My twins

I was looking after twins, twins with bronchiolitis.

At morning signover, whoever had been on call would tell me how much trouble the twins, those terrible twins, had been overnight. During morning rounds, I'd joke that I had only bothered to do one physical exam for the both of them. I tried, succeeding on some days and failing on others, to find some time to take with their exhausted mother, who was being worn away by the demands of her babies who were sick and the other kids at home who weren't. I struggled to remember which boy was which, eventually keeping it straight by thinking of them as “the one by the window” and “the one by the door.” Consequently, I lived in terror that the nurses might, for some inscrutable purpose, switch the boys' positions. That never happened, but they did get moved to another room, and I had to adapt quickly to calling them “the one on the left” and “the one on the right.” When on call at night, I'd check on the twins, those worrisome twins, and listen to the frightful difficulty of their breathing. Once or twice their nurse found me there in the middle of the night, and joined me in my fretting.

There was something weird about those boys. On admission, each was struggling to breathe, too tired to eat, and suffering from an ugly diaper rash. They were in the same shape, more or less. Then one of the boys improved, his breathing becoming less harrowing. But his brother worsened. Then he started to get better as well, but only after we got a report of a positive blood culture from a sample taken before admission. We decided it was probably a contaminated culture and nothing to worry about, but then the other one's rash got worse. One change of antifungals later, the rash was improving, but the boy got a fever. We x-rayed him and found a pneumonia.

As I wrote the order to start antibiotics, I was wondering what was going on. There seemed to be, between the two boys, a fixed and limited amount of health that was being traded back and forth. Was there only one life between the two of them, only half a life each? Would one eventually snatch all of that life away from the other?

Before I had much chance to think about this, to get into a philosophical frenzy about it, the twins, my helpless twins, started to get better. They went home with their mother, and I went on looking after other patients.

Paul Moorehead Pediatrics Resident Memorial University of Newfoundland St. John's, Nfld.