Category — controversial

It’s end of March.  I’m ~3 months from the end.  There’s almost light.  But these are dark times for an intern.  Most interns this time of year have what we call “compassion burnout,” a terrible, but real, condition that happens to even those of us who would’ve considered ourselves as deeply compassionate previously.  But there’s only so many times you can deliver the “C” word before you stop feeling that stabbing pain when you tell a patient they have cancer.  And only so many times you can sit and sympathetically listen to a people’s illogical reasons for wanting a family member to remain “full code,” when you know it’d just be torture (for them and the medical team) if they were to require intubation or chest compressions.  You start despising family members who insist their loved ones are “fighters, and would want to fight ‘til the end,” when you realize your patient wants nothing more than to be allowed to die peacefully but continues permitting aggressive medical care to appease others.  You start resenting the patients that ask anything of you, as their doctor, in the afternoons because it only means you’ll have to stay later…knowing if it were your family member, you’d be asking the same of their medical team to make sure they were getting top care.  You loathe the patients who become anxious at 3am or start having non-cardiac chest pain because any chance you may have had at closing your eyes was just taken from you.  You become intensely irritated when asked to fill out the 50 page stack of FMLA paperwork your patient hands you, even though you once considered yourself a patient advocate. 

I am sometimes ashamed that I find it therapeutic to be part of a group of interns that convenes in the wee hours of the mornings in the computer area of the doctor’s lounge.  It’s there that we sit facing our computers, collecting patient vital signs, labs, test results, with our backs to each other, just venting.  We spew venomous, horribly uncompassionate words, talk about how much we hate our jobs, our patients, our attendings, and then leave feeling lighter to start our dreaded days.  I guess it’s healthier than carrying all that negativity around all day?!  At any rate, I feel bad about it with what little energy I have at the end of the day.  I don’t hate my patients, and I pity admire my attendings who have to do this daily until retirement.  But I do hate my job most days. 

It’s funny.  I always wondered why / how doctors could have higher rates of alcoholism, suicide, and divorce than the general population.  It’s no mystery anymore.  This job shaves years off a person’s life.  Intern year alone probably stole 10 years from me, left my kids in a place that’ll require more healing, threw my marriage into stress it’s never seen, and turned my body into a recycling bin of redbull, diet coke, wine, and vodka.  I’m gonna make it, and so are my kids and my marriage.  But as my mom pointed out, there’s no glory in medicine these days.  It’s a daily sacrifice in exchange for very little respect or reward. 

These are not the Marcus Welby days.  Rather, these are the days of shift work, litigation, and overworked for constantly threatened pay.  I had a debt collector show up at my house last week, informing my nanny I have $120,000 in collections (that was the portion of my loans for which I apparently didn’t get forebearance granted).  As for the personal reward?  Even that’s debatable.  I cross-covered on a patient during an overnight call (30hr shift) the other night who came in critically ill from injecting drugs.  I got paged at 2am saying he was going to leave AMA (against medical advice).  I raced to the scene (it’s the interns’ shit job to try and talk patients out of leaving AMA) and tried to figure out why he was agitated and wanting to leave.  He cursed me out, told me I sucked at life and my job, and that our hospital wasn’t doing $hit for him.  Mind you, this is a patient without insurance, who my hospital treats at a loss.  He threatened me and talked to me in a way that was so appalling.  Normally, I’d have just taken it.  But that night I was exhausted and I’d had it.  So I said “I’m sorry you’re unhappy with your care here.  But I’m not going to BEG you to allow us to treat an infection that will otherwise kill you.  I don’t think I should have to care more about your health than you do.  If you’d like to leave, that’s your choice and your right, so go ahead, though I think that’s a poor choice.” I walked out and was paged about 10 minutes later by an attending telling me to get my ass back in there, apologize to the patient, and convince him to stay.  That’s the reality of medicine as a profession.  It really is a crappy job a lot of the time and the patients who deserve our attention and time don’t get it because it’s taken up by the ones who don’t want to help themselves or just want to whine about stuff.  Damn, that sounded unintentionally republican!  For the record, I have not converted to the dark side!  I’m just jaded and disgruntled.

Please know that I’m not depressed.  No one should be concerned about me, I’m just using this space to vent!  I’m actually doing very well and my resident and co-intern are always telling me they can’t stand how upbeat, enthusiastic, and energetic I always seem, even post-call.  You’d probably only know how much I dislike going to work if you’re aware of how much I love being at home (or if you know me, read my blog, etc;).  And despite the dread that surrounds my work life, I do take good care of my patients and I’m anal thorough in a way that compels me to check in on them from home.   Part of why I don’t like internal medicine is because it’s stressful and hard for me to let things go, even when I’m not technically “at work.”  I’m a worrier.  I really do love my life, just not my job on a daily basis.  So don’t worry about me after reading this (Yiayia!).

Nothing in medicine is more painful, more torturous, more heart-wrenching than providing futile medical care to a patient who is suffering.  I am not talking about a person who carries a terminal diagnosis but is still coherent and choosing to pursue experimental treatments, even if they are hail mary options.  I’m talking about the patient who is no longer mentating, who needs modern medicine to breath for him and a tube to feed him, who is developing decubitus ulcers all over his body from laying in a practically vegetative state, who moans if the ativan and morphine wear off, who has to have the suction jammed down his throat to remove the sloughing mucosa from the back of his dry, blood-crusted oropharynx, who is barely recognizable because fluid has left the intravascular space and pooled in every dependent area of tissue, leaving him swollen and water-logged.  I’m referring to the patient whose family members STOP visiting his bedside because even they can’t stand to look at him like that anymore.  Yet they still want everything done to keep him from dying. 

Talking and pleading with families in the most compassionate way I know how becomes a frustrating effort when they continue to believe a miracle might occur.  In one breath, they realize that if God wanted a miracle to occur, he would make one occur.  But in the next breath, they aren’t confident enough in their God to allow us, the medical team, to stop prolonging the patient’s suffering and just leave it up to God. 

I know it often takes people a long time to come to terms with a family member’s death.  I don’t ever want to be in those shoes because I can’t imagine how painful it must be.  I never know the people I take care of before they became ill, but for me to show up and see them in a state of suffering day in and day out while their families debate pursuing aggressive, futile medical treatments, is really hard.  Our 1st obligation as physicians is to “do no harm,” but I can’t think of anything more inhumane than prolonging death under those circumstances.  Yet, in this country, we are virtually powerless and our hands are practically tied.  We aren’t able to say “I’m sorry, I cannot / will not put a feeding tube down your father’s throat because it will only cause him more discomfort and there is truly no benefit to him.”  In an ideal medical world, I would be able to say “I’m sorry, but it would be against the medical oath I have taken as a doctor.”  But we don’t live in Europe, we live in a highly litigious country where doctors are puppets out of the fear of a lawsuit.  So we go on torturing patients when they’re families demand us to.  And we bring in palliative care, case managers, hospice, the ethics committee, and so many other people to try and help us make our case.  But in the end, we bend to the families’ wishes and allow the antibiotics, the feeding tubes, the blood draws, the suctions, beeping alarms, the rib-cracking CPR, the defibrillator, the breathing machines to continue to prolong suffering.  It’s truly disturbing.  And in the end, the patient dies a painful death, and all that is gained goes to insurance companies – the  hundreds of thousands of dollars our futile care costs. 

If you don’t have a living will, even if you are 30 years old and healthy as can be (believe me, I’ve had this patient who was hit with something out of the blue too), sit down with your family and talk about these things.  Everyone who sees these patients always says “please don’t ever let me go like that,” but it’s so hard for the family members left behind to make such huge decisions when they haven’t explicitly had these conversations with their loved ones before tragedy befalls.  No one wants to be responsible for saying “ok, withdraw treatment and let him/her die in peace.”  So everyone defers making a decision, and the patient just lingers and suffers.  Something to think about.  Here’s a site to help you think through these things if you haven’t before: http://www.yourcommunityhospital.com/LivWill5wishes.cfm

First of all, anyone is welcome to weigh in on this.  I am hoping, specifically, my friends in medicine will also comment, and anyone else out there who may have personal experience with the dilemma faced by a woman who learns she is (+) for the BRCA 2 mutation.  My friend, S, is not looking for medical advice per se; she has a doctor.  But she is interested in hearing a lot of perspectives from people who have a sense of what this all means – the surgeries, the grieving, the tradeoffs of prophylactic surgery versus surveillance versus chemoprevention (tamoxifen, raloxifene)…if you’ve taken care of patients who have been through this decision-making process, or taken care of them on the post-op end, or known someone close to you who has been through this, your input is specifically requested!

For those of you who are not in the medical field, the BRCA gene is a breast cancer susceptibility gene and there are inherited genetic mutations that result in a high risk of developing breast or ovarian cancer.  My friend S was given these stats by her genetics counselor:

• breast cancer by age 50 is 33-50% (vs. 2% in the general population)
• breast cancer by age 70 is 56-87% (7% general population)
• ovarian cancer by age 70 is 27-44% (<2%  general population)

Basically, my friend is pretty comfortable with the salpingo-oophorectomy part.  She is not planning on having biological kids and is ~40, so she is confident in her decision to have her ovaries & tubes removed prophylactically.  She is more torn about the mastectomies.  Understandably, she is concerned over the gravity of that operation, the post-op recovery, etc.  She is interested in hearing how other people would go about processing this type of news and making such a huge decision.  It is obviously impossible for most of us to say for sure, if we’re not REALLY facing this decision, but speaking hypothetically, what do you THINK you would do?  And why?  Thank you in advance, on behalf of my good friend S, for contributing / commenting on this post; no matter who you are, your input is greatly appreciated here.

First, I want to point any local readers to a RIDICULOUS sale Ambajam is having this week in Denver.  Details are below, but it’s a MUST if you are in the market for baby gifts: 

In case you don’t know Ambajam, it’s the maker of the world’s most wonderful baby blanket.  Just ask Fin, Shane, and Jack!

Quick update on Fin: She had gotten into the midnight snack cycle and largely stopped eating dinner.  She would honestly look Travis in the eye and say “see daddy when my sleepin’ for cottage cheese and yogurt honey!”  That was her version of “goodnight daddy, see ya at 4am!”  So 2 nights ago, we told her at dinner “tonight there will be NO MORE cottage cheese or yogurt honey in your bed, so fill your belly now.”  That night, she woke up SCREAMING “cottage cheese,” which went on for hours.  I paced the hallway while Travis stayed in her room.  The next day, she told us “no more cottage cheese in bed,” and we said “that’s right Fin.”  Last night, no wake-ups.  Can you believe that?!  She ate a HUGE dinner tonight and topped it off with cottage cheese (her fave) before hitting the sac, so my fingers are crossed.  I’ll keep ya posted and thanks for all your input!  Oh, also, I hope everyone read my friend Sarah’s comment about leaving food/snacks in her room.  Seems harmless, and I actually had considered it, but it is most definitely NOT safe to give kids food unsupervised so I’m glad she pointed that out to me and others.

So, in the comments on my last post, Christina pointed us to an article on a website for adoptive families that talks about the new ABC show I mentioned, Find My Family.  I read the first few sentences of this article and IMMEDIATELY knew from whose point of view that article was written – had to be an adoptive parent (I didn’t verify that, but I can’t imagine it’s anyone else’s vantage point).  And actually, the author struck me as a fairly insecure adoptive parent.  However, reading that post made me realize why I have felt so conflicted about the show ever since I saw its first preview: it seems like it’s the kind of reality TV exploitation that will leave clueless American viewers with all sorts of assumptions and presumptions about what it feels like to be an adoptee. 

Unlike the author of that article on Rainbow Kids, I don’t care that the makers of the show don’t focus on the adoptive family side of things.  I’m not offended that the show a show about birth family searches is called “Find My Family;” it doesn’t threaten my role in my children’s lives to recognize they have another family.  Aren’t we, adoptive parents, already over-credited by the media?  And doesn’t that create issues in and of itself?  With the “your kids are so lucky” crap that always makes us squirm and the “thank God you adopted them” comments want to hide our kids from?  Aren’t we already glorified as if we’ve done something other than selfishly want a child to love and raise, just like any other parent?  I do not feel slighted in the LEAST that the show focuses on a need that’s central to many adoptees quest for identity: the search for birth family. 

What does concern me is the potential impact of a far reaching show that makes entertainment out of deeply personal experiences and could cause viewers from the general public to project stuff onto my kids.  But I guess that’s just the nature of reality TV.  I just don’t want my kids to ever think they’re “supposed to” feel ANY particular way about adoption.  They aren’t supposed to be pro-adoption just because they’re adopted.  And I don’t want them to think they’re supposed to feel a certain way about their birth families.  I don’t want them to feel weird if they do or don’t want to search out their birth families.  I will support them either way, I just don’t want their experiences shaped by an external source like ABC or other people who watched ABC’s show and think they now know what all adoptees must go through without their first families in their lives.  There is already a serious lack of sensitivity towards adoptees by ignorant people who make offensive comments or ask very intrusive questions to our kids, or to us about our kids right in front of them regarding personal issues. 

Creating an adoption-based reality TV series, on the one hand, might increase awareness about adoption, first families, and the serious disservice that is done to children when a closed adoption occurs.  That could be a really positive thing.  So maybe it’ll actually decrease adoption ignorance??  I don’t know.  It kind of touches on a different side of adoption that isn’t often recognized – the loss (for birth families and adoptees).  BUT, the show really just uses that loss as an emotional backdrop to its happy ending, which comes by way of reunion of birth family and adoptee, which isn’t in the cards for a lot of our kids who may never find their birth families again.  In the end, it does provide a glimpse into a side of adoption we don’t normally hear about, but ultimately is a warm, fuzzy portrayal that is probably unrealistic for most families.  Personally, I wish there was less “Extreme Makeover” dramatization and a little more real life adoption issues addressed, if it’s going to bother trying to be “reality TV” and all. 

Reality TV is complicated; it does give the general public a glimpse into lives or circumstances they otherwise might not understand at all.  But then again, maybe it just allows generalizations to be made based on a few very intimate portrayals.  And maybe those portrayals are so over-dramatized that they’re not even accurate in the first place.  Thoughts?

That said, I’ll probably watch the show if I can catch it while it’s on; I am curious and I am interested in whatever adoption stories are told, especially because the typical adoption shows are usually on TLC and focus exclusively on the adoptive families perspective.  At least it’s a change from that.

First, I want to point people to my friend Brandy’s etsy site.  She and her husband are raising money to adopt their first baby.  They are planning to adopt domestically and I’m SO hoping it happens soon for them; she and John will make awesome parents.

Ok, so my intention with yesterday’s post was not to ignite the “cry it out versus attachment parenting” debate; I was more looking for suggestions with Finley’s feeding cycle problems than critiques of sleep or parenting philosophies.  For the record, Healthy Sleep Habits Happy Child is in my collection of parenting books and I have read it; it’s just never felt right to my gut, for my kids.  Yes, I should probably go back and revisit the book with Finley in mind, but to be honest, I’m somewhat turned off by the die hard cool-aid drinkers.  However, your comments did make me stop, think, and wonder WHY this is such a divisive issue.  Sleep training really is one of those weird, touchy parenting philosophies that, when challenged, gets peoples’ panties in a bunch. 

I’ve said this before, but I feel like the more parenting experience I gain, the less sure I am that my way of doing anything is right.  I definitely started out that way – had all the answers before I even had the kids to test them out on!  But truly, the more I learn, the more I realize there is no “right” philosophy, no 1 size fits all parenting strategy, and no sure bet method that works for every parent / kid.  So I am not condemning anyone else’s methods or saying that mine should be followed by anyone else.  I’m not even sure I should be following my methods…or even what my methods are;)  Honestly, I’m starting to believe that each child, even within the same home, deserves a custom parenting approach.  It’s interesting to see it when your kids are essentially all the same age – they each respond to certain parenting strategies in COMPLETELY different ways.  What works for Jack does not always work for Shane, and what works for either of them doesn’t ever always work for Finley. 

Anyway, I have a little theory that I want to explore.  Here are my questions:

1. Are you a believer in sleep training?
2. How much sleep do YOU, personally, need to function optimally? And what’s the minimum amount of sleep your body could take for a night without feeling like you’re dragging as$ the next day? 
3. How many hours do your kids sleep at night?  How many hours do they nap in the daytime? 
4. Do you forgo fun activities or spontaneous vacation opportunities to adhere to a rigid schedule of naptime / bedtime? 
5. On a scale of 1-10, 10 being “the most important part of the day”, how important is sleep to you?
6. On a scale of 1-10, how important do you think sleep is to your child? 
7. Bonus question: would you consider yourself a strict disciplinarian? 

I’ll be more transparent, since this isn’t exactly a research study I’m doing or anything.  I think we, as parents, sometimes do things because they’re more convenient for ourselves.  Or because WE need to do them, but not necessarily because it’s what’s truly best for our kids.  Then we come up with ways to justify it to ourselves and everyone else - we create a parenting philosophy out of it, and we debate it and insist it’s the only right way.  It seems like the toughest part of parenting is recognizing when we’re doing something because it’s best for us, versus something that’s truly in our kids’ best interests. 

Again, I’m not criticizing anyone else.  I’m saying this humbly because that’s exactly what I can’t figure out in this Fin situation.  I don’t know if the real reason I can’t let her cry is because it’s terrible for me but would be better for her in the long-run [oh, and this discussion is purely academic since I couldn’t stand to hear her cry even if it is what she needs]!  I am aware that Finley has potential to grow up and be one of the most successful manipulators of all time, and that does worry me.  Maybe she has a future in politics.  But seriously, I do think a large part of her nighttime habits are about control, and I realize we are going to lose big wars with Finley when she’s a tough teenager if we don’t start winning some of these baby battles now.  I get that.  But I do NOT like the idea of my child crying herself to sleep.  Ever.  Plus, for those of you who had good intentions in trying to give me sleep training encouragement, telling me how it only lasts short periods of time for a few nights…you don’t know my child.  I mean that respectfully.  You truly don’t.  And I doubt you’ve EVER met one like her.  I know I haven’t, and I’ve been around a lot of babies.

Even though adopting our boys when they were not newborns was challenging, the “right way” of dealing with the nighttime stuff was very clear to us.  They needed us, each and every time they cried out; they needed to know we were going to be there.  With the boys, letting them cry and validating it by “saying that kids need sleep, it’s the most important thing for a child’s brain development,” or anything else, would have been empty justifications for doing something that was just best for us.  It’s obviously different with Fin; she knows we’re always going to be here.  Since she was 1 second old, we’ve ALWAYS been here for her.  She’s just a very different personality than her brothers, and our issues / struggles with her are SO different.

I DO agree that there’s a tipping point – the point where doing what’s best for yourself IS what’s best for your child.  We all suck as parents when we’re half alive and suffering from extreme sleep deprivations.  I’m there PLENTY often.  We all have different thresholds and breaking points with regards to sleep.  But I wonder if people who are SUPER rigid about sleep are people with lower tolerance for sleep deprivation.  I’m not accusing anyone, I’m just curious.  Thoughts?

UNRELATED QUESTION: how are people feeling about ABC’s new show that starts tomorrow, “Find My Family?”  It’s about birth family searches…a topic I’ve been meaning to write about.  Thoughts?

First, I have 2 giveaways going on: a winner’s choice craft kit from Creativity for Kids and 4 tickets to Disney on Ice in Denver!  Drop a comment on those posts before November 22 for a chance to win those cool prizes.

Tara and Christina both asked excellent questions about adopting from Vietnam if the program reopens, as is expected at some point in the relatively near future.  My friend, Jena, offered to guest post on this topic and I quickly accepted her offer because I knew she’d be able to write on this better than I could have.  And she did.

There may be things flying around about VN renewing, but in your honest opinion, is it wise to adopt from VN when/if it is possible? Is it ethical? Do you think it will ever happen?

-Guest post by my friend Jena

Laurie and I "met" through blogging about 3 years ago, Jack had been home for about 4 months and our son Khai had been home for about 2 months.  Laurie and I are pretty different, demographically speaking, but found that we often ended up at the same place when it came to things adoption related especially Vietnam adoption (and actually quite a lot of other stuff too).

About 2 years ago I started blogging over at VVAI (which a lot of you probably have read), and have since learned and had conversations with many many people within the Vietnam adoption community.  A lot of what I know now, I wish I didn’t.  And I wish even more that it wasn’t true.

I started out this process of adoption believing with all my heart that I was doing a good thing by adopting a child.  I assumed that if an agency was licensed in a country, it was there to help children.  I am not sure when the reality began to sink in that something wasn’t right.  I think it was when I joined APV (a yahoo group for parents of children from Vietnam).  There were a few voices on APV (old timers) that kept questioning the vast amount of agencies being licensed in Vietnam, questioning the ability to choose gender, questioning the YOUNG ages of the children, questioning that people were being asked to bring cash with them.  They kept saying how much the current situation looked a lot like the old one.

And then we got an email from our agency that they had been asked by one of the orphanages they were working in to provide incentives for hospital workers to funnel children to that orphanage.  Our agency would not do it.  And I watched person after person working with other agencies whose children were in the same orphanage that our agency was working in announce their referrals on APV…. person after person…baby after baby….

And it began to dawn on me that things were not ok. 

And we all know what happened after that.  Kind of.

Somewhere along the way I realized that I didn’t save my son.  And while we have many reasons to believe that his adoption was ethical, (agency we used, health situations, relinquishment vs abandonment) we don’t know.  And at the very least, I live with the belief that our very participation in such a corrupt system contributed to the problem. 

So here we are.  Many of us have beautiful wonderful children from Vietnam.  Many of us have been left with at the least, questions, or at the worst certainty, that our children’s adoptions were either outright corrupt or tainted by a very corrupt system.  But many of us have a love for Vietnam, and the children of Vietnam… and we want a Vietnamese sibling for our child/ren. 

And the question asked is, is it wise to adopt from Vietnam if/when it reopens.  The short answer is no.

The long answer asks more questions.

What is your measure of wisdom?  By wisdom do you mean that you will be able to know beyond a shadow of a doubt that your adoption was not tainted by corruption?  Do you mean, will the same thing happen again?  By wise, do you mean is it the best way to look at becoming parents?  What level of doubt are you willing to live with? 

Is it ethical?

The answer to that is still up in the air.  I do believe that there were ethical adoptions happening in Vietnam at the time of my son’s adoption.  I believe that those adoptions were the rarity, and that there were many measures taken to ensure that they were ethical.  Measures that most of us did not have as options (because of the agencies that we chose to use).

I think adoptions will reopen in Vietnam.  I think that ethical adoptions will happen in Vietnam.  I think that they will be few and far between, because here is what I think potential adoptive parents need to do in order for ethical adoptions to take place (I am not even touching on the systemic/governmental changes that I think need to take place):

• You need to use an agency that processed adoptions during the last opening, do not use an agency that has Vietnam as a program for the first time. 
• Use an agency who has a long tack record in Vietnam, not only of adoptions but of humanitarian work, and by long I mean 30 years or more of CONTINUED work in Vietnam.
• Use an agency who is commited to finding ways to keep Vietnamese families together and believes that adoption should be a last option for children.(and has a track record of such work).
• Ask for a child who has been in an orphanage/foster care for a long time, whose parental rights were terminated a long time ago.

I think that if you follow all of those recommendations you will find that there are less than a handful of agencies that could have accommodated those qualifications.  Less than a handful.  Out of over 40 licensed to do adoptions in Vietnam the last time.

Do I think that people shouldn’t adopt from Vietnam if it reopens?  I think there is a LOT that still needs to be determined.  I think if you want to provide a home for a child who you can be sure needs one, there are MANY other options that would leave you with less doubt and questions.  Having said ALL that, I am still waiting for Vietnam to reopen.

- guest post by Jena

For those of you who read my previous post and its comments, I just wanted to take a minute to reply.  Btw, I know blog traffic slows a little over the weekend, but check back for a giveaway!

ATL - please don’t apologize. Your comment did not offend me at all and I deeply appreciate your honesty. Your perspective is unique from mine and most of my readers, and I am glad you shared it.

Tahna also presented some really valid points.  Unfortunately, I wonder if the anger in her tone might prevent her message from being heard as clearly.  I politely disagree with her statement that we all have a Pollyanna view of Vietnam over here, nor do I think most of us are as naive as she’s assuming.  If I learned anything through adopting my boys from Vietnam’s corrupt system, it’s that there are people at the bottom willing to lie, cheat, steal, and exploit to make it higher up.  It’s survival, and much of that holds true anywhere there is suffering and poverty.  There are plenty of people willing to lie, cheat, steal, and take advantage of anyone who’ll let them right here in the USA too.  It’s not unique to Vietnam or anywhere else, unfortunately, but I do think it might be more overt there because there is such an underdeveloped legal system.  There are many other developing countries like that.  I certainly never said all Vietnamese were good and honest, but I would also never say that about any group of people. 

Also, it was not long ago that THIS country was murdering natives, stealing their land, hanging Black men, putting Japanese in camps, or telling women their voices didn’t matter and they couldn’t vote.  It was also quite recent that Germany was exterminating Jews, the disabled, the weak.  I think it is common for people to form very broad, negative, generalizing opinions of countries or peoples when they lived through (and at the other end of) atrocities like those, or wars like in Vietnam.  I am not trying to discount Tahna’s perspective, or the perspective of the veteran I wrote about yesterday, I am just trying to say that it is different from my more limited experience with the Vietnam of the last 10-15 years.

Tahna is also right that we, AP’s, do our best to expose our kids to the culture / country they lost, however best we can, but no matter how hard we try, we fall short.  For some of us, those efforts mean cooking the limited Vietnamese recipes we are able to master.  For others, it means returning to Vietnam as often as possible, living there for a period of time with our kids, or hiring a Vietnamese tutor, sending our kids to Heritage Camp, attending a Vietnamese church, celebrating Tet, etc. We do our best, but you are right - since we are not Vietnamese, our kids’ exposure to their birth culture is limited.  Travis and I will never be more than travelers through or temporary residents of Vietnam, volunteers, parents to Vietnamese-American children, and perhaps doctors who work in Vietnam (if we ever get out of medical school debt).  But our goal is to provide our kids with enough of their own experiences in Vietnam that they can grow up and draw their own conclusions, having seen it through their own eyes.  Obviously, it might look very different to them had they been raised there, but it’s the best we, as their parents, can do.

My posts are always up for respectful discussion and I enjoy learning from the peoples’ comments, so thank you for the courteous dialogue.  Feel free to comment, just try to refrain from personal attacks and remember we’re all people doing the best we can. 

I love the VA.  Lots of people hate working there…actually, I think most people do.  But each week I look forward to my time at the VASpa, where I listen to war stories, talk to service people, and help them heal (more by just listening to them recount memories and have someone to share those with than by anything else I’m ever able to do for them). 

Today I spent time with a vet who served in Vietnam as a special ops assassin.  Without violating HIPAA, I’ll just say he’s written books based on his experiences and he shared fascinating stories with me.  I can’t even believe half the stuff my ears were hearing, but I know this guy was not confabulating.  As I carefully examined the skin on his scalp, he was telling me about leaders he had to hunt during a particular operation when Vietnam soldiers crossed the Cambodian border.  My hands made their way across his cheeks, looking for any change in the texture of his skin, as he told me about soldiers crawling through the tunnels, getting bitten by cobras on the nape of the neck because the Viet Cong hung them from the ceilings of the tunnels.  It reminded me of our trip to the Tunnels of Cu Chi the 1st time we traveled to SE Asia (2002).  My Lord were we young.

[Tunnels of Cu Chi, 2002]

That was when Travis and I had our eyes opened to the atrocities of war, on both ends.  We visited the “American War Crimes Museum,” the name of which has been changed to be less offensive to tourists, and I remember sobbing on a park bench while Travis held me for HOURS after we left that museum, where we saw the effects of Agent Orange – fetuses in jars and pictures of the most horrifically malformed babies.

As I examined the skin on my patient’s chest, he explained away several entrance / exit wounds made by shrapnel and bullets.  He then told me about small minority groups, hated by the Northern Vietnamese, that he trained, fought with, loved, and tried to airlift, but many were killed after the US troops were evacuated. 

Most of all, we talked about my boys when I told him they were from Vietnam, which led him back to some memories of an orphanage he and his men looked after.  His special ops team was able to get some of the children out (to Western Cambodia and Eastern Thailand through rice paddies and over land BY FOOT), but when the US started pulling out and it was clear the war was over, the remaining children were killed by the Northern Vietnamese.  Hearing that reminded me of Hoi An Orphanage, where Travis and I volunteered in 2002 and were first inspired to adopt, and where we volunteered again while waiting for Shanie’s adoption to be approved.  It’s an orphanage with a large number of special needs kids.  I imagine many of the kids my patient’s team was no able to save were kids with special needs, or infants, because they could not make the rigorous overland trip.

[Hoi An Orphanage, 2002]

It’s SO hard to hear these stories, and the comments that often follow (he made several comments thanking God I got my boys out of there), but I can’t even imagine living through what this man survived.  It hurts me to hear anyone say things like “thank God you saved those children from the hell of a country they came from.”  Those who know me are aware that we adopted our children after falling in love with their birth country, and that adoption (of infants!) to us is not about saving children; it’s about building a family.  But hearing that from a veteran like this man is not quite the same as hearing it from an ignorant moron off the street.  The Vietnam he knows is VERY different from the Vietnam we have been fortunate to know.  It still cuts me, and I’m always floored to meet people who still don’t see the Vietnam War as “our country’s mistake,” with the awful tragedy on both ends that resulted.  I can’t articulate why it was different or less offensive to hear what I’d consider fighting words if they’d come out of anyone else’s mouth, but I didn’t resent him at all after he said it.  I just felt really really bad for him.  I thanked him, sincerely, for his service, he thanked me for mine, and we shook hands long and hard.  It was another encounter that challenged my emotions, my mind, and left me thinking, long after we’d parted ways.  And that is yet another reason I love medicine: the intimate, but challenging human encounters only a doctor-patient relationship can provide.

I’m talking about birth order again, btw!  **As an aside, we are NOT planning to add children to our family at this juncture, I’m only answering this as a hypothetical adoption question!**  Christina asked if I would ever adopt a child out of birth order.  For those of you who aren’t familiar with adoption talk, an example would be if we adopted a child older than Jack, Shane, or Finley so that all of the sudden their relative “order” in the family was disrupted.

I wanted to write about this since I just posted about how important I think birth order, temperament, and sibling relationships are in the development of our self-esteems, identities, roles, and personalities.  My answer is that I would most definitely NOT consider adopting out of birth order.  I can’t imagine anything more confusing for a child being deposed of his “place” in the family, whether it’s going from being an only child to a 2nd child, or a 3rd to a 4th.  It’s not that I think it would be impossible for healthy, well-adjusted, normal kids to come out of a situation like that, I just think it creates a LOT of additional challenges. 

Adding more children to a family can be really stressful for kids in a “traditional” family, and the mom guilt can be horrendous.  Compound that with the likelihood that if you’re adopting out of order, that pretty much implies you’re adopting an “older child.”  [I guess the only exception would be if you have an infant and you are adopting a child only slightly older in age.  I’d consider that more of “virtual twinning,” which would have been our case if Shane’s adoption had been delayed and we’d delivered Finley before bringing him home.  Still a challenge, but not the same as having a child out of the infant range and then adopting an older sibling for him/her.]  So by adopting out of birth order, you would 1) be throwing off the relationships and identities built based on age/birth order, and 2) have the added hurdles of helping an older adopted child adjust, which is H-A-R-D on its own. 

As a hypothetical example, if we had adopted an older sibling for Jack, he would have still gone through the stress of no longer being our only child, and I would experience all the mom guilt that goes with that, but instead of having a smaller, less capable baby for him to help with and from whom he could perhaps derive a modicum of positive self-esteem, there’d be an older child in the home who would bring with him (assume it’d be a brother for simplicity) all the exposures he had in the orphanage.  The good, bad, ugly.  And orphanages are often pretty tough places for a little kid to spend his early years – lots of bullying, sometimes abuse, and survival strategies.  At a very minimum, that child has not been raised with our values or teachings.  We have done our best to protect Jack from bullying so that he can have a fresh start at a strong, healthy, developed, positive self-image.  So on the one hand, I’d be fretting about my newest child who has experienced extra time living in an institution and trying to figure out how to ease his adjustment, and on the other, I’d be worrying like hell about my baby boy who might end up suffering from 2nd hand abuse AND the normal neglect that happens when you add another child of any age into your family. 

Phew, I got tense and stressed out just thinking about that hypothetical!

That’s just my 2 cents.  Take it for what it’s worth.  I’ve seen some pretty effed up situations result from jacking up the birth order, but there are some families that turn out fine too.  It’s not right for my family, but a lot of people would say the same thing about adding 2 kids, almost simultaneously, 12-14 months after adopting your first child…which is what we did.  To each his own, but to answer Christina’s question with regards to our family, that would be a no.  Thoughts and comments are welcome here.  If your family was built “out of order,” please don’t be afraid to share your experience.  I always come off as far more opinionated than I actually am…or maybe sometimes I am really that opinionated, but lately I’m finding myself feeling less and less like I know enough to be strongly opinionated about anything.  Motherhood is humbling like that;)

First, THANK YOU guys, that was such helpful input on the School Age and Montessori posts.  Clearly I had no idea how to even spell Montessori (I spelled it Montessouri a bunch and couldn’t figure out why spell check wouldn’t get off my ass;)…or kool-aid, for that matter (it’s really not coolaid?!).  There were also so many insightful comments on the School Age post from people who have been there, done that as parents of grown kids and/or teachers, as well as people like us who are currently debating this very issue.  We are strongly leaning towards delaying Jack, but we’ll see how this year goes and try to keep an open mind about things.  I loved what 1 commenter said about gifted kids - they don’t get bored, they just find different ways / levels on which to enjoy the same activities.  I can see that in Jack, and I think the right school could bring that out in him, even if he was in preschool twice.  Also, I know every kid is different, and there are some very mature 17 year olds and some very immature 19 year olds, but my point is more that the same kid might make wiser decisions at 19 years old than he would have at 17 years old.  Someone else also reiterated my thought that all the brains in the world cannot compensate for emotional and social immaturity, and I think a child will get a lot more educationally if they are secure in those other areas.  As Kristina suggested, "fine in the classroom, miserable on the playground" is such a bummer way to spend kindergarten and possible beyond and his social development and emotional growth is every bit as important to me as his academic advancement; I just don’t ever want Jack to feel uncomfortable in social settings..  So we’ll see I guess, but we’re going in very open to delaying Jack’s entry into kindergarten. 

My new education question / topic is the issue of age mixing in the classroom.  You know, the programs that do the 3’s and 4’s combined, or even 2-4 combined?  I know lots of Montessori’s do this, but so do many many other schools.  What have peoples’ experiences been with this?  Personally, I have watched a few friends deal with issues related to a mixed age classroom recently and I’m terrified of it, especially for a kid like Jack.  Consider these 2 scenarios (both happened to IRL friends):

1)  Small Montessori program with 2-4’s together.  One student is 2.5, does great in the class, and her mom tells me the older kids in the room are extremely tolerant and helpful with the younger kids.  It fosters a great social dynamic where older kids help lead the way for younger ones, etc.  The 2.5 year old’s mom then admits the class is almost entirely female (I think there were 1 or 2 boys, both younger and very mellow) and that if there had been a rambunctious boy or 2 in her daughter’s class (she glances at Jack while she says this) the dynamic would’ve been TOTALLY different.  NOTE: I recently spoke to my neighbor and apparently things changed since I wrote this a few months ago.  Her daughter will start at a new school since the dynamic in this mixed-age classroom did change and the age difference became an issue.

2)  ECE program that mixes 2-4’s.  One little guy turned was just barely old enough to make the cut and is a rowdy boy like Jack (and very bright).  That little guy gravitated towards the oldest kid in the classroom who turned 4 exactly at the cut-off and is also a very rambunctious boy with some, um, aggressive / bullying tendencies on top of his high energy.  The teachers have a challenging situation to diffuse because the older boy is the leader of the younger boys, who are eager to follow the oldest boy’s lead.  The older boy watches older boy TV, plays older boy games, belittles younger boys who want to spend time in the dress-up station, etc.  I think her son does derive a lot of positive things from that friendship, but I can’t help but wonder how that would have played out for Jack.  And for Jack, I don’t think anything positive could have come out of that relationship (Jack and my friend’s son are very different kids). 

I don’t see any potential benefit to Jack of being in a mixed age classroom.  I am terrified of the dynamic in scenario 2 because I think it’s natural for the older kids to lead, and there’s such a huge difference, emotionally and socially, at these ages between kids just 1 year apart.  I can see Jack gravitating towards the bullyish kid and 1 of 2 things happening: 1) taking on those bullying qualities and exaggerating behaviors and tendencies we’re really trying to downplay in Jack (this outcome would especially be awful for his little brother and sister!), or 2) having a very damaged self-esteem as a result of that dynamic.  I can see the potential benefits of mixing ages for a kid like Shane - he is so social, so gentle, loves learning from his peers, and I don’t worry at all about him becoming a bully when he’s the oldest kid in the class (although I do worry about him getting crowded out and lost, but that’d be the case with any school and is exactly why I will not consider daycare or anything like that for him). 

I have to preempt this with my/Trav’s parenting philosophy because I know a few of you might be inclined to say "kids will be kids and they need to figure out how to work those things out."  I think that is true to a large degree when our kids are in middle school or high school.  At those ages I think we, as parents, need to have given our kids the tools necessary to ward off bullies, racism, and any other negativity they might encounter, while still being very involved in their day-to-day lives to continue talking them through those encounters.  But while they’re still little, I think equipping them with strong senses of self by creating environments in which they can build healthy, positive self-esteems is the best set of tools we can give our kids to carry through life.  3, 4, or 5 year olds still needs parents protecting them and they are WAY to young to deal with assaults on their self-esteems at that age.  There are things, like racism, that are my job to prepare my child for as well, and we take that very seriously.  I will not always be there to protect him from slurs or the racism he may experience growing up or as an adult.  But again, I believe it is my job to PREPARE AND PROTECT while he is a baby, and to me, a 3 year old is very much still a baby.  This brings me to my next controversial blog post, which I’ll hopefully be writing about soon…my review of Parenting with Love and Logic, the book and the parenting philosophy.  I’m almost done with the book, and while some of it is very smart parenting, there are things about the philosophy I find horrifying.  Plus, if you’re in the adoption community and have the misfortune of understanding RAD, you might recognize one of the authors (Foster Cline) for his very controversial therapy techniques and attachment center here in Colorado.  More on that later though. 

Back to the mixed-age classroom topic…I know it all depends on particular classroom dynamics, but what have your experiences been with age mixing?  Does anyone share my fears? 

Here’s a quick video of my kid’s future as a graffiti artist.  We have about 20 letter H’s, a few squares, and a T or 2, “decorating” the exterior of our home.  At least it’s chalk and it washes off easily.  No time to sweat the small stuff, but I do draw the proverbial line on our house’s interior walls!