Our Exotic Zoo Family

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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.

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The Terrorists Within our Midst

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My heart was saddened when I read the headlines on Friday about another bomb incident in London. I thought of not only the 22 individuals that were affected by this violence but also the thousands of Brits that need to use the subway each day to get to their jobs and back home again. Going to work should not involve terror about what may happen before you start your job.  Soon after the news appeared it was listed as a “terrorist event” and further headlines contained the words travel ban, building a wall, immigrants and terrorists. If we can just prevent “those” people from coming to our country we will be so much safer.

But there is a more dangerous, violent and ruthless killer in our midst.  Post Hurricane Harvey, He appeared at a football party in Texas and killed his ex-girlfriend and eight others.  Last week, He walked into a school in Spokane, Washington and killed a classmate. Over Labor Day, He murdered his pregnant girlfriend and then appeared with her parents pleading for someone to find her. And these were only the high-profile events that made the national news in the last 2 weeks. On average, three or more women are murdered by their boyfriends or husbands every day in the US. All of the above killings were done with a gun.

Today, the President of the United States of America, someone who is supposed to be a role model for not only America but the rest of the free world, tweeted a video of himself hitting a golf ball that struck Hillary Clinton in the back and knocked her down. If you watch the video, you understand that the golf ball hit by Trump did not actually strike Clinton. THAT is not the point. The point is that we have an epidemic of male violence in this country and our President is signaling with this tweet that it is ok to physically strike down someone with whom you disagree.

I would challenge every American to think about the real terrorists in our midst – young men who believe that using violence and guns is a solution to their problems. These men are not being recruited over the internet by a religion, they are not recent immigrants from a country in the Middle East, they don’t have long beards or speak a different language. The terrorism that they create is much more prevalent and difficult to stop. They have almost unlimited and immediate access to firearms so that they can destroy before their temper cools down. No elaborate terrorist network is needed for their plans.

Many will brush off President Trump’s latest tweet as just a joke against his former running mate. Those of us who rush to pronounce judgment will be considered uptight liberals and not able to enjoy humor.  If you are a woman in this country, think about what tone is set when we can consider a woman being intentionally struck by a much physically larger man as humor. If the President can do it and Americans laugh it off, why isn’t it justified to put a woman in her place with a fist or threaten her with a gun?

Just imagine if we could use a small portion of the proposed funds for a wall on the southern border of our country and use the money to implement a school based program starting in middle school that addresses safe outlets for anger and treating each other equally. Because the terrorists aren’t across the ocean trying to get into the US …. they are already here.

The Parental Bond – birth vs adoption

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This past weekend I fulfilled a promise that I had made to my oldest daughter on the first day 18 years ago that I saw her olive skin and almond eyes in the far away land of Korea. We were traveling west to move her in for her first year of college 1600 miles away. Just like that first trip, my nerves were on edge for the entire time – anxious about having her so far away and excited for her sense of adventure and for the incredible experiences that she would have.  Remembering the first time that we held her, I was reminded of that long ago promise – to raise her for 18 years, pay for her college and then she would move out of our life.  Memories have a way of showing up at the most inopportune times. What a difference those 18 years have made.

Bonding to an infant or child is different for everyone. Sometimes it is instant and other times it takes days and months of care giving. When my biological children were born, I never thought too deeply about bonding. Nursing was a time when I allowed myself to slow down and focus on my love for their tiny bodies and connect thru their eyes. Bonding with an adopted child is a bit different – not bad, but different. They have already had time to be fed by someone else, to form a personality separate from their adoptive parent. Some adoptive parents bond instantly.  That was not me.

I realized when I first saw my daughter that we may have completed this adoption for the wrong reasons. Was wanting a daughter to complete our family of 3 boys an adequate reason to take a child out of her homeland of Korea and raise her in a predominately white culture?  Was I qualified to parent an Asian child? Was I doing a dis-service to my three boys by creating a family that would forever be viewed as different? And amidst all of those thoughts swirling in my head, I made the promise out of fear. Fear of the future. Fear of walking out of the room and telling everyone this had been a mistake and I was not up for the challenge. I thought I could fake the “bonding” for 18 years and then go back to my normal life. As we all know, life doesn’t work like that.

The process of caring for someone unrelated to you but who is wholly dependent on you for food and shelter eventually creates a bond just as strong as birth. I was able to fake being a loving parent for a few days and gradually the fear went away and was replaced by a steadily growing love. It may have taken a bit longer than a biological child but the eventual bond was no different. Now I have the same hopes, dreams and worries for my adopted children that I do for my biological children.

Within a day of leaving my daughter at college, she had her first stab of homesickness and questioning whether she had made the right choice by moving so far from home. I reminded her of my promise 18 years previous and how our lives would have been so different if I had decided to walk away from the unknowns. Now it was her turn to “fake it” for a few days or weeks or months until she grew to like this new phase of her life.

 

Why domestic violence needs to be a “guy” issue

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Although I have never been the victim of physical/sexual/verbal abuse, I see the consequences of these actions in many of my patients. I try to listen, not judge and provide resources for women who are either in an abusive relationship or suffering mental/physical repercussions of a previous relationship. But more than a few times I have thought, “Why doesn’t this woman just leave?”.

Over the past few weeks, two seemingly disparate articles have made me rethink this statement. The Star Tribune newspaper published an investigative article on sex trafficking, highlighting the customers of prostitution rather than the female victims. Efforts have succeeded in many states to prosecute the pimps and sex customers and not the female victims, as the majority of these young women are the victims of violence and feel enslaved and unable to leave. They often start as teenage runaways trying to escape an abusive home life, only to find themselves picked up by an older male who seems to provide safety and love. It doesn’t take long until these young women are enslaved in a different way – to drugs, sex work and physical violence from their pimps. Leaving is not an option as they have no family to go home to, no friends who can help and they carry the societal shame of what they have done. With this in mind, new initiatives have begun to educate and prosecute the male customers of the sex trade. If demand can be decreased, there will not be a need for supply.

The second article appeared on the blog  of a former neighbor and friend. This independent, opinionated, musically and athletically talented young woman had been the victim of domestic violence dealt by her boyfriend. Her story was horrifying as she came close to death a few times while also being  psychologically abused and estranged from her close and loving family.  Why didn’t she leave?  Why did she continue to make excuses for someone who left bruises on her body? But what if we changed the “blame” game? What if we asked, similar to the prostitution story above, why is the abuser abusive? What led him to believe that he has the right to choke and punch someone that he loves? Where has he learned the words that can systematically wear down a person’s self-esteem?  Why isn’t his family recognizing the bruises, put down words and unhealthy control he exerts?

The majority of our current resources around domestic violence are geared to protecting women once they leave an abusive relationship; providing a safe place to stay, legal services and job training. This is important but will never effectively change the behavior that led to the situation. We need research to find out what exists in our society that allows men to believe that this is acceptable behavior. Only when we understand that this is a “guy” issue and not a female victim issue, will we be able to effect change.

 

My Day of Confusion at Work as an Ob/Gyn

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During the delivery of a baby last week, the parents informed me that they had decided not to know the sex of the baby prior to delivery. I joked that I would need to watch a You Tube video prior to the momentous event so that I would be reminded of how to correctly identify the “parts” as either boy or girl. Luckily, I got it correct under pressure of both the delivery and the gender identification and disaster was averted. But it did allow me to reflect on how important this subject has become for the newest generation of parents.

When I first started in practice 25 years ago, routine ultrasound at 20 weeks gestation was not standard practice. The quality of ultrasound was far inferior to current imaging and even when looking for gender, you could be mistaken or not obtain a clear picture. Although not evidence based, routine ultrasound at 20 weeks gestation is now the norm and anticipated from the time of the first OB appointment. The purpose of the scan is to rule out major structural abnormalities but expectant moms see it as “finding out the sex of the baby”. Relatives and siblings are invited to view the unveiling and crowd into the small, darkened room for the 45 minute procedure.

Reveal events have now become the mid-pregnancy social occasion. The sex of the child is concealed in some way and the expectant parents “reveal” boy or girl status to invited guests. A competition seems to have started for favorite You Tube video/creativity with these events. Subsequently, our office has been swept up into the planning process for the Reveal. Following are just a few of the duties that our Ultrasound Techs have been asked to perform.
1. Call the Bakery and note boy or girl for the couple so that a cake can be baked with either a blue or pink interior frosting, revealed when the cake is cut.
2. Stuff the appropriate color golf balls into a box so that when the balls are hit they emit either a blue or pink cloud of dust.
3. Stuff a pinata with either blue or pink candy.
4. Write the sex of the baby on a piece of paper and fold in such a way that prying eyes can’t deduce the writing. That paper is then given to a favored family member to see, while everyone else stays in the dark until the day of arrival.

Studies have shown that parents bond better with their newborn when they are aware of the sex of the baby prior to delivery. It would also make sense that they would have a name for the baby at delivery, but this seldom seems to be the case. With the current generation of parents, planning how events will unfold during the delivery as well as in the first days post-partum is a priority so it only follows that knowing the sex of the baby would be part of the plan. It is only when they have parented for a few weeks or months, that they come to realize that this wonderful journey is full of detours and bends in the road and not a straight path.

Here’s hoping that I will get the sex correct the next time I am under pressure to perform. I have the You Tube video bookmarked for quick reference.

My Gifts from Korea and China

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Since the adoption of our children 14 and 17 years ago, I have been told repeatedly how lucky my daughters are and that they are a gift to our family. The definition of a gift is something that is given freely. Although I am not exactly sure of the reasons their birth families chose not to raise them, I don’t think it was a choice that was freely made.  In Korea there is no social or familial support of unwed mothers and in China the pressure from the family is to produce a son to carry on the family name.  Circumstances prevented their mothers from making a free choice.

This week is Kamp Kimchee, a camp for Korean adoptees in northern MN, and a time when I get away from our hectic daily lives to  reflect on how adoption has changed our family and changed my perspectives. And this is when I hear from many of the older Korean adoptees that have been thinking about this from a personal viewpoint for much longer than I and that are brave enough to share their stories with adoptive parents. The reality is that in order for the gift of adoption to benefit my family, parents in another part of the world lost their child and our daughters lost a culture. Our fortune is built on others misfortune.

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Lee and Whitney Frisk, Korean adult adoptees who are married and live in Tennessee, shared their stories with us this week and provided some insight into what our kids may face as they venture beyond their home nests. The gifts that were adorable Asian toddlers  will be seen as “not white” or foreign when they venture out into the world in young adulthood. Having been seen as Asian within a Caucasian family, they will now be viewed as Asian with a non-Asian sounding name. They will be repeatedly asked, “Where are you really from?”. They will need to look at the part of the country where they receive job offers to determine if they are brave enough to face discrimination on a daily basis. Living in a part of the southern US, they have seen a sharp rise in the amount of racism directed their way since the election. In this era of globalization, our children  will need to determine if they ever want to return to their home country and search for birth parents or learn more about their origins.

As a white parent with white privilege I can never fully understand how all of this will make my daughters feel. In the words of another adoptive parent, Martha Crawford, I am an invited guest to the adoptive experience and my job is to support, always love and accept who they become. Not that much different from a bio parent but with the possibility of another family a world away becoming part of our extended family if a birth family search is started and successful.

But the unexpected gift that no one told me about all those years ago when we attended our first adoption meeting is the wonderful friends we would make thru this experience. Our week at Kamp is when I get to reconnect with many of these friends from other parts of MN and share both joys and sorrows, laugh and cry together. Because only these special people understand the slight curves in the road that an adoption journey can bring. My daughters have allowed me the privilege to be a part of their cultures, share their fabulous food and art and only ask that I pay for a few melon bars at the end of each day.

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Who is responsible for the Health Care Mess?

CRO_health_affordableCareAct_05-14[1]I as a physician am. You are. The President and Congress are. Pharmaceutical companies are. Or, as President Trump was heard to say, “Health Care is a lot more complicated than I thought”. As someone who has been in the midst of health care for 30+ years and who has also seen better health care for fewer dollars in other parts of the world, I would like to share my thoughts as to how we can talk common sense and come up with a better solution than either ObamaCare or TrumpCare.

We first have to discuss whether health care is a human right or a privilege. As the richest country in the world and one with the largest economy, I would argue from a moral standpoint that access to basic health care is a right. Luke 12:48 was quoted to me by a judge when our family appeared in court to formally adopt our Korean daughter. “From everyone who has been given much, much will be demanded; and from the one who has been entrusted with much, much more will be asked.” The judge understood that our family was blessed with talents, wealth and knowledge and asked that we use these instruments in the community for a greater good. The same should be held true for America – we benefit from living in a country with numerous natural resources, a democratic government and public school system. Using great minds in our country, we should be able to implement a basic health care system that is available to all of our citizens. If we have a finite amount of money to spend in the budget, where should health care fall in the priority list? Currently 55% of the US budget is spent on the military and only 6% on healthcare for all US citizens. Are we ok with spending money to defend our country beyond US soil while back home our own citizens die or become sick due to preventable illness?

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Now that you are well into the quagmire of the ethics of Health Care, lets turn to the players in the system. The current system of paying hospitals and physicians is backwards. Spending my time in the office doing procedures is much more lucrative than counseling patients on improved lifestyle and performing preventative care. I can deliver a baby by cesarean in 30 minutes during daylight hours and be paid almost twice as much as compared to managing a women in labor for 24 hours, spending all night in the hospital and getting up for a 4 am vaginal delivery. Treating a woman with heavy menses with either birth control pills or a Mirena IUD only generates an office visit charge vs. performing a hysterectomy that takes an hour and increases my payment 10x.   The ACA made an attempt to fix this by implementing quality care standards (such as lowering the cesarean rate) that if met, increased your paycheck from the government. Unfortunately, the cost of implementing and reporting those standards was often more costly than the payback. Physicians are human just like every other American – some of us will strive to provide the most cost-effective care for our patients while others will look out for only their bottom line.

US senators are currently tying themselves in knots trying to come up with a Health Care plan that satisfies both conservatives (any government health care is too much) vs. moderates (expand benefits to the needs of their specific state). I find it ironic that conservative states such as Ohio and West Virginia want more federal money for the  opioid epidemic that has devastated their health care budget but yet these are some of the same states where the citizens and government officials are working to defund  Planned Parenthood. Having seen the astronomical costs both emotionally and economically when babies are born to drug addicted mothers, common sense would be to provide free or reduced cost birth control in those impoverished areas where opioid addition has taken hold. Each government representative is doing what is best for their state and citizens and not one of them has been willing to stand up and declare what is best for the country as a whole. If they really cared about America they would put aside political divides and approach this as adults, not toddlers trying to protect their pile of toys. Our President, as a former Democrat and now a Republican, should be working to bring these opposing sides together and Make American Great by being the champion of a health care policy for all Americans.

The price of prescription medications in this country are higher than anywhere in the world. And yet the pharmaceutical companies that develop and manufacture these same drugs are based in the US and use taxpayer dollars to fund the research and development of drugs. Drugs are sold to other developed nations for 30-40% less than what our own citizens are charged. These same countries have a universal health care system that negotiates drug prices with the manufactures, something the US lacks. The US lacks an impartial regulatory board that not only regulates the prices of drugs but also puts restrictions on the use of new and expensive medications. Regulation also needs to be instituted in regards to advertising of drugs, both to patients and to health care providers. When I started in practice 25 years ago, my clinic had a policy that drug reps weren’t allowed into physician offices to meet with us. We were also discouraged from receiving freebies such as dinner. At the time, I thought it was a bit overboard. Now I realize that this practice shaped my ability to fact check dubious claims made by well dressed pharm reps who were treating me to an expensive dinner. How is the average consumer able to decide between a generic inexpensive drug that has no public advertising and a drug that appears in a full-page color spread and is purported to drastically alter their life for the better?

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And finally the American people are to blame for the health care mess. We want to have our pick of the candy store (health care) without regard to price or outcome and we don’t want to be held accountable for our personal decisions that drive up the cost of the candy store. 35% of Americans are overweight and 10% are morbidly obese, contributing to the skyrocketing incidence of hypertension, diabetes, joint and low back pain, heart disease, sleep apnea and endometrial cancer. But we continue to sit on the couch and eat unhealthy diets, all while complaining about the price of medications to control our illnesses. I discussed this very subject with a mid 50 woman this week. She smokes 1/2 a pack of cigarettes a day and is taking 4 medications related to the health effects of her smoking. We discussed  priorities regarding her health and how she spends her money in addition to options to improve her overall health. She has knee pain and doesn’t feel that she can walk or exercise. She is worried about the health effects of pesticides on food, so limits herself to one fruit or vegetable a day. The perceived level of stress in her life limits her ability to quit smoking. She enjoys the sun so spends summer weekends laying outside and visits tanning booths in the winter. After twenty minutes of this, I gave up trying to motivate her. And I was paid the same amount for a preventative care visit whether I had started this discussion or not.

Yes, it is much more complicated than anyone imagined. But not impossible. We don’t need to recreate the wheel, as many first world countries, such as Australia and Canada, have health care systems that not only work but also cost much less and have better outcomes. I think whether you call yourself conservative or liberal, we can agree that a health care system that costs less with better outcomes is a winner for all Americans.