Boundaries: The Space Between

Twenty-one weeks into my second pregnancy, I just did not feel right. An ultrasound a few weeks earlier had shown that I was carrying twins, and I’d taken to assessing my tummy with a measuring tape, like the doctor did at my visits. I was pleased that the twins seemed to be growing quickly, adding about a centimeter per day to my ever-increasing uterine size. Little did I know that this was not a good sign, and when the doctor asked me to come in after hours, he was shocked to find my cervix already dilated to 3 cm. Being a family physician, he realized he did not have the expertise to care for this now very high-risk situation, so he packed me up in an ambulance and sent me to the best high-risk maternity hospital in the area, 90 miles away, my husband following in our car. Our first baby had been stillborn at 19 weeks, and I just knew God would not put us through that again, so I clung to the hope that everything would be ok.

Being the middle of January in Wisconsin, our trek was slow-going, and we made it to the hospital about two hours later. A cervical check revealed that I was now 5 cm dilated, and as the medical residents on my case scurried around me and my bewildered spouse, I felt a “pop” as my water broke. It quickly filled up the bed linens and flowed onto the floor; then it was obvious that there would be no stopping these babies from coming that night. The NICU doctors were gently honest about the fact that at 21 weeks things did not look good, but that they’d do everything they could. My two boys arrived, one right after the other, about an hour later, eyelids still fused, no ability to breathe or cry. I spent the next hour cradling them both in my arms, watching their hearts beat more and more slowly, until their tiny chests were completely still.

The next morning, the kindly attending perinatologist overseeing my case sat down and explained what had happened. My twins were identical, and had developed the condition known as “Twin-Twin Transfusion Syndrome (TTTS)” that sometime affects identical twin pregnancies. He reassured me that I had not done anything to cause this; it was a one-in-million fluke of nature, and I should be able to go on and have more children when I was ready.

Above is a pictorial representation of what happens in Twin-Twin Transfusion Syndrome. Somehow in the process of twinning, the shared placenta develops blood vessels that are abnormally connected to each other. The number and type of abnormal placental connections determines how severe this process will be; a small number of connected vessels of similar type (artery to artery, vein to vein) may not affect the pregnancy to any great degree. However, pregnancies like my own, where multiple arteries connect to veins, all leading in the same direction, result in one twin becoming the Donor twin, while the other is known as the Recipient twin. As blood from the Donor twin gets sent to the Recipient twin, each twin develops problems related to fluid balance. Although the details of this sequence of events is physiologically quite complicated, it all boils down to one twin ending up with too much while the other doesn’t have enough. In severe cases, both twins become quite ill while the mother develops “polyhydramnios” and goes into preterm labor, as was my situation.
Treatments that exist today can now save some of these pregnancies; a laser is used to coagulate the errant vessels. I think of it as “creating a space” between the vessels so that each twin can be fully separate and develop individually as was originally intended.

It’s been nearly 40 years since this life-changing event happened. I was so profoundly affected by it that I found myself gripped with a zeal for helping families touched by pregnancy loss and infertility, and researched how I might be able to best do that. Our family welcomed 3 sons by adoption and birth over the next 7 years, and during the first successful pregnancy I decided to become a physician. While pursuing and accomplishing that goal was one of the highlights of my life, the realities of practicing medicine while raising a young family began to take its toll on my mental and emotional health. I’d seen a therapist to help me handle the overwhelming grief after losing the twins, and although quite helpful at the time, I now needed more in-depth assistance. The new therapist quickly recognized my tendency for codependent behaviors and although I intellectually understood what that meant, I had trouble making the changes I needed to make that would free me from a behavior pattern that had been predominant since childhood. It would be another twenty years before a relationship made the importance of this crystal clear.


Twitter user and personal coach @SayItValencia has this to say about codependency:

“Codependency is excessive emotional or psychological reliance on a partner, typically one who requires support on account of an illness or addiction. The codependent’s main need is to feel needed; they enter relationships with people who need help. That’s how they feel worthy. Codependency is when you do a majority of the emotional labor within a relationship, but you don’t receive what you need in return. You overly give, help, teach, nurture, control…All because you excessively rely on your partner’s behavior to feel love, cared for, valued…You want things to change, they don’t. You try harder to make things mutual, they aren’t. You’re suffering, yet you still stay in the relationship. Codependents tend to chose people who need a lot of help but can’t reciprocate what’s given to them. Codependents want to help, but things don’t change. That’s when they might try to control the other person. Why? Because they excessively rely on that person’s behavior to feel good; they rely on the relationship to feel needed, loved, cared for, valued, and appreciated.”


I’d been practicing medicine for awhile and was going through a divorce, when I met the person who’d help me connect the dots between Codependency and TTTS.

Soon after our first meeting, we fell in love. I had a strong feeling that he was a soulmate, or “Twin Flame”. Our connection seemed to be destiny, and I poured myself and everything I had into helping him in his recovery from a nasty addiction. Not understanding the nature of addictions, I was quite disappointed when his recovery soon gave way to yet more addictive behaviors, and I felt like I had failed the person I loved most. My self-esteem plummeted, which affected every other area of my life. It wasn’t until I found myself having lost nearly everything that it clicked for me: like a light bulb going on (or a bomb going off!) I had a sudden realization that I was in the same boat as my son who’d been the Donor twin, unwittingly sending all my resources to someone who could not reciprocate. A name for this situation popped into my head: Twin Flame Transfusion Syndrome.

Those in the New Age community are familiar with the voluminous amount of information regarding Twin Flames. The concept that resonates most with me is that a twin flame is a karmic partner who comes into our life to help us deal with and overcome certain particularly troublesome and challenging patterns. They are a person who is a catalyst for change. Unlike a soulmate, with whom you might share values, goals and purpose, the twin flame may not be the person who is best suited to be a life partner. In my case, I eventually realized that my twin flame was there to showcase for me (in heartbreaking detail) the pitfalls of being a selfless savior who becomes easily enmeshed with others. I saw the good in him, but as with the candle in the photo above, perhaps it was simply a reflection of the good in me. I needed to accept the fact that unless I made some drastic changes I would soon be swallowed up into the void in which my loved one was trapped. I knew that without a significant intervention we would both die, just like my twins.

I’ve always been a believer in a higher power. Early on in life I thought of that being as God, and felt that He always had a protective hand on me. Losing the first baby at 19 weeks had been so devastating that I didn’t think I could go through anything like that again, so when the twins were lost my faith in God and many of my beliefs were severely tested. Initially I had no idea why I’d been given two such significant pregnancy loss experiences, but when I saw the parallels between TTTS and Co-dependency, I began to understand. It all has to do with solving the problem.

While in medical school, I had the great fortune to meet and work with Dr. Julian DeLia, an OB/Gyn who was pioneering the first laser treatment for TTTS. I was even allowed to be present during several of his first cases, and to be honest, having “hands-on” experience being involved in a successful procedure was more therapeutic for me than anything else could have been in processing my own grief. It also cemented in my mind the concept of creating a space between the vessels to stop the process of unremitting one-way blood flow.

When it comes to codependency, I’m quite sure I am not unique in unsuccessfully attempting to put space between myself and my partner. After all, as with the twins, there was (and still is) definitely great love between us, and the inability to reciprocate was nobody’s fault. I guess the big difference and life lesson is the existence and use of Free Will. I have it, and the twins did not.

Now, because I finally understand the lesson, it is up to me to create a healthy space between us, so that we can be fully separate and develop individually as was originally intended. Even though we are both fully grown adults who have been engaged in this dysfunctional pattern for decades, there is still time for each of us to develop to our full potential and fulfill our life purpose, whatever that may be.

The key is to set and maintain boundaries, which does not come naturally in this dynamic. At first, neither “co-twin” will take to it easily, with the “donor” feeling as if they are cutting off a part of their own body, while the “recipient” feels as though their partner is starving them to death. But as time goes on, and as boundaries are strengthened and maintained, each partner will begin to see their life change in many positive ways.

So, I write this to offer hope to those who struggle with codependent tendencies. Practicing self-care is a good first step; it can lead to setting reasonable and effective boundaries. If both partners are understanding and accept the need for this, the relationship has a chance of being saved. Like the normalization of fluid dynamics that occurs after a successful TTTS “Laser Ablation” surgery, each partner will come to depend on their own flow of energy to sustain them, rather than relying on another.

Although my twins were only with me for one hour, the profound lesson they taught me has likely enabled me to save my own life. The magnitude of this never fails to bring me back to the faith I thought I’d lost forever and the belief that “everything happens for a reason”.

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