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.

There were three places I wanted to be on Saturday night: my sister-in-law's surprise fortieth birthday party in Wisconsin, our church's annual fundraiser to support outreach to the marginalized in St. Louis City, and an Eagle Scout ceremony for a young man Rich has encouraged for years.

Instead I spent Saturday evening standing outside a chicken coop with Nathaniel.

I write so much about Nathaniel's communication needs, that I have not put into writing the other areas of development that we are addressing in therapy. There are many. Nathaniel continues to have a global developmental delay and some significant sensory processing needs. He has consistently received Occupational Therapy and Physical Therapy in addition to his twice weekly Speech Therapy.  We had a long day of appointments at St. Louis Children's earlier this month and the collective decision was to start some new weekly therapy there to address some of the sensory needs. We go tomorrow for our first visit, which increases OT to twice a week now. We are putting PT on hold for a time to allow for the extra focus on OT.

Calling 911 brings help, right? For most of my life I have understood that to be true. Growing up in a small Ohio vacation town as the daughter of a police officer and volunteer firefighter I was familiar with the world of emergencies. Multiple summer mornings I woke to the scanner tones and heard the dispatch give our address as the location of the call. The first few times it happened I flew out of bed in a panicked pursuit of a stricken family member only to learn it was someone at our front door looking for help. Symptoms of a heart attack. A fishhook caught in an arm. Heat stroke. A Lake Erie rock thrown at the back of a head. Our porch steps were an open triage unit if the police car was parked in front of the house. If my step-father called for additional help and a transport to the hospital, our small yard filled with black cases of medical equipment, a gurney, and the guys who graduated high school a couple years ahead of me who were now volunteering. 911 called. Help arrived.

That paradigm might have been turned completely upside down on Nathaniel’s first night home.

Nathaniel and I achieved a milestone recently. I had been out grocery shopping and he was home with our private duty day nurse. As I walked through the front door I called my usual to him, “Nathaniel! Mommy is home!” He ran to me. Arms out stretched. Smiling broad. A first.

Earlier this month Tactus Technology released their new Phorm case that can add and remove tactile buttons to the iPad mini's screen. Dr. Craig Ciesla, CEO and co-founder of Tactus stated, "Typing on a flat touchscreen is still a really unnatural user experience. Adding a tactile dimension to an otherwise flat surface changes the way we will interact with all the screens in our lives. This is just the beginning." This month, we are counting on that being true.

We had our first snow today!

All morning I wanted to get Nathaniel outdoors, but it wasn't until after his nap that it happened. When adding the second layer it occurred to me that I didn't know if the trach goes in the coat or stays out? Do I zip the coat tight to his chin? In the end, I zipped and went out. Just keeping the hat and mittens and boots on was challenge enough. (Snow pants? Didn't I buy those last fall? Where did they go?)

It has been awhile since I have compiled thoughts on Nathaniel's communication skills and use of augmented communication. We are headed to St. Louis Children's Hospital today to check in with the Aug-Comm team; I am excited to share Nathaniel's progress with them and thought I would use my preparation for the meeting to pull together a blog post on communication.

When the sun shines in January, my home is flooded with light. Designed by a carpenter in the 1950's our house has wide overhangs that protect the rooms from direct sunlight in the summer, yet allow the warming rays in through out winter. The two feet of extra roof saves us in heating and cooling costs all year. There is cozy spot on the couch in the living room where the sun shines in almost hot in the early afternoon. It is a good place to spend Nathaniel's nap time. Reading. Writing. Editing photos. Drinking the last of the morning coffee. It is a good place.