When her daughter was diagnosed with a rare autoimmune disease in 2010, Amy Gleason attacked the challenge.

She carried binders of medical records to doctors' appointments across six health systems seeking the best care for juvenile dermatomyositis. She volunteered at a nonprofit searching for a cure. She also started a health care company to create record-sharing software that would make life easier for chronically ill patients and families.

Within five years, President Barack Obama's White House recognized Gleason as a "Champion of Change" in the industry. When the coronavirus struck in 2020, she was a health care technologist in the first Trump White House who worked grueling hours building data systems to guide the federal response. (And her daughter was a thriving college student.)

Now, her journey has improbably led to President Donald Trump naming her the acting administrator of the U.S. DOGE Service, a position that seems to convey extraordinary power. Except almost no one has heard of her and everyone knows the man the president says is actually leading the unparalleled effort to gut the federal workforce and shutter agencies: Elon Musk.

While Musk has claimed his Department of Government Efficiency is fully transparent, until last week the White House press secretary would not even say Gleason's name -- which does not appear on the DOGE website.

In his address to Congress Tuesday, Trump made clear that Musk is in charge, saluting him as the head of DOGE, with Musk smiling down on the president from the visitors' gallery. Yet government lawyers have argued in court that Gleason and not Musk is the agency's leader.

The confusion has added to the mystery around the role of Gleason, who did not respond to a phone call or text message for comment.

"I don't think anyone really knows for sure what her role is and whether she actually has any oversight of any of the people doing the work, or is she just there as a punching bag and a distraction to keep their actual activities shielded from the public," said Brett Hartl, government affairs director for the Center for Biological Diversity, an environmental group that sued the DOGE Service and Gleason seeking access to records that would shed light on their operations.

DOGE claims credit for saving more than $100 billion through mass firings, cancellations of contracts and grants, office closures and other cuts that have paralyzed entire agencies. Many of those claimed savings have turned out to be overstated or unproven.

On one level, Gleason fits the mold of a Musk employee, one willing to work arduous hours to meet his goals. Former colleagues say she is an effective behind-the-scenes operator and say her rise is the story of a former nurse who got into health care technology to help patients and doctors and climbed through merit.

"From my perspective, I can't imagine somebody I'd rather have there," said Jamie Grant, a former Republican lawmaker in Florida who worked with Gleason to start a health care company. "Somebody saying yes to that job right now better believe in the mission and better have a spine and be talented and she's that in spades."

White House press secretary Karoline Leavitt told reporters that Gleason had served as the acting administrator at DOGE for weeks. But that was not the widely held understanding of her position internally, according to three people with knowledge of the office's operation who spoke on condition of anonymity out of fear of retribution.

While the exact nature of Gleason's portfolio was not well defined, what was clear is that she was working closely with DOGE leaders. She attempted to push civil service staffers in the office to hire at least two people who failed screening reviews for prospective hires; both were later hired by DOGE, according to two of the people who spoke to The Associated Press.

The uncertainty over her role -- and when she was appointed to it -- could have far-reaching implications in a series of ongoing lawsuits filed to blunt the impact of Musk's radical paring of the government workforce.

Under questioning from U.S. District Court Judge Colleen Kollar-Kotelly recently, government attorneys struggled to explain who was in charge of DOGE or Musk's precise role. That led Kollar-Kotelly to wonder if the office was running afoul of the Constitution's appointments clause because Musk had not been nominated to lead the office, or received confirmation from the Senate.

The Trump administration announced the following day that Gleason was DOGE's acting administrator, a question they had previously refused to answer.

Unlike many DOGE workers, Gleason has no prior ties to Musk. She recently worked as chief products officer at Nashville-based health care firms founded by Brad Smith, who worked in the prior Trump administration on health care and is also a DOGE adviser.

Smith and Gleason began working on Trump's transition after the November election, and her role in Trump's orbit has grown. In December, she rejoined the United States Digital Service, where she had previously worked from 2018 through 2021 on high-level government health care technology initiatives.

On his first day back in office, Trump signed an executive order rebranding USDS as the US DOGE Service and giving it a mandate to help Musk's cost-cutting initiative. Soon, dozens of Musk acolytes associated with DOGE began arriving at agencies across the government demanding access to sensitive data systems and pushing for drastic changes.

While 21 others in the office resigned in protest rather than carry out Musk's initiatives, Gleason accepted a position that thrust her into an unfamiliar spotlight.

Health care entrepreneur Travis Bond, Gleason's colleague over two decades at companies in Florida, said Gleason will hate the public attention but excel in her new role.

"I'm not sure they could have picked a better person. She just thinks, eats and breathes this stuff," he said.

Bond, Gleason and Grant in 2011 launched CareSync Inc., which developed an app to allow patients suffering from chronic disease to keep their medical records in one place. After benefiting from a $7.25 million grant from one Florida county, CareSync found it hard to attract buyers for subscriptions that cost up to $199 annually.

CareSync pivoted in 2015, taking advantage of a new federal rule that allowed Medicare providers to bill for chronic care management services delivered remotely. The company raised millions of dollars from investors and began rapidly adding staff and serving more than 20,000 patients nationwide. By summer 2018, CareSync ran out of cash and closed without notice, firing 300 workers and leaving creditors owed millions.

Gleason recalled later that she was "trying to figure out what in the world to do in life" after that experience and applied for the USDS with encouragement from Aneesh Chopra, U.S. chief technology officer under Obama. Chopra declined comment.

She focused on improving technology systems at the Centers for Disease Control and Prevention and the Centers for Medicare and Medicaid Services. During the pandemic, she worked under White House response coordinator Dr. Deborah Birx to develop laboratory and hospital data reporting systems. Birx praised Gleason last week in an interview with CNN as a "really competent, hardworking, focused woman who understands the value of data."

Near the end of her three-year stint in 2021, Gleason reflected on her work in a podcast interview, saying the digital service sought to "empower the civil servants and to bring new approaches in technology to the government and to help modernize their efforts."

"Our mission is really to do the greatest good, for the greatest number of people, in the greatest need," she said.