A parent notices a small opening on the side of the child’s neck that occasionally drains clear or cloudy fluid, or a soft swelling that enlarges after a cold. In the Hawthorne clinic the first question is usually “what is branchial cleft?” The branchial apparatus is the embryonic framework that forms the face, neck, and pharynx between the fourth and seventh weeks of gestation. Each arch is separated by external clefts and internal pouches. Incomplete disappearance of these structures leaves cysts, sinuses, or fistulas along predictable paths. I have traced those paths in the operating room at Maria Fareri Children’s Hospital, and versions of those cases appear in the true surgical stories of Breathless: Surgical Tales from the Brink (and Back), available on Amazon.