Abstract
Zeke is a 1 1/2-year-old blue-eyed cherub whose Cupid's bow was broken at birth by the fissures of a bilateral cleft lip and palate. His mother Jean walked the precarious tightrope of the poverty line, often slipping and losing her balance but always seeming at the last moment to catch herself and her baby and pull them back to their unstable perch. Zeke's father worked a minimum-wage job, and I often sensed a distance between him and his family. I saw him only once during the preoperative and postoperative period of Zeke's cleft lip repair. When the time came for Zeke's surgery, he was readmitted to the hospital. During his preoperative visit, I found him as I usually did in my office, a bright, happy child, plump and well cared for. Jean, on the other hand, looked cadaveric. Her ashen skin was stretched tightly across her prominent cheekbones. Her deep-set
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