Conjoined Twins Twin Girls Krista and Tatiana Hogan, A Medical Wonder. Conjoined Twins Twin Girls Krista and Tatiana Hogan, A M edical Wonder Part 1 of 2: Read the second instalment in Saturday's paper …More
Conjoined Twins Twin Girls Krista and Tatiana Hogan, A Medical Wonder.
Conjoined Twins Twin Girls Krista and Tatiana Hogan, A M
edical Wonder
Part 1 of 2: Read the second instalment in Saturday's paper or at vancouversun.com.
Tatiana and Krista Hogan hold hands.
The twins are as delicate as the fairies for whom they were named, small for their six years on earth, with pale skin, long feathery lashes and pretty, glacial green eyes.
Their heads tilt gently toward each other as if by choice, or a gesture of affection, the exact place where their skulls are fused barely visible behind wisps of brown hair.
When they sit, or kneel on the ground to page through a book, their bodies lean in, head-to-head at the tip, then arc to either side, outlining the shape of a single, perfect heart.
Today they perch on a sofa between the two women raising them in Vernon — their grandmother, Louise McKay, and their mother, Felicia Hogan.
Louise covers Tatiana’s eyes.
Felicia holds up a small stuffed animal in front of Krista’s open eyes.
“What am I holding?” she asks Tatiana.
Tatiana, her eyes completely covered, hesitates.
Her mother prompts her. “Tati, look through your sister’s eyes.”
There is a pause, a breath held.
Then Tatiana, eyes covered, somehow floats into her sister’s brain: “The Lorax!” she announces.
In order to see through each other’s eyes there is some internal shift, a decision, as if each sister’s soul moves over and makes space for the other.
The moment, repeated at will or on request, is as magical every time as the last. Each girl can see through the eyes of the other: a purple crayon, a teddy bear.
Recent functional MRIs demonstrate that physical sensation can be a shared experience too: one can feel the touch of a hand on the other’s kneecap, identify a particular toe being tugged, laugh when her twin is being tickled. They also may share some motor function.
This seemingly magical ability — to see through each other’s eyes, to feel what the other experiences, perhaps even to share thoughts — has stunned neurologists and makes these tiny girls unique in the world.
They are conjoined not just by flesh and bone. Their brains are “zippered” together by a neural bridge between the thalami, the sensory processing hubs of their brains.
This bridge, which the girls can flitter across at will, has raised questions and inspired a sense of wonder among even the most seasoned specialists.
How does it work? What are its limits? What could it mean to our understanding of the ability of the brain to change and adapt? What does it mean in terms of how we understand the development of personality, empathy and consciousness?
What does it feel like to literally see through another’s eyes?
See more pictures of Tatiana and Krista Hogan here
Their grandmother, Louise, has more practical questions: What is it going to mean as the girls, now in Grade 1, go through school?
Krista’s a prankster to begin with, she explains. A universe of startling possibilities instantly comes to mind: one learns the math for both, one writes the test for the other.
“We’ll just have to see,” says Louise.
From the beginning, Tatiana and Krista were extraordinary.
Their emergence, first on the murky black of a radiologist’s screen, like the appearance of an unexpected comet flaring in the night sky, generated both alarm and awe.
Doug Cochrane, a neurosurgeon at B.C. Children’s Hospital, was part of a multi-disciplinary team assembled to attend the birth and followup care of the girls in 2006.
He had never worked with a set of craniopagus twins; conjoined twins are extremely rare and those joined at the head are the rarest, with an occurrence rate estimated at one in 2.5 million births. Few survive.
The coming birth became an event for the world to watch as, behind the scenes, physicians and a family prepared for the unknown.
Everyone had questions. Should Felicia, a 20-year-old single mother of two, carry them to term? If she did, would they live? If they lived, what kind of life would they have?
Conjoined twins have historically elicited fascination, not only for their difference and rarity, but perhaps also because in them we see the embodiment of soulmates: two beings fated to live as one, a physical expression of what Plato considered an eternal longing for unity with another, that each human is “driven by a deep longing for its other half, for another to love as oneself.”
Best friends are described as “inseparable” or “joined at the hip”; in romantic love we promise till death do us part.
The Biddenden maids, who lived in AD 1100 in Biddenden County, Kent, England, are one of the earliest documented sets of conjoined twins. Eliza and Kate, joined at the hip and possibly the shoulder, lived for 34 years. According to the story, doctors offered to attempt a separation when one twin died. The remaining twin declined, stating “as we came together, we will die together.” She died a few hours later.
Conjoined twins have also provoked the dark side of human nature and imagination: fear. They were often depicted as monsters, examples of black magic, God or nature gone horribly wrong, destined for lives as circus freaks at best, vulnerable to exploitation and suffering at worst.
As surgical techniques improved throughout the 20th century, separation became the ideal. For the public, a separation story had it all: medical drama, life-and-death stakes, children.
“At the time,” Dr. Cochrane says, recalling the twins’ birth, “the immediate reaction to conjoined twins was, ‘gee whiz’ you’ve got to get them separated. You’ve got to make them normal. They’ve got to fit our social context of what normality is.”
Dr. Cochrane knew that somehow the twins would have to tell him what was optimal. “I became a member of one of the teams trying to support the family and learning with them.”
The first thrill came when they were born, more than six pounds each, perfectly formed, crying lustily, stronger and healthier than anyone anticipated.
The girls, who arrived Oct. 25, 2006, were healthy enough to go home by Christmas. Media interest was intense as the possibility of separation hung like a tantalizing second act: Tyra Banks flew Felicia and the infants to Hollywood for a taping of her TV talk show.
Right away, imaging revealed the depth of their brain connection, their unusual wiring.
“All along we knew that these kids were connected in a way that was different than other craniopagus twins, so the risks of separation would be different than what we might reasonably expect in other circumstances.”
Each child has a fully structured brain, two cerebral hemispheres, a fully formed brain stem, cerebellum and spinal cord. There was also the bridge of tissue, through which neurological information might be shared; within days of their birth, it became apparent that if one twin was pricked with a needle, the other would cry.
Cochrane found the mere thought of separation “frightening.”
Their particular combination of features presented what would be a huge social and physical challenge if they were to live conjoined, but the alternative, he was sure, was worse.
He concluded it was not possible to separate these children without creating a neurological injury more devastating than what they now have to deal with.
“It’s not my role to create injury for the sake of social conformity.”
The decision rested with Felicia. She would have to be thoughtful and courageous. In spite of criticism from ethicists, many of whom believed she should have terminated the pregnancy, the family decided not to risk a separation surgery.
Cochrane is used to the interest in the girls — documentary crews and journalists have knocked on his door, medical experts around the world stay in touch — but when he speaks of the twins, it is with wonder. Beyond the neurological intrigue of their shared brain matter is something unquantifiable.
“They give us the opportunity to appreciate the differences and similarities we all share; we are all human, they are very much human. The fact that they are different just makes them something to be cherished, and not something that goes into the circus.”
Enter the circus
The circus has already come calling. Hollywood agent Chuck Harris, 75, has signed the family. Harris, the so-called Wizard of Odd, represents curiosities like the fire-breathing midget, “Wolf Boy,” and the world’s longest surviving set of craniopagus twins, the 51-year-old Schappell sisters.
Harris has gained the trust of the family and hopes to bring the twins to the biggest big top of them all: reality TV.
Over the phone from Los Angeles, Harris says the Oprah Winfrey Network is interested.
Despite a career as a sort of sideshow barker, Harris convincingly frames his interest in his clients, and the family, as altruistic rather than predatory.
“I represent a lot of oddities, but not because I make a lot of money. Someone has to care for these people. No one cares for them.”
Harris confides that he is concerned about the family’s living conditions. The girls share a tiny warren of rooms in two cramped ground-level apartments with an extended family of 14, including several cats, guinea pigs and a dog.
His voice drops quietly. “The way they are living right now, it’s not good. I just want to help out.”
A few weeks ago, Harris helped the family set up a website on gofundme.com, with hopes to raise $500,000 in order to buy a home suitable for the girls. After a month, only $205 has been raised.
It kills him.
The jury is still out on whether the reality show will get picked up; the family doesn’t share the apple-pie appeal of American conjoined twins Abby and Brittany Hensel, whose “reality” as portrayed on their hit TLC show seems cheerfully perfect. They drive! They’re boy crazy! They’re just like you and me! (Except, of course, they’re not.)
Any part of their reality that includes struggle, fear or limitation hasn’t made it onto the screen.
Complicating things is the issue of consent. Abby and Brittany, who share a torso, are 22. Tatiana and Krista, who have just turned …
Conjoined Twins Twin Girls Krista and Tatiana Hogan, A M
edical Wonder
Part 1 of 2: Read the second instalment in Saturday's paper or at vancouversun.com.
Tatiana and Krista Hogan hold hands.
The twins are as delicate as the fairies for whom they were named, small for their six years on earth, with pale skin, long feathery lashes and pretty, glacial green eyes.
Their heads tilt gently toward each other as if by choice, or a gesture of affection, the exact place where their skulls are fused barely visible behind wisps of brown hair.
When they sit, or kneel on the ground to page through a book, their bodies lean in, head-to-head at the tip, then arc to either side, outlining the shape of a single, perfect heart.
Today they perch on a sofa between the two women raising them in Vernon — their grandmother, Louise McKay, and their mother, Felicia Hogan.
Louise covers Tatiana’s eyes.
Felicia holds up a small stuffed animal in front of Krista’s open eyes.
“What am I holding?” she asks Tatiana.
Tatiana, her eyes completely covered, hesitates.
Her mother prompts her. “Tati, look through your sister’s eyes.”
There is a pause, a breath held.
Then Tatiana, eyes covered, somehow floats into her sister’s brain: “The Lorax!” she announces.
In order to see through each other’s eyes there is some internal shift, a decision, as if each sister’s soul moves over and makes space for the other.
The moment, repeated at will or on request, is as magical every time as the last. Each girl can see through the eyes of the other: a purple crayon, a teddy bear.
Recent functional MRIs demonstrate that physical sensation can be a shared experience too: one can feel the touch of a hand on the other’s kneecap, identify a particular toe being tugged, laugh when her twin is being tickled. They also may share some motor function.
This seemingly magical ability — to see through each other’s eyes, to feel what the other experiences, perhaps even to share thoughts — has stunned neurologists and makes these tiny girls unique in the world.
They are conjoined not just by flesh and bone. Their brains are “zippered” together by a neural bridge between the thalami, the sensory processing hubs of their brains.
This bridge, which the girls can flitter across at will, has raised questions and inspired a sense of wonder among even the most seasoned specialists.
How does it work? What are its limits? What could it mean to our understanding of the ability of the brain to change and adapt? What does it mean in terms of how we understand the development of personality, empathy and consciousness?
What does it feel like to literally see through another’s eyes?
See more pictures of Tatiana and Krista Hogan here
Their grandmother, Louise, has more practical questions: What is it going to mean as the girls, now in Grade 1, go through school?
Krista’s a prankster to begin with, she explains. A universe of startling possibilities instantly comes to mind: one learns the math for both, one writes the test for the other.
“We’ll just have to see,” says Louise.
From the beginning, Tatiana and Krista were extraordinary.
Their emergence, first on the murky black of a radiologist’s screen, like the appearance of an unexpected comet flaring in the night sky, generated both alarm and awe.
Doug Cochrane, a neurosurgeon at B.C. Children’s Hospital, was part of a multi-disciplinary team assembled to attend the birth and followup care of the girls in 2006.
He had never worked with a set of craniopagus twins; conjoined twins are extremely rare and those joined at the head are the rarest, with an occurrence rate estimated at one in 2.5 million births. Few survive.
The coming birth became an event for the world to watch as, behind the scenes, physicians and a family prepared for the unknown.
Everyone had questions. Should Felicia, a 20-year-old single mother of two, carry them to term? If she did, would they live? If they lived, what kind of life would they have?
Conjoined twins have historically elicited fascination, not only for their difference and rarity, but perhaps also because in them we see the embodiment of soulmates: two beings fated to live as one, a physical expression of what Plato considered an eternal longing for unity with another, that each human is “driven by a deep longing for its other half, for another to love as oneself.”
Best friends are described as “inseparable” or “joined at the hip”; in romantic love we promise till death do us part.
The Biddenden maids, who lived in AD 1100 in Biddenden County, Kent, England, are one of the earliest documented sets of conjoined twins. Eliza and Kate, joined at the hip and possibly the shoulder, lived for 34 years. According to the story, doctors offered to attempt a separation when one twin died. The remaining twin declined, stating “as we came together, we will die together.” She died a few hours later.
Conjoined twins have also provoked the dark side of human nature and imagination: fear. They were often depicted as monsters, examples of black magic, God or nature gone horribly wrong, destined for lives as circus freaks at best, vulnerable to exploitation and suffering at worst.
As surgical techniques improved throughout the 20th century, separation became the ideal. For the public, a separation story had it all: medical drama, life-and-death stakes, children.
“At the time,” Dr. Cochrane says, recalling the twins’ birth, “the immediate reaction to conjoined twins was, ‘gee whiz’ you’ve got to get them separated. You’ve got to make them normal. They’ve got to fit our social context of what normality is.”
Dr. Cochrane knew that somehow the twins would have to tell him what was optimal. “I became a member of one of the teams trying to support the family and learning with them.”
The first thrill came when they were born, more than six pounds each, perfectly formed, crying lustily, stronger and healthier than anyone anticipated.
The girls, who arrived Oct. 25, 2006, were healthy enough to go home by Christmas. Media interest was intense as the possibility of separation hung like a tantalizing second act: Tyra Banks flew Felicia and the infants to Hollywood for a taping of her TV talk show.
Right away, imaging revealed the depth of their brain connection, their unusual wiring.
“All along we knew that these kids were connected in a way that was different than other craniopagus twins, so the risks of separation would be different than what we might reasonably expect in other circumstances.”
Each child has a fully structured brain, two cerebral hemispheres, a fully formed brain stem, cerebellum and spinal cord. There was also the bridge of tissue, through which neurological information might be shared; within days of their birth, it became apparent that if one twin was pricked with a needle, the other would cry.
Cochrane found the mere thought of separation “frightening.”
Their particular combination of features presented what would be a huge social and physical challenge if they were to live conjoined, but the alternative, he was sure, was worse.
He concluded it was not possible to separate these children without creating a neurological injury more devastating than what they now have to deal with.
“It’s not my role to create injury for the sake of social conformity.”
The decision rested with Felicia. She would have to be thoughtful and courageous. In spite of criticism from ethicists, many of whom believed she should have terminated the pregnancy, the family decided not to risk a separation surgery.
Cochrane is used to the interest in the girls — documentary crews and journalists have knocked on his door, medical experts around the world stay in touch — but when he speaks of the twins, it is with wonder. Beyond the neurological intrigue of their shared brain matter is something unquantifiable.
“They give us the opportunity to appreciate the differences and similarities we all share; we are all human, they are very much human. The fact that they are different just makes them something to be cherished, and not something that goes into the circus.”
Enter the circus
The circus has already come calling. Hollywood agent Chuck Harris, 75, has signed the family. Harris, the so-called Wizard of Odd, represents curiosities like the fire-breathing midget, “Wolf Boy,” and the world’s longest surviving set of craniopagus twins, the 51-year-old Schappell sisters.
Harris has gained the trust of the family and hopes to bring the twins to the biggest big top of them all: reality TV.
Over the phone from Los Angeles, Harris says the Oprah Winfrey Network is interested.
Despite a career as a sort of sideshow barker, Harris convincingly frames his interest in his clients, and the family, as altruistic rather than predatory.
“I represent a lot of oddities, but not because I make a lot of money. Someone has to care for these people. No one cares for them.”
Harris confides that he is concerned about the family’s living conditions. The girls share a tiny warren of rooms in two cramped ground-level apartments with an extended family of 14, including several cats, guinea pigs and a dog.
His voice drops quietly. “The way they are living right now, it’s not good. I just want to help out.”
A few weeks ago, Harris helped the family set up a website on gofundme.com, with hopes to raise $500,000 in order to buy a home suitable for the girls. After a month, only $205 has been raised.
It kills him.
The jury is still out on whether the reality show will get picked up; the family doesn’t share the apple-pie appeal of American conjoined twins Abby and Brittany Hensel, whose “reality” as portrayed on their hit TLC show seems cheerfully perfect. They drive! They’re boy crazy! They’re just like you and me! (Except, of course, they’re not.)
Any part of their reality that includes struggle, fear or limitation hasn’t made it onto the screen.
Complicating things is the issue of consent. Abby and Brittany, who share a torso, are 22. Tatiana and Krista, who have just turned …