A Letter to our Adoption Lawyer

After last summer’s ordeal, we have not progressed in fertility efforts, so we have decided to begin the adoption process. What follows is a letter to a lawyer with whom we met in January:

Dear Ms. ...:

This letter is a much-belated follow-up to our meeting in January. Kay and I meant to write you shortly thereafter, but the school year took over and we got busied in those concerns. Now that we have some time off around Easter, we wanted to sum up the things we discussed with you and ask you a few questions for clarification. I would appreciate if you are able to answer the questions and correct any misapprehensions I might have.

As a first step, you suggested we get licensed with DCFS, not necessarily as a way of taking in foster children, but because many of the agencies require that prospective parents be vetted with them. I have looked over their website, and from what I can see, it seems I have to call them to begin this process. There doesn't seem to be a way to do it online. I plan to call them on Monday.

Second, you said the next step is to figure out our path. As I remember you suggested four choices, with the following commentary:

DCFS: this would be true foster-parenting, with the problem that the children we take in would not necessarily be up for adoption, and even those who were could at some point be removed from our care. I believe you said also that there is a wide range of ages and conditions of the children that one cares for as a foster parent.

Charitable Sectarian Organizations: You mentioned that Catholic Charities, Lutheran Family Services, and the Jewish Children’s Bureau all offer adoption services on a non-sectarian basis. I do believe you mentioned that the children available from these groups are more likely to have health problems, though I don’t remember for certain.

Adoption Agencies: The Cradle, and others, offer adoption services. Some of these specialize in the U.S., others in foreign adoptions, and others offer both. The quality of these is varying. You suggested that we interview a number of them to figure out which fits our needs the most.

Private Ads: You suggested we could also place advertisements in newspapers looking for a private adoption. You said that you would be willing to serve as a go-between, setting up meetings between us and the prospective parents, using your experience to vet them.

I assume that pursuing more than one of these avenues is fine, with cost being the limit, correct?

Third, you have said that we need to figure out our own requirements. As I remember, there are at least three questions:

Age: we said we would like to adopt an infant.

Sex: we are open to either; I would guess, especially with foreign adoptions, that girls are more likely.

Open or Closed: probably the biggest question. Your opinion on which we should choose was that it simply depended on our own preferences. We expressed an bias towards closed adoptions, but are definitely willing to consider open adoptions, especially because, as you noted, being open to either kind obviously increases our options.

Fourth, you said we would want to put together an album showcasing ourselves as adoptive parents.

A few questions that we have are these:

•Do you have a list of agencies that you would recommend we start with? Part of what we are looking for is advice in this area. Rather than searching and interviewing at random, we hope your experience can give us a few starting points, so that our interviews can then be a more subjective exercise of deciding whether we are personally comfortable with the agency in question.

•Are there any books, websites, or support groups you suggest we read or join as a way of understanding this process better?

•Where might we get some guidance for putting together an adoption album or an newspaper advertisement? Would you also be able to recommend publications or websites on which to post these ads?

Thank you so much for any advice you can give. The meeting we had with you was very helpful in orienting us. We will be pursuing this process more consistently from now on, especially as the school year comes to a close, and I will make sure to keep you up to date as we make progress.

Sincerely, ...

Apology

Yes, I know, if I’m going to post at all, I oughtta post something important, something relating to the somewhat impressive difficulties my small family endured this summer. Unfortunately, return from Omaha was an escape of sorts, and so I didn’t blog; school has since intervened, as have the election (loved the end of McCain’s speech, though were my policy differences with him great enough, it would not have persuaded me to vote for him), and the looking-like-it-might-be-abysmal Notre Dame football season.

Suffice it to say, for now, that Kay is doing well, mostly. A few small issues from the operation remain – a healing thrombosis, scars, a not-quite-normal-feeling abdomen (muscularly and otherwise vaguely, though seemingly improving); and then there is the sadness of it all, and her continual frustration with my position, which never boils over and only occasionally seems to surface.

I will be back. I will provide the answers to the five questions. I will, when I know, answer the question of, will we try again? I will discuss some of the adoption advice I’ve heard (four routes, one bad, one probably best, that one sort of like what happens in Juno, so they say). And you’ll hear a small yippee from me when we (they, I suppose) beat Michigan next week, most probably by something like a point.

Results

Kay’s follow-up surgery is over, and went reasonably well, though not as well as it might have, in a best case scenario. Kay knew that, if she woke up in the recovery room after the surgery without me already attendant upon her, she would be staying in the hospital. Although it was not the predicted outcome, it did happen. She immediately searched for confirmation of her worst non-death fear – a colostomy – and found that she had not received one. Indeed, no indication had been given that such a measure was even a possibility, much less a likelihood, but it is one of her least dispellable fears. She did find, however, that she had been fitted with another JP drain, and if she looked at the clock, if there was even one available, she found that she had been in the operating room for two hours total, one more than had been planned.

The reason for the extended surgery time was simply the difficulty of the surgery. The abscess wreaked considerable havoc in Kay’s gut, essentially undoing all that had previously been done to un-stick the organs from each other. All was tender, inflamed adhesion, as far as the scope could see, which was not far, as of the reproductive organs only the end of one fallopian tube – whether left or right could not be discerned – was visible. (This tube, for what it’s worth, did have intact fimbria.) Drs. Hilgers and Fitzgibbons also found some remnant of the abscess, though only a teaspoon-sized portion, which they removed, and they “irrigated” – medical-speak for “rinsed” – the area with an antibiotic wash. The JP drain was fitted to allow anything remaining of the abscess to be pulled out, along with blood, irrigating fluids, and whatever other incidental liquids had collected as a result of the surgery.

The primary object of the operation was, I may remind you, the extraction of three pieces of GoreTex bandage. Those bandages had been placed over Kay’s ovaries and uterus to reduce the normal adhesions due to any surgery as much as possible, but had been overwhelmed by the toxicity and ubiquity of the abscess, which left scarring everywhere else. In their efforts to remove these pieces, they had to remove some of the new abscesses, but were hindered in their efforts by the effective blockade created by the jumbled and cohered organs. They hesitated to do much in the way of what they had done last time – separating the organs by removing the scarring – because the inflammation has not yet settled down, and the organs are thus weaker than they would be normally. Of particular concern was the possibility of penetrating the wall of the bowel. Both because this surgery was planned to be less severe, and thus a full bowel prep was not ordered, and because of the weakened nature of the bowel due to the inflammation, which could result in a torn bowel, the surgeons in the end chose to curtail their chase for the third and final piece of GoreTex membrane, leaving it behind.

Kay stayed in the maternity ward, where all of Dr. Hilgers’s patients stay when hospital time is required afterwards (this is either ironic or appropriate, depending on the eventual outcomes of their cases – though the Pope Paul VI Institute and the nurses there were good enough to inquire of us whether we thought the maternity ward was a bad choice for their patients; we told them we were happy to see the babies, if for no other reason than that they were a welcome diversion from the task of healing). The maternity nurses, though a bit shocked to see us – they had hoped Kay would have to endure no more hospital time – were as kind and attentive as ever, apparently giving Dr. Hilgers the news that they felt Kay deserved a gold medal for her behavior, news he promptly passed on to us. Kay was a bit befuddled by this compliment, asking me, “What have I done to deserve a medal? How terrible must the other women be who come through here that I deserve a medal?” I told her it was due to her almost utter lack of complaining, to her patience and mildness when she called the nurses in for help, to her continual sense of humor, to her persistent efforts to comply with their healing instructions (particularly the need to take multiple walks a day). I doubt the other women, mostly delivered mothers recuperating for a day or two, were great termagants, but the nurses’ sense of pity for her rarely precedented stay in their ward, and her perfect behavior throughout, likely elicited the compliment.

On Monday, at one o’clock in the afternoon, Kay and I had our regularly scheduled post-op with Dr. Hilgers, though he had been quite attentive that week already – as is customary he came in to see us every day, skipping only Sunday this time as Kay was clearly in no danger (though he did send his resident in to see her). He had little to say that he had not already said, and his usual joviality was rather suppressed by his discouragement over the results of the June procedure. We had plenty of questions for him, of course, mostly about the future. As the blog format and its readers, however, are polonian in their prejudices, I will attain brevity by saving those – including the questions addressing the mystery of the missing third bit of GoreTex and what happens next – for the next posting.

A Strange Season

This has been an odd summer. As Kay and I walked in the cool of the summer night around ten o’clock, the breeze just ruffling the leaves so that their silver undersides glimmered dimly in the street lights, we marveled at just how little heat there has been this summer. We’ve been blessed, though, for the heat would have added to the discomfort she has felt recovering from her surgery. In the cool, she is progressing apace, and looks to be healing fully. The hole from the JP drain is closed and is almost healed, and her scar looks great. There are still a few issues that seem to be left over, however, from the stress her body has been through. She’s still complaining of an odd taste in the mouth, but I think that will go away once the effect of the antibiotics wears off and her system is allowed to return to normal. Because of her temperature being lower than normal for the past few days, we are not really worried about a resurgent infection, but the doctors have suggested that she may have a bit of anemia, so they have scheduled a blood test for tomorrow. And she has had some problems with digestion. We have introduced new foods to her system gradually, a few fruits here, a couple of seeds or nuts there, but after a particularly rich delayed anniversary dinner (we hit five years in early July), including escargots, Alaskan king crab, and rice pudding accompanied by the ever-perilous raspberry, she awoke at 2:00 AM with stomach pains. Sitting up helped to ease them and allowed her to sleep eventually, and nothing more occurred. Tonight she is a bit uncomfortable, too. I hope that some Tums antacid will help her to sleep.

Meanwhile, I have become beleaguered as well. Yesterday, lying on the bed in the hotel room we ended up scoring for free on the night of our anniversary celebration, I felt the room begin to spin. Only once or twice did it go round, and then it was over, but it was alarming. Rising, I realized that I didn’t feel quite right in the head, and I haven’t since. My head spins seem to be related to the motion of getting up or lying down, and it’s more common when I am lying down. Luckily, my mother is office manager for a neurologist. When I called him after hours yesterday, having mentioned these odd symptoms to my mother late in the day and getting her imprimatur to call her boss, he dashed away my apologies, saying something like, “No, you are not allowed to apologize – you are a member of an honorable family that are good friends of mine. You are welcome to call.” When I explained my symptoms and answered his diagnostic questions, he said I was likely suffering from something in my inner ear, not my brain, but that I should get an MRI anyway, just to be safe. So off I go tomorrow, to relieve my wife’s (and my own) lingering fears that I might have a brain tumor or a stroke, that she will not be left alone at the end of this strange cool summer that we have spent fearing for her, not for me.

The String Has Been Cut

For some reason, I have found myself unable to finish off a review of Neil Gaimon’s American Gods and so have done nothing else in the way of publishing in my concentration on, or wholesale ignoring of, that so far abortive project. I’ve not talked about Lovecraft, whom I’ve also been reading (he’s kind of silly, overall), and I’ve not updated Kay’s condition, despite knowing that there may be some who are interested in the latest. Those who are interested, by the by, are welcome to prod for more information, either through the comments (all three of which I checked before allowing two of them to be published, the first being abusive), or through personal e-mails to jrrhawking@gmail.com.

Kay’s condition is pretty good. A few days ago her spirits received an uplift when we were called by Dr. Hilgers’ office to let us know that the second bacteria in her abscess had been identified, and that the Flagyl she was already taking orally would kill it. Up to this point, knowing only that the E. Coli was being taken care of, we were uncertain that the second, as-yet-unidentified, bacteria was going to be destroyed. They had told us that the Flagyl was likely to do it, but not knowing the identity of the bacteria, they couldn’t be sure until they received a positive identification. As the days stretched on, we were both worried and mollified, worried, because we weren’t sure whether the delay was caused by the slow growth of the bacteria (which we assumed could only be good) or their inability to find something that would kill it (which we assumed could only be bad); mollified, because the output of the drain both lessened and became less yellowish-brown, more clear, with a pink substance we were told was new tissue, white blood cells, and other signs of a return to normality. Clearly we are not really sure how bacteria cultures are accomplished. But however it’s done, it’s been done, and the infection is at bay, if not positively defeated.

So effective has Drs. Hilgers and Fitzgibbons’ effort been, in fact, that the drain’s outflow has dropped beneath the magical number of ten cc’s per day (cc’s are apparently equivalent to milliliters). Once beneath that number, said Dr. Fitzgibbons, the drain could come out. It attained that level on Thursday, at which point Kay called him, and he contacted a local surgeon to remove it. That local surgeon was leaving for vacation, but asked a colleague to do it. This colleague, whose odd name I will not repeat, because I am about to make fun of it, but the oddity of which can be hyperbolically approximated by the pseudonym “Dr. String Barracuda,” was available today, Monday, and, after having been needlessly warned by Kay, as she had been told to warn the person taking it out, to “cut the string,” thus releasing the coil that held it in place, removed the thing out without incident. The extra time with it in did cost Kay another few days of mild discomfort, and some lost sleep as she does not sleep naturally on her back, but it also afforded us the added satisfaction of knowing that the level of drainage did not go up. It has, in fact, not gone above around seven per diem since then, implying that the infection is properly finished. She will, however, watch the leftover wound – small enough to be only bandaged – closely, to make sure there is no excessive drainage, and plans to continue taking her temperature well after this entire project is over, as fever seems to be a good indication that the body is up to something that is causing it exertion, whether or not it is obvious on the outside.

Dr. Barracuda and Kay chatted about how she had gotten to this point, and he did worry her some by his surprise that Dr. Hilgers was using GoreTex to reduce scarring. Just now, in fact, I went into our bedroom, where I found her sitting in front of the TV with worry stitched into her face. I reminded her, as I reminded her earlier, that Barracuda is not a fertility doctor and has no previous experience doing or exact knowledge of what Hilgers has been doing, with some success, for many years. Presumably, had GoreTex not, in the past, precluded adhesions from forming post-surgically, Hilgers would not be wasting his time with the stuff. I also reminded her that Dr. Fitzgibbons, the chief of surgery at Creighton, is aware of and accepting of what Hilgers does, and has said that he uses internal GoreTex bandages all the time. Back when we were in Omaha, Dr. Fitzgibbons said, specifically, that he would have no trouble removing the bandages when we came back. These reassurances had their good effect, but more will undoubtedly be needed, for worry with Kay is like a persistent army that lays siege to her piece of mind, fortified howsoever it may be, and will not be dislodged without a determined assault on his supply train, or an end, altogether, to the war.

We are due to arrive again in Omaha on the 30th of July, with the 31st reserved, we assume, for a pre-op visit, and the surgery scheduled for the 1st of August. Assuming all goes well, and assuming the surgery is able to be conducted laparoscopically (there is some potential that it will become a laparotomy, mini- or otherwise), we will head for home on the 3rd or so, with just under two weeks to prepare for the beginning of the school year. Whether Kay will start on time or not, or as a full-time teacher or not (we are lucky in that, childless and with some help from our families, we can afford to do either), depends on the outcome of the surgery (which will be reported here), as well as on a conversation she will have with her school principal, a woman sympathetic to her because of similar fertility ordeals she underwent herself, some years ago. One way or another, we hope for things to continue looking up, so please place or keep us in your prayers.

We're Home

Kay and I are at home now, having gotten back to our apartment around 7:00 last night. Her parents came over last night with dinner, and my mother will be bringing dinner over tonight. My dear sisters brought over flowers and basic groceries for us, leaving them with a sign that said, “Welcome Home!” By the time we got home, the cold I'd been nursing along the last few days was in full force, so I've been feeling poorly to the point that I could barely rouse myself at 10:00 this morning. I only got out of bed because the nurse was coming over to administer Kay's IV. Having the family care has therefore been a great boon.

The nurse, who came from Coram Specialty Infusion Services, was very friendly and professional. She was entirely unfazed by the abscess – beyond feeling bad for Kay that it had happened – saying that these things happen and are easy to solve. When we said we didn’t know what the second bacteria causing the abscess was (the first is e. coli – very common and nothing to worry about once identified, she said), she speculated that it might be a type of staph infection from the skin. No matter how much they do to clean the surface of the cutting area, she told us, sometimes things survive. Kay lamented that she forgot to wash with Dial antibacterial soap before the surgery, but I figure that if the iodine and things they use in the OR didn’t do it, store-bought bar soap is unlikely to. Still, would have been better to be safe than sorry, I suppose.

We are likely to return to Omaha in about three weeks, when Dr. Hilgers and Dr. Fitzgibbons (the chief of surgery at Creighton) will remove the Gore-Tex bandages. By that point, the course of anti-biotics will be over (the one being given via IV will end on Tuesday), and, we hope, the drain will have been removed. Kay is doing pretty well overall, though she is suffering some minor discomfort from the drain – when the nurses ask her to list her pain on a scale from one to ten, she usually says one or two. Her taste buds are also a bit discombobulated, we think as a result of the antibiotics. All told, we will be glad when the bandages are out and this part of the process is over. We can only hope that the inflammation from the abscess has not undone the progress of the surgery, but we won’t know until we go back in August.