Creating an Intended Family

Earlier this month I had the honor of speaking at the local Resolve seminar, a day for people who have been challenged in their family building journey to educate themselves about the various options. I was speaking as a patient and not an ob/gyn physician, although my experiences helping create families via non-traditional options certainly had an impact on my presentation. For those of you who may be new to my blog, a bit of background. I started writing because of my personal experience with non-traditional families as well as my work as an ob/gyn physician both in the US and abroad. My immediate family is comprised both of biological and adopted children. My extended family involves three children who were created thru my egg donation to a friend. All of these children are now young adults, ages 19-29, and we recently had the pleasure of adding our first in-law when my son was married.

Walking into the Resolve conference brought back numerous memories from my brief time as a patient in the infertility world. Countless pieces remain unchanged… the injections, uncertainty, invasion of personal space both physically and mentally to name just a few. However, much has changed with improved technology. No longer do you need to find a friend/sister if you are in need of an egg donor, as technology has advanced to allow for the freezing of both eggs and embryos (fertilized eggs). Young women can donate their eggs just as men have been able to donate sperm. Surrogates or gestational carriers are available if a couple is in need of a person to carry their pregnancy.

I was asked to speak not only about my experience as a known donor, but more importantly about the experience of an “open” donation where all of the children were aware of their biologic relationships. Traditionally the majority of couples that have used either egg or sperm donation to create a child have kept that part of the infertility journey secret from their child and family. Research has shown that open adoption, or the knowledge from an early age about how you became part of your forever family, allows for development of better self confidence and identity. Due to the advent of genetic testing thru such services as 23andme, it is believed that anonymous sperm and egg donations will soon be a thing of the past.

Eight children connected thru both nature and nurture has had few drawbacks in our families. Our agreement early on in this process was that any children created thru the donation of my eggs would be made aware of their origins, as would children that were raised by my husband and myself. My husband and I chose to tell the story to our children individually around age 10 at a time when they could understand the biology involved. Our families had remained friends and it was often uncanny to see the close relationships between the children despite only seeing each other every 1-2 years.

As I spoke, I realized one of the most important lessons I have learned during this journey. Although there were four adults involved in the decisions that were made to create our “intended families”, our children are required to navigate the family bonds and stories behind their origins. These stories involve loss of biologic parents and culture in international adoption, living in a multi-racial family that often draws unwanted attention and vying for parental attention and resources as a triplet. It is not my story to tell any longer as these children are the individuals that will write the remainder of the book as they live their lives.

 

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Love Them First: How to Make A Difference

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My Love Them First post last week compared the community around two schools – one in North Minneapolis and one in rural Minnesota. Kate O’Reilly from Minneapolis took the Star Tribune article about Worthington to heart and started a Go Fund Me campaign to provide assistance to immigrant students with both monetary funds and a coat drive. It was featured in the local Worthington paper and has raised just over $10,000 already. Funds are to be donated to the Immigrant Law Center of Minnesota in Worthington as well as the Nobles Country Integrative Collaborative, a consortium of school districts promoting community acceptance of cultural differences.

The rural-urban divide has become a catch phrase to describe political differences, economic disparities and racial animosity. This is a wonderful opportunity to show rural Minnesota that we not only understand the burdens that immigrants can have on schools, but also show our support and offer encouragement by demonstrating how immigrants have improved our urban areas. I grew up in rural Minnesota and have lived in urban areas since my early 20’s. I understand the divide but am hopeful that situations such as this will generate more bridges than partitions. Please consider donating so that immigrant students are given the resources to be successful … and we can start to heal a fractured society.

Love Them First: 2 schools, 2 different responses

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Two news articles, albeit from different ends of the spectrum, caught my attention last week. The first article described the conflict in Worthington, MN created by immigrants and unaccompanied minors from Central America. The second article described the impact that teachers and a principal in a North Mpls school working together to help their students succeed. Both touched me in different ways; I grew up 30 miles from Worthington and my current job involves taking care of families that live in North Mpls.

As an obstetrician, taking care of pregnant women is part of my job. However, my job doesn’t end once a child is born. Raising a child is much more difficult than a 9 month pregnancy and a journey that requires medical and emotional support. Keeping a mom healthy via preventative health care, providing information on birth control options and screening for mental health problems are all part of what I do as a gynecologist. Healthy moms who feel connected to their community give a young child the best chance of success in life. For these reasons, I also volunteer at an elementary school that has a large percentage of children that qualify for free/reduced meals. These children are often in need of extra help with encouragement, tutoring, mentors and guidance.

If you want an inside view of the struggles that many of these children face, “Love Them First” is an inspiring documentary about an underperforming school in Minneapolis where not only the teachers but the entire school staff is committed to lifting up their students. It also opened my eyes to more of the inequities and injustices that my patients and their children face every day as a person of color. For the month of October, this movie will be streaming for free on the Kare 11 webpage. Make sure a box of kleenex is close to you while you watch.

The article about Worthington is how individuals can choose to close their minds and hearts to the struggle of children in need. Many of the townspeople are upset about the change in demographics as recent immigrants from 80 different countries comprise 1/3 of the population. This has put a strain on the schools, not only in increasing numbers of students but also in the need for language and tutoring services. The immigrants have  traveled to this town on the wind swept prairie for a good reason – the draw of jobs at meat packing plants that require minimal education or training. Jobs that local residents do not want and would otherwise be unfilled. The tax base of this busy food industry fills the coffers of many small towns while the immigrant work force opens ethnic grocery stores and restaurants to further improve the health of rural communities.

Rather than refusing to greet these students as they board the bus, as described by one farmer turned bus driver, or organizing a community to vote down a school referendum, the residents of Worthington could live out their Christian faith by seeing  immigrants as a means to authenticate the message of Jesus. Love Them First as the staff of Lucy Laney in Mpls has chosen to do. Volunteer in the school as a tutor so that when that child graduates from high school, they feel the support of the local community and choose to live and work where they have friends and family.  See immigrants as opportunity, not a burden.

 

Why Gratitude can be difficult for Immigrants and International Adoptees

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Rep Ilhan Omar has recently been criticized for her lack of gratitude to America, a country that took in her parents as they were fleeing war-torn Somalia. The reasoning is that she should not criticize America because this country “saved” her family and provided her with the educational tools to become a legislator.  Further, Rep Omar should be more humble and refrain from criticizing the injustices that she sees in our country as well as our policies abroad, especially when it concerns Israel.

These criticisms have brought back memories of similar conversations that I have heard in international adoption circles. Some adult adoptees have coined the term “toxic gratitude”.  International adoptees are expected to be grateful to their adoptive parents as well as the US for saving them from a life in their birth country.  How can you be grateful for losing not only your birth family but also a birth culture, growing up in a country as a minority rather than the majority? Gratitude implies choice. Adoptees don’t have a choice in their circumstances, in the family or countries that become their forever home. They should not be burdened with the additional weight of gratitude.

Similarly,  immigrants often don’t have choices. If their home country was stable they wouldn’t be looking for a different country to call home. They wouldn’t be leaving a language, culture, food and family to relocate to a place where all of these items present new and difficult challenges. When they arrive in America, they are expected to embrace all that is America without hesitation or criticism. How dare immigrants be ungrateful for the material wealth and opportunities that America can provide.

A recent patient shared her immigration story from an African country with me when she was discussing her post partum low mood. If she had had her baby back in Africa, she would be surrounded by friends and relatives that dropped by daily to visit, often without calling first. Food would be prepared for her and household duties completed. She moved to this country years ago to provide a better future for her children. Now she is questioning that decision, as the lack of community in this country seems too large a price to pay. Would we call this ungrateful or constructive criticism of our culture?

Many adult women in the Somali culture have undergone female circumcision prior to their arrival in this country. Western terminology used to describe this practice include mutilation, illegal, abhorrent and disfiguring. Should Somali women now be grateful that they have escaped this practice for their daughters, only to be raising their daughters in a culture that accepts breast implants and labiaplasty?

Many medical professionals that immigrate to America do not have financial resources to commit to redoing their education in this country. I have worked with many medical interpreters who were esteemed physicians in their home country. Are they to be grateful that their years of medical training and language skills only allow them to explain medical visits to more recent immigrants?

When there is dysfunction within a family, often it takes an outsider to provide better insight and allow each of us to examine what we value in our relationships. Immigrants have the ability to bring the best ideals from their countries and mix with the best traditions from America. We are and have always been a country of immigrants. We should allow immigrants to be a reflection of what is best in this country and acknowledge that we are not perfect but can strive to do better. I am grateful that I have the opportunity to learn from them and share their stories.

Vagina: The Original Self-Cleaning Oven

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I often use the phrase “self-cleaning oven” when discussing vaginal hygiene practices with my patients. This refers to the fact that the vagina takes care of itself and the use of outside products often cause more problems than benefits. The vagina contains millions of bacteria, most of which are beneficial, just as the bacteria in the intestine. Disrupting the balance of the micro flora by outside products (antibiotics and douching) allows for the overgrowth of yeast and other bacteria that can cause bothersome discharge and irritation. My colleagues and I recently compiled a list of objects that we have seen women place in their vagina that we would not recommend.

  1. A “Lost” tampon – Tampons themselves are perfectly fine, but when they become lost it means you forgot to remove it and the vaginal bacteria are loving their new friend as they multiple in huge numbers trying to remove the offending object. The result is a foul smelling discharge that doesn’t abate until the tampon is found and removed. No further antibiotic treatment needed. Realize the term “lost” is not appropriate, as the vagina is a blind ending tube with sperm being the only object capable of going any farther.
  2. Vegetables. Although not recommended, these are used as inexpensive and easily available sex toys. I will never forget the reeking smell of cucumbers when I was called to the Emergency Room to remove a partially shredded cucumber from the vagina of a very embarrassed young woman. Even if they are removed intact, vegetables are porous objects that can leave behind bacteria that do not belong in a warm and moist environment. And garlic, although technically not a vegetable, just becomes more funky smelling.
  3. Women love to use dress up their fingernails with fake nails, but these can become a problem when you are trying to remove #1. Luckily the bright painted colors are easy to locate when your gynecologist looks with a speculum.
  4.  The natural probiotic properties of yogurt have headlined numerous health articles recently. This does not mean that those probiotics are beneficial to vaginal flora. Trying to get the yogurt from the refrigerator container into your vagina seems like an ill-fated adventure that only ends with the yogurt quickly making an exit and creating a odoriferous mess. Be content with eating the yogurt for breakfast.
  5. Topical skin products. One of my patients noted that since aloe lotion or the plant was beneficial in providing relief to a sunburn, inserting a branch of an aloe houseplant into the vagina would be a quick all-around fix for the vaginal irritation that she was experiencing. Another patient tried a gentle douche with tee-tree oil. Once these patients arrive in the office, it is impossible to determine if the vaginal irritation is due to an underlying infection or to the inappropriate product that was used.
  6. Christmas ornaments, especially the glass kind. With even gentle force, they can easily shatter in a million pieces. You may never celebrate the holiday again if you associate the holiday with an ER visit.
  7. Although you phone can be set to vibrate rather than ring, it should not be used as a vibrator.
  8. Pencils and pens. The ends are sharp and can cause abrasions and trauma, as well as small parts that break off. Keep their function to writing instruments.
  9. Panti-liners. Although I have never found anyone who has mistakenly stuffed these in her vagina, I do have many patients that think the daily use of liners is cleaner than just underwear. The opposite is true as a liner holds moisture next to the perineum and allows for overgrowth of some of those millions of bacteria as well as serving as a highway for bacteria to travel from the rectal area to the urethra, increasing the risk of a bladder infection.
  10. Vaginal Steaming and Jade Eggs. The completely falsified claims of both of these expensive practices have been pushed by Gwyneth Paltrow to financially benefit herself. Not only will they not do what she purports (spiritual detox and balance female hormones etc), but your cash balance will be significantly lower.

The good news is that the healthiest treatment for your vagina is…..NOTHING.

 

Not in my Backyard

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Summer is here, a time when many churches send their youth on mission trips both in the US and abroad. My family is sharing in this experience as my husband and youngest daughter leave in a few weeks to travel to an under-served area in the Midwest. Many youth that travel outside of the US visit areas south of our border in Mexico and Central America. Days are spent painting, teaching arts and crafts to young kids and sleeping on the floor while sharing a single shower at the end of a long hall. Camaraderie between youth group members is built, selfies with cute kids are shared with friends back home, and youth hopefully learn to be more appreciative for the lifestyle that they enjoy. Upon returning home, testimonies are relayed about the difference a smile or a helping hand can make in the life of an impoverished child.

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Unfortunately, when those same citizens of Central America show up on our southern border we are not as generous with our time or our money. In a recent poll, 67% of white evangelicals did not believe that America had any responsibility to house refugees. These refugees are the same parents and kids that youth groups may have visited the year previous on their church mission trip, but when the refugee parents take an active stance in their children’s lives and advocate for their future safety by making the dangerous journey to the US, they are separated from their children, and the children placed in camps without adequate food or hygiene. Where did all those friendly American faces go who were only to happy to provide coloring books and games when visiting  Central America? Now the US government argues whether soap and toothbrushes are part of basic hygiene.

Some churches are doing the work that Jesus commanded when he exhorted his disciples to care for the poor and forgotten. They have opened their doors to refugees and help families find their relatives and become resettled.  But these are the minority and more are needed. What if we used the millions of dollars that is expected to be spent on church mission trips over the next 5 years and research programs that will allow many of these refugees to make a living wage and stay safely in their homeland. For example, a recent article by the NYTimes details the falling price of coffee beans as a driver of Guatemalan immigration when families are unable to support their children in rural parts of the country. The primary exporter of these beans, Caribou and Starbucks, are making even larger profits as their cost of supplies is lower. Putting people over profit would mean that part of the increased profit be used for community development to keep families together… in their own country.

Individuals are not corporations with large profits but we can make small contributions that make a difference. If we don’t want to stare at pictures of refugees on the southern border that pepper our news-feed daily, we should research organizations that are working to improve the daily lives of these people and contribute. Spend the hundreds of dollars that would pay for a youth trip abroad on a tax deductible organization working in Central America and then volunteer with your youth at a local homeless shelter or food bank. You might both learn a few lessons and share a memory for the future.

 

Girlfriends are like a box of chocolates. You never know what you’re gonna get.

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Girlfriends have always been difficult for me.  In high school, I was the nerdy, science loving girl who would rather have my nose buried in a good book rather than the latest Teen magazine. While I moved on to college and then medical school, my high school friends attended trade schools, got married and started families. My friends in college had a more expansive view of the world than my limited scope incurred from a rural small town childhood, making it difficult to connect.  Their summers/school breaks involved vacations and unpaid internships while I was constantly scrambling to find multiple well paying jobs that allowed me to live in the city while earning enough for books and pocket money.

Once I arrived in medical school in 1983, only 1/3 of the class was women and most of my classmates had well established relationships with friends from college and high school. Developing friendships was fraught with the knowledge that we would soon be moving out of touch as we started residencies across the country. I met Lisa, a fellow medical student, during our third year of medical school when we shared a internal medicine rotation. I think we connected because we had both grown up in southwestern MN and shared many of the same high school experiences. Other shared rotations allowed us to reconnect but then we lost track of each other when I moved to Colorado for residency and she moved to Bangladesh after her residency to work. Social media connections had yet to be conceptualized, which is why I love when circumstances occur that connect us to someone from our past. 20 years later, while working in the kitchen as a parent volunteer at Korean culture camp, we reconnected while chopping vegetables for lunch. We shared a family structure that included both birth and adopted children and each of us were working full time in our physician careers. Since then, our adopted daughters have become best friends and despite living 3 hours apart, talk to each other more than they talk to their mothers.  It seems like it was meant to be.

 

 

Moving to Colorado for residency was a major physical and psychological move for me. I had barely traveled outside of MN during my 26 years and although I hadn’t lived at home since I left for college, I always knew my family was a 3 hour drive away. My co-resident, Marie, was the opposite. She had moved across the country for college and had a thirst for international travel as well as women’s reproductive rights. I admired her convictions and activism, as well as her spontaneity and community spirit. Following residency, we kept in touch by an occasional phone call and yearly Christmas letters. I was intrigued by her ongoing activism for women’s reproductive rights and became more involved in numerous organizations on her recommendations. Because of her involvement in an international organization that was promoting a new method of cervical cancer screening in developing world countries, I saw the need in Haiti and started teaching this method to Haitian providers as well as implementing a screening program. I heard about Dining for Women via her Facebook posts and was motivated to start my own group. Marie continued to be involved in these groups as well as advocating at the legislative level until her untimely death last year due to complications following a heart transplant. At the same time as her illness, I was contemplating a sabbatical from work that involved teaching in Haiti and Vietnam. She was upset that I was “considering” this option, rather than executing the plan. If possible, she would have been next to me on the plane, oxygen tank between us as we shared a drink and laughs. Instead, I spent one of my nights in Haiti mourning and celebrating her wonderful spirit as her family celebrated her life in a memorial service a hemisphere away.

 

 

Some obstetric patients become more than just patients.  Hieu is much younger than I, but we connected over mutual interests (ethnic food, rural roots, 3 sons) and given her close proximity, my daughters were included in her babysitter list. After her last child was born, I was mournful that I wouldn’t see her again.A few years later when she was seeking a change from full time to part time work as a surgical PA, she applied for a job at our clinic and has become our second set of hands in the operating room. She was not about to let me travel to Vietnam (the country of her birth) without offering to act as translator and cultural guide. Lisa offered to be our third wheel, craving the adventure that she had experienced years earlier in Bangladesh.

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The sheer joy that I experienced with these 2 women for a week in a foreign country is difficult to describe. It took Lisa and Hieu only one shared meal to feel that they had known each other far longer than the time it took to eat. These were friendships that had I had made, lost and then reformed. Marie was watching all of us from the other side, accepting thanks with a smile as I realized  it was her nurturing spirit that had brought all of us together on the other side of the world. At the beginning of each of these friendships, I never could have imagined the life path I would take that would eventually bring all of us to the same destination. That box of chocolates has been bittersweet, but well worth the experience.