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 to 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.

The decision for Nathaniel to have hand surgery was a very hard one for me. It was an elective surgery. Nathaniel’s right hand did not have to be fixed. It was not causing him any discomfort. The problem would not have worsened with age or time. Nathaniel’s primary care physician and orthopedic surgeon, while very eager to address the problem now, were also open to the idea of waiting until Nathaniel was older if that was our preference as parents. The only potential problem that could have developed if we held surgery was Nathaniel developing compensation techniques for his nonfunctional right thumb and then later struggling to fully use the hand even after it was surgically repaired.

When we scheduled Nathaniel’s surgery last fall, I was very torn about the decision. One day I felt strongly that the timing was right. I felt confident that fixing Nathaniel’s hand as early as possible offered the best chance of him growing into normal hand use as his fine motor skills develop through his preschool years. The next day I wanted to call and cancel the surgery. In the end, having to postpone due to a hospitalization for a respiratory virus was a relief. It reminded me that while Rich and I can make the best decisions we see possible and come up with logical treatment plans with Nathaniel’s medical team, the Lord is ultimately in control.  We do not have to know the right answer on surgery timing. It does not rest entirely on our shoulders. God is sovereign. He can stop a surgery. He can allow a surgery to go through. He has done both now.

Nathaniel has a bit of a fan club when he is at the hospital. Nurses, nurse practitioners, respiratory therapists, social workers, nurse techs… they know Nathaniel. They recognize his name on a wall assignment chart or an admit list and hunt us down to visit. A comment I heard last week during one of these impromptu visits struck me hard, “I can not believe he is still alive.”

The woman who said this had interactions with Nathaniel prior to us becoming his parents. I met her as Nathaniel’s foster mom anticipating his adoption, but we have not seen each other in well over a year. Her comment was made after watching him climb in and out of a little car and use his iPad talker. “I can not believe he is still alive,” she said in amazement. I heard genuine excitement in her tone of voice. I saw enthusiasm for Nathaniel’s achievements in her nonverbal communication. I felt a sincere compliment for our care giving. But her word choice said more than these positive things. It also revealed her original presumptions on Nathaniel’s future.

This was not the first time we have been aware of others' speculations about Nathaniel. We were given many impressions about his abilities and potential at our adoption staffing. Most have been proven wrong already. Doctors are more cautious about making predictions. “We don’t know what to expect…” or “We have to wait and see…” are common phrases I hear at appointments. Open-ended aspirations are only a slight bit more encouraging than the limited ones. What would we be saying if we changed our thinking and assumed Nathaniel would make it? That he would live? That he would find ways to communicate? That he would someday drive a car or go away to college or get a job or raise his own family?

This is why I struggled with hand surgery. Fixing Nathaniel’s hand was the boldest decision we have made to date that proclaims hope for his future. If we have no hope for continued life and achievement, we have no reason to prepare him mentally and physically for what lies ahead. To be more specific to this last week, if we do not expect Nathaniel will come through airway emergencies or respiratory illnesses and learn to write his name, we have no reason to fix his hand to hold a pencil.

Nathaniel’s hand deformity was not his greatest disability. Neither is his airway abnormality or his inability to use his vocal chords. It is not the residual effects of his brain bleed or his congenital heart defects or his dependency on g-tube feeding. Nope. The greatest barrier that Nathaniel will ever have to overcome is low expectations.