On everyone’s mind were a lot of what-ifs. What if Ana or Carmelo had had relatives in Bucaramanga? Then their sick baby would have been treated closer to home and never would have traveled to the hospital in Bogotá. What if Bogotá’s preemie nursery hadn’t been so crowded? There would have been less chance of a switch. And what if Ana had delivered her babies at home? Home deliveries have their own risks, but baby switches are not one of them.
Having Babies: Hospitals and Homes
In 1900 most deliveries of newborns took place at home, but their frequency fell to 44 percent by 1940 and to 1 percent by 1969.26 Home deliveries in the United States now represent less than 1 percent of all births, but their frequency increased by 60 percent between 2008 and 2012. Their frequency grew even though infants born at home experience more complications, such as neonatal seizures, and more mothers receive blood transfusions.27 Perhaps the general public is less familiar with the hazards of home births than the benefits. However, in a curious twist, 2012 national health statistics show that home births may pose a lower risk than hospital births, but that could be because birth attendants purposefully select low-risk women to deliver at home.28
The human female psyche’s absence of baby-switching fears is clear if we listen to women who planned for a home delivery. Women delivering at home do so mostly to avoid unnecessary medical procedures, exercise control over the birth, and enjoy an intimate experience; they rarely mention worry about receiving the right child.29 A 2001 study found that 9.1 percent of a small group of new mothers acknowledged that baby switching was a predelivery concern, but much higher percentages of women felt anxious about the pregnancy, the delivery, and the hospitalization. In fact, the small percentage of concerned women may not have even thought about baby switching until they heard about their hospital’s practices for matching mothers and babies—perhaps they suddenly worried that an ID bracelet might fall off their baby’s thin wrist.30 I know a new mother who caught a glimpse of her newborn daughter just after delivery, before the infant was taken for a checkup, noting that the baby had an unusually high hairline. When the infant was later taken to her room for breast-feeding, the hairline seemed lower, but the mother assumed that her faulty memory reflected her exhausted state and began nursing the infant, falling madly in love with her. Suddenly, a nurse burst into her room with another baby, one with a high hairline. The mother began breast-feeding the child, learning to love a new baby all over again.
Now that most women in the United States deliver their babies in hospitals, there is some reason to be concerned that the right babies are matched with the right mothers. As I indicated earlier, it has been estimated that twenty thousand to twenty-three thousand infant misplacements occur in US hospitals annually, for example, when babies are returned to mothers after examinations or after mothers are allowed to rest. These figures are staggering and should be taken seriously because they were arrived at independently by a consultant hired by Talon Medical Ltd. in San Antonio, Texas, and the DNA Diagnostics Center in Fairfield, Ohio. Nicholas Webb, head of Talon Medical, claimed that the vast majority of these errors are corrected quickly—but because the misplacements are so numerous, it is likely that each year several families unknowingly receive someone else’s child.31 Most of these switches will never come to light because the children involved do not look alike. Identical twin switches have a far greater chance of detection, because of the twins’ matched appearance, relative to switches involving fraternal twins or unrelated infants.
Multiple pregnancies and deliveries require optimal care because of the risks involved. The recommendation that twins and triplets be born in hospitals brings a bit of irony to the conversation because hospitals are where baby switches occur.
Chapter 6
Finding the Colombian Four
Twins and Other Curious Pairs
You’re traveling through another dimension—a dimension not only of sight and sound but of mind. A journey into a wondrous land whose boundaries are that of imagination … a land of both shadow and substance, of things and ideas.
—Rod Serling
As a child, I loved this magical introduction to the weekly television show The Twilight Zone, whose episodes portrayed ordinary people in extraordinary circumstances. Each thirty-minute episode blended science fiction, high suspense, and great drama, giving viewers a fanciful white-knuckle ride through exotic places with infinite unforeseen possibilities. The current stream of online and on-air reruns attests to the show’s universal and enduring popularity.
The story of the switched Colombian brothers could be an episode from that series. From the twins’ perspective the discovery was a sudden and unexpected rewrite of their life histories, a complete revision of their childhood memories and the heartbreaking business of squaring opportunities lost with opportunities gained. Studying their experience and its aftermath also promised an adrenaline-charged ride for me, a journey to a new land to hopefully meet a type of foursome that no researcher had ever encountered. Without doubt, these brothers would leave an indelible mark on our understanding of how interactions between genes and environments affect our abilities, job choices, eating habits, and physical strength. Events in the twins’ lives would also expand knowledge of how new mothers know who their babies are, the status of legal procedures and rulings regarding switched-at-birth infants, and the emotional impact of finding out that you are living someone else’s life.
Questions Without Answers
The only information about the Colombian twins came from Caracol TV’s two-part series produced by Séptimo Día, a 60 Minutes–style newsmagazine that told the story to the people of Colombia and the adjacent nations of Ecuador and Venezuela.1 The report, “Crossed Lives,” was not broadcast widely, although Yesika, who is from Bogotá, saw it when it first aired in October 2014. She knew of my previous work on switched-at-birth twins and emailed to see if I was interested in this case—I was!—and we soon agreed to work together on one of the most fascinating projects either of us could have imagined.2 My research experience with reared-apart and switched-at-birth twins in Minnesota and elsewhere had taught me what information we would need from the twins and the types of interviews we would use and questionnaires we would administer. Yesika’s social work training and professional associates in Bogotá would facilitate contacts and interactions with the twins and their families, as well as meetings with the psychological examiners, geneticists, hospital staff, and attorneys we hoped to visit. We also hoped to write a series of scientific articles and a book that would describe the findings and events that so radically changed the life histories of four young men.
It turned out that William, assisted by his then girlfriend, who had some television contacts, was responsible for bringing the twins’ story to the media; he called every department at Caracol TV until he found the right one. Jorge was enthusiastic about his twin’s idea, but Carlos and Wilber were not. Carlos had strong reservations about involving the media, concerned that he would lose control of what was aired, and he was largely correct. “Some TV people wanted me to act really sad, do this, do that, act like I was depressed and really exaggerate my feelings. I dislike sensationalism,” Carlos said. Jorge also has his limits; he did not want to be “turned into a clown,” but he was eager to share his story with the world. Each brother’s reared-apart twin held attitudes about public attention that aligned perfectly with his own. Nevertheless, Carlos and Wilber, while reluctant, agreed to go along, most likely because of Séptimo Día’s offer of free DNA testing, a costly but vital step toward confirming beyond a doubt that a baby exchange had occurred. Everyone had to know because their life histories, personal identities, and family relations hung in the balance.
* * *
How the exchange of babies actually happened was the great unanswered question, just as it was in the seven other cases of switched-at-birth twins I have known. These mysteries are rarely solved, so imagination and speculation run wild. We learned that babies like the fou
r twins, born prematurely at seven to eight months, were routinely placed together on a large table in the newborn nursery of the Bogotá hospital, so perhaps William was lying closer to Wilber than to Jorge, and a staff member forgot which twins belonged together. Or perhaps an overworked assistant misread the babies’ identification tags, or maybe the tags fell from their wrists and were incorrectly reattached.
Séptimo Día producers dramatized these possibilities when they filmed part of the report in the baby nursery of the Bogotá hospital where one set of twins was born. Two incubators were positioned several feet from each other, each with a pair of infant twin dolls dressed in striped pajamas and matching caps with small white ears protruding from the top, giving the impression of tiny bears. The incubator on the left held the La Paz pair dressed in blue, the one on the right held the Bogotá pair dressed in purple, and each twin doll had a different name emblazoned across his belly. The narrator walks toward the incubator on the left, removes Carlos, and brings him to the incubator on the right, placing him between Jorge and William. Moments later he picks up William and delivers him to the incubator on the left, setting him next to Wilber. Then we see the four adult twins sitting alone, slumped between incubators and looking forlorn. Of course, this was all done for effect because no one really knows what happened in the nursery a quarter of a century ago. This imaginary scene embodied all that Carlos disliked about media attention and Jorge’s cautious, but less intense, reservations.
Despite this dramatic depiction, or perhaps because of it, many new questions arose. Did the exchange of babies happen on the day the baby from La Paz arrived in Bogotá or later in the week? And why didn’t his grandmother notice the difference between the baby she brought to Bogotá and the one that came back to La Paz? Or perhaps the nurses were tipsy, as one of the twins’ aunts truly believed.
None of these hypotheticals and unknowns was as haunting as the statements made by Gilma Ospina, a nurse who appeared on the program and had worked in the premature care unit in 1988, the year the twins were born. She acknowledged that she could have inadvertently switched two of the twins, but she did not feel the need to apologize for such a mistake because no one can know whether she was truly responsible. She speculated that the two babies’ identification tags, just simple pieces of tape, had fallen off and were incorrectly reattached. Even if she had misplaced the babies, she was happy to see that the switched twins were doing so well as adults.
The program also equated Jorge and Carlos’s city life with wealth and opportunity, and William and Wilber’s country life with poverty and deprivation. It made for a great television story, but a crucial aspect of the difference in their childhood environments is easy to miss. In terms of material possessions and necessities of life, both sets of accidental brothers did differ—except that each pair believed they were living in homes comparable to others in their area. Both families worked hard to maintain the standard of living they had set for themselves, and both families were successful in that respect.
Turning to science, Séptimo Día interviewed the geneticist Dr. Emilio J. Yunis of Bogotá, whose Institute of Genetics performed the DNA analyses. Yunis was stunned by the striking physical resemblance of each reunited set of twins, half-seriously suggesting that a DNA test was probably not necessary. But the seriousness of the twins’ expressions as they listened to the results reminded viewers of the far-reaching implications of this news for the twins and their families.
Tracking Down the Twins
Séptimo Día included a short interview with the Colombian attorney Francisco Bernate, who was not officially involved in the case but was prepared to offer an opinion.3 We never met him, but on-screen he looked professorial in a gray jacket and purple tie with his long dark hair swept back from his face. He commented first on the slim possibility of the twins’ receiving compensation from the hospital where the switch had taken place; he believed this was unlikely because more than twenty-five years had passed since the mistake was made. He opined that the damage began when the truth was first known, asserting that everyone has a right to their identity and to know where they have come from.
We had been unsuccessful in trying to reach the twins because we were unable to find the twins’ phone numbers, contact the TV show producers, or find additional information online. But we realized Bernate could connect us and after weeks of waiting he did. It helped that Bernate was a professor of criminal law at the Universidad del Rosario’s law school, where Yesika’s sister, Alexandra Montoya, who is famous for her impressions of Colombian celebrities, was working toward her second career. This personal connection probably was responsible for the lawyer’s email message to Yesika that included Jorge’s email address and cell phone number.
Yesika and I were now on an exciting journey together, with the dual goals of finding the four brothers and convincing them to participate in the first-ever research on doubly exchanged adult twins. By the end of December Yesika had flown to Bogotá for the holidays and met with three of the four twins; Wilber was unable to attend because he was covering the butcher shop. The three young men and Yesika discussed research plans, when they might be available to us, and a little more about their getting to know one another. Later I received a photo that showed Yesika and the three twins seated around a table, as well as a little boy who was cuddling up to Jorge. That was Santi, Jorge’s then four-and-a-half-year-old son, whose mother was Jorge’s former girlfriend. The recently reunited twins Jorge and William were seated together, while Jorge’s accidental brother, Carlos, sat apart.
For two tense months, October to December, we waited to find out whether the twins would meet with us. But as 2015 approached, Jorge told us we would be welcome in Bogotá. We arranged for a ten-day stay in Bogotá in late March and early April, including a one-day trip to La Paz. Information gleaned from doubly exchanged twins, especially those raised in such contrasting environments, would be a unique addition to the rich history (since 1922) of reports, articles, and books about reared-apart twins, as well as to my own ongoing research about reared-apart Chinese twins and other separated pairs.4 The first mention of twins reared apart was not in the scientific literature, but in a play by the Roman comic dramatist Plautus (254–184 BC), The Menaechemi (The Twin Brothers), a hilarious tale of separated twins, mistaken identity, and widespread confusion.5
Twin-Family Relations
Seeing the photo of the twins and Santi suggested to me that William, Jorge’s identical twin, might be rejoicing at the sudden acquisition of a nephew. In fact, he is Santi’s genetic father as well as his uncle, because William’s biological relationship to Santi is exactly the same as Jorge’s. Parents transmit half their genes to each child; because identical twins share 100 percent of their genes, either twin could have fathered little Santi. Until recently genetic testing was unable to distinguish an identical twin father from an identical twin uncle, but in 2014 German investigators figured out how to do this. If one twin develops a mutation after birth it could be passed down to his child, and since the other twin would not have that mutation he could not be the father.6 This technique would be handy in cases of disputed paternity in which both twins had sexual relations with the same woman and she became pregnant or if a twin was suspected of having an affair with his brother’s wife. Before 2014 judges were powerless to assign responsibility for child support in such cases, but now they can because ten to forty mutations can be expected in each paternal generation.7
An array of other curious relationships emerges when identical twins raise families. When William has kids, they will be cousins to Jorge’s kids, but all the children will have a genetically identical parent. This quirk of birth transforms close cousins into genetic half-siblings, who share an average of 25 percent of their genes, whereas ordinary first cousins share just 12.5 percent. Family relationships grow even stronger when identical twins marry identical twins because all four spouses turn into the genetic parents of their nieces and nephews. In one such family that I kn
ow the wives became pregnant at the same time and delivered their children on the same day, changing these legal first cousins into the equivalent of genetic fraternal twins.8
Not surprisingly, one of my ongoing studies shows that identical twin uncles and aunts feel socially closer to their nieces and nephews than do fraternal twin aunts and uncles. I suspect that behind those feelings are identical twins’ perceptions of the behavioral and physical similarities between themselves and their nieces and nephews. The growing field of evolutionary psychology adds an intriguing explanation: it makes sense to “be nice” to your close relatives as a way of getting your common genes into future generations, namely the concept called inclusive fitness. Of course, people do not make genetic calculations in their head as they go about their daily interactions, but they act as though they do.9 In contrast fraternal twin aunts and uncles share an average of 25 percent of their genes with their nieces and nephews, the same as in nontwin families. Thus, investigators would expect to find more variability in the nature of their perceptions of similarity and social closeness.
I wondered whether Jorge’s accidental brother, Carlos, was suddenly grieving the loss of a nephew he had loved for nearly five years, now that he was no longer the uncle he had thought he was. These were among the hard questions for which I hoped to find answers in Bogotá.
Transformers and Matryoshka Dolls
I occasionally teach a graduate-level seminar about twin research, and one of the exercises I assign students is to dream up an ideal experiment for figuring out the extent to which genes and environment affect our different traits. “Be creative,” I tell them. “Really stretch your mind and go beyond the classic twin study.” At this point in the course the students understand the logic of the classic twin study design, which involves comparing similarities of pairs of identical twins (who share 100 percent of their genes) and pairs of fraternal twins (who share an average of 50 percent of their genes). Greater resemblance between identical than fraternal twins in any trait, such as solving math problems, participating in sports events, or attending religious services, shows genetic influence on those behaviors.10 We find that genetic influence affects virtually every trait we have measured, but the environment also plays a role, affecting some behaviors more than others. For example, genetic factors more strongly influence general intelligence, accounting for 50 to 75 percent, whereas their influence is less on personality (50 percent), self-esteem (38 percent), and longevity (33 percent).11
Accidental Brothers Page 16