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Separation Anxiety

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James Goodrich in his study.  

Goodrich pioneered a yearlong, four-stage method for separating head-joined twins. The standard practice has been to rely on a single, up-to-50-hour operation. I ask Goodrich what he thinks about that technique. His response, again, is over the top: “Why anyone would want to go through with a buzz saw . . . ”

James Goodrich and his colleagues completed the last of the four surgeries to separate Carl and Clarence Aguirre on August 5, 2004. The brothers weren’t the first craniopagus twins to be separated, but the sheer oddity of their condition, the sympathetic figure they and their single mother, Arlene, cut, and the dizzying degree of difficulty involved in the process made the boys a global sensation and turned Goodrich and his medical team into media heroes. The Montefiore public-relations staff estimates the Aguirres’ story has made 3.6 billion “impressions” in the United States alone, meaning people have encountered it 3.6 billion times.

The procedures, in the most critical sense, were successful. The boys are alive and separate (they’re currently undergoing physical, occupational, and speech therapy at Blythedale Children’s Hospital in Valhalla). Many of us don’t want to know much more. Conjoined twins are frightening to contemplate, downright stomach-turning to a lot of people. “The public is horrified at conjoined twins,” says Cassy Aspinall, a social worker at a Seattle children’s hospital that has separated twins, “and relieved at their separation.” But a year after the Aguirres’ final surgery, there are soft spots in their tale. Was the twins’ separation the singularly spectacular achievement Goodrich and the hospital have repeatedly claimed? Have he and his colleagues really proved that a series of surgeries, not one operation, is the best method? And perhaps the most surprising question: Should head-joined twins always be separated in the first place?

Within the field of pediatric neurosurgery, doctors who perform craniopagus-twin separations are an elite clique. The condition is exceedingly rare, occurring in an estimated one in 10 million births. No more than 40 surgical separations of head-joined twins have been attempted worldwide.

Goodrich joined this rarefied group by a wayward route. Raised by a Catholic adman and Christian Scientist mother in Portland, Oregon, he barely graduated high school (GPA: 1.62), then escaped to the California coast. It was the late sixties. His four sisters were always in trouble: “Total chaos,” Goodrich says. “The generation gap was enormous; my parents didn’t know how to handle it.” Living a few blocks from the beach, Goodrich painted houses and surfed. To avoid going to Vietnam, he signed up for the Marine reserves but was sent into combat anyway. During the Tet Offensive, he saw a Vietnamese surgeon in a medical tent opening up a soldier's head. “Cool,” he thought. “I want to do that.”

When he returned to the United States, Goodrich couldn’t get into a four-year university, so he attended Orange Coast community college and parlayed the first good grades of his life into admission to the University of California, Irvine, and from there, Columbia Medical School. He didn’t set out to specialize in pediatrics, but when he finished his residency in 1986, there were two neurosurgery positions open: pediatric neurosurgery at Montefiore and adult neurosurgery in Oklahoma. His wife, a dental hygienist who had already moved across the country so Goodrich could attend medical school, wasn’t about to move to Oklahoma.

Over the years, Goodrich says he’s grown fond of interacting with children on the job, but he doesn’t have any himself and says he’s never wanted them. “When I come home at night, I enjoy my meal with my wife, my glass of wine. Then I go to my study, turn on my music, do what I’m going to do. If a little kid came in, three years of age, scampering across the room, I would have been annoyed.”

At Montefiore, Goodrich established a reputation as a gifted surgeon and helped build the hospital’s craniofacial-surgery unit into one of the best of its kind. But before the Aguirres, he says, the only case he handled that attracted any media interest was when he put a shunt into the child of a senior surgeon in the Soviet Politburo. 

Goodrich first heard about the Aguirre twins in the winter of 2003 from Dorita Urrata, a wealthy Connecticut woman who wrangles free medical care for Third World children. She’d called on him before: Charitable organizations regularly tap Goodrich and his colleagues to treat poor children from around the world. Sometimes the kids are brought to the Bronx; other times the Montefiore doctors set up shop in locations like the former Soviet Union, Peru, and the Czech Republic and perform a roster of surgeries there. Though Goodrich had never separated twins, Urrata says he was her first choice because of both his personal skill and Montefiore’s excellent craniofacial-surgery program.


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