They never said it outright — people like the Vances rarely say the cruelest things outright — but it was there, in every comparison to a healthier cousin, in every remark about how the Vance family “had always been built on strong men,” in the particular thin disappointment that came into Eleanor’s face whenever Tommy had a bad week.

My son had grown up absorbing, in a thousand small doses, the message that his own body had made him less.

I remember the worst of those early years so clearly it still stops my breath.

The nights in the pediatric ward, the small oxygen mask over his tiny face, the alarms, the way I learned to sleep sitting up in a plastic chair with one hand through the crib rails so he’d know I was there.

And I remember calling Joe from those wards, more than once, and hearing the impatience in his voice — not fear for his son, impatience, as though the child’s struggling lungs were an inconvenience scheduled at a bad time.