I had a title and a job description.  I was The Mamma. (See Maternal Coat for backstory.)

This realization goaded my Midwestern work ethic just about the time another doctor entered the room to join the troupe already assembled.  I was offering The Oldest Girl the comfort of the breast again when the new M.D. positioned herself directly behind me, so that she could get a better view of the already crowded monitor.  Frustration tensed my neck as I finally began to wonder how many cardiologists it takes to read an echo.  The night before when doctors lined up with their stethoscopes three and four deep to listen to The Oldest Girl’s breathing, I was impressed by the volume of care she received.   A shift had occurred since then, however, and the same level of attention felt redundant, oppressive and even voyeuristic in this context.  The stress of feeling like a goalie in a soccer game was more pressure than my already challenged milk supply could withstand. My doppelganger turned to her and said, “Who are you?”

“Dr. Another One,” she confidently replied.

“Do you have to be here?” my doppelganger asked.

“She’s a member of our team,” the eldest, female consultant intervened authoritatively.

“Is she a vital member of the team?” my otherself surprised me by asking.

“I can leave,” Dr. Another One offered.

“Thank you,” my twin replied signaling her dismissal.

“But…” the elder discouraged as her pledge left the room.  Disapproval veiled her face as she muttered something else I couldn’t hear.  An awkward pause perpetuated the veneer of her objection before her attention returned to The Oldest Girl and the answers the echocardiogram screen would provide.

Those answers were not as concrete as anyone would have liked.  The cardiac team was able to determine that it was probable that The Oldest Girl had a heart defect called coarctation of the aorta.   She did not have palpable femoral pulses, and the pictures suggested an obstruction.  One of the cardiologists drew us a diagram as he explained the condition.  He used his pen to punctuate points as he made them to educate us about a coarch (“co-arc”); a narrowing of the aorta that restricts or limits the blood flow to the lower extremities.  He outlined the surgical repair that would be required if this diagnosis was confirmed.  He assured us that the surgery was one that boasted a high survival rate, but it was premature to assume that it would be necessary until an angiogram or heart catheter verified the diagnosis.  The prospect of a heart condition and likely surgery eviscerated the remnants of denial I held about the gravity of the situation.  He then asked us what questions we had.  We asked many.  Among them, I asked if we could control the number of people in the room during procedures.  Disapproval brushed his face as he asserted that one of the frustrations of being associated with a teaching hospital was putting up with those physicians who were in training.  He indirectly judged my dismissal of Dr. Another One as inappropriate.  He argued that inconveniences such as having many people in the room were a part of the package that was balanced by the exceptional facility and treatment options.  However cordial his language, his message was not subtle, he advised me not to tamper with the status quo.

His dictate to play nice really resonates with me.  My entire upbringing socialized me to be nice.  My earliest training reinforced the message my daughter’s cardiologist had just delivered.  These memories include lessons about manners, praise for cooperation and practice following the rules.  I grew up without outgrowing my eagerness to please my parents and teachers and friends.  Marry this conditioning with society’s reverence for doctors, and I felt it was incumbent of me to be good.  He had, after all, just reminded me to be a good girl.  I felt the pull to be obedient and quiet.  Liquid tractability intoxicates.  Unfortunately, it does not inform or guarantee quality care.  However traumatized I felt by my daughter’s illness, no matter how compelling the temptation to follow orders, I knew it did not feel appropriate to subject myself and my family to more stress than necessary, even if doing so did provide excellent opportunities for the professional development of others.  I had just been told my daughter was a candidate for heart surgery and simultaneously counseled to be a good sport.  I not only didn’t want to play; I knew that I could not simultaneously participate and do my most important job.  My already depleted resources could only be invested into being The Oldest Girl’s mom and advocate even if it didn’t feel comfortable, I wasn’t going to blindly follow guidelines that I did not believe to be in the best interest of her care or my family.

The slippery thing about hospital guidelines was to become educated about which were necessary regulations and which were rules of convenience.  Unfortunately, I knew as little about this as I did about heart disease at the time.  One benefit of my eager-to-please nature is that I learned how to be a good student.  Like an anthropologist, I had to study the foreign culture and mores of this hospital civilization in order to understand our experience and make informed decisions.  Like a native tour guide, my first source of information was our floor nurse.  Much like the teachers of a high school, nurses run the hospital and offer the best chance for a continuity of care.  The doctor administers as little of the day-to-day care to his patients as the typical principal provides daily instruction to students.  I discovered there were many familiar parallels between teaching and nursing, a realization that helped me acclimate to my new environment.  Our nurse explained the hierarchy of a teaching hospital.  One of the most ambiguous aspects of The Oldest Girl’s initial treatment was trying to determine who was who in the myriad of medical players that we encountered.  Much like a caste system, she explained the progression from medical students to attendings.

Lions and tigers and bears?

No…

Medical students, interns, and residents, oh my!

And The Mamma better know which is which and who does what!

I’ll stand before the Lord of Song
With nothing on my tongue but Hallelujah