Becky and Steve Petry got some important advice before they left home for their adoption journey to Kazakhstan: "try not to fall in love on the first day."
For those who have been through the International Adoption Program at CHOP, you may recognize this advice. For those of you who are thinking about international adoption, keep in mind that once you land on the ground in a foreign country it may not be one of the fairytales you hear so often about. And you will only have the expertise and guidance of a qualified team of doctors if you arranged for it ahead of time.
The day my husband and I arrived in Kostanay province in Kazakhstan, we were taken to meet our referral. We had no pictures, no physical description, and no age indication. We had requested a healthy child of either gender, aged 8 to 36 months old with mild, correctible medical conditions. First the director showed us the file of the child we were there to meet. His photo showed a fair skinned, frightened boy. The doctor read his file while the coordinator translated for us -- we heard rickets, anemia, and a mild, correctable club foot, but we couldn't interpret most of the medical information. The rest we wrote down so we could ask Dr. Friedman for more information.
When they carried the child into the room, I couldn't breathe. Before us was this wide-eyed, curious boy named Artyom, looking cautiously at everyone in the room. He was 28 months old, and to us he was beautiful. He looked more like a baby than a toddler, but neither Steve nor I had much experience with very young children. We did not realize at that time how tiny he was for his age or that he was far from where he should be developmentally. Little Artyom could stand if he held on to the coffee table, and eventually I held him in my lap. That is when I began to panic.
Arytom had a huge belly that was as hard as a rock, and tiny little limbs. It was winter so he was heavily dressed, but there was no mistaking that something was wrong. The clouds of doubt began to creep over us. We knew this was not going to be one of the fairytale experiences we'd heard so much about with other adoption stories.
Back at the hotel, we e-mailed Dr. Friedman with everything we had learned. The news that came back was alarming. According to his medical report, many of his organs had abnormalities. The muscles in his legs had atrophied. His head circumference was on the 25th percentile for his age. His length was on the fifth percentile and his weight was far below that. His speech was significantly delayed. Dr. Friedman wrote to us, "all of these are NOT issues that result from normal developmental delays of being in an orphanage. We were instructed to look for more symptoms, take more measurements, and try to get him to interact.
The next day my husband and I were asked to sign papers to proceed with the adoption, and we asked for more time to make a decision. This was not at all what we expected and we didn't know what we were going to do. We tried our best to be optimistic but things looked bleak. This boy would not interact with us. In fact, he appeared to hate us. He did not speak, but he had a scowl on his face and seemed to be annoyed by everything we did. When a caregiver would pass by, they would speak to him in Russian and he would smile at them. Then they would leave and he would go back to being miserable with us.
The information we could get about this little boy was very limited, but Dr. Friedman was very patient. We made own observations and reported back. The more we told her, the more concerned she became. She knew that this child was high risk and she wanted to make that very clear to us. That was why we turned to CHOP in the first place. She was doing her best to deliver her message gently, but needed to be candid and frank at the same time as she knew we were still considering adopting him. "I am quite concerned about this little boy," she wrote. "There are several abnormalities that suggest to me that he may have a significant medical disorder. Should you decide to proceed with his adoption, you should be prepared for the possibility of chronic medical and neurologic disorders. Until the underlying cause of his abnormalities is clear, I cannot tell you what outcome to expect long term in terms of his health or development. If you do decide to proceed with his adoption, I will certainly do all that I can to help you proceed with his medical evaluation and treatment here."
After four more days of visits and one long night of tears, soul-searching, and committing to each other that we would endure the stress on our marriage of a special needs child, Steve and I made the decision to move forward with the adoption. Thanks to CHOP, we were able to make this decision fully informed of what might be in store. We had to rethink everything we had planned. We had hoped to adopt at least one more child in the future. Now we knew that Artyom might need our full devotion and may be our only child.
We emailed Dr. Friedman, letting her know our decision and that we were fully aware of her concerns. Our email read, "we feel that if he is in fact a very sick boy that he needs our help more than a healthy child does. He is ours and we are bringing him home." Part of the reason we could make this decision was because we knew that he could find no better care than the doctors as CHOP. Dr. Friedman replied to our news with her most sincere congratulations, and with a plan for how to proceed with the rest of our trip and preparations for bringing him home.
Diagnosis would be impossible without further medical tests, but we checked in with Dr. Friedman though the remainder of the trip with little pieces of information and minor milestones. Early on, I received an email from Amy Lynch at the CHOP International Adoption Program. Little did I know what a big part she would play in our journey. She gave us pointers on how to interact with him, to promote bonding and determine some of his developmental stages. She repeatedly adjusted her instruction based on what worked and what didn't.
We spent the remainder of our first trip visiting Artyom twice daily (an exception made by the baby home director in hopes of helping him bond with us.) There was no time for sight-seeing or souvenir shopping. It was very different from the other adoption stories we had heard. We arrived home one month later and began to prepare for the arrival of a child who we hadn't "fallen in love" with yet and who clearly did not love us.
Artyom and his brother Kirill in Fall 2012.The day that we brought Artyom home, Steve and I quickly learned that we had adopted a very strong-willed child. He had outbursts that lasted over an hour. He resisted everything we did. He was angry at the world. We were able to get him in to see Dr. Friedman within a few days of returning home. (She had suggested we line up the appointment very early before our last trip.) She had a battery of tests lined up for him. We spent the whole day at CHOP going to from department to department. There was no stone left unturned. Her examination was the most educational for us. She explained everything she was doing and what she was looking for.
Amy Lynch even got him to be cooperative at some points, something Steve and I were unable to do on our own. Inevitably, he had one of his tremendous melt-downs in the exam room. I explained that this goes on all of the time, sometimes for over an hour. I asked how a child could have such stamina to not completely exhaust himself after such long eruption of pure anger. Her reply resonates with me to this day. "Look at it this way — he is incredibly strong-willed. There is no question that strong will is one of the reasons he has survived until now. Think of it as a good thing." It forever changed the way I look at him.
Meanwhile, Dr. Friedman had advised us ahead of time to bring an overnight bag in case she needed to admit Artyom. She explained that the only reason she wasn't admitting him was because it would cause even more trauma than he had already been through. We were given strict instructions on how to put some weight on him and that she needed a report on his weight from our pediatrician in one week. If he did not gain any weight she would admit him to the Hospital.
Her feeding advice was right on target. He began gaining weight. I remember Dr. Friedman calling me back and telling me that "we are headed in the right direction. He is in the fifth percentile for weight but at least he is on the charts now." Shortly after we got the test results. None of the serious conditions attributed to his symptoms were detected. He did however test positive for celiac disease, and it was one of the possibilities she had told us about.
We had removed gluten from his diet on her advice earlier, so the fact that the test results still indicated a strong reaction meant that he was extremely sensitive. To be 100 percent sure, we had to put gluten back into his diet and do an endoscopy with biopsy. She quickly got that test lined up, and when the results came back she assured me that the positive result was "extremely good news." This condition was manageable strictly by diet. There would be no surgeries, no medication and no hospitalization. It explained all of his other symptoms. And his club foot was actually weakened, atrophied muscle and tendon in his left ankle — the result of never having walked.
As we proceeded with his gluten-free diet, something amazing happened. Arytom began to feel better. He began to smile. Out of this unhappy, angry child blossomed a happy, funny, clever personality. Loving, but not cuddly. Sensitive, but not affectionate. His own person on his own terms. And definitely strong-willed. And we did fall in love with him. And he with us. Not at first sight, and not overnight. And none of that matters.
Artyom endured one year of multiple doctors appointments, lab tests, and frequent occupational and speech therapy. He had two and a half years of physical therapy. By the time he was five years old he was running, jumping and climbing with his friends. There is no doubt that the early detection of his celiac disease along with his recovery regimen conducted by the International Adoption Program at CHOP is the reason that our son is where he is today; a thriving first-grader in a classroom full of friends and a home with a family who loves him.
Now Artyom (who goes by his middle name "Rohan") has a younger brother named Kirill, who also became part of our family earlier this year through the guidance and support of the CHOP International Adoption Program.