Vernon, B.C. — Tatiana and Krista are lying on their backs, on a blue mesh bath seat designed just for them. Ordinarily, the twins hate being bathed and scream mightily, but today they lie back and make faces at their mother, Felicia Simms, who rubs shampoo on their skulls, which they happen to share.
The twins are joined at the head, just above the ear. The official name of their condition is craniopagus twins, and there isn't another set like these in the world.
If you look at them straight on, Tatiana is on the left, her gaze locked upward and to her right. Krista is on the right. Because they can't move their heads without getting into a pushing match, the girls have lively, darting eyes. They can't see each other's faces, although their mother has used mirrors to give them a glimpse.
Bathing, dressing and feeding them was at first a logistical challenge for Ms. Simms, 21, but now she's an expert. Krista chuckles when her mother squeezes a washcloth over them to rinse off the shampoo.
Felicia Simms kisses her daughters Tatiana, left, and Krista at their home in Vernon, B.C. (John Lehmann/The Globe and Mail)
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“You're enjoying your bath, aren't you?” Ms. Simms coos. “Maybe you'll be a party girl like your dad.”
Wednesday, Tatiana and Krista Hogan-Simms of Vernon, B.C., will turn six months old, which is a remarkable milestone. Most conjoined twins die within hours of birth, or are plagued with ailments caused by shared organs, vascular and circulatory systems.
But Tatiana and Krista are healthy and thriving. They smile and cry and jostle one another in their crib. Each week brings a fresh achievement. In late March, Tatiana surprised her mother when she grabbed her right foot with her fist, a feat still beyond the grasp of her chubbier sister.
But there are obvious reminders that these infants are different. Unable to roll, they spend nearly all their time on their backs, which has flattened the backs of their heads. Tatiana has even developed a bald spot, although she and her sister were born with a thick thatch of brown hair. Ms. Simms tried to breastfeed the twins but, because of their immobility, could manage only one girl at a time, sending the other into a fury. They rely on the bottle now.
And there are the endless questions about their future. Can they be safely separated? Should they be? If surgery is ruled out, what kind of life do they face? How will they learn to walk? Can they live independent lives if their skulls remained fused? And how will the family — an extended family that travels in packs, talks by cellphone constantly, eats most meals together but gets by on social assistance — cope with the conjoined twins over the long term?
These are questions Ms. Simms must confront as she prepares for another crucial medical test in Vancouver this Thursday. A cerebral angiogram is planned, in which blue dye is injected into the girls' blood to trace the shared blood vessels in their brains. Doctors hope this test will illuminate a bridge of tissue that connects the twins' brain stems. They want to know whether this bridge carries important brain signals between the two infants.
If indeed it transmits vital signals needed for vision, physical sensation or motor movement, then separation surgery could drastically impair or kill one or both of them. If it is simply tissue, surgery could get the green light.
But in the meantime the twins remain figures of curiosity, their parents at once celebrated and vilified. Strangers approach Ms. Simms on the street and at Wal-Mart, full of questions. In January, she and the girls and their grandparents were flown to Los Angeles to appear on The Tyra Banks Show.
They stayed in a four-star hotel near Sunset Boulevard and walked the broad, sunny streets. Ms. Simms loved L.A. It was the first time she'd ever left Canada, the first time she'd ordered room service, and she adored Ms. Banks and her team of producers, who treated the family “like royalty.”
But not everyone has. Ms. Simms has been skewered on websites and in the media for her decision to have the babies. Others have attacked her family's dependence on welfare. Strangers have sent her hate mail and said the twins are freaks.
“To have deliberately brought babies like this into the world is disgusting,” said one anonymous letter writer. “There is absolutely no reason in this day and age for you to have had any child and I hope you will not produce any more.”
Family life Inside their three-bedroom basement apartment in Vernon, a picturesque town in British Columbia's Okanagan Valley, Tatiana and Krista aren't medical marvels or subjects of contention. They're babies, or “my little angels,” as their mother calls them. Home life — set to the infants' time clock — is an endless cycle of feedings, diaper changes, naps and baths. In between, Ms. Simms tries to carve out time for her two older children.
While she bathes the twins, Ms. Simms's four-year-old daughter, Rosa, watches a DVD in her bedroom but gets bored and wedges herself between her box spring and mattress. Two-year-old Christopher climbs into the bathroom cupboard, calling out to his mom to find him.
Brendan Hogan, Ms. Simms's boyfriend and the twins' father, is in the living room, engrossed in an epic battle with his new God of War video game. Born in Calgary into an ex-pat Newfoundland family, and raised in Vernon, Mr. Hogan is 23, unemployed, with red hair and multiple silver rings in both ears. He and Ms. Simms have been together, on and off, since their first date in a Vernon park seven years ago, although he moved into the apartment only in January.
Ms. Simms emerges from the bathroom with the girls wrapped in a towel and asks Mr. Hogan to put their diapers on. He gets up, performs the requested task, then returns to his quest to digitally destroy Ares, the Greek god of war.
This is what Felicia Simms has always wanted: a family of her own. She has a natural touch with children, rarely raising her voice and taking genuine interest in their daily trials and triumphs. Her lifelong desire was so acute, she said, that she couldn't articulate its depth until after she became a mother at age 16.
“Before I had kids, I felt numb,” Ms. Simms said, comparing her adolescent yearnings to the Evanescence song Bring Me to Life.
Reserved and private, with a bashful smile, blue eyes and long dark hair, Ms. Simms isn't the type to gush about her feelings. Instead, she has an endearing habit of referencing a pop song when she's trying to express herself. She has a song for nearly every emotion.
“She doesn't feel human,” Ms. Simms said, explaining the lyrics of the Evanescence song. “It's how I felt before I had kids. I felt like I was in the dark.”
She was 14 when she met then-16-year-old Mr. Hogan, and she quickly decided they would be a family one day. Two years later, she gave birth to Rosa; at 18, she had Christopher.
Last winter, at 20, she learned she was pregnant for a third time. But in the spring, Richard Long, her family doctor, summoned her to his office. In a shaky voice, Dr. Long told her she was carrying twins who were joined at the head, an extremely rare phenomenon.
The prognosis was bleak. Twins of this kind rarely survive to a full term, the doctor said. Terminating the pregnancy was an option she could consider.
She told Mr. Hogan at her mother's house. He cried and said, “Is there any way either one of them can be saved?” She didn't know the answer but says she never considered terminating the pregnancy. Later she cried for hours with her friend Sonya DeVries.
Ms. Simms was confined to her bed to prevent early labour. For hours at a time, she listened to her MP3 player, finding inspiration in Carrie Underwood's spiritual ballad, Jesus, Take the Wheel. It made her feel less helpless.
But the twins didn't die. When Tatiana and Krista were born last Oct. 25, their healthy screams echoed through the operating room at Vancouver's B.C. Children's Hospital, where a 16-member medical team safely delivered the girls by cesarean section.
Overnight, Ms. Simms's life turned extraordinary. A year ago, she had been just another young, single mother, with a penchant for goth culture, horror movies and all things dark. Now, the young woman who was kicked out of college for not having a proper high-school diploma finds herself a celebrity in Vernon.
When she and the girls walk on the street or into a mall, heads turn and crowds gather. The questions come: Can they be cured? Do they cry at the same time? What if you just broke them apart? Which one is older? Their presence at church one Saturday in March prompted a small stampede in the foyer.
“Look, it's the twins!” a little girl cried.
Making ends meet Money has always been tight in the Simms household. Ms. Simms has suffered from crippling panic attacks since childhood, hampering her schooling and ability to work. She has raised her children almost exclusively on social assistance.
Her relationship with Mr. Hogan hasn't helped much financially. It's an unconventional pairing; they aren't married and didn't live together before the twins' birth.
After moving into Ms. Simms's apartment in January, Mr. Hogan began working as a labourer on a condominium construction site. He doesn't have a driver's licence, so he arranged for a co-worker to pick him up each morning. But many times his ride didn't show, Mr. Hogan said, and he was fired.
Ms. Simms's parents, who live a 10-minute drive away, have helped out. Louise McKay, 45, receives a $1,300-a-month disability pension because of her own panic disorder. She supplements that with part-time work taking orders for a food-delivery company. Her husband, Doug McKay, 54, is a former farm hand who's had two heart attacks and now ferries his family around Vernon in a minivan provided by social services.
Meanwhile, a family friend set up a trust fund for the twins, and Ms. Simms drew on it to pay for baby formula. The fund is nearly depleted now, with just under $300, which is earmarked for a new stroller. They receive some money for their trips to Vancouver for the twins' medical tests.
They have been touched, too, by the generosity of strangers. A Vancouver woman sent boxes of new baby and toddler clothing. A woman at her church organized a five-kilometre run that raised $2,000. Two Vernon girls, 7 and 8, sold $600 worth of lemonade.
But there have been stresses as well. Ms. Simms's childhood friend, June Thomas, has not come to see the girls since Ms. Simms returned home with them at Christmas.
“She came and seen them once and I haven't heard from her since,” Ms. Simms said. “We went through everything together, boys...And now, just because I had conjoined twins, I haven't heard from her.”
A few weeks ago, Ms. Simms spotted her friend on a Vernon street and asked her stepfather to stop the van. She ran toward her friend and the two hugged. Ms. Thomas promised to come by the next day. She didn't. She did call Ms. Simms later that night and the two women talked for about an hour.
Ms. Simms said their bond is like the Spice Girls song Viva Forever. “It's like our friendship lives on, no matter what we've been through.”
Ms. McKay has a more pragmatic take on Ms. Thomas's post-twins absence: “She can't handle it. Some people can't.”
In the future, there are bound to be other friends and family who won't want to be part of the girls' lives, Ms. McKay says, who will avert their eyes or stare in pity. The family expects this, but they also plan to instill the twins with pride.
She thinks the girls were born for a purpose: to teach people about tolerance, that it's okay to be different. “I think the babies have already done a lot of good for a lot of people,” she said.
Separation anxiety
There are fewer than a dozen craniopagus twins in North America. And even then, Tatiana and Krista are unique. Not only do they share hundreds of blood vessels in their brains, but there is the bridge of connective tissue just above their brains stems, which doctors still don't fully understand.
Vancouver neurosurgeon Doug Cochrane says surgery poses dicey ethical questions for the parents and the medical community. “When people ask, can they be fixed, it implies that they're not normal at the get-go,” said Dr. Cochrane, who has treated the girls since they were born. “And I think it's pretty clear right now, as best we can tell, that these kids are developing normally.
“So when society looks upon them, does society see them as sufficiently different and therefore needing to be fixed? Or could society look on them as being normal, healthy kids who have a different relationship to each other than we would normally expect.”
Doctors have said the girls are in no danger and could simply grow up as they are. And the prospect of separation causes deep anxiety for the whole family. The mortality rate for craniopagus twins who undergo separation surgery is higher than 50 per cent. The complex surgery, which involves severing hundreds of blood vessels, has been compared to defusing a bomb.
“It's really scary for me to think about,” Ms. Simms said. “I don't think I could handle it if something happened to either one.
“If they do have surgery, it will be long. Anything can happen. I hope they can be separated. If not, it doesn't really matter to me. I'm still going to love them if they're separated or not.”
The decision is weeks or months away. But increasingly, when Ms. Simms discusses the girls' future, she talks of them as joined. For her, the safety of both girls will always trump separation. She had a dream about them recently and they were teenaged girls, still together. One was goth with a mohawk hairdo and body piercings; the other had long hair and wore dresses.
“I know life will be hard, but around here, they have a lot of support,” she said. “I don't want them to go through life thinking everything is a breeze. They have to learn that there is a lot of hurt and a lot of pain in life. But there is a lot of love.”
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