May 31, 2010 12:00 PM

Oxygen whirs softly through the tiny tubes inside 5-month-old Josie Duggar’s nose. The steady, quiet beeps of a monitor track her heartbeat, pulse and the oxygen levels in her blood. These are the only sounds coming from the neonatal intensive care unit at Arkansas Children’s Hospital-until a more heartbreaking noise emerges. Josie’s mother, Michelle, snuggles her daughter close to her chest and starts to cry. Turning to Josie’s physician Dr. Robert Arrington and assorted nurses, she says through her tears, “You have orchestrated the fact that she is alive. I can never express my gratitude. You are part of our family.”

For Michelle Duggar, 43, and husband Jim Bob, 44, such a display of raw emotion is rare; on the family’s hit TLC show 19 Kids and Counting (the season finale airs May 25 at 9 p.m.), the Duggars seem preternaturally unflappable as they raise 19 children-ranging in age from 22-year-old Josh (now married and a father himself) to 5-month-old Josie. But, Jim Bob and Michelle confess, they’ve never been quite so shaken. While doctors try to determine why Josie, born three months prematurely, is now struggling to digest normally, the couple are just grateful for their littlest girl’s continued survival. “We’ve never walked through anything like this,” Michelle says. Agrees Jim Bob: “The first 72 hours in the NICU rock your world. This is like surviving a hurricane.”

Josie was born on Dec. 10, weighing just 1 lb. 6 oz. She was delivered via emergency C-section, necessary-despite the fact that she was only at 25 weeks gestation-because of Michelle’s life-threatening pre-eclampsia (pregnancy-induced high blood pressure). The devoutly Christian Duggars held their collective breath and prayed; Josie recovered from a dangerous bowel perforation at 8 days old without surgery.

Yet with each hour in the NICU holding the potential for a new triumph or a devastating setback, Jim Bob and Michelle say the past five months have brought challenges they’ve never faced before in their 25-year marriage. “This has tested our marriage and family relationships. It tests the foundation of your soul. Our prayer is that we stay close,” Jim Bob says. “We have totally felt overwhelmed-we didn’t know if Josie was going to live or die or what kind of problems she would have. It’s tough to accept all these things.” And under those conditions, even the most serene couple can start to clash. “When you are under pressure, you have the tendency to be quick to anger and become self-centered,” Jim Bob admits. “We try to have a loving response instead of a sharp one.”

But it isn’t always easy. The couple find themselves struggling over how to make the right decision for their baby’s well-being-and they don’t always see eye to eye. When Josie was scheduled to have an MRI as part of an optional study, Michelle worried the loudness of the machines would cause her baby further stress. Jim Bob thought the test was a good idea in order to see how Josie’s brain was developing-until Michelle woke up in the middle of the night, panicked and convinced that the test should not proceed. “Jim Bob and I talked about it,” Michelle says. “He said we should pray about it, and then it would be up to me.” In the end, Michelle allowed the test-but it was halted when Josie became too upset by the entire process, much as Michelle had feared.

Frustratingly, just when it seemed the worst was behind them, Jim Bob and Michelle say they reached their darkest moment. On April 6 Josie was released from the hospital, going “home” to the house the family rented in Little Rock to be near the hospital. But just two days later, in the early morning hours, her vital signs dropped dangerously and Michelle called 911. “I was terrified. I was thinking, ‘My baby is going to die. I am losing her now.’ I held her skin-to-skin in the ambulance, trying to warm her,” says Michelle. “I was crying out to the Lord for her life because I didn’t know what was going on.”

After a frantic race back to the hospital, Josie has stabilized, growing to an impressive 6 lbs. 9 oz. But complex questions remain about her condition. Unable to normally digest her feedings, Josie needs enemas every six hours and constant staff assistance. Ligaments that should keep her stomach in place are weak or nonexistent; portions of her intestines are similarly mobile. Doctors next plan on a surgery to repair three hernias; they may also try to anchor certain organs in place. “We still need to understand what all her issues are,” explains Arrington, codirector of the NICU.

Now, as Josie’s journey continues, Jim Bob has accepted the fact that “this is going to alter the course of our lives. We’ve just had to say, ‘God, you’ve given us this baby, we put her in your hands and thank you for every moment with her.’ ”

Michelle is making the most of all those moments, sometimes staying at the hospital up to 15 hours a day. Meanwhile the Duggar children at home-twins Jana and John-David, 20; Jill, 18; Jessa, 17; Jinger, 16; Joseph, 15; Josiah, 13; Joy-Anna, 12; twins Jedidiah and Jeremiah, 11; Jason, 10; James, 8; Justin, 7; Jackson, 5; Johanna, 4; Jennifer, 2; and Jordyn-Grace, 16 months-are doing schoolwork, playing in their rental home’s yard or exploring a nearby park. The older kids visit their newest sister. “This has changed me,” says Jill, who is now considering a career in nursing and often comforts younger siblings Johanna and Jennifer. “They ask me, ‘Can she come home?’ ”

Some experts are concerned that Josie’s older siblings may be shouldering too much responsibility. “It isn’t advisable for parents to place an adult burden on their children,” says New York City-based child psychiatrist Dr. Roy Lubit. Daughter Jessa says her parents are doing fine: “They’ve done a good job. They’ve made it a point to keep up with our hearts. It’s tough to worry about Josie. A lot of days I wish that I could just wake up from a dream. I wish she was home.” Jana agrees: “This has been a hard experience, but we have drawn together closer as a family.” Says Jim Bob: “We talk with the kids about what is going on. We share the ups and downs. Our children are learning more from us in difficult times than they are in easy ones.”

As for whether Jim Bob and Michelle will continue to procreate (other than a brief period of abstinence after each of their children was born, Jim Bob and Michelle do not use contraception, as they believe each child is a “gift from God”), the couple say they are ready and willing to have more kids-perhaps sooner rather than later. “I don’t know … it’s possible,” Michelle says simply, when asked if she might already be pregnant. As Jim Bob explains, he and Michelle remain ready to face any challenge-including the public criticism that could accompany yet another pregnancy: “We trust God with our lives, our children, our future. Let’s pass this test. Let’s have the right response.”

Jim Bob and Michelle’s room at home is decorated with little cards, homemade signs and outfits of Josie’s, as fans of the show rally around the tiny infant. The Duggars are often stopped by well-wishers offering hugs and tears. “I hate that Josie has to go through this,” says Jim Bob, “but we try to look at the positives, and there have been many blessings.” Michelle nods and whispers into Josie’s ear. “You are so precious,” she coos. “Mommy loves you so very much.”

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