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It's been an exhausting few days. Scores of doctors, nurses and therapists have poked, prodded, measured, scanned and weighed the five-month-old conjoined twins, Tatiana and Krista Hogan-Simms. They are trying to determine, on this March visit to Vancouver, whether these unique sisters can be separated.

At B.C. Children's Hospital, doctors put small electrodes on the twins' scalps to see if one girl's brain responds when the other is touched. "This allows us to look at how their brains work," Doug Cochrane, the twins' pediatric neurosurgeon, said.

The girls' separate brain functions are normal and the tests reveal no evidence they have shared physical sensations.

Next, magnetic resonance imaging is attempted on the twins' skulls, but they won't stay still. Their father, Brendan Hogan, tries to lull them to sleep, but each time they are placed in the doughnut-shaped magnet, Tatiana wakes up and cries. In the end, the MRI is only partly successful, and the delays put the rest of the testing behind schedule.

Their mother, 21-year-old Felicia Simms, has come to a decision: They will postpone the next test, a cerebral angiography, which would provide the clearest picture yet of the blood vessels in the girls' brains.

The next morning, she leans over the crib, touching Tatiana and offering words of comfort.

"She looks like a starving Africa baby," Mr. Hogan says, eliciting disapproving stares from Ms. Simms and her mother, Louise McKay.

Later, he is more reflective. "It's so unbelievably stressful. I can't sleep, I can't eat . . . Anything with Felicia and the kids, it's just so hard to watch."

Dr. Cochrane has tried to persuade Ms. Simms to go ahead with the angiography. But Ms. Simms has seen enough. She chose to give birth to them despite dire warnings that they would not survive. She is their primary caregiver and, to her mind, the girls just aren't right.

Tatiana, at about eight pounds, is far smaller than her pudgy, double-chinned sister. (The twins are weighed together, but, based on body size, doctors estimate that Krista represents 60 per cent of the total and Tatiana 40.) Ms. Simms says Tatiana is agitated, exhausted and "slipping away" from her. She knows that the costly trip has so far yielded few new results, but she also knows her own mind.

"I thought I was going to have a breakdown," Ms. Simms recalls later. "It was so hard to see the girls not themselves. . . . I felt like I had to protect my child at that point."

So, two days after the twins are admitted to hospital, Ms. Simms confirms that there would be no more tests -- for now. "Dr. Cochrane wanted it done," she says. "But he also said I am their mother and I should trust my instincts."

They reschedule the angiography for late April -- for today. Once they have the results, doctors in Vancouver will consult with experts from Toronto, Baltimore, New York, Chicago and Salt Lake City, not just neurosurgeons but facial, cardiovascular and plastic surgeons as well.

They will not have a recommendation for several weeks.

Scathing critics

Like many women her age, Felicia Simms is a study in contrasts. One minute she's discussing the twins' eating patterns, the next she and her brother Doug are arguing good-naturedly about how many body piercings are too many.

Another favoured topic is her belief in a magical life. "I do believe in fairies; I always have," she says one afternoon, a dreamy smile on her face. "They're magical and mischievous creatures, like a mystery to life."

Yet Ms. Simms also has four children, including Rosa, 4, and Christopher, 2. And as the mother of Canada's only craniopagus twins, she is learning that celebrity parenthood has as many perils as perks -- and she is learning how to stand her ground.

In Vernon, a city of about 35,000 in B.C.'s Okanagan Valley, most residents have embraced the family. They've held fundraisers, set up a trust fund for the girls, and showered Ms. Simms with clothes, diapers and presents.

Public-health nurses make house calls to her small, three-bedroom apartment, so she doesn't have to leave home to get the girls vaccinated and weighed. She was even flown to Los Angeles to be celebrated on The Tyra Banks Show.

But Ms. Simms's high profile, combined with the family's reliance on social assistance, has invited judgmental, often hostile scrutiny as well. Even before Tatiana and Krista were born, the twins were the topic of editorials and open-line talk shows across the province.

The most scathing critics have hidden behind anonymity. After Ms. Simms's TV appearance, a Canadian writer posted this response on the program's website: "I live near where the three-month-old conjoined twins live in Canada and personally find the case heartbreaking. . . . I do . . . believe that the mom in this case is flat out selfish. She is no way in a situation that will be beneficial to raise these children."

In a letter, another critic scolds her for bringing conjoined twins into the world. "Dear Miss Simms," the letter begins. "This is to let you know how disgusted I am that you continued your pregnancy with these twins when you could have aborted them.

"It is bad enough that you are only 21, have two kids already, a boyfriend who doesn't support you and you live off the taxpayer and no one seems to be making an attempt to get off welfare."

The writer repeats a rumour that Ms. Simms collected a fee from a pro-life group as an enticement not to terminate her pregnancy. "It made me sick," the writer says, signing the letter "a B.C. taxpayer."

Miss Simms tosses the letter aside and shrugs. She says no one paid her not to terminate the pregnancy, although a local pro-life chapter gave her $2,000 after the girls were born to help her out.

The hate mail doesn't bother her, she insists. "It doesn't really matter to me. They're my children. I love them the way they are." But she was concerned enough to show the letter to police. She felt the tone was threatening.

The minister at the church the family attends has heard the barbs. Pastor Lee Patterson of Vernon's Seventh-day Adventist Church believes the twins' arrival has sparked an important debate about the rights and value of disabled people in society.

"People ask: 'Why bring them into this world with such obvious problems. What a terrible fate.' We just don't know what the future holds. The only thing we can do is uplift them."

Curious onlookers

Then there is the curiosity factor, and the good feelings and small hurts that come with it.

One day in a crowded mall, Ms. Simms and Ms. McKay sit on a bench to feed the girls. "Are these the twins?" an elderly lady asks. Ms. MacKay nods proudly. "Yes, they are."

A father and young daughter approach. "Look, they're stuck," the man says.

Ms. McKay enjoys the role of grandmother and talks happily about each girl. Krista is bigger, she tells one woman, but Tatiana eats more. Ms. Simms doesn't engage the onlookers with her mother's gusto. She keeps her eyes on her girls.

After the shopping trip, Doug McKay, Ms. Simms's stepfather and the family's constant chauffeur, drops his daughter and the twins at her cousin Cindy Schmidt's apartment, which she shares with her boyfriend and two young daughters. Ms. Simms sits on the couch, grabs a blanket and places the infants on their back for a feeding.

"How do you do that?" Ms. Schmidt, 17, asks.

"What? Multitask?" Ms. Simms says.

"I'd be afraid to even hold them," Cindy replies.

A friend, Sonya DeVries, arrives with her son, and the three young women talk about their children. Cindy's boyfriend, Joey Townsend, sits across from them. When the twins start to cry, he puts on his MP3 player, rises and heads to the balcony for a cigarette.

But before closing the glass doors, Joey asks: "Do they pee at the same time?"

Ms. Simms rolls her eyes.

Adding up costs

When she's asked how her life has changed since having conjoined twins, Ms. Simms says the experience has brought her "out of herself."

"They've opened my eyes to other things. I'm shy. I don't usually go up to people and say: 'Hi, I'm Felicia. Do you want to go have coffee?' "

Despite help from her family, friends and church, Ms. Simms is still maturing. She has a computer-accounting certificate from a local college, but did not get the business diploma she sought and has no work history. Neither she nor Mr. Hogan can drive a car. The young couple relies on her parents not only for rides but for financial help. Ms. McKay arranges all the twins' medical appointments in Vancouver.

Even Ms. McKay says her daughter tends to let things slide. "She is very loving and she has a lot of patience. She was my star babysitter. When the rest of us are stressing out, she's like, 'Whatever.' " But, sometimes, Ms. McKay added, "she's too laid-back."

How Ms. Simms and Mr. Hogan will handle raising the twins is unclear. The next couple of years will include countless appointments with doctors and therapists. At every stage, the girls will need physical therapy, with or without separation surgery.

Ms. McKay has been calculating the costs the family will incur if the twins undergo surgery. A conservative estimate is tens of thousands of dollars. The McKays have already gone through their savings to help pay for the Vancouver trips. The trust fund is nearly depleted. And bills are piling up.

Ms. McKay might throw a yard sale. Mr. McKay is trying to fix up his old Plymouth Fury to sell.

"Brendan didn't realize what the costs of this would be," Mr. McKay says, referring to Mr. Hogan. "We told him: 'This is going to be a rough ride.' "

Ms. McKay wonders whether the family should move to the Lower Mainland, where jobs are plentiful and they wouldn't have to go into debt whenever the twins needed a specialist. But these are her daughter's decisions, she adds.

"She's got to step up, find some ways to make some money," her mother says. "I love my daughter, but I don't think she has any idea how much this is costing.

"I'm glad she made the decision she did [to have the babies]. I love my grandchildren, but it's a big responsibility."

*****

Muscle building

Doctors and therapists say Tatiana and Krista are healthy and growing like normal infants. But because their heads are fused, there have been some developmental roadblocks.

The most obvious is that the girls' movement is restricted: they can neither roll nor move their heads from side to side. Most of their first six months of life have been spent lying on their backs.

At Vancouver's Sunny Hill Health Centre for Children, therapists Maureen Story and Dave Cooper measured the babies for new equipment and checked their muscle development.

"The biggest challenge is to get them moving so their muscles develop," Ms. Story said.

Ms. Story predicted they will be able to crawl but she wanted to see them use their arms more. "I'm not sure if they'll ever be able to roll. I do foresee them sitting up, getting some weight-bearing for their arms and neck and then going into a four-point kneeling position." The girls were lowered onto a piece of foam. Their heads and arms dangled over the top. If they can lie on their stomachs, elevated, perhaps they will attempt to crawl, Ms. Story said.

Jane Armstrong

Tomorrow, Chapter 4: The Fateful Decision. As doctors complete tests this week, the twins' mother may soon face the most excruciating of choices: to separate or not.

jarmstrong@globeandmail.com