Nathaniel pulled out his tracheostomy tube tonight. A first since airway surgery. The setting was close to what I have always imagined to be the worse possible. We were northbound on Interstate 44 returning to the St. Louis area from visiting our daughter and husband. The highway had just widened to three lanes. I was driving; our van was in the middle lane with semi-trucks on both sides of us. Everyone was traveling around seventy-five miles an hour. Rich was beside me in the front, trouble shooting a problem with Nathaniel's talker. We had just driven through one of many hard rains. I heard velco and Nathaniel's breathing sounds changed.

"What's wrong with him?" I said to Rich. He turned his head to the back seat, then undid his seat belt and lunged backwards. "His trach is out," he said.

Those four words have precipitated some of the scariest moments of my life.

There was an immediate instinct to panic. But also an immediate thought that his airway is safer now. Previous experience and new information were competing for control of my body and mind. It was just turning from dusk to night; Rich asked for the inside light. I have driven my van for eight or more years, but I could not remember how to turn the lights on. Still searching for the light, I slowed and moved to the right lane, also trying to figure out if I should pull to the side of the highway or use an exit that I could see just ahead. I remember thinking that there was too much to think about - I did not know what to do first.

I found the light switch. Nathaniel's breathing noise changed to coughing. "It's back in," Rich said. He was more in the back seat than the front now, his legs all that were left near me. "I just have to refasten your ties," he continued, now talking more to Nathaniel than to me.

I stayed on the highway. Rich returned to the front seat; he suctioned Nathaniel. A mile further down the road, Rich gave the talker back to Nathaniel. He asked for a cookie.

Moments after decannulating himself in a dark van on the highway, he was breathing normal and happily eating a cookie. It felt surreal.

Rich and I took a couple deep breaths. One of mine slightly resembled a sob. Not because of what had happened. But upon realizing how tonight's accident and likely the outcome would have been very, very different if this had happened before February's airway surgery.

The Lord has done great things for us; we are glad.
Psalm 126:3