One and the Same

by Abigail Pogrebin

  The Pauls no longer strive to distinguish themselves; in fact they are invested in the idea that officially, they’re genetically the same, so much so that they were reluctant to find out they might not be. “We took the DNA test,” Alexandra explains, “because people always asked us if we were identical, and my mother would say, ‘No,’ because she wanted us to be individuals, while Dad would say we were. A few years ago, we decided to offer ourselves up for sexuality studies, since she’s gay and I’m straight—we thought it would be a help to figure out whether it’s nature versus nurture—so we took the test by swabbing our cheeks, and the results were to be mailed to me, and we were so afraid that it was going to be fraternal, we didn’t open the envelope for two and a half years. My sister said, ‘If you open it and it says we’re fraternal, don’t tell me. Say you lost it.’”

  What were they afraid of?

  “That we wouldn’t feel close,” Alexandra replies. “That it would break a bond. But one night at midnight, my husband was away and I thought, You know, the truth is in that envelope and I’m going to open it up. And of course it said we were identical—seven out of seven markers. … We were thrilled and relieved. And we entered into twins studies. They’ve never called us, but they do send us a birthday card every year.”

  Jane Harnick is the only friend who has stayed friends equally with Robin and me since we were four years old and met on the bleachers of the baseball field on Fire Island.

  ABIGAIL: Do you see Robin and me as competitive with each other?

  JANE: I feel like each wanted the other to do so well—and that your competitiveness was with everybody else, not with each other.

  ABIGAIL: Do you think that I am protective of her?

  JANE: No. And when you guys were younger, she was the one who took control of the situation and got you through things. I don’t see you as protective.

  ABIGAIL: You’re saying she was the adult in the twinship?

  JANE: Yes. She was definitely the adult. Remember your trip to Greece, when she held the plane tickets and kept you from getting lost? Those stories were always hysterical. That’s another thing I should mention—the way you two make each other laugh. When you’re together and you’re on some kind of roll, I’m crying, I’m laughing so hard.

  ABIGAIL: Do you remember that dinner a few years ago when we made you angry because we were laughing so hard?

  JANE: Maybe because that reminded me of childhood, when the three of us would be together and you two were onto something and laughing; I wasn’t included. And here you did it again.

  ABIGAIL: What was it like when we were younger—for you to be the third wheel?

  JANE: Horrible. I remember when the three of us would plan to do something together, and I’d always be very excited ahead of time, but then I’d get into the situation and say to myself, Why do I keep putting myself in these situations? It’s awful to be with the two of them. Because you guys would ignore me. You’d have your own private language. It was a feeling like, They don’t need me here. Now it’s better, but when we were younger, you were so tight; there was no room. I wanted to be the third Musketeer and you just wouldn’t let me. I don’t know if you let anybody.

  ABIGAIL: And yet you stuck with us.

  JANE: We’ve been friends since we were four. You don’t give up on that.

  ABIGAIL: How would you describe our relationship with our brother, David, growing up?

  JANE: When we were kids, David was just your little brother, just like I had a little brother; they were annoying, but we liked them. Then in high school, when David started having some trouble, I just remember thinking it must be so hard for him with the two of you as sisters. How could it not be? And your mother on top of it. I mean, three strong women in that family, how could he not have struggled the way he did? And now I think you’re both incredibly supportive of him and it’s lovely.

  ABIGAIL: What do you mean when you say, ‘it must be so hard for him with the two of you as sisters’?

  JANE: Well, you and Robin were sort of famous. You were smart, you had each other. You had each other. I mean, being the younger brother of twin sisters who were as close as you two had to be so hard and lonely. The pressure. I feel like there must have been extra pressure for him in that house.

  • •

  I interviewed my brother, David Pogrebin, months later in my living room.

  ABIGAIL: Do you remember Robin and me leaving you out?

  DAVID POGREBIN: There were times, particularly in adolescence, when it was hard because Mom and Dad were such a tight unit and you and Robin were such a tight unit that I felt literally like a fifth wheel, and I had no one to be a unit with. But that wasn’t till adolescence.

  ABIGAIL: Then things got bad?

  DAVID: I don’t think things were terrible, I think it’s a function of odd numbers; I was the odd man out. You and Robin had such a strong relationship. I’ve always felt that you two were so much each other’s soul mates, and I think there was a part of me that would enjoy when you would fight; in fact, I think there still is a part of me that gets a secret pleasure when the two of you are not on the same page.

  ABIGAIL: Do you feel like we’re insular even now?

  DAVID: There are times where I’ve felt like, Why bother? Not that being close to somebody is ever competitive, but there are times where I think, She gets everything she needs from her sister. … And the fact that I was the one who broke from the family mold, so to speak … I felt you and Robin took the path Mom and Dad wanted; I took my own path. If one of you had gone to Yale and the other went to a non-Ivy school, for instance, it would have been easier to wedge myself in, or feel like, ‘I can get closer to her or to her.’ But once you both went to Yale, that sealed the deal for me. There was a way in which it felt inevitable. … So I made choices to compensate. I did things to bolster my own feelings of specialness to counter yours. …

  ABIGAIL: So would you say, looking back, it was hard to be the nontwin sibling?

  DAVID: Not so consciously, because it’s all I knew. All I’ve ever known is having twin sisters. I will tell you the one thing Alina [his ex-wife] said is that the reason I’m overweight, and have been since I was ten, was that I wasn’t part of a twin. That I ate to be big enough to get noticed. I would try to make myself two people or a bigger one person. But I don’t put a lot of stock in that theory.

  ABIGAIL: Did you think we had it better being two?

  DAVID: Not always. I didn’t think until I was older about how hard it must have been for you to be twins. To constantly split the attention.

  ABIGAIL: Do you see Robin and me as competitive?

  DAVID: I would guess there’s some subconscious competition. There are things you both do around the same time—have children, get second homes. You can’t look at that and say there’s no looking into your sister’s yard. There must be something subconscious about the timing of your children, because that was just a little bit strange.

  ABIGAIL: If someone asked if you are close to your sisters?

  DAVID: I would say yes. I feel I can talk to you about almost anything. But I think there’s a judgmentalness that has kept me from being a closer brother.

  ABIGAIL: Both Robin and I are judgmental?

  DAVID: Yes. In a way I’m not. I think being the least financially successful in the family has given me a unique perspective that makes me less judgmental.

  ABIGAIL: Do you feel you have to treat Robin and me equally?

  DAVID: Yes. I feel like if I call you, I should call her within the week.

  ABIGAIL: Why?

  DAVID: Out of fairness. Fairness between twins is a big thing for the nontwin, not wanting to ever blow the equilibrium. I’m painfully aware of that, in terms of everything. I don’t want either of you to think that I’m closer to one of you, that I like your children more than her children, your husband more than her husband. I don’t want Robin to feel that I’m closer to you than her. Which is a little odd, when you think about it, becau
se I’ve felt that way my whole life—that you were closer to each other.

  ABIGAIL: You wouldn’t say that you’re closer to one of us?

  DAVID: There have been times in my life where I’ve been closer to each of you. And I stand by and stick to that story.

  ABIGAIL: Can you describe our differences now?

  DAVID: That’s a difficult question to answer.

  ABIGAIL: Really? What if you had to speak at our funerals tomorrow?

  DAVID: I’d have to think about it. [Laughs.] It would not be something that would just zip out there.

  ABIGAIL: I just want to say for the record that if Robin and I die at the same time, we should have separate funerals. I just realized that. Will you make sure?

  DAVID: Don’t even say that.

  ABIGAIL: Seriously, if we died together, God forbid, and we had one funeral, that would really suck. I have different friends, different worlds.

  DAVID: If you and Robin died together, God forbid, why would you have separate funerals? What a waste! I can’t believe it. [We’re laughing.] You want me to have to go through that twice? Why should Jane Harnick and I have to go to two terrible occasions and endure? That would be terrible. It’s already going to be double the grief.

  ABIGAIL: I’ve lived my own life. I want my friends to be able to talk about me without being cut short so Robin’s friends can get equal time. This really never occurred to me until this moment. I don’t want any efficiency at my funeral—two for one. I can just hear Mom saying, “Let’s use the leftover lox for Abby’s reception. …”

  DAVID: You’re insane.

  • •

  5 RISKY BUSINESS: THE SHOALS OF BIRTHING TWINS

  Not being able to have a baby can be heartbreaking. But having too many at once can be even worse.

  —Health reporter Christine Gorman, Time, 2002

  Ricki and Steve were like so many couples trying to get pregnant: anxious and ill-informed. Though this couple, in their early thirties, went to one of the most reputable fertility clinics in New York City, they heard few specifics about what they might be in for. “No one informed me of the risks of multiples,” says Ricki, a genial woman with shoulder-length black hair, who works part-time in her suburban library. “I just thought that with twins, you got more uncomfortable at the end of the pregnancy and were more likely to have a cesarean birth. I didn’t realize how common premature birth was with twins.”

  Ricki’s husband, a furniture maker who is dressed in his company work shirt when I meet him, recalls trying to obtain some hard data. “I really felt that I had to fight tooth and nail for every number, every statistical fact, every probability,” says Steve, whose baby face contradicts his graying hair. “I’m well versed in calculus and statistics and things, but whenever I wanted to see real solid IVF numbers and probabilities, I felt that, at best, the doctors were extremely evasive and not forthcoming. They would say something like ‘I don’t have those figures, and even if I did, they wouldn’t be meaningful to you.’ I don’t think it’s a nefarious conspiracy on their part. But I do think that perhaps on some unconscious level, their impetus is numbers: They want to be able to point to statistics and say, ‘We have a certain percentage higher success rate than the next clinic.’ To a large extent they were more motivated to push you through the process than to make you aware of what can go wrong. If you were going to go out and buy a car and the dealer said, ‘You have a two percent chance of this car killing you as soon as you leave the parking lot,’ you would never buy the car. It would be considered statistically absurd to take that kind of risk. If they told you the real numbers for prematurity and birth problems, a lot of people might be dissuaded.”

  “But what if it meant no car at all?” Ricki calls from the kitchen, where she’s making tea.

  There’s the hitch: no risk, no baby—or that’s what Ricki and Steve were led to believe. They don’t regret their sweet twins for a moment; they just wish they’d had a more realistic sense of what might lie ahead.

  They ended up having premature fraternal twins, born at twenty-four weeks (full term is from thirty-seven to forty-one weeks), each weighing a precarious one pound, twelve ounces. Both babies were immediately intubated, hooked to respirators, and rushed to the Neonatal Intensive Care Unit (NICU). Sammy fought for his life in his early weeks; part of his intestine became infected and failed, so doctors inserted a drain in his side. When his condition worsened, they performed surgery for seven hours to remove a third of his small intestine, and later confessed they were surprised he pulled through. “One doctor told me, ‘I’m not supposed to say this, but it must have been the hand of God,’” Steve recalls, “‘because we didn’t think it would make it. Not one in ten children would have even survived that surgery at his size.’”

  Today, at three years old, Sammy has mild cerebral palsy—he has worn leg braces, and until recently, his speech was unclear. But he holds his own in a regular nursery school class with his brother, Ste-vie. When I meet the boys at their noon pickup on a sunny fall day, they appear chipper and healthy. During the short drive home, they sing along in their car seats to “Here Come the ABCs” by They Might Be Giants, and ask Mom what’s for lunch. Sammy takes my hand to walk up the steps to his house, and when he passes his father in the doorway, he blurts out matter-of-factly, “I missed you today, Daddy.”

  Both parents say they feel lucky, but it’s evident they were traumatized by the roller-coaster events of the boys’ earliest months. “There’s a lot of shock,” Ricki admits over mugs of tea at her blondwood kitchen table, “a feeling of free fall and dread. I remember thinking I would have given everything I owned just to give them another week of gestation. Because it makes such a difference.” She adjusts her titanium glasses. “I remember feeling so much guilt that we did infertility treatments and caused them to be born; that maybe I hadn’t taken it easy enough during the pregnancy and I caused them to be born early; that they’ll have to deal with this prematurity and low birth weight the rest of their lives. During the first six months when they came home, there were times when I felt like I shouldn’t have done this.”

  Most people are aware of our national twin boom: According to the Centers for Disease Control and Prevention, twin births in the United States have increased 70 percent since 1980. Between 1980 and 1995, the number of triplets (or “high-order multiples”) born to white mothers ballooned by an astounding 500 percent. Today, one in thirty-one births is a twin. (In 1970, it was one in sixty births.)

  Credit goes chiefly to reproductive technologies like IVF (in vitro fertilization), and to delayed maternity—women conceiving between the ages of thirty-five and forty—when there’s a greater chance of releasing two eggs in one cycle. From 25 to 35 percent of IVF pregnancies produce multiple fetuses, and there are an estimated three million–plus IVF children in the world today. (Natural twins will happen only one or two times in a hundred births.) Which means the vast majority of these twins are fraternal (dyzygotic), the result of two separate sperm fertilizing two separate eggs, and, as with any other two siblings, roughly half their DNA is shared. Identical twins (monozygotic)—which occur when one fertilized egg splits—share 100 percent of their genes. Identicals are always a gestational fluke, although studies show the accident is more likely with reproductive technology. Fraternal twins can run in families when the mother has a genetic predisposition to hyperovulate, meaning she releases more than one egg during her monthly cycle; identical twins are not hereditary. And there’s no proof that twins skip a generation: “An old wives’ tale,” says Dr. Louis Keith.

  Obviously, reproductive technology has answered the prayers of countless couples, and the high success rate of IVF is a potent justification for the craze. However, I was struck during my research by the intensity of some doctors’ concerns that the hazards are not always highlighted, and even when they are, couples pay no heed.

  The fact is that multiple births are high-risk. Neonatal death is five times higher for twins than
for singletons. For triplets, the chance of infant death is eleven times higher than for single babies. Twins and triplets are often born too early and underweight (50 percent of all twins are premature, 90 percent of triplets), which can cause developmental problems in utero, at birth, or later on. Twins who are small for their gestational age suffer motor deficiencies, mental retardation, visual abnormalities, behavioral disturbances, and speech problems. A twin is four times more likely to be born with cerebral palsy.

  “It is true that modern reproductive technologies and medications started an epidemic of multiple birth,” says Dr. Avner Hershlag, the venerable head of the fertility clinic at Long Island’s North Shore Hospital, who happens to be Natalie Portman’s father. “The reason why multiple pregnancy became such a problem is because the principle of fertility drugs is to make multiple eggs, which can result in multiple babies. … I know that your perspective is twins, but the main concern is actually over supertwins—triplets and higher—because that really increases the risk to the babies and the mother.”

  Hershlag, who speaks with the Israeli accent of his birthplace, rattles off the risks to the newborns: “severe respiratory problems, liver problems, blindness, and mental problems, with delayed developmental milestones. There’s the need for long-term admissions to the NICU, huge costs incurred to the system and to the parents, and it goes on. There is also significant mortality. I’ll give you a number I just read today: that in the UK each year, one hundred and twenty-six babies born after IVF die as a consequence of multiple birth.”

  He turns immediately to the mother’s risks: “Everything that can happen adversely in pregnancy happens more with high-multiple birth, including diabetes in pregnancy, premature separation of the placenta with abruption and bleeding, hypertension, increased discomfort in the pregnancy, increased bed rest—including loss of working days—and that’s all before delivery. The most major impact is probably after delivery, and that is the social change in people’s lives as a result of multiples. There are studies that specifically address the parenting anxiety index. An article from 2004 in Fertility and Sterility says the anxiety increases severalfold as you conceive with multiples and deliver them, and any additional baby increases your stress by that much more. We in our practice would not have to do any surveys; we know that reality; we live it.”