Change Agent Podcast, First Episode

The first episode of Change Agent, a new podcast hosted by Carey Watson, MD is now available. This week she interviews Dr. Brigid McCaw about the creation and evolution of Kaiser Permanente’s innovative Family Violence Prevention Program. I’m very excited for this podcast and am really proud of Carey’s hard work putting this together.

You can listen above to the episode. You can stream the podcast on her website or on Soundcloud. You can also subscribe via iTunes or Stitcher. New episodes will be available weekly on Wednesday. Please leave some comments and reviews to help get the word out.

Announcing the Change Agent Podcast

I’m excited to announce a new podcast, Change Agent, hosted by Carey Watson, MD. (Carey is not only my favorite gynecologist, she’s also my wife.) Each week she interviews social entrepreneurs in the field of family violence prevention and advocacy. These leaders are creating new ways to bring wholeness and justice to families in the San Francisco Bay Area.

You can listen above to the first season’s introduction. In the future, you can stream the podcast on her website or on Soundcloud. You can also subscribe via iTunes or Stitcher. New episodes will be available weekly on Wednesday. Please leave some comments and reviews to help get the word out.

The Damn Shoes

A prose poem about parenting.

Nothing has humbled me as much as becoming a father. Not my deficiencies as a husband when I see my selfishness firsthand. Not my inability (unwillingness?) to be a good long-distance friend. Not my failures as a pastor when the congregational leaders said they wouldn’t talk with me—and what else did I have to use as a pastor, but words? No, being a dad has revealed just how short my fuse is. How sensitive I can be—a three year-old’s smile fuels me for days, but his rejection is like having someone cut the power to our home. All my skills I pride myself in—responsibility, analysis, reason—mean nothing. I cannot convince him to put on his damn shoes. He screams and writhes about having to put on his damn shoes. And I’m about to throw my own tantrum about the damn shoes. As I go to bed, I pray the examen, and shudder with embarrassment that my desolation for that day is the argument over the damn shoes. And how I stewed throughout the drive to the park, the spins on the tire swing, the tumbles through slides, the return home, about the fight over the damn shoes. I could not calm down. I began to harbor a festering grudge against my son and his damn shoes. When two days later I ask him to put on his damn shoes (minus the profanity) and he does so gladly. And I rejoice, nearly in tears, as if I were watching Neil Armstrong step on the Moon. I pick him up, smother him in hugs, and say a prayer of thanks for those damn shoes.

Adopting the Twins, Part 5: Home, the Miracle of Court Dates, Reflections

We came home on August 4 to begin our new life as a family of five all under one roof. I won’t go into many details here as it is a story still being written with fits and starts, successes and failures, and very little sleep.

God has blessed our kids with some extremely generous grandparents. For the first six weeks home, one or more of our parents stayed with us, helping with the day-to-day operation of the house as well as childcare. That childcare took mostly the form of playing with Elijah while Carey and I tended to the twins’ needs. I don’t know that we will ever be able to adequately express our gratitude for the grandparents.

While we signed agreements to care for the girls and received all the legal permissions to bring them home, we still waited to begin the next step of the adoption process: foster parenting. This could not happen until the courts filed relinquishments of birthparent rights. Again, I’ll spare you the specifics since there are several directions this journey could have taken. The short of it was once we had the needed paperwork, our lawyer instructed me on how to file it at the court. I went to the Contra Costa County Court in Martinez one Monday morning, papers in hand, waited in line, and prayed for helpful clerks. Thankfully the clerks I dealt with gave this novice patience and detailed assistance. I filed the papers and took and sent the needed copies to Independent Adoption Center (IAC) and our lawyer, respectively. Within a few days we officially became foster parents for the girls.

Twins

Until the relinquishments were signed and filed, all parties could change their minds about adoption. We therefore still refrained from using familial language with Elijah. Carey and I would cringe whenever an understandably excited and well-meaning friend would ask him if he was excited to be a big brother. Again, we did not want to confuse him more than necessary in case the adoption did not work out. We found this aspect of waiting for relinquishments especially difficult. We wanted to fully embrace being a family. Once the relinquishments came through, we celebrated. We could not tell Elijah enough that he was now Bethany and Joy’s big brother. A weight had been lifted.

We remain in another holding pattern waiting for the adoption to finalize, which will probably take about six months. During this time social workers from IAC will visit and interview us. They will file a report assuring the court of our competence as parents. At the end of this period I will go back to Contra Costa County Family Court to wait in more lines and file more papers. We will then receive a court date for our family to appear. Carey and I will then sign further paperwork and a judge will ask us to legally swear that we will care for the twins. I know, the miracle of childbirth. Except for the bureaucratic labyrinth, the finalization is truly beautiful in its own way. At Elijah’s finalization the judge told us he loves such cases because it is some of the only happy work he does as a family court justice. Normally the court intervenes to prevent abuse or neglect, often making the awful but necessary decision to remove children from their homes. With adoptions the judge helps to legally create new, loving families.

At first we could not convince Elijah to pose for pictures with the girls. This was a symptom of his adjusting to the new family reality. He also initially wanted nothing to do with a stuffed dinosaur we said came from the twins. (He eventually welcomed and named the dinosaur Pickle.) Then when we prepared to shoot the girls’ one-month photographs, Elijah asked to be in the picture with them. He beamed with pride as he held his baby sisters. He proclaimed, “I love them!” Ever since he has been a doting big brother, giving them kisses on the head and wanting to help when they cry. Granted, much of his “help” needs vigilant guidance, but we are grateful for his excitement and love.

Three Kids One Month

IAC reminded us each adoption is unique and we can attest to this fact. We matched with the birthmother beforehand instead of having a last-minute placement. We’ve had contact with the twins’ birthfather all along. These are singular relationships with individuals and we are all learning to be family together. Caring for twins is not merely twice the work, but an exponential increase in energy and resources—the speed with which we go through diapers is staggering. In many ways it feels like we are doing this for the first time.

Some similarities between the adoptions remain. I want to include a couple of paragraphs from my reflections on Elijah’s adoption, updated for the girls. I think they are relevant to our experience this time around.

Having heard the stories of birthmothers who have placed their children for adoption, I know that it is not an easy choice. I also know the way our society views the participants in our situation discourages women who do not want to parent from placing their child with another family. Adoptive parents are often seen as heroes, rescuing innocent children from the jaws of poverty and neglect. A birthmother is viewed as immoral and unfit and clearly does not love the child growing in her womb because no good, loving mother would never abandon her baby. Birthfathers are talked about even less and are seen as deadbeats at best. Abortion thus becomes a more attractive option because it can be done with greater secrecy and seemingly with less societal shame. But the stereotypes of birthfamilies are not based on much reality. The fact is Bethany and Joy have been surrounded by love their entire lives from their birthfamily to their adoptive family. Their birthmother made sure they received prenatal care and prayed for them regularly. This is not to make adoption a pollyannaish process, but to say that though this situation was born out of difficulty, the people involved truly love Bethany and Joy and express it in unique ways.

Having gone through two adoptions, I can say there are many disincentives for adoptive parents along the way. Private adoption, either domestic or foreign, is expensive. We were subject to background checks, financial checks, fingerprinting, and home inspections. All of these are reasonable, but as we proceeded in the process, I kept thinking, birthparents never have to do any of this stuff. A pregnant couple’s custody of their child does not depend on correctly answering questions about their philosophy of discipline or making sure all their medicine is in a locked box. Adoption agencies in most states are non-profit corporations and ours certainly earned their fees, but I could not help thinking that while adoption was an excellent use of our money, a good portion of our fees could have started a college fund for my child. In our research of which adoption route to take we also looked into the public foster-adopt system, which is even more difficult to navigate. There are similar background checks and home studies. While it is less expensive, the bureaucratic maze is worse than the private option. There are mandatory classes held over several weeks, each offered only once a year, meaning it could take years for parents to be considered ready for adoption if their schedules do not line up with the local government’s. There are groups in America working hard to ensure abortions are available regardless of ability to pay. I wonder why there is not a similar cry for making adoption available regardless of ability to pay. How many incredible parents are out there who would gladly adopt a child who needs a home but cannot because they are unable to afford the high costs? Health insurance plans often cover infertility treatment, but offer little help with adoption. With the large amount of kids in foster care and the continuing high percentage of unintended pregnancies, why do we not support adoption and adoptive parents with more resources?

I am more exhausted than I have been in years. The incessant childcare can consume my thoughts and I run the risk of losing my appreciation of this season. Strangely, Elijah, in his sweetness and excitement toward Bethany and Joy, reminds me just how miraculous these girls are. Gratitude overcomes me those moments I can stop, breathe, and simply hold the girls. Such moments seem to be increasing as the girls’ schedule has stabilized. They have both just started to smile. They can focus their eyes more and we can gaze at one another. I can say I am grateful to God for making us a family together. I cannot believe Jesus allows us to know these amazing people when they are so young and fragile. I am awed the Holy Spirit has given us the gift of knowing these girls as they grow.

Tyler and Joy

Adopting the Twins, Part 4: Intermediate Nursery, Preemie Care, Monotonous Intensity, Family Visits, Homeward

Bethany and Joy’s birth aunt and birth grandmother visited them in the Intermediate Nursery (IMN). As we marveled at the little girls we all simultaneously realized none of us had eaten dinner. The adrenaline that pushed us through the last several hours had worn off. It was close to midnight and we were famished. I volunteered to pick up food at In-N-Out for everyone. After I returned and we all had eaten, Carey and I were left alone with the girls.

The time came to give the girls their first feeding. While it had been a few years since I fed a baby, I figured it would come back to me quickly. We did not, however, anticipate the specific needs of premature infants. Holding each baby proved to be a challenge as we negotiated the tangle of cables attached to their probes. While I fed Bethany, her lips turned blue, and the alarm on her monitor sounded because her oxygen saturation decreased to dangerous levels. One of the nurses quickly and gently stepped in, told me to dip the bottle down. She explained preemies’ brains are not developed enough to do more than one thing at a time. They cannot breathe and eat. Preemies will eat until they pass out, so it is the responsibility of the feeder to pace for them. The nurse taught me how to hold the bottle to the side so the formula didn’t fill the nipple entirely. She coached me on when to dip the bottle down in order for Bethany to take a few breaths.

Given my exhausted state I found her instruction hard to grasp. Despite my efforts, Bethany’s lips still turned blue a few times. Nothing could reinforce a sense of ineptitude like a blaring alarm telling me my baby is close to asphyxiation. I grew impatient both with myself and the nurse. I thought I was failing as a father in the first hours’ of my daughters’ lives—I couldn’t even feed them without harming them. The nurse gave us a lot of attention, but in my tired state I took her watchfulness as hovering and I don’t respond well to that. I wanted to throw the bottle across the room in frustration or snap at the nurse. I believe the Holy Spirit gave me a moment of pause and reminded me I was tired and learning. The girls would be fine. I would soon know how to care for them adequately.

The hospital gave us a room on the postpartum ward. This step was just one of the first dramatic differences we had in our experiences between Elijah’s and the twins’ adoptions. The hospital where Elijah was born didn’t know what to do with us—it was as if they had no concept of adoption. Initially they shoved us into the nurse’s lounge before giving us a delivery room. The Kaiser Santa Rosa staff, however, treated us as full patients with medical staff checking in on us and bringing us food. Carey went to rest in our room while I sat with the girls. I held Joy on my chest and we both fell asleep. In the early hours of the morning the staff brought the birthmother into the IMN to see the twins. We shared a groggy greeting. I went to our room on the postpartum ward where Carey slept on the bed. I spread a sheet on the pullout couch and crashed.

IMN-Feeding

The next day combined monotony with intense focus. Our lives centered on the babies’ routine of eat, poop, sleep, which coincidentally was the the working title of Eat, Pray, Love. To visit the twins in the IMN we went through a security checkpoint. The guards were of varying help and kindness. We continued to learn how to care for preemies, growing more competent in feeding the girls. We reported every milliliter of formula they drank as well as the contents of their soiled diapers. I’ll spare you those details. Alarms still went off and nurses would silence them. Holding babies attached to wires became second nature. We picked up the art of swaddling again. On Friday morning Carey wheeled the girls’ birthmother into the IMN and we sat together in awe of the twins together. During the long hours we tried to read on our phones. Carey or I would peel away for a few minutes to eat food in the hospital cafeteria or take a shower. The new parent haze surrounded us.

The neonatal staff initially recorded the girls as “Baby A” and “Baby B” and their names remained that way in their chart, meaning the staff called them by those aliases. Each time they talked about “Baby A” (Bethany), I could only think of Radiohead’s song “Kid A” from the album of the same name.

Thankfully, the girls’ weight was the only real health matter that concerned us. Because of the girls’ small size and the fact that nearly every infant loses a few ounces after birth, we would probably stay in the hospital for several days. The pediatricians gave them higher calorie diets and a rigid feeding schedule in the hopes they would gain mass and we could go home.

Bethany responded well to the new diet and transitioned out of the IMN Friday night. The staff moved us into a room on the pediatric ward. New nurses checked her vital signs. We were finally sleeping in the same room as our child. During the next day, we would cart Bethany over to the IMN to be in the same room as Joy. One time Carey rolled Bethany back to our room on the same floor without a nurse escort. The security guard at the door nearly called a Code Pink—a stolen baby—and came from behind his desk to stop Carey. He then chewed her out despite the fact the IMN staff had approved Carey’s actions. He would give Carey grief just about every time she went back into the IMN.

Carey-IMN-Twins-BW

Unfortunately, Joy kept losing weight. Never enough to require further intervention, but nearly every conversation we had with a pediatrician at rounds included a discussion of possibly feeding her through a tube. She was so small and eating taxed her body to the point of exhaustion. She would fall asleep after drinking only a few milliliters of formula. One the one hand, the feeding tube could help her receive the calories she needed. On the other hand, she needed to learn and develop the stamina to eat and the tube would only delay this goal, keeping us in the hospital longer.

The girls’ birthmother stayed in the hospital a few rooms down the hall from us as she healed from surgery. She came to hold the babies a couple of times a day. She healed quickly from the surgery and the hospital staff discharged her Saturday. She and her family visited several times after she went home. We were grateful to participate in their bonding with the girls.

Working with the hospital social workers marked another dramatic difference between our adoptions. With our first adoption, the social workers displayed both an ignorance of how an adoption works as well as a reluctance to figure it out. We even had one social worker try to dissuade us from open adoption. This time around the social worker admitted helping with an open adoption was new to her, but she leaned into the experience. She wanted to learn. As we sat around a table signing papers she said, “I love this. We’re bringing two families together.” She took the extra steps, calling our agency, Independent Adoption Center, herself when she needed help, and made sure we could focus on childcare.

Along with the helpful social worker, the nurses and pediatricians all gave us excellent care. I cannot sing their praises enough. They showed wonderful concern for the girls and paid attention to Carey and my needs as well. One of our pediatricians had four adopted kids of his own, so he could relate to our experience and helped us attain some paperwork necessary for the process. We enjoyed sharing stories of our adoptions. This was a gift.

On Saturday Carey’s dad and Elijah drove from Pleasant Hill. Elijah met Bethany in our hospital room, but he seemed more interested in playing with the buttons on the bed. For that reason we elected to not take him to the IMN to meet Joy. We did not mind him playing with the angle of the mattress—pushing the wrong the button attached to a premature infant in the IMN, however, could have grave consequences.

The pediatricians discharged Joy from the IMN Saturday night. California law requires every patient to have their own bed. Since the girls were each a patient and the pediatric ward at the hospital had one bed per room, that meant the hospital gave us another room. We kept the girls together and used the second room for Carey or I to sleep and shower. We took shifts during the night with one of us feeding and staying with the girls while the other slept in the empty room. This system worked rather well for us.

The pediatricians shared our commitment to get us out of the hospital as soon as possible. All hinged on the twins gaining weight. At each set of rounds, twice a day, we were told we would have to wait and see. The girls slowly increased or steadied their food intake, but it was not yet enough. We set volume goals for each feeding. The uncertainty prevented us from planning our return home. On Saturday they told us it might be Sunday night. Then on Sunday the doctors bumped that back to Monday, perhaps. On Monday, our departure was again delayed.

On Sunday the girls went through a car seat test to make sure they could breathe freely. We brought the car seats and the girls back into the IMN. The nurses situated them, hooked up the appropriate monitors, and then we waited. The test took 90 minutes, which was also the amount of time it would take us to drive home. One nurse told us to get out of the hospital during the test. She volunteered to watch the girls once they were finished. She also recommended a frozen yogurt shop. We relished the freedom to be outside and have a treat, but of course the minute we sat down with our desserts, we wanted to return to the hospital as quickly as possible.

The girls passed the test. We were blessed that the car seats we owned were one of the only models on the market approved to carry infants as small as the twins. So now I was thankful I returned that car seat I bought in April.

We grew more anxious to go home. For the first few days of the girls’ lives we were so exhausted and stressed we did not care much about comforts. The hospital brought me a hamburger for dinner on Saturday night. I took one bite and said to myself, “This is the worst hamburger I have ever had and I’m going to eat all of it.” By Sunday eating hospital food, wearing the same few shirts and shorts, and being cooped up in a sterile room grew old. Earlier the thought of caring for two infants at home without a nursing staff helping worried me greatly. Now I wanted to be home with my family, finding a routine for our new lives. I wanted to be with Elijah, hear his stories, play with him in the backyard.

Monday morning our good friends the Seos visited. They lived nearby in Petaluma. Carey and Monica have been friends since junior high. We loved being able to celebrate Bethany and Joy with these dear people. They also brought us some fresh fruit and snacks, which were a godsend.

When we learned we would not head home Monday, Carey’s parents drove Elijah to the hospital again. He finally saw Joy in person. Carey’s mother met her granddaughters for the first time. The birthfamily also arrived and Elijah played with the birthmother’s daughter. Carey’s parents told us as they left the hospital and drove home Elijah had a meltdown. Because we did not know exactly when we would come home, we could not prepare him for how long we would be apart. Separation anxiety set in and stayed even after we returned to Pleasant Hill. For over a week he had difficulty going to bed and would ask us several times if we would be home when he awoke. He heard my car leaving the driveway when I went grocery shopping one night and he broke down in tears. In all our work preparing Elijah for two new babies at home, we had not considered preparing him for our hospital stay.

Carey,-Elijah,-and-Joy

On Monday night we began to see some hopeful signs. Bethany began to gain weight and it looked like Joy’s loss was slowing to the point of bottoming out. At the Tuesday weigh-in Joy not only had stopped losing weight, she had put on five grams. Technically she still weighed less than the medical staff wanted in order to discharge her, but because she was gaining, they said we could go home that night. We would monitor her weight closely and they made a pediatrician appointment for us the next week.

Nothing in a hospital moves as fast as I would like. We packed our belongings. Nurses came in to say goodbye. We prepared the car seats. The hospital staff brought in a Radio Flyer wagon so we could cart our stuff out to the car. I went down to the parking lot, packed the car, and returned. And we waited. I felt almost as anxious as I did when I sat in the waiting room during the twins’ birth.

Finally a nurse came in with the last bits of paperwork we needed. We strapped the girls in their car seats, placed the seats on the wagon, and bolted for the elevator. As Carey waited with the twins by the curb we caught a glimpse of our new life. Most of the hospital offices had closed and the parking lot stood still. From out of nowhere three women who must have sensed a tremor in the Force appeared and began to fawn over the girls. We knew from our experience with Elijah that babies have a magnetic pull. With twins that power seemed exponentially stronger. I imagine if you held a compass near the twins, you could not find true north.

We packed the twins into the car and began the hour and half drive home. I remember when we took Elijah home from the hospital, I drove incredibly slowly and carefully. The distance between the Kaiser Walnut Creek facility and our home is only 5.6 miles. Now we had 67.8 miles of road to contend with, including freeways and unlit country roads. Still, the terror of driving with newborns was preferable to another taxing yet mind-numbing day in the hospital. I pulled the car out of the parking lot and we drove to our new reality, grateful to God for the girls’ health and their birthfamily’s generous love.

Twins-in-the-Wagon-and-Garden