China Experience

Email to Dr. Wilson

Thursday, October 07, 2004 11:06 AM

I was most interested in reading about your time in China and the work you did with doctors there. The reason I was so interested in what happened to you was that I had my glaucoma diagnosed while I was living and working in Xi’an, Shaanxi Province, China in 2000-2001. I was a glaucoma suspect here in the USA and my ophthalmologist told me I was OK to live in China for up to six months but if I were staying longer I must have my pressure checked. About five months into my stay there, I decided to stay for at least nine months and knew I needed to have my IOP checked so I would know if it were safe for me to stay or if I needed to return to the USA for treatment. My first try at having my pressure checked was in the hospital run by the university where I was editing papers for an international conference on Project Management. The doctor who saw me had me to close my eyes. She pressed each of my eyeballs with her index finger and told me I had no problem what-so-ever and didn’t need a pressure check. I told her I knew I had a problem and my pressure was higher than normal. What I needed now was an accurate pressure check to see if it were elevated enough that I needed to start medical treatment. She said she had an instrument which touched the eyeball and could do such a check however no one was willing to have it touch their eye and she no longer used it. I could not convince her that I was used to such a check. She told me to go downtown to Hospital Number Two and have a check done there if I were really interested. I learned from a friend where the hospital was located and persuaded a good friend of mine to accompany me since my spoken and receptive Chinese were not quite up to a visit to a sophisticated hospital setting. In China when you ‘go to the hospital’ you are often going to see a doctor, as we would go to a doctor’s office here in the USA. When my friend and I arrived at the hospital there were long lines outside each doctor’s office. My friend was very assertive and kept walking from place to place asking for someone to check my IOP. It was impossible to call ahead and get an appointment at the doctor’s for any kind of medical care. He finally got the attention of a doctor who started to talk to him and explain how busy they were. Just then a woman who appeared to be in her sixties came down the hall. Two young doctors were supporting her on each arm. I looked at her and felt pity for someone so obviously exhausted and ill who was in the hospital. Imagine my surprise when she stopped in front of us and listened to my friend and the doctor as they talked. She turned to me and spoke in English and said she accepted me as a patient and told them to check my pressures and do several other examinations. To my surprise I found she was the head of the Eye Hospital. She was working in spite of her extreme exhaustion (and as I learned later a very bad pinched nerve in her neck). The doctors had two puff tonometers in the exam room she sent me to. One registered my eyes at very different pressures 16 in one eye and 28 in the other if I remember correctly. They then checked my pressures with the other puff tonometer and it registered two completely different pressures. They then shaved several spots of hair from my scalp, attached electrodes and did an examination where they flashed small lights in front of my eyes and recorded the brain activity the lights caused. I think this was a measure of the optic nerve. They had a big discussion and then took me down the hall to yet another puff tonometer which they said was more accurate and did yet another measurement which was vastly different from the previous two. I left that day with a variety of measurements and no real idea of a diagnosis. They asked me to return several days later for another pressure check. When I came back the next time, they had yet more inconclusive measurements. Dr. Zhu asked me to return on an inpatient basis where they could do a more accurate assessment of my eyes. My husband and I discussed it and decided I could do that. They wanted me to spend 5 days in the hospital. Since I was teaching two kindergarten classes and one graduate level creative writing course, plus taking three classes myself besides my editing work, I had to find a substitute and make plans. I talked them into trying to do the tests in a timelier manner so I could be in the hospital only 2 or 3 nights. Going to the hospital in China means going prepared to take care of yourself. I bought fruit, nuts, bottled drinks and water, bread and peanut butter and jelly. They were kind and put me in a two-person room thinking my husband would spend the night to ‘care for me’. They were scandalized when he left me there and returned to the university campus to his own bed and his work. They were not used to American patients and their independent ways. This hospital was rather clean and I had a toilet and sink in my room. The young doctor who was given charge of my care was still a doctor in training. He was very kind and gentle and took great care in all he did. I had no idea from any past experience of mine in the USA that tonometry could be done with a little ‘balance scale’ on my eyeball. I was rather scared of the whole procedure. Previously I had almost panicked when an ophthalmologist put eye drops in my eyes. I really didn’t like it at all. Imagine how I felt when I was told to lay on my back and keep my eye open then they put drops in my eye and then balanced ‘something’ on my eyeball and put little weights in it. I wasn’t sure about sanitation and was concerned I would get some sort of an infection and/or scratches on my eyeball. This procedure was repeated day and night every few hours to see how the round the clock IOP varied. After each measurement a nurse would put drops in my eye and say, “Wu Fen Zhong” which means 5 minutes. I would keep my eye closed for 5 minutes. This habit that I developed in that hospital continues until today in how long I keep my eye closed after I put my IOP drops in. I had piles of student papers to read and grade and I sat cross-legged on my bed reading between times I was seeing a doctor. In the evenings giggling young nurses in training piled into my room to talk to the first ‘wai guo ren’ (outsider) they had ever had in the hospital. They were about 15 or 16 years old boys and girls alike. We had so much fun talking. They enjoyed my faltering Chinese and the chance to talk to someone from far away. I enjoyed having a chance to get to know some really cute young people. One day the doctor in charge of my care took me by taxi to another eye hospital across town which had more sophisticated equipment. They had a Zeiss Humphrey System machine for checking RNFL thickness. I still have my Fundus Video picture and the colored pictures of my thickness, a line graph and two pie charts from that visit. One evening when they did the last IOP measurement of the day they told me NOT to get out of bed in the morning until after they did another special check. They came in the next morning checked my IOP and then told me to drink two liters of water as fast as possible so they could check to see if my IOP rose quickly. I know few doctors use this test here now. Repeatedly they told me how very different my eyes were from the eyes they were used to seeing what an odd shape my eye had. I tried to argue that the outside fold of the eye was different but that surely my eye was the same. Finally they convinced me that my eye shape was quite different. What they seemed to be describing was a difference in the angle that they said made glaucoma happen more often to Asian eyes than to ones like mine. Since mine were the first non-Asian eyes seen in this Eye Hospital (except for Dr. Zhu who had worked and studied in the USA for 6 months some years before), I suppose they were mysterious and a little harder to diagnose. The vast number of patients they saw day in and day out were people in crisis with sudden angle closure glaucoma. They didn’t do much screening since there are just too many people for any such routine medical care. They took in patients who came in agony and did their best to save the eyes. One funny day the glaucoma specialist on staff took me into a dark room and put something in my eye which looked like the end of a microscope to me (I had never heard of a device to check open and closed angles). (I will repeat here that my receptive skills in Chinese were not fantastic). She told me what I thought was ‘close your eye’. So, I closed my eye and the ‘microscope end’ flew out and bounced across the room. She was mighty irritated! She repeated, “I told you NOT to close your eye”. I didn’t need a lesson in what she was saying. Her body language translated it for me. I knew the words for open and close for doors and windows, etc. but previously didn’t know they weren’t exactly the same for opening and closing eyes. She wiped off the instrument and put straight back in my eye. That was a scary moment since I figured the floor and the cloth were both pretty dirty. Of course she found my angle nice and open. The final diagnosis I received was POAG with cataracts in both eyes. That didn’t sound too good. When I returned to the USA, my doctor told me I had no cataracts at all. They had never seen pseudoexfoliation syndrome glaucoma and the exfoliative material on the lens must have looked like a cataract to them. They wanted to start me on Betoptic S but needed to be sure I didn’t have diabetes. So they came to do a blood draw. That was a wild experience in the midst of a wild experience. The nurse did all the normal things, palpated for the vein, cleaned the area, held the needle at the correct angle and THEN she put the needle in parallel to my shoulder, twisted it and turned it toward my wrist, retwisted and turned it upward toward the shoulder then drew the blood. I was looking at it absolutely terrified and afraid to say anything for fear she would withdraw the needle and do the same thing again. My husband was there that day. When the nurse left the room, he whispered, “You were so brave.” I looked down at my arm and there was a hematoma approximately the size of a lemon which rapidly got to be the size of an orange. I walked down the hall, found my doctor and asked for ice. He asked me why and I showed him. He looked like he was going to faint. They went out to a restaurant and found some ice for me. The hospital had no food or ice or anything like that inside it. All patient care was to be done by family with things brought from outside. She was the only nightmare in my entire stay in China. I don’t know if she was totally incompetent or if she hated Americans. Everyone else was kind and competent and eager to do his or her best to care for me. I was so totally impressed with the high level of care I received in a hospital that was far from modern. I was so confident in the care I received that I stayed the next 4 months and finished the work I was doing. I did a lot of e-mailing back and forth to my primary care doctor who would consult a ophthalmologist in our HMO and report back to me if medications they were suggesting were appropriate, if my pressure were high enough that they would be treating in the USA. At all times the Chinese doctors and the American doctors were in agreement until the Betoptic failed to keep my pressure down. Since Xalatan was not available at all in China at that time and Betoptic S or pilocarpine were the only two meds available, I used pilocarpine and Betoptic S for almost three months until I returned home. The first time I put the pilocarpine in and in about 5 minutes realized I couldn’t see in the dim lighting I had available in my rooms, I was pretty scared. I didn’t know they would change my visual acuity so much. You can believe I did a lot of reading on the internet to learn as much as I could. One day I was talking with my Chinese doctor about laser treatments. He was astonished to hear lasers could be used in the treatment of glaucoma. He said the only treatment he knew was needling or the two drugs I had already received from him. There were many things even this find Eye Hospital didn’t know.

Completely off this eye trouble. My last week in China I developed a sudden case of pneumonia. I was well one minute and dreadfully ill within 15 more minutes. . Fever of 105, etc. This time I was taken quickly to the internal university hospital (that of the finger on the eyeball IOP test). It was a very dirty hospital with no modern amenities. I carried my own bedding since the sheets there are not changed between patients most of the time. My friends sat in the room with me and carried all my meals. I was asked if I wanted the ‘regular’ antibiotic or an ‘effective’ antibiotic to treat my pneumonia. I asked for that sentence to be repeated. I said certainly I wanted an effective antibiotic. They said, you are the first person ever to want the effective one without waiting to see if the regular one makes you well. It was a cost issue. I was newly diagnosed with glaucoma and was on a Beta Blocker. I was also newly diagnosed with high blood pressure and was on an Ace Inhibitor. I was scared that the antibiotic would somehow or the other interact with those two and kill me. So I insisted on reading the entire brochure through two times. It was in Chinese on one side and English on the other. The Chinese was small and the English smaller. My fever of 105 was making it hard for me to read anything. They were saying, Hurry , hurry we need to get this started at once. I was saying, You can’t use anything in me till I finish reading this. While I wasn’t looking someone stuck a needle in my arm and I started crying. They had put a few drops of the antibiotic under my skin to see if I had an allergic reaction. The shock of a needle in my arm when I wasn’t expecting it was the last straw. I was sobbing like a baby and the doctor said, “Acting like a baby” in Chinese supposing I didn’t understand. I calmed down, looked at him and said, “The reason I am crying like a baby is I AM a baby”. He heard my Chinese realized I knew what he had said, we all laughed, they explained what they were doing and I quit being terrified. They got the IV started and off I went on another hospital adventure in China. Need I tell you my worst case scenario that had gone around in my head for years was I might some day need an IV? I had just gotten over being terrified of eye drops and now put them in my eyes on a four times daily basis. Now I was facing and conquering my long time horror of an IV. I had antibiotics dripping in my arm for 5 days. Once they hung a bag with a brown substance and put it in my IV. After it dripped for about a half hour they came in and said, “Don’t be scared if you suddenly start to sweat and get hot all over. That is an infusion of herbal Chinese medicine that will make you sweat and break this 105 fever:. They had boiled a tea of herbs and then distilled it and stuck it in my veins. Oh dear!!!! I decided they knew what they were doing. Sure enough about an hour later I woke up soaked to the skin. I had to change all my clothing two times and then the fever was gone for good. Very good medicine. They also used a Chinese herbal antiviral IV since they were not positive if I had a viral or a bacterial pneumonia. I enjoyed some large black balls of chewy and delicious herbs for my cough. But they had never heard of a cough medication that could make you cough up phlegm. I tried to explain an expectorant and they said that sounded wonderful but it was not in their knowledge base.

The toilet in this hospital was not-to-be-believed. It was totally down at the other end of the corridor. To get there I had to get my body out of bed (fever still raging) and hold my IV bag up in the air-no rolling poles). I had to step high over all the door jams. They are about 6 to 10 inches high at each doorway. The opening for the toilet was just a hole in the floor. I had to squat on the floor and try to keep the IV bag high enough not to have the blood return down into the bag, not lose my balance so I wouldn’t fall into the hole, carry my own tissues since there was no toilet paper, etc. The water closet was above the hole and there was a totally filthy rope you had to pull to flush. There was a cold-water tap only with no soap or paper or cloth towels. So I also had to carry my soap and a washcloth to wipe my hands. This room had an open window to let air in. I think germ control was by letting the germs all blow out the windows since most were open. Often I had a friend just stand there and hold the IV bag. Modesty wasn’t very important in this situation. The hospital president, a physician, came and apologized for the dirty hospital and said he knew it wasn’t up to American standards. He asked how he could make my stay better. I told him to PLEASE put some soap in the toilets so at least the nurses could wash their hands and to put a metal pull on the toilet so the filthy rope could be taken out. The metal would be easier to get clean. He seemed to think that was a novel idea. He assured me the nurses returned to the station and washed their hands after using the toilet. I was not convinced. The station was on the opposite end of the hall and I felt sure if a patient called out for help as the nurse walked down the hall she would probably stop and do whatever was needed instead of thinking about hand washing. There were no rubber gloves even for those drawing blood.

Again, a very primitive hospital yet full of caring people who did what they could very very well and made me recover quickly from a bad pneumonia. I was so impressed with how hard Chinese doctors and nurses work and how very well they function in the midst of conditions no one would tolerate here.

I hope you never have to be sick far from home where your language skills are poor to mediocre but if you are I hope you meet medical professionals who treat you as well as I was treated. I am off to the Czech Republic for six months soon. If I have more eye adventures there, I will write you again.

Nancy