The Incest Clinic

published in the G.W. Review, April 2011

As soon as my wife’s father left her mother for a woman in an iron lung, I guess my fate was sealed.

My wife’s name is Simone, and her first affair that I knew of was with a reformed rabbi. He was reformed and sterile because he lost his entire pelvis to bone cancer. Since that sad time, I was always fearful that Simone’s next affair would more than make up for the absence of testosterone in her first.

I’m a cardiologist; Simone, a psychologist. We live in a small Pennsylvania town, not far from the Maryland border. Perhaps it’s hunger or fate which draws the crowds on their way to Gettysburg for a tank of gas and some directions.

The problems usually start if they decide on a bite to eat and descend the mildewed stairs down to The Rickety Freighter, our local diner. Soon thereafter, they often wind up in my office with chest pain, on Simone’s couch, or next to a meandering stream in the cemetery off of Route 15.

Simone says it’s tough being married to a cardiologist who has no heart. I say it’s tough sticking it out with a shrink because she’s out of her fucking mind.

“Some day I’m going to leave you,” she warns, “and escape from this life of being your slave.”

But I tell myself that I’m the one in shackles, a victim of my wife’s whimsical coldness and taste for the most bizarre sexual encounters imaginable.

If we’re all victims, it must have something to do with that big black cloud hovering over Main Street. It smells like coal and tastes like the cheese steaks Arnold Garnet recycles in The Rickety Freighter, and I’m sure it clogs anyone’s arteries who even smells the stuff. God knows, it killed Arnold’s wife.

Once again, Simone and I are just sitting down to dinner when the phone interrupts us.

“Where are you going this time?” I ask her when she puts her coat on again at the dinner table. It’s the night after Dalia Garnet’s funeral.

“That was Arnold Garnet,” Simone answers curtly. “He’s beside himself.” And then I don’t see my wife again until the following morning.

Of course Simone begins to become quite popular with the members of our community. They say it’s a wonderful thing my wife’s willing to spend all that time consoling family members of patients I fail to keep alive, yet with my wife’s history, I can’t help but get a little paranoid.

The next morning, Simone seems uncharacteristically chipper.

“What time did you make it home last night?” I ask at the breakfast table.

“For a cardiologist, you really are a heartless bastard,” my wife says. “Which in hell’s name do you think is more stressful, signing that old lady’s death certificate or managing the spiraling grief of her husband?”

As Simone scolds me at the breakfast table, I can’t help but notice her breasts peeking comfortably from the top of her tight-fitting sweat suit. It doesn’t make sense that she would be up so early, let alone dressed to demand attention. Then I remember it’s Tuesday.

* * *

The Incest Clinic is held on Tuesday mornings in a plain, rectangular brick building, a deserted slaughterhouse with large steel doors and tulips along the walkway.

Shortly after they finished sandblasting the bloodstains and completed the paneling that transformed the kill floor into an airy waiting room, my wife spoke at the ribbon-cutting ceremony.

“Incest,” she said, “is something if left untreated will tear a community apart.” Then she eyed me with more the look of a competitor than a spouse and added, “It’s potentially even more devastating than heart disease.” All the while, Arnold Garnet glared at me angrily, his wife still alive back then, comatose and gasping on a respirator.

For weeks, since the opening of The Incest Clinic, Simone returns on Tuesday nights emotionally drained but somehow, I always suspect, in a sexually charged kind of way.

Her most challenging patients, I soon learn, are two brothers, a pair of conjoined twins originally named Mason and Dixon.

We first meet at the frozen yogurt place.

My attention is drawn to an obese, shouting man at the front of the line. He wears a yellow rain slicker, which already makes me suspicious because it’s such a clear night.

“This marshmallow has the consistency of piss,” he yells at the kid behind the counter. “Come on!”

The acned kid stutters about equipment problems, and then everyone in front of us is silent until Simone calls, “Mason? Dixon?” with the affected therapist’s voice  I can’t stand, and a bloated, freckled man turns to face us. He has unruly red hair and chocolate accenting the recesses in his gums.

“Mason, I’d like you to meet my husband, Robert.”

The large man scrapes the bottom of his waxy dessert cup before looking in our direction. In another few seconds, a hump under his windbreaker germinates into a small, shining head, and the hopeful eyes of an anemic child ascend as if from an awkward papoose.

Then the windbreaker unzips to reveal the common torso of a freak show scenario.

From a small amount of research, I soon learn that conjoined twins occur in one in 50-200,000 live births, and that in approximately 75% of the time they are “thoracopagus” twins; that is, they share a common chest. This being an even rarer variety, it involves two heads, four arms, and two legs. In this case, the powerful shoulders of Mason are bridged on the left to what looks like a rubbery novelty item from a costume store. It is the bald head of Dixon, blinking his dark eyes like a helpless sparrow. Attached at the abdomen, he twists his scrawny neck awkwardly, still trying to break free after all these years, summoning for a rescue with shriveled arms.

They share a common pelvis.

And as the weaker half of this enormous package comes to waken, I develop a most queasy feeling, not unlike the first time I saw a boy remove his prosthetic leg at the local swimming pool. The tip of his stump glistened in the sun like the tied-off end of an oversized sausage.

“Hi Dixon!” My wife blurts out with her phony stewardess dialect and drags me over to this pitiful mutation of brothers. Meanwhile, the other customers stare, gasp quietly, and distance themselves.

“Maybe your brother would like an ice cream,” I say to Dixon as they begin to step away from the counter. He seems to be ignoring his brother entirely.

Dixon shows a hopeful blink of his small eyes, but Mason dismisses my remark and pulls his shoulders towards me. This has the effect of shifting Dixon out of my line of sight, a tactic at which Mason seems quite efficient. It makes me wonder if this is something he usually does at mealtimes, effectively shutting off his feeble brother from the luxury of nourishment.

Simone grits her teeth to admonish me.

“He can’t have any ice cream,” she hisses. “He has digestive problems. Mason has most of the intestines.”

As they leave the place and Simone alternates her empathetic and smiling face from one sick head to the next, I finish my ice cream alone. The anguished childhoods of Mason and Dixon play through me in somber and burning Technicolor, like the decaying eight-millimeter movies I imagine buried somewhere in their parents’ basement.

I see the young and loving couple, heartbroken over the futile attempts to rock their conjoined children to sleep. Spiteful Mason poking, and his exhausted brother gasping in the fumes of Vicks VapoRub. The small room with more the atmosphere of a sideshow than a nursery.

From a distance, I watch as my wife walks alongside the two brothers. Simone with her bouncy walk, and the twins with their awkward limp, a result of their common pelvis.

When they turn the corner slowly, I can make out the hint of a wry smile on Mason’s chocolate-stained face, while Dixon seems to doze off, his head rocking on the side like a child nodding next to his mother on an overnight Greyhound excursion.

Mason seems to enjoy talking to my beautiful and patient wife. The one who has time for everyone else except for me.

“It must be so tough for them,” I say later when we are back home and in bed. “They share the same pelvis,” I remark. “I can’t help but wonder about the condition of their hearts.”

“They also share the same cock,” Simone says matter-of-factly, and I know that trouble is soon about to begin again.

“It seems that Mason has more control,” she continues. I’m afraid to ask her how she knows this.

“Of the cock or the whole body?” I ask.

“Everything, but especially the cock.”

“Maybe it’s because he is the dominant twin,” I say and somehow realize that I am going to be forced to learn a lot more about this subject than I ever aspired to.

“Or maybe he’s the dominant twin because he controls the scrotum,” Simone retorts smugly, “and all the testosterone that comes along with that.”

“Then again,” I reach for my wife who has now turned her back to me, “they share the same bloodstream, which nullifies that theory.”

Over the following weeks, and after several more “meetings” at the frozen yogurt place, the details of their situation emerge. They become quite obvious to me when there is a very large line for the restroom, and the acned kid who still works there has to unlock the door at the insistence of another customer whose crying daughter needs desperately to get to a bathroom.

Inside the restroom, the twins stand in limbo. They have reached a state of stalemate. Mason, his arms crossed with the spiteful scowl of a bully, and Dixon flaps his eyelashes, dabbing at silent tears with his withered arms like a fifteen-year-old teenage girl watching her favorite soap opera.

What’s now obvious is that Mason controls the right leg with his left side of the brain. Dixon, the more artistic of the two, has right brain features but controls the left leg. When the two of them coordinate things properly, they can run faster than my wife, unless of course Mason becomes his obnoxious self, as we now observe, in which case Dixon withdraws, and then they can’t even crawl out of the bathroom.

“Are you guys okay?” the kid from the store asks.

“I think he’s having chest pain,” Dixon says.

Mason denies this.

Some of the customers urge me to take charge.

“You are the cardiologist,” one of the customers reminds me. I recognize her as Julie Garnet, Arnold Garnet’s daughter and another one of Simone’s patients.

“Have any of you guys been to The Rickety Freighter lately?” I ask, and of course this is an obvious insult to Julie Garnet.

Mason denies everything, and Dixon can’t deny anything because Mason won’t let him speak.

Simone insists that she spend some more time alone with them. She grabs the key from the acned kid and locks the three of them in the bathroom again. This time, they stay inside even longer.

“What is that lady doing in the bathroom with the fat man and his baby?” the upset girl asks her mother. She ends up urinating at the Laundromat two doors down.

“What a great therapist,” Julie Garnet remarks. “At least some health professionals care about their patients.”

If caring for the twins was all that Simone did in that restroom, I would feel fine, but behind the background noise of multiple flushings, I convince myself that I can make out Simone’s throaty cries of ecstasy.

Of course my suspicion deepens over the ensuing weeks when she begins knitting oddly-shaped sweaters.

“Simone?” I ask one night. “Is there something you’re not telling me?”

“I think Dixon and I are in love,” she says quite matter-of-factly, and I want to laugh and puke at the same time. Instead, I retreat back into my own separate corner of our bedroom, seeing and hearing my wife but no longer listening to a single thing she says.

* * *

In the following days at the office, I begin a thorough evaluation of Arnold Garnet’s cardiovascular system. I spend many hours trying to make up the time with him for all of the care I neglected to offer him when I cared for his wife.

It is tough to lose a spouse. Perhaps that may very well be the worst affliction of all.

When I think of losing my wife to another man, I think usually in terms of athletic prowess. The feats of strength are never sexual. Usually they relate to the ability to kick a soccer ball or finish a faster triathlon. I was always fearful of losing Simone to a gymnast, not a Siamese twin.

This all makes me wonder why it is that I hate Mason so much. Is it really because he has stolen my wife’s affection? Or is it because as half a man, he is more of a man than I ever can be?

When winter arrives quite suddenly with two-foot drifts of snow in front of the office, I arrive early because I know after lunch will be heart attack time.

The phones are out, and instead of driving home, I make the way down Main Street. The only place open is The Rickety Freighter.

I’m still not sure which can be more cruel and unpredictable, heart disease or my wife, Simone, because after the stench of burning cheese and frying grease, other than Arnold Garnet at the grill, the first thing I notice is Mason and Dixon at adjoining tables, each with half a buttock on touching chairs, pretending to be miles away from one another, albeit only for the solitude of another artery-clogging meal.

When I arrive, Mason has already made quite a commotion about the check and being charged for an extra side of bacon. I find my wife huddled behind in a booth nearest to Dixon, wiping his shining bald head and feeding him baby food. This time, I’m not sure if he looks more like a child or a prisoner of war.

Before I can even call Simone’s attention, she begins aggressively kissing Dixon’s pale skin and sucking his lips as if she’s madly in love with him.

For some reason, my wife is not at all ashamed when she finally sees me and introduces me once again to Dixon. He struggles dearly to maintain his composure as his brother continues to shout out obscenities at the waitress from the table behind.

Dixon looks up at me for the first time, though only momentarily. His thin lips are clenched tight with a sort of guilty smirk. I’m not sure if he looks guilty because he is embarrassed about the scene his brother is making or because my wife now has her hands on his leg and very close to their shared groin.

From the very first day I saw Dixon stick his head out of that rain slicker, I could never forget that stupid, hurtful look. It kills me to think that the entire time I pack my stuff up to leave Simone, I actually feel sorry for Dixon, the man who has stolen my wife from me.

I say to Simone on the way out, “The least you can do before I leave is explain to me how you do whatever it is with the two of them.”

During countless nights before then, I had tried to picture my wife sucking Dixon’s cock, which was really controlled by Mason, while he stared down at her not in pleasure but with his look of despondency, like it was unfair not only that he was the weaker Siamese twin but that he was being deprived of much of the pleasure that was due to him because Mason controlled most of the nerve endings necessary to feel pleasure.

“Why Dixon?” I ask. “It’s as if you’re sacrificing our marriage to make love to a pimple on someone’s ass.”

“You never understood me,” she says. “As small of a man Dixon may seem to you, at least he listens to me. Besides, he’s spent the last twenty-four years being ignored.” She pauses, looks down at her fingernails and doesn’t make much of an effort to conceal the same evil smile she had when she admitted to me she allowed cock-less Rabbi Bowman to perform cunnilingus on her while he was supposed to be fasting on Yom Kippur.

“I think it’s time Dixon felt some love for a change,” she continues. “At least he’ll appreciate it. This is something the two of them have worked out. They have a small wall in their bedroom with a hole in it and a separate bed on either side. I never have to look at Mason when I’m doing it with Dixon.”

“Well, congratulations,” I say. “It sounds like a great case report for one of your psychology journals. Just don’t come groveling back to me when the novelty wears off.” And then I pack up most of my things and leave her.

Of course, the novelty wears off rather quickly.

Three weeks later, her three a.m. phone call startles me.

“I’m tired,” I say to her on the phone. “I really don’t feel like talking.”

“It’s Mason,” she says. “I think he’s having a heart attack.”

I try to hide my yawn with a voice of concern. “How does Dixon feel?”

There is some squirming in the background, a few muffled groans.

“What’s that noise? Are you in bed with them?”

I picture her fucking their common torso.

“Whose groaning is that?”

“It’s Mason next door,” she says. “He’s having crushing chest pain. I’m very worried. It really could be a heart attack.”

“I have no interest in being the cardiologist of anyone who’s fucking my wife,” I say, and then I remember that Arnold Garnet needs a renewal on his blood pressure medication.

Finally, we settle on a deal.

I agree to come over and take care of Mason only. To hell with Dixon.

When I arrive on his side of the wall in their small, divided apartment, I find Mason much fatter than he was last time. He’s so fat, in fact, that the entire shape of his face and neck have changed. In bed he clutches his chest.

I notice that his pelvis is on the other side of the wall. It turns out that Mason’s jealousy over Dixon led to a terrible weight problem. This was quite unfair to Dixon who hardly ate at all but was unable to control the dangerous behavior of his dominant, conjoined twin.

Although each twin has his own heart, it’s unfortunate for Dixon that his is small and weak. It’s also unfortunate for Mason that even though he possesses the larger and stronger heart, he’s the one with the blocked artery causing the heart attack.

I offer Mason aspirin and a few nitroglycerin tablets.

“It’s time to get to a hospital,” I say.

“What are my chances, Doc?” he asks.

“To be honest,” I say, “I really don’t know, but if things get really bad, they may want to consider emergency surgery to separate the two of you.

“What?” Mason yells, “you expect me to separate from Dixon? What kind of brother do you think I am? You know that the overall survival rate for conjoined twins is only five to twenty-five percent. As far as I’m concerned, we’ve already beat the odds.”

There’s a knock on the wall from next door, and I can hear Dixon’s muffled voice.

“Can you quiet down in there!”

It seems that Dixon’s victory over his brother in obtaining my wife’s affection has given him a sudden sense of confidence. Now he has the gall to demonstrate his newfound authority while his brother is suffering a heart attack.

Even though I’m a cardiologist, it’s hard for me to think objectively. At that very moment, I reason, Dixon is probably performing a sexual act with Simone using part of the same body I’m now treating on the other side of the wall.

It doesn’t seem fair.

I change my diagnosis to stress and non-cardiac chest pain.

A week or so later, I bring them to my office for some testing. In one of those graceful and cooperative moments, they walk smoothly and lie under the nuclear camera, arching their heads away to avoid minor concussions.

“You guys really huge,” my Asian technologist says. “It’s like taking picture of two-headed giant. Camera not made for that.”

Dixon smiles, but Mason scowls and proudly opens his shirt to reveal something new–a jagged line, tattooed vertically down their torso like a giant zipper.

“You see this?” Mason asks. “It’s our Mason-Dixon line. That’s what separates the man from the boy. He can keep anything he wants on that side.”

It turns out that neither of them trusted my diagnosis and that they went over to Johns Hopkins for a second opinion. There, a conjoined twins specialist defined their exact boundaries.

It seems quite obvious that Mason has more than half.

“No one crosses that line,” says Mason, but Dixon disagrees. He’s extremely depressed. For some reason, during their rendezvous down south, Simone broke up with him. Soon they argue into paralysis. They can’t even agree on when to go to the bathroom, which doesn’t seem to bother Mason because even though he controls the bladder on his side of the line, it’s Dixon who has the feelings of a full bladder.

Dixon’s depression seems quite serious. He stops eating. For most people, this would lead to starvation, but of course Mason more than makes up for the loss of calories with his own consumption of meals ridiculously high in fat. High enough to give the twins a combined cholesterol count of 289.

The high cholesterol can be treated with medication; more of a problem, is now that Simone has left both of them, their psychological counseling is really messed up.

* * *

The following spring brings a few new changes to our town. The repavement project on Route 15 results in a long detour that funnels the Civil War buffs by the carload to The Rickety Freighter. This provides the owner, Arnold Garnet, with enough money and, after my intense rehabilitation, enough incentive to buy a new grill and overhaul his menu. He eliminates the cheese steaks and replaces them with grilled salmon.

Simone and I get back together again, and she agrees to cut back her hours at The Incest Clinic to only half a day a week.

During much of this time, it seems we have lost touch with the dynamic duo known as Mason and Dixon who have made the unfortunate mistake of seeing Simone’s sister, another therapist two towns north, who specializes in gender identity disorders. As she does to most of her patients, she convinces Dixon that he’s a woman in a man’s body.

“It’s not a man’s body,” he whines, “it is my brother Mason’s body.”

Then Dixon decides to become a woman. He takes hormone injections against Mason’s will. Eventually he gets breast implants.

When it’s finally time for his checkup, I examine Mason and notice that he also has some breast tissue, though it’s difficult to say for sure because he’s so freaking fat.

“It’s from those damned hormone injections my other half is taking.”

We discuss all options, including stomach stapling and separation.

“Do you think we could survive?” he asks.

“You have a better chance than your brother,” I say, “because you own a larger and stronger heart.”

“It’s not my brother. Stop calling her my brother. It’s Dixie, my sister.”

When his other half comes out from behind the examination room curtain, I’m quite shocked to see the same frail face of Dixon, only now with a pathetic and cheap-looking blonde wig. His face is made up like a gothic transvestite. This time, the same hurtful expression arouses something inside of me. I want to speak to her and tell her it’s okay to be a man and that she probably was a stronger and more courageous man than she ever knew.

Of course, Simone is right. It turns out that Dixie is quite a good listener. She reminds me in some way of the first woman I ever wanted to leave Simone for, way back in medical school.

A few months later, I’m on the other side of the wall, and I’m banging Dixie. For the twins, things have changed for the better. Because Dixie is now a woman, she has no use for the penis. Dixie agrees to give Mason full use of the genitalia under the condition that he start a sensible diet and enroll in anger management classes. The classes prove unnecessary once Mason gains full possession of their sex organ. This leaves Dixie with only a rectum. A rectum, two new breasts, and her frail, now beautiful face with that hurtful look that evokes sympathy in everyone, including Mason who eventually becomes jealous of our relationship.

“You stay the hell away from my sister,” he yells one day when he hears us arguing, and he squirts me with a bucketful of liquid marshmallow.

It has the consistency of piss.

* * *

Arnold Garnet passed away the other day. It wasn’t a heart attack. He was killed in front of the abandoned locomotive by some lost and frustrated driver in a hit-and-run accident. The only witness was the acned kid from the yogurt place who just happened to look outside after hearing a sickening thud and noticed an SUV speeding away down Main Street. It had a confederate flag waving from behind.

We bury the former owner of The Rickety Freighter just as the apple blossoms are poking through next to a meandering stream in the cemetery off of Route 15.

I spend a lot more time with Simone now.

This summer, we actually plan on taking a trip together. It will be our first vacation away from this town in a very long time. Our experience with the twins has taught me to become a better listener and my wife to be more comforting. She now routinely wipes down my balding head in restaurants, for example, or feeds me baby food after we make love in most unusual positions. Sometimes I have to pretend I’m missing all my limbs.

Following her father’s death, Julie Garnet decides to close down The Rickety Freighter for good, unless, of course, they can find a new manager.

Once again Mason and Dixon, now known as Dixie, come to the rescue. They agree to buy the restaurant with some of the earnings they’ve made from their “Fund Raiser for Separation” money. They rename it “The Underground Railroad.”

Mason specializes in northern-style cooking, such as Yankee Pot Roast, and Dixie in fried chicken and biscuits. Of course, they agree, after my insistence, to offer an abundance of heart-healthy alternatives.

Attendance at The Incest Clinic is up again, though Simone refuses to extend her hours to more than half a day. She agrees to take the twins on as patients again, when it’s learned that Mason and Dixie are having a true incestuous relationship.

Dixie goes through with an operation to place a “vaginal pouch” on her thigh that is accessible to their penis, which now belongs exclusively to Mason.

They agree on a fair balance of testosterone and estrogen and reconsider separation along the Mason-Dixon Line.

“If we separate,” Mason cries to my wife the following week, “can we get married?”

“This is Incest Clinic,” my wife reminds him. “We are supposed to discourage you guys from getting together even if you are apart.”

“If we separate, we will die,” Dixie reminds them.

“I still have a chance,” says Mason, “because I have the larger and stronger heart.”

“But could you take a chance on losing me?” Dixie asks, and I imagine the look she gives him. The helpless expression of a unique individual with the smallest and simultaneously largest heart I’ve ever known.

“Never,” Mason answers her. “When we get home, I’m going to tear down the wall in our bedroom for good.”