Hidden Beneath the Hospital Gown
“Here is your gown,” the nurse had said as she handed over a cotton frock. After hours in the hectic emergency room, we arrived in my mother’s hospital room. My mother quickly assured her that she would not be needing it. She knew she was sick; she did not need the gown to confirm it.
My mother unfortunately was not new to life in the hospital; she had come prepared. Before we had left for the emergency room, suspecting she would be admitted to the hospital for at least a few days, she had meticulously instructed me on what clothing to pack: comfortably fitted but loose T-shirts, sweatpants and patterned pajama bottoms. For good measure, we had also brought perfume and deodorant.
Like my mom, I was not a stranger to the hospital environment. While she was the professional patient, my father and I were the physicians. For better or for worse, the white coat is a symbol of that status. We are meant to undergo a kind of identity transformation when we put it on for the first time in medical school. There are even ceremonies dedicated to this moment.
In a similar way, patients step into the “sick role” when they don their hospital gowns. In this role, they are exposed, vulnerable and deidentified, contrary to the authority and protection conferred by the white coat. They relinquish control.
Of course, the hospital gown serves practical purposes from a hospital standpoint. It is unisex and supposedly “one size fits all,” for any patient of any body type. It provides easy access to intravenous lines where medications may be infused and facilitates physical examination by physicians and other providers. Yet, it leaves many body parts exposed unnecessarily. Would care really be impeded if other patients wore their own clothes as my mother did?
In one study from five teaching hospitals in Canada a few years ago, only 14 of 127 patients were wearing anything more than underwear beneath their gowns. But doctors felt that more than half of the patients were “eligible” to wear more than just underwear. According to the researchers, a hospital gown may be preferred in cases where patients have urinary catheters or are too immobile or incontinent to wear full clothing. For patients who may be bleeding, for example, it’s easier to change quickly into a clean hospital gown than into their personal pajamas.
Many patients interviewed in the Canadian study said they would have liked to wear clothing on their lower bodies if given the opportunity. Putting on a hospital gown is often done without question. But it need not be that way.
Dignity is measured in different ways, but key components include feeling comfortable and in control. One’s physical presentation and presentation of self are important manifestations of this. In addition, wearing one’s own clothes can boost self-esteem and help confused patients remain oriented to their surroundings.
For my mother, her non-hospital clothing provided moments of comfort and individuality. Her simple soft cotton T-shirts lessened some of the anxiety of sleeping alone in her hospital bed. Although she had little control over when she took her medications and when her blood was drawn, she retained dignity and self-expression in choosing what to wear in the morning. Even when she needed assistance getting dressed, she became a person. She was not just a patient, obscured by unflattering cotton.
I recently cared for a lovely woman waiting for a heart transplant. In many ways, she reminded me of my mom. They were around the same age, suffering from chronic diseases, yet with unwavering spirits and spunk. Unlike many of her neighbors in the cardiac care unit, my patient was able-bodied, walking and talking although quite sick. She was attached to continuous infusions of medications to help her heart squeeze. She had been waiting in the hospital for an organ for weeks, each day with a similar monotony.
“They really need to do something about these hospital gowns,” she told me as she walked around the unit holding the back of her gown closed.
A few days later, I saw her in a leopard print gown that she had ordered online. Her personality became even more vibrant. She walked around the unit with her family, her hand now free to wave at her doctors and the staff members.
In many ways, she and my mother had become their own advocates in re-claiming this element of themselves.
Others have realized the need to transform the hospital gown. The designer Diane von Furstenberg helped the Cleveland Clinic design more chic attire without the open back. Similarly, Cynthia Rowley contributed to some design changes at Hackensack University Medical Center in New Jersey. More recently, students from Parsons School of Design created a hospital gown that opens in the front. A quick search on the internet reveals companies taking advantage of this opportunity, selling personal hospital gowns with phrases like “A scar is a tattoo with a better story” and “the beat goes on.” Yet, cost and standardization across hospitals remain barriers to adoption. In addition, one cannot underestimate the power of the status quo in medicine.
But what about going one step further and breaking outside the mold of the hospital gown altogether? It’s as if the concept of the hospital gown is so irrevocably tied to what it means to be a patient that we haven’t considered the patient experience without it.
We could empower patients and family members to bring in their own clothes, in the same way that we encourage them to bring in pictures or other mementos. This small act can go a long way with respect to physical and emotional healing.
After a little more than two weeks in the hospital, seeing numerous doctors and having various tests, it was finally time for my mother to go home. She was able to exchange those pajama bottoms for her favorite jeans, leaving the hospital gown still cleanly folded next to her bed, unworn.
Dr. Ersilia M. DeFilippis is a fellow in cardiovascular medicine at NewYork-Presbyterian Hospital — Columbia University Medical Center.