Not Always Wonderful with Dana Gal, MD
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What challenges do doctors face when hospitalized patients try to reclaim autonomy?
At the Nocturinous, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
When a person is hospitalized, not only do they lose their health, but also their agency, since the hospital takes over their entire daily routine. What's it like for the doctor when patients attempt to reclaim their autonomy in ways that are frustrating or even dangerous? I'm Emily Silverman, and this is the Nocturnists stories about what it's like to work in medicine. In this episode, pediatric's resident Dana Gall tells a story about a young woman who railed against the hospital environment and the challenges that came out of it. Afterward, we talk about the complexities that arise when caring for children in the hospital and how we might try to give back a sense of control to our patients, even with actions that may seem small.
Without further ado, here is Dana Gall.
Hi everyone. I don't have any family members who are in medicine and since starting being a doctor I've noticed that a lot of people I meet ask me what it's like to be a doctor. And a lot of the times that question goes like What's it like to be a doctor? And before I can even answer, they say, Is it just like house? And I have to say Oh, there's not quite as much excitement in our diagnosis. There's a lot more common things being common. Um and then they say, Okay, then Is it like Grey's Anatomy? And I say, Well, I think there's a lot less sex happening in supply closets, but that's only as far as I know.
Yeah.
Um so then they of course assume well Maybe it's like scrubs and I have to say, you know Fewer of us are well rested, eating all together in the cafeteria, pulling pranks. And when I'm running down the hallway, it's usually to catch the shuttle, not to a code, and my hair doesn't splay out nicely from my face, it's like this in the wind. Um so no, it's not like any of those things. And um what I really think about is that I spend most of my days as a doctor wondering things. Um and a lot of it is really benign stuff. I'm wondering what the cafeteria serves and crossing my fingers that it's Ethiopian Day. It's my favorite. Um or I'm wondering if the night in turn is gonna get in on time so I can make it to dinner with a friend or with family.
I'm wondering how I can help my my co-interns or now my co-residents, um, how I can teach med students better. Uh but most of the time I'm wondering what my patients are thinking, what their parents are thinking. Um, it's something that I can't stop wondering about. Um and because of the power dynamics in medicine, they often don't necessarily share that with you. But it is something that I spend a lot of my time wondering about. I'm wondering, you know, if they're satisfied with their care, if they're afraid, if they even understand what's going on. If they know what's going on at all. And I found that um while my career has not been that long in this time there Is one patient in particular who I have not really been able to stop wondering about.
She had type one diabetes as well as an eating disorder that she was struggling with. And multiple infections that were causing her a lot of pain. And she's over eighteen. She's over that magical arbitrary age in our country where people are adults and are able to give consent. Usually in pediatrics we deal with patients who are giving what we call a cent or accent. Um they're not legally capable of agreeing to treatments or procedures, but in this case she was. Or more importantly, she was able to refuse treatments and procedures, which was very challenging. And in the hospital Something to remember is that People lose all their control. You know, they come in and there are these autonomous individuals and we take away their clothes and we give them a nondescript gown.
And we take away their schedules and we wake them up every four hours or sometimes even more often to check their vital signs.
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Chapters
6 chapters
1
What challenges do doctors face when hospitalized patients try to reclaim autonomy?
0:00–5:20
2
How did Dana Gal describe the young patient’s attempt to control her environment with soda cans?
5:20–11:03
3
What was the significance of the hidden salt packets and how did they illustrate the patient’s need for control?
11:03–17:42
4
Why was creating a pain‑medication contract so difficult for the care team?
17:42–24:08
5
How did the team finally resolve the patient’s pain‑management needs and what role did patient choice play?
24:08–30:19
6
What is the role of child‑life specialists in making hospital stays more tolerable for kids?
30:19–34:03