“I’m not adoptable,” he stated flatly.  “What?”, I replied, surprised by his comment.  “I’m.  Not.  Adoptable.”  He repeated it louder, as if perhaps he thought I was hard of hearing.  He was sitting on my exam table, and I had just been looking in his ears and asking him about school and friends.  Then the conversation turned to family and why he was in foster care.  His parents had been involved with drugs for many years.  His dad was now in prison, mom was nowhere to be found – he wondered if she might be dead.  He had been in DHS custody since the age of 5 – he was now 15. 

“I went to this adoption party, and I overheard some people say that I’m not adoptable because I am too old.”   At that, tears welled up in his eyes and began to spill down his face.  I grabbed him, held on to him.  Not exactly what we are trained to do in medical school, but it was a reflex- I couldn’t help it.  He took a few breaths and went on.  “I met some people who wanted to adopt a son. They talked to me for a little while but then moved on to meet other children, and I overheard them saying that I was too old, that no one would want to adopt someone my age.”  His eyes were dry now but sad.  “All I used to want was to be adopted.  I am a good kid – I am not the smartest, but I do OK in school.  I know how to take care of myself.  I don’t get in any trouble.  I don’t understand why no one wants me.” 

My mind was spinning, quickly assessing my own family situation.  A toddler at home and another baby on the way, in a three bedroom house that was quickly becoming decorated in “toy.”   Both my husband and I working full time, and me taking night classes in health administration on top of that.  Did I want to add a 15 year old boy with 10 years of foster care and a lifetime of baggage to that? 

No.

I told him that I thought he was perfectly adoptable, and that I was sure someone would come along who wanted him.  It sounded lame even to me. 

“Do YOU want me?  Would YOU ever adopt me?” 

I was frozen.  Of course I wanted him to have a family, I just didn’t want the effort of being it.  He could sense my struggle, and his face changed again, this time looking reserved and emotionless.  “It’s OK,” he said.  “My case worker says I need to spend the next couple of years learning how to take care of myself anyway.”  Head down, I left the room and went on to the rest of my day, but I never forgot him.  And I didn’t sleep for a week.  And I felt like a fraud.  And I have always wondered if he should have been MY son. 

“If I speak in the tongues of men and angels, but have not love, I am only a resounding gong or clanging cymbal.” – 1  Corinthians 13:1 (NIV)

(the following story is from a recent conversation with a foster mom) 

Recently my (foster) kids and I were having breakfast.  One of the boys was messing around, as he normally does, and bumped his hand on the table.  He began to cry, and when I asked where it hurt, he lifted his hand.  I kissed his fingers and he said “no, right here.”  I had only missed his hurt spot by a tiny bit, but he knew it and wanted me to kiss his hurt again.  He has been with me a long time, and I wonder when he goes back home if his mom will understand what it means when he says “no, right here.”  Will she know that he has a favorite bedtime story?  And that he wants two hugs, not just one before he will fall asleep.  Will she know that he likes goldfish crackers for his afternoon snack?

I am beginning to realize just how much there is about him that I should try to share with his biologic parents.  All the ways that I help him get through the day.  My biggest fear is this – will I forget something as small as the little kisses that heal his hurts?

If you are a foster parent, what can you do? Take pics, scrapbook, fill out a Life Book with your foster child’s likes and daily habits, talk to the biologic family at visits – be willing to learn a little about their traditions/habits and incorporate some of them, as well as share yours.

As a pediatrician working around foster kids all day, my million dollar question is this – How can I end child abuse?  How?  How can I work myself out of a job because there are simply no more kids coming to the shelter?  How can I close down my clinic because there are no more children in foster homes?  How can I create a world where the Department of Human Services can actually serve humans, instead of being shoved into the role of investigators and enforcers?

I think the answer lies in the successes of those who have survived it.  Those adults whose life story is a laundry list of childhood adversity, and yet who have somehow come through the fire to find  hope, freedom, grace, and perspective on what matters in life.  Those adults who grow up to get an education, a job, and a family, and don’t mistreat their own kids.  So what is the secret to their success?  Here’s what they tell us…

I had healthy adult relationships.

I had good counseling/mental health care provided at the time I truly needed it.

I had a mentor.

What else.  Nothing else.  Surely there is something else.  No, that’s it.  Come on – what about placement stability, case worker continuity, not changing schools or docs or counselors.  Those things helped me learn how to form relationships, get mentally healthy, and find a mentor.  Oh.

If I am willing to buy in, to drink the kool-aid and believe what survivors say, then what does my role in all this look like?  Perhaps like this.  Always being genuine and at my best around foster kids.  Opening my home on the holidays to young adults who have challenging childhoods and don’t have a family of their own to hang with.  Being willing to invest time in those whom no one has given the time of day to.  Taking a risk on hiring a new employee whose life experience may far outweigh their work experience.  Not being afraid to address someone’s depression or anxiety and point them in the direction of mental health assistance. 

That’s the million dollar answer.  Only it doesn’t cost a million dollars.  It costs me everything – costs me my life.  Is it worth it?  Every single day. 

What’s your life worth?

(this is the 3rd part of a discussion on the impact of Adverse Childhood Experiences – if you haven’t looked at the first two posts, I recommend starting there)

She was beautiful – petite with shoulder-length auburn hair, blue eyes and a quick smile.  She sat across the desk from me as we discussed work first, then family, and finally life in general.  She was interviewing for a job, but I forgot about that quickly, as I found myself much more interested in her story than in her qualifications.  Childhood was not kind to her – she was one of three kids born to young parents who struggled with poverty and substance abuse.  Her first contact with foster care was at age 3, but after a couple of years she was allowed to reunite with her parents.  Soon they moved to another state – it was easier for her parents than dealing with the close monitoring of child welfare. 

Within another year or two, she was back in foster care, and this time she would never leave.  She saw her parents from time to time – they were never quite “bad” enough to lose their rights to her, but never quite “good” enough to get her back, whatever that means.  It didn’t make a lot of sense to her – she only knew that she missed them.  Twenty-one foster homes later, she graduated from high school, went to college, got married, and was now interviewing for a job.

What?  How did that happen?  Why isn’t she depressed?  Sick?  On drugs?  Who convinced her to go to college?  How did she become part of a normal, loving relationship?

That is the million dollar question.  And tomorrow, I will give you a million dollar answer.  One that you can be a part of.

Yesterday I talked a little about the impact of childhood adversity on adulthood.  Let me tell you a story about that…

So in the late 1980′s, there was a guy who was an internal medicine physician (adult doc) in California.  He ran an employee health clinic, and spent his time trying to get obese people to lose weight and become healthier.  The clinic helped folks learn about nutrition, gave them an exercise regimen, and monitored their progress.  And, they lost weight.  However, what he noticed was that there were some people who were initially successful, but then reverted back to their old habits and regained the weight.

Can you relate to that? 

Well, this doc didn’t like that one bit (you can imagine what Jillian Michaels would have to say about it…), so he sat down with some of these folks over a cup of coffee and let them tell him about their problems.  At first they talked about the role of food in their lives, but eventually the conversation drifted to the things that we humans use to comfort ourselves – food, alcohol, drugs, tobacco, sex, sleep, withdrawal from relationships. 

If we’re honest, we all use those things or others to comfort ourselves.  For me, it’s chocolate.  And caffeine.  And maybe occasionally a margarita.  With lots of tequila. 

The problem is that you can’t really heal an internal problem with an external solution.  And when the internal problems are a gaping, bottomless pit, all the chocolate or caffeine or alcohol in the world won’t help.  And in the meantime, you get fat.  Or sick.  Or addicted.  Or dead.  In fact, in the population that this doc studied, not only were folks obese, they had high rates of heart disease, diabetes and high blood pressure (from overeating),  liver disease (from alcohol), lung disease (from smoking), drug abuse, sexually transmitted disease, unwanted pregnancy/abortion, depression and suicide. 

Not just a little more.  A LOT more.  In fact, they were dead men walking…

Depressed yet? Hang in there – we will get to some hope soon.  Tune in again tomorrow…

One of my favorite reality TV shows is The Biggest Loser.  I enjoy the creative competitions, last-chance workouts, and of course the drama of the weigh-in.  But what fascinates me most might be lost on the majority of viewers.  Every once in a while there will be an occasion when a contestant has a private conversation about their weight issues with one of the trainers.  There are usually tears flowing as the trainer probes the depths of the contestant’s soul, attempting to get at the cause of a lifetime of unhealthy behaviors.  In the middle of all the made-for-TV drama, if you listen closely, you will hear them answer.

My parents divorced.  I was molested.  My mom was a drug addict.  No one cared about me.  I was abandoned. 

Now THAT is reality.  Reality is that some kids have a childhood full of pain and loss.  Reality is that some kinds of adversity screw you up.  Reality is that surviving childhood does not guarantee a clean slate into adulthood.

Want to know more?  Stay tuned for the next episode…

The door swung open abruptly.  “What are you doing right now?”  I was a chief resident, a young pediatrician who had just completed my own medical training, and was now responsible for administrating the training of other residents.  I was working on the resident schedule at the time.  He stomped impatiently and waved to me.  “Come on, let’s go.”  I followed him, after all, he was going to be my boss in a few weeks.  I had no idea where we were going, and he didn’t offer an explanation.  We got into his Jeep and drove a few miles from the hospital, stopping at a low brick building with no sign.  “This is the foster shelter.  I want you to think about being the doctor here,” he announced.  The shelter?  Come to think of it, I had heard the social workers at the hospital talk about kids from the shelter,  but I had no concept of what it might be like, or why kids would even be there.

We took the tour.  Offices.  Dorm-style bedrooms with 2 plain beds and a small dresser.  A half-court gym that reminded me of my own gradeschool.  A common area with books, games, and a television.  As buildings go, it wasn’t too bad – a little institutional, but not too bad.

Then I saw them – children.  Everywhere. 

Babies.  Toddlers.  Kids.  Teenagers.  Moving in small groups through the halls and rooms, led by direct care staff from lunch to naps, school to free time.  A few days ago they were at home with their families.  Now, because of what their families have done or neglected to do, now they are homeless.  Sure, they have food and shelter.  But this was no home.  There were no homes – no relatives or foster parents waiting to hold them, to comfort them, to encourage them. 

I was horrified.  I didn’t sleep for days.  And I knew without a doubt that I was going to be the shelter doctor.

He was 17.  Tall and handsome, with thick, curly black hair and dark brown eyes.  He created distance with those eyes – they weren’t emotionless or cold, but they did express a sort of reservation to engage in a conversation.  He answered my questions without elaboration - mostly “yes” and “no”.  What grade was he in?  He wasn’t sure – hadn’t been in school for a couple of years, and the case worker hadn’t tried to enroll him yet.  The last grade he had completed was 9th.  He looked surprised when I asked what he wanted to do after he turned 18.  What did he want to achieve?  Did he want to get some additional education?

“I’m not smart enough to go to college.”

Many kids in foster care and the juvenile justice system find themselves educationally delayed, losing one or two school years by the time their peers reach 12th grade.  The delays occur for a variety of reasons, largely related to school attendance and continuity.  As tragic as that is, perhaps the greater tragedy is that the kids often don’t understand why they are behind.  Just that they are 1 or 2 years older than anyone in their class.  And often that translates into the belief by themselves or others that they aren’t intelligent, aren’t as capable as everyone else at setting or achieving educational goals.

At age 18 kids “age out” of foster care.  15% of them do not have a high school diploma or GED.  Only 2% will graduate from college.  The lack of education translates into poor job options – by 25 years of age they will earn 1/3 less than their peers and be less likely to have a job that provides important benefits such as health insurance.

But what disturbed me most was the hopelessness of his statement.  I’m not smart enough…Who told him that?  More importantly, who is going to tell him something different?  Will you?

What YOU can do: tutor, buy school supplies, sponsor a kid’s school activities (sports, choir, etc.), help kids apply to or visit college and vo-tech campuses.  Contact your local child welfare/foster care agency and ask how you can help.