Johnnie, July 24, 1968, 9:28 am EDT, Portland, ME
Dr. Millard wrote:The last time I saw Johnnie was when he had his pre-school physical. When I examine the five-year-olds who are about to enter kindergarten, I ask them to draw a man. The extremely immature ones will hang their heads and refuse. Some will draw pictures which are so bizarre that you wonder what can be going on in the mind of the child. Johnnie drew a man which was so small that I could hardly see it. He was the normal twin and his brother Joe was the sickly one who had all the attention of the family from the age of three months. Johnnie feels small and insignificant.
The case is very baffling. There is only five minutes difference in the birth times, and yet there is all the difference in the world between the modes of expression of the planetary energies in the two cases...
Until the age of three months, both twins grew and developed normally. Then Joe began to have seizures, and was admitted to the hospital in status epilepticus, a potentially fatal disorder in which the seizures are so continuous that the brain cannot get enough oxygen. Unless the seizures can be stopped, the patient will die... None of the consultants called in knew what was going on and the only suggestion they could make was to send the child to specialists in Boston.
I was the pediatric resident on duty the night Joey was admitted. We first tried to stop his seizures with phenobarb and Dilantin, then we sought the cause. It turned out to be hypoglycemia, the rarest cause in children of this age... His blood sugar was so low that we thought the lab must have made an error and repeated it... This [low level] is supposed to be incompatible with life. He did not die, but unfortunately suffered severe brain damage, which is irreversible.
The problem which was never solved satisfactorily was the mechanism of the hypoglycemia... It was impossible to make a diagnosis. The presumptive evidence was for a number of scattered wild cells in the pancreas, producing insulin in excess... but not in a circumscribed area where it could be removed surgically.
He was sent home on an experimental drug... which kept his blood sugar reasonably normal, but is mother also had to feed him with a high protein - low carbohydrate diet every three or four hours day and night. His seizure threshold was low... he seized easily, and was not completely controlled, even with maximum doses of Dilantin.
Hypoglycemia is still a confusing disease, especially in children. There are many metabolic pathways by which the needs of the brain and body can be met. There are two organs which use glucose, but do not need insulin in order to get it into their cells. These are the brain and the red blood cells. [A long discussion of the many pathways follows. Most areas of the body are at least peripherally implicated.]
...Finally [the experts in Boston] decided that his pancreas should be removed. This would have meant lifelong diabetes and his parents would not give their consent, especially since it was obvious that his brain was already badly damaged. They compromised and removed half. The half pancreas was... flown to Denmark, where one of the world's foremost authorities on infantile hypoglycemia has his research lab. No insulinoma was found...
As Joey grew older, his hypoglycemia improved. He wears braces, and attends the special school for children with cerebral palsy. Of course, his brain is very damaged, and he will never be able to do much with his life. Johnnie goes to the local school and is now in the fourth grade... I have not seen Johnnie for several years, but last time I saw him, he could not draw. One wonders how much psychological damage was done to him at the time that his twin almost died.