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Separation Anxiety

When James Goodrich separated the head-joined twins Carl and Clarence Aguirre a year ago, he performed a singular medical feat. He also entered a world of squabbling over just what, exactly, he accomplished.


From left, Carl and Clarence Aguirre in a playroom at Blythedale Children's Hospital.  

James Goodrich is showing me his fetuses. His conjoined-twin fetuses, to be precise, two sets of inch-long, perfectly formed bodies (except for a bit of tissue joining them at their chests), each pair floating in its own baby-food-size jar. They were given to him by Eastern European pathologists who knew about his interest in all creatures conjoined, and he seems as unself-conscious about this show-and-tell as he did about greeting me at his front door barefoot, wearing sweat pants and a T-shirt.

Goodrich is the pediatric neurosurgeon who last August led the celebrated team that separated Filipino head-joined twins Carl and Clarence Aguirre at Montefiore Medical Center in the Bronx, and I’ve invited myself to see his study—the place where he says he spends most of his time when he’s not at work and the subject of murmured awe around the hospital. The first time I’d met him was in February, in his office at Montefiore. A handsome 59-year-old, with a perpetual tan and silky white hair and a beard, Goodrich had just removed a brain tumor the size of an orange from a Korean child. In his green scrubs, with his surgical mask still hanging around his neck, he reminded me of how Ian McEwan, who shadowed a neurosurgeon for his recent novel Saturday, jokes about the specialists’ macho élan: “The trick I’ve noticed with neurosurgeons is that they have a deep V-cut to the neck, and what you have to do is angle it so chest hair just pokes through.”

This late spring afternoon, Goodrich seems a little more mortal, if not exactly ordinary. His house is modern and very white, with views of the Hudson. I catch only a glimpse of the river—it’s too foggy to see much—before Goodrich leads me to the place in question, his large cherrywood study. The room looks like it was lifted from another house, a nineteenth-century manor, though Goodrich’s music, Bob Seger and the Silver Bullet Band, doesn’t quite fit. The walls are lined floor-to-ceiling with some 10,000 rare medical books (Goodrich runs a mail-order antiquarian-book business in addition to practicing medicine), and every available surface is packed with medically themed artifacts. There are rows of shrunken heads from Ecuador; skulls from Peru, a few of them bored with holes where Goodrich guesses surgery might have been attempted; a wood sculpture of an African shaman; dozens of tiny white ivory netsukes from China; and assorted pre-Columbian figures of poor souls with humped backs, cleft palates, and other deformities. Goodrich’s desk too is an artifact—it once belonged to the founding father of American neurosurgery, Yale’s Harvey Cushing.

“Every three or four years I pick a goal, to learn something new,” Goodrich says of his obsessive curiosity. “I started out with wine, then it was books, then it was bonsai trees, then it became the didgeridoo. It’s the way I approached the twins. I sit down and learn everything possible.” He shows me an original newspaper article from 1874 announcing the deaths of the most famous conjoined twins, Chang and Eng Bunker (attached at the chest and from whom sprang the now discredited term “Siamese twins”), and circus brochures from the nineteenth century to the sixties telling the stories of various sets of conjoined twins. I pick up a saber-tooth tiger’s skull, actually two tigers joined at the head like Carl and Clarence. On top of a cabinet are the fetuses—he can see them when he’s working at his desk.

We eventually move to the kitchen and Goodrich pours me a glass of wine from his vast cellar. For a few minutes, he is his usual smooth self, but when the conversation turns to the Aguirres, particularly to questions about his work, he turns defensive and blunt. For almost a year now, Goodrich and his colleagues have maintained that they were the first team ever to separate so-called craniopagus twins without causing brain damage to the children, and I ask him what he makes of the fact that Johns Hopkins surgeon Ben Carson, the dean of craniopagus surgeons in the U.S., says that he achieved that feat back in 1997, when he separated Zambian boys in South Africa.

“Bullshit,” Goodrich says, batting at a shock of hair that’s slipped into his eyes. “He has twins that nobody has ever known or seen, which I find amazing. If I was in his situation, I’d be having photographers all over the place.”

I tell him that I’ve heard that Egyptian craniopagus twins Mohamed and Ahmed Ibrahim—whose separation by Dallas doctors two years ago was accompanied by fanfare similar to that surrounding the Aguirres’—are doing about as well as Carl and Clarence. “The few pictures that have been shown of [Mohamed and Ahmed], you can see they have what I call that ‘la-la look,’ ” Goodrich says. “La-la look” is Goodrich shorthand for the vacant stare of brain-damaged children. “Carl and Clarence look at you and smile, interact with you. Neither of these kids do that, other than when you rub them the right way.”

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