I gave him one last kiss and walked out, leaving the surgeons to do their work

Akiva’s first surgery was when he was a tiny three months old. The procedure, which is mainly cosmetic, closes the lip and attaches all the split muscles in the area, and does help somewhat with eating and speech.

When the adult teeth start coming in (usually around 8 years old), kids with cleft generally have a second surgery to repair a cleft in the alveolar ridge, the bony part of the jaw that holds the teeth. This second surgery is mostly about function.

The third, optional, surgery, which some have as teenagers, is to touch up the scars and make the lip look as typical as possible.

On the day of Akiva’s first surgery, only one parent was allowed to accompany him into the operating room. I donned hospital scrubs and followed the little gurney into the OR. The bright lights shone overhead, and we listened to the clatter of technicians preparing scalpels — the ones they would use to cut open our son — as the doctors surrounded Akiva, preparing for the surgery.

“It’s going to happen very quickly,” the anesthesiologist told us. “Give him a kiss and then you can hold his hand while I put him to sleep.” He put the tiny mask over Akiva’s face and we watched his eyes droop shut. The doctors had warned us that it’s heart-wrenching for parents to watch their kids go under, but I wanted to be there. I needed to be there to see our son off.