Tuesday, May 27, 2014

Step 4: Happy families are all alike

I've been putting off writing this for a while now, but I think it would be dishonest for me to discuss my family's adoption journey without a candid discussion of the feelings behind the events that put us on this path. A preface here: emotions have always been difficult for me. On an intellectual level, I can discuss complex emotions and relate episodes from my past that are quite upsetting. However, it has always been difficult for me to just feel the feelings. I tend to revert to medical student mode and present the case, leaving the emotion out of the story altogether or else naming the emotion without giving it any power.

For instance:

A 30 year old married woman, Gravida 1 and Para 1, with a ten year history of endometriosis, had a complicated pregnancy and delivery of her biological child. She had progressive pelvic pain and dysmenorrhea despite multiple pharmacologic interventions. On the recommendation of her gynecologist, she underwent an elective laparoscopic-assisted hysterectomy and bilateral salpingo-oophorectomy to alleviate pelvic pain. Relief of physical pain was nearly immediate, but her post-operative course and recovery were complicated by a struggle to accept the reality of infertility.

All of that is true. The pain was terrible, and I felt better the day after the hysterectomy than I did the day before the hysterectomy. In fact, I took only two days off of work after the operation. It was easy for me to do, since I physically felt so much better.

And, of course, I was aware that a hysterectomy would be a permanent form of sterilization. I knew that I would have to take hormones to replace something that my body had produced naturally before the hysterectomy. I knew that I would never menstruate again (yeah!) and that I would never be pregnant again (um, yeah?!). I thought that I had weighed all the risks and benefits before having the procedure. Angry Driver and I talked extensively about the options beforehand, and his input was basically along the lines of "I would love to have one more, but I want you to feel better and we can always adopt".

I knew the consequences of the decision. I knew. I really did. However, that meant nothing in the weeks and months following my hysterectomy.

I started out happy enough. "No, really. I'm ok" became my mantra.
"It's fine. I'm lucky to have one child".
"I'll never have to buy tampons again!"
"There were no guarantees I would get pregnant again anyway".
"We are happy with one child, but we have always talked about adopting, so we can adopt if we want more children down the road".

Once I grew used to feeling physically so much better, I think the magnitude of the consequences of my decision started to become more apparent.  First, I resented my gynecologist. Looking back, it felt like I had been put in a no-win situation. I could continue to have terrible pain in the hopes of possibly having another biological child at some point, or I could remove all of my internal female organs and have pain relief. He hadn't wanted to prescribe pain medications. I had asked him to remove my IUD, but he told me it wouldn't help the pain. I asked about laparoscopic treatment for the endometriosis (I'd had the procedure years before with some improvement in pain) and he said that what I needed was a hysterectomy. When a two year old boy stands at your bedside day after day and says in his sad little voice, "Mommy hurt?", you feel like you are being herded down a chute with only one opening. I felt like my only option to be able to continue working, be a mother, and be a wife was the hysterectomy. So I had the hysterectomy. And, boy, did I resent it.

My seething anger toward the gynecologist gradually spread outward. It didn't really help that we had moved back to my hometown and it seemed like everyone I had ever known was pregnant. I kept telling myself that my pregnancy had been miserable, that I didn't even want to be pregnant, that I had no guarantee that I would have even been able to become pregnant, deliver a healthy baby, etc. There are no guarantees in life. The past is the past. It's done. Move on. I told myself these things, but I didn't believe them. Everywhere I turned, friends were pregnant. Colleagues were pregnant. People on Facebook were pregnant. I eventually concluded that Facebook is only for two types of people: happy people, and people who desperately want everyone to think that they are happy.

I was not happy. Of course, I couldn't lash out at Facebook friends or high school/college/residency friends. And, really, I wasn't mad at those people anyway. I was just pissed off in general. I don't know that I ever regretted having the hysterectomy, but I do think I regretted not insisting on having the IUD removed, insisting on a second opinion, insisting on an alternative procedure before doing something so irrevocable.

Since the deed was done and I couldn't really be productively angry at my friends or my gynecologist, I subconsciously directed my hostility and resentment to the one person who I knew wouldn't reject me: Angry Driver.

I'm not proud of this, but I found myself saying things like, "Well, you can always have more children if you want".

When that didn't get a rise out of him, I threw another, more powerful grenade: "If I die, you can get remarried and have ten more children. What about me? What do I have?"

Angry Driver refused to play into this, but I kept up the assault. It didn't help that my own parents married and divorced several times when I was a child, and I really did worry on some level that our marriage would fall apart and I would have to watch my husband cultivate a new family with someone else while I would never be able to have another biological child. No matter what I said, though, Angry Driver never did take the bait. He did nothing but reassure me or, if I was particularly vitriolic, ignore me.

Eventually, the resentment and hostility flamed out. Pseudo-acceptance was gradually replaced by a real acceptance that I had made the decision to have the hysterectomy, and it was up to me to live with the consequences - both good and bad. In my work as a physician, I frequently find myself counseling patients and families about treatment options. I tell them that all they can do is make the best decision possible with the information available to them at the time. Whatever decision they make is the right decision, since it is right for them and their family.

Those are easy words for a physician to say, but they are hard words for a person to live. Regret is the whisper that came when I saw pictures of an exhausted family holding a squalling newborn, or when I saw grinning siblings who were the spitting image of each other... and their parents. "What if?" was the voice that nudged me when I imagined a petite blond-haired, green eyed daughter who loves to read like I do and who inherited a passion for philosophy and cinema from Angry Driver. That little girl won't exist. She won't ever exist. And that made me so sad. At times, it still does make me sad.

Adoption could never happen for me while I was feeding that little festering monster of resentment and regret. Eventually, though, I stopped feeding it.

I knew that adoption was right for me when I found myself thinking about a child who looked nothing like me. In fact, I couldn't even picture the child well enough to know if it was a boy or girl. I imagined a child living without parents, without a solid foundation of love and support. I imagined that child jumping on the trampoline with Bean, snuggling in to watch Harry Potter (again!) with Angry Driver, and reading The Poky Little Puppy with me before bed. "I regret..." evolved into "What if?", and "What if?" became "Let's try".

When I started the discussion with Angry Driver, he embraced the idea, leaving me no doubt that he would love our adopted child just as much as Bean. I realized (I finally realized!) that he has dreams for his family too, and he had to come to terms with the consequences of the hysterectomy just as I did. I will forever be grateful that he was there for me when I needed someone to absorb my emotion. He was probably going through so much, but he lovingly carried my burden with his own. He loves me and he will love me. I am not an incubator for a baby; I am his wife and the mother of his child. When we adopt, I will be the mother of his children. As our discussions continued, we agreed that we both want a daughter. And we are lucky enough to be able to pick our child's gender this time!

Bean's first concern, of course, was that he would lose his playroom. When we assured him that the playroom would not be his sister's bedroom (but they would have to share his playroom), he was surprisingly amiable. I witnessed my son's own transformation as the process progressed. Initially, he said, "Will I marry my sister when we grow up?" Later, he said, "I won't go to China if it means getting shots". Lately, he chatters on and on about "When we get my sister..."

I think maybe Tolstoy got it wrong when he said, "Happy families are all alike; every unhappy family is unhappy in its own way." It is rare that life can be condensed to black and white, good and bad, all or nothing. There are certainly dichotomies, but black and white eventually bleeds into shades of gray.

All happy families are unhappy at times. Happy families are those that carry each other through those unhappy times.

Mine is a happy family...and it is growing.




Friday, May 23, 2014

Step 3: The I-800 blues

When I was fourteen years old, my stepfather became an American citizen. I remember helping him study for his citizenship test, and those questions were not easy. As I have grown older, I've often wondered how many born-in-the-USA citizens would pass the citizenship test if they had to take it. I usually wonder this while I'm waiting for thirty minutes in the checkout line at Wal-Mart behind people who can't figure out how to write a check, or when I'm stuck at an intersection because the concept of a 4-way stop is too complex for many motorists to grasp.

Although I have insight into the naturalization process, I never even knew that there is an agency called USCIS.

United States Citizenship and Immigration Services

Like any government agency, USCIS specializes in forms with multiple random numbers and letters strewn together in order to confuse the populace and slow down the process. My introduction to USCIS came after our home study was finally approved, and our agency informed us that we needed to submit an I-800A form.

Of course, this sounds simple. It is not. The purpose of the I-800A is for prospective adoptive parents to apply to be deemed suitable by the US Government to adopt a child from a country that participates in the Hague Convention. China participates in the Hague Convention. Hence, the need to complete the I-800A.

I briefly entertained the idea of buying a child on E-Bay, but then our agency helpfully supplied us with the aptly titled "I-800A Filing Packet", complete with a Table of Contents and several pages of instructions. In addition to the completed I-800A form (shall we create a drinking game out of the term "I-800A"?), we needed the following:

1) A cover letter introducing ourselves to USCIS and listing the documents enclosed with our application
2) Photocopies of our birth certificates
3) A photocopy of our marriage certificate
4) Our original home study
5) Proof of our pre-adoption training
6) A completed G-1145 form, so that we could receive an e-mail or text when our application packet was received by USCIS
7) A completed Supplement 2 form, giving USCIS permission to communicate directly with our adoption agency if needed
8) A check for $720 because, why not?
9) A check to cover the Biometrics Fee, or the cost of fingerprinting each adult in the household. In our case, this worked out to $85 X 2 = $170.

Thankfully, neither Angry Driver nor myself have any history of arrests or divorces, or we would have had the added bonus of completing even more forms.

We (meaning I) dutifully gathered all of the documentation and completed the forms, and our packet was mailed out in February of this year. My text arrived (thank you, G-1145!) on 2/28/14, informing us that USCIS received our application. I congratulated myself on my stellar paperwork skills and settled in for a short wait for approval.

Unfortunately, I quickly discovered that I am not perfect. I know, it was a shock to me too. I forgot to include the $170 biometrics fee. Quickly realizing my mistake, I called USCIS in a panic, hoping to send them a check and keep the process moving. Yeah....no. Did I mention this is a government agency?

When I reached the officer at USCIS, I was told that I could not pay the missing fee because I had to wait for USCIS to mail me a Request For Evidence (RFE), otherwise known a Form I-797C, Notice of Action. This form would officially notify me of my Underpayment of Required Fee. Once I received the RFE, I could mail a check to the lock-box in Texas. Once the check cleared the lock-box, USCIS would take up my application again. Pay before receiving the RFE? Inconceivable!

And so, I waited. And waited. Finally, after two weeks, I called USCIS again to inquire as to when I might expect this RFE. During that phone call, I learned that USCIS employs the classic approach of "Good Cop / Bad Cop"...with a twist.

The Agent who took my call heard about my egregious error. She then spent 3 minutes berating me for failing to include the check for the Biometrics Fee with my original application packet. Whenever she paused for breath, I made sure to apologize profusely and thank her for her concern and understanding of my problem. After telling me that the Agent in charge of unpaid fees (because of course there is an Agent in charge of unpaid fees) would get to it when she gets to it, we said our heartfelt goodbyes.

I swear, not even five minutes later, Agent Fury called me back and sweetly told me that she felt so badly about my situation, she went right over and spoke with the Agent-in-charge-of-unpaid-fees about our case. The RFE would be sent, and was there anything else she could possibly do to help me?

The twist in this story, as you might have already deduced, is that Good Cop and Bad Cop are the same person. Like Fight Club. Or the Lego Movie. Sorry if those were spoilers for you.

I finally received the RFE on 3/27/14, and I mailed out the check for the Biometrics Fee the next day. And then...I waited again. And waited some more. Apparently, the Lock Box people communicate with USCIS via the Pony Express.

I initially believed that my Good Cop / Bad Cop experience with USCIS was a fluke, but it turns out that the paradigm held true whenever I e-mailed or called USCIS. Initially, there would be a display of anger and/or contempt. This was inevitably followed by a near instantaneous outpouring of concern and dedicated effort. As in, "we told you that you will get a fingerprinting appointment when you get it", followed by "I personally made sure that this will be taken care of today." It's kind of dysfunctional, I admit. I almost expected to receive flowers and dinner at a nice restaurant after each verbal harangue.

We finally received our fingerprint date: 5/13/14. The helpful people at China Adopt Talk often spoke of "walking in" early for fingerprinting, but, of course, our state does not allow prospective adoptive parents to walk in early to be fingerprinted. So we waited some more.

Finally, on May 13th, Angry Driver and I drove 2 hours to the assigned federal building in order to be fingerprinted at our appointed time. It was actually pretty cool. The fingerprinting was done electronically, so there was no messy ink and we instantly knew that our fingerprints were accepted. This was in stark contrast to our fingerprinting experience at our local Blahtown Police Department, undertaken for the purpose of our Home Study. Those were standard ink prints. Angry Driver's fingerprints were rejected twice due to poor ridge detail. Apparently, two rejections means the FBI has to accept a person's crummy fingerprints, but I digress.

The employees at the USCIS field office were friendly and efficient. Of course, I missed the old Good Cop / Bad Cop routine, but a good time was still had by all.

In order to keep the fun times rolling, we took the opportunity to visit the Secretary of State's office to have 9 notarized documents state sealed for our dossier. And, guess what! They were all very nice too! Maybe it's the fact that we live in a state known for friendly people, but I have to say that these were the best government workers I've ever encountered.

Since things were going so well, I decided that we should celebrate by dropping a small fortune in little girl's bedroom furniture. That, however, is a story for another day.

Now I will wrap up my tale of the I-800A (drink!)...

Our application was finally approved on 5/19/14, and we received our official I-797, Notice of Action, i.e. Approval Notice, on 5/22/14.

Yesterday!

Hallelujah!

The United States of America has approved us to adopt one or two female children between the ages of zero and 48 months from China. Our 80-day I-800A wait is over!

We can finally wrap up our dossier (I'll explain later) and get this party started! No more singing the I-800A blues for me!

Wait...Hold on...What's this?

I've just learned that the I-800A approves us to adopt a theoretical child or children. Now we need to complete the I-800 process (no "A"), which will approve us to adopt an actual, real, living child. This form is also known as the "Petition to Classify Convention Adoptee as an Immediate Relative".

It's a good thing our agency has a 3 page I-800 Information and Instructions Packet for this very occasion. I've got the I-800 (no A) blue-uuu-huuu-uuuues...
 

Wednesday, May 14, 2014

Step 2: But I signed up for the 100 meter dash

  To continue with the back story...

  Angry Driver and I decided, after many thoughtful discussions and hours of online research, that international adoption would be the best option for us. A brief inquiry of Professor Google revealed that our thriving metropolis, hereafter known as Blahtown, had an impressive total of 1 local adoption agency. Perhaps naively, we decided that a local agency would mean quick, personalized service with more accountability than some faceless national agency. Our rationale was something along the lines of this: if something goes horribly, horribly wrong, isn't it preferable to be able to march directly into an office and insist on a solution?
  I filled out a preliminary online application in June of 2013, and we were quickly approved. I suspect that approval has more to do with a credit check than suitability to parent, but that would be pure speculation. Thanks to the internet, we were quickly set up with an online portal through which direct agency communication could occur. We read about various international adoption requirements, the myriad fees involved, and different country programs. The country was not too important to us since we had no clear mental picture of "our child's" ethnic background. The equation as we understood it was:

Family needs child + Child someplace in the world needs family = Instant happy family!

 Here's how the process was going to play out, according to my mind:
1) select country from which to adopt
2) complete home study
3) agency matches us with a child.
4) we go get child
5) child becomes part of the family
6) live life

  Those of you with even the most tenuous grasp of reality will recognize at this point that my understanding of adoption was So Adorable, in much the way that a raccoon trying to dislodge his head from a garbage can by crawling around with a garbage can on his head is So Adorable. To put it bluntly, I was an idiot. I didn't know what I didn't know. But, hey, remember Step 1? Step 1 was all about acknowledging the problem, and I was about to acknowledge my problem in a big way.
  I'm the type of person who thinks long and hard about every potential decision. I obsessively research and consider various scenarios. Once I actually make a decision, though, I expect instant gratification. I thought long and hard about the IA process; ergo, the process would move quickly once the decision was made. I figured 3-6 months from start to finish, tops.

  Here is a summary of how things actually go down:
1) Meet with social worker from Blahtown branch of agency. Be overwhelmed by the number of IA programs, the various program requirements, and the fees involved. Try to lighten mood by responding to the question, "What are you hoping for in an adopted child?" with "We would like to adopt a child who won't murder us in our sleep or torture our cats".  Sit in uncomfortable silence while the social worker appears to consider whether or not we are seriously mentally ill.
2) Take 2 weeks to decide that China is the program for us. Tell ourselves that this decision is based on logic: China has a well-established, reputable, straightforward process and, since most children are institutionalized, they really do need families. Secretly wonder whether we chose China because we both know how to use chopsticks, China was often featured on the popular cable television show "Adoption Stories" and, well, things seemed to work out ok for those families, and because we had to pick someplace.
3) Spend the next 2 months filling out a formal application, various checklists, Openness Forms, and consent forms, and gathering documents. Briefly consider joining CIA since process probably involves less paperwork and fewer background checks. Briefly pause in the midst of the interminable process to appreciate the irony that we are paying someone thousands of dollars so that we can gather all this documentation ourselves.
4) Spend the next two months begging our friends, family members, physician, and my employer to give us letters of recommendation. Compile tax returns, bank statements, and proof of health, life, and disability insurance. Request (and pay for) background checks for every state in which either of us have lived since the age of 18. Try to recall every address we've ever had. Realize that Bedouin nomads probably had fewer addresses than we had during our college years. Enjoy it when our agency repeatedly reminds us that there are no guarantees that we will have a child at the end of the process.
5) Begin home study process. Pay $2500 up front. Spend most of process trying to track down Blahtown social worker, who is conveniently never available and doesn't answer the phone or emails.
6) Complete home study process. This is no small achievement since Bean makes every attempt to embarrass us as parents by passing gas and insisting on playing Angry Birds Star Wars on the tablet for two hours in exchange for good behavior. Who says you can't negotiate with terrorists?
7) Begin interminable wait for home study report to be written. Spend many enjoyable hours replaying every word Angry Driver and I uttered trying to determine whether or not we sound like good prospective adoptive parents. Pause at Christmas to learn that Blahtown social worker wants me to have a psychological assessment because I took an antidepressant while in college. Really? It was a public American university at the turn of the 21st century. Wouldn't it have been abnormal for me to not have taken Prozac? Listen to Angry Driver gloat that he doesn't have to have a psychological assessment. Enjoy some measure of satisfaction when I am able to wave the written document that declares me "sane" in Angry Driver's face.
8) Scour photo listings of Waiting Children looking for "our child". Horrify myself (and Angry Driver) when I discover exposé about crazy people advertising on the internet to take unwanted adoptees. Here, now you can be appalled as well:

Horrifying Crazy Adoption Rehoming People

9) Finally get completed home study approving our family to adopt 1 female child or 2 children, ages 0-48 months, from The People's Republic of China. Finalized home study arrives 7+ months after we filed our initial application with the adoption agency.
10) Make the exciting discovery that now we get to really begin the paperwork process. Or, as my new mentors on China Adopt Talk refer to it: "The Paperchase". Remember all those documents we gathered? The letters we requested? The forms we completed? Yeah, we get to do all of those things over again and pay even more fees!

I thought I told these people that I signed up for the 100 meter dash, not the 26.2 mile "fun run".

Tuesday, May 13, 2014

Step 1: How hard can this be?

The key to any good "Step" program is clarity. Order. Follow the steps and work the program and enlightenment will ensue.
  I'm a reasonable person, really. After 13 years of high-quality suburban public school education, 4 years of university schooling, 4 years of medical school, 3 years of medical residency training, and completion of a one-year fellowship, I must confess that I even consider myself to be well-educated. How hard could adoption be, really?
  Compared to vomiting my way through a pregnancy and taking a two-week maternity leave, I reasoned that the adoption process would be simple. Well, maybe not simple...but, certainly it would be straightforward. Orderly. Right?
  You can probably guess where this is leading. Step 1 is usually admitting that you have a problem. I had a problem. Perhaps there was a component of arrogance, but I think my issues had more to do with ignorance. I didn't know what I didn't know. And what we don't know that we don't know...it most certainly can hurt us.
  The things I didn't know (and the things I still don't know) would fill volumes. So, ultimately, Step 1 for me in the journey to international adoption turned out to be this:
Embrace humility. I have a problem. I know nothing. I am the Jon Snow of international adoption.

The Origin Story
  I was about 13 or 14 when I first thought that I would like to adopt someday. My thinking was (and still is) that all children deserve to grow up in a loving, stable home with parents who care for and protect them. As a teenager, my worldview was obviously simplistic, but a little bit of that idealist still lives inside my cynical adult self. As I grew, the desire to parent grew as well. Endometriosis meant that fertility was not guaranteed. A family is a group of people bound by love and commitment, and those traits are not necessarily linked to shared genetic code. All of these thoughts tossed around inside my brain for years while I pursued an education, marriage, and a career.
  Fortunately, my husband (let's call him "Angry Driver" since anyone who knows him will immediately recognize the moniker) supported the idea of growing our family through adoption. We began learning about the adoption process even before we got married and we started looking into various avenues of adoption: private infant, foster to adopt, international, etc. We were reading about adoption agencies when we found out I was pregnant with our son (let's call him "Bean" since that was his womb-name).
  Having Bean was a true blessing, and I am in no way trying to minimize my gratitude when I say that my pregnancy was awful. My delivery experience was decidedly Not Good. My postpartum experience was Certainly Not Fun. The endometriosis pain was a Decided Negative. By the time my gynecologist recommended a hysterectomy, I was ready on every level. I reasoned that I could keep the factory equipment in the hopes of possibly manufacturing a future bean (No guarantees), or I could raise the beautiful Bean I already had. When your not-quite-two-year-old stands next to your bed every day and asks, "Mommy hurt?", the decision is actually quite easy. Angry Driver and I agreed that the Bean was everything we ever wanted and hoped for. If we decided to have children in the future, adoption would be our path.
  The hysterectomy happened. I took two days off of work to recover (The road to ignorance is paved with ill-advised bravado and wonton disregard for the advice of experts). I completed my medical training and started my first job as a Grown Up Doctor.
  When Bean was about 3 years old, we felt the time was right to formally begin the adoption process. Families are created in many ways and they are all valid. For us, private infant adoption was not the path we wanted. We did not like the idea of competing with other families for a baby, and we did not want to be in the emotional position of worrying that a birth mother would change her mind and want to keep her baby. The ideal state is one in which parents raise their children. We wanted another child, but we wanted to offer our family to a child who would otherwise not have one.
  We began by exploring foster care adoption through our County Social Services Department. Let's just say that this was a Subpar Life Event. We attended the training class. We filled out the Magna Carta of applications and we heard...nothing. Angry Driver and I took turns calling the County, but all we ever heard were  lamentations regarding the evils of the Governor and the horrors of Budget Cuts.
  After 6 months of such exchanges, I asked the County worker to call us if she ever wanted to talk about our application. Meanwhile, I frequently passed a highway billboard that poignantly asked me to consider adopting a child from the foster care system. Irony is a witty mistress, indeed. For people who believe in fate, I imagine the experience would be summed up with the words "Not Meant To Be".
  Two years and one move later, we agreed to try again. Angry Driver did not want to repeat the foster to adopt fiasco, so we agreed to explore international adoption. I couldn't argue with his reasoning.   And so we took another step in the 1,000 step program.
  That, however, is a story for another day.