A Heart Divided

C. Everett Koop and wife, Cora at Painted Bride

Few of us remember the poignant real-life story of the conjoined twins who shared a single heart, as well as surgeon C. Everett Koop.
Who would live and who would die? was the unthinkable question that drove the parents, the rabbis, and the medical staff at Children’s Hospital of Philadelphia at the time.

Which is why the former US. Surgeon General now 96, drove with his wife 7 hours from Dartmouth to Philadelphia to be at a play reading in Philadelphia last week about that very case. Later, he spoke about one of the most profound dilemmas of his long, illustrious career.

Donald Drake, who wrote the play, “Choice,” covered the story in 1977  for the Philadelphia Inquirer. It was among the most powerful he ever wrote (among many powerful stories). And as a young reporter at the Philadelphia Bulletin at the time, I remember, jealously, his access and his insight. 

As a journalist, Drake thought constantly about “story” and studied the techniques of suspense and climax.  Not surprisingly, after “retiring,” he turned to play writing. Many of his nearly two dozen works have drawn on his years as a medical writer.  “Gorked, ” which had me sobbing when I saw it, is about the isolation of an elderly man, frozen in his body after a stroke, who, unbeknownst to his children actually knows everything going on around him. “Clear and Present Danger,”  is about a schizophrenic teenager who tests her parents’ love, and stems from the story of Sylvia Seegrist, who flipped out in 1985, firing wildly in suburban Philly's Springfield Mall, killing three people. The twins' story was one  that Drake could not shake either.

Donald C. Drake

In “Choice,” a religious Jewish couple are torn apart by the decision they must make. The surgeon tells them that only one child can live; the other – without the shared heart – will have to die. But which would it be? And was killing one to possibly save the other justified? A violation of Jewish law?  Should the babies live joined for as long as they could?

In real life,  the choice was wrenching but ultimately clear.  Saving a life is paramount. And one of the babies contained the greater share of the heart. (See the rabbinical explanation.) But Drake takes the liberty of art to make the decision even more fraught, with the couple warring against each other; the hospital staff threatening to boycott, and the rabbis disagreeing on God's law.

Dr. Koop,  who as surgeon general unflinchingly rampaged against cigarettes, sat in a wheelchair in the front row of a sparse performance space in the Painted Bride. Though he now wears hearing aids,  he appears vigorous for his age, with a full head of hair and his trademark Amish-like flowing beard. He remarried two years ago, after the death of his wife of 60 years.

Dr. Koop had no reluctance addressing the audience, talking about the strange feelings he was having  seeing his story – his character – depicted on stage, a weird convergence of art and life.

The reading had brought back to mind his own “religious” moment during the surgery.

He explained that at CHOP,  he had been caring for the children of a rabbi and had talked to this rabbi about the case of the twins.

Still, Dr. Koop had not planned for what to do with the body of the baby destined to die during surgery.

 “When I tied off one carotid artery and killed a child,” Dr. Koop said,  “I’d given no thought about what would happen to the body… I had one dead baby and one live baby; I separated them. One of the nurses took the child who was now dead and carried it to the door of operating room. The door opened and there stood the rabbi. … The fact that he was there, seemed almost like God’s blessing on what I had just done. It was very important to me.”