WEEKLY WHINE

Interaction: The perils of disjoinment

Myers: Hello, and welcome to this week's edition of Interaction, where our guests take you on and apply figurative body slams to your questions. We're in Singapore today, and it's now just over a week after the failed operation to separate Iran's famous conjoined twins, Ladan and Laleh Bijani. That operation, at the Raffles Hospital, was to last about two days, but on the second day, a bypass in their shared skulls began to be blocked, eventually leading to their deaths some ninety minutes apart. The various successes and failures in separating conjoined twins have led to endless debates. Should separation operations still be attempted? Is a new approach in these operations needed? Do we need to be making it more fun to be conjoined? I'm Debbie Myers, and with me here today in Singapore, first, is a heart surgeon who has separated conjoined twins twice, Dr Zach McKinley.

McKinley: Good evening Debbie.

Myers: We've got the editor of the Journal of Conjoinitive Studies, Dr Rashelle van Brochlin.

van Brochlin: Hello there.

Myers: A well known author whose works include the exhaustive study of the lives of conjoined twins, So That's What You Look Like, Mr Marc Perry.

Perry: Nice to be here.

Myers: Also joining us, a former conjoined twin, Ms Nadia Albertson.

Albertson: Hello.

Myers: Thank you all for joining us here tonight. Zach, this operation must surely highlight the risks of separating conjoined twins so late in life. What can really be expected in such cases?

McKinley: Well, Debbie, it's important to note that older individuals have developed their bodies in tandem for so long that if we're to take them apart, we must be careful.

Myers: Certainly noted there. Rashelle, why are survival rates for conjoinments generally so low to begin with?

van Brochlin: One important factor is the birth. It's hard to get them out of the uterus to begin with, and generally something like 20% of all conjoinments survive beyond the first few days. The good news, though, is that once they get that far, the rest of life is fairly benign.

Myers: Interesting figures there. Marc, once they do get past those first few days, how are their lives afterward? Do they live happy lives together?

Perry: Sometimes, but frequently they wind up with different career choices, as in the case of Ladan and Laleh. One wanted to be an attorney, the other a journalist.

Myers: An important point to think about there. Nadia, as a former conjoined twin yourself, what was the most profound difference between you and your twin?

Albertson: Our hair colours, I guess. I don't really remember.

Myers: Well, Marc, one thing that cannot be denied is the public's fascination with conjoined twins. All of Iran, in fact, rallied round the Bijanis. What exactly is it that makes people so interested in conjoined twins?

Perry: I think it's a number of elements. For one thing, many of us don't get to experience what it's like to share a body with another human, to know that someone else is seeing what you see and smelling what you smell without necessarily thinking what you think, to have someone else around whenever you need them, to play such a leading role in another person's life... to... well, that's about it I guess.

Myers: Rashelle, what about the medical community as a whole? Are doctors generally as intrigued with the phenomenon of conjoinment as the general populace?

van Brochlin: Not so much. Doctors really have to be pulled kicking and screaming from their own specialisations to contribute to conjoinitive studies. It's quite irritating.

Myers: Zach, would you agree with that assessment? Are doctors in fact too attached to their own fields?

McKinley: Of course, Debbie. Certainly doctors are willing to share if their own expertise will come in handy someplace else, but not much short of a club over the head will make them voluntarily ship out like that.

Myers: Okay then. We've had our fun, so it's time to get in touch with everyone on Earth who's watching us tonight, as well as any Expedition 7 crewmembers on the International Space Station who may also be tuning in today. And if they are tuning in today, we'd like to extend a special wedding gift to our friends Yuri Malenchenko and Ekaterina Dmitriev. Keep an eye out for a toaster oven from us. Anyway, our first question is in an E-mail from Justine Gregiuer from Saint-Etienne, France. She asks why the operation to separate Ladan and Laleh was permitted to go forward when the chances of success were so low. Zach, what exactly were the chances that both twins would survive the operation?

McKinley: The odds of success, Debbie, were generally reported as 50%, but I believe that figure to be too high.

Myers: Why is that?

McKinley: Debbie, this is the first time. Craniopagus conjoined twins - those who are joined at the skull - have never been separated at adult phase.

van Brochlin: That may be so, but there were several other factors working in Ladan and Laleh's favour.

Myers: What factors?

van Brochlin: The doctors involved had spent so much time working on this particular case. I think that at every point their preparation had indicated what would be likely to happen next, and what they could do for each of many problems that might crop up. It was simply unfortunate that there was so much blood loss right around the time that the separation was finally completed.

Myers: Nadia, what sorts of complications occurred during the operation to separate you from your twin?

Albertson: I'm not really sure. I don't recall.

Myers: At what age were the two of you separated?

Albertson: Hmm. I don't know. It must have been before I can remember.

Myers: You haven't spoken to your family or your doctor about it?

Albertson: No. I'm told it would be fairly traumatic for me.

Myers: I see then. Marc, are twin separations generally considered traumatic events?

Perry: They can be, particularly for those of us who have to observe the twins go through with it. Look at the mood that Iran was in as the operation progressed. This was very hard for everyone in Iran, and I think that even if Ladan and Laleh had survived, people would still have an element of sadness at what was lost.

Myers: Okay then. With that, we'll take a telephone question from Marcos Quaranta in Medellín, Colombia. Marcos, are you there?

Marcos in Medellín: I'm here. Hi.

Myers: Hello Marcos. What is your question?

Marcos in Medellín: I would like to - [gunshot] - hang on...

[Pause.]

Myers: Marcos? Are you there?

Marcos in Medellín: Hi. Sorry about that. It's nothing. My question is, why - [gunshot] - why were they so keen on being separated when - [shouting in background] - hang on... [faintly] Not now! I'm -

Voice in Medellín: [faintly] ¡Tiene que llamar al doctor! ¡Mi esposo está muriendo! ¡Está -

Marcos in Medellín: ¡Cállese! Anyway, I was asking - hey! ¡Necesito - [gunshot, static]

Myers: Are you there, Marcos? [pause] Well, we may have lost Marcos there, but I can tell you that his question was about why Ladan and Laleh wanted to be separated. Marc?

Perry: They were quite concerned about the way they were living, particularly that they had such different career ambitions. Ladan wanted to be a lawyer, and so that forced both of them to attend law school. Laleh, though, was interested in journalism. That's not as divisive as it may seem, though, as the two careers are similar in the respect that they earn, ie, not much.

Myers: Right then. Zach, would the doctors really have been as willing to perform the surgery if the chances of success were even lower?

McKinley: It's up to the individual doctors, Debbie. Clearly no doctor is going to perform an operation without the patients' informed consent, but in this case Ladan and Laleh had indicated that they wanted to be separated whatever the risks.

Myers: Isn't that really an indictment of our own society, though? Rashelle, are conjoined twins being scrutinised and treated so inhumanly by the media that they feel they can't continue living together?

van Brochlin: That's obviously an issue. Most conjoined twins are separated at infancy, but some are not depending upon the particular circumstances into which they're born. When the Bijanis were born in 1974, Iran did not have the capability to separate them. As it turned out, they became media sensations, mostly because of their rarity. Craniopagus conjoinments have been born, on average, once worldwide every twenty five years. I think that Ladan and Laleh will end up being the last set of craniopagus conjoinments to remain joined beyond adolescence.

Myers: On to another telephone question now, and it's from Buffy in Singapore, so not very far away. Buffy, are you there?

Buffy in Singapore: Yes, hi. I'm here with my twin sister Muffy.

Muffy in Singapore: Hi.

Myers: Hello to both of you. What is your question?

Buffy in Singapore: We -

Perry: Just a moment. Are you the Andrulis conjoined twins?

Buffy in Singapore: Yes we are. Have you heard of us?

Perry: Heard of you? You're so attractive! I think the way you share that middle leg is so beautiful. I'm your biggest fan.

Muffy in Singapore: You'd better not be that guy who keeps sending us those weird IMs. I don't want to see those any more, and if I do, there's a restraining order coming your way.

Buffy in Singapore: Buffy, knock it off! His IMs are fine. There's nothing wrong with him wanting to come here and put his -

[I guess that was Muffy, not Buffy. Sorry about that.]

Myers: Um, okay. Perhaps we could hear your question, Buffy.

Buffy in Singapore: No way. I'm not letting that nutjob hear my question.

Muffy in Singapore: Oh please, Buffy. She was going to ask where - [muffled]

Buffy in Singapore: Shut up, Muffy! I'm warning you!

Muffy in Singapore: Ooh, what are you going to do? Slap a restraining order on me? I'm so scared! Woooee! Oww! Hey!

Buffy in Singapore: Aaaah! Aah! Owwwww! Geez, you psycho bitch! How about some of -

Myers: Okay, I think that's enough of that. I understand that Buffy's question was about separations after adolescence and how successful they are for other types of conjoinments besides craniopagus. I think I can see why Buffy was interested in that topic. Rashelle, how does age affect the disjoinment operations?

van Brochlin: Well, as time goes on, the twins' organs become more and more intertwined until there's almost no separating them. I don't think I've heard much about their case lately, but as I recall they didn't seem to be sharing any organs. That will make it considerably easier.

McKinley: Well, Debbie, they're actually sharing legs. There are three legs between them.

van Brochlin: Oh. Damn.

Myers: How does that type of conjoinment compare with a craniopagus conjoinment, Zach? Is it considerably less risky?

McKinley: It is less risky, Debbie, but that doesn't make it more desirable. Either Buffy or Muffy would have to end up with one leg. Whichever one it is, they'd both look lopsided anyway. They'd probably do a lot of falling over.

Perry: And they'd have to find a different line of work too.

Myers: Why? Do they make a living from their condition?

Perry: They do. They have a website where they pose with all kinds of things, in all kinds of positions.

Albertson: Really? Cool! I wish I could do that.

Myers: Nadia, where were you and your twin joined?

Albertson: I don't know. I'm not even sure I had a twin.

Myers: You don't know whether you were conjoined?

Albertson: No, I know that I was conjoined. I just don't know if it was to someone else.

Myers: Um, I think that's going to have to do it for Interaction this week. Thanks go to Ms Nadia Albertson, Mr Marc Perry, Dr Rashelle van Brochlin, and Dr Zach McKinley for being here this week. Next week we'll head back to Warwickshire, and we'll discuss the threat to Tony Blair and George W Bush over the lack of weapons in Iraq. We'll be joined by a weapons finding specialist, a cultural observer in Iraq, a former member of Iraq's information ministry, and a man who is training his dog to sniff out weapons of mass destruction. Until then, good night.

Perry: You can be conjoined to me if you want.

Albertson: Okay, but only on weekends. And make sure it's water soluble.