Saturday, April 7, 2007

Days of our lives

Our friend and neighbor, Jane Ellen, once jokingly referred to this blog as her daily dose of "Reality Show". Little did she know how right she was. The comings and goings of the residents of 14th Floor Taoyuan Road rival those of the denizens at Melrose Place. There is courtship between the young nurse and her patient's son that eventually fizzled out. Then there is Lady Machiavelli who so skillfully manipulated me that I fell into her trap willingly. But in general, the folks here are kind, decent people caught in the same predicament of watching their loved ones suffer from some incurable disease and are doing the best they can to get along with each other.

There is much camaraderie amongst us. We check-in with each other on a daily basis. If we find someone missing at the PT sessions, we make it a point to verify that he/she is well. We also cheer each other on and celebrate even the smallest moments of triumph when someone is able to gain feeling in her finger for the first time in ten years. We share the highest of highs and the lowest of lows. With so many nationalities and close living quarters it is a small miracle that we all get along so well. United Nations can certainly learn something from us.

However, not all patients and their caregivers participate in this commune. Some are more reserved in nature and prefer to keep to themselves. We find that the language barrier can be daunting to many, this is especially true for the Italian and Eastern European patients. Then of course, there is the occasional oddity in the form of Mr. Body Beautiful who I've described in my post "The naked man on the floor". He almost never left his room at all during his entire stay here.

Because our weekdays are full with rehab and injections, the only chance that we get to go out either by ourselves or in a group is on the weekend. We've ventured out with a group to Sea World and had a nice, leisurely dinner at a fantastic Italian restaurant one evening. Then there were short shopping trips locally for groceries and to Lowu Commercial City for souvenirs. Most weekday evenings we while away our time surfing the net, posting to the blog or catching one of the movies that we've brought with us.

Some evenings we have impromptu going-away pizza parties in the common room. We make a toast (with Coke) to the ones who are leaving and exchange addresses and phone numbers with promises to stay in touch. We've missed Debbie and Sue from Canada who are the most fun and down-to-earth people we know, David and Karen from Scotland, and Nick and Maria from Buffalo, NY. It is generally a good idea to try to get to know the people on the floor. Aside from providing moral support, the ones who have been there for a while are invaluable resources as you try to figure out the protocol of the program.

Richard continues to do well. The bruise on his hand and the rash on his body have resolved themselves. He has started to ambulate around the floor with his walker. The most noticeable improvement so far is his stamina and energy level. He is now able to shorten his naps and stay up a lot longer. The evening that we went for dinner at the Italian restaurant, we did not get back to the hospital until past 11:30pm. At home, he is usually in bed by 10pm. His gait and upper body stability are also good. We continue to be hopeful for further improvements.

Thursday, April 5, 2007

The Impeach Box

By the bank of elevators on the Stem Cell floor is an inconspicuous metal box affixed to the wall. The English words “Impeach Box” appear in bright orange letters on it. Below these letters are the Chinese characters for “Complaints Box”. “Chinglish” signs can be found everywhere both inside and outside the hospital. Some are side-splittingly funny while others are just plain mystifying. My favorite so far is the phrase “tenderly reminding” which prefaces every bulletin and warning posted in the corridors and elevators. We are hereby lovingly and gently reminded that there is no smoking in the waiting areas and that certain exits will be inaccessible after certain hours.

Speaking about the Impeach Box, I would like to submit the following item for consideration:

Yesterday afternoon while Richard and I were at PT, I received a sharp rap on the top of my head by Dr. X (to protect his privacy, he will be unnamed), a PT doctor/therapist, who then upbraided me for sitting on the a piece of rehab equipment. I was in a state of shock because in the entire three weeks that we’ve been in PT, Dr. X has never spoken to me, save once. A week or two ago he told me that I could not park Richard’s wheelchair in the PT room. My cousin from Shanghai was visiting us at the hospital then. My cousin was the one who put the wheelchair there because she was not aware of the rules. Nevertheless, I apologized to Dr. X and brought the chair out.

Going back to the rap on my head, I reacted by jumping off the rehab equipment that I was sitting on (it was a padded bed with a U-shaped indentation at the head of the bed). Apparently, I was being reprimanded for sitting on the head of the bed. Richard has never used this piece of apparatus before for his PT. There were no signs or warnings posted in either Chinese or English on the equipment. It was not intuitively obviously, at least to me, that the head of the bed was fragile. The knock on my head was not painful but it had enough impact to be jarring both mentally and physically. I was embarrassed to be treated like a naughty child in front of all the patients, their caregivers and other therapists.

As the day progressed, I could sense a feeling of unease welling up inside of me. But I couldn't put my finger on why I was feeling that way. Later that night, I lay in bed running the day’s events through my mind. Was Dr. X’s rap on the head a Draconian punishment? More fundamental that that, what excuse does he have to meter out punishment to me, a stranger? Does he even have the right to even touch my head without asking? Could a similar incident happen in the United States or any other parts of the world? Yes, no, no and probably no in other parts of the world.

Because I could not think of a single occasion that I have offended Dr. X, it is baffling to me that this person should resort to physical force to get my attention. The only explanation that I could come up with is that I was the chosen victim or some scapegoat for their discontent. I did not come 7,000 miles to be someone’s punching bag. This thought so disturbed me that I had a sleepless night.

This morning, I spoke to Grace and Dora, the Beike program and patient managers at Nanshan. They were sympathetic and promised me that they’ll investigate the matter. I had two objectives in reporting this incident. First, I want to bring to their attention that such behavior is totally inappropriate and unacceptable. Even if it is condoned in China, which I doubt, I will not tolerate it. Secondly, I told them that if Dr. X were ever to behave inappropriately towards me again, I will take my compliant to a higher level.

A short while after, Dora came to my room and told me that she and Grace have had a chat with Dr. X. He was surprised that I had taken such offense to his “playful trick”. Furthermore, Dr. X had misinterpreted my rueful smile after receiving the rap on the head to be a smile of pleasure. Dora explained that Dr. X was totally caught off-guard by my complaint. Dr. X thought that I understood that he was just being “playful”.

I can see how I might have blown the whole incident off as high jinx had it been big Dr. Lee or the other doctors/therapists who had administered the blow. Over the last three weeks, I have chatted up all the doctors/therapists in both the PT and OT areas but Dr. X. Beyond the quick nod or “good morning” now and then, I have never elicited any conversation from Dr. X before. It therefore makes no sense that he would consider himself acquainted enough to “play a trick” on me.

For now, I will give him the benefit of the doubt. In the meantime, this unfortunate incident was the straw that broke the camel’s back. More than ever, I yearn for my family and friends, for their soothing words and touch, for their skill in coaxing me out of my melancholy. I am exhausted and demoralized. I remind myself that there is only another week left and it can’t come too soon.

Beginning yesterday, Richard has developed a mysterious rash on his upper torso and buttocks. Although the rash is somewhat noticeable, it is neither itchy nor painful nor does he have a fever. The two Dr. Yangs wanted Richard to be seen by a dermatologist at the outpatient clinic. This poor dermatologist was dispatched three times yesterday afternoon to come up to our room for a consult and all three times we were out at PT or OT or on our way up to the room.

We finally saw the dermatologist today and she confirmed that it was nothing more alarming than some sort of contact dermatitis resulting from either the recent changes in weather or the new detergent that the laundry company was using. (We have been sending our laundry out to be washed since the humid weather makes it impossible to air-dry clothing) She prescribed some skin ointment and oral medication. Richard is now resting comfortably on his bed waiting for the stem cells to arrive for his third lumbar puncture at 4pm.

Food glorious food - but beware

China is very much a developed country, with some caveats. Specifically, one should be cautious with foods. The following advice comes from my own experiences in China and Hong Kong:

One should expect packaged and bottled goods to be fine. I would avoid street vendors, but most established sit-down restaurants are fine. Also, delivered cooked foods are fine, but raw fruits and vegetables must be washed thoroughly. I would avoid the skins of most fruits. Salads are not widely served, perhaps for a reason.

Tap water is fine for gargling such as when you brush your teeth. However, I would only drink boiled water or bottled beverages. Beware of iced drinks since the ice cubes may be made from tap water.

There are some special rules for seafood. I would avoid uncooked shellfish and probably uncooked fish in general (i.e. sushi). Cooked seafood I would consume but in limited quantities.

End of my sermonizing.

Godzilla hasn't called the last two mornings so we've been able to sleep in a little more. Godzilla is our nickname for the construction machinery. We met son of Godzilla in the freight elevator the other day in the form of a rusted trolley. The screeching sound was spine tingling.

Today was a little different in the hospital. The morning routine includes Acupuncture and Physical Therapy. Dr. Lee suggested that instead of using a wheelchair within the hospital, I need to get up and use my walker. Morning PT was also delayed as I've developed a non-itchy rash. I hope I didn't upset the dermatologist when I failed to be in my room when she came by. I'll trek over there tomorrow (Friday) morning probably.

Lunch was interesting as Lily and I went to dim sum with several key Beike staff members, Dr. Hu, Jon, and Grace. We were originally to go with two other patients and their caregivers but due to a mix up, they had to cancel last minute.

The conversation over lunch focused on how to "get out the message" that stem cells are real and are available. I now have a sense why Beike has been successful in Canada, Italy, Romania and Hungary but not as widely represented (though by no means zero) in the rest of the world.

Tuesday, April 3, 2007

Hope

I was intrigued by the comments made by a patient in this ward. There are so many differences in the patients here: language, culture, nationality, injury/disease type, etc. The common thread though is hope. Everyone has refused to accept the response, "There is nothing more that can be done." It is one thing to be trapped in a dark room and another to look for the light that will guide you to the exit.

Today is a typical weekday in the hospital. The morning routine includes Acupuncture and Physical Therapy with PT and OT in the afternoon. The hospital staff is hoping for some visible progress as proof of the effectiveness of my treatment (like unassisted upright walking). The intangibles resulting from the stem cell therapy and rehab are better energy level and more control of my upper body.

Over the Hump Day

We're roughly at the half way point of our stay and no longer seem to be the strangers among the patients. Moreover, we are envious of those who are leaving before us. We're longing for a meal at our favorite restaurant, the sight of friends and family ... in short, we're missing home!

Health wise, I'm feeling fine. I'm very glad that Monday's stem cells for me was via IV. Gone were the restrictions of bed rest and no food for six hours after the lumbar punch. This was especially crucial given that stem cells didn't arrive until 8 PM that night.

My next stem cells (fourth of five) are scheduled for Friday via lumbar puncture. So far, I would guess that my energy level is better and my upper body seems steadier. During PT, I need to retrain my brain on how to walk with a regular gait.

I think it is wise to always check with the medical staff often to ensure that one's stem cell injections happen when promised and are of the desired type (IV, lumbar puncture, etc). Give about a week before the last injections in case any changes are required; you never know if there might be unannounced changes.

I also added a link to the Google Earth community on the post "You Can Run But You Can't Hide". To use the facility, you do not have to register with Google (thanks to the suggestionof an anonymous comment). Zooming around the earth on a flying tour is pretty cool.

Monday, April 2, 2007

Have you eaten yet?

With a population of over 1.3 billion people, it is little wonder that there's such significance placed on food in China. One of the most common greetings among the Cantonese is "Have you eaten yet?" In fact, the Cantonese are known to be the most finicky of gourmets whose insatiable quest for the freshest and most exotic of dishes earned them the reputation of "eating everything that has four legs except a table and everything that flies except an airplane."

It is therefore the ultimate irony that I cannot find a decent Cantonese restaurant around Nanshan Hospital. Not only are restaurants specializing in the local cuisine far and in between but the variety of the dishes on the menu dismal and inadequate. By contrast, there are Szechuan restaurants, Mongolian restaurants, Shanghainese restaurants, Peking restaurants, Shandong restaurants galore. I was told that it is because Nanshan has a large migrant labor population so the restaurants tend to cater to non-Cantonese palates.

Since arriving at the hospital, we've been ordering out our meals. There is a communal kitchen but the logistics of shopping daily for food and preparing it in an unfamiliar kitchen proved too daunting. We've found that by sticking with Chinese food, our per diem (lunch and dinner for two) amounted to no more than 70 to 80 Yuan (US$10) which is unbelievably inexpensive. Lunch is usually a plate lunch of rice or noodles, meat, and vegetables. This usually costs around 10 to 12 Yuan (US$1.50). Another of our lunch favorites is jook (Chinese porridge or congee) favored with chicken or fish. This is augmented by Deep Fried Devils (Chinese crullers) and a plate of fresh greens seasoned with oyster sauce. Dinner is a bit more elaborate. I usually order the soup of the day, a meat and vegetable dish, a tofu dish, and white rice. Sometimes, we order from the beef noodle place. The meals there come with small side dishes like tea marinated eggs, and preserved bean curd.

For a change of pace, we ordered a pizza from Papa John's last Friday. We usually see 3 to 4 empty Papa John's pizza boxes in the kitchen trash here everyday. So Papa John's is very popular at the Stem Cell Ward. Imagine our surprise when we found that a 14 inch pizza ran 100 Yuan! (US$13) By U.S. standards, the price is not outrageous, but for the locals, the same amount of money will buy a nice dinner for 8 people.

For non-Chinese speaking and reading patients, there are three alternatives in feeding themselves :

1. Shop for food at the local supermarkets and prepare the meals in the communal kitchen.

2. Go out to local restaurants (including the restaurant on the first floor of the hospital) and order from the menu which may or may not be in English. Western fast food outlets like McDonald's and KFC also have a big local presence.

3. Order from Papa John's or the restaurant on the first floor of the hospital and have the food delivered to your room.

I have a bone to pick with regards to the restaurant on the first floor. The first time we tried eating at the place, we had a fairly good experience. The food and service were OK if not memorable. The second time we went there, we sat at the table for half an hour. The staff ignored us, never bringing us even a glass of water or the menu. Needless to say, we left without eating.

Today, the heavens opened up just as we returned from Richard's morning acupuncture and PT session. I decided to give the first floor restaurant another try and ordered some food (a noodle dish for Richard and a club sandwich for me) to be delivered to our room. After an hour and a half, the food failed to appear. Every time I called the restaurant, the line was busy or the call went answered. At this point, I decided to hedge my bet and called my usual Chinese takeout place across the street. This order arrived at our room in under 25 minutes even though it was pouring rain outside.

As we were hungrily shoving down our food, there was a timid knock on the door. It was the delivery from the restaurant on the first floor. The elapsed time was slightly over 2 hours. It was almost 2pm. Our nurse happened to walk by at that moment. She told me to send the food back and not pay for it. Although I felt sorry for the delivery person I complied. Richard is having his stem cells injection by IV this afternoon. Had it been through lumbar puncture, the situation would have been serious as he would not be allowed to eat or drink after 12 noon. It would mean that he has missed his time window for lunch and would not be able to eat again until after 10pm.

The poor weather also caused the plane carrying the stem cells to be diverted from the Shenzhen airport to the nearby Guangzhou airport. Consequently, we were told by Dr. Guo moments ago that the stem cell treatment will not commence until after 8pm. We had planned on going out with another group of patients for dinner at a nice Italian restaurant but it looks like we will have to reschedule for tomorrow night.

Since I'm bilingual, (and love food) I've started to collect takeout menus from local restaurants to translate them into English so that future patients will have a choice of foods during their stay at Nanshan. I'm planning to represent this book of menus to the Beike staff before we leave.

Sunday, April 1, 2007

You can run but you can't hide

Thanks to our friend Peter, this weekend edition of the blog is coming to you from 22° 32' 2.26" N (latitude) and 113° 55' 8.67"E (longitude). Check out the Google Earth website if you'd like to see the actual image of the Nanshan Hospital.
http://bbs.keyhole.com/ubb/download.php?Number=628175

Today marks the occasion of Richard's first "field trip" since arriving at Shenzhen. He has been hospital-bound because of his headaches and the rather exhausting daily rehab sessions. We went out with a few other patients to Sea World this afternoon and sat outside Starbucks with our drinks, whiling away the afternoon talking and people watching. Afterwards, we went to a Tex-Mex restaurant to have an early dinner. It was a morale booster for Richard to feel like he's a part of the world again.

As usual, our presence at Sea World attracted a lot of gawking. There were three of us in wheelchairs (Richard, Debbie and Marija), Nick who walked unassisted, his wife Maria, Debbie's friend Sue, and myself. We had a heck of a time getting Richard and Marija to the bathrooms since there were numerous steps even to get into the main area of the restaurant and the facilities were not handicap accessible. But we got plenty of assistance from the restaurant staff and passersby.

When I was growing up in Hong Kong, I did not recall seeing any people in wheelchairs on the streets, shops or restaurants. I just surmised that there weren't any handicapped people living there. The only people who were visibly mobility-challenged were beggars sitting silently on the street corners. People generally ignored them or cast furtive glances their way. The infirm and handicapped were hidden away by their families to lead life as hermits. It was also the same way in China. This practice probably discouraged anyone from advocating for the rights of these individuals. Hong Kong has made great leaps and bounds in the recent years in remedying this situation while China remained the same.

In terms of the attitude towards the handicapped, I'm seeing more understanding and compassion in the majority of the people that we've come across here. When we visited Shanghai and Hangzhou about five years ago, Richard was still mobile but had to use a cane to walk. While visiting Zhou Zhuang, a tourist attraction, we had to cross numerous narrow arched stone bridges. People around us grew impatient because Richard had to walk very slowly on these bridges. They clucked their tongues, cursed, shoved and cut right in front of him making every crossing an ordeal. I cannot see the same thing happening today in Shenzhen although I have a sneaky suspicion that this courtesy is granted more frequently to foreign guests than to Richard who looked like a local.

Now and then, we still catch glimpses of the mistreatment. Yesterday, I went with Kim Poor's friend and fellow Arizonian, Marija, and her family to Lowu Commercial City to do some shopping. The place was even more of a madhouse than usual because it was the weekend. It was wall to wall people. After just a few hours, we beat a hasty retreat. As we reached the head of the taxi queue, I walked ahead to ask the taxi driver to open up the trunk so that I can put Marija's wheelchair in. The driver responded by stepping on the gas and speeding ahead to pick up another passenger at the adjacent queue. This repeated itself four different times.

Meanwhile, I'm standing amidst the gas fumes with Marija sitting flabbergasted in her wheelchair. She was trying to comfort her 4 year old daughter, Sienna, who was on her lap because the youngster was both tired and hungry. Marija's mother, Sonia, was equally exasperated . She had purchased so much stuff that she was lugging a huge suitcase filled with her purchases. When the sixth taxi finally arrived, a man and a woman jumped the queue, cut in front of us and started to open the door of our cab. This prompted spectators to cry "Yu mo gow chor!" ("You've got to be kidding!" in Cantonese) The interlopers quickly withdrew and scurried away from the angry mob. In the mean time, someone got the attention of a policeman who was standing a few yards away. It was his job to see to the orderly loading and unloading of the cabs in this area. He had observed the fiasco with great detachment so far. People started to motion impatiently for the policeman to come over to intercede.

As we hurried over to the cab, several men in our queue volunteered to assist Marija into the cab. One man spoke soothingly to Sienna in broken English to ask her to wait while I helped the cab driver load the wheelchair and suitcase into the trunk. All these good samaritans spoke Cantonese and from their accents, I'm sure they were from Hong Kong. I've never been more proud of my heritage. Richard and I have experienced similiar discrimination and mistreatment by taxi drivers in the U.S. Therefore, I'm not condemning Chinese cab drivers but all cab drivers who are too apathetic and lazy to do their jobs. I hope that there's a special place for them in hell.

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