Just over a week ago I had an incredible opportunity to serve as a keynote speaker at the Society of Diagnostic Medical Sonography 2024 Annual Conference. I have a deep belief that story-telling is one of the most powerful ways for us to connect with one another, and so included in my talk, Echoing Mentorship: The Power of the Next Generation, was a personal story from a case in which collaborative mentorship would go on to save the life of a very loved little boy.

It was June 2020. In January of that year I was so excited as I had finally landed the position I had always wanted at a prestigious high-risk maternal-fetal medicine department. I was so ready for that change, so looking forward to a new chapter in my life—and a very big chapter it was indeed…just not quite in the ways I had hoped.

The COVID-19 Pandemic would go on to become one of the darkest periods of my life. My mental-health declined to a degree I did not know was possible, and the burnout and empathy fatigue that was fueling the flame felt, at times, inescapable. I will be honest—I don’t remember much from this period of my life, but I do remember this case and my patient.

I had just started to scan independently, and with it being such a, you know—unprecedented time—I really just had to be thrown into the thick of it all. Prior to this position, I had never scanned formal obstetrics—I was a radiology girlie trying to prove myself within the MFM world, and there was a ton to learn.

My patient was a 23 year-old first-time mother presenting for her fetal anatomic survey at 23 weeks and five days. She was warm and bright, and so excited to see her baby boy. The patient experience is everything to me—always keeping at the forefront of my brain that it quite literally is part of our patients’ medical treatment. Positive patient care experiences save lives—in a county with alarming maternal mobility and mortality rates are deafening, these moments are critical.

So to eliminate certain possibilities that can arise from misunderstandings between sonographer and patient in the pregnancy setting, I always make sure to communicate with my patient before I ever pick up the probe. In this case, I took the time to communicate to my patient that, while I was an experienced sonographer, I was new to scanning obstetrics. I let her know it was likely I would ask one of my teammates for help, and that I would be fully transparent with her the whole time—under no circumstances would I lie to her, even if I could not provide certain information.

With our safe space created, my patient was fully ready for tour-guide Hayley to take her through her anatomy scan. I put the probe down to the perfect little patient—chest up, giving very much textbook cardiac model. I quickly began the start to my ritualistic protocol. Cervix, cervical measurement, lower uterine segment, adnexa, placenta, PCI, situs. Alright, let’s get this heart: 4-chamber…wait. Is that a little bright?

My own heart sunk to my gut. Posterior to the perfect 4-chamber view were tiny, seemingly symmetric echogenic…areas? We're they echogenic? Was that real? Was it impactful? I didn’t know! I was minimally experienced with general pathology, let alone a cardiac anomaly. While I didn’t know…I had that feeling. You know it, that special sonographer sense that only shows up when you just know something isn’t right.

I adjusted the tone in the room. I turned my head from the screen to the patient’s eyes. As a sonographer, it is very important to me that I do my best to avoid blind-siding a patient at all costs. It is my belief that just because we are unable to communicate our thoughts with our patients does not mean that we have to put on a front where we act as though everything is okay, just for someone else to come in with the devastating curveball.

“Okay, the baby is being really good for me right now—and I really want to get some good pictures of his heart so we can make sure it’s healthy. I’m going to be a little quiet for a bit while I do that.” Back to the screen—RVOT, LVOT…okay, now that’s definitely bright. What is it, bronchial? It has to be, right? Like this is not in my head, I’m actually seeing this. Okay, let’s just get what I can of the heart while I can...

I worked my way through the heart as best I could—obviously this was one of the areas I needed to work on most—and then told the patient I was going to step out for some help. “Okay so, baby is really just being so good to me right now. This is the part where I’m going to ask someone for help—just so we make sure we don’t miss our chance to get these important images! I’m not done with the scan yet, but I’m going to show the doctor what I have so far so that we make sure we don’t miss our window of opportunity.” She understood. I stepped out and walked the short walk across the hall to the reading room.

As I entered the reading room, I saw that the reading physician was one of our previous fellows who was just transitioning into her role as an attending, and that the overseeing attending was not in the room—in fact, she had been called up to the floor and was not expected back for some time.

I sat down next to the doctor, who was well liked and, as a fellow, had gone through our extensive sonographer-lead ultrasound training curriculum—but I, being newer, did not know her well and had not presented to her before.

I reminded her that I was just beginning to scan independently and let her know that I was not yet finished with my scan, but that I had some concerns about areas of echogenicity I believed to be around the heart. I told her the baby was in the perfect position to capture more images so I came out early to show her in case she wanted extra views of those specific  structures or had important feedback on my approach.

I could feel my heart in my gut sinking deeper, as I could already sense that my concerns were not being taken too seriously. She flipped through my images and quickly told me to leave and finish—that it was fine.

And just like that—conversation over.

I walked out of the reading room, and I remember thinking that I hoped she was right, but knowing that we had not done our due diligence to come to that conclusion. I stood in the hall, contemplating my next move…

For a lot of sonographers, this could have been crippling. I was able to go with my gut without reservation, because I knew without a shadow of a doubt I hade a safe space in my mentor.

Psychological safety is the perception that a working environment is safe for team members to express a concern, ask a question, or acknowledge a mistake without fear of humiliation, retaliation, blame, or being ignored³. Psychological safety is critical to growth, and I think this case is very great example as to why.

Christina has mentored me my entire career. What started as one Facebook message has turned to a lifelong friendship rooted in mentorship. Christina and I had only gotten to work with one another when she recommended me the role. Christina had always been invested in me, but now we were working together and I was excited for the opportunity to prove myself in growth to her. Christina was by herself back in the ATU, and while I knew she had absolutely no time to come take a look at what my little rookie nervous brain conjured up out of total paranoia…I also knew she absolutely would, no questions asked.

“Okay, I could be totally wrong but…” As I filled Christina in I could tell she was just so leaning toward me being a little off the edge on this one—and I mean I got that, of course. And then without even a signal, we both start to walk toward my patient’s room.

Baby was still ready for his close up—chest up and ready to bear us his heart. As I watched Christina sweep through the cardiac views, I watched diligently—studying her expressions and taking note of where she froze and what she clipped. Okay so we’re going rogue here, protocol who? Is she doing a full fetal echo now? She measured the ventricular walls. Okay, so a little thick… Checked for patency in the pulmonary veins. All good. And took cine after cine…of the same echogenic areas. She sees it, too. It’s real!

Christina left me to finish the scan and headed to the reading room to discuss with the new attending our findings. I of course was not there for this interaction, but I know it was another that was spirited in mentorship as, not to say that the attending didn’t respect me, but she learned ultrasound from Christina. Christina was her mentor in this way!

Christina and the new attending discussed what was concerning about the images, and Christina also encouraged the new attending to be critical and stand on her own—realizing that it was a less than psychologically safe environment she and the overseeing attending were in that even contributed to her dismissal of me in the first place.

The final anatomy report indicated IUGR with baby at < 3rd percentile, mildly elevated MCA Doppler, and bilateral calcifications in the chest appearing to be at the location of the bronchi, with a differential diagnosis of bronchial atresia vs. calcifications of the pulmonary arteries. My patient was referred for a fetal echocardiography and consult at a special delivery unit.

My patient’s baby was ultimately diagnosed with a rare autosomal recessive disorder called Generalized Arterial Calcification in Infancy—or GACI. GACI causes fibrous proliferation and the excessive deposition of calcium salts into vasculature lumen due to low levels of pyrophosphate and affects both large and medium-sized arteries⁴.

GACI is rarely diagnosed prenatally, and when it is, it is typically in the third trimester in the setting of aortic and pulmonary calcification and nonimmune fetal hydrops. Without care, babies with GACI typically die before six months of age, and if they survive this critical stage may live into adolescence or early adulthood.

My patient’s baby was ultimately born at 34 week and five days via c-section in the setting of preeclampsia, pulmonary stenosis, and pulmonary hypertension. Had I not felt supported by my mentor that day, as a sonographer the understandable nerves that come with learning a new specialty I may have talked myself into a different call—one where this could have ended in a miss with devastating consequences later. Thankfully this story has a much different ending, because collective mentorship gave my patient the opportunity to make the most informed decisions possible for her and her pregnancy. Her baby was born in a special delivery unit in a facility leading the world in GACI research.

As this story tells, our decisions of today are the everythings of tomorrow. That’s a major responsibility! And not one we are meant to navigate alone. The power of mentorship is immeasurable—when we pour into one another, we pour into ourselves.

After my talk an overwhelming amount of people asked me how baby boy is today, and at the time I did not know anything further—but after looking into it, I am happy to share that he is doing great at over three years old today! So there's the update we needed—especially to the lady in the buffet line—I did not forget about you!

3. McClintock AH, Kim S, Chung EK. Bridging the gap between educator and learner: the role of psychological safety in medical education. Pediatrics. 2022;149(1):1-. Available from: https://publications.aap.org/pediatrics/article/149/1/e2021055028/183907/Bridging-the-Gap-Between-Educator-and-Learner-The?autologincheck=redirected.

4. Pu L. Prenatal diagnosis of generalized arterial calcification of infancy in the second trimester. Prenat Diagn. 2022;42(12):1487-1489. doi: 10.1002/pd.6245.