her parents to put her in the Sunbeam Home, an institution for disabled children in Kitchener. They visited weekly, but Mrs. McGee says she never recognized them. She died at the age of 4, when the McGees were away on their first vacation. The doctors never gave them an explanation. Crystal Ann was buried in the family plot. Later, they moved Sherri Lee there.
Several years later, Mrs. McGee had a nervous breakdown. Her doctor said it was a delayed reaction. After 12 shock treatments, she went back to work at the tobacco factory.
"What can you do, eh?" she says. "You can't do anything. That's life."
Nearly 40 years later, Mrs. McGee doesn't have a single photo of her twin daughters. Once upon a time, Sick Kids had taken one, which she kept on her mantel. Every time she looked at it, she would cry. "Finally, one day my husband said, 'I'm taking it away.' "
Mr. McGee died of heart disease at the age of 51 in 1992. She never learned what he had done with the photo.
THE LATEST WONDERS
The most recent pair of twins to be separated at Sick Kids have brighter prospects. They're also the only case in which Sick Kids admits initiating coverage. "Somebody will find out anyway," said spokesperson Lisa Lipkin. "So we asked, could we release a photo?"
Tinashe and Tinotenda Mufuka arrived at the hospital in December, weak and emaciated, from Zimbabwe. Their matching cleft lips and palate had prevented them from properly feeding. While staff at Sick Kids tried to fatten them up, doctors tried to understand exactly how they were joined.
Their operation in March, led by Dr. Langer, lasted a mere five hours. The babies, then eight months old, were conjoined at the chest, and shared a liver. The thin scars across the top of their chests healed fast. Less than three weeks later, therapists at Sick Kids were teaching them how to sit up alone.
Their mother, Elizabeth Mufuka, a single parent who lives in three grass-roofed huts without running water or electricity, has had no trouble adapting to downtown Toronto. With the help of volunteers, she and the nurse who came with her from Zimbabwe, Grace Chirinda, have window-shopped at the Eaton Centre, visited the CN Tower and seen the Lemony Snicket movie at a theatre.
"But we are craving sadza," says Ms. Chirinda, referring to the mainstay of Zimbabwean cuisine, maize porridge.
Ms. Mufuka, who farms with a plow and ox, is fretting about the harsh drought back home. "They didn't harvest enough food," she says through Ms. Chirinda, who translates for her. Meanwhile, two of her other children have stopped going to school because no one paid their fees. Her 10-year-old isn't brushing her teeth. "She just eats the toothpaste," Ms. Mufuka says.
Ms. Mufuka is a tall, striking woman with the cheekbones of a supermodel. With a huge smile, she says the biggest change, since the surgery, is choosing which son to pick up when they're both crying. Ms. Chirinda says Ms. Mufuka always chooses Tinotenda, the smaller one.
At that moment, the twins return from physiotherapy. Tinotenda starts crying. His mother picks him up and cuddles him. Then Tinashe starts wailing, and the nurse picks him up and cuddles him too.
FOREVER JOINED
The Ramkhalawan twins haven't followed the progress of the babies from Zimbabwe. They're too busy with school, basketball and girlfriends. The only other conjoined twins they've actually met were Lin and Win.
Heera and Shiva were 10 in 1994 when Lin and Win, then 12, dropped by for an afternoon visit. The boys had no common language. Heera and Shiva have only faint memories of the visit, but Mr. Ramkhalawan recalls the older boys scooting around on crutches.
"I remember feeling sorry for them," he says. "They only had one leg each."
As with the Burmese twins, separation surgery was only the beginning for the Ramkhalawans. They've had so many operations, their father lost count. In 1990, their parents applied for landed-immigrant status, citing the twins' unique problems and the high cost of colostomy bags in Trinidad. These normally wouldn't be valid reasons for immigration, but afterthe story reached the media, Ottawa processed the application. In 1998, the family became Canadian citizens.
Mr. Ramkhalawan, who works for the Toronto Transit Commission, and Mrs. Ramkhalawan, a teaching assistant, remain highly protective.
"Our curfew is 8 p.m., and we're boys and we're 20 years old," says Shiva, who studies business administration at George Brown College.
"Once we stayed out until midnight," says Heera, who is taking computer programming there. "Our parents were crying, they were so upset."
But the twins don't rebel. Instead, they point out a plaque on the kitchen wall. In 1984, when Mr. Ramkhalawan stayed home to care for them, a local women's group named him "Most Outstanding Father of the Year."
Over a lunch of chicken chow mein at their favourite Chinatown restaurant, the twins sit bumping arms. Shiva is left-handed and Heera is right-handed (just like Lin and Win and Artamis and Alexi).
Heera and Shiva always position themselves this way -- it's the way they were fused in the womb. They say they had never noticed before now, but in their double bed, the living-room sofa or at the restaurant table, Shiva is always on the right, Heera on the left.
Today, they might as well be conjoined. They've never spent a night apart. They fall asleep at the same time. They share the same friends, clothes, laptop and cellphone. There's no need for two cellphones. If you get Shiva, Heera's right there.
"We're always together," Shiva says. "We can't go a day without knowing where each other is."
Do they follow each other around even on dates? Heera snorts, "No, of course not."
Shiva teases: "He sits home and wonders when I'm coming back."
Jan Wong is a feature writer for The Globe and Mail.
Next in the series: Canadian ingenuity deep undersea. Monday in The Globe and Mail.