Birth vs. Adoption; Child vs Animal


15 years ago this month I was agonizing over the delay in travel plans to China where we would meet our soon to be 2-year-old daughter for the first time. Fast forward to last week when that same daughter, now 17, lamented that the rescue puppy we were adopting was getting older without her. Although we have had 3 dogs over the past 29 years, this is the first dog that we have obtained thru a rescue agency. I am impressed with the thoroughness that is provided to make sure that each dog goes to a home where they will be loved and well taken care of.  I am saddened that we as a society do not do as good of a job with children – both those who are born into a family and those who are adopted. Over the past month we have been made aware of the family in California who kept their children hostages in their own home while using  home-school as the cover and the father in Texas who disciplined his newly adopted daughter so severely that she died.  I was struck with the similarities between adoption of an animal and a child and believe that we would make lives better for our country’s children if we borrowed some of the same guidelines.

  1. Home Study – Thankfully we passed both the child and dog home study. Slightly different requirements each time. We didn’t need a fenced in yard for a child, but did for a dog. All family members required an interview for the child but not the dog. Fifteen years ago the house was large enough to add a fifth child; today the house is too empty and we are adding a dog. In contrast, no home study was required when I became pregnant with each of our first three children. In my job as an ob/gyn,  I often recite a silent prayer when discharging infants to a parent that I feel is living in a dangerous situation or has had difficulty taking care of  herself during pregnancy. The lives of many children could be remarkably improved if we were proactive in helping families provide a safe living situation.
  2. Cost – The cost of a child adoption, whether domestic or international, is something that many families are not able to afford or need to take on additional debt to accomplish.  The cost of a rescue dog adoption is considerably less but still significant.  Creating a child is free. I wish there was a warning before conception similar to the one on the rescue dog webpage. “If you don’t think you can afford the adoption fee, you probably shouldn’t consider adopting a dog”.  Access to free birth control and improved contraceptive education would help to reduce the incidence of unplanned human pregnancies – currently at 50%.  And when you plan a pregnancy, you are much more likely to be able to afford the costs of raising a child.
  3. Parenting – As part of the child adoption classes we attended, we heard from parenting counselors about problem solving and resources for seeking help. We agreed to puppy obedience classes as part of the dog adoption and were instructed in how to perform redirection type of discipline. No formal parenting training was provided for my birth children. I quickly learned with boys that parenting is similar to dog training – short, repetitive commands with frequent redirection and lots of love. We could help break the cycle of child abuse if we required basic parenting classes of both birth moms and dads and resources for follow-up support.
  4. Healthcare –  We needed proof of medical insurance with the adoption of a child and were encouraged to purchase pet insurance for the puppy adoption. Many children in this country don’t have health insurance because their parents can’t afford it. Needed childhood immunizations and check-ups are put off, only to incur greater healthcare costs later in life. This is only one of the litany of reasons why our healthcare system needs to change.
  5. Food – The multitude of choices for puppy chow is overwhelming – organic, high protein, vitamin supplemented, minimally processed.  We were instructed in portion control and not overfeeding.  Putting a priority on feeding children similar quality food in appropriate amounts would pay dividends in reducing the epidemic of obesity and diabetes. If I wouldn’t give my dog a Happy Meal with a Coke, why should I feed it to my children?

Our puppy has now been home a week and has settled into a routine. That process took much longer for the Chinese 2-year-old. Different language, food, smells and faces, in addition to grieving for her foster family, required 3-4 months to produce a child who slept thru the night and allowed her dad to hold her. Giving her wings this fall as she moves on to college will likely dredge up memories of those first few months; sleeping beside her so she could fall off to sleep, sharing a meal @ 3am as she recovered from jet lag, listening as she lost her Cantonese language and formed a new vocabulary in English. Tears will be shed on that day – mine for sending off the last child to college, hers for missing her dog.  But she has assured us she will facetime weekly – if only to see her dog.



My Love Affair with a Sh*thole Country


I first visited Haiti in 2006. It was not love at first sight, or even a like. I spent a week on a medical mission trip, missing my family and sweating in the operating room while I performed some of the most difficult surgical cases of my career, without adequate lighting and unfamiliar instruments. Climbing the steps of the airplane to return home was a welcome relief from the searing heat of the tarmac and the aroma that is Haiti (think rotting fruit mixed with exhaust fumes and burning charcoal). I’m not sure when the amnesia set in over the next few months, but I was soon planning my return visit the following year. 15 or so trips later, I look forward each visit to spending time in a country that I have visited more frequently than any other.

My  trip last week coincided with the recent comments about Haiti from President Trump. While he was ranting about the immigration of Haitians to America, I was participating in distributing microloans to a new group of 10 Haitian businesswomen. The women received $200 to help fund their small businesses and will be responsible for paying back the loan over 10 months with a low rate of interest. Each of these women has worked hard selling clothes, food, shoes and motor oil to support their families. This is in addition to the daily tasks that a Haitian woman must perform without the benefit of running water or electricity. Entitled or lazy would be the least descriptive terms that I would use.


The following day I worked with one of the Haitian seamstresses that we employ to construct reusable menstrual pads for distribution to Haitian girls. She uses a manual sewing machine and is able to make $4 a day working  5-6 hours. She also participates in menstrual hygiene instruction at area schools so that young girls will have the benefit of knowledge about their bodies and not the fear that her generation of women experienced. She has no desire to immigrate to America away from her family, but wants the opportunity to make her life in Haiti more comfortable.

I am not quite sure why this country has occupied so much of my time, energy and pulled at my heart. The opportunity to leave a frigid Minnesota in January makes the idea of sweating in the operating room more palatable. But is much more than that. Haiti is a land of contradictions – corruption and family strength, sadness and laughter, illiteracy and value of education.  There is very little black and white, rather many shades of grey. But it makes my brain think and try new ideas, something that is more difficult to do in my American job. I have been the recipient of many opportunities in the US, and although I have worked hard and been the first to graduate college in my immediate family, there were many along the way that provided encouragement and a helping hand. I would like to think that I can be that helping hand for Haitians – providing business loans for women, saving a baby’s life when her mother is suffering from seizures/eclampsia, removing an enlarged uterus so that a woman can better perform her household chores and providing education and hygiene products so that young girls are able to stay in school during their period. Yes, Haiti is a destitute country that has suffered from both outside forces and its own corruption. But its people are willing to change that – if we would only give them a fighting chance. And remarks such as those from our President don’t help to provide that chance.

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The Search for Happiness in 2018


With the upcoming New Year, most of us will make resolutions that we seldom are able to keep beyond January. Many of those resolutions revolve around changes in diet and exercise. Because if we are more fit and weigh 10 lbs less we will be happier.  Health clubs depend on the uptick in memberships in January, but they would not be able to sustain those memberships if everyone that signed up continued to attend on a weekly basis. So what can make us happy beyond January 2018? Dan Buettner, a native Minnesotan and author of “The Blue Zones of Happiness”,  has studied cultures around the world that live successfully into old age with the greatest degrees of happiness. Membership in a health club was not on the list of lessons for longer living, but an active lifestyle was. The other lessons included:

  1. Socialization – face to face communication, not work related and not social media. The happiest people socialize 6-8 hours a day with positive minded people and often use humor in their conversations.
  2. Financial Security – but more money does not always buy happiness and usually has the opposite effect.
  3. Buy experiences, not things. A good experience gains luster with time.
  4. Eat more fruits and vegetables, less meat. Eat less processed food. Share meals with friends, especially friends who laugh.
  5. Find a purpose in your life – whether that be at work or in volunteer efforts.
  6. Pursue an inquisitive life by learning and trying new things.

I recently had the opportunity to check a box on my bucket list and unknowingly incorporated all of the above into my 10 day journey. It involved a trip to the tip of South America and an awe inspiring 5 day trek in Torres del Paine National Park, Patagonia. We had the opportunity to sample the local cuisine – grains, vegetables and seafood in plentiful supply. We became acquainted with new friends that were part of our trekking group and shared stories of families and work as well as the events that occurred during our daily travels. Each day was a new adventure and involved learning about the history, flora and fauna of Chile while laughing, fording glacier fed streams and climbing rock fields.  I was able to put aside the divisive culture that has become so prevalent in our country as I didn’t have internet access.  My time was spent framing pictures for my camera while laughing at the stories from my fellow trekkers. All of this for me invokes true happiness. So it was no surprise when I realized that the National Geographic magazine that I had purchase just before we left was the “Happiness” issue and included many of the above items that I have come to believe can make us all happier if we are only willing to listen.

I believe that a large part of my job as a doctor is to help patients stay healthy thru improved lifestyle and circumstances. As detailed in the National Geographic article, happiness doesn’t come thru reading the latest self help book or making a New Years resolution. The best way to be happy is to not worry about being happy but surround yourself with the right environment and relationships. Pictures can often be more informative than words, so enjoy some of the many pictures that help to explain the above.


Humor as we dressed for our zodiac ride


It is easy to be happy when this is your trekking view.


The camera that never left my neck, even over water.


My crazy friends from Germany, Chile, UK and US.

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My personal stairmaster


Sharing food, drink and conversation after a long day on the trail.


Quinoa, radishes and mushrooms.

#MeToo in Women’s Healthcare


The #MeToo Movement, in regards to sexual harassment, has created a great awakening in our country as to what we have tolerated in the past and what we are willing to tolerate in the future. This powerful movement needs to extend beyond just sexual harassment and into other platforms that are unique to women but have been controlled by men. One of these areas is women’s healthcare policy, a sphere that has been traditionally dictated by men as the people in positions of power in government  that make the decisions around funding and laws.

Two conversations with patients this week made me realize how far we have come in women’s healthcare over the past 10 years …. and how far we have backtracked in the last year. A new patient in her early 20’s presented for discussion of contraceptive options. After reviewing the pluses and minuses of each contraception method, I realized that her job was with Hobby Lobby. This is one of the businesses that have used the religious objections to birth control by their founders to justify that they will not provide coverage of contraception to employees who use employer-provided healthcare. Although many forms of hormonal contraception are used for non-contraception reasons, these are also not covered. Luckily the patient was well aware of these limitations and had remained on her parents insurance plan for this reason.

The second patient was an immigrant from Liberia and delivering her first child. When the baby was born she and her husband informed the delivery room staff and their family that the baby was being named after the husband’s sister – a woman who had died in her late 20’s of an illegal abortion in Liberia, leaving behind 3 small children. That same week, CNN published an article with the statistics that only 1 abortion clinic exists in Kentucky and the governor is working hard to outlaw abortion in the state. With 47% of pregnancies in Kentucky being unplanned and the teen birth rate 68% higher than the rest of the country, it does not seem that the women of Kentucky are being served well by their male governor.

The most effective way to prevent abortions and reduce the teen pregnancy rate is providing education and free or reduced cost access to contraception. Statistics prove that contraceptive education does not increase teenage sexual encounters but does reduce the teenage pregnancy rate.  When teens in a rural area of Colorado were provided with contraception education and free access to long-term contraception (Nexplanon or IUD), both the teenage pregnancy and abortion rate declined by almost 50%, saving the state $70 million in public assistance.

The current administration is attempting to take away the gains that were made in women’s health care over the previous 8 years by limiting funding for sex education, removing contraception as a required insurance benefit and pushing the anti-abortion agenda to include the persistent attempts at de-funding Planned Parenthood. This affects not only women but also their partners. We need to use the tidal wave of the #MeToo movement to include a push back against the current culture of anti-women healthcare policies that have been put into place by male legislators. Speak out, call and write your legislators, donate money. But don’t be SILENT. We have seen the power of our words changing a culture of sexual harrassment and we know that a long history of silence didn’t effect such a change.

What Women consider “Sexy”


I have been seeing female patients for 27 years and we frequently discuss difficulties with intimacy. Topics can include decrease in libido, vaginal dryness causing pain, body image after childbirth or cancer treatment and the list goes on. I jokingly tell my patients that God messed up when he created sexuality since 90% of male libido is between the legs and 90% of female libido is between the ears.  We work together to try and problem solve both physical and emotional issues, sometimes with medication and other times with support and understanding. We discuss what it takes to “get in the mood” for intimacy. Which brings me to many of the revelations of male behavior that have appeared in news headlines over the past month. These are powerful men trying to create intimacy with co-workers and strangers.

Given my experience, I think I can speak for a great majority of women. We don’t find a picture of a man’s naked body or his genitalia sent to us via text “sexy”. We don’t appreciate sex toys given as gifts. We don’t find it “sexy” when more attention is paid to our bodies/clothing than to our work performance. We avoid friendly hugs that may turn into grabbing other body parts.

You may ask what is left? What do women consider sexy?  Here is my non-scientific report from what I hear from women ages 18-80.

  1. Love and Intimacy.  When a couple is having relationship difficulties outside the bedroom, low libido in the bedroom is often a side effect for women. We have a hard time separating our brain/emotions from intimacy.  Male libido can thrive despite relationship conflict, which often makes women even angrier.
  2. Contributions made to childcare and household chores. There is nothing better to kill a woman’s libido than doing 3 loads of laundry, cleaning up the kitchen and putting a few kids to bed while their partner watches a sporting event on tv, only to have that same partner try to initiate intimacy as she is falling asleep while brushing her teeth. A partner that volunteers to clean up the kitchen while the woman puts the children to bed stands a much better chance.
  3. Exercising with your partner increases endorphins, the feel good substances that the brain produces, which also increase libido.
  4. Taking the initiative to arrange a date night (planning childcare is a bonus). Women are better able to separate from their household duties when they are OUT of the house.

The majority of men in this country are much different from the men that have made headlines in the last few weeks. They may need a bit of guidance to improve their game, but they can learn from others mistakes and make life better for themselves and their partners.

Why you need to check the donor box

In the past month I have had the opportunity to witness the incredible benefits that one person can make when they decide to donate their organs at the time of death. Most of us don’t like to think of the day when we will no longer be on this earth, much less consider that eventuality when we are standing in front of the drivers license registrar and asked if we would like to become an organ donor on our drivers license. As each of my children have completed drivers ed and then successfully passed the behind the wheel test, I have urged them to check that box on their forms. Just imagine your mother telling you what to do even when you are dead!

Last month one of my friends from medical residency received a new heart and kidney as hers had been slowly failing due to previous chemo and radiation from Hodgkins lymphoma. She was fortunate to find a match within a few months of being placed on the transplant list as her heart was tiring quickly and wouldn’t have lasted for the usual 8-10 month wait. Someone had to die for her to receive an extension on her life. She has always been a person who fights for the under-served and I would like to think that this life extension allows many more individuals to benefit from her new and improved heart.


Marie one week post heart/kidney transplant

A short time later, my daughter had the misfortune to get tackled in the Homecoming powder-puff football game and tore one of the ligaments in her knee, the ACL She required surgery and the decision was made to use her hamstring tendon as her new ACL as it is stronger than a cadaver tendon. During surgery, it was discovered that she had very short and narrow hamstring tendons and they would not suffice to repair her ACL. Luckily, cadaver tendon was available and the surgeon was able to augment the repair to ensure that she has the strongest knee possible for skiing and soccer in the future. IMG_6154


Torn knee ligament

While 95% of Americans support organ donation, only 54% sign up as donors. 117,000 people are currently waiting for a transplant and 20 people die each day while waiting. We can’t control when we lose our lives, but we can control how we want to be remembered.  Marie and Molly have a new heart, kidney and knee due to the generosity of others. Please consider signing up to be an organ donor.

Our Exotic Zoo Family


One of my favorite TV shows growing up was The Waltons, the story of a large multigenerational family during the depression in a rural area of the SE US. Growing up in a rural part of  Minnesota, I could relate to the small town setting as well as the plight of the oldest son, who is the first in his family to leave the farm and go off to college. We never know what childhood experiences drive our adult decisions, but I think the relationships within this family of seven children may have something to do with my motivation to create a large family of my own.

My five children have slightly different takes than myself on what it means to be part of a large family at a time when most families consist of two children. My experiences drove the decision to create this family, but they are the ones who have lived it daily. This became even more apparent when I read my sr daughters college essay. She compared our family to a zoo of exotic animals that gets more than the average attention and has ever-changing relationships and dynamics. This may get her notice during the college application process, but made me step back and consider the dynamics of who we are and how we have changed with the addition of each child.

  1. Our first child was born in 1990, when parenting books were all the rage. We tried out the more permissive parenting routines, but with the addition of a second son threw away the books and used common sense. My child’s self-esteem became secondary to harmony between sibs and our ability to get out the door on time.
  2. We may live in Minnesota, which has cold weather for 4-5 months each year, but my kids were made to go outside and entertain themselves almost daily. It is much easier to tolerate yelling, shouting and crying when 4 walls don’t amplify the noise. I was that mom pulling a wagon full of toys and kids while trailing after boys skateboarding down the hill to the park.
  3. By child number 3, I had adopted the dog owner style of parenting. This involves using short, repeated commands to get your kids to do what you want. No explanations about why you need to get dressed in the morning, just do it. I could care less who started a fight between sibs, just stop hitting.
  4. Natural consequences. If you decide not to take a coat to school, you may need to sit in from recess because the teacher thinks you will be too cold (my kids were never cold).
  5. We are a multicultural family so our family was required to attend ethnic events. I agree that Chinese music can be shrill and grating, but we would have never learned that until we sat thru an hour-long performance. And the food is always better at these events than a typical Midwest potluck.
  6. When you have 4 siblings there are always changing alliances, just as with world nations. The older brother who always bossed you around can become the driver who gets you to your friend’s house. When you are on the outs with one sibling, there is always another in the wings waiting.
  7. Vacation memories are a kaleidoscope of stories. Everyone seems to remember different variations of a trip, even though we were all in the same place at the same time.
  8. There will always be one child who is not happy. Family harmony as depicted on social media never happened in our house. Most group pictures of my kids have one child pouting or standing off to the side not wanting to be there. Now these are my most treasured photos as they tell the real story of our lives. It was a hard lesson for me to learn – that it is not my job to make everyone happy.
  9. There is never a dull moment. The kids and their friends who frequented our house found this to be enjoyable – the parents could have sometimes used a break in the action.
  10. With two working parents our kids were called into action early on. Chore lists were the dreaded weekend routine and male/female roles were frequently shuffled. Girls can mow the lawn and boys can dust and vacuum.
  11. Meals were a one size fits all approach. No separate tastes allowed or individualized meals. If you didn’t like this meal, there was always tomorrow.
  12. With 5 kids within 10 years and 2 of those children being Asian, we always garnered stares and comments when out in public. Some of the kids loved the attention but not all. Over the years I have chosen to share less and less with strangers about our origins as I feel that it is time for the kids to take on that burden. It is their story now, not mine.

Our house will be a much quieter place by this time next year. I relish the memories of our zoo and hope that there will be some baby animals to care for in the future.