The Shape of Things to Come

We've settled into Henry's adjustment at home and have begun our medical visits. The adjustment is going well. From our doctors we've picked up some clues to what's next, a few details of which we offer here in appreciation of what so many other families have also chosen to go through by adopting children with cleft issues or other special needs--or often just by making the unusual commitment that is international adoption generally.

Our first medical visit last week focused on the basics. Henry got a once-over general exam by our pediatrician, who is familiar with internationally adopted children and head of the cleft team at the medical center we use here. Henry was pronounced developmentally delayed but generally healthy and, sure enough, has gained a pound or two in just the past three weeks.

Although his orphanage medical records contained some immunization info we've learned from experience with our girls that it's wise to redo all the standard vaccinations and to just get them over with all at once--rather than to prolong the pain of these shots over extra visits. The nurses who administered the shots were fast, but needles are no fun and Henry wasn't happy about any of them. He screamed through the whole procedure as well as the blood work later that was worse, but held no grudges. This week we met in sessions with our cleft team, which in addition to our supervising pediatrician includes three surgeons (oral/maxillofacial, plastic, and pediatric dental), a pediatric ENT specialist, a medical geneticist, a hearing specialist, a speech therapist, and a social worker.

In advance we were given a set of DVDs used for training surgeons in a variety of cleft reconstruction procedures. As expected, Henry will need more than one operation to redo the attempt to construct an upper lip tried in China and to close his cleft palate. It now appears that his lip reconstruction alone will require two surgeries in stages, perhaps 6-8 weeks apart. He'll need tubes for his ear canals presently holding fluid that is blocking his hearing; this could be combined with his first stage lip procedure. Additional work will be needed to construct some nasal passages and elevate his flattened nose, which could be combined with the second stage "full" lip procedure. [The clip attached to the above right image shows two of many nasal reconstruction incisions.] Palate surgery may need to wait until after his lip is complete, in reverse of the usual early treatment sequence used for infants.

Our first overall medical goal will be to close at least the rear portion of Henry's palate as quickly as possible since this is the area most important to speech development. This means we've a lot of work to do beforehand in the next several months. The wide width of his clefts, a late start, and tissue damage from the unsuccessful first surgical attempt will be challenges. The team will combine procedures where they can. We now know that each surgery will be a serious undertaking and it's obvious that we're about to help Henry through a series of very long bouts with terrible pain. We can't pretend to be prepared for this sort of thing, but we'll get through it. Milder dental work and orthodontia will follow. When Henry is about ten he'll need bone grafted from his hip into the gaps in his maxilla. Later in adolescence he may need adjustments to his jaw or nose, or treatments for scarring. The huge rewards in all this are obvious for a child who began life with the odds so stacked against him and therein lay the huge rewards for us.

Three and a half weeks of nonstop eating has made Henry's lower abdomen bloat like a beach ball on his tiny frame but his cheeks, arms, and legs are already getting that pudgy baby look and feel. Eventually his growth will even out with help from the exercise he's getting from tottering back and forth down our long center hallway at home. He still has trouble sitting up or standing up on his own but once up, he's raring to go. His radical change in food intake last week produced an extraordinary number of "exploding" diapers overflowing with a very runny light-colored poop. The treatment was patience while his system adjusted and it has.

Orphanage environments can easily produce difficult behavioral or cognitive developmental issues in children and separately the transition into a family can have traumatic consequences lasting weeks, months, or longer. Not so for Henry, who really is 21.9 pounds of incredibly resilient good nature. By now we know it's not an act. His has by far been the quickest and easiest early transition of our three. Indeed he has quite conspicuously helped himself to ease into our family--clinging to each of us, copying our gestures, blowing us kisses. He cleverly obliges his sisters when they play with him like a soft toy. One night last week he fell asleep and giggled in a happy dream before we moved him to his crib, a good sign that things are going okay. So our attachment plan over the next several weeks is simply to pour enough cement on this status quo. We suspect we'll need a foundation as strongly cemented as possible for all the physical pain ahead. But we seem to be off to an unusually good start.

A Lesson From Crows

In a dream Henry and his dad are once again in Gansu Province. But they have become two crows who are peering out over the arid town of Jingchuan from one of the old caves that long ago were dug into the sides of the tall sandy cliffs along the town's southern edge.

It is daytime there and small vehicles are busily motoring about on the streets.  Men and women, a few with children, are walking into and out of the stores on Zhoung Shan Road, the town's main artery. Other people can be seen in front of the small mud brick houses in the dusty back area of town just below the cliffs. All are shadowless under a typically cloudless but hazy sky.  Eventually the crows leave their perch; the father and his little counterpart. They dip low toward the town for a moment before their wings catch the air currents swirling invisibly over the Jing River valley. They begin to climb.

First they fly north across the valley's wide floodplain and then turn to follow the gravelly river bed west, mountains on each side of the plain, fields and villages below. Carefully tended fruit orchards and irrigated terraces planted with neatly spaced rows of vegetables or wheat pass underneath, this directly below in vertigo flashes of green against backgrounds of yellowish tans. Small villages are set on either side of the highway that runs parallel to the river; more clusters of small mud brick houses with tiled or thatched roofs. Each entrance door is covered by a sheet of cloth, fluttering in the breeze. The houses are dark and most are empty since almost everyone who is not too old leaves early in the morning for work or school. Most will return only when the sun sets; many younger people of working age will seldom return and some have left for good, as they have moved on, often far away, to find work elsewhere in China’s urban economy, joining more than 150 million others who have given up on an increasingly meager subsistence in the rural countryside.

The two crows rise higher above the valley, high enough to see beyond its bordering mountains. In either direction are more dry and nearly treeless mountains as far as they can see. Almost every incline not too steep has long ago been terraced for planting, which is a solitary and back breaking occupation. Only occasionally a man or woman is seen stooped and tending to one of these terraces, always alone and often separated by a quarter mile or more from the next farmer. Small dusty trails lead up and over these mountains connecting terraces to other terraces, and remote villages to other more distant villages on mountains even farther away.

At the long valley's widest point, the black winged pair circle once over the small city of Pingliang, which they see is surrounded by the same parched and precipitous landscape. Something more about this place below feels familiar but at this moment they are pulled by a greater force and so continue on. Ahead to the west the horizon turns greener, a sign that they are crossing the narrow southern tip of Ningxia Province, the autonomous region for Hui muslim Chinese, where moisture from clouds collects in front of Liupan, the tallest mountain range in this area and a geological fortress historically remembered as one of the most difficult passages in the Red Army's Long March northwest across China, after which so much changed, in so many directions.

As the two birds draw closer to Liupan Shan they can see the rare dark emerald forests of spruce trees on its steep eastern slopes. Flying fast against this mountainside the air grows thinner from elevation and damp from cloud mist. Near the top a cold updraft lifts them way above the summit, the ground suddenly disappearing below. The little crow struggles against the battering winds and dizzying height, and gives his father a frightened glance. The father crow reaches out with his claws and gently but tightly gathers his little one beneath him. Then they veer toward the orange sunset now on the western horizon and set their path toward Lanzhou.

The little crow feels safe now, having learned that he doesn't really have to fly all on his own.