Reflections on 2014 – The Mom I Am

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In 2014, I became the mom I wasn’t used to being. The abrupt addition of two toddlers into our family took us on a wild ride. This past year, I was the mom whose three toddlers were fighting with one another in total melt down as we waited at the doctor’s office – kicking, throwing shoes, jumping on the doctor’s ipad, you get the idea. I was the mom whose child screamed for 2 ½ hours straight on a flight without Erik there to help me. I longed to just forget our checked bags and run out of the airport, never having to face the other passengers again! I was the mom that completely no-showed a long awaited subspecialist appointment because on that day, well … I just … forgot. I was even the mom who brought her child into the ER and watched my coworkers descend upon him in a flurry of IV lines and lumbar puncture kits, etc. as I sat wide-eyed next to the bed afraid for his life and worried that I had waited at home too long (in the end he was fine and I realized my clinical judgement was correct). I have been on the other side of all of these moms. I’ve been the provider nudged by the nurse to quickly see room 3 before the children destroy the place, and the one who has time to kill due to no-show appointments, and the one who is attempting to comfort the worried mother, but in my own mind questioning why she didn’t recognize the signs of illness sooner. I find myself searching the depths of my memory, wondering who I was two years ago, and if I was ever tempted to pass judgment on the family whose kids are ill-behaved, or, more likely, tempted to feel pride in my well-mannered children.

I will admit, the thankfully short-lived ailments we faced in 2014, including melanoma, mono and meningitis, didn’t help subdue the roller coaster ride we chose to be on this past year (and oh how the pediatrician in me wants to regale you with my tale of triumph over head lice in a family of eight, but, I’ll refrain). Suffice it to say, life presented its challenges for us in 2014, and I’ve had to sacrifice not only my calm, orderly life, but also my pride.

Thankfully, the story doesn’t stop there. Because you see, somewhere in the midst of those chaotic moments, something incredible happened. In a miraculous way, that’s difficult to describe in words, our hearts became filled with unconditional love towards our two new family members. The struggles and trials and disruptions to our calm life grew dim and meaningless, as we fell in love with them.  The joy of having them in our family replaced a thousand fold over the accompanying trials.

We have never experienced anything here on earth that has so intimately drawn us to an understanding of our adoption by God. God, in his infinite mercy, chose to save us, to claim us, to call us His. Erik and I were lost, and wretched, and have done nothing to deserve such unconditional love before or since.   And God found us and adopted us into His family. This is only possible because Christ came – the very thing we celebrate at Christmas! He was born that first Christmas morning, with the purpose of dying on the cross to pay the ultimate and final sacrifice for our sins.

I have hope for 2015, that I may again have children who can consistently sit still and wait patiently, even without the use of an ipad, or that I will at least remember to call if I have to cancel an appointment. But, you know what, even if I don’t get there in 2015, it’s okay. God has allowed me to experience a miracle here on earth – as the miracle of my own salvation is reflected in the miracle of our adoption of Maya and Zach. And that is worth far more than my energy, my ambitions, and my pride.

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“Won’t it Be Hard to Say Goodbye” – Part II

A few weeks ago I spent the early part of the morning in a hospital conference room listening to the workings of the children’s ED.  Baby boy in tow, I left the meeting and drove further south to the DFPS building for a bio parent visit. Pensive following the collision of my medical world and my foster mom world, I drafted this post, which has been one that has been brewing for months now.  Consider this a sequel to the “Won’t it be hard to say goodbye” (Nov 2013) post.

Often physician groups will devote time to “M and M”, morbidity and mortality. A time to review as a group particular cases with bad outcomes and what went wrong, what could have been done differently, what could be changed in the future.  This morning a patient was mentioned who had presented to the ED, was sent home, and came back a few days later with a very significant disease process.  The physician who had seen the patient on the initial visit spoke up, and as he described what had happened on the initial visit and the numerous times he has reviewed the chart since then, I could see his eyes watering.  Ugh, I have been there, and wow is it painful.  As a Christian, I know that it is God who sovereignly ordains the time for man to die, as is the motto at a Kenyan missions hospital, “we treat, Jesus heals”.  As a physician, I know intellectually that there are times that despite my intervention, despite my appropriate thought process and assessment of risk, etc. there can still be bad outcomes.  I remember my first boss out of residency telling me years ago about a patient he was involved with who had died.  He shook his head and said, “sometimes you just have to reconcile that you didn’t do anything wrong, you were just in the wrong place at the wrong time”.  Well, that was the sentiment that I felt hearing the story today, knowing full well that had I been the one seeing the patient on the initial visit, I would have also sent them home, and then I would have been the one pleading with my conscience to be fully assuaged by my colleagues reassurances that they would have done the same thing.

I am going to tie this back into foster care.  See, again and again, I hear, “I could never do that, I am afraid of getting attached and having to say goodbye”.  The sentiment reminds me of medicine.  And I do hear that with some frequency when I mention pediatric ER to people, “oh, I could never do that.”  Just like my colleague, who spoke with an obvious burden that morning over the patient he had treated, we all go to work every shift knowing that we are taking the same risk.  That at some point, some child is going to come along, and despite your best care and concern, things aren’t going to go as you would expect and there will be resultant significant morbidity or even death.  The physician will then be left picking up the pieces, reviewing the chart over and over, running it by their most trusted co-workers, asking themself and others again and again, “should I have done something differently?”.  That’s a heavy burden to carry.  I am reminded of an adolescent I saw years ago in the ER.  I poignantly remember him lying on the gurney in the resuscitation room and my putting my hand on his shoulder, looking down at him, and saying, “(his name), you are very sick, but we are giving you the medications that you need and they are getting ready for you to go up to the PICU … it’s going to be okay.”  But it wasn’t okay.  He went to the PICU and died 12 hours later.  I was devastated.  I was left reeling over his case, I could probably still tell you his vital signs, every medication that was given, every presenting symptom, etc. and if given the right audience I may still be tempted to rattle off his case in hopes that yet again I can hear the, “I would have done the same thing” platitude.  I remember the distracted tone in my voice for days afterwards when my children would ask me for something and I would look at them blankly, realizing that my mind was again wandering back to lab values, and IV fluids and my final conversations with that patient and his mother.  Despite my best efforts to reassure myself that there was nothing I could have done to change that outcome, I can still feel my eyes water when I think about him.

Recently a question went around on the Pediatric Hospitalist Medicine listserv along the lines of, “how do we, as hospitalists, deal with kids dying, the multitude of abused patients we see, unexpected bad outcomes, etc, etc.?”  The sentiment of the post being, ‘sometimes this is emotionally very hard, help me figure out how to cope and still be able to function in my non-hospital life’.  This single email prompted more responses than any other listserv topic.  And they were passionate responses, and responses from listserv “lurkers” who had never posted before, things like – ‘I listen to music, I take time on overnight shifts to sit in the rocking chair and hold a traumatized baby, I meet with the residents and we go over the case and use it to teach about compassion, I talk with my spouse over a glass of wine, I review with my colleagues, etc., etc.’.  But here’s the point, and listen closely, not one person, not one, said, “you’re right, this is emotionally just too hard, maybe you/we should quit?”  No one would have written that!  It almost seems comical to even suggest it.  Why?  Because we all go to work every day believing that we are making a difference, that we are helping families and children in significant distress, that we are using our skills to change the outcome of illness, often devastating illness, from bad to good.  Man, that’s worth it.  That’s worth the risk, that’s worth the (at times) emotionally heavy burden.

I find a similar resolve in the foster family warriors I meet.  Erik and I are such newbies at this, I don’t give us any credit.  But those families that have loved and said good-bye, and loved again and said good-bye, and loved again, they are true warriors.  And I know that they would tell you the same thing I would tell you about pediatric hospital medicine.  Yes, it may be painful at times, but it’s more painful to know that the need is tremendous and children are hurting and not do anything about it. Yes, there is significant risk that in this process you will be hurt, but the chance to impact a child’s life by providing them a safe, loving home for even a time, is worth so much more.  Again, it may be hard, but it’s worth risking and even enduring the hard, to have an impact that is great.

So again, I say this to make a point about fostering.  See, whether we are talking about medicine or foster care, you must realize that it’s not that any of us have developed some super-human strength that allows us to separate our emotions from work that needs to be done. Man, going back now 15 years even, I can tell you details and names and faces of children and their families who I have witnessed facing that most unimaginable pain of childhood death. They are forever etched in my mind, and sometimes when I’m reminded of them I may even be moved to tears, or else prayer for them, wishing that there were anything I could do to ease the pain I know they still experience.  In response to the listserv query I mentioned above, one person wrote, “the day that any of us stop being affected by the sad cases we are involved with, is the day we should stop practicing medicine.”  Similarly, foster parents fall in love with kids too and feel the pain of loss as poignantly as anyone. In fact, if one had the ability to take foster children into their home and remain completely unattached, well, maybe they shouldn’t be fostering.  No, it’s not that any of us know the equation for blocking our emotions.  On the contrary, we’ve made the conscious decision that we don’t care if it hurts sometimes, we don’t care if it’s painful at times, because without doubt, it’s worth it.

So, thank you, to those of you who’ve read this far and are among those foster families who have loved deeply and said “goodbye” and done it again. You know who you are. You not only have given those children a tremendous gift, you have inspired others to follow you on this path. After all, people like Erik and I have been watching you – and you’ve given us the courage to take a risk for the sake of a child in desperate need.

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Let’s Talk Family Court

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It’s time I wrote about court.  The last time Erik and I went to court we proudly realized that we have learned enough of the system to enter the Bexar County Courthouse (that’s San Antonio, for you non-Texans) with confidence.  We know where to park, we know how to wait for that funky diagonal crosswalk signal that gets you through the whole intersection, we know which door to enter in and we empty our pockets for the metal detector and place our bags on the x-ray belt without hesitation.  We know which elevators to take, we get on and press the 3rd floor (family court), and then turn to the left – because that’s the direction of our judge’s courtroom.  We can spout off all of the typical cast of characters – the judge at the front of the room, the ad litem who sits to the left and represents the kids and their best interests, the DA and CPS caseworker in the center who act effectively as the plaintiffs, the line-up of bio parents (often one mother, and one or more fathers) and each of their attorneys sitting to the right.  We don’t wander the halls looking lost anymore.  When we actually ran into another foster parent friend at the courthouse last time, we really felt like we belonged.  Yes, we feel relatively at ease at the courthouse.  Is that something to be proud of?

The Bexar County Courthouse is a striking old red brick 5 story or so building in the center of downtown.  We now know that one end of the family court hallway holds Judge Garcia’s courtroom and the other end Judge Montemayor – two men who have one of the most intriguing, influential, powerful and yet unenviable (in my opinion) jobs imaginable.  I am amazed at how many times I am asked by a fellow foster parent, “who is your judge?”  Hmm, The Lord, God Almighty?  Oh, no wait, you mean for my foster children.  Somehow the reputation of these two men circulates around the foster world and everyone enthusiastically offers their two cents on your judge and whether they are on a “unification” (send kids back to bio parents) or “termination” (don’t send them back to bio parents) kick.  Since all of the cases are public hearings, you have the option of waiting in the hallway for the name on your case (usually the child’s last name) to be called, or sitting in the back of the courtroom listening until your case comes up.

The first time we went to court, we were immediately greeted by our CPS caseworker, who warned us that baby boy’s dad was waiting in the hallway and asked if we wanted to meet him.  “Sure?” we answered, in the same tone a more cautious child might use if you’ve just asked them if they’re ready to ride without the training wheels.  Thankfully, Dad was very kind to us.  As we had been warned, he was willing to stand and talk and talk as long as we would listen – telling us about his attempts at employment and residence, etc., etc.  Had I had my whits about me, and not been in a minor state of shock meeting this man, I would have put on my medical hat and snuck in questions along the lines of, “does anyone in your family have asthma?  eczema?  allergies?  has anyone had heart disease at a young age?  sudden death at a young age?  high blood pressure?  diabetes?  any mental illness?  did bio mom use drugs during the pregnancy?”, well maybe some of that would have been going to far, but you get the idea.  Erik at least had the forsight to ask if we could take his picture, which he was more than willing for us to do.  (Someday, that may be a treasured small piece to the puzzle baby boy will construct as he answers for himself who his bio dad was.)  He talked about his faith and we talked about ours, and told him we would pray for him.  We shook hands, assured him we would take care of and love baby boy for as long as he was with us, and parted ways to go into the courtroom.  The second time we went to court, which happened to be the termination of parental rights hearing for our case, I couldn’t bear to stand out in the hallway and make small talk with baby boy’s dad.  The pit in my stomach of what was about to happen, compelled me to say a brief hello and then excuse myself into the courtroom to sit quietly in the back.

Now in the courtroom, I was in awe of the commanding presence of the judge.  Hearing him speak with such confidence, quickly making decisions and justifying them, taking time to explain why the law mandates his rulings.  While awaiting our case, we heard one case that involved termination of parental rights in which both biological parents were present to argue their side.  Several minutes into the case I recognized the story as a family whose children had been placed with foster friends of ours.  As such, I knew some back story, and that drug addiction and its, at times, violent and neglectful consequences, was the primary impetus for keeping these parents from their kids.  While bio mom was sitting next to her attorney in tears, the judge turned to address her and took her back hearing by hearing over the 12 months of the case and explained why the law dictated that termination now occur.  He made it very clear that when CPS takes custody of a child at 262 (see Let’s Talk CPS Timeline), one of two things usually happens.  Parents freak out and immediately do anything and everything CPS asks of them in order to get their kids back.  These terms are clearly spelled out in the “service plan” created for each case.  The service plan often contains steps such as attending counseling, drug rehab, documenting stable residence, obtaining a psychologic evaluation, etc. So parents appropriately freak out, or (going back to the judge now) parents do nothing – for months and months on end.  This case had been the latter.  As such, the judge again looked directly at the parents and stated, “Quite frankly, you’re out of time.”  I watched the mother exit the courtroom in tears and for a moment wished I could disappear and weep myself.

Erik and I have now been to a total of three hearings on the case of our foster children.  The experience for me always proves to yield both an emotional and visceral response.  At times I am hopeful, as our case moves closer and closer to adoption.  At times I am nervous, even though I have clearly done nothing wrong.  I have always driven home from court, wishing for nothing other than to climb in bed, pull the covers over my head and sleep – a testament to how emotionally exhausting I find the process.  Our termination hearing was 30 minutes or so of listening to the cast of characters above, review the past year of CPS custody for our children and the lack of progress on the necessary service plan.  For a long thirty minutes, I sat on the wooden bench in the back of the courtroom, knowing that at this point my heart was very much on the line, listening to more sordid details of my foster children’s past, hearing attorneys grill bio parent on points of the service plan.  At one point an attorney made the statement, “little girl has an amazing bond with the 3 year old biological child in the home.”  I bit my lip, and looked down at my shoes as I felt my face flush from the emotion of hearing my Nate be called out as evidence before the judge.  Several minutes later the ad litem added, “foster mom is a pediatrician and as such has been able to take care of all of baby boy’s medical problems.”  Again, face flushing, lip biting, looking at floor.  Erik tapped me on the knee reassuringly.  The judge finally pronouced the inevitable termination, with a heaviness in his voice.  Erik and I left court, with an internal maelstrom of emotions.  Our excitment over the prospect of adoption was tempered with sorrow.

I can only metaphorically describe the experience as if we had just attended the funeral of our foster children’s biological parents, without our foster children even knowing.  Baby boy and little girl are too young to even have a glimmer of understanding of what it meant that Erik and I were going to court.  But someday they’ll understand.  And although Disney may try to convince me that this scenario ends with “happily ever after”, I know that there will be a necessary and hopefully healthy grieving in their future.    Of course I know that the alterative would be far worse, had the ruling been to return the children to bio parent, we would have left terrified.  For the days that followed our termination hearing, when my whirlwind of intrusive thoughts about how life-changing that court day was for our family would calm, I was left pensive, saddened that the children that I now love will someday walk the difficult road of mourning the loss of a life with their biological parents.  And yet, there is good associated with the grief.  I know God has used my own grieving for baby boy and little girl’s loss to transform my heart from that of their foster mom to, Lord-willing, adoptive mom.

When Pink Melts Your Heart

 Going for the double entendre here – as facebook is filled today with hearts and pink and words on love.

A couple of weeks ago we took our kids to the Great Wolf Lodge during winter break.  Our school has always had a winter break during the first week of February, a coveted time to vacation in spots that are otherwise crowded with children during normal school breaks.  Initially we decided to put little girl and baby boy in “respite” care (remember, that’s when you let your foster children stay with someone else who has met all of the arduous licensing requirements necessary to take them).  I dropped them off on Friday afternoon to a sweet family that we know and trust.  Friday night our house was a buzz with about 30 guests for Bible study, and hoping to keep the trip a surprise, we pulled off the evening without our older kids realizing that baby boy and little girl weren’t with us (they “went to bed early”).  After our four bio kids were in bed, Erik and I stealthily packed and loaded the car.  Saturday morning Erik and I woke up, enjoying that first-day-of-vacation giddiness.  But something was missing.  “Do you think we should take little girl with us?” I asked him coyly.  He confidently smiled and replied, “yes, I’ve been thinking that all morning”.  So, feeling a little schizophrenic, I promptly texted our sweet respite care friends and said, “do you mind if we change the plan and come pick up little girl on our way out today, we just can’t stand to leave her?”  A good sign that our hearts are embracing her as part of our family.  As we envisioned her smiling and playing in the waterpark, we just couldn’t bear to leave her behind.  (In contrast, we felt quite confident baby boy, although we would miss him,would have a better time staying behind – he’s just not old enough).

We had a great time at the Great Wolf Lodge.  We took little girl swimming for the first time since we have had her.  We have tons of photos and videos documenting our time together, and I know those will be treasured.  Particularly if someday I get to share with her how she became part of our family.  I will treasure sharing with her those vacation pictures with her in them.  But here’s the story I want to share.  One morning I woke up and took my loud, boisterous Nate and little girl out into the hotel with me to get coffee.  While walking around the lobby, I noticed that the Pink song “Just Give Me A Reason” was playing through the hallways.  Now, I’m not really familiar with Pink songs, well with most of pop-culture for that matter, but this one I know.  You see during our foster training our instructor played this song for us.  She loved the lyrics and applied them to fostering.  So here I am, coffee now in hand, walking through the expansive lodge.  Ahead of me are Nate and little girl.  They are running down the long hallways together squealing and laughing.  Periodically Nate would halt, hold out his hand and exclaim, “wait, ‘little girl’”.  She would stop and smile at him with anticipation.  He would then announce, “on your mark, get set,go” and they would be back at it again racing the lengths of the lodge.  While sipping my coffee, watching them completely engaged with one another, her eyes sparkling at him, his laughter echoing the lobby, the chorus line lyrics “we’re not broken, we’re just bent and we can learn to love again” were resonating in the background.  Taken back to a mere 9 months ago, when we were wide-eyed newbies sitting in training class, the moment was almost too much for me to bear.  I was biting my lip, pinching my fingers, whispering in my head “hold it together Viv”, trying to keep myself from becoming a bawling, blubbering mess in the middle of the Great Wolf Lodge.  In my mind were days of our training, days of uncertainty of what lie ahead, days of wondering what we were getting in to, and days when our excitement was tempered by the realistic fear of the unknown. As  I looked back on those days I couldn’t help but wonder “what if”.  What if we hadn’t done this, what if we had thought it was too much work, what if we had decided it was just too risky, what if we had chickened-out?  Now I was in the moment, staring at this beautiful little girl who is so much a part of our family that she laughs and plays with no inhibition, that her mannerisms are becoming “Carlin” in nature, that we can’t bear to not take her on vacation with us.  In that moment I wished I could just disappear into the walls and weep and weep, out of shear amazement and gratitude for what the Lord has done.  I felt so incredibly grateful.  So grateful that God has led us to this point and has given us little girl and baby boy.  So grateful that He didn’t let our fears or apprehensions allow us to miss out on this or miss out on them.

This Valentine’s Day I am seeing lots of reminders of Mark 12:30-31 “And you shall love the Lord your God with all your heart, with all your soul, with all your mind, and with all your strength.  This is the first commandment.  And the second, like it, is this: You shall love your neighbor as yourself.  There is no other commandment greater than these.”  Loving your neighbor as yourself means not just loving when it’s easy or comes naturally, but also when it is hard and requires sacrifice.  Man, that’s a hard commandment, and certainly one I only partially achieve intermittently at best (yes, I need a Savior!).  But I will say this, we are loving little girl and baby boy.  And more so than any other time I can think of in life, it has been hard to love them.  Not hard because of who they are – they are adorable, sweet children who anyone would be endeared to.  But hard because it’s so much work, and there is so much risk involved – so much risk in giving of our hearts, knowing that we don’t have the green light yet that they are ours forever.  But boy, has it been worth it.  Allowing God to use us, even in our imperfect love, to show them love,  allowing Him to be the strength we depend on to carry on day by day, seeing the joy in little girl’s eyes as she becomes an integral part of our family, seeing baby boy grow and develop and overcome his prematurity and failure to thrive – wow, I have trouble explaining in words what all of that feels like.  And so my sentiments are those that I felt that vacation morning while listening to the words of Pink.  These children weren’t broken, just bent.  And God has given us the privilege of taking a role in healing them with our love.  There is nothing I can do but weep.

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Let’s Talk CPS Timeline

Before we can have a discussion about going to court, you need to have some background understanding of how children come into CPS custody and the legal process that follows.  I remember my excitement when we finally came to this point in our foster care training.  Being analytically minded, I was chomping at the bit to take in every ounce of information in an attempt to understand the process we were signing up for.  Again, this is specific for Texas, but at least it provides a point of reference for those of you who live elsewhere.

Okay, let’s say CPS has been called by a school nurse for suspicions of neglectful care of a child.  CPS conducts an investigation, and does confirm concern for neglect.  Depending on the degree of neglect and circumstances, CPS will generally follow one of three tracts:

1.  They recommend Family Based Services.  The child stays in the home, the family receives services, which may include help finding permanent housing, employment, parenting classes, etc.  CPS may choose to follow that family for a year or so to ensure that the child is being cared for and the parents are making progress.

– OR –

2.  The child is placed in a kinship placement.  Now, this is a huge one here in Bexar county, and because this option is always considered first, the majority of kids who need to be removed from their home will land in one of these placements.  From what I understand, the definition of “kinship” can be pretty broad.  There are the obvious options – grandma, grandpa, aunt, uncle, but if none of those come through, well let’s also consider mom’s friend, a neighbor, a friend’s family, uncle’s girlfriend, the family at church, 1st cousin, you get the idea.  CPS will continue to monitor the child without taking custody, and creates a “safety plan” that sets the terms for the placement (for example, bio dad is not allowed to visit the home).

-OR FINALLY –

3.  CPS removes the child from the family, takes custody and places them in a foster home.  Because of #2 above, a fairly high percentage of children who make it down to #3 actually end up being adoptable by the foster family.  The statistics I have heard range from 40-70%.  You can imagine the number of resources you have to fall through and lack of support you have to have for your child not to have a kinship placement option.  Sometimes I muse myself with the thought of how many people I know who would step forward as a kinship placement for my biological children should they be removed from us, heck, I mean I think besides our family and closest friends, likely our entire church could qualify as a kinship placement, and then what about my neighbors, etc., etc. so I hope the list could be pretty long.

Now, let’s say the above child, who was alerted to CPS by the school nurse, has had their home investigated and CPS has deemed it necessary to remove the child from the home.  No appropriate kinship placement has been found and they have now chosen option 3 and are placing the child with a foster family (watch for a future post discussing what that fateful day looks like for the accepting foster family).  Within 72 hours or so, CPS goes to court for what is called the “262 hearing” (termed such after Family Code, Chapter 262, subchapter B “Taking possession of a child”).  CPS may continue to look for a kinship placement while awaiting the first hearing.  At the 262 hearing the case is presented before the judge and a decision is made as to whether the child should be returned home to bio parents or CPS should officially take custody.  72 hours is a rough guideline, 262 can be delayed if the bio family is taking legal action, hiring an attorney, etc.

Okay, so the child’s case has been presented to the judge and the ruling is that CPS will take custody of the child.  Now, the timeline begins.  The bio parent(s) are given a CPS plan as far as what steps they need to take to regain custody of their child and exactly how long they have to complete their plan.  These steps may involve drug rehab, regular drug testing, parenting classes, anger management classes, demonstration of consistent employment, demonstration of a place to live, a psychological evaluation, etc.  This plan is clearly laid out for the parents and dates are set for the future hearings.  An ad litem is assigned to the child, the bio parents are also assigned attorneys.  CPS, the ad litem, the bio parent attorneys, the bio parents, and the foster parents (if they choose to attend as listeners only), will now be in court at 3 months, 6 months, 9 months and 12 months to present progress on the case.

Keep in mind, that when CPS takes custody there are two possible outcomes (you will here these terms frequently):

1.  Reunification (child goes back to bio parent – an outcome that everyone in the process has to hope for unless deemed unsafe)

-OR-

2. Termination (bio parent rights are terminated, either because the court deemed the parent unsafe or because the parent chose to relinquish their rights).  Termination of parental rights is often referred to as “TPR”, that’s another good acronym to store in your back pocket.

Until the 9 month mark, CPS has a legal responsibility to track the case for both possibilities.  As early as 9 months the court can terminate parental rights if it has already become clear that the case is headed in that direction.  If that doesn’t happen, then by 12 months a “decision of permanency” needs to be given – either we’re going for reunification or we’re terminating parental rights.  If bio parent seems to be “working their plan” but isn’t quite there yet, they can give one 6 month extension.  By 18 months, at the latest, everyone should have a final decision.  Of course there are exceptions to any rules, but this is generally how things flow.  If termination of parental rights occurs, the case enters a final 90 day waiting period for any extended family to come forward (although remember, at this point they’ve often already had one year to come forward).  After the 90 days, the foster family is given the chance to adopt.

This sets the stage for me to tell you the story of our court experiences.  Until I have time, you can wow your fostering friends by speaking their lingo and asking them questions such as, “has 262 happened already?”, “does it look like it’s headed towards reunification or termination?”, “has TPR happened?”  Oh yeah, you’ll be down with your CPS peeps.

Does twelve months seem fast to you?  It did to me.  Here’s the thing though, one facet of this process that no one will argue with is that children do not do well in the foster system.  By that I don’t mean that they don’t thrive and heal in loving foster homes.  But as soon as children pass 262, the preeminent goal of everyone involved must be to get them out of CPS custody – either home with bio parent, or permanently into a loving adoptive home, hence the rigid timeline.  We know some sweet foster children whose bio mother was a product of the foster system.  She spent her entire life in foster care, over 30 placements, suffering some abuse, and finally becoming an emancipated minor at 17.  It’s too late to change her past, but it’s not too late to change the course for her bio children who are now in that precarious place that is the foster system.  Get it done, make decisions, get these kids in their forever homes (bio or adoptive) as quickly as possible!

IMG_3036My rough sketch of the above info.  I am in no way an expert, if you have more to add or correct, then please comment below!

Let’s Talk Benefits. I’m Glad You Asked.

Since my last post (Ages ago, I know. Holidays, family in town, celebrations, what can I say?  You know how it goes.), anyway, since my last post, many the astute reader has asked, “are you paying for synagis?”  What a good question!  And a well-informed question as well, since it implies a knowledge that synagis is expensive.

For my non-medical peeps, synagis is a specific antibody, against respiratory syncytial virus (aka RSV), that is given as a shot.  Aaaah, RSV, the archnemesis of the pediatrician during the winter, often arriving with its compatriot, the flu, causing ER censuses to double or more for months, filling hospital beds with infants on oxygen, during bad seasons sending otherwise healthy infants to the PICU.  Synagis is given as a monthly shot at the onset of RSV season (typically October).  Since it is not actually a vaccine, where lasting immunity is built in response to an antigen exposure, the shot is only effective while the recombinant antibody is circulating – typically one month.  Therefore, the shot has to be given monthly through RSV season, 5 months or so.

So as I was crafting this post, I thought to myself, “I wonder if the average, non-medical person knows how much synagis costs?”  So I turned to my resident average non-medical person, Erik, and inquired of him, “how much do you think synagis costs?”  Now to say that Erik has the medical knowledge of the average non-medical person is probably underestimating him.  I like to think that his marriage to me has at least allowed his medical knowledge to increase to slightly above average.  At very least he would understand me if I told him I had a champagne tap at work and he knows that most pediatric ailments can be cured with Tylenol, Motrin, and most importantly, time. I’d like to say that my marriage to him has similarly increased my technology skills, but in fact I am afraid I still dwell at “below average” on that one.

Okay, so I ask Erik how much he thinks synagis costs.  “Well,” he says, “I know you’ve said it’s very expensive, so I’m going to say … $200 per shot?”  Aha, I’m thinking, this is good, he is actually a full order of magnitude off.  So synagis costs approximately $2000 per shot.  It’s hard to put an exact figure on the cost since it is dosed by weight, but $1500-$2500 per shot would be a reasonable range.

Even if I couldn’t anticipate your next question Erik would have revealed it, as he looked at me in shock and said, “What!  That’s crazy!  Our tax dollars are paying for that?  What is this shot for anyway?  Is it really necessary?  If one of our bio kids needed that, there’s no way I would pay $10K for it!”  (LOL, glad someone in the family confronts modern medicine with healthy skepticism.)  So, RSV, like any viral respiratory illness, can masquerade as a common cold, but don’t let its benign act fool you – its effects in infants can be quite severe, sometimes downright scary.  Hypoxic infants with RSV fill pediatric hospitals during the winter season.  And while the full term infant with RSV who needs a little oxygen and some help feeding is so common place that it is considered the bread and butter of pediatric inpatient care training, that same infant with extreme prematurity or cyanotic heart disease likely provokes tachycardia in even the most seasoned of medical staff.  The effects of RSV can be devastating in premature and otherwise at risk infants.  It’s not uncommon for the treatment course in that situation to involve a PICU visit, intubation, a prolonged hospital course and lingering side effects on those susceptible lungs.   Perhaps, someday, we’ll defeat and cage this villain with a simple vaccine, as medicine has done previously and triumphantly over smallpox, polio, Hib, pneumococcus, etc. Then I’ll be the senior ED provider who can speak the lore of “back in the day” when the ED was filled with sick infants with RSV …, just as some of my colleagues can talk with seniority about diagnosing meningitis “all the time” in the 80’s (prior to the development of Hib and prevnar vaccines).  But until an effective vaccine is developed, our only option is the insanely costly synagis course.  In case you’re wondering, there are strict algorithms to determine which infants qualify for synagis.  They typically include premature infants (degree of prematurity and age at onset of RSV season taken into account), significant congenital heart disease and chronic lung disease.  And yes, $10K sounds high, but it’s a steal compared to paying for a PICU admission.

So, all of that brings me to a topic that I have wanted to address for a long time – benefits.  Whether you are considering fostering, know people who are fostering, would never consider fostering, etc. I feel that everyone should be equipped with an understanding of the support the government provides to help enable families to foster.  At very least, it may come up for you at some time as a conversation point when a friend says, “we’ve been thinking about adoption.”

Until we started looking into foster care we had NO idea that foster children come with incredible benefits.  So let me tell you the benefits our kids have.  If I had infinite amounts of time to write, I’d love to do an analysis of how this varies state to state, but – infinite time to write – who am I kidding?  At least this will give you an idea of what benefits Texas foster children have.  To start, they have Medicaid.  So, Medicaid pays for synagis, and everything else for that matter.  Baby boy has had multiple doctors visits, therapist evaluations, a couple of medications along the way, as well as his monthly synagis shot.  I haven’t paid a cent, no copays, nothing.  Nearly every year during open enrollment Erik and I methodically weigh different insurance plans as far as copays and deductibles and prescription coverage and incentives for routine health visits, etc.  I have to say, it feels odd to experience a plan where I pay nothing for anything.  Foster children are also eligible for WIC (similar to food stamps).  As baby boy downs around $250 per month of Alimentum (special formula), the WIC benefit has been substantial for us, as it fully covers this and more.  Incidentally, it is also the benefit that has caused me the most personal dilemma over whether or not I should take advantage of, since it is optional for foster families.  Someday, I’ll write about my experiences as a WIC shopper.  Foster children also come with a monthly stipend.  Children without any significant medical or behavioral needs are considered a “basic” placement and the government pays the foster family $23.10 per day per child.  Children with significant medical needs are considered “moderate” or “advanced” and the stipend is appropriately increased.  If a foster parent who is single or both foster parents of a couple are working they are eligible for coverage of daycare costs.  When a foster child is adopted many of their benefits continue.  Depending on circumstances (age of child at adoption, adoption of a sibling group, etc.) foster children may be eligible for Medicaid and their monthly stipend until they turn 18.  Children adopted through the state receive full tuition at a Texas college.  Adoption fees are – WHOA, wait, what was that, did I just say that adopted children have full in-state college tuition covered?  Yes, I did.  That’s a big one.  And, adoptions fees are covered by the state.

Of course this is not meant to be incentive alone to cause people to foster.  Clearly, foster parents give much more of their hearts and time than could ever be fully compensated by benefits.  But, the benefits do help remove some potential practical roadblocks that could dissuade families from fostering.  Nonetheless, when money is involved, there will be someone looking to take advantage.  I will always remember the first phone call I made researching foster agencies, this was years ago.  The man on the phone at this particular foster agency implored to me repeatedly in the first several minutes of our conversation that individuals/couples considering fostering must make a minimum annual income to qualify.  After repeatedly stressing this point upon me I tried to assuage his concern and assure him that we met the requirement.  Apparently not satisfied, he continued on with his tirade about people fostering for the wrong reasons and wanting to make extra money, etc.  We didn’t go with that agency.  When I first called Pathways, the agency we are licensed through, my conversation with the recruitment director went something like this:  After initial introductions, she said, “the first thing you need to know about fostering is that ALL children who are placed in foster care have been traumatized in some way.”  Pause.  Okay … you’ve got my attention.  Go on, I’m listening.

I’ll leave it at that for the night.  Someday I’ll elaborate fully on the sentiment that all foster children have been traumatized, as well as tell you what it’s like as a physician to be the patient at WIC, and take you on a journey with me to family court – in as much heart wrenching, tear-invoking, eye-opening detail as I can confidentially provide.  Perhaps for some this post has made foster care seem more financially reasonable than you may have thought, hopefully for others you now at least know more than you did when you started reading this post – if not about foster care benefits, then perhaps, about RSV and synagis.

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(baby boy laughing at “ride a little pony”)

Two Months Strong

I have looked forward to writing this post for a long time.  When baby boy and little girl first came to our home, I often wondered what it would feel like to make it this far.  This past week marked two months that they have been with us.  It seems like a small monument to pass, but for some reason, I have held on to the goal of making it to two months and I feel a sense of victory and renewed energy to see it pass.  When baby boy and little girl first arrived on our doorstep, they were accompanied by the necessary upheaval and acute transitions that would occur in our home.  We knew this was coming, we did not have any false pretense that it would be easy.  Our expectations were met, it has indeed been difficult.  Nate, who used to be potty-trained, reclaimed his position as baby and, despite my failing efforts, is now back in diapers.  Not to mention that he has also taken to stripping himself naked, diaper and all, and falling asleep on his bedroom floor after we have tucked him in and left his room.  Yes, two year olds have creative ways of protesting change, but I digress.  Erik and I spent the first three full weekends, from Friday evening to Sunday evening, trouble-shooting and problem solving, in desperate attempts to make our life more manageable.  Imagine baby gates, child proofing rooms, buying extra sippy cups, re-creating a quiet homeschool space, setting up diaper changing stations, etc, etc. – such was the fodder for discussion in any free time we could find.  I cleared out our schedule to accomodate a flurry of initial doctors appointments, therapist evaluations, and caseworker visits.  After two months, the whirlwind of craziness is settling, and those necessary, but pesky guests, “upheaval” and “acute transition”, that accompanied baby boy and little girl through our doorway, are finally making their exit.  Aahhh, little victories.  We have made it to two months and I breathe a sigh of relief.  Now I am excited to be through with “settling in” and turn even more attention to enjoying these sweet children.

And enjoy them we have.  All of us have, including each of our bio kids, who give us unsolicited glimpses here and there into their feelings.  The other night I was telling Bryce it was time for lights out.  “Oh, I have great news,” I exclaimed (I had found a set of Scooby-Doo chapter books that he loves on Ebay).  He put his book down, his eyes widened and with a grin he inquired, “we get to adopt them?”  I chuckled, “no, no, only God ultimately knows what will happen, we won’t know for a while.”  That night he made me smile, as he had given me a candid glimpse into his heart.

Similarly, I was talking with Bethany at the kitchen table one night after all of the littlest ones were in bed.  She was asking me details about court dates, judges, bio parents, timelines, caseworkers, etc.  I explained to her the steps that the courts go through to determine where children are permanently placed.  For the first time, she told me she was afraid that we wouldn’t be able to adopt little girl and baby boy.  Again, she had given me a glimpse into the leanings of her heart.

Despite Nate’s shenanigans and regressions he is still his happy, exuberant self and I know with time he’ll adjust and act as if there never was a time without baby boy and little girl.  To see him and little girl together, you’d think they had been siblings for life – they play with intensity, they bicker and fight with intensity.  Despite the considerable size and weight advantage Nate has on little girl, she has proven herself his worthy camrade when it comes to climbing and running and his worthy opponent when it comes to taking toys from one another.  Despite her petite package, she’s fiesty.  I like that.

In this whole process, it has always been Leah that I have been the most worried about.  We’ve done everything we know to do for her.  We reassure her of how much we love her and remind her that that will never change.  We make attempts to carve out special time with her, which has required some creativity.  For example, she has become my special “synagis” helper (synagis is a shot given monthly to premature infants during the winter to prevent RSV).  So every month, when I am taking baby boy in for his 8:30am synagis appointment (always go for the first appointment of the day – that’s one of my mantras in life 🙂 ), I wake Leah up and she accompanies me.  Actually, if I have hope of any of my children going into the medical field, it’s her.  She is fascinated by doctors visits and likes to watch how they give baby boy his shot.  So our “synagis dates” have been a good fit for her.  The clinic happens to be right across the street from a starbucks – so add coffee for me and a cake pop for her and it’s golden!  We also have tried our best to give her space and to not be surprised by or overreact to negative comments she may make along the way.  Early on she was quite clear, “I just want to go back to being us”.  Two weeks in her tune changed, “we can foster them but I do not want to adopt them.”  Four weeks in her tune changed again, “oh, baby boy is just soooo cute, can we please adopt him?  And, by the way, I do NOT want to adopt little girl.”  (Why, you may ask?  Because little girl is almost two – she cries, she takes toys, she occasionally hits, etc, etc.  I get it, two year olds can be hard to love wholeheartedly).  Now, two months in, her tune has changed again, “I really like little girl, can we please, please adopt both little girl and baby boy.”  It took some time, and there were moments when my heart cringed with fear as I heard her honestly express her concerns and wondered if she would always feel so negatively.  I am now overjoyed to begin changing MY tune with her from, “don’t worry about adoption, that is nothing we will even discuss for months and we may not even be given the chance to adopt them,” to “I am so glad that you want to adopt them, but we won’t know for months if we can, and it’s good if they can be with their biological family again.  Only God knows what will happen so we have to trust that He is good and is doing what is best.”  I’ve always known Leah would get me on both ends.  The initial adjustment and acceptance would be hard and slow, then she would attach deeply and, should the day come that baby boy and little girl leave, she will have the hardest time letting go.  I love that about her.  She is the only one of our children who still refers wistfully to the two Ugandan girls who stayed with us one week last year as they were passing through San Antonio with an orphans choir.  She’ll mention them by name, with that tone in her voice that indicates she is on the verge of tears.  Ugh, saying goodbye would be most difficult for her.  But, I’ve already shared with you, I’m not afraid of hard, even for her (see previous post).

A couple of weeks ago Erik and I ventured out with our six children to the Hondo Corn Maze.  It was a Friday night, and I was reluctant to go – as I envisioned spending my entire time frantically counting heads in the dark in an effort to not lose a child.  Well, much to my surprise and cluelessness, the Hondo highschool football team had made it into some big playoff game that night.  As such, we practically had the entire corn maze to ourselves (ahem, non-Texans, high school football is a BIG deal around here, I am not kidding).  One of the favorite attractions, for all of my kids, was a 50 foot tube slide mounted on the side of a hill.  The kids would climb the hill, slide down the pitch dark tube, emerge at the bottom triumphantly, and run off to do it again.  Initially we hadn’t paid the extra $4 for little girl to ride the slide, unsure if she would even be willing to try it.  As a test, Erik took her up with the older kids, set her in the dark tube and launched her down (she had to go by herself, no lap riding aloud).  I watched with some trepidation to see her response at the bottom.  Several seconds later she appeared from the tube.  As she came to a stop, she paused briefly, then rose victoriously as her expression changed from bewilderment to all-out smile, and exclaimed “again!”.  As she ran to climb the hill, I overheard Bethany tell the teenager working the slide, “my Dad is going to pay to get my little sister a wrist band to ride the slide”.  I smiled, “little sister”, I liked the sound of it as it rolled so easily off her tongue.  For the next 45 minutes, I sat on a picnic bench facing the slide.  I watched as my children appeared one by one from the end of the slide, laughing, screaming, giggling, calling to one another, “come on, let’s go again!”, waiting for little girl and taking her by the hand.  Erik was poised at the bottom taking pictures.  As the sun set beyond the hill, pinpoint stars began to dot the sky.  I sat there with all of my senses focused on the moment – the sight of happy children and my husband, the perfect 70 degree breeze on my face, the smell of the night air, the warmth of a happy baby in my arms, the sounds of laughter and togetherness before me.  It was one of those rare instances in parenting, well, in life in general, when all of the cares and distractions of life completely fade away, and it’s as if time stands still.  For a moment all the world seemed right and with joy in my heart, I took in a long, deep breath of contentment.

So things are better, much, much better.  That’s not to say that it’s all fun and games and shiny, happy moments around here all the time.  Last week, Leah came to me after an altercation with Nate, crying, “I just can’t take this many babies!  Do you know what hard work this is for me!”  What could I do but hug her tight so that she couldn’t see me laughing?  Last week we also had another round of sickness go through the house.  This time, when Erik and I were both hit hard on the same day, we learned that we can debate as vehemently as trial lawyers when it comes to trying to prove who is the more suffering patient and therefore most deserving of going back to bed.  One night that week, after tucking six children safely in bed, I was uncharactersitically struck with fear – fear that this is too much, fear of what the future may hold, fear that we’ve overestimated what we can handle, fear of the unknown, etc., etc.  In our sickly state, Erik and I candidly lamented over our fatigue and my fear and prayed together for God’s grace.  In the morning, after the gift of a good night of sleep, the fog of fatigue and fear had lifted.  Now, when those moments come, they are countered by the strength and resolve this past two months has built in us, a resolve that this is without doubt the craziest, hardest, most unusual, yet … BEST … thing we have ever done!

So, I have a list in my mind of FAQs I want to take the time to address at some point.  One of those questions is what it’s like to go to court.  Well, it’s almost time for us to find out.  Our first court dates are approaching, and I’ll admit, I’m a little anxious – anxious about potentially meeting bio family (who I’ve heard can be loud and aggressive – wouldn’t we all be??), anxious about having unmet expectations, anxious about facing the attorneys and judge who will ultimately decide the fate of these children (humanly speaking, that is), anxious about what I will wear (silly, I know).  All that to say, stay tuned, there’s so much more to this unfolding story.

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(Little girl stuffs Bryce with bread at Thanksgiving)