Who Am I To Decide?

I can't really say when it started.

Shortly after Sati and I were married we talked about adopting, but life was chaotic. We were both students about to embark on 8 years of residency and fellowship, and after our daughters were born four years later, it was all about work and daycare and mortgages and laundry and just trying to keep our heads above water. Until it wasn't. Until it was sixteen years later and when we looked around we saw some of our friends sending their kids off to college or planning weddings for their children or welcoming grandchildren into their lives, and we realized...we're not done.

April 20th, 2018, the day after our 16th wedding anniversary, Sati and I signed a contract with Children of the World adoption agency in Fairhope, Alabama. Our fates taking us to India.

It's been a whirlwind two months, and since that day we have had three visits with our social worker, a background check from every state we've lived in since the age of 18 (that's 10 for each of us), FBI fingerprints, 15+ hours of adoption education (where I have had to listen to my husband's incessant insistence that he has already raised two wonderful children and he shouldn't be require to do this), buckets of paperwork requiring original signatures and notarizations, references from six separate families, and a psychological evaluation to include a 300+ question personality assessment. And there was more. But I just can't remember it all right now and it's too painful to attempt to recall. We're just waiting on two more background checks to clear (Nevada and California) so we can schedule our final visit with the social worker, and then we'll be ready to register with the Indian government and be matched with our child. Or children.

And herein lies our first emotional hurdle. Don't get me wrong; the home study was no barrel of monkeys, and there may or may not have been some bad words tossed around during the last couple of months, but what we're facing now is the very definition of heart-wrenching:

***The List of Special Needs***

Let me back up a moment and give a brief overview of the India adoption process. India prefers for its children to stay in India and be raised by Indian parents. Perfectly understandable. And in a perfect world that might even happen. But in this imperfect world of poverty and disease and stigma, this is obviously just not possible. The next best thing, according to the Indian government, would be for a family with Indian heritage living outside of India to take in the orphaned children. And the least ideal, aside from leaving the children on the streets or in orphanages, is to allow non-Indian families outside of India to adopt.

So there's a hierarchy of sorts, and if your family falls into one of the first two categories you are eligible to take the healthy-child track. That means you are eligible to adopt a normal (India's word - not mine) child under the age of two. However, the wait time for this "normal" child is typically a couple of years. With my husband's Indian heritage, we are considered an NRI, or non-resident Indian, family, falling into the healthy-child eligible track. Which, I can't deny, was tempting, but ultimately a route we chose to forego. The children who are adopted through this route are in no danger of aging out of the system or ending up on the streets, and - let's face it - we're too old to be waiting around for another two years.

Hence the list of special needs.

If you ever want to feel like a total jerk, there's nothing that will take you there faster than putting Xs on a special needs list to indicate which children you would NOT be willing to adopt. After half a dozen times of poring over that list, and researching medical diagnoses with more fervor than we showed in four years of medical school, Sati and are really no closer to done. On a good day, we might be open to a sibling group of five with developmental delays and missing limbs and seizure disorders and thalassemias and Down syndrome. But on a not-so-good day, we can't remember why we even started this, and just one more healthy child in our home seems overwhelming in itself.

I think the first time we went over the list, it was decidedly easy. There were a lot of big Xs under the NO column, because we were approaching it with the mentality of new parents. If we were pregnant, which of these would we be okay parenting? Cleft lip - no problem. Premature birth - both of our kids had that. Poor eyesight - we all have that. We can totally do this.

But the more you play this game the more you realize this isn't about what you WANT your child to come into the world with. These children are already here. Whether we adopt a child with HIV or not, our decision will not erase that illness from that child. There are thousands of children sitting in orphanages with illness and disabilities that won't go away just because we don't wish for our children to suffer from them.

Unfortunately, the more we go over that list, the worse the guilt becomes. Because we're getting close now. And it's getting real. And the things we have to take into consideration are painful to address. When we're gone, will we be burdening our current children with the care of their sibling? It's one thing to birth a child with a major medical condition and to expect your other children to step up, but it's another to knowingly and willingly take in a child who will one day become their burden. And I know the negative connotation of the word burden. And I understand that the "burdens" we bear become the guiding forces in our lives, and many times make us stronger and more compassionate people.

But who am I to make that decision?

S. No.	Type of Special Needs	Yes	No	May be
1.	Low birth weight
2.	Premature birth
3.	Birthmark : On visible part of body, not disfiguring
4.	Heart defect: a)     Minor: (Murmur, etc.) (No surgery required) b)    Major: (requires open heart surgery)
5.	Hepatitis B. carrier
6.	Blood disorders: a)     Thalassemia b)    Sickle cell anemia c)     Hemophilia (bleeder)
7.	Child needing sex change due to injury of birth defect
8.	Child requiring wheel chair
9.	Spina Bifida-walk with help, crutches braces, etc.
10.	Cerebral Palsy: a)     Mild b)    Moderate c)     Severe
11.	Orthopedic problem Correctable (now using braces or crutches or future ability)
12.	Rickets
13.	Congenital hip defect
14.	Malformations: a)     Webbing of fingers and or toss (operable) b)     Partially formed fingers and or toes c)     Club foot or feet (correctable) d)     Missing or malformed ear Missing or e)     malformed fingers and or toes f)      Missing limb(s) g)     Malformed limb(s)
15.	Vision a)     Child with vision in one eye b)     Child with poor vision, unstable eyesight c)      Child with crossed or wandering eyes (squint) d)     Totally Blind
16.	Hearing: a)     Partial hearing, stable b)     Partial hearing, unstable c)      Totally deaf
17.	Diabetes
18.	Seizure disorders (Epilepsy) a)     Mild b)     Severe c)      Controlled with medication (does not include frequent convulsion which are common)
19.	a)     Cleft lip b)     Cleft palate c)      Cleft lip & palate d)     Facial clefts
20.	Malnutrition a)     Mild b)     Severe
21.	Kidney malfunction: a)     Mild b)     Severe
22.	Burns (needing plastic surgery) a)     On arms & legs b)     On face c)      Mild d)     Severe
23.	Developmental delay (child who is behind emotionally, physically, and or socially) a)     Mild b)     Severe
24.	Emotional problems
25.	Abuse: a)     Physical b)     Sexual
26.	Hyperactivity: a)     Mild b)     Severe
27.	Learning disability: a)     Mild or b)     Moderate
28.	Speech stuttering: a)     Delayed speech b)     No speech
29.	Positive VDRL (Congenital Syphilis)
30.	Family background: Family history of medical problems a)     Alcoholism b)     Drug usage c)      Parent who is mentally ill d)     One parent mentally retarded
31.	Multiple birth defects
32.	Dwarfism
33.	Twins or Sibling groups older children above 6 years
34.	Requires some corrective surgery of a minor nature