Saturday, March 24, 2007

Similarities and Differences between Nanshan Hospital and Hospitals in the US

Earlier on Saturday, we had some family members visit us here in Nanshan. I think we're one of the few patients in the Stem Cell Ward who have relatives living nearby.

It struck me that bringing meals to the patient is expected in many hospitals around the world. The smells and aromas of the food permeate the entire floor. In a recent phone conversation with my sister, she asked, "Where is Lily staying?" I responded, "In the same room." In the US, that just isn't done. It is not unusual in China and Hong Kong that the hospital would allow a caregiver to stay overnight in the room with the patient. Another difference is the fact that Nanshan does not have a centralized meal service for the patients. At least, I have not seen meals being delivered from within the hospital to the inpatient wards. The patient is left to find the means to feed himself. There are a lot of take-out places that would deliver to the room and the restaurant downstairs will also make deliveries.

Now for some of the similarities. The "technology" available is plenty adequate. At Nanshan, there is a blend of new and old ---- MRI's and acupuncture can be found at the same facility. Is a motorized patient bed that reclines that different from a hand cranked one or does iodine as a disinfectant (which stains) versus disposable alcohol wipes matter that much?

What is unique about Nanshan's Stem Cell Ward? There are about 20 rooms on the floor. Each room can accommodate three beds, but one patient gets to use the entire room. The rooms are very bright and spacious. We are very fortunate to have Wi-Fi reception in our room because our room is adjacent to the common room where the internet connection is. Most patients bring their laptops into or use the computers in the common room in order to surf the net. Also, Nanshan is one of Beike's first and well established locations. Especially for English speaking patients, Shenzhen's close proximity to Hong Kong means a good availability of English speakers.

Friday, March 23, 2007

Sorry to keep you waiting but Kwan Yin was calling

Every day when Richard and I ride the elevator, a disembodied female voice pleads "sorry to keep you waiting" every time someone presses the "door close" button. It is no exaggeration to say that each of the eight elevators at Nanshan is packed to the gills most hours of the day. (and night) During rush hour, the elevator stops on every single floor in this 21 floor building. Jockeying for space is not for the timid. But what struck me is the serendipity that I'm hearing an English speaking voice in a Japanese-made (Mitsubishi) elevator in China.

Richard received his first lumbar puncture yesterday afternoon. The stem cells arrived around four o'clock. Richard was one of the six or seven patients scheduled for the procedure. Everything went very smoothly, he was in and out in less than half an hour. Afterwards, he had an IV in his hand from which he received growth factors to help the newly injected stem cells "take" to his body. He spent the next six hours flat on his back. At 10:30 that evening he wolfed down the takeouts that I've warmed up for him.

Today he woke up refreshed but somewhat groggy from having slept so much. I noticed that there is a rosy glow to his face and his eyes looked exceptional bright. He said he felt rested but other than that, he did not feel anything different. Big Dr. Lee and Dr. Ye both have the day off, so we did not have acupuncture, PT and OT today. Richard rested on and off while visitors like my mother, sister-in-law, cousin and Mary Ann O'Donnell dropped by. Mary Ann discovered our blog and mentioned it in one of her posts which in turn led to the Salon.com article. She came by to talk to us and other patients on the floor and was also given a tour of the facilities by the Beike staff.

Richard had a tough time resting during the day because of the noise from the construction site across the street. We were told that a new Shenzhen Metro stop is being built there. The hospital is very close to the city government center. The Chinese restaurant at the Xin Tao Yuan Hotel across the street is apparently the preferred place for power lunches of the city's bureaucrats. From the window in our room, we can see lots of new buildings and a highway overpass in the distance. Shenzhen is growing at an enormous pace. Its labor is supplied by young people from all across China. I read somewhere that the average age of a Shenzhen resident is 25. This melting pot of migrant workers results in restaurants serving virtually every regional cuisine imaginable.

A few nights ago we went for a stroll with my mother who is visiting us from Hong Kong. We saw two men dressed in Buddhist saffron robes squatting by the sidewalk near the hospital. They were talking in an animated fashion with some pedestrians. My mother said that the monks were telling the fortunes of the passersby for a fee. The Goddess of Mercy, Kwan Yin, is believed to whisper secrets of the future to the monks whom she favors. It is these secrets that the monks are now divulging to their paying customers. Apparently the goddess was a lousy judge of character because my mother saw these holy men last night eating BBQ meats, chugging down copious amount of beer and chain smoking in the restaurant at her hotel.

Thursday, March 22, 2007

The Yellow Brick Road to Shenzhen

I forgot to post this one earlier... Richard

We took a direct flight across the Pacific that arrived in the early morning on Monday (6:30 AM). By 9AM we had arrived in Nanshan.

We opted for ground transportation from Hong Kong airport instead of the ferry to Shenzhen. A mini-van came to pick us up and we never left our seats once we boarded as the driver handled the customs at the border crossing. We still needed to get the visa to China, but Hong Kong has no visa requirement for Americans.

Also long gone are the drab olive green uniforms of the Chinese border guards that is reminiscent of the PLA when Hong Kong was under British control. Now the guards wore smart, form fitting dark blue duds. In the interest of commerce and efficiency, the customs process is much more streamlined as there are many more commuters between Hong Kong and Shenzhen. The only major traffic jam that we encountered on the way was in Shenzhen.

You don't want to drive between Hong Kong and China. Aside from the dense traffic and aggressive drivers , Hong Kong still drives on the left side of the road while in China one drives on the right.

I am looking out our window now and the same hazy sky persists. It only rained Monday morning since we arrived. I can't tell which way is north since I haven't seen the sun!

Later today (Friday) is the first stem cell injection.

Fly on the wall

I've had my share of hospital stays in the United States. Much of daily life in a hospital can be summed up as "hurry up and wait". It is very much the same here in Nanshan except for a cultural twist.

The department of rehabilitation at the hospital is quite large and has the reputation of being the best in the area in terms of specialized equipment and medical personnel. As a result, there are many outpatients who are treated here daily on a first come first serve basis. Factor in the twenty of so patients in the Stem Cell Ward and other patients in the hospital and you have a scheduling problem that rivals chaos theory. And yet, to my amazement, we never had to wait for more than 5 to 10 minutes for Richard's daily appointment.

Richard's PT, OT and acupuncture treatments are performed in three separate areas. The acupuncture and Chinese massage (Tui Na) area has around ten narrow cots laid out in close proximity to each other. Each cot can be curtained off from the rest of the room. Almost every patient that I've seen in the last three days is accompanied by one or more companions. You do the math. Twenty people plus up to five therapists coexist in the same room. There is absolutely no privacy. You can hear every word that's spoken. The privacy curtains are rarely used. Despite all this, there is almost a spa-like atmosphere to the place. It felt cozy rather than claustrophobic. Total strangers banter back and forth. The foreign patients used the time to catch up with each other. Though I must admit that the locals love to stare openly at the foreigners in the room. For a while, I had the dubious distinction of being the star attraction:

Richard and my entrance to the room barely caused a ripple of interest since we blend in with the locals. I then address Dr. Lee in Chinese to let him know that Richard is ready for his treatment. So far so good. As Richard settles into his cot, Dr. Lee comes over to apply the needles. I start to wander off to chat with the other patients and caregivers from our floor. The first time I did this, heads swivelled. After a while, I noticed that some people from the next room which is the PT gym area started to migrate over to stare at me through the open partition between the two rooms. Good lord, she looks Chinese, she speaks Chinese but she's really a lao why (foreigner in Chinese, but it mostly refers to Caucasians)!

The OT room is run by an all female staff. Dr. Ye and her staff share a soft spot for the children under their care. I asked Dr. Ye about the incidence of autism in China. She told me that she has seem her share at the hospital. Her heart goes out to the parents of these children. She showed me a photo of a young, autistic Australian boy who she's treated. He was a little over one year old when his parents brought him to Nanshan.

Nanshan (or Shenzhen People's Hospital Number 6 as it is officially known) is a teaching hospital. On a regular day, there are quite a few interns getting their hands-on experience in the rehab department. They work under the watchful eye of the doctors. There are two Dr. Lees in rehab. "Big Dr. Lee" is the supervisor of acupuncture, Chinese massage and PT. He got his moniker since he is larger in physique (taller) than "small Dr. Lee" who coincidentally came from the same city as Richard's parents. Big Dr. Lee is often frustrated by the antics of some of his interns. The young 'uns apparently tend to bite off more than they can chew in order to one-up each other. When one of them tried to emulate the way that Dr. Wang, another doctor in the PT department, threw the ball to Richard the previous day, Richard started to keel backward. Luckily, big Dr. Lee was watching through the open partition. He started to yell at the intern to quit showing off and to stick to the basics like making sure that the patient does not fall down.

In the spirit of what's good for the goose is good for the gander, I decided to seek Dr. Lee's help in getting rid of my chronic neck, shoulder and back pain. He prescribed heat treatment, the electric stimulation machine and Chinese massage and kindly squeezed me in as the last patient of the day. As a result, I not only got effective pain relief but also a telling glimpse of the closeness between the interns and the doctors.

I was lying on my cot in the empty acupuncture room waiting for my muscle stimulation machine to finish the program when in came three interns. It was five thirty-three in the afternoon, a little past quitting time. It has been a long day for the interns. A female intern pleaded with a male intern for massage relief on her sore neck. He replied that he can do better than that --- he was going to do his "famous" neck adjustment for her. She protested vehemently that he had not gotten the doctor's approval to perform the delicate maneuver. The young man waved off her objections and started to massage her neck a little too roughly. The girl squealed and told him to be more gentle.

Meanwhile, the other male intern wandered over to fan the flames. He said that he does the neck adjustment better than anyone else and he'd be willing to do it. Just as the girl was starting to panic, little Dr. Lee walked in and asked what was going on. He listened with an expression of mock gravity and went over to the girl. He then put his hand on her neck and carefully performed the adjustment. The interns watched in a respectful silence that was broken when another female intern rushed in to ask the doctor for permission to leave for the day. I have a feeling that all these interns are going to make fine doctors one day. Yes, I would even ask any one of them for a neck adjustment.

Wednesday, March 21, 2007

Babelfish in iPod City

Hi, this is Richard here! Lily "guest-wrote" the last four posts so I felt that I should be doing my share. I am more of a computer geek while Lily and Andrea possess a literary flair. Case in point: instead of calling the earlier post "What time it is in Milan?", I would've chosen something you'd read out of a computer manual like "Day 2- .... ".

With that said, I cannot thank my wife enough for using her fluency in Cantonese and Mandarin to help me ease communications with the staff at the hospital. By the way, the correct way to refer to the official language in China is Putonghua (literally, the common language). At physical therapy today, Dr. Lee gently chided me when I said my one and only phrase in Mandarin,"I do not speak Mandarin" to him . He told me that since Mandarin or Guo Yu, means language of the country, it therefore includes all dialects of China. Because I spoke Cantonese, (albeit very limited) I cannot say that I do not speak Mandarin.

While most of the staff here speak some English and a large portion of the patients (at least while we're here) are from English speaking countries, "lost in translation" is a daily affair. However, any effort to communicate is welcomed by both parties. Hand gestures like a thumbs up are readily understood. If one can secure the services of someone to help translate during the first few days, that would be tremendously helpful.

IPOD City in the title of this post refers to Shenzhen where many of the IPODs are manufactured. In fact, you can have your IPOD engraved for free when you order it through APPLE. It will be shipped to you direct from Shenzhen.

Tuesday, March 20, 2007

What time is it in Milan?

Between the hard beds and jet lag, we slept rather poorly last night and got up at six in anticipation of an agenda-packed day. The nurse came to get Richard's blood pressure, and blood, urine and stool samples. Then we were shepherded with an Italian family to the outpatient department for tests. Richard had electromyography which tests the muscles of his legs and feet.

After that, Dr. Yang (not the same Dr. Yang from yesterday) who is the supervising physician, came with the other interns to take a comprehensive medical history and performed more motor tests on Richard. Then we rushed down to start acupuncture with Dr. Lee. Electrical current was applied to the needles to stimulate the muscles. All of Richard's needles were put on his legs. The movement of the muscles of his legs made the needles quiver rhythmically. Richard said that he only felt a slight prick when the first needle went in and after that he was not aware of the other needles going in at all. The stimulation from the electrical current was quite bearable as long as Dr. Lee receives continuous feedback as to what was Richard's comfort level.

Physiotherapy came next. The same Dr. Lee prescribed and had Richard perform various isotonic exercises using 5lb. weights in each hand. Dr. Lee emphasized that he was looking for both stability and strength in these exercises. Luckily for Richard, our Pilates instructor, Karen, had coincidentally been having us do the same movements for the last couple years so it was par for the course. By the end of PT, Richard was quite exhausted.

After lunch, a quick nap, and an EKG, Richard attended the second half of his PT session. This time, he practiced throwing and catching a ball with his therapist. Then Richard was asked to walk heel to toe while holding onto parallel bars. It has been a long time since he has walked without the help of his walker but he managed commendably. After this, we went to occupational therapy with Dr. Ye. She evaluated Richard's handwriting which has deteriorated progressively over the past few years. As she massaged Richard's arms and hands, she had him perform a series of exercises using special equipment to strengthen the fingers. At the same time, she put a collar-like device around Richard's throat. The electrical current through the collar was suppose to stimulate the throat muscles and help with swallowing and speech. Later on, Richard amused the other patients in the OT area when he was asked to pick up marbles with chopsticks. This he did with the patients' and Dr. Ye's beaming approval.

Dr. Guo who is in charge of the stem cell injections came by to introduce herself and to confirm our request for four lumbar punctures and one IV. Richard's first stem cell lumbar puncture is scheduled for this Friday. We were told that he needs to rest up in order to improve the effectiveness of the treatment. In an attempt to get a good night's rest, Richard took an Ambien and is now acting out his dreams. I've never seen such a volley of rapid movements in his fingers, hands and arms. This is different from his usual myoclonus when the whole of his upper body jerks forward violently. I am wondering if taking the Ambien is such a good thing. Dr Perlman, if you happen to be reading this post, can you comment to let us know if Richard should stop taking Ambien?

Monday, March 19, 2007

The Eagle has landed

Hello everyone! We’re here at the Nanshan Hospital in Shenzhen. Logistically, it was no small feat traveling with 4 suitcases, a wheelchair, walker, CPAP machine and backpack. But we made it!

Hong Kong was drizzly this morning and the temperature was pleasantly cool. The efficiency of the airport staff in Hong Kong never ceases to amaze us. We landed at 6:30am and were ready for pick up curbside by 7:00am. Shenzhen has gotten even more cosmopolitan since Richard last visited in 2002. There are high rises everywhere and the traffic rivals that of LA.

Our first day on the 14th floor (the stem cell ward) is kind of like the first day at college. You are shown your room by people who are essentially the RAs, except at Nanshan, they are the liaison and administrators. There is a tour of the common, kitchen and laundry areas. We also met some of the other “kids” on the floor. There are patients from all over the world --- Brazil, Romania, Italy, Singapore, Scotland and the United States.

Dr. Yang came by shortly after we arrived to take Richard’s medical history. Temperature was taken in the axillary fashion. Then we were given a tour of the Physical Therapy, Occupational Therapy and electro-simulation areas. Next, Richard’s eyes were dilated and the fundus photographed. By this time, jet lag hit Richard hard and when he got back to the room, he climbed in bed for his well-deserved nap.

Tomorrow’s agenda includes blood tests, some sort of leg muscle test and the start of his PT, OT and electro-stimulation. Stay tuned!