Content note: this article goes into detail about surgical separation of twins and medical treatment without consent.
False Hearts stars formerly-conjoined twins raised in a cult, and there’s also futuristic San Francisco, brain hacking, dream drugs, a mob, and a fair amount of violence. Though I researched many topics for the book, I spent the most time learning all I could about conjoined twins to ensure I depicted my twins respectfully and without falling into harmful tropes. The initial book idea was sparked by reading an article on io9 about Daisy and Violet Hilton, who were 1920s vaudeville stars. They were so famous that they were essentially the Olsen twins of their day. In the course of my research, I learned of other historical twins, and also their own opinions and beliefs about being conjoined, which differs to the mainstream narrative that all twins desire separation above all else and it is their ultimate goal.
Daisy and Violet Hilton were born in 1909 in England and were connected by skin at the base of their spine. They became successful freakshow and vaudeville performers in the. Their manager was their stepfather, who controlled their lives, denying them access to money. They sued for emancipation and went a little wild, becoming 1920s party girls. When vaudeville began to fade, they worked in early film for a time. At the end of their lives, they worked as supermarket clerks until they died in 1969 (io9). A film the Hilton twins starred in, Chained for Life, features one of the twins on trial for shooting her sister’s lover. I began thinking about how, as a conjoined twin, you have little secrecy and privacy, so what if your literal other half kept a secret like murder from you? How far would you go to find out the truth? From the Hilton sisters, I picked up my main resource, One of Us: Conjoined Twins and the Future of Normal by Alice Domurat Dreger, and researched other conjoined twins.
Ruthie and Verena Cady were born in the 1980s in Colorado, and they were conjoined from breastbone to waist and shared a three-chambered heart. They were therefore the closest, physically, to the twins in False Hearts. Separation was not possible, and their long-term prognosis was not positive. Ruthie and Verena did live until they were seven and were, by all accounts, active and happy children. Dreger writes that, “by age five, Verena was more verbal and more cautious, while Ruthie had become more domineering and mischievous and tended to like hands-on activities” (Dreger, 34). The Cadys’ mother said of disciplining them that “when one misbehaves, of course, the other has to suffer some of the consequences too” yet “they’re never lonely, they always have someone to hug them if they get hurt or to share secrets with” (Dreger 34). Of the research I did, these personalities revealed themselves most strongly in the characters of Taema and Tila. Taema is the hesitant one and Tila is the brasher one, yet they both have a deep bond, despite the difficulties they face in the novel.
Conjoined twins are usually separated at a young age. The only twins who consented to separation surgery as adults were twenty-nine-year-olds from Iran, Ladan and Laleh Bijani. They had both studied law, but wanted different careers in separate cities. The Bijanis “decided that their conjoinment intolerably limited their lives” and “in 2003 were the first twins in history to be separated by an operation to which they had personally consented” (41). They searched for surgeons to perform the operation. Several doctors said it would be too difficult, but Dr. Keith Goh of Singapore agreed to conduct the surgery following the decision of an ethics committee that agreed separation could be attempted. Sadly, both twins died as a result of the surgery and they were buried in separate coffins. Some people felt that the doctors were too reckless in performing the surgery and did not accurately state the risks to the twins, whereas a lot of mainstream press “lauded their heroism and bravery… few singletons could imagine living a life conjoined, and most believed the sisters had made the right choice—risking their lives to try and achieve physical independence” (Dreger, 43).
In the case of Taema and Tila, I had them mirror the sentiments of other twins who were happy to remain conjoined, and so the necessity of separation after they arrive in San Francisco is something they fear rather than something they desire. As Dreger writes, “many conjoined twins often explicitly say they do not want to ever be separated, since it would result in a profound change of identity” (Dreger 43). In fact, there have been several cases where one twin dies, and the other elects to go at the same time, as with Chang and Eng Bunker, the original “Siamese twins.” Chang died first as a result of an illness, and Eng supposedly said, “Then I am going!” (Dreger 46). In 1967, one conjoined twin, Margaret Gibb, was diagnosed with cancer. The other twin elected not to be separated and so the cancer spread to both of them and “they died within two minutes of each other” (Dreger 46). Perhaps these twins may have made different choices if surgery was not as medically risky, as it is in False Hearts’ future, but my twins are pressured into separation to fit into San Francisco’s society, which is obsessed with a narrow perception of perfection and is ableist as a direct result.
Many twins are not given this choice, though, as they are operated upon when they are too young to consent. One of the saddest instances I came across in my research was the story of Katie and Eilish, born in Ireland the same year I was born, 1988. Despite being significantly conjoined, with two upper bodies but one lower body, much like Abigail and Brittany Hensel, their health was fairly good. Separation would, in fact, be difficult, resulting in one leg each, reduced reproductive systems and sexual sensation, half of their digestive systems, and large wounds with risk of infection (Dreger 53-54). The doctors began preparing for surgery anyway and in 1992 they performed it when the twins were just under four years old. Katie died of heart failure four hours later, and “surgeons harvested some of her skin and used it on Eilish in an effort to improve Eilish’s health […] Eilish’s psychological distress at the loss of her sister was evident early on. She named her prosthetic leg ‘Katie’” (Dreger, 55).
I read that story in a café and started crying. I came across similar stories when researching intersex people for my first book, Pantomime. In both cases, the medical profession as a whole is wary of atypical anatomy, opting to interfere through surgery both when patients are too young to consent or there may not be a medical reason to intervene. Conjoined twins Lin and Win Htut were conjoined at the pelvis and doctors assigned one twin the male genitalia and the other they essentially performed sexual reassignment surgery as a girl (69). They were two—far too young to be able to state their gender identity. This fierce desire to “normalise” children came through in False Hearts, where Taema and Tila are basically told they will never fit into San Francisco unless they elect to separate. They didn’t want to, but they felt they had little choice, and they often mourn their separation in later years. There was no fear or threat of “sacrifice surgery” for them, where “doctors effect the death of one twin, separated one head and other duplicated parts from vital organs […] in an effort to construct one viable child” (Dreger 83), but this does occur on a regular basis in our world.
Doctors are trying to do what they think is best for their patients, of that I am sure, and the moral implications can be difficult to navigate in certain cases. Yet the deep persistence that normal is the ultimate goal comes up again and again in my research, and this unease of its larger implications for society ends up coming out in the book. To the outside world, Taema and Tila are now “normal singletons,” yet they feel more at a disadvantage than they ever did when they were together. San Francisco as a whole is so obsessed with perfection in the world of False Hearts, that it does not stop, step back, and consider how much they are erasing in this yearning for “normality.”
Dreger, Alice Domurat. One of Us: Conjoined Twins and the Future of Normal. Cambridge, MA: Harvard UP, 2004.
Newitz, Annalee. “The Conjoined Twins Who Were More Famous than Movie Stars in the 1920s.” Io9. Gizmodo, 25 Feb. 2013. Web. 1 July 2016.
To Learn More:
- Book: Quigley, Christine (2003). Conjoined Twins: An Historical, Biological and Ethical Issues Encyclopedia. McFarland & Company.
- Documentary: Bound by Flesh, directed by Leslie Zemeckis, about Violet and Daisy Hilton.
- Documentary: Conjoined Twins, BBC horizon. A documentary about several conjoined twins.
- Documentary: Twin Life: Sharing Mind and Body, CBC, about Krista and Tatiana Hogan, who share aspects of their brain and can see and feel what the other experiences.
- Reality TV: Abby & Brittany, The Learning Channel, about conjoined twins who share a lower body. The series follows them going to college, being with their friends, and finding a job as teachers.
Laura Lam is the author of False Hearts, Pantomime, Shadowplay, and forthcoming Masquerade and Shattered Minds. She grew up in California but now lives in Scotland, where she writes, reads, and misses the sunshine.