Patrecia Coble watches as her 14-month-old son, Michael, chases his dog, Rusty, around their Chesapeake, Va., living room. "Dr. Magee has to do another operation to remove the scar tissue under his nose," says Trecia, looking on with delight. "But I think Michael looks great. I can't imagine him looking the way he did when he was born."
Michael Coble was born with a bilateral cleft lip and palate. Both sides of his mouth were slit up to his nose and back through the roof of his mouth, leaving a tangled red knot of skin and muscle that Wayne, his father, likened to an accordion. Most doctors wait until a child is 6 to 18 months old before doing corrective surgery. But for several years now, Dr. William Magee, a Norfolk plastic surgeon, has been setting his own timetable. Magee operated on Michael just 15 days after his birth. "Doing the surgery early lifts a huge burden from the parents' shoulders," says Magee. "The infant can immediately begin its life with nearly normal functions of eating, breathing and smiling. He or she can coo like any normal child."
Michael's birth defect was first discovered on Jan. 19, 1993, during a routine seven-month ultrasound. Trecia, now 25, was devastated. "At first I wished I would not have even known," she says. By contrast, Wayne, 28, an easygoing Navy gunner's mate, never lost a beat. "As long as he had 10 fingers and 10 toes," says Wayne, "I was happy."
The Cobles spent the next two months adjusting lo the realization that they were not going to have a picture-perfect baby. "We felt so much relief," says Trecia, recalling their first meeting with Magee when he explained how he would repair the palate. Magee introduced them to other parents who had had the surgery done on their newborns.
But nothing was going to be easy about Michael's birth. During the March 30 delivery at Chesapeake General Hospital, the umbilical cord wrapped four times around the baby's neck, and his heart rate plunged for a few seconds, scaring everyone. No sooner was the crisis past, however, than the pride was evident in Wayne's face as he joined a cluster of relatives waiting outside the birthing room. "He is healthy," said Wayne. "He has blue eyes. Man, he has real blue eyes."
Later, as everyone crowded around Trecia and her newborn, Wayne grew thoughtful. "See where it's bunched up," he said. "That is supposed to be his palate and two pieces of his lip. If it can't be repaired, we will have to accept it. This was the baby we were given, and we were given him for a reason."
Dr. Magee wanted to operate on Michael the day after his birth but could not because his platelet count was low, which could have lead to excessive bleeding. Five days later, when the count stabilized, the Cobles were able to take Michael home.
Feeding Michael proved to be a nightmare. Michael's cleft prevented him from nursing, either with Trecia or a bottle. But using special bottles designed to squirt milk to the back of his throat was tricky also—wayward teeth, sensitive to an accidental knock, had to be avoided. For two weeks, nobody slept.
On April 14, the day of the surgery, the Cobles were at Children's Hospital of the King's Daughters in Norfolk by 7 a.m. But when the time came for the operation, Trecia, a jangle of nerves, was having second thoughts and didn't want to let Michael go. "I'm gelling pretty used to him the way he is," she said.
In the operating room, Dr. Magee looked down at the tiny bundle on the table. Peering through a microscopic lens, he began to separate the tangled parts of the infant's palate. Above all, Magee was concerned about getting the soft palate, which is essential to speech, to stretch all the way to the rear of the throat.
"If you look at the anatomy," said Magee, "it will tell you exactly what to do. See that white roll?" Magee pointed to a sliver of skin buried in the ball of flesh. "That's the white highlight over everyone's lip." Magee brought the sliver up to form a Cupid's bow.
To date, Michael has had three operations. The second, at 7 months, removed scar tissue and reshaped his nose; the third, at 13 months, involved putting tubes in his middle ears—to correct drainage problems that can occur with cleft palate—and untying his tongue, enabling him to speak more clearly. "He is able to say a lot of different words—Papa, Mama, more, yes, no," says Trecia. Eventually he will have a fourth operation on his nose, lengthening the columella, the little bridge of flesh that divides the nostrils, to make it less flat. In a few years, Dr. Magee predicts, the only sign of Michael's cleft palate and lip will be his scars.
None of this has affected Michael's motor skills. He took his first steps at 9 months and was walking—make that running—before age 1. "Michael does everything, except hang on the fan," says Trecia. "He has a wonderful disposition, in spite of everything he has been through. He blows me kisses when I go to [weekend nursing] work."
Michael is not the only one who has developed. Trecia feels that Michael has changed the way she and Wayne, who have been married six years, look at life. "It has made us closer," she says, "and more compassionate toward other people, whether their problems are big or small." As for her mischievous little boy, says Trecia: "Michael is my world. He is everything to me and his daddy. Everything."
WILLIAM PLUMMER
GIOVANNA BREU in Chesapeake
- Contributors:
- Giovanna Breu.
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