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From the Annals of Medical Detection: Twins

Dirk van Nouhuys*



GEMNOGEN is a mild central nervous system stimulant, marketed by prescription in the United States from 1974 until 1978. Gemnogen produces extended wakefulness. A person who has ingested Gemnogen typically feels lucid perceptiveness and marked capacity to apprehend detail. Unlike amphetamines, Gemnogen does not reduce appetite, does not produce the unpleasant tension associated with speed, and up until the events recounted here, had no known side-effects beyond the consequences of prolonged sleeplessness. Above a certain dosage it has no increase in effect; like Vitamin C the excess passes out through the urine.

Gemnogen was marketed in the United States for treatment of narcolepsy (chronic sudden and excessive sleepiness), an organic disturbance that seriously handicaps about 400,000 Americans. By the time Gemnogen was withdrawn from the market, it was finding its way increasingly into the hands of truck drivers, college students, and the like — groups who perceived a need to stay awake for long periods.

Gemnogen was developed by the Minneapolis-St. Paul Laboratory of the Uptex Company. It passed through normally rigorous testing and screening before Food and Drug Administration (FDA) approval, including tests for tetrogenicity on pregnant rats and cats. As its action is now understood, it slows growth of certain cells of the blastomere (the hollow ball that is the first step from fertilized egg to fetus), that will later develop into the spine and central nervous system. In humans the blastomere takes on a grooved appearance because of uneven growth, and then the two halves develop as if each were a single sphere. The dangerous period is only a few hours long. In the usual test animals these cells are not differentiated at this period, and Gemnogen has no effect.

Trouble first appeared in 1975 when six known pairs of conjoined, or Siamese, twins were born to women who had ingested Gemnogen during early pregnancy. The epidemiology branch of the University of Minnesota attempts to watch various statistical indicators for any rise in the occurrence of medical problems. The number of Siamese twin births in the United States annually is not large, almost too small to be treated statistically. By the mid-1970s it was several times normal, discovered Dr. Bruce Conners of the Minneapolis branch of the Medical School. With the small number of incidents involved, it was the middle of 1977 before the connection with Gemnogen was definitely isolated.

In August of that year the FDA began proceedings to remove it from the market and a search was undertaken for women who had ingested Gemnogen during the critical period. Appeals by Uptex delayed removal of Gemnogen from the market for four months after that.

In all, 23 pairs of twins associated with Gemnogen were documented in the United States. Outside the U.S., where the use of Gemnogen had not been extensive and collection of statistics is less reliable, figures are uncertain. Of the 23, eight were operated on by a team headed by Dr. Connors, six separated at other medical institutions, six were declared inoperable, one pair died during an operation, and two died of other causes. Dr. Conners’ interest in these cases did not rest easily.

As this story takes place, Dr. Conners is an athletic man of forty. His 210 pounds make him look less than his six feet and exceedingly solid. He played lacrosse for his alma mater, Northwestern. He is married to a girl he met in college who is now active in the PTA, and works part time as an interior decorator. Together they decorated their home in tertiary colors saturated with white to give the comforting sensation of whitewashed stone. His two sons, both majoring in chemistry in high school, also plan to be doctors.

His straw-colored hair and pink skin display his mixed Irish and Scandinavian ancestry. The tetrogenicity of Gemnogen, Dr. Conners frequently asserted, is of a peculiarly heartbreaking kind in that the victims are all joined at the skull or at the spine in the region of the neck. This caused the disease to be dubbed the “Janus Syndrome.” Of the six inoperable cases, four pairs are without mental function; one joined in the spine has various dysfunctions of the sensory system and musculature; and the exact condition of the sixth is still in doubt. “Even when the operations were relatively successful,” he declared, “I felt there was some missing element that stood behind, or to one side, of what I sought.”

It was a case that occurred in a poor Greek family living in the industrial ghetto of St. Paul that interested Dr. Conners in medical detective work. The children had been delivered at home. As was later discovered, the event had for its participants some of the shameful and frightening overtones of the Mediterranean tradition of supernatural or monstrous birth, of the Minotaur, the Discordia (Castor and Pollux, Helen and Klytemnestra), traditions foreign and repellant to Dr. Conners. The husband was absent at work; the midwives fled and left the mother with her husband’s sister. What the two women endured in that room is beyond consideration here.

The family concealed the event. The pair of girls never left their parents’ bedroom where they were born. The only other person to see them was a priest who baptized them and agreed to keep the secret. Their life continued in this way until in their fourth year, when the father lost his job and the family was forced on welfare. They claimed benefits on the basis of the baptismal record, asserting the children were out of town staying with relatives. Absence of other documentation of the children’s existence made the caseworker suspicious. At first she suspected fraud, then she feared real children had been murdered and wanted to expose the crime. Finally she was so frightened she almost let it pass. Faced with possible prosecution for welfare fraud, the parents at last took her to their apartment, where she was the first outsider to see the girls since the priest.

Their case came to the attention of Dr. Conners and when the parents resisted expert intervention, it was he who persuaded them to allow the operation. “He extended to the family a certain manliness,” recalled a law enforcement officer involved, “that more than anything else enabled them to bear the shame.” Though the operation went without technical complication, the girls are still behind socially, in school, and in muscular coordination. Their doctors are uncertain if undiagnosed physiological problems are holding them back or if it is because of the isolation and anomie of their parents’ bedroom.

This experience led Dr. Conners to suspect that other parents might be hiding children deformed by the action of Gemnogen. He publicized the problem through the cooperation of medical societies and journals, particularly in the field of public health.

In the spring of 1975 he received three reports separated by about fifty miles in the northernmost lake country of Minnesota of a man of unknown name calling a doctor with a description of his sick daughter, evidently tonsillitis, but refusing to bring in the child. That was enough to set him off. It was the arrangement of the calls on the map.... A man who broke off with one doctor because he had something to hide might reasonably call the next nearest. “The evasive pattern drew me on.”

Dr. Conners drove in his new Buick to the lake region the next day. It was May 28. In that area snow still held out in shadowy places among the trees. He visited first the doctors who had received calls. Each was quite cooperative. “I did get the impression they were a close-knit community and anyone who wanted to get medical services in this area and preserve anonymity would be hard pressed.” Dr. Conners spent the rest of the day talking with local health and social service organizations where he failed to turn up any leads. When he returned to his hotel room the second night he received a report from the same time-period of a similar call fifty miles north in Canada.

Dr. Conners picked out the spot central among the first three calls, figuring that the call to Canada had been born of desperation. The convergence was in Wonder Lake, a small lake near Panawanda, the largest town in the district.

The reader may recall that Panawanda attained some notoriety several years ago when what was first believed to be a meteorite landed in a suburban street, gashing a scar five feet wide at the widest and about thirty feet long in the asphalt and damaging local windows and garages with fragments thrown up on impact. Within about half an hour the area was cordoned off by representatives of the Defense Intelligence Agency, the FBI, and the Defense Communication Agency, the street torn up, a collection of metal fragments removed, and the street repaved the next day. The matter was not reported in the local or national media, a circumstance that made a profound impression on the hundreds of local citizens who witnessed all or part of the action. The story circulated that fragments of a Soviet or Chinese spacecraft had been involved.

Dr. Conners’ plan for the next day was to interrogate local people who had wide public contact, tell them his story, and ask if they had any relevant information. We are dealing here with matters the heart wants to hide. People who are concealing massive, heartfelt shames are marked. Bystanders at once recall their strange behavior once they have the clue. He believed his sincerity and obvious purposefulness when he explained his mission disarmed people deeply. Dr. Conners readily acknowledged that it gave him a certain pleasure, driving about the spring countryside explaining his purpose.

The second place he stopped was an ice cream parlor. A child there described having seen, the summer before, a little girl who sat funny in her car. The funny little girl’s father had a dead hand. The child informant had only seen the funny little girl that once and she had not left the car, but she had seen the father, a tall man with black hair, on other occasions. She did not know his name. No one at the ice cream stand understood what she was talking about. When Dr. Conners asked her address, she ran away. He learned her family name from the counterman and noted it for further checking but went on to the next public place. He felt his instincts, the same instincts that guided him when he faced something with a puzzling appearance during an operation, were guiding him well.

The fifth place he stopped was Wonder Pier on Wonder Lake. A center for ice-skating, ice-boating, and tobogganing in the winter, and in height of summer for fishing and swimming, but now it was quiet. The short grass on the toboggan runs sloping down to the water looked mowed. A ramshackle wooden building, weathered to a beautiful silver in places, housed a restaurant, an office with a sign “MANAGER,” and an outdoor counter for equipment rental. Dr. Conners parked in the wide paved lot with only four other cars. A road ran away to the right among budding trees, along the edge of the lake. It was sunny and quiet; no other human being was to be seen.

Dr. Conners sought out the proprietor in his office. He was a burly man and a former lumberjack. As Dr. Conners began his account, the proprietor guided him out-of-doors and then interrupted him to say he had seen some weird things around here. Why, he had been standing in this very spot last October when a man he knew personally had driven a snowmobile full-speed with six people into the lake, and, before his horrified eyes, broken the thin autumn ice and drowned them all.

As the burly manager was speaking, Dr. Conners felt a familiar cold breeze on the back of his neck. He heard a rushing sound. The two men turned to see an old, randomly painted Volkswagen bus driving over a grassy slope directly at the water. It was moving at moderate speed over the soft earth.

Both men ran toward it. They were on the driver’s side. They caught up with it a few feet from the water. The outdoorsman was first. He pulled open the door. A sullen-looking boy, about twelve, in overalls, tightly gripped the wheel. “Grab the wheel,” the outdoorsman shouted and himself grabbed the boy by the shoulder and heaved him out of the car with a tremendous effort. The two fell to the ground and began rolling toward the water. Dr. Conners jerked himself into the driver’s seat and brought the car to a stop a few feet from the edge. The people in the car included several small children who were yelling and crying. Dr. Conners instructed them to be calm, that he was a doctor, and to remain where they were. He climbed down and walked to his own car where his seldom-used black bag resided in the trunk. He observed the proprietor of Wonder Pier walking toward the building, grasping the boy-driver by the right arm; by the look of the left arm, it had been dislocated in the pulling from the bus or the fall to the ground.

Dr. Conners was about halfway through handing out tranquilizers and bandaging minor cuts and abrasions when he heard a police siren. He raised his eyes to see a local police car come to a stop in the parking lot with a crunch of gravel. A small crowd had gathered in the parking lot and several more cars appeared. A man parked in an old Chevrolet was supporting his face with his hand, leaning his elbow on the windowsill. The hand was wizened and dark. Dr. Conners’ instinct told him that it was the man with the dead hand described to him by the child informant. Dr. Conners shifted his gaze to the interior of the car. A woman with dark hair sat by the window on the other side and a short form with a wide-brimmed hat was hunched peculiarly between them.

Dr. Conners dropped the hand of the child he was salving. He began to run towards the old Chevy. The father straightened, dropped his dead hand into the car and started the car with his other hand. The sound was very vivid to Dr. Conners as he ran toward them. When he reached the blacktop the car was already moving. Dr. Conners shouted to an officer in the parked police car, “Block the entrance!” The police car started smoothly and rolled across the exit of the parking lot.

The man with the dead hand stopped his car and with the engine running he climbed out. He faced the approaching doctor. Dr. Conners glanced at the small figure in the front seat. It sat forward in the seat. The hat had fallen; there were two faces, one facing forward and one back. Apparently the twins were extensively joined from head to hips; perhaps their spines were fused. He looked at the father. He was a tall man with a black crew cut, and dressed in tacky jacket and slacks. As Dr. Conners approached him he turned away, stooping. Dr. Conners could not tell if the gesture were shame or preparation for some violent act. He ran up and grabbed the man from behind, locking his arms by encircling them and clenching his own hands in front of him. The man was tense in his arms but did not struggle. The doctor looked into the car. The wife was crying. She was a plump woman in curlers and a cheap cotton dress. The figure in the middle of the seat had not moved. Dr. Conners jerked the father to one side so he could see the face facing rear. The eyes were blank. No mind. Police were approaching with their hands on their weapons.

When the police questioned him, the man with the dead hand gave his name but refused to identify himself in any other way. He was carrying a 22 pistol and in the trunk of his car they found a 22 rifle, a 30-30 and 30.6, the normal hunting tools of that area, with a large supply of ammunition. Dr. Conners was glad he had grabbed his arms! The police booked the man for assault and possession of concealed weapons. Dr. Conners did not want to proceed in this way. He would have preferred to earn their confidence. But their attitude made it necessary. By afternoon the cooperation of county medical officials had already initiated procedures that would insure that the taciturn parents could not interfere with the operation Dr. Conners planned for the child.

The reluctance of the suspect to give his address provoked Dr. Conners’ instincts. He had an unusual name and the police were able to find his address in the telephone book. When they informed him, Dr. Conners asked to accompany the officer to the house. He had a feeling that he might find there the element that stood to one side.

It was a low white house with wood siding in a bleak neighborhood where some of the dwellings seemed to Dr. Conners no more than shanties. The garden appeared unkempt and parts of two cars spilled from the driveway onto unmowed lawn. The doors and windows proved locked. The officer had brought a supply of master keys and was able to open the front door. The door exposed the living room where a large television set on a bureau on the opposite wall dominated a space furnished sparsely with worn furniture. No sound rustled the cold rooms.

They separated, and while the officer went into the kitchen, Dr. Conners entered a short hallway. He opened a door, which revealed a bedroom with one double bed and one child’s bed. A second door was a closet filled with auto accessories. A third door ended the hall. That door puzzled him. If it were a bedroom, why did the girls sleep with them? Was there another child? He did not imagine this family having a workroom. He tried the door. It was locked. Dr. Conners went to look for the officer. He found him in the garage. He was checking the serial numbers of several automobile engines against a list he had brought with him. He handed Dr. Conners a key. “The locks in this house are standard,” he informed the physician. That should do the trick.

The window blinds were drawn and the room was filled with an obscure dark yellow-brown light. It was empty except for a dresser against the opposite wall whereon an object about the size of a child’s head was glowing. It was like one of those rocks you see in a museum under ultraviolet light except the glowing masses were deeper and more translucent. It shown in several clear, spectral colors: red, turquoise, purple. When he stepped closer he could see the stone had the rough shape of a human head, or a Pan’s head with knobs for horns. It was so rough that if you found it somewhere among unweathered rocks, a slag heap, you could not tell if it were an artifact.

He bent close to the face. His instinct told him it was the twins’ brother and diabolically intelligent. He brought his eyes a few inches from the surface, stricken by the beauty of the glowing parts. He would have kissed the mouth place, but he was afraid he would never be able to tear his lips away. He felt a painful cracking sensation in his spine and the back of his head. The pain brought him to his knees. Panic buffeted him. He believed that his own unacknowledged twin was linked to the back of his head at that spot and he could feel swelling the twin’s mind, full of unknown feelings, separated by no bone but only by the parchment bag that contains the brain. Dr. Conners stretched out his arms, palms toward the stone. He felt in his shoulder blades that the twin was doing the same thing, and he could feel the back of the twin’s hands and his nails brush against the backs of his hands and his nails. The head had no eyes but seemed to be watching him.

It was also as if he had always been an insect in disguise as a man, like those beetles that live in ant societies masquerading mechanically as their unwilling hosts, and his wings had broken from his shell in response to the clock of his instincts, gaudy polychrome wings like the angels of Isaiah. Tears of humiliation stung his eyes. His breast heaved. He would be too ashamed ever to face another human being. He felt such intense shame he believed he would never be able to leave this room. He was trapped in the brown twilight with the head stone. He could hear his mother saying, “I would rather Bruce had never been born than suffer the exposure he did in that room.”



*2009 WOOD COIN: You’ve Reely Scored a Movie Issue: van Nouhuys, “From the Annals of Medical Detection: Twins”