Twins

This morning Anna Maria Tremonti, the excellent host of the CBC Radio current affairs and documentary program, The Current, had a fascinating half hour feature on twins. The emphasis was on some of the curious and interesting behavioural qualities that have been observed in identical twins. There's a podcast at cbc.ca/thecurrent.

I got interested in twins about 60 years ago when I was in general practice in Adelaide in the late 1950s. I had two sets of elderly identical twins among my patients. One set was a pair of old men, widowers, who moved in together after both their wives died. Both had caring middle-aged children who looked after them very well, although I got the impression that they'd have coped fine even without the way their daughters, sons and grandchildren lavished meals and loving care upon them. They were fun-loving old rascals, an inexhaustible source of off-colour jokes. They both smoked like stoves and loved a drink at the end of the day which they usually spent in their large vegetable garden. They looked set to live forever.  It was heart-warming to see how they cared for each other and their many progeny. Their only complaint - the same for both - was severe arthritis which was limiting their capacity to care for their garden. They weren't fussy about dressing alike, but shared a carefree willingness to be filthy dirty.

The other pair of twins were old maids, spinsters who had lived together all their lives. To say they disliked each other is an understatement. They detested each other. I never explored the reasons for this but I got the impression that it began with mutual irritation and escalated over the years and decades. They were in their 70s when I first met them and I was intrigued to see that despite their obvious mutual dislike, expressed in vicious comments and whining complaints to me about their twin sister's innumerable faults, they dressed in identical blouses and skirts, had identical hairdos, wore identical shoes that I thought were probably interchangeable with each other. Their diseases weren't identical, however: One of these twins had high blood pressure and heart disease, the other had breast cancer.  

Not long after my acquaintance with these two sets of twins ended, Wendy and I and our kids spent a year in London in 1961-62, during which we saw a BBC TV feature about the identical twin test cricketers Alec and Eric Bedser. I learnt for the first time that there were two kinds of identical twins, collateral twins, both stamped from the same mold, so to say, and mirror image twins, one right-handed the other left-handed, one with clockwise whorls on finger prints and hair parting, the other counter-clockwise (and also subtle and unmistakeable chromosomal differences). The Bedser twins were mirror images - that one was right-handed and the other left-handed first brought this interesting fact to light.     Until an observant cricket lover looked closely at the Bedser twins, these odd facts about identical twins had never been noticed. I wish I'd noticed whether my two sets of twins were mirror image or collateral but alas, in the careless way one overlooks obvious but seemingly irrelevant clinical details, I never had.  Would identical arthritis in both twins be associated with mirror image or collateral twinning? Would cancer in one twin and heart disease in the other be associated with mirror image or collateral twinning? By now, perhaps, someone knows the answer. Maybe I would have sixty years ago if I'd been more alert and observant.

Long after we'd left Australia I found out during a return visit that I was one of twins, the other of whom was stillborn. I learnt this from an old lady I met, who had been a young nurse in the hospital in Tailem Bend, South Australia, where I was born.  My mother was dead by the time I learnt this, so I wasn't able to ask her to confirm it. She may never have known anyway, because she had severe toxaemia of pregnancy, was very ill and recalled little of the events late in her pregnancy and even less of the actual birth. I don't know whether I was the survivor of a pair of identical or fraternal (non-identical) twins, but there is a rather strong tendency to fraternal twin births in my family tree.       

Choosing Canada - 2

In my previous post I said a little about arriving in Canada as a landed immigrant on November 9, 1969. There’s more to say about the context of the decisions that led to our family move from the culturally and historically rich city of Edinburgh, where we were very happy and I worked in one of the greatest universities in the world, to a small city (albeit a national capital) with a nonentity of a medical school in a nonentity of a university.

In the late 1960s I had established a scholarly reputation. I began to get enticing invitations to move. None came from Australia, where we really wanted to be, and I was passed over twice when I applied for Australian positions for which I was well qualified. I was interviewed for both, but both went to candidates who were well connected and inside the ‘establishment’ in Australia.

In the early summer of 1969 I was invited to a workshop on Hospital Discharge Abstract Systems at Airlie House, an elite think-tank in the rural country outside Washington DC. It was an arcane topic about which I knew very little, and I hesitated about accepting.  My friend and mentor Kerr White persuaded me in a phone call from Baltimore to Edinburgh. The invitation, he said, was a subterfuge, intended to provide an opportunity for several people to meet me, to find out whether I was the candidate they sought for a challenging role as a cross-appointed professor of primary care in the Harvard Medical School and professor of epidemiology at the Harvard School of Public Health.   

I was awestruck to be considered for a position at Harvard. I shuffled my teaching schedule and other commitments in order to get across the pond in time for the workshop and to visit Boston and Cambridge, Massachusetts. I’d already met one of the two Harvard bigshots and knew the other by repute; they proved to be easy-going, as did the deans of Harvard Medical School and the Harvard School of Public Health.  Despite my misgivings about the political minefields I’d have to contend with while straddling Harvard Medical School and the School of Public Health, and misgivings about returning to the USA where neither Wendy nor I had any desire to settle permanently, I provisionally accepted the position. But my greatest misgiving remained.  One reason for our happy lives in Edinburgh was a delightful balance between work and home life.  If we moved to Boston/Cambridge we would have to live far away, perhaps as far as New Hampshire. I’d face a long commute, perhaps 2 hours each way. When there were evening meetings I’d seldom get home before midnight.

Almost as an afterthought when I’d already provisionally accepted the position at Harvard, I flew on to Ottawa, because I’d had a hand-written invitation from the head of the small department of preventive medicine in the new medical school in Ottawa. The department was expanding to embrace family medicine as an academic discipline. It had changed its name to Epidemiology and Community Medicine, one family practice teaching unit was already getting off the ground, and a second one was in advanced planning stages. As an experienced family doctor with training and experience in epidemiology I was well qualified to head the expanding department.

I arrived in Ottawa late on a summer afternoon with several hours’ daylight to come. I checked in at the Bytown Inn on the corner of Albert and O’Connor, an old colonial but rather down-at-heel pub. I walked up to Parliament Hill admiring the Peace Tower, across to the new National Arts Centre, and beside the Rideau Canal, a leisurely stroll on a lovely summer evening. Across the Canal was the campus of the University of Ottawa. Heading south I came to the Glebe, and somewhere there, on First, or Second or Third Avenue, I headed away from the Canal. Mums and Dads sat out on their front steps chatting and sipping cool drinks while their kids played street hockey. 

I had an epiphany: This would be a better place than Harvard for our family! We could live close to the campus, perhaps within walking distance as we did (in theory) in Edinburgh, so there would be no time consuming commutes. The University and its medical school, nonentities in the late 1960s, had nowhere else to go but up. I could help them make this laborious climb.

From my room on a high floor of a hotel in Boston, I’d phoned Wendy in Edinburgh to tell her we’d be moving back to the USA – news, that she later told me, had filled her with dismay. There wasn’t time to phone her again from Ottawa but I told her when she collected me at Prestwick airport, that we wouldn’t after all be moving back to the USA, but to Ottawa, where her brother John had learnt to fly spitfires before going on to Britain early in 1941.  She was greatly relieved. Like me, she felt confident that our move would prove to be a stepping stone on our journey home to Australia, or to New Zealand, we didn’t care which. But it would be in the British Commonwealth rather than the USA where we had never really adapted to a culture and values we found alien.

When that seemingly irresistible invitation to come home to Sydney arrived in the early 1980s, carried personally by an eminent Australian academic, it was too late. Wendy and I and our three kids had all put roots down too deep to face the prospect of yet another major intercontinental move. We were all Canadian citizens by then. Thanks to the vagaries of international diplomacy, our kids were also New Zealanders as well as Canadians, but I was no longer Australian: I’d had to surrender my birthright when I became a Canadian citizen in 1976.

Now there is no room for doubt. Our move to Ottawa was the best thing our family ever did. It proved to be a resounding success in every way possible.

Choosing Canada

Some dates are engraved on my soul. Wendy’s birthday, and mine; our wedding day; the date of Wendy’s death; birth dates of our three children; dates of epochal world events like September 3 1939, June 6 1944, August 6 1945, and a few others I’ve noted in posts on this blog.

November 9, 1969 is another. That was the day I arrived in Canada as a landed immigrant. Three weeks later I flew back to Edinburgh to collect Wendy and the kids; we all came back together to Ottawa a week before Christmas (incubating influenza B, which made our first Canadian Christmas rather miserable). This year is the 45^th anniversary of our Canadian lives. I’ve been a resident and citizen of Canada for a little more than half my lifetime. Now I am more proud of being Canadian than of having been Australian.

I never thought I’d live to hear myself say that, but recent actions of the Australian government would have made me ashamed to be Australian if I still were one. The fact that these actions have wide public support makes me aware that I am out of step with prevailing Australian opinion, not for the first time.

When it comes to human rights I’ve put my money where my mouth is throughout my adult life. Amnesty International has been top of my list of causes worth supporting since the 1960s and was intermittently on my list before then, philosophically from medical student days onward. It’s to be expected, therefore, that I oppose Australian policy and practice towards what Australians call asylum seekers. This is a reincarnated version of the White Australia policy of the 1920s and 1930s, a manifestation of bigotry and intolerance, as obscene as the anti-Semitism of the same era. It is profoundly depressing that the policy is supported by a majority of the Australian people. The intelligent ones use weasel words and spurious rationalizations about “fairness” and “queue-jumping” to justify the policy and turn blind eyes to the evil consequences of the practice.

Under the present government, we are no better in Canada.  When it comes to compassion and empathy towards refugees from the brutal Syrian conflict, Canada’s record is deplorable.  It’s covert anti-Islam prejudice.

The Australian government’s policy and practice in the face of the Ebola epidemic is epidemiologically indefensible – an example of the anti-science approach that has characterized the present government, for instance denying the evidence on climate change and its causes. Canada’s policy on the Ebola epidemic, announced a few days later as I was assembling this post,  is the same, flying in the face of science, epidemiology, public health practice, and common sense, catering only to the base instincts of ignorant brutes. When it comes to official responses to the Ebola epidemic, I’m equally appalled by the actions of my old and my new homelands.

All that said, there’s so much to admire and love about Canada and the people who live in this great nation. High on the list is multiculturalism. We have achieved a happy balance and comfortable acceptance of the ethnic and culturally distinct groups that live amicably in Canada. For about 30 years I observed the process close up among classes of medical students. The names below the mug shots of the entering first year medical student classes revealed the process at work as Canada's social demography shifted under the influence of successive waves of refugees and voluntary immigrants.  I had the great privilege and pleasure of many contact hours with the first year class, and I saw the composition of names and appearance of mugshots changing. In 1970 the names and faces reflected the British Isles and France. South Asian names began to appear in the early 1970s, not from the Indian Subcontinent but from Idi Amin's Uganda. Then came Vietnamese boat people, then Chinese from Hong Kong and Taiwan, followed by Chinese from the PRC and Sikhs, Parsees, Hindus and Moslems from South Asia, and Croats, Bosnians and Serbs when Yugoslavia disintegrated. Only the very topmost layer of intellectually outstanding youngsters survived the rigorous selection process, and they were not only superb students, but lovely young people too.  I was a mentor to selected students and a confidential counsellor to a handful each year; some of these became life-long friends and some of these, about a third, came from cultural backgrounds different from my own, often from a different ethnic group too. I  observed how the class of 84 students bonded into one big happy family during their first year.  A good deal of “assortative mating” went on, not infrequently across ethnic divisions. I’ve formed long-term friendships with enough former students to be confident that many such unions survive intact.  Of course I knew a very small and unrepresentative sample, but I know many provided moral leadership to the ethnic communities from which they came. The children of such unions form a wonderful foundation for the next generation, and give me great confidence and optimism about the future of Canada. Of my reasons for loving Canada, the manifest success of the multiculturalism policy is high on the list. Long may it prosper. As I look at the little school children in the French immersion school at the other end of the block I live on, I see them playing in the playground, taking no notice of differences in skin colour, hair texture, clothing. Some of what I observed among medical students is harder to observe now. The year I officially "retired" the class size which had been pegged at 84 each year began to increase and is now over 200, too many to get to know on first name terms as I was always able to do, too many, probably, to bond into a single large happy family. That was another precious way life was so kind to me, less kind to those who came after me.  Indeed I've had a fortunate life in so many ways, have so much to be grateful for.

Holding my favourite of all the books I've written or edited, the second edition of Public Health and Human Ecology (1997). I smuggled many of my values and beliefs, as well as a great many facts and much good science, into this book.