As Nature Made Him

John Colapinto

• Publisher: Harper Perennial
• Year: 2013
• ISBN:
  9780062278319
• Topic: Medicine
• Subtopic: Anatomy

NEW YORK TIMES BESTSELLER

"We should aspire to Colapinto's stellar journalist example: listening carefully to the circumstances of those who are different rather than demanding that they conform to our own." — Washington Post

Thetrue story about the "twins case" and a riveting exploration of medical arrogance, misguided science, societal confusion, gender differences, and one man's ultimate triumph

In 1967, after a twin baby boy suffered a botched circumcision, his family agreed to a radical treatment that would alter his gender. The case would become one of the most famous in modern medicine—and a total failure. The boy's uninjured brother, raised as a boy, provided to the experiment the perfect matched control. As Nature Made Him tells the extraordinary story of David Reimer, who, when finally informed of his medical history, made the decision to live as a male.

Writing with uncommon intelligence, insight, and compassion, John Colapinto sets the historical and medical context for the case, exposing the thirty-year-long scientific feud between Dr. John Money and his fellow sex researcher, Dr. Milton Diamond—a rivalry over the nature/nurture debate whose very bitterness finally brought the truth to light.

A macabre tale of medical arrogance, it is first and foremost a human drama of one man's—and one family's—amazing survival in the face of terrible odds.

PART ONE

A Game of Science Fiction

1

THE IRONY WAS that Ron and Janet Reimer’s life together had begun with such special promise. That it would survive its trials is attributable perhaps in part to their shared heritage in an ethnic and religious background virtually defined by the hardiness of its people in the face of suffering.

Both Ron Reimer and Janet Schultz were descended from families who were Mennonite, the Anabaptist sect founded in sixteenth-century Holland. Like the Amish, Ron’s and Janet’s Mennonite ancestors were pacifists who followed a simple, nonworldly life based directly on Christ’s teachings in the Sermon on the Mount. During the Inquisition, Mennonites were tortured and slaughtered in the thousands, the survivors escaping to begin a three-hundred-year search for a country that would allow them to live as a culture and religion apart. The majority went to Russia and farmed, but in the late 1800s, large numbers began to migrate to the New World, some settling in Nebraska and Kansas. The densest concentrations, however, settled in Canada, where the federal government, eager to populate its empty western plains, offered to the Mennonites complete religious freedom, their own schools, and exemption from military service. The first Mennonites arrived in southern Manitoba in 1874. Within five years, over ten thousand had followed, transplanting entire Russian villages to the Canadian prairie. It was in this wave of immigrants that both Ron’s and Janet’s great-grandparents, who were Dutch Mennonites directly descended from the earliest followers of the sect, came to Manitoba.

Their arrival coincided with that moment when the Canadian Pacific Railway reached Winnipeg, and transformed the once tiny and isolated fur-trapping settlement and Hudson’s Bay trading post. Within three decades the settlement had become a major grain capital of the North American middle west. “All roads lead to Winnipeg,” the Chicago Record Herald reported in 1911. “It is destined to become one of the greatest distributing commercial centers of the continent as well as a manufacturing community of great importance.”

Though the city failed to live up to those grand predictions, Winnipeg did grow rapidly in size, sophistication, and importance over the first half of the twentieth century, establishing the country’s first national ballet company and symphony orchestra. Today its population is over 600,000, and the city’s downtown core, built around the meandering curves of the Red River, boasts an impressive stand of modern high-rises to complement its fine Victorian buildings.

The Mennonites on the surrounding prairies had long felt the lure of Winnipeg’s affluence, and after World War II the more assimilated families began to move into the city to take jobs in manufacturing, trucking, and construction. Among them were Ron Reimer’s parents, Peter and Helen, who in 1949 sold their farm in nearby Deloraine and moved to the Winnipeg neighborhood of St. Boniface, where Peter took a job in a slaughterhouse and Helen raised their four young children, of whom Ron was the eldest.

Even as a small child, he was dutiful and hardworking, a boy whose combination of personal privacy and dogged industry often amazed his own mother. “He was always so shy and quiet,” Helen Reimer recalls, “but he was also such a busy little boy. I had to think up ways to keep him out of trouble. I would show him how to cook. He always wanted to be doing something with food and cooking.” It was a passion that would stay with Ron. As an adult he would eventually support his wife and two children by running his own business as the operator of a coffee truck, supplying sandwiches and other prepared foods to construction sites around Winnipeg.

By 1957, when Ron was in his early teens, the music of Elvis Presley, Chuck Berry, and Little Richard had reached Winnipeg. Cars, girls, beer, and rock ’n’ roll music soon had strong claims on his attention. For Mennonites of Ron’s parents’ generation, the swift cultural changes of the late 1950s were threatening. Though not themselves especially devout, they had only a decade earlier moved from an almost exclusively Mennonite farm community where some of the day-to-day values and assumptions were still closer to those of nineteenth-century rural Russia than late-twentieth-century urban North America. In what would prove to be a kind of reverse migration, the Reimers were among many Mennonite families who, in an effort to resist the seismic cultural shifts taking place in the city, returned their families to their roots on the prairie. In 1959, Ron’s father bought a farm some sixty miles from the city, near the town of Kleefeld, in Mennonite country, and moved his family there.

Ron, fifteen years old at the time, hated the move. Kleefeld itself was little more than a ramshackle scattering of stores along a few hundred yards of gravel highway (grain store, post office, grocery), with nowhere for Ron to channel his formidable work ethic. He would pick two hundred pounds of saskatoons and sell them for twenty-five cents a pound—grueling labor for little pay; nothing like the money he was able to make in the city. And his father insisted on taking even those paltry sums from Ron for upkeep of the old clapboard farmhouse on its patch of scrubby land.

It was in this state of boredom, penury, and growing friction with his strict and authoritarian father that Ron, at seventeen, accepted the invitation of his friend Rudy Hildebrandt to visit Rudy’s girlfriend in the nearby town of Steinbach. Rudy’s girlfriend had a nice-looking roommate, a girl named Janet, whom Ron might like.

Like Ron, Janet Schultz was raised in Winnipeg, the eldest child of Mennonite parents who had joined the postwar migration from the prairie to the city. Growing up in the Winnipeg neighborhood of St. Vital, Janet was a lively and inquisitive girl whose passion for reading—first Nancy Drew and Hardy Boys books, then thrillers, and eventually books on psychology—opened up for her a perspective on life beyond the traditional Mennonite values of her parents—and in particular her mother, with whom she constantly clashed. “I wanted an education, but my mother wanted me to get out to work and bring home money,” Janet says. Eventually she was convinced to quit school after ninth grade and take a job at a sewing factory. Janet gave her paychecks to her mother, which did little to foster goodwill between them. A further gulf opened between mother and daughter when Janet, in her early teens, stopped attending the Mennonite church. “I found it was so restrictive,” she says. “I didn’t think it was biblical. They said it was a sin to smile. I didn’t think that way.” In fact, by age fifteen, Janet was given to joking about her parents’ religion. “Why don’t Mennonites ever make love standing up?” she liked to ask her friends. “Because someone might think they were dancing!” Janet herself loved to go dancing and roller-skating, and as an exceptionally pretty hazel-eyed brunet with a shapely figure, she never lacked for dates.

Convinced that their eldest child and only daughter was slipping dangerously from their control, Janet’s parents, like Ron Reimer’s, joined the migration of city Mennonites back to the farm. In 1960, when Janet was fourteen, the Schultzes relocated to New Bothwell, a tiny settlement amid the silos and grain fields forty-five minutes from Winnipeg. Janet missed the city’s movie theaters, restaurants, roller rinks, and dance halls—and soon began accepting dates from any boy who had a car and thus could offer her escape from the farm. Janet’s mother tried to curb her daughter’s social life but to no avail. Shortly after Janet’s fifteenth birthday, her mother told her to move out. Janet went gladly. She moved to the nearby city of Steinbach, where she found work at a sewing factory and shared a small apartment in a rooming house with her cousin Tina. Not long after that, Tina’s boyfriend brought a young man over to meet Janet. He was a tall blond boy of seventeen with large blue eyes and a shy way of glancing at her. His name was Ron Reimer. “I was flirting with Ron,” she says, laughing, “and I was thinking he wasn’t flirting back, so I figured he didn’t like me.”

Ron did like her, but was too shy to reveal his feelings in front of the other couple. He invited Janet to have a look at his car on the street, then asked her out to see a movie on the weekend. He raised money for their date by taking the transmission out of a junkyard Ford and selling it to a friend for ten dollars. That weekend, Ron and Janet went to see Gidget Goes Hawaiian. “I don’t think I watched five minutes of that movie,” Janet laughs. “I was too busy eyeballing him. Oh, he was so sexy!”

Over the course of the summer they saw a lot of each other, joining Tina and Rudy on double dates—usually just a drive out to one of the isolated country roads where they would park, drink a six-pack, make out, and talk. As Ron and Janet compared their backgrounds, they were amazed to discover how much they had in common. Their similarities drew them together, but paradoxically enough so did their differences. Janet could compensate for Ron’s sometimes passive reluctance to take decisive action; Ron, on the other hand, with his slow, considered approach to life, could rein Janet in from her more reckless enthusiasms and impulses. Together they made up a single entity stronger than either one of them.

When Janet decided to move back into Winnipeg, there was never any question but that Ron would follow her. Though they did not rent an apartment together—this was the early 1960s, and such boldness would have been unthinkable for a pair not yet out of their teens—Ron did spend much of his time with Janet in her rooming house. It was there that they slept together for the first time. Both had been virgins. And not long after that, Janet missed her period. She had just turned eighteen. Ron was nineteen, soon to turn twenty. It was young to marry, but they had talked about marriage before. This was simply a sign that they should bless their union sooner rather than later. The two were married on 19 December 1964 in the city of Steinbach. In acknowledgment of the emancipation they now felt from their disapproving parents, they deliberately declined to be married in one of the city’s twenty Mennonite churches.

The newlyweds moved into a tiny cold-water flat in downtown Winnipeg. They couldn’t afford better. Janet was getting minimum wage working as a waitress at the Red Top diner; Ron was toiling for low pay at a factory that made windows. That they would have to bring in more money was obvious—especially when, during one of Janet’s checkups with her obstetrician, she learned that she was pregnant with twins. Ron was nervous, but Janet refused to be anything but optimistic. “I was so excited,” she says, “because all my life I’d been dreaming, Oh wouldn’t it be wonderful to have twins?”

That June, when Janet was five months pregnant, Ron landed a union job at one of the city’s biggest slaughterhouses, and his pay more than doubled, enabling them to move into a two-bedroom apartment on the corner of Dubuc and Des Meurons Streets. Then the couple had a scare. When she was in the latter stages of her pregnancy, Janet developed a serious case of toxemia—a pregnancy-related form of high blood pressure that, untreated, can be harmful to the fetus. Her doctor recommended that she have her labor and delivery induced.

On 22 August 1965, some four weeks before her projected due date, Janet was admitted to St. Boniface Hospital. During his wife’s labor, Ron sat in the visitor’s lounge nervously awaiting the outcome. After several hours, a nurse came and announced that everything had gone fine and that he was the father of identical twins. In his relief and excitement at hearing that Janet and the babies were alive and well, Ron failed to take in anything else. So as he hurried through the doorway toward the nursery to see his children, he was brought up short by a smiling nurse who called out to him, “Boy or girl?”

“I don’t know!” Ron called back. “I just know there’s two of ’em!”

They named the twins Bruce and Brian. They were so similar in appearance that people could not tell them apart, but Janet and Ron, like the parents of most identical twins, could soon distinguish the children easily. Bruce, the elder of the two by twelve minutes, had been born slightly underweight and as a result had had to stay in the hospital a few days to be fattened up. But by the time he joined his twin brother at home, it was clear that he was the more active child, tending to writhe and wriggle and to wake in the night with greater frequency than his brother Brian, a peaceful, less rowdy baby. Both bore a striking resemblance to Janet, with their upturned noses and small round mouths.

By the time the boys were six months of age, Janet felt like an old hand at pacifying, feeding, and changing them. Ron had received another raise, and the family moved to a still bigger and nicer place to live—an actual house on Metcalfe Street, not far from their former apartment. Life seemed to be shaping up beautifully for the young family.

Which is what made it so unsettling when, shortly after the twins were seven months old, Janet noticed that they seemed to be in distress when they urinated. At first she thought it was just the wet diapers that made them cry; then she noticed that even after a diaper change they would scream and complain. She examined their penises and noticed that their foreskins seemed to be sealing up at the tip and making it difficult for the boys to pass water. She took the babies to see her pediatrician, who explained that they were suffering from a condition called phimosis. It was not rare, he said, and was easily remedied by circumcision. After talking about it with Ron, Janet agreed to have the children circumcised at St. Boniface Hospital.

The operations were scheduled for the morning of 27 April, but because Ron was working the late shift at the slaughterhouse, he and Janet decided that he should drive the kids in to be admitted the night before. Apart from the normal concern any parent would feel on the eve of such an operation, Ron and Janet felt no particular trepidation about the circumcisions. Nor should they have. St. Boniface was an excellent, fully modern general teaching hospital. Housed in a seven-story building, it had seven hundred beds, a cardiac care unit, and a children’s hospital where, in the mid-1960s, some 2,600 babies were delivered annually and roughly a thousand circumcisions performed each year, all without mishap.

“We weren’t worried,” Janet says. “We didn’t know we had anything to worry about.”

Ordinarily, pediatricians experienced in circumcisions performed the procedure at St. Boniface Hospital, but on the morning of 27 April 1966 the usual attending physician, for reasons lost to history, was not available when the Reimer twins were scheduled for their operations. The duty fell to Dr. Jean-Marie Huot, a forty-six-year-old general practitioner.

When a nurse was dispatched to collect the first of the children, it was pure happenstance that she lifted baby Bruce from the bassinet first.

With the baby fixed and draped on the operating table, Dr. Max Cham, the anesthesiologist, administered gas to put Bruce to sleep. (Though newborns were routinely circumcised without anesthesia, a child of eight months, like baby Bruce, could not be operated on while conscious.) Sources differ slightly on what happened next. Court papers later filed against the surgeon, hospital, and three attending nurses refer to an “artery clamp” that was used to secure the piece of foreskin that was meant to be cut away. An artery clamp, however, would be a most unusual choice for such a procedure. According to Dr. Cham, with whom I spoke in the winter of 1997, Dr. Huot used the standard Gomco clamp. Designed specifically for circumcisions, the clamp is used to prevent excessive bleeding: the foreskin is stretched over a bell-shaped metal sheath; a round clamping device then closes over the stretched foreskin and compresses it against the bell, squeezing the foreskin and thus making it blood-free for excision by scalpel.

Regardless of which clamp was used, it is not in doubt that Dr. Huot elected to use not a scalpel to cut away Bruce’s foreskin, but a Bovie cautery machine. This device employs a generator to deliver an electric current to a sharp, needlelike cutting instrument, which burns the edges of an incision as it is made, sealing the blood vessels to prevent bleeding—a quite superfluous consideration if Huot had indeed used a Gomco clamp, and a dangerous one, since it would bring perilously close to the penis a current that could be conducted by the metal bell encasing the organ. If, at the same time, the current to the needle were to be turned up almost to the maximum, the results could be cataclysmic.

According to the later testimony of operating room personnel, the electrocautery machine was turned on, and the hemostat dial, which controlled the amount of heat in the needle, was set at the minimum. Dr. Huot lowered the needle and touched it to Bruce’s foreskin. Subsequent testing of the machine revealed that it was in proper working order. Whether through temporary mechanical malfunction, user error, or some combination of the two, the needle failed to sever the flesh on the first pass. The hemostat control was turned up. Once again the instrument was applied to the foreskin; again it failed to cut. The cautery machine’s current was increased. The needle was once again brought into contact with the foreskin.

“I heard a soun...