Thursday, July 5, 2012

My experience in a (four) Chinese hospitals

(This was written on Tuesday, June 26, on my last day in the hosipital, but couldn't be posted until I returned home.)

On Thursday, June 21, I was in Beijing, China.  I had been in China for almost two weeks.  My friend checked me into the nearest hospital ER (emergency room) a few minutes past midnight.  Praise God the doctor on duty for the night shift could speak English (this was a local hospital, not a big one) and the cardiac specialist could also speak English.  I went in because my stomach was feeling really bad.

A few days prior, on Sunday night, I was in Jiamusi (very northern China) and my friend took me out that night after we checked into our hotel.  There was a street fair going on (kind of like an annual town party up and down a few blocks of the street).  We walked around and my friend bought some local food being cooked on the street.  It looked like an omelet wrapped in a lasagna type noodle and put in a cup.  We watched him cook it, then my friend gave it to me.  I said something like "yeah right" and he said it's a Jiamusi unique food and I should try it because it's very good.  He had bought one for me and him, and we had watched it get cooked, so I said I'd try it.  Then we took two steps over and he wanted another (what I would call) exotic food that looked like a squawker of little squid tentacles.  We watched it get cooked and then when he asked for two I knew what was coming next.  Again he said this was unique in all of China and it's good so I should try it.  The first thing I thought was I have no drink.  If this is revolting, I'm stuck with it.  But he insisted and had bought it already and we watched it get cooked, so I accepted it.  I sampled both and that night I woke up in the middle of the night with diarrhea.  I took a pill of antibiotics that the company nurse had given me a few weeks prior and instructed me to take if I got traveler's diarrhea.  The diarrhea didn't return and I took the pills twice a day for two days.  That left me with two pills left which I saved for the trip home, which was the upcoming Saturday.  However on Wednesday (the day I stopped taking the pills) I started feeling bad in the mid afternoon.  I took a nap from 6-11pm and woke up at 11 with a really bad feeling in my stomach.  Specifically the top of my stomach, like I needed to throw up but for some reason couldn't.  It felt so bad that I was honestly concerned for my life.  Oddly, it wasn't "painful" like you might think, it just felt really really "bad," as unspecific as I'm sure that sounds.  It was midnight where I was but back home it was noon, and my company nurse would be online.  So I instant messaged with her and she suggested I start the last dose of that medicine, and I did.  But it was going to take up to a couple hours to take effect and I'd obviously need more to last me until Sunday, and I was feeling really bad, so I asked my friend to take me to the hospital.

By the time the hospital had taken their blood test and gotten the results, the antibiotics had kicked in and my stomach felt almost fine again.  But the blood tests were very alarming to the doctors.  They thought I had in process or had just had an acute myocardial infarction.  I had no idea what that was, and I felt fine so all I wanted was more antibiotics to make it through the rest of the week and I figured I'd check with the doctor when I returned home.  But while waiting for another test to come back I looked up the definition of this problem they said I had on my free Merriam Webster's Dictionary on my phone and it only had two words.  That was all it needed to say.  It means "heart attack," so though I felt fine, I decided it was too risky to ignore their concerns and let them do what they thought needed to be done.  The staff took an ECG (electro cardio gram) and were even more concerned.  The blood test showed that three enzymes were up ridiculously high.  (Later, a friend from home whom I called said this was evidence that my heard muscles were dying.)  They had me take some aspirin and after the first two (with no water) the doctor said I should chew the next three.  Not fun.  I almost gagged and threw it all up.  But I appreciate his attempt to keep me alive.  I asked them to write down in English what statistics they had seen that worried them so much and called my mom, since she's a retired registered nurse.  I gave her the stats and she was of course concerned.  My colleagues who were with me were trying to get a hold of my doctor in the USA but weren't successful for various reasons.  This hospital wasn't prepared to do anything further and I was transferred to an international hospital later in the morning (probably about the time most of us were waking up).  But when they found out I was there because there was a strong chance I had had a heart attack, they immediately sent me to a specialty hospital.

At the specialty hospital they did more tests and were sure I needed an angiogram.  (This is where they make an incision in your groin and stick a fiber optic camera up one of your arteries all the way to your heart and take a look from the inside.)  It was hours between when I arrived and when I went in for surgery.  I got the feeling later that financial details were being worked out but I didn't care, I wasn't in a hurry to go in and I didn't want to know what it would cost.  So I laid there almost flat on a bed for many hours.  Fortunately for me I had I think 4 coworkers there who cared about my health.  This was my first experience in a Chinese public hospital.  Really my first experience in any public hospital.  I was in a room with seven other people with curtains dividing the room (sort of).  I had to use the restroom and instead of being brought a wheel chair they brought a custom shaped bucket and said I should go in that.  Yeah right.  Perhaps it's standard to do that worldwide when you're stuck in a hospital bed for fear of any biological movement to exceed an invisible threshold and kill you, but I've never done it and wasn't excited to try.  So one of my colleagues got me a portable potty and I was allowed to get off the bed to sit on the potty four inches away from the bed.  This guy helped me go potty (including holding the curtains so I had a semblance of privacy) and then literally carried the mess away for me.  What a friend!

I went into surgery at exactly noon, and they finished about 12:45.  They were expecting to find 95% or more blockage, but praise God they found 0% blockage.  I was awake during the procedure and only had local anesthetics because the doctor wanted me awake so I could tell him if I felt any pain where it wasn't expected.  Not the most comfortable activity of my life, but the local anesthesia was essentially effective and there was no significant pain.  After the surgery I spent the next six hours laying in a hospital bed (which is very normal for angiogram recovery).  It was a room with seven other beds, though the one next to me wasn't filled while I was there, and the beds were separated by a curtain like the previous room.  While in bed I just couldn't win.  It was a firm mattress (if you call it a mattress) and when I was flat on my back, my spine hurt (as it has for years whenever I lay like that).  So I got the doctor to agree to my laying with head and feet slightly elevated, which made my spine feel fine.  But then I just couldn't lay there any longer without going crazy and after a couple hours asked if I returned the bed to a flat position if I could lay on my side.  It took a couple times asking before he thought it was safe, but eventually he did.  Then that got old and I returned to the somewhat laying position.  I spent an hour or two like that and felt fine this time, but then realized both my wrists had gotten completely stuck in a bent position, presumably from laying the same way for so long (though that has never happened before and I've laid in the same position for longer).  It took a full hour of gently urging back to a straight position before they were normal again.  My fingers worked during this time, but my wrist was unable to obey movement commands.  I asked one of my colleagues to ask the nurse (who didn't speak English) for a washcloth soaked in hot water to help the restoration of my wrists.

After the six hours were up they suspected I'd want to change hospitals.  A doctor from the International SOS (a global healthcare coordination company my company works with) arrived and offered if I wanted to go to a more "western" style hospital in town or if I wanted to be "air ambulanced" to a hospital in Hong Kong.  I figured if I was going to fly, I'm flying home, so across town would be fine.  They decided that since the next day (Friday) was a holiday that traffic would be worse than normal in Beijing, so I should be transferred to the next hospital ASAP, even though the city's rush hour still wasn't over at the time (7pm).

So an ambulance showed up shortly after my 6 hours in bed were up and took me to the fourth and final hospital of my adventure.  It was interesting going to so many hospitals.  You can probably tell by the style of my writing in this post that I'm a factual and logical kind of guy.  So as I was being carried on stretchers (both ambulance and hospital kind) I couldn't help but notice what it was like to actually be the one on one of these things, just like I see on TV (especially since my wife likes to watch murder mystery TV shows).

I was admitted to the ER, and requested to use the restroom immediately.  I felt like I was going to explode.  They let me go and then I figured out the fun way that by taking anti-diarrhea medicine I was now constipated.  Great.  So they helped me back to a private room in the ER and asked me the usual questions of the day (do you smoke, do you drink, do you do drugs, do you or your family members have any history of heart disease).  Whenever I'd say "no" to both the smoking and drinking questions all the nurses would raise their eyebrows in surprise and go "huh?" and often they'd say "you are a good man."  My colleagues were there with me, I think five of them.  The staff decided I didn't need the ER services and quickly upgraded me to the ICU (intensive care unit).  They did the usual tests (blood sample, blood pressure, pulse, ECG, oxygen ratio, and heart ultrasound) and we called it a night.  By the time all these were done it was 11:00pm, 24 hours since I had last woken up.

Considering what seemed to be going on, my experience of the day was very nice.  All the doctors who've seen me have spoken English, my colleagues in country here have done a fantastic job of keeping me company and watching over me in my many times of need.  My boss back home in the USA has assured me to worry about nothing and she'll take care of everything.  People from the ISOS company have offered options, advice, and help coordinating anything I'd like, though my local colleagues have been taking care of enough for me.  (By the way, the term "local" isn't exactly right, because they all live and work 2 hours away in TEDA (tianjin economic development area, but they came to Beijing to help me).  The nurses who don't speak English have tried their best to meet my needs and explain what they need me to do, and were very nice about it.  All the doctors were very courteous and seemed to genuinely care about making me healthy, even when I looked very skeptically at them that I had any problem of the magnitude they suggested since I felt fine.  The nurse who rode in the last ambulance with me was very nice and talkative, which was exactly what I needed since I had to go to the bathroom so bad and needed a distraction.  I don't really know what it's like to literally be a prince, but I'm sure it feels like this.  (Not that a prince would want to be hospitalized, but if you're going to, this was great care.)  I think six people from work have kept me company each day.  Three of them had cell phones that could call home and I was able to call wife every twelve hours the whole time, as well as occasionally updating mom and boss.

The ICU room was a huge private room.  It was big enough for at least a dozen people and equipment, with a private bathroom.  That stay only lasted a day, and I don't remember much from Friday.  I do remember that walking was not easy, a few steps was as far as I could go without help.  The only practice I got was walking in the bathroom (which wasn't more than a few steps, but that was enough).  At first they wheel chaired me all the way to the stall, then by the next day I was able to walk across the little room, barely.  For those of you logical people like me out there, it's curious why my body didn't function.  The difficulty was mainly the discomfort of the angiogram healing, which wasn't "painful" but rather uncomfortable, but I didn't want to cause damage (which would surely be painful) before it was done healing.  Having one or two IV's (intervenes) sticking out of you doesn't make it easier, either.  Saturday morning I was doing well enough that I was upgraded again to the general ward.  On the way we stopped by the x-ray department and they confirmed there was a problem with my lower lungs, probably a bacterial infection.  The new room was still private, not quite as big (but big enough) and with more character (not a huge sterile white room) and just as many (if not more) features (including big screen TV, sink, private bathroom, and fold out love seat).  I spent almost four days here and it felt like a dorm room, because there were always between 1-4 other people here, we had a TV (which we didn't watch) and we were in a big building on a floor with a bunch of other people and girls (nurses and other workers) came and went all the time.

Saturday afternoon I was able to walk around the room without difficulty, but I could tell that was going to be as far as I got that day.  Sunday I walked down the short end of the hallway and was able to shower for the first time since Wednesday morning.  This was the first time I showered since it was the first time I could stand long enough (though they had one of those shower seats so I didn't have to literally stand the whole time).  Monday I walked down the long end of the hallway and walked to radiology in the next building over, where they rechecked my lungs.  (After three days of antibiotics on Monday my lungs were fine.)

Saturday I still couldn't talk on the phone very long without getting tired.  This is a really weird feeling for someone who's used to being healthy.  (Also, in case you don't know or don't remember, Beijing is 13 hours ahead of Chicago, so when I'd call home at night it was their time to wake up, and when I'd call when I woke up they were going to bed.)  My breathing on Friday and Saturday was often short unless I intentionally slowed it down.  It didn't feel bad to breath slow, but if I forgot about it I would breath fast (short).  I had my friends read to me in the morning but then realized my brain couldn't stand sensory data and had to ask them to stop.  All the lights were turned off and though I have a ton of music on my phone I just couldn't listen to it.  We talked sporadically because that involved short gaps rather than a continuous stream of sight or sound like recorded media has.

Sunday was relatively quiet.  Between one and three friends were around most of the day.  My friend tried reading to me but it was getting too much, so I asked her to read me anything she wanted in Chinese, so my brain wouldn't be able to "process" what she was saying, but I could close my eyes (they still for some reason were tired) and her voice would keep me company.  The rest of what happened that day I already explained above.

Monday afternoon I went to radiology while my friends went out to lunch.  When I got back I looked through the stack of DVDs they have in the room and found one that I thought I'd try.  I started it but then my friends returned and I turned it off to not waste my time with them.  That evening after they all left (but one) I resumed the movie.  It was "It's Complicated."  By Hollywood standards it's probably a great movie.  But by Christian and otherwise generally human standards it stunk.  The reason I kept watching it was it created a great opportunity to discuss these normally difficult and tender concepts with my friend, who is at least ten years younger than me.  I paused the movie I think three times so we could discuss how much people want to choose both their actions and their consequences, but we only get to choose the former and we're stuck with the later.  We discussed how wrong adultery is, even though the movie didn't come out and say it (that stupid movie even hinted that the opposite may be true).

I talked to my Cardiologist, Dr. Bai, this morning and she confirmed I did not have a "heart attack."  The data we had on Thursday morning (the blood test with elevated enzymes and the EKG) did point to one, but subsequent data (mainly the angiogram) has made it clear I did not.  Assuming God didn't do a miracle and clear up my arteries for me, the latest theory is that I contracted a bacteria and/or virus that attacked my heart and lungs.  This is a serious differentiation for my future health, my sister's, and that of my biological daughters.  Thursday morning my white blood cells were up, later that morning after I had taken some antibiotics they were down, then after that wore off the white blood cells were back up again.  This is textbook symptom of a bacterial infection (and tells you how many blood tests I got that day).  The ultrasounds have all turned up normal (I suspect even the one at the first hospital did too) and the EKGs have been fine since day 2, though they were completely different on Friday, Saturday, and Sunday, but completely normal on Monday and today.  They also revealed an incomplete right bundle branch block, which she said 20-50% of all people have and is insignificant.  Ken Ham, the founder of one of my favorite ministries (Answers in Genesis) has a saying: "It's designed to do what it does do. What it does do it does do well."  I suspect my heart is working just fine, but I appreciate the care and caution I got when the warning signs were noticed.

Followup: I did some Internet searches after I got home (at 3am while jetlagged) and found that there are a lot of people in the last decade or so who don't think heart attacks are caused by the traditional paradigm of artery blocks.  A growing number of people seem to be thinking heart attacks are caused by very small fatty deposits on the artery wall that break and form only temporary clots that quickly disappear.  Obviously this would stink, because detecting these is extremely difficult.  I'm no doctor and don't know if this is an acurate model of reality, but if it were true would make it more believable that I had a [minor] heart attack.