I was driving home from grocery store the other night and started to sob. A chest heaving, can not catch your breath sort of sob. Nothing had happened that day or during the shopping trip that warranted tears. As I was leaving the store, Rich and I had exchanged texts. He and Peter were finishing up changing Nathaniel's tracheostomy ties and he was putting Nathaniel to bed. "Will you be home to say goodnight?" The last text from Rich that I read before the convulsive gasps gripped my torso like fingers grip a steering wheel when driving in a torrential rain.

We had a very happy little guy at dinner tonight. Nathaniel ate orally. And he loved it.

I had one overriding thought when the team in Cincinnati told me we could start oral feeds - "I want this to be simple." Advocating for someone's safety is hard work. Watchful waiting for three years is stressful. As we find a new routine to life post surgery, we are just beginning to see how much strain our whole family has lived with for a long time. Intense feeding therapy is the last thing I want to start right now.

When Nathaniel discontinued oral feeds, we decided to keep him at the family dinner table. He prayed with us. He listened and participated in our conversations. He received his g-tube feed while we ate. Almost nightly, he would reach for our silverware, plates, and glasses. I broke my heart. Often he ended the meal with someone's fork or spoon in his mouth. We kept his oral stimulation toys and other quiet activities available, but I think holding and pretending to use a utensil, even without food, gave him pleasure and helped him feel like he belonged.

Nathaniel was discharged from Cincinnati Children's on Saturday, February 13. During our visit to Cincinnati last September for the tonsillectomy, we became friends with the crews at the Blue Ash Fire Department. They offered to provide a few dinners for us this trip. A delicious steak dinner, and teddy bear for Nathaniel, was delivered to our hotel Saturday night to celebrate both Valentine's Day and Nathaniel's successful surgery.

Nathaniel has improved by leaps and bounds since the third day post surgery. He's playing with trucks, working on language, and roaming the halls pushing and pulling a wagon. Opps! It is not so quiet around here anymore. We're even back to taking hospital selfies. (Boy, do I have a lot of hospital selfies with this kid.) Tomorrow morning early (6:30) the doctors will change his tracheostomy tube for the first time. If you happen to be a Saturday morning early riser - pray for us. Rich and I both need to be present to learn new care. We will see the incision and new stoma for the first time. We have been through many surgeries as parents; it never gets easy to see a fresh surgical wound on a small child. Afterwards Rich and I will each demonstrate our ability to care for the stoma and change his trach tube. If we do this tomorrow, Nathaniel will be discharge. The discharge is two days earlier than doctors told us to anticipate - a sign of how quickly he has recovered in the last couple days.

There have been a few post surgery issues to cope with that have made recovery not fun. No complications, just not fun. Nathaniel's IV needed restarted; I have decided though I strong description, 'hate' is how I feel about the word occluded when it flashes from an IV machine. Nathaniel has also had some difficulty with voiding and has needed multiple catheterizations. Hopefully these minor issues will continue to improve. 

We learned last week that our friend, Maverick, was traveling to Cincinnati and having surgery this week too. Maverick and Nathaniel were featured in a St. Louis Post Dispatch last spring when we met doing trach training for first responders.  Maverick's room is four away from Nathaniel's room, and he came by this morning to share some toys. It was good to see Nathaniel smile during the visit.

We arrived in Cincinnati yesterday afternoon, and Nathaniel had Laryngotracheal Separation surgery today at Cincinnati Children's Hospital.

Last May our daughter suggested that I put together an list or index for blog posts about Nathaniel. When she tells people that she has seven brothers, that the youngest is three years old and the oldest is thirty-three years old, she gets a lot of questions. She likes to send the curious to my blog for information about Nathaniel.

"But where should they start to read, Mom? And how do they find specific posts?"

I have been working on this list since that conversation. The process of compiling and specifically having it completed today, the second anniversary of Nathaniel's adoption, has been a special gift to myself.  It was good to reflect on where we have been, what life has been like for Nathaniel and our family,  and how God has been faithful through it all. After spending hours rereading these old posts I must add my AMEN to Jason Johnson's words tucked in a recent blog post, "foster care and adoption are not just the process by which we may change a child’s life but also the means through which God will radically transform ours." 

Nathaniel's airway surgery is about a month away. Now that Christmas and New Year's is over, it seems close. We wanted to share our plans and the needs our family has as the date approaches.

Both Rich and I will go to Cincinnati for the surgery. We have been told to expect a five hour surgery and for Nathaniel to spend a week in the Critical Airway ICU afterwards. Nathaniel will have a new stoma and possibly medical new care routines that we will learn before his discharge. We have been asked to stay in the Cincinnati area for a second week to be close to the surgeon and hospital in the event of complications.  There are three different ways you can help our family now.

A friend sent me this photo on Christmas Eve. "Baby Jesus has a trach this year," her text said.

Doll baby Jesus' mother is six-year old Maggie. Maggie's mother is a medic who spends her days training first responders in tracheostomy emergencies.  Maggie's grandmother is a Sunday School director. Maggie's grandfather had a trach. Blend it all together and it is logical that when a baby was needed for the Family Service nativity at church that Maggie's trached baby doll was cast for the leading role.

The baby wrapped in swaddling clothes and lying in the feeding trough had a tracheostomy.