Carla Hartenberger

In the pages of a textbook of landmark surgical cases, my brother and I hold each other at birth, bond crafted in tissue, amphibious. Straining in opposite directions, we fight out blood from double aortic arches; four legs kicking, counter breaststrokes, submerged in each other’s chests. We enter the world screaming in tandem, beholden to one another. This is Cook County Hospital, northern Ontario, 1983. There are the nurses watching us under warming lights and our mother wringing her hands in recovery. We will be lucky, they tell her, to survive the night. In fact, we do survive the night. And the next. By the time we celebrate our first birthday, we’re babbling and flinging vegetables from our highchair; our body is its own thriving machine, and we have become something of a celebrity in our town.

Aristotle’s organ-based logic: two hearts equals two beings. Did one then, beating between us, imply a unity of our souls? The questions whispered by neighbors seemed expectant: Do they share sensations? Does one feel the other’s pain?

There were nights spent raging back and forth in the sheets for a better position to sleep. I felt that a demon clung to me inside my skin, some kind of shadow self. My brother’s face, lidless eyes and crudely formed features, described as rudimentary in one text, seemed to me subhuman, a parasite leeching my life away from me. My spine grew lordotic from straining, constantly, away from him, and I promised myself to find a way, one day, to freedom.

I once saw a photograph in a fashion and culture magazine of a legless man doing a push-up. It was a black-and-white shot of the muscular raised torso with a small-print caption below that described the trucking accident that had cost the man his lower half and the lawsuit that had paid for his rerouted digestive system. It turned out to be one of those inspirational advertisements for a brand of water, touting the resilience of the human spirit. My thought looking at the picture was—legs, arms, stomach, spleen—how much of the body can you throw away?

Cook County, 1995, twelve years old: Before we learned to feed our mare carrots from a flat hand, she snapped the tip off my middle finger. We searched out the stump in the grass along the fencepost, and in the emergency room the doctor restored it. The sutures dissolved and in a few weeks I could catch a baseball and tie my laces like nothing had happened. And so, I began to form the idea that splitting apart could just be a sort of refashioning, the pieces of our body like our mother’s MacLean’s catalogue dress designs that could be stitched and sewn. And, I explained to my brother as I searched through the cupboard of kitchen appliances, we could do it ourselves.

I knew from the barium tests in the hospital that our intestines were separate, but our peritoneal cavities communicated. One liver between us had migrated to our middle before birth, where it set itself up sideways and did its work through our shared bile duct. We set up a little armamentarium of tools on a hand-towel in the barn: knives, nail scissors, blades from a Bic razor dislodged from the pink plastic handle, clipped chicken-wire, a bottle of rubbing alcohol. I considered the possibilities; it could be something like carving a pumpkin: off with the top of our bulging omphalocele and down to our diaphragm digging out the gloop of our organs. Or we could take one side each, split ourselves like halving an apple, beginning at the top of our sternum and sliding under to meet at our heart, where the fine work would begin.

“…This isn’t a good idea. I’m going to—”

“—not going to bleed out. It’s going to be fine if you’re fast enough—”

“—enough pressure, but if you’re distracted I’m—”

“—not going to be distracted—”

My brother picked up the utensils and examined them one by one, making gruesome faces at his reflection in the shining metal. I negotiated our new blueprint with a felt pen over our skin and held a bag of frozen peas to numb our chest. A bastard litter mewled pitifully up in the rafters. I steadied my hand on the blade of the boning knife.

The first thing we cut into, the doctors would later explain in the emergency room when I surfaced back to consciousness under the stern pulse of OR machinery, was the squishy hyaline cartilage between a couple of upper ribs, which buffered the blade enough to blunt the nicking of bone on the way to our xiphoid. Normally our breathing seesawed back and forth, but the bags that breathed for us in the recovery unit forced us to synchronize. My brother was in a coma, sleeping peacefully against my shoulder. The CT scan showed shadows in his brain where he’d suffered a stroke from a hemorrhage where we’d cut into arterial blood vessels. We would be in for a long wait. I looked down at our chest, which was sealed with a white binding. The doctor advised me to wait until further along in the healing to inspect the area, and motioned for our parents to follow him into the hall for a talk.

Teratology: the study of physiological abnormalities. From the Greek teras, meaning monster, and also, marvel. Can the definition of a human body expand to a person with two heads? Three legs? Some twins share a bladder, an anus, a birth canal. There are twins whose connection is fleshy and flexible enough to turn cartwheels one at a time, and there are some—like those born with their brains bound together—whose connection locks them into a steadfast, lifelong interdependence. Ours was somewhere in the middle. We could twist around just far enough to face ourselves side-by-side in the mirror. We could walk forward together, crabwise, but if one of us stopped suddenly we would change course or turn in circles.

My brother’s stroke encumbered us considerably. We lilted through our days and I exhausted myself lifting his slackened weight like a bag of sand. We found ourselves stuck in shopping mall turnstiles and soft couches. We sweated through those first months in remission and when we made the mistake of sitting in public for a break, it would take both of our parents or a few good Samaritans to help us to our feet.

We started going to the YMCA community pool to perform a set of physiotherapy exercises prescribed to us, motions like semaphore underwater. They were supposed to help us build back strength and re-establish the procedural harmony that our day-to-day choreography required: fitting together on a toilet seat, preparing breakfast. I hated these sessions, but the water was the only place my brother seemed to be at home. We found that we could hold our breath for an unusual length of time, and if we coordinated our strokes we could stay upright, mermaid-like, to tread. He wanted to swim laps together, to move with speed; staying buoyant involved countering each other’s motions—on my end, tensing up enough to lift against the dips of his front crawl, on his, stretching skyward to keep his head above the surface.

The pool was open early, and our mother would drive us there before school started. Pulling into the parking lot one morning, she pulled the keys out of the ignition and froze. She’d forgotten a meeting, she said. She stepped out of the car and we sat inside while she made a phone call. Through the window I watched people walking to their cars, gym bags over their shoulders. I imagined the places they were headed. An office somewhere in town. Maybe to serve customers at a restaurant, or teach students in a classroom. Maybe they had a family they’d go home to, sit down with at dinner, kids to put to sleep at night. I wondered if this would ever be me—running off on a whim to meet a friend for coffee, picking up dry-cleaning for a date in the evening. My brother was making buzzing noises over my shoulder, pushing little balled-up pieces of Kleenex into the car seat between the cracks. What kind of life would be ours?

“I’m not going,” I said. Our mother had come around the side of the car. I gripped onto the back of the seat.

“You’re going.” She put out her hand and my brother reached for her. I held on. He strained against me. She put her arms around me from behind and grabbed my brother under his armpits, wrenching us from the seat and kicking the door closed with her foot, dragging us flailing across the gravel.

In the water, my brother was doing his side of our routines. A tall girl in the shallow end practiced handstands. I scanned the bleachers, but I’d lost sight of our mother. I turned to the other end of the pool but I couldn’t find her. My brother was resting now on my shoulder. I pushed him off. He sputtered and kicked me with a weak thrust, and I leaned forward and dunked him underwater. When I let him up, he was coughing, and I plunged him forward again before he could take a breath. He swung at me in slow motion, a wild stroke that cleared my head by several inches. I watched his expression under the water morph in panic.

In nature, beings in shared bodies fight to their own detriment: two-headed snakes battle each other over food to the point of starvation. Dicephalic turtles, when they sense a threat, will try to retract both of their heads into their shell at the same moment, preventing either from retreating. By the time people were lifting us out of the water, I was gasping for air too. We were being rolled onto our side, coughing together on the tile.

That night, we could hear our parents fighting in the living room. There was a kind of wedge that seemed to have been driven between them since the incident in the barn six months earlier. We snuck to the edge of the stairs and sat down to watch. Our mother wanted to hire a full-time support worker to monitor us. I just can’t be there every second, she snapped. We can’t afford it, said our father. In the end, they both agreed that we required resources that Cook County could not provide, so we packed up our things, and set out for the city.

Cabbagetown, Toronto, 2003: We are twenty. Waiting for an appointment in a clinic lounge. That morning, an American politician had been found not guilty of first-degree murder due to a seeming quirk of legal proceedings, and the news stations were in a frenzy with footage of bodyguards folding him through the crowd of protestors into his SUV. Nurses and patients emerged to watch the hysteria and drink coffee.

“That could be you guys up there,” said a girl next to us, pointing to the screen. “Think of the crimes you could commit. They’d never be able to imprison you as long as one of you was innocent.” She drank from her Styrofoam cup and her sleeve fell down her arm a little, just below the band of her hospital bracelet.

The girl’s name was Jen. Jen had a sarcoma in her pelvis. The way she described it to us later was a small, round mass eating her up, like Pac-Man for your bones. She was getting treatments every couple of weeks and we began to see her there regularly. Her skin was salamander-like from radiotherapy. When I think about it now it reminds me of the Buddhist technique that’s supposed to help you let go of romantic longing; you picture the object of your affection as their skeleton, every bone in their hand, the churning contents of their stomach, the mortality of their body grounding you in the mundane.

Jen was two years older than us. She wanted to go into law. She was studying for her LSATs that winter, and began coming over to our house after classes to lie on the bed and practice logic games. “I could be making so much money off you circus freaks,” she liked to say. “We need to get serious if I want to put down tuition next year,” and she thought up tricks we could perform. She would edit our term papers for us if we bothered her enough, but she thought it was funny to mess with the pronouns: We is deconstructing postcolonial identity; I are comparing continental philosophers.

She liked to try and push us to get out of the house. “What are you so afraid of?” she’d ask.

“Large groups of little kids,” we’d answer. Or, “cell-phone cameras.”

“You can’t control that stuff, silly,” she’d say, and kiss us on our heads. “So stop worrying.”

The summer we graduated university Jen convinced us to come with her and a few friends on a drive up to the Sandbanks, a big baymouth dune formation in Prince Edward County near Picton, Ontario, in mid-July. It was so hot the shade felt wet. My brother didn’t like the sun, so we stayed back with the bags while Jen and the others stripped to their swimsuits and ran out towards the water. Jen’s body had begun to diminish, and her swimsuit hung loose on her hipbones. One of the guys with us picked her up and carried her over his shoulder, and she squealed and swatted at him until they reached the shoreline, and then she gripped on tight, pulling her feet up, away from the water.

Jen was a hopeless romantic, I think. I once found a story she’d written about a man who hears his neighbour playing the piano through the floorboards and falls in love with her without ever meeting her. I thought about it that afternoon, trying to determine if her descriptions matched anyone in the group. The tide that day was strong. Everyone was piling onto a blow-up hippo raft and paddled hard against it, fighting their way back, but they were carried too far out. I watched the little dot of Jen in the distance. It looked like she’d jumped off and was having trouble getting back on to the raft. I stood up halfway, trying to find her dot. Bulging plastic hippo eyes dipped in and out of the waves and my brother pulled me back down. Jen’s head appeared and disappeared again, and I forced us to our feet. I dragged closer, and pushed us into a stumbling jog through the sand towards the shoreline.

The water was freezing cold. We swam past the raft, angling against the undertow with the coordinated strokes we’d practiced so many mornings in Cook County. Then we spotted her, mouth gaping open before she went under. We pushed forward until we felt her in our arms, and leaned back together to pull her to land. I remember her wet hair plastered to my neck as we were laying her down, and the rash on the side of her face where she’d been dragged along the floor of the bay; she’d be sick for the next few days from swallowing too much water.

Once she was talking again, she was protesting that she didn’t want to go home. She wrapped herself in towels and curled up beside us next to the cooler, and we stayed that day until it was dark. We made a fire-pit in the sand and sat around it in the evening talking about our futures, and Jen murmuring something about how the moon was spiraling slowly away from the earth, some centimeters per year. It was full that night, or nearly. I tucked the corners of the towel under her neck, watching her blue lips ramble.

Within anomalous groups, you will always find further anomalies. In 2001, Australian sisters were born connected upside-down at the back of their heads; one girl’s cerebellum flowered into the other’s through a hole in their crania, and they were joined at a vital sinus: a type of twinning previously unrecorded in medical literature. In 1958, there was the case of French girls joined in the shape of an ‘O.’ A Polish report from 1897 followed a case of conjoined triplets. Our aberrant heart piqued widespread interest for its lamp-like shape and the strange variations in our intra-hepatic network. Visiting academics were often invited to sit in and observe our exams. This bothered my brother, who recoiled away from anything that felt like prying. But I knew that it was our duty to share our intimate anatomical details. That our body belonged to history. I tried to use these opportunities to ask what new surgeries were becoming possible. I brought in newspaper clippings after the first successful double-hand transplant surgery, reading out an interview with the man who said he could now feel sensation in the donor’s fingertips.

We found ourselves in East General Hospital one afternoon after tripping down a flight of stairs. We sat on the cot in a large gown, waiting to have scans taken to see if we’d injured my brother’s back. At a table in the corner, I noticed a man in plain clothes, quietly slipping slides into laminate. I felt like I’d seen him many times before, but no name came to me. “Are you on TV?”

The man looked up and put down his work. “No,” he said, smiling. “I’m a researcher. I live in California.” When he saw me still studying his face, he stood up and walked over to us with the portfolio he was holding. “I’ve been following your case since you were born. I’ve visited from time to time.” I could feel my brother twisting slightly to watch in his periphery, and the man bent over to introduce himself, Dr. Ramirez, nice to meet you, nice to meet you. I asked to see his notes, and he sat down beside us.

“This is when you had your liver infection last year.” He pointed to a series of angled close-ups of the abscess before it had been drained, and my brother turned away, facing the wall. “And here—”

“—that’s when I drank the laundry soap,” I said, pointing to a photograph of a tube snaked down my esophagus. I turned to a slide of our ribs. “And this is when I jumped off the garage.”

“That’s right, here’s the fracture.” Dr. Ramirez flipped to find an angle that showed the full view of the site where our bones had crunched together.

I turned over a new tab in the folder and fanned out a sequence of X-rays. This next section was a series of coronal cross-sections, marked-up circulatory maps and blood-pressure charts. There were illustrations drawn by hand: conceptual diagrams, apparent visualizations of ways our heart could be dismantled and reconfigured. My brother was swinging his legs around off the edge of the cot, crumpling the paper cover. A nurse had finished taking our vitals and was asking us to stand, this way please, over to the room down the hall. I needed more time with the portfolio. “Can I keep it?” I asked, gripping onto a corner.

Dr. Ramirez stood up with us and pried it gently from my hand. “I’m afraid not,” he said. I let go.

“But I need your help,” I said, and tried to explain. As the nurses began to usher us away, he scrawled a phone number on the back of our chart, and said he’d be in town until the end of the week.

There is more opportunity for creativity than you might imagine when designing a separation. When I met the next day with Dr. Ramirez, he showed me articles on Nigerian doctors who’d reconstructed one twin’s eyelids from tissue under her sister’s tongue, and records of a German couple who’d reassigned gender to one of their twins so that the other could retain the penis they’d shared. It’s more about imagination, he was saying. I would be up late that night at the computer, unscrambling the terminology in the papers he’d photocopied.

Jen called us one day in the middle of the afternoon from a bar near her school. She’d finished her last exam, she said, and wanted to celebrate. My brother was watching a made-for-TV drama set in the middle ages. He’d refused to shower for a couple days, and it took some convincing to get him up to get dressed. We took the bus uptown and found the place Jen had described. Inside, we waited for our eyes to adjust to the dark and maneuvered around the sticky tables to find where she was sitting at the bar. She was talking to a man with glasses and trim black hair. She introduced him, another law student, Jackson, she said, while holding onto his forearm.

The bartender was leaning over the ice trough to get my attention, and my brother was twisting around and waving him away, no thank you, but I called him back and ordered an amber lager, and when the bartender set it down I ignored my brother’s objections. I finished off the pint myself and Jen had gone outside to feed the meter. Jackson was talking about brands of digital cameras, and my brother was swooning forward sloppily, garbling nonsense sounds. His leg hit me under the table. I kicked him back. The bartender took away my empty jug, and as I was ordering another round, my brother stood us up in protest—no more for us, we’re fine as we are.

He took a long step sideways and Jackson reached out to steady us, but I wheeled around and struck his hand away. My brother sidestepped again, pulling us back from Jackson, and I pushed against him. His back hit a table and he swung around, knocking me over a chair, where we both toppled sideways to the ground. I imagine people were gathering around us when we started striking at each other, and I could hear Jen’s voice somewhere in the air like a lovely urgent bird. My brother shielded himself from my downward blows, and even though I leaned over and vomited instantly after I shouted that I was retaining legal services to pursue our separation, I would stand by my decision in the morning.

2005, age twenty-two: In a courtroom in Queen’s Park, with our lawyers on either side of us on benches in the middle of the hall, our trial began. My brother had filed a countersuit against me for endangering his life. The judge passed down an order for the assembly of a team of experts to determine the viability of Dr. Ramirez’s proposal. Echocardiography, MRIs, and gastrointestinal contrast studies were conducted. My brother would keep our heart. Mine would be transplanted from a donor in an orthotopic procedure. Two halves of our liver would be re-grown outside our bodies, our abdomens reconstructed. We would be attached to a heart-lung bypass machine and our body temperature would be lowered to 68 degrees, bringing us to hypothermic arrest. I’d read reports of twenty, thirty member teams preparing for eighty-, ninety-hour operations; our plan involved a series of procedures over seven weeks during which doctors would insert tissue expanders to increase the girth between us.

Jen followed the trial with studious excitement and weighed in on the developments whenever she would take us out for lunch after the hearings. In August, the court heard arguments on whether the doctors operating could be charged with homicide should my brother not survive the surgery, and in September the decision was read. A mob scene converged along Wellesley Street and a riotous group kept pace behind us as we exited. A hand reached out and folded Canada’s Pro-Life Alliance literature into my brother’s, holding it tight. “We can help you!” a woman’s voice urged. “You can leave the country! You’ll be safe in Europe!

A few days before we were scheduled for surgery, Jen showed up at our door with a bunch of dogs—maybe eight or nine—on a cluster of leashes, all clamoring at our door like a slobbering, happy version of Cerberus at the gates of hell. My brother and I were at the end of the five-month period it had taken the doctors to prepare for our separation; they’d practiced on life-sized dolls stuck together with Velcro; each person knew exactly where they would stand on the floor at all times, as if they were staging a military coup. Jen coaxed us out for a walk in the ravine. She said she wanted to talk about what she planned to say in her job interview that week at a firm downtown. She had her hair pinned back neatly in a twisty style at her neck, and despite her skinny arms she was able to hold the group of dogs at a heel. When we reached an opening at the bottom of the slope, she released the dogs and they all ran for the same bird in the grass. She told us she’d heard the results from her latest round of tests. “It’s not good news.”

Janus: a cephalophagus type, one head looking to the past, one to the future; initiator of new historical ages. During the slow, flat hours lying in recovery, I asked to see footage of the surgery. The nurses let me watch on a laptop while my brother slept in a bed across the room. Later, our father showed me the photographs he’d taken from the landing pad where he stood breathlessly with our mother waiting for the helicopter that had airlifted the donor heart on ice. Our aunts and uncles, cousins, friends, and journalists came to visit. And, of course it was silly, but I couldn’t keep from looking at the door, as if Jen might materialize and come strolling in any minute, flop down on one of our cots and say, “Something’s different. Don’t tell me—you’ve lost weight? Changed your hair?”

Some time after the operation, my brother moved into a group home with full-time support workers to attend to him. He’d been back in the hospital a handful of times for infections, and had several reconstructive surgeries on his colon. He’d relearned to walk on a treadmill with a coach and a brace to keep him from tumbling forward where he used to lean against me. I found an apartment and moved to Manhattan, and began medical school.

It is astonishing to think how quickly I began to feel that things had always been this way, that we had always been separate. One year passed. And the next. We didn’t speak. My new world was lecture halls and meals from street vendors between classes. My new world was coffee dates and friends filling my apartment on weekends, nights on the fire escape watching the city below. The life I’d shared began to fall away, one memory at a time.

It was close to our thirtieth birthday when I stopped in the middle of washing dishes in my apartment, one afternoon. The water running over my hands was freezing cold. I held them together under the tap until it pooled. I wet my face. There was something there in the sensation, but it was submerged, like trying to remember a dream. With the tap still running, I walked to the phone and found myself dialing. The line rang. I held my breath. After a minute my brother picked up. Hello, how are you, fine, how are you. Do you remember that day? I was saying. We were on the beach. Please, start from the beginning.

His voice was so close on the phone, he could have been right there resting against me, murmuring again over my shoulder. “It was so hot that day, the shade felt wet,” he began. “The water was freezing cold.” If I squinted out the window at the traffic, I could almost see Jen’s dot in the waves. Describe her hair, I said, describe the raft. Yes, it was real, my brother said. I was there, too. This happened. I held on tight to the receiver, leaning back against him. 