Polly Hesterberg begins each day in the Pediatric Intensive Care Unit looking for adults in distress. With a mother's instinct for caring - and a nurse's attention to detail - she will check each room and bed for the tell-tale signs.
A tearful mother has left her infant's bedside when some doctors approached. Did they unfairly push her out?
The mom down the hall speaks only Turkish. Better call in a translator to make sure she understands what's happening to her son.
The mother one door down was upset that her daughter was awakened so often during the night for tests. Could that be handled better?
While 800 doctors and nurses at Johns Hopkins Children's Center spend their days watching out for sick children, one woman is focused exclusively on their families. It has been this way for more than a generation.
Hesterberg is sometimes called the "Mother of Children's Center." She is too modest - her daughter calls her "excruciatingly modest" - to accept such a title.
But this unflappable 69-year-old grandmother is a medical pioneer as surely as any doctor or researcher at Johns Hopkins. When she graduated from nursing school in 1952, the mother of a hospitalized child was treated no better than any visitor - she could see her son or daughter no more than for a few hours twice a week.
Today, mothers, fathers and other family members are regarded as an important part of the healing process with 24-hour access to a sick child. And pediatric hospitals routinely have someone assigned to look out for the family's interests.
Polly Hesterberg helped make that happen. She has taught hundreds of fledgling doctors and nurses about the needs of parents.
"When situations get difficult, the most difficult of the difficult, Polly will come in and calmly and unfailingly get families through these disasters," said Jim Fackler, a pediatric critical care physician. "She's the ultimate psychiatrist, social worker and grandmother wrapped into one."
Her title is "family care coordinator," and she has held the job for most of her 35 years at the center. It is a one-woman office, and her impact has been felt by tens of thousands of people who have come to Hopkins for help.
Sometimes, her role is to hold a parent's hand when they learn their child is dying. Often, the job involves making a visiting family's life more physically comfortable - finding them lodging or maybe just a parking place or a place to eat near the maze-like hospital complex in East Baltimore.
"So many times before I was a mother I thought I understood what mothers go through," she says. "I think it was not until I became a mother that I looked back and thought, ohmygosh, I really didn't understand."
It's a far cry from Hesterberg's early career when, as a registered nurse in the 1950s, she wore a white cap and uniform and always stood in a doctor's presence. Photographs she keeps from that era inevitably show hospitalized children looking sad and lonely - not surprising since they so rarely saw their families.
But as families began to have greater access to sick kids beginning in the early 1960s, conflicts arose. What role should parents and siblings play? What effect does the parent's stay in the hospital have on healthy children left at home? How can relatives be advocates for a child without interfering with medical treatment?
"Inevitably, conflicts arise between doctors and families," said Dr. George Dover, the center's director. "Polly sorts these out. She can pick out the real issues."
The words Hesterberg's colleagues most often choose to describe her are compassionate and a good listener. She is also an educator, conducting regular classes on how hospital employees can be more responsive to the needs of families.
Families, in turn, learn to trust her judgment. When a child faces a lengthy hospital stay, what a parent often needs to hear most is permission to leave a child and go home once in a while.
"Polly has empathy," said Jerriann W. Wilson, the hospital's director of child life. "In her wisdom, she can see that maybe the 7-year-old in the hospital is doing fine, and maybe the 3- and 4-year-old at home needs [the mother] more."
After visiting intensive care, Hesterberg will often float between the infant and toddler ward, oncology and surgical recovery room where a lot of long-term patients and their families can be found.
She is usually paged when a complaint is filed by a parent or the medical staff is having difficulty with a family. Rarely do 30 minutes go by when someone doesn't take her aside with a "Polly, when you have a minute, we need to talk..."
"Parents sometimes worry that if they complain to nurses or doctors, their children will suffer and they won't get good care," said Nancy Cournoyer, a nurse who has worked at the hospital since 1971. "Parents don't feel threatened by Polly. The hospital could never replace her."
It would be impossible for one person to keep track of the more than 6,000 patients admitted to the hospital each year, let alone their families. Much of her attention must be in crisis management - giving advice when critical problems arise.
Her encounters with families are often brief - like finding extra blankets and a better chair for a Canadian couple living at the hospital while their 2-year-old son recovers from surgery to correct a birth defect.
"Little things mean a lot," said Mary Aubie of Calgary. "She has a compassionate air about her."
One recent morning, Hesterberg had to deal with a mother who was caught stealing a candy bar from another parent in the middle of the night.
On another floor, she soothed the concerns of a mother and grandmother who were convinced doctors hadn't adequately prepared for an 11-month-old's potentially adverse reaction to anesthesia.
Often, she takes a parent's side of a conflict. But she'll also side with nurses and doctors when she thinks they're in the right.
"The most challenging moments are the total misunderstandings," she said. "There are reasons behind some hospital policies, but sometimes it's difficult for parents to understand them."
In an environment where family involvement is cherished, parents with sick children can find sanctuary and support. Amy Schwiegerath, 27, whose 10-month-old daughter Katelyn was hospitalized with leukemia in February, said she has found it easier to live in the hospital than take her daughter home to Eldersburg.
"When I go home, the neighbors don't know what to say. It's as if they think I wouldn't want to talk about it," she said. "I realized my family was at 8 East [the center's oncology floor]."
All this concern about feelings and family would seem to run counter to current cost-cutting trends in managed care. But Hopkins officials are talking about making more accommodations for families, not less, beginning with a planned renovation that would make more space for live-in parents.
"With managed care, we need more of [Polly]," said Dover. "We used to have a more leisurely pace with families. Now, the patients come in sicker and they leave before they're fully well."
Hesterberg's skills in dealing with families came early. The second youngest in a family of 22 children, she grew up on a dairy farm in rural Thurmont when a relatively minor injury, a pulled shoulder ligament, introduced her to a local doctor and the possibilities of a nursing career.
Even as she approaches retirement age, her legacy at the hospital is secured. Her daughter, Lisette Stamato, is employed by the center as a pediatric nurse. Her son will soon graduate from the FBI's training academy. Gordon, her husband of 36 "wonderful" years, died four years ago.
"People ask me if she was just as calm at home as she is in the hospital," said Stamato, 32. "I tell them she always reasoned with us. We used to tell her, 'Mother, couldn't you please get mad?' "
Hospital officials say Hesterberg's most lasting contribution may be the influence she has had on her fellow Hopkins employees, who now understand they sometimes need to mother the mothers of their patients.
"I don't profess to be super-human," she said. "I just try to put things in perspective, and I believe there is a power greater than we who directs us. I see that every day in my work."
Pub Date: 5/10/98