In January 2022, a 4-year-old foster child named True was wheeled into pre-operative care at Children's Nebraska in Omaha. He was about to undergo heart surgery for hypoplastic right heart syndrome — a serious congenital defect that left the right side of his heart underdeveloped. He'd already survived one open-heart procedure. This time, there was a complication before the scalpel ever touched skin.

No one was with him.

"He was sitting there all alone and it just kind of took me aback," pediatric cardiac anesthesiologist Amy Beethe told KETV. "This 4-year-old was going to be undergoing heart surgery and just no one was there."

True's caseworker had called in sick with COVID. For reasons that remain unclear, no one else from social services was able to step in. So a little boy facing one of the most daunting medical procedures imaginable sat in a hospital room, alone.

Amy stayed.

A phone call home

Through the hours-long procedure, Amy kept watching True's face. Something shifted inside her. She and her husband Ryan had already opened their home before — the couple had three biological children and had previously fostered and adopted three more.

"After I dropped True off in recovery, I called my husband and I just said, 'We need to have a talk when we get home. I need you to have an open mind,'" Amy told CBS News.

Ryan Beethe admitted he was hesitant — briefly. "But it didn't take long to hear what was needed, and it just felt right," he said.

Within a month of the surgery, True was staying with the Beethes. Soon after, the adoption was official.

"He's truly become my son," Amy said. "I would battle for him like anybody else. You're a mama bear, and you fight hard."

The trickle effect

But True's story doesn't end with one adoption. It multiplies.

Before the Beethes took him in, True had been living in an unstable home with five biological siblings. Amy and Ryan knew they couldn't take all six children — but Amy wasn't willing to let the others fall through the cracks.

She started making phone calls.

Her sister and brother-in-law adopted True's sister TyLynn. Her sister-in-law and her husband took in Tyra. A colleague — another anesthesiologist at Children's Nebraska — welcomed siblings Tacari and Malia into their home.

That left one sibling: True's older sister Laney.

"There was one left, and then I went back to my husband," Amy told CBS News.

The Beethes adopted Laney too. All six siblings now have permanent, loving homes — and they're all close enough to stay in each other's lives.

"We found a home for everyone," Amy said. "It's like one big extended family."

Ryan calls it the "trickle effect" — how one decision to act, to not look away, rippled outward until it changed the lives of an entire family. "They make us better people," he said. "You can't imagine your life without them."

"They're my mom and dad"

Today, the Beethe household has eight children. True, now 9, is pushing life to the limit. His heart condition hasn't gone away — doctors say he will eventually need a transplant — but he has something he didn't have in that pre-op room: a family in his corner.

Dr. Jason Cole, a pediatric cardiologist at Children's Nebraska, told CBS News that True's heart disease "is on the severe end of the spectrum." But he emphasized that a stable, loving home isn't just good for True's wellbeing — it's medically necessary. "To be even considered as a viable candidate for a heart transplant, you must be in a stable environment with consistent care," Cole said.

True has that now. Asked about his family, his answer is simple and sure.

"It's been good because they're nice and caring," he said. "They're my mom and dad."

His motto for the road ahead? "Keep going and don't stop."