Seven Days to a Miracle

August 11, 2015
I am reading a trashy romance novel and wondering why my husband chose to stay in St. Louis with his family for another day. I know he was too tired to drive the five and a half hours back home, but I hate being alone in the house, and our dog isn’t helping by barking hysterically at every little noise.

The phone rings, and the caller ID reads “Out of Area.” This normally means it’s a telemarketer – but at 11:30 at night?

newbornA very soft voice says, “Stefanie?”

I say, “Yes.”

The voice says, “It is Dave*.”

My heart starts pounding 1,000 miles an hour. “She had the baby,” he says. I don’t say anything; I try but I can’t.

“I guess that you are a mom,” he says. I manage an, “Oh my God!”

I ask how Mary* is and tell him that he sounds tired. He admits that it has been a strange experience. I tell him he has been brave. (Why did I say that?) He snorts. Then he says, “Don’t you want to know? It is a boy. He was born at 11:07.”

“Tonight?” I ask.

“Yes,” he says. “He’s either 7 pounds, 6 ounces or 7 pounds, 4 ounces.” He apologizes because he can’t remember.

I realize now that I am crying. I try to not cry on the phone with Dave. I do not want him to be uncomfortable. “Will you call us again?” I blurt out. “Just tell us how she is doing, how he is doing. You can call collect, anything.”

“Sure,” he says. I tell him that we respect their decision for us to not be at the hospital, but we just want to know how they are doing. He says “OK” and “goodbye” and we hang up.

I call Brian at his parents’ house. I wake up his mom. She must have heard something in my voice, because I hear her anxiously say, “Get up! Get up! It is Stefanie!”

“She had the baby,” I say.

“What?” Brian asks. “I can’t understand you. Why are you crying?”

“She had the baby,” I scream. “Mary had the baby.”

“Wow!” he says. “I love you. I love you so much. I will come home really early tomorrow.” Then he hangs up!

The phone rings. It’s Brian. “I am never going to be able to sleep now!” he says. He tells me he loves me and says he will be here soon.

Anticipation

I try to read. I try to gather my thoughts. It is impossible. I call my mom. She is stunned and just keeps saying, “Wow! We are so happy for you.” Then she says that she will pray for us for the next 72 hours.

I get off the phone with her and remember that I am supposed to call our adoption agency when Dave phones us. Does this mean tomorrow? Does it mean tonight? I call.

I can’t describe what I am feeling. Am I scared? A little. I am definitely anxious. I know that this could be our son. I know they have every right to parent this miracle, but I can’t help being excited. Is this it? Is our baby here? What does he look like? Is he doing OK? How can I be so worried about someone that I have never seen? Heard? Held?

They say adoptive parents in this stage should be cautiously optimistic. I am trying really hard to be cautious, but the reality is that my heart will break if something happens. We will go on and try again, but I can’t not wish and wonder!

This is not our baby, yet. He is Mary and Dave’s baby, and maybe they will give us the most incredible gift anyone could ever give us: the ability to raise their child as our own. I do not dismiss the magnitude of their decision. I can’t possibly understand what they are going through right now. We just have to wait and see if it is our time.

August 18, 2015
On Monday, Brian and I visit what just could be our little boy. Mary and Dave have left the hospital and have signed a form stating that we can see, hold and care for their baby.

At the hospital, we wait for the social worker to call and OK our seeing the baby. They are making sure that Mary and Dave have not changed their minds. It’s a long 30 minutes, but a nurse pulls the bassinet up to the window.

newborn2

I don’t burst into tears the first time I see him. I am just in awe. This little being fascinates me. He doesn’t look like a newborn. He doesn’t have the puffy face and squinty eyes. I just stare, and Brian is speechless. I think he is close to tears. After 15 minutes, the nurse pulls the baby into the station and tells us that we can touch him in the bassinet until the social worker calls.

Once the call comes, we are given a room. We are told how to care for him, and then we are left alone.

We stay for five hours. The entire time, one of us is holding him, and the other is taking pictures or excitedly talking on the phone.

We finally leave and decide to get a hotel room where we can get our final full night of rest. We order pizza, and I am asleep by the time it arrives. Brian wakes me, and we eat in silence. Finally, he says, “I can’t believe that we are parents.”

I agree. I try to go back to sleep, but I can’t.

The next day, we go back to the hospital. We sign the papers and go home. It is anti-climactic. Shouldn’t a band play and a thousand white doves be released?

Homecoming

At home, we sit him on the couch and stare at him for hours. He sleeps the entire time. We call our parents, and then the phone calls start flooding in.

The night goes well. He wakes about every two hours and drinks about 2 ounces each time.

He is beautiful. I can’t believe how perfect he is! I spend hours just staring at him and admiring what amiracle he is. I cannot get enough of him.

 

So You Want to Adopt? A Beginner’s Guide

Making the decision to adopt is hard enough. Figuring out what to do next can be a bit overwhelming. How should you begin the process?

Common Myths

adopt1Several myths surrounding adoption need to be dispelled. A common one is that you’ll walk into an agency and get a child a short time later. “Adoption is a long, complicated process where the parents have to jump through a lot of hoops that take time and energy,” says Erin Brown Conroy of Portage, Mich., a child expert, author and parent of seven adopted children. “The whole process can be overwhelming, but if you keep your mind on the goal that child in your arms and take one step at a time, then the process doesn’t seem so daunting.”

Another myth is that you should adopt a newborn so you can raise the child properly, says Dr. Stanley Grogg, a pediatrician who teaches at Oklahoma State University College of Osteopathic Medicine and who has helped prepare hundreds of families for the adoption process. “There are many things that you would know about an older child that you couldn’t know about a newborn,” Dr. Grogg says. Certain genetic disorders and the outcome of the effects of prenatal drug or alcohol use may be obvious in an older child while unknowable in a newborn.

Dr. Grogg says that many people think internationally adopted children arrive with several problems. While it is true that early interactions with a child have a lifelong effect, once the child has a consultation and therapy, the long-term complications can be minimal. Not only do internationally adopted children not have major problems, but neither do children in foster care. “Children in foster care are frequently from parents who do not want to care for the child for various reasons,” says Dr. Grogg.

Common Concerns

Now that several myths have been cleared up, you probably have some concerns, like the cost, which varies.

Usually newborns and internationally adopted children are the most expensive, says Dr. Grogg. Prices may range from $5,000 to $30,000. “On the other hand, foster children adopted through state or local social services can be done without significant cost,” he says. “If a family works through a private agency, the costs are likely to be higher.” Children with special needs can have grants or gifts attached to their adoptions to help place the child, adds Conroy.

If you’re worried about the biological parents taking your child away, this should put your mind at ease: Once the adoption is finalized, the court terminates the rights of the birth parents.

adopt2And how long will you wait for the adoption to be finalized? The length of the wait depends on the kind of adoption. According to Dr. Grogg, adopting foster care children usually takes four to 12 months. Newborns can take from one to 12 years. International adoption usually can be completed within two years.

First Steps

To actually begin the adoption process, search for an agency in your area. Agencies “usually hold ‘free’ informational meetings on the type of adoption placements they offer,” says Maxine Chalker, founder and executive director of Adoptions From the Heart, based in suburban Philadelphia. She suggests going to one or many of these to compare information and find the agency that meets your needs.Some things to consider, courtesy of Adoptions From the Heart, are:

  • How long has the agency been in business?
  • How many children does the agency place a year, and what are the ages of the children?
  • What are the qualifications and experience of the agency staff?
  • How and when are fees collected?
  • What are matching fees?
  • What are the agency’s requirements?
  • What are the agency’s policies?
  • Are international placements done by the agency or referred to another?

Remember to take your time and do your homework. “Don’t just go with anybody,” says Conroy. “You’re entering into a close relationship with lots of personal contact, time and resources spent over many months and even years, with follow-up visits required by [some] staes or countries.”

Once you decide what agency to use, that agency will tell you what the next step is. At Chalker’s agency, they utilize applications, interviews, study groups, home visits and educational courses and meetings. If they’re doing an international adoption, there are additional paperwork and procedures to complete. They then wait for a referral from that country and usually complete their adoption overseas.

If choosing an agency isn’t a big enough decision, you have to decide what kind of adoption you prefer. In addition to domestic versus international, newborn versus older child or foster care child, there’s adoption of more than one child from a family, transracial, special needs and open versus closed.

adopt3“Many people make snap judgments about what type of adoption they want to pursue based on what they have ‘heard’ from others,” says Connie Haessler, director of adoption at The Children’s Home of Pittsburgh. “Many times, [these are] the nightmare stories from the media or from well-intended, but not so well-informed, friends or family members. People need to make their own decisions based on information they learn from adoption professionals.”

To help with your decision, Conroy, who’s in the process of adopting an eighth child, suggests asking the following questions:

  • What kind of child do I want to parent or do I feel capable of parenting?
  • How much money do we have to spend?
  • How long do I want to wait for a child?
  • Do I want contact with a birth mother or birth family?

 

Happy Holidays!

Happy Holidays to all from Sam, Julie and Anika! We enjoyed an unusually balmy night and ventured out to see the lights on “The Castle” up on Arborway. Anika was entranced. I’ll probably put up one more post – a recap of the last day in Kazakhstan before we left, and then bring this blog to a close. The plan right now is to take the text and pictures, buff and polish them, and then bind them into a hardcover book for Anika, as it is after all, her story. I’ll be sure to post some parting thoughts for the last entry. Until then, stay warm (especially those in Kostanai, where it’s a nippy -13C).

My first cookie

I had to share these photos, if only because they show the delight with which Anika is adapting to the simple pleasures of life at home. In this case, a teething biscuit.


teething-biscuit 

We survived the big snowstorm here without difficulty. Here are a couple of photos:

snow2 snow1

We did it!

The three of us are absolutely exhausted after being awake for the past 36+ hours.  So until I gather the energy to sum up the events of the past couple of days, I’ll let this one picture say it all.  As you can imagine, we’re happier than words can express.  Thanks for all of your support over the past couple of months.  We are very happy to be home!

Embassy Day Update

We just got back from the US consulate and we are very happy to announce that we are finally coming home!  It’s hard to believe that we are 48 hours (plus the 11 hour time change) away from the end of this entire process!  We now have all of the documents necessary for Anika to become at US citizen — all she has to do is land in the United States.

The whole consulate process was actually interesting.  It turns out that the US consulate is on the 17th floor of a seventeen story office building that is otherwise non-descript (that is, it looks like all of the other high-rise buildings here in Almaty).  Security to get into the building is just as draconian as it is for getting on a flight.  Maybe a little more.  You can only bring one small container of liquid (e.g., a sippy cup), and you can’t bring in any recording devices, cell phones, etc.  We couldn’t bring in any bags whatsoever.  You go through a magnetometer, and have to check in with your passport.  You’re escorted by armed guard everywhere – to the elevator, from the elevator, down the hall.  The door to the waiting room was like a bank vault door, with two guards at the entrance.  All business is conducted through bulletproof glass windows and microphones, all under the pictures of the smirking Bush, the scowling Cheney, and the sinisterly squinting Condi Rice.  Truth be told, I’d rather see another picture of Nazurbaev.  But I digress.

Apparently all of the adoption interviews are conducted at the same time, so when we arrived, we saw about 6 other babies and their newly adoptive parents.  I chatted briefly with a woman had just adopted a little girl from Kyrgyzistan but had to come to Almaty because we don’t have a consulate in that country.

The whole thing took under an hour.  We filled in a one-page adoption survey where we were asked a number of “customer satisfaction” type questions, such as what agency we used, who our Almaty coordinator was, how much the process cost, how much travel cost, how much other expenses cost, did we have complaints or problems along the way, etc.  Then we went to a window and paid our fee for the visa, and waited to be called for our interview.

The interview was very brief – and more of an informational session than anything.  We were told that all of our paperwork was in order and that there weren’t any problems.  We signed a handful of documents: the I-600 petition, a certificate saying that we’d vaccinate her on our arrival home, and her visa application.  We were given Anika’s Kazakhstani passport with her US immigrant visa, her new Kazakhstani birth certificate, and a number of the original documents from her file.  We were also given a large brown sealed envelope that is to be hand-carried to the immigration office at her point of entry to the US.  We were congratulated by the consular officer and then sent on our way!

We made a stop at the KLM office on our way home and managed to change our flight to Friday morning, meaning that we’ll be back home by Friday evening!  Anika is clearly delighted, as we are.

Tomorrow we’ll get wrapped up – some last minute shopping, packing, and early to bed.  More soon!

Embassy Day!

Things continue to go well here in Almaty.  We are anxiously awaiting our interview at the US Consulate this afternoon.  According to our Almaty coordinator, Oleg, everything is OK with the paperwork, meaning that if all goes well, we’ll have our walking papers before too long.  I have decided that if there is enough time to make it to the KLM office this afternoon, I’m actually going to see if it is possible to get onto the Thursday morning flight.  Despite the fact that this would mean rushing to get packed up and off to bed in time to wake up at 4:00 am (not a problem for Anika) tomorrow, it would be entirely worth it to get out of this hotel room and into our home.

Truth be told, for what this is, we’re actually very lucky.  The hotel has a restaurant in the basement and the room service isn’t half bad (although you only get an English speaking person on the line about half the time).  The location is also good: close to restaurants and stores.  Plus we have two queen-sized beds, a bathtub (not Anika’s favorite, yet), and a crib with enough room to be able to walk around.  However, as I mentioned before, the tiny fridge, no microwave or teapot, only sporadic internet access (one-time, one hour connection for 700TT), and the fact that Anika still requires 3 naps/day means that we’re stuck in the room for most of the day.  We’ve been working hard to figure out her routine and her cues.  We’ve definitely learned when she’s hungry, and that we had seriously underestimated how much food she could hold for the first couple of days.  Now we know that she needs a substantial breakfast, a mid-morning snack, lunch, a mid-afternoon snack, and a substantial dinner in order to be happy.  We definitely her good mood emerge once her belly is full.

Sleep-wise, we’ve managed to get her to sleep through the night, with occasional late-night arousals.  Last night we got her to sleep around 7:00 and she stayed mostly asleep until about 6am.  Then, to my surprise, she hung out in bed with us for about 45 minutes more before wanting to eat.  I don’t think that’s so bad given that it’s only our 4th day with her.  Figuring out the nap times when we have different things to do during the day is bit more of a challenge.  For example, as I write this, we’re probably going to have to pack her up and leave in about an hour, but despite an hour’s walk around town and some quiet play, she’s standing in her crib pretending to be Galileo as launches every pacifier and toy over the side of the crib while happily babbling away at us.  We’re hoping that she’ll sleep now so that she doesn’t lose it completely when we are traveling to and from the consulate (not that it isn’t entirely entertaining to listen to, and watch her, do all of these things).  As I said, it would be worth it to get home as soon as possible, just so that we can begin to recover from the jet lag and get her on schedule.

She definitely seems to be re-attached to us.  From the way that she’ll sit and stare out our faces as we hold her in the carrier, to the way that she stands at the crib and smiles back at us, and especially the way that she’ll crawl into our arms while we’re playing with her, it seems that she’s truly happy around us.  This doesn’t mean that I think that she’s completely recovered from the separation from the orphanage and her regular caretakers, but I’m a lot less worried about her being comfortable with, and bonded to us as her parents.  As promised, I finally had my hands free enough to get some good pictures of her in all of her glory.

If we don’t leave until Friday, then I’ll go and visit the Almaty Postgraduate Medical Institute tomorrow.  Yesterday I had a fascinating (and unexpectedly long) visit at the Scientific Center of Pediatrics and Children’s Surgery.  The trip was arranged by Dr. Azhar Nugamanova who works for the ZdravPlus project, which is a medical assistance project organized through USAID.  The hospital was outside of Almaty in what looked like a poorer residential district.  I was picked up by a USAID driver and the trip took about 45 minutes.  On arrival, I was greeted by Dr. Alzhan Salpynova, who is one of the hospital’s pediatric gastroenterologists.  She had fairly good command of English, and served as my translator and guide for the trip.  After dropping off my bag and coat in the physician workroom (a very small office with 4 desks and a couple of computers), I was told that the head of the hematology department was busy and was offered a tour of the hospital.  Much to my surprise, the hospital was less modern than I expected, but not surprisingly, I was told that it was “undergoing renovation”, which is what I’ve been told about every other hospital that I’ve visited here.  I was shown a number of wards, including the hematology ward.  In Kazakhstan, the hematologists treat malignancies of the blood and bone marrow (leukemia) as well as non-malignant conditions (aplastic anemia, ITP, hemoglobinopathies, etc.).  This is different than in the US where oncologists treat leukemia.  The ward I was shown was pretty big, and very crowded.  Between the two hematology wards, they had the capability of holding about 40-50 patients – the entire hospital has about 250 beds.  Most of the rooms on the hematology ward were doubles or triples, with beds for the parents along with beds for the children.  There were a small number of laminar-flow isolation rooms.  Interestingly, there was a community dining area, as opposed to the in-room dining that is standard in the US.  I was also shown their activity room which was well-equipped and very crowded.  Outside in the hall I came across a group of boys who were playing with a miniature pool table.  Theirs was the one and only picture that I took (with the boys’ permission) during my time at the hospital since I ended up being busy talking to so many people.

miniature_pool

This hospital is one of two pediatric hematology centers in Kazakhstan that is equipped to treat children with leukemia.  As such, children from all over the country, as well as from nearby countries, will come and stay for the duration of their therapy, which can sometimes be many months time.  This facility sees about 80 new diagnoses of leukemia per year, and about 600 new patients per year (all blood disorders combined).  The government covers the cost of both the hospitalization, the medications, and the transportation.  Parents (usually the patient’s mothers) stay in the hospital with their children.  Kids with leukemia who complete their induction therapy and go on to receive outpatient treatment  can be cared for by pediatric hematologists in the larger towns and cities in their home region (oblast).  I asked about the numbers of pediatric hematologists/oncologists in the smaller cities and towns, and was told that while there weren’t enough, there was some available in the larger regions.  With regard to solid tumor patients, I was told that children with solid tumors are cared for at a different hospital in Almaty.

Kids with acute lymphoblastic leukemia (ALL) here are treated according to the German BFM protocol.  When I enquired about survival rates, they told me that their 5 year survival rates were about 70-75%.  For acute myeloid leukemia (AML), their survival rates are only about 50%, but this rate is higher than I expected given the more intense chemotherapy required, and the fact that AML patients are at much higher risk for relapse.  Right now there is no capability for either autologous or allogeneic stem cell transplantation, but I was told they hope to have this capability in the next year or two.  From what I understood, doctors here will often travel to other countries to learn these techniques – for transplant, they will probably go to Israel to learn.

I was subsequently taken to the radiology department where I was introduced to their “CT doctor” and shown the CT scanner (Toshiba).  I was told that in the new hospital building that’s being constructed, they’ll have a new CT scanner (Philips) with a digital imaging system instead of their current film-based system.  They also told me that when this new building opened in 2009, they would also have an MRI machine as well.  From radiology we next went to the neonatal ICU where, pleasantly, conditions were much better than in Kostanai.  There were a number of brand new isolettes and ventilators, and I was told that this hospital had the ability to support premature infants as small as 600 grams.  Surprisingly, I was told that in the near future, Kazakhstan will adhere to WHO guidelines and attempt to resuscitate and save premature infants as young as 22 weeks gestation.  While I didn’t have a chance to see them, the hospital also has wards for gastroenterology, trauma (including burns), general surgery, and two “reanimation” units (ICUs).  Alzhan, my guide, took me to meet her mentor, Dr. Mashkeev, clearly one of the senior doctors in the hospital.  Both doctors are very interested in celiac disease and are looking for any international collaborators to assist with their research and the care of their patients.  They peppered me with questions about celiac disease, which is about as far from pediatric brain tumors as you can go, and as such I felt bad that I had little to tell them about what was available in the US in terms of diagnosis.

Before long, it was time for me to give my talk.  For reasons that remain unclear to me, of the topics that I offered to speak on (based on the previous tumor boards and talks that I’ve given over the past few years), they asked to hear about Langerhans Cell Histiocytosis (LCH), an uncommon disease that is only somewhat like cancer (it’s an interesting disease where a certain type of immune cell proliferates in bone or skin).  I had a chance to describe the current treatment protocol that we use for treating this disease, and despite the fact that this hospital sees only 3-5 cases per year, they seemed very interested based on the half-hour long question and answer session that followed the talk.  From what I gathered, one of the bigger problems here is the limited laboratory capabilities.  While they have CT and ultrasound imaging, doing cytogenetics and immunohistochemistry is a problem due to lack of access to specialized reagents.  Hopefully, when I get back to the US, I’ll be able to dig around and see if there’s any assistance to be offered by companies that make some of the antibodies used for diagnosing this disease in tissue sections.

After the talk, I had a long visit with Dr. Kulyan Omarovna, who is the director of pediatric hematology.  We spoke at length about the treatment modalities available here, the types of diseases they see, and the directions they want to go in the future.  Then, to my surprise, she ended up presenting me data from three very challenging clinical leukemia cases, seeing my opinion.  One of the patients – a 15 year-old girl from the southern region of Kazakhstan who has been impossible to diagnose over the past month of her hospitalization – sounded to me like like she needed a bone marrow biopsy to make a definitive diagnosis.  You can imagine, then, how shocked I was when Dr. Omarovna asked me if I wouldn’t mind doing the biopsy on the patient myself.  She even went so far as to bring me the needles and the anesthesiologist!  Having been previously told that it was not possible for me to see/treat patients here (not that I would’ve minded doing it), I demurred as best I could, and was ultimately saved by the anesthesiologist who told me that since the patient had already eaten, it wouldn’t be possible to anesthetize her until much later.  I sincerely wish that I had better command of Russian, because there clearly is a great deal of need her for additional expertise and assistance with some of the more difficult cases.  Nevertheless, I told detailed notes on all of the cases and told Dr. Omarovna that I would contact the leukemia experts at my program and see if they had any advice to offer, and then relay that information to her by e-mail.

By the time I got out of there, it was nearly 2:30pm and I still had a long car ride back.  By the time I got to the hotel, I’d been gone for 6 hours, meaning that Julie had been single-handedly taking care of everything for that entire time.  When I got to the room, I could tell that she needed some relief.  She must’ve really had her hands full, because I learned later that after ordering room service she inadvertently gave the waiter a 2000TT tip (about $16) instead of a 200TT tip (about $1.50) for her 1000TT lunch.

For the afternoon, we packed Anika into the carrier and took her for a walk, and then fed her and took the post-meal good mood as an opportunity for us to head down to the restaurant for an early dinner.  It’s amazing how quickly we’ve gone from the dinner-reservations-for-8pm couple to the alone-in-the-restaurant-at-6:00pm family in 4 days.  Nonetheless, Anika was in a great mood during dinner, and we both managed to eat a proper meal and have a much-needed drink.  We were happy to eat in the bar area but were moved by the hostess to the main dining room because the bar area because the bar area could be a little cold and was “not good for baby”.  At dinner, we realized that Anika was beginning to understand the concept of gravity as she began to purposefully launch her toys onto the floor with obvious delight.  Afterwards we decided to try the bottle/book/bath/bed routine, leaving out the bottle and the book for now.  She wasn’t particularly thrilled about the bath, but she tolerated it, and once she was fed, washed and changed, she was feeling good and we enjoyed her playfulness and managed to get her to sleep in short order.

The next installment will hopefully be stories of packing our suitcases, or even better, will come from Schiphol Airport as we begin to make our way home.

Could we be getting out of here soon?

[Author’s note: Because I brought my fancy-shmancy MacBook Pro with me to Almaty, instead of the 4-year-old iBook that we had in Kostanai, I don’t have a modem, which means no in-room dial-up internet for me. There is WiFi in the hotel, but it’s by the hour, and the signal isn’t so great, so I’m posting three days worth of stuff in one magnum opus.]

Somehow, we all managed to get some sleep Sunday night, but by 5:30am Anika was up and ready to go. The timing was a little unfortunate, because we were told by Nikolai that we had an appointment for her medical exam at 10:00am, which meant that we had only 4 hours to get up, showered, fed, some play time, and then a nap in before we left. We knew that it was going to be a long day, and we really wanted to avoid a total meltdown which likely would’ve happened had she not gotten a morning nap. With some creative shift-work, we managed to accomplish all of this, and by 9:30am we were in Nikolai’s van and on our way.

We made a quick stop at a photo store to get an additional passport-sized picture of Anika for the medical examination form – apparently the passport photos that we struggled to get in Kostanai before we left in November, were too big. This time, Anika was much better in the car – after a 36 hour train ride, I can assume that she’s now used to moving vehicles. As a result, she was also much better with getting her picture taken. As opposed to November’s 25 attempts, this time it only took two quick pictures to get a good one.

From the photo store, we traveled through downtown Almaty to the International S.O.S. clinic. I am now quite familiar with this company – having called a couple of weeks ago in an attempt to help out a sick American Kostanai. They run a fairly modern clinic for tourists, ex-pats, and apparently, international adoptions. While sitting in the waiting area we met an extremely nice father-son pair who were there for their immigration exams. The father is a health economist who works for the CDC and lives in Atlanta, and his son is an extremely handsome, and extremely affable young man who goes to college at the University of Waterloo. It was quite amusing to hear this young Kazakhstani man speak English with a very clear Canadian accent. We chatted for a while while being shuttled between different stations. Anika had to have a quick blood test (a rapid HIV test, apparently required by the US government), vital signs (where she comes in at 72cm in length and 9kg fully clothed), and then a brief exam by a physician. It was a strange place for me to have my first experience of being a pediatrician standing by as he watched his child being examined by another physician. By the time she had her exam, it was nearly noon and Anika had had just about enough. She was completely asleep before we arrived home, which we converted in to her afternoon nap.

While she was asleep, I set out into town to pick up some additional supplies, and also to book Anika’s return flight home. We were told, prior to leaving this trip, that the infant airfare would be substantially cheaper if we bought it in Kazakhstan, and so I was hoping at some point to get to the KLM office to make sure that this was the case. You can imagine my pleasant surprise when I inadvertently came across the KLM office while randomly walking the streets. I ended up booking her flight and was very pleased to find that the fare was not the $800 or so that I was quoted in the US, but a rather fair $140! I also took the opportunity to ask that we be seated in the front bulkhead row, where the airline can provide a bassinet that clips on to the wall, potentially freeing our hands for a bit.

On the way home I stopped by at one of the outdoor food stands and ordered up two doner kebab sandwiches, and a container full of something that turned out to be rice, meat and red peppers, making for a very cheap (800TT) lunch for the two of us. By the time I arrived home, Anika was awake and so Julie and I switched off and she enjoyed her sandwich while I provided entertainment. Before long it was nap-time again – in the hopes of keeping her on the same schedule that she was at while in the baby house. This time it took a little more effort – she fussed for about 30 minutes but was asleep in under 10 minutes once I put her into the carrier and walked her around the room.

Oleg swung by the hotel around 3:30pm to help me fill out all of the paperwork needed for our petition to the US Consulate. None of it was particularly difficult, and we were finished in about 20 minutes. Once were were done, Oleg told me that he expected to file the paperwork today, to hear about our appointment time tomorrow, and that if all was in order, we’d have our consulate interview on Wednesday and at that point we’d receive all of Anika’s immigration documents. I asked him if that was all, and he said that yes, once that was done we were free to leave. I told him that our flight was booked for Sunday because we were told to expect an interview at the consulate on Friday. He was a little surprised by this and suggested that we try to change our flights.

This, of course, sounded like a mighty fine idea to me, and so if things go well on Wednesday, then I’m going to make a beeline for the KLM office and attempt to change our flights to Friday, meaning that we’ll be home two days ahead of schedule. It’s a good thing that we purchased the unrestricted and fully changeable tickets. I hope that there are seats available, because as much as we enjoy being here, we really want to start the work of getting Anika acclimated to life in Boston.

The rest of the evening was fairly uneventful: room service for dinner, a little playtime with Anika followed by a moderately long period of fussiness capped off by falling asleep (once again) in the carrier. I’m going to send a letter to the woman who invented this particular brand of carrier to ask her what the secret is, and also to thank her. Julie’s sleeping even as I finish writing this, and I’m going to spend the next couple of hours in the hotel lobby working on two lectures that I’m giving tomorrow. Hopefully tomorrow, since we have no “official business”, I’ll be able to snap some good photos of Anika.