I SAW the scar the first time I changed Natalie’s diaper, just an hour after the orphanage director handed her to me in a hotel banquet room in Nanchang, a provincial capital in southeastern China.

Despite the high heat and humidity, her caretakers had dressed her in two layers, and when I peeled back her sweaty clothes I found the worst diaper rash I’d ever seen, and a two-inch scar at the base of her spine cutting through the red bumps and peeling skin.

The next day, when the Chinese government would complete the adoption, also was Natalie’s first birthday. We had a party for her that night, attended by families we’d met and representatives of the adoption agency, and Natalie licked cake frosting from my finger. But we worried about a rattle in her chest, and there was the scar, so afterward my husband, Matt, asked our adoption agency to send the doctor.

We had other concerns, too. Natalie was thin and pale and couldn’t sit up or hold a bottle. She had only two teeth, barely any hair and wouldn’t smile. But I had anticipated such things. My sister and two brothers were adopted from Nicaragua, the boys as infants, and when they came home they were smelly, scabies-covered diarrhea machines who could barely hold their heads up. Yet those problems soon disappeared.

I believed Natalie would be fine, too. There was clearly a light on behind those big dark eyes. She rested her head against my chest in the baby carrier and would stare up at my face, her lips parting as she leaned back, as if she knew she was now safe.