What you would probably notice first about Thomas Richards are his eyes.

He's just 17 months old, but perhaps because he is unable to speak, he uses his eyes the way other babies coo and babble. All the subtle little muscles around his eyes go to work. They engage you.

And then comes the grin. Once Thomas has caught your eyes, he delivers his drooly grin.

Hello.

Jennifer Delaney, the doctor who delivered Thomas at Ministry St. Joseph’s Children’s Hospital in Marshfield, remembers being startled by Thomas' eyes.

Thomas was born without a trachea — the cartilaginous tube through which we breathe. The condition is called tracheal agenesis, and it is extremely rare. Fewer than 200 cases have been identified in more than a century.

The lifespan of an infant born without a trachea is measured in minutes. Such a baby dies silently, having never drawn a breath. Only a few of these babies, and only because of extraordinary surgical interventions, have survived.

In the United States, Thomas is the first.

In Marshfield, quick-thinking doctors and nurses, coached by doctors at Children's Hospital of Wisconsin, found a way to get air into Thomas' lungs. The way Delaney remembers Thomas' eyes is how they appeared during that life-or-death struggle:

Wide-open. Pleading.

* * *

The Milwaukee Journal Sentinel published a story in November about Thomas and the heroic efforts undertaken by Children's Hospital to preserve his life.

It describes how a team of doctors, led by pediatric surgeon John Densmore, disconnected Thomas' esophagus — the floppy tube through which we swallow — and turned it into a kind of trachea, connecting his lungs to a breathing hole at the front of his neck.

Unable to swallow, Thomas received his nourishment through a gastric tube. Fluid that accumulated in Thomas' mouth drained through a small fistula Densmore created at the side of Thomas' neck.

Once he had sufficiently healed, Thomas was discharged from Children's Hospital and returned to his home in Stevens Point, where he lives with mother, Jessica, his dad, Corey, and his 5-year-old sister, Autumn.

Densmore's plan was to give Thomas a chance to settle in and to grow. Then, when the time seemed right, he would bring Thomas back to Children's and the team that figured out a way for him to breathe would figure out a way for him to eat.

An incident in early September underlined that Thomas had reached that point.

Densmore was visiting Marshfield Clinic when Thomas came in. He had swallowed a crayon, which became jammed in the fistula at the side of his neck. Densmore fished it out.

"It was confirmation that this is a kid who is fairly normal and is putting things in his mouth," Densmore said.

"And he needs to swallow them."

* * *

Densmore and his team operated on Thomas on Sept. 22.

The procedure, which lasted 12 hours, is infinitely easier said than done. Densmore broke the operation down to 30 steps, which he printed out with drawings and contingency plans and mounted on a pole beside the operating table. That way, everyone involved was, literally, on the same page.

Thomas' stomach was loosened from its perch in his abdomen, elevated through the diaphragm and behind Thomas' left lung and placed so that its tip reached into Thomas' neck.

There it was stitched to a remnant of Thomas' esophagus.

"Plumbing," Densmore joked.

"High-stakes plumbing."

Not long after the operation, Corey Richards asked Densmore: "What's next?"

Densmore said the question humbled him. To have been part of something so unique, to be part of a team that successfully responded to something so extraordinary, to have seen it through to the end, all that humbled him.

"We started this conversation with: I don't know that your baby can be saved," Densmore said.

He was recalling the day Thomas arrived at Children's, his first conversation with Corey and Jessica.

"And to sit here, 17 months later, with a kid who is part of this world and interacting ..."

Densmore looked for a way to end the sentence, and not finding one said: "I mean, it's pretty amazing."

* * *

Thomas, Autumn, Jessica and Corey went home last Tuesday afternoon.

Among the things they packed was a toy moose the size of Thomas. The moose had shared Thomas' hospital bed and accompanied him to surgery. The moose's hospital bracelet, with Thomas' name on it, was still attached to its left leg.

In the months to come, Thomas will have to learn how to eat. In the meantime, he will still be fed through a tube attached to his small intestines. He's had a few popsicles and some flavored water, but solid food is still down the road.

Thomas will also need to learn a way to communicate. Because of his birth anomaly, his vocal cords don't function. Soon the complexity of Thomas' thoughts will out-grow even his eloquent eyebrows.

Densmore has a picture of Thomas on a shelf above his desk.

In it, Thomas and Autumn are playing in a pile of leaves. Autumn is throwing leaves into the air. Thomas is laughing.

Not long after the Richardses returned home, Densmore took the photo down to look at it. He was exhausted. In the middle of the night, he had to rush to the hospital to treat a teenager who had been shot in the head.

Densmore looked at the photograph and smiled.

"Look at that face," Densmore said.

"Pure joy."