Three times it happened during Nathaniel's recent hospitalization.

"He's in here with Grandma," said the Emergency Room attending to the resident as they discussed Nathaniel's case outside the partially opened thick sliding glass door.

"Are you hanging out with Grandma, today?" the respiratory therapist asked Nathaniel when she came into his room to administer a treatment.

"Grandma, will you be staying the night instead of Mom?" asked a night nurse new to Nathaniel's case just after shift change.

"I'm Mom," I replied.

Once I added a smack, "A twenty-something Mom or Dad couldn't handle this kid."

Nathaniel was discharged from the Pediatric Intensive Care Unit and went straight to the cast room. We missed our previous scheduled 7:00 am appointment to get his cast removed and pins extracted, but the hand surgery team squeezed us in when we got there. I just wanted to be done. To come home knowing Nathaniel and I would not have to go back in a couple days. Not have to face the waiting room apprehension. Not have to open just scabbed over wounds of fear.

Dinner: snack packet of humus and pretzels and an ice tea. The cafeteria worker, the same one I have seen countless times in the last week, glanced my way and said, "$7.61."

"You're kidding me," I replied. "Seven dollars and sixty-one cents for that?" I wished I had walked to Panera Bread, spent two dollars more, and gotten the Mediterranean Chicken and Quinoa salad. It is amazing, by the way. Try it.

"Four dollars work?" His expression was flat, but kind as he punched in his employee id.

Nathaniel took two steps forward today. He spent most of the late afternoon and evening on room air. Hooray! We also were able to increase his daytime feeds to two ounces given over a two hour period. Hooray! Hooray!

The doctor and I are ready to push that gas pedal to the floor.

I woke early Tuesday morning to Nathaniel's suction machine turning on and off. I glanced at the clock. 3:15 am. Rich had woken me when he crawled into bed around 12:40 am. He needed sleep. It was my turn to help the nurse and check on Nathaniel. I have learned over the last two years that there are little indicators of seriousness in how the nurses manage Nathaniel's care. Suctioning by flashlight is evidence of minor intervention. Walking down the hall, I noticed a brighter-than-flashlight glow from the room. The lamp by Nathaniel's crib was on. It announced an increased need for triage by his nurse and myself. Nathaniel had a fever. A very real aspect of our life is that Nathaniel can go from running and playing like normal to Pediatric Intensive Care Unit in a few hours.

My husband is an Emergency Preparedness Merit Badge Counselor for Boy Scouts of America. I do not remember now why he took signed up for the responsibility, but for years he has counseled young men through the badge. Many of those years our sons' troop dedicated an entire weekend camp out to helping the boys earn the badge, including an emergency with injuries. While sorting campfire smoke laden clothes in the laundry room on Sunday afternoon, I would listen to Rich share about the "accident," find out which boy in the troop suffered severe injuries, and ask questions about how the troop solved the crises. I learned a new application of a word through that process - mitigate. At the end of every drill the troop would mitigate the accident; they would sit around and discuss what could be done next time to lessen the severity of a similar emergency.

Monday morning I told crews at the ambulance house that, "someday Nathaniel will have a very two-year-old moment, probably when he is mad at me or wants to get a reaction, and pull his trach tube out." At 6: 31 Monday night, he proved me right.

Rich, Peter, Nathaniel, and I had gone for a walk and were coming up our sidewalk. Peter was ahead of the stroller; Rich and I behind it. Peter looked at Nathaniel who was in his stroller playing with his Ligntening McQueen matchbox car, then turned to unlock the door. Two hands were on the stroller tray playing with a car. Not angry. Not having a temper tantrum. Nathaniel was waiting happily with a smile on his face. Peter turned the key, pushed the door open, turned back towards Nathaniel and yelled, "He pulled his trach out!"

Hand surgery is behind us. Probably by the time I finish writing and uploading this post, the first three days post surgery will be also be behind us. Three days is the length of time I hear hand surgery pain is the most intense. Managing Nathaniel’s pain has been tricky and some unexpected respiratory issues complicated our post surgery hospital stay. But today I catch myself taking deep breaths and releasing loud exhales of relief. The big day is over. The surgeon cut Nathaniel’s right thumb metacarpal, rotated it one hundred and ten degrees, and pinned it back together. The doctor then sliced a segment of muscle on the pinky side of Nathaniel’s hand and brought it over to support the thumb and increase thumb to finger opposition. Wow. The whole thing amazes me. We will know the final outcome of the surgery in five weeks when Nathaniel’s cast comes off. But for now we rest in the surgeon’s explanation that things went well. I am glad the last four days are behind us.

Nathaniel was scheduled for hand surgery the last week in September. He was diagnosed last spring with "Thumb in the Plane of the Hand" on his right hand. It is exactly what it sounds like - his right thumb is in the same plane as his other fingers on his hand. He does not have thumb opposition with the right hand and the web space between the thumb and index finger is not as deep or wide as it needs to be. The finger painting photo above shows the abnormality pretty well. Consequently Nathaniel's grip with his right hand is very different. He tries to hold things between his index and middle finger using the thumb and index as a claw. Frequently he initiates play or grasping with his right hand and then transfers to his left. More often he just lets his right hand rest and uses his left as the photo below, taken last week in the St. Louis Children's Zoo, shows.