There were other situations where the teen lacked control over whether CHD was a background issue. CHD became a foreground issue when the boundaries of what the teens deemed to be normal were breeched, such as when a new test was necessary or when they saw the doctor on their own for the first time. For one teen, an additional new test was done while he was anaesthetized. On two separate occasions, he mentioned that he had not been told (prior to being put to sleep) about the additional test and how upset he was by this. Understanding what was going to occur during each appointment was an important feature of the doctor–patient relationship and helped build trust. When this trust was broken, the CHD diagnosis and its sequelae were suddenly brought to the foreground.