Gemma was diagnosed with Esophageal atresia, Tracheomalacia, and Laryngeal cleft—among other diagnoses and complications—upon birth. This means that she cannot breathe or eat without special medical devices and skilled nursing care. This also means that she is medically authorized for 68 hours of skilled private duty nursing (PDN) care per week delivered by a pediatric nurse qualified to keep her safe and healthy at home.