The nurse knocked on the bedroom door. I had heard Nathaniel’s oximeter alarm go off prior to her knock and was already out of bed. I ran to his room. Upon entering, my eyes went to the machine recording his oxygen levels. Seventy. And then before I looked away, it dropped to forty-seven.

The nurse was bouncing him up and down in her arms, ignoring his gasps for breath. "He's cold," she said. "He needs warmer pajamas." He seemed slightly blue. 'No maybe ash is a better color choice,' I thought to myself. All the lights in the room were on, but I desperately wanted more lighting to figure out what was wrong with his coloring.

The oxygen sensor alarm kept signaling. Suction. We needed to suction. I remembered the simulation class I had taken. Suctioning was the first step in analyzing an emergency. "Have you tried to suction?" I asked the nurse. She had not. I took Nathaniel in my arms. "Please do so now," I pleaded. The alarm and the voice in my head created a loud symphony of staccatos. Alarm. Alarm. Alarm. Alarm. Hurry. Alarm. Alarm. Alarm. Alarm. SUCTION!  After taking the time to put on two gloves, she turned on the machine and eased the catheter into Nathaniel's tracheostomy tube. It stopped short of the anticipated premeasured depth.  I turned to Rich, now in the room. “He has a mucus plug. We need to do a trach tube change now.”

The nurse screamed.

"NO! We need to call 911 and wait for them to do it!”

She ran from the room.

Rich opened the top middle dresser drawer searching for our spare tracheostomy tube. I laid Nathaniel in the crib and unbuttoned the snaps on his sleeper. He wasn’t breathing. He was whistling, straining to pull air through a tube blocked with dry mucus. We had each completed one tracheostomy tube change on Nathaniel prior to this moment. Both were in a controlled setting with an experienced nurse present. We quickly agreed that he would remove the old trach tube and I would insert the new. Rich undid the trach ties, counted to three, and pulled the plugged trach tube out just as the nurse reentered the room yelling. “I don’t know your address. Where am I working tonight? Here talk to 911!” She pushed Rich away from the crib and thrust her cell phone in his hand.

The hands that had been holding Nathaniel’s head back, exposing his neck, and keeping his airway open were gone.

What happened next will forever be etched into my memory. Nathaniel tucked his chin, blocking his stoma. He tightened his neck muscles. He had no open airway. I fumbled to reposition the new tube in one hand so I could manipulate his head with the other. I tried to insert the new tracheotomy tube three different times before hearing my own voice cry out, “Jesus! Help me!” The tube went in on the fourth attempt. Rich was there again. He attached an resuscitating bag to the new trach tube and started giving Nathaniel breaths.

Eleven hours after being placed in our care through foster care, Nathaniel went into respiratory distress due to a mucus plug blocking his tracheostomy tube. God delivered him. We watched our new little son’s lungs fill with air as if for the first time. We saw him transition from ashen blue to pink. Where death seemed imminent, suddenly life was kicking and smiling again. When Nathaniel grows up and asks about the day he was born, I will tell him about two days. This was our birth story.

Continue the story by reading: Day One: Our Baby's First Night Home