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Your wife has already composed his own lullaby, “Sam, Sam, the Little Man.” But she and you and your three other children have spent the past 24 hours learning about the incredible uphill battle Sam faces.

“Trisomy” means “three chromosomes.” Each cell in your son’s body should have a healthy pair of the chromosomes scientists call No. 18. The unkind twists of the genetic lottery have given him instead a crippling threesome.

Sam was born breech in an emergency procedure in Mary Greeley Hospital, in Ames, Iowa. You and your wife accepted the attending physician’s advice to Life Flight him immediately in a helicopter to the Infant Intensive Care Unit at the Iowa City Hospitals. You were told that Sam could not breathe on his own, although no one ever asked whether you approved his being hooked up to a ventilator. You overheard the emergency personnel relaying in medicalese the reasons for the flight to Iowa City: microcephaly, low-set ears, flat midface, short stature, proximally placed thumb and potentially abnormal male genitalia. All signs, you have since learned, of genetic abnormality, and indicators that he will be, as a friend puts it — choking on the words — “mentally retarded.”

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