After completing the procedure on baby No. 1, we would start again with No. 2. At first, the process often took 45 minutes per baby. We quickly learned the twins had healthy lungs. Crying is too serene a verb to describe their reaction. Bloodcurdling, the-world-is-coming-to-an-end screaming is a more apt description of our nightly descent into noisy chaos. And as Betsy and Elana grew, they gained strength with which to protest. Sometimes the babies would pull their plates out or rip the tape off, even though they wore mittens to prevent them from doing so. And we’d start all over again.

Every week, Grayson or one of his associates would adjust the plates, adding acrylic to create extra pressure, or shaving off material to reduce irritation to portions of the gum. The modifications were especially important for Elana because the extra acrylic would gradually force the premaxilla down and into the gap at the front of her mouth. During the first month, there didn’t appear to be much progress, only irritation inside the mouth. But in the second month, September, changes began. Elana’s premaxilla was moving into place in the upper jaw. Betsy’s cleft was narrowing as well. We began to visualize exactly where Cutting would be sewing the lip and gum together.

While the special bottles allowed us to squeeze formula into Betsy and Elana’s mouths, there was nothing easy about it. Imagine trying to drink from a bottle if your upper lip were not intact. For Betsy, the plate was an annoyance, a chunk of plastic now covering much of the roof of her mouth, though after several weeks she adapted. For Elana, it was doubly difficult because of the cleft in her palate. In theory, the addition of a molding plate was supposed to make drinking easier for Elana, since it covered the hole in the roof of her mouth, effectively creating an intact palate. But we had no such luck. Elana continued fighting off the bottle, often crying while she was being fed. Her feeding aversion grew with age.

Of course, we endured. “I quickly learned to block out the screams, as I knew I had a task to complete,” Robin says. “I became very focused on our goals, to the point where it became more important than my child’s immediate anguish.”

At midnight on November 11, 2002, I vented into my diary:

“It is hard to describe how much this stinks, making your own newborn child writhe with discomfort. One moment she is smiling and cooing. Then, as we place her down on the changing table and restrain her, the coos turn to yells. Tonight we have to pull the tape off Betsy’s right side three times to get it properly aligned; each time Betsy’s screams and efforts to kick and fight loose are at a maximum level.”

The next focus of molding was the nose. Children with clefts tend to have flat noses, often due to collapsed nasal cartilage and short columellas, the structure separating the nostrils.

Nose molding for Betsy began in her tenth week (seven weeks after she first began wearing the plate). Grayson added onto the front of the plate a metal stent covered with soft acrylic. As we put the plate into the baby’s mouth we now also inserted the stent into the nostril to help push the nose up and out and to extend the columella, which would help Cutting form a symmetrical nose.

Elana’s nose molding started at thirteen weeks, once her premaxilla was fully inside her mouth. Since her cleft was bilateral, two nose stents were added, one for each nostril.

“It’s a godsend,” said Cutting. “Having the columella stretched and the nasal lining stretched makes it possible to get a good-looking nose.”

From cutting tapes to cleaning molding plates and inserting them—not to mention changing diapers and feeding the twins—the workload was constant. I found that the most relaxing part of my day was the subway ride to and from the office. Robin, at home with the kids, really had no break, even with one nanny helping during the day and another on duty overnight.

“All I saw was the four walls of our apartment,” Robin recalls. “The nanny and I would sit on the couch just feeding the babies. For the second time in my life, I became addicted to soap operas; they were my only mental break.”

Four months after her birth, Betsy went in for surgery—though the morning began with Elana’s weekly adjustment at Grayson’s office. Then it was upstairs to NYU’s day-surgery floor.

Betsy was so cute, so innocent, cooing and smiling at us as we held her in the waiting room. Is this how Abraham felt as he brought Isaac to be sacrificed? I wondered. Thank goodness she will never remember any of this. We played a Baby Einstein video for her as hunger from the presurgery fasting gnawed at her stomach.

Four nerve-racking hours later, the alert came that Betsy was out of the OR. I darted into the recovery room to see a nurse holding our baby’s limp body. I took hold of Betsy, my eyes welling. Yet, even bloody from the operation, her nose was perfectly shaped and her lip was sewn up artfully.

During the recovery period, Betsy had to wear arm restraints that prevented bending at the elbow, to ensure that she wouldn’t play with her lip. And for five weeks we had to apply a strip of surgical tape across her lip to protect the healing stitch line. But applying the one piece of tape was nothing compared with the previous fifteen weeks. It was thrilling to see that she was on her way.

Betsy’s successful surgery also was an encouragement as we continued taping Elana. Cutting instructed us to further extend Elana’s columella. Grayson and Larry Brecht, a prosthodontist on the team, added plastic to the front of her plate in order to put more pressure on the columella. About three weeks before her surgery, Elana appeared to be in great shape: The premaxilla was in, her lip was in position, and the nose was gaining shape. But the doctors still wanted the columella stretched a bit more. It turned out to be more pulling than Elana could tolerate. The base of her nose began bleeding, forcing us to take the plate and tape off for several days. Frustrated, I feared Cutting would have to delay the operation.

But a week before the surgery date, Cutting examined Elana and declared her ready to go. This time, I was permitted to bring my daughter into the operating room. Carrying Elana down the hall, I thought of my father and the numerous times we had been in and out of the hospital in Boston. I had seen enough of hospitals.

In the operating room, the nurse and I removed Elana’s outfit. The anesthesiologist placed the mask over her face. She cried and then was out. I removed her molding plate for the final time, gave Elana a kiss, and whispered, “You’re going to be a star.”

Six hours and more than 200 stitches later, Elana was lying in the arms of a nurse in the recovery room, crusty blood covering her upper lip. But the lip was intact for the very first time, and her nostrils were well shaped rather than flaring to the sides. Cutting had operated brilliantly.

Late in the day, he came down to the pediatric floor to check on Elana. He examined his latest patient and declared himself pleased with his work.

“I know you’ve been through a horrendous few months,” he told us. “But I don’t know what I would do without parents like you. I’d rather put you through it for a few months instead of the alternative. And look at the outcome! Think of all those parents who have to go through surgery after surgery and their kids don’t come out looking as good.”

At a checkup one week later, Cutting was still exuberant. “I could never get that result on a bilateral without the molding,” he said. “I’ve been doing this for 25 years, and we could never achieve then what we’re able to do now.”

Four months after Elana’s surgery, she looked better than ever. Many people didn’t even notice the two little lines coming down from her nostrils; a few have asked if she had a cold.

Relieved as we were, there was one more major surgery to go: closure of Elana’s palate, which would bring her to anatomical conformity. Cutting scheduled the surgery for July 29, several days after her 1st birthday, a point early enough that the cleft should not affect her speech. Anticipating the surgery, Robin and I decided not to throw a big birthday party. We’d celebrate at 2.

The day before the operation, I took Elana for a swim. Gliding through the water, she shrieked with delight. I looked into her wide-open mouth to look at the cleft—narrow near the front then widening as it extended deeper back. It would be the last time I would be viewing that cleft—thankfully.

The next morning, we arrived at NYU. By now we were pediatric-surgery pros, familiar with the full process. In the recovery room, Elana cried as a doctor suctioned blood from her mouth. As before, her nostrils were packed with blood. To protect against choking, the surgeon had sewn a thread through Elana’s tongue, taping the thread to her cheek. In the event of breathing trouble we were to pull the thread to move her tongue and open the airway. Fortunately, it wasn’t necessary.

Though the surgery was successful, we had one remaining problem to tackle: Elana’s feeding aversion. Her battle against the bottle had forced us to have a gastrostomy tube inserted into her stomach, allowing us to pump formula directly into her. But now we’re teaching her to drink from a sippy cup and eat solids.

Today Betsy and Elana are happy toddlers who have been progressing through milestones: sitting, crawling, pulling themselves up, cruising, and now beginning to talk. Betsy began walking first, but Elana wasn’t far behind. They love climbing stairs, pulling books from shelves and leafing through them, waving bye-bye and blowing kisses, clapping hands, and raising their arms when we shout “Hooray!” These are victories for all four of us, rewards for our perseverance. And the only molding Robin and I will ever have to think about again is that of our girls’ characters.