.comment-link {margin-left:.6em;}

So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

My Photo
Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Wednesday, February 28, 2007

Reality check

So folks are insane if they adopt a child, especially an older Eastern European child?

Well, maybe.

Our local adoption agency stresses the need for appraising attachment issues realistically. They've told us about the good adoptions, the bad adoptions, and the ugly adoptions.

I've been reading my way through "Attaching in Adoption" by Deborah Gray. She covers about everything that could go wrong in her book, along with coping skills to overcome them.

My wife stopped reading the book. "It's like being pregnant and reading about every possible birth defect there is. I can't take it." I'll be doing the reading for now.

The interesting thing is that even in high risk situations, eg. adoption out of a marginal background, poorly run orphanages, etc, that only about 30% of the children go on to develop Reactive Attachment Disorder. That means that 70% don't. You see where I'm going with this?

As we check around our town, that seems to be a rough approximation for the local experience. We hear about the "nightmares", and for every nightmare there are two where the families/children couldn't be happier.

Love is not enough. Let's see, we've had experiences in our family with severe learning disabilities, severe childhood trauma, marital discord, mid-life crisis issues, poverty, etc. Things have worked out in spite of all of that. I like languages (although I'm not sure about Russian), and we know lots of Ukrainians for support. I get a quick language lesson at least three times a week, and I know how to get hold of the Russian cartoon network, though I probably won't let her watch it unless she gets severely homesick.

I only speak for myself. I've gone about the last 8 years (the beginning of the first lawsuit) until now feeling sorry for my sad plight and wanting to avoid all psychic pain, maybe pain altogether (an exception made for biking). I've also felt a little less than totally alive during that time. This is something I'm called to do, and not just for the adopted. My whole family will need more of me. I think that's a good thing.

One of my favorite quotes if from Mother Theresa: "We cannot do great things, only small things with great love". I modify it for me: "I can't even do small things with great love. I can do small things with just a tiny bit of love, and the Lord, who feed the five thousand with a few fish and a couple of loaves of bread, can do the rest."

And if it ends up being a disaster, at least we will have tried.

Friday, February 23, 2007

Dear congressperson

I'll be up front with you. I neither like nor respect you at all. You beat out one of hardest working, most competent congresspersonages this last election, based on you personal wealth and name recognition. Too bad for the district, I say.

Nonetheless I'm sucking up to you to give us doctors a break. I don't know how I distrust more, the Republicans with their glib talk of improving health care access while they cut the budget for Medicare and the VA hospitals, or the Democrats with their glib talk of improving health care access while they do their best to criminalize the practice of medicine.

Anyway, I appreciate all the lip service everyone is making for colorectal cancer screening. I think folks get a little carried away with it - I was recently referred a 91 year old gentleman for screening - but generally speaking the yield is high enough to make it worthwhile.

However, in order to balance the books, the reimbursement for colonoscopy has been in a free-fall over the past 15 years. I'm now getting 25-30% of what I received for this procedure in 1991, and this is not adjusting for inflation. The reimbursements for 2007 look even worse. The private carriers base our reimbursements on Medicare, so every time you folks lower the reimbursements, they do too. Except for (would I get in trouble for mentioning the company's name?), who now is reimbursing me for less than Medicare does.

A recent article in the NEJM demonstrated that when colonoscopists are in a hurry, they miss stuff. A lot. It has always been a temptation for docs to turn their practice into an assembly-line. Now I think it will be inevitable.

This is not an issue of me not being able to afford that beach house or making my Porsche payments. I'm having trouble making payroll right now, between taxes (I appreciate your pledge to raise taxes as one of your campaign promises. The voters in this district must have lost their minds on Election Day), health insurance which paradoxically has become almost prohibitively expensive, malpractice insurance, and employees who expect merit and longevity raises right on schedule in spite of the fact that it's getting tougher for me to make a living. Plus, I had to update my phones, my computer software, my computer memory, and replace my fax machine that died a violent and painful death about two weeks ago.

I'm reexamining the way I practice medicine right now. I've prided myself in taking time with my patients right up to the present. If I can make a living, or if I could do better selling Amway or something, I'll have to do what's necessary. Right now I'm working for the health insurance.

By the way, if you and/or Hillary and/or Obama want to nationalize health care, now would be a pretty good time to do it. I feel less than no sympathy or loyalty for the health insurance industry. They can all go to blazes.

Anyway, I worked in the military during the 80's and have a good idea how health care rationing works. I can get used to it again if I have to. Just let me make a living at it. I'm getting too old to be retrained.

Yours truly,

Monday, February 19, 2007

Orphan role models

Here are the roles models that I think all orphans should follow:

  1. Anne of Green Gables. Bright, beautiful and personable, Anne is a wonderful model for orphans everywhere. Orphaned as a result of the tragic deaths of her missionary parents, she is adopted by good-hearted but basically clueless spinsters, who raise her as if she were their own flesh and blood. In gratitude for their sacrifice, she leads an exemplary live and lives happily ever after.
  2. Jane Eyre. She might be the greatest orphan ever. Orphaned because of the sad deaths of poor but noble parents, she is taken in by an aunt who despises her. She is abandoned to an evil church orphanage, where, in spite of harsh conditions, she becomes fluent in French and learns how to paint. She becomes a governess for a wealthy but troubled Master, who falls in love with her. She becomes the means of his redemption.
  3. And of course, Little Orphan Annie. No matter how bleak today is, she always has "Tomorrow" on her lips.

We are reading a book about RAD, or reactive attachment disorder. It seems likely that orphans in reality are more like this:

  1. George, age 5. He hugs and kisses everyone he meets, but when he is taken home by his parents, becomes sullen and distant. "We feel like he is always interviewing other families for our job", one of the parents said.
  2. Nicole, age 8. She'll enjoy cuddling with one her parents for twenty minutes, and then, as the parent is kissing her good night, says "I wish Aunt Mary would have adopted me instead of you".
  3. Harry, age 10. He views his adopted home as a "very well-stocked orphanage" and says that his adoptive parents are fine, but if he really loved them he would be disloyal to his biological mother, who he really never knew.

I must say that as we progress through this book, we wonder if we're spending a lot of time, effort, and money to import a psychopath. If only I could be guaranteed of Jane or Anne.

Sunday, February 11, 2007

A good stoker is hard to find

A few months ago my wife and I bought a tandem bicycle. As we work together (she's my office nurse) and live together, I figured we could spend every waking hour together, riding our bike off to marital bliss.

For married couples, tandems either are wonderful or evil, depending on skill of riders, temperment, control issues, and so forth. We happen to get along great together, I as the captain and my wife as the stoker, the person who sits on the back seat, peddles obediently, and, other than yelling at or cajoling the captain, has absolutely no control over where the bike is going.

It's a good arrangement if you ask me. I love doing it. And it means at least one person on the road is not going to pass me.

It's been an emotional weekend, to say the least. We went to a major fund-raiser for Ukrainian orphanages last night, of some interest to us as we are attempting to adopt out of one of the orphanages this group ministers to.

Have I mentioned yet that the Russian language is a pain in the patoosh? I'm working through Rosetta Stone. It's not their fault that Russian is so inscrutable.

Anyway we chatted with folks who have seen our adoptee and it was encouraging. "She is just the sweetest girl. We gave her extra hugs for you."

We also watched a video of what happens to these kids when they reach 17. It's on the streets for them. Girls are often involved in sex-trafficking in one form or another.

We can't save the world, but we can give one of these kids a chance. Yana (it's either that or Anya. We haven't figured out how she spells it. I hope to find out soon) will get a chance, if heartless bureaucracies don't tank the effort.

We received a digital photo album of the orphanages last night, and we poured through them looking to see if we could identify this little girl. We did. The kids get access to hot water once or twice a week, in the winter no one washes their hair, so everyone looked a bit disheveled, and most of the girls' hair was dirty looking. Yana/Anya had also hit a growth spurt and had shot up about half a head. She looked quite a bit older than pictures of her just three months ago had looked.

My wife was a bit shocked, as she was hoping to have bonding time before the onset of puberty. It also occurred to her that this undertaking was no longer some cool abstraction. It is now our responsibility to take a street urchin and raise her as our own.

Times like these, I'm glad I have a Y chromosome, along with all the rights and privileges that come along with it. While my wife is mourning a bit about losing some of this girl's growth, I'm rejoicing on how, now that she is getting bigger, I won't have to worry about converting the stoker seat on the tandem for a child.

I can't think of a better way to show off our great country, plus get a little exercise in the process. I'll worry about harsh reality, including my Russian studies, later.

Monday, February 05, 2007

On the cutting edge

We passed one of the major hurdles in the international adoption process last Thursday: the home study visit. Keeping details to a minimum for now (office starts in 5 minutes), the home study people, who have gotten to know you extremely well from all the paperwork and interviews that they have done up to that point, spends a minimum of three hours in your home. Their mission is to make sure that you are a suitable family, that you have the means and resources to take care of a new child, and that you're not a pedophile or some other low life. We think it's a very good program. We also think that if we had to provide the documentation for one of your "natural" children, the human race would die off after two generations.

There are some "hot buttons" in the home study process. One of the biggest is the question of firearm ownership. The home study agency doesn't want little kids getting into the family armory and raising havoc with themselves and others. Ideally, you should not own a gun, but if you do, it should be kept under lock and key, preferably in a safe, preferably at the gun club. We were questioned about it several times, and, no, we don't own guns. I get nervous with my son's paintball gun in the garage.

We take the home studier around our house. We show her my son's house, which is astonishingly clean. She nods in approval as she leaves the room. My son is turning very pale.

He had layed out, very neatly, on his dresser, his knife collection, some ten or twelve knives, ranging anywhere from a scrimshaw pocket knife to this huge machete that his brother-in-law had brought back from Guatemala. There was enough cutlery to slice and dice everyone in the neighborhood without having to use the same knife twice.

Only guns kill people, I guess. It certainly didn't bother the home study people.

Our paperwork now goes to the CIS/INS. We hope to hear from them in six weeks.