‘Go on,’ Monika said, ‘You go and have that surgery. And then you can tell us all about it so we know what to expect if we ever end up in a Chinese hospital…’ I get it, I am the guinea pig, the one who undergoes the experiment so others can reap the benefits. I do not mind, really, but some paths are better well trodden, and navigating the path of the Chinese health system is definitely one of them. Not that I am the first one to get a taste, the Hangzhou Expat Forum sporadically posts stories of those who had their own brushes… Are these reports always accurate, though? Remember the scaremongering around the G20 which turned out to be grossly exaggerated and blown out of all proportion??
What to do when a knee becomes bothersome?? Ignore the damn thing and put it down to the effects of a life well lived??? Grin and bear it. Or acknowledge that maybe with a stitch in time, I can save nine… Admittedly until recently my attitude to issues of a medical nature generally fell within the first category. Sweep it under the carpet and it will disappear with some patience. And even now, my only concession to age is being less flippant about such matters. Creaks at least deserve to be investigated before they turn into nasty, irreparable cracks.
June saw the first sign of trouble. I had barely joined the gym after pondering a couple of months about spending what seemed like a fortune on an annual membership. Stiff and painful knee after running 5 km on the treadmill: I ran less frequently. My journey home in the summer, by aeroplane, resulted in a swollen knee making stairs a trial of stamina: I called upon the services of the Great British NHS. Maybe if I had followed my friend A’s advice and arrived at the hospital in a wheelchair, pretending untold agony, I might have made it to the X-Ray department. Instead, a nurse in the hospital’s drop-in clinic advised physio and rest for a possible sports- or running-related injury that could only be confirmed with the help of an MRI scan. Not a chance of that happening in the UK then, as I was only there for two weeks, and the wheels of the NHS grind slowly, painfully slowly… And as for resting?? I had just booked two trips that would involve a fair amount of leg work…
As it was, I returned to China, via Thailand, none the wiser about what was going on inside my knee and at the mercy of my Chinese medical insurance. My first attempt at securing an MRI scan went rather awry. Instead of taking me to a hospital with at least an orthopaedic department, the English assistant accompanying me, ushered me to the nearest medical facility: a maternity hospital around the corner from my school… ‘A maternity hospital? They can give me an MRI scan? They know about bones and joints? ’ I queried. ‘Sure,’ she said and we joined the queue for the doctor, watching each patient being examined in front of me… At least I was only there to have my knee looked at, without the need to answer any questions. The doctor relied entirely on my assistant’s very brief description of my issues and indeed agreed that they warranted a closer look.
We set off to the X-ray department… ‘This is not an MRI scan,’ I established , passing by the reception counter to pay my dues in advance. The assistant looked quizzical, ‘No???’ She seemed surprised and unaware that an X-ray was not the same as an MRI scan. Maybe ‘Grey’s Anatomy’ has not yet found its way onto the Chinese television screens. There, everyone is having MRI scans… I had my knee duly X-rayed and handed the pictures to the same doctor for his medical view on the matter. After a mere cursory glance and an extensive discussion in Chinese between the doctor and my assistant , I got the abbreviated version: ‘It’s your age. You need to sit down and rest..’ I sighed at the wasted time and journey. I am a Westerner who asks questions and I wanted answers and explanations, not Chinese advice: rest, rest and rest… Clutching the X-rays and the diagnostic blurb, I went home trying to figure out how to get a second opinion in a more appropriate hospital…
I do some moonlighting, all English teachers do… teaching private students in the evenings to supplement our salaries . It’s lucrative and there is plenty of demand from ambitious parents who believe that the only way for their children to succeed in later life, is to excel academically . And they pay for private tuition, burdening their children as young as four or five with more and more extra-curricular lessons and activities. On a Friday evening, I travel into Downtown Hangzhou to work with two such young boys, lively and full of beans, but eager to absorb the English language.. It’s exhausting, but great fun AND one of the fathers is a doctor… Who better to show my X-rays to? Although not an orthopaedic specialist himself, Tommy’s dad agreed to help me arrange an MRI scan at the hospital where he worked and would ensure I had access to an English speaking doctor!! But not until after my Yunnan trip, I would not let a little thing such as a bothersome knee interfere with my walking plans.
Still nursing the effects of my fall near the Yangtze River, I finally had the MRI scan mid-October. Whereas the school’s English assistant, whose job it was to help me, had made as little effort as possible, Tommy’s dad left nothing to chance. In China, it pays to make the right kind of friends. He met me at the reception desk of his hospital and accompanied me to the orthopaedic department, selecting the most senior doctor to authorise the MRI scan. When the next date for a scan seemed too long to wait for, he organised an impromptu scan jumping the appointment queue as well as the line of waiting patients. He took me back to the first orthopaedic surgeon, who there and then analysed the MRI results, saving me another trip to the hospital at a later date. ‘The MRI scans are inconclusive,’ the surgeon decided, ‘ too much fluid around the knee. It needs an arthroscopy to see what is going on. Maybe take the scans back with you to the UK and have the surgery on the NHS.’ I groaned…
With my next visit to the UK not due until May 2017, relying on the NHS was not an option and, after all, I had Chinese medical insurance through the agency I work for. The internet detailed the procedure as minimally invasive, the kind of keyhole surgery that is performed as an out-patient, no need to stay in hospital… After establishing that in the worst case scenario I could afford the operation out of my own pocket, Tommy’s dad put me in touch with the orthopaedic surgeons in his hospital. The insurance company required details, lots of details before authorising the surgery and paying most of it!! I must admit, I was pleasantly surprised, but it appears that the Chinese Government insists that foreigners who qualify for the Foreign Expert Certificate (me!!!) indeed have adequate medical insurance.
It wasn’t until I read Dr Wang’s letter to the insurance company that it dawned on me that the Chinese idea of this ‘minimally invasive’ keyhole procedure did not entirely match what I had read on the internet, or indeed had learnt from other people (outside China) … Dr Wang, one of the few surgeons in the orthopaedic department with reasonable proficiency in the English language, had been tasked with explaining what the operation entailed and his description at our first meeting seemed to tally with my expectation: minimally invasive, endoscope, two small incisions on either side of the knee and no general anaesthetic. And he promised me, only the most competent and experienced surgeon, Dr Li who specialises in keyhole surgery, would be allowed anywhere near my knee.
Imagine my surprise when Dr. Wang’s letter arrived and referred to 7 days of hospitalisation and months of rehabilitation and further hospital visits! ‘Don’t worry,’ he assured me when I queried this, ‘I have made it a good letter for the insurance company, so they will give you more money..’ I acquiesced, vehemently insisting that I would not have the operation in China if it meant staying in a Chinese hospital… I had seen the wards: regulation stripy pyjamas worn by all the inmates of the concentration camp. An assortment of beds squashed in a small room with no room for privacy and certainly no curtains… I could envisage the stares and curiosity I would be subjected to as the only non-Chinese person around… On the other hand, maybe just one night would be tolerable; I was supposed to have an epidural and needed the use of my legs if I was going to be able to cope in my flat on my own!!
With a lot of foreboding and trepidation, a nod from the insurance company, and Dr Wang’s relenting that maybe two or three days of hospitalisation might suffice, the date was set for Monday 21st November. ‘As long as the wounds are clean and not infected,’ he grudgingly agreed. ‘And who is going to keep me in hospital against my will?’ I thought. Pre-op tests had been arranged for the Friday and Dr Wang was eagerly awaiting my arrival to show me the one and only private room on the ward, which he had reserved especially for me. Although maybe not very clean to Western standards, the room was furnished with all the mod cons to make my stay comfortable and enjoyable: a flat screen TV (which I never used), a microwave and a fridge… I was certainly getting the VIP treatment! It looked like a slightly longer stay might not be too bad after all and it would definitely take care of the minor inconvenience of making coffee, cooking food and shopping on one leg once I returned home..
Dr Wang introduced me to Nurse Sherry, who had been entrusted with my pre-surgery tests and also my care whilst in hospital. Of course, I was expecting a few blood tests, as is the norm, but was it really necessary to repeat the HIV test?? Surely I had been cleared of that on my entrance into the country and my status was unlikely to have changed… I would be so lucky!! After the bloodletting, a chest X-ray and EKG followed. If I was about to be admitted for open heart surgery, I would have welcomed a thorough check-up, but for a minor bit of keyhole surgery on my knee with not even a general anaesthetic??? Still, it is reassuring to find out once in a while that all is well and in reasonable working order.
I was officially admitted to the hospital that Friday. Not that anyone clarified this bit to me.. ‘No need to stay in the hospital at the weekend,’ Dr Wang had declared. ‘You go home and have a restful weekend and come back on Monday before 7.00am.’ Only when my daily hospital bill appeared on my phone Saturday morning did I realise I was not only paying the premium rate for the luxury of my empty hospital room, but also for the nurse’s unused services. In the meantime, trying to strike a balance between following doctor’s orders of a good weekend’s rest before surgery and making the most of my last weekend of mobility and properly working knees (for a while at least), I rushed back to work on Friday afternoon; I joined a long and strenuous Hangzhou Harrier’s Hash (hike) on Saturday and spent Sunday running emergency errands and doing shopping trips to Walmart to stock my cupboards ready for the enforced relaxation time in the coming weeks. I eventually turned myself in on Sunday evening; I needed to have some rest at least and might as well make use of the facilities I was paying for.
Monday morning arrived, D Day and at exactly 8.30 am I was welcomed into my own episode of Grey’s Anatomy when the surgical team arrived to clear up last minute uncertainties. They spilled into my tiny room, barely able to fit in: Dr Li, Vice President of the Department, lead surgeon for my run-of-the-mill arthroscopy on a foreigner; Dr. Wang, his wing man who would be assisting and translating when necessary; and a troupe of lesser surgeons and student doctors trailing in their shadow. I thought it only fair to commit the event to permanent memory, but just whisking out my phone had them scurrying away, suddenly camera shy… ‘And what was the long-term outlook for my knee,’ I wondered. ‘Rest,’ Dr Wang repeated, ‘rest…’ ‘And hiking?’ I enquired.. He looked puzzled, ‘At your age and with your knee… no running, no hiking, no stairs, no cycling…’ I smiled, ‘At least I am still allowed to ride on a motorbike then…’
I cannot profess to be an expert on Western surgeries and my knowledge is limited to hearsay, undergoing a few minor surgical interventions performed under local anaesthetic and watching Grey’s Anatomy, copious amounts of Grey’s Anatomy. With the only English channel available on my TV broadcasting a Chinese take on the world, the internet and downloads are invaluable sources of entertainment, often the only sources… In the blink of just six months I absorbed all twelve series and have even caught up with the American episodes of series 13… This does not make me an expert on surgeries, but at least meant I understood Dr Wang’s technical jargon of ‘resection’ and had a good idea of the goings on in the OR when patients were unconscious and none the wiser.
My nurse arrived mid-morning with some sketchy details of what would happen before and after the surgery… Her suggestion of a catheter was immediately dismissed!! ‘What on earth for??’ I demanded to know. My kidneys were on an extended holiday and in total relaxation mode having been deprived of fluids for over 12 hours… After consulting with the medical team, she yielded and I would be allowed to make the journey to the bathroom after all. My bedside table was cleared to make room for heart monitoring equipment and an oxygen mask put at the ready. ‘You will be needing oxygen after the surgery to speed up your recovery,’ the nurse explained, ‘And no food or drink for at least another six hours whilst lying flat on your back without a pillow…’ ‘Oxygen after keyhole surgery on my knee with an epidural??’ the mind boggled and as for lying flat for six hours, starving and thirsty, studying the dirt stains on the ceiling, we would see about that…
Whilst nurse Sherry was busily plotting a lengthy Chinese-style immobilisation after surgery, I had different ideas. ‘Are there any crutches on the ward, so I can get to the bathroom once I have regained the use of my legs after the epidural?’ ‘Crutches…,’ she pondered, clearly plunging the depths of her brain… ‘I am not sure about crutches.’ No crutches on an orthopaedic ward? ‘Maybe a Zimmer-frame??’ she continued. Obviously nurse Sherry’s English vocabulary did not stretch to ‘Zimmer-frame’ but her description left nothing to the imagination. Did I look like the kind of person who was going to be pushing around a Zimmer frame when I still had one perfectly good leg to hop on? ‘I need crutches,’ I insisted. We came away empty handed from the hospital pharmacy; no crutches available there, ‘but maybe in another shop just a little further away from the hospital..?’ they suggested. It did not sound promising and about to give up on a lost cause, we bumped into a pair of abandoned crutches next to the lift. Hooray, they existed after all. And suddenly Nurse Sherry came up with the brilliant plan to ask one of the ward porters whether they SOLD crutches after all… Ten minutes later and 120 RMB (about £15) poorer, I had my crutches at the ready. No rest for the wicked, I thought with a big grin on my face…
After more hours of waiting impatiently and battling mirages of hot steaming food, and coffee – definitely coffee-, the cavalry arrived to wheel me to the O.R. floor for pre-surgery medication. I am not sure whether the sedative that was added to my drip was part of the epidural plan or just a special treat for a VIP foreigner as none of the other patients had anything but a clear liquid in their bags, but I was soon blissfully engulfed in a fluffy cloud of Amsterdam space-cake tranquillity and felt ready to face just about anything.
Once in the actual OR, I was introduced to the anaesthetist. ‘I assume you will be having a general anaesthetic,’ he chirped cheerfully, his English impeccable. ‘Everyone in the UK is having a general anaesthetic for this kind of surgery.’ He had just returned from a stint in the UK to get a better understanding of Western practices and methods. Did he forget to inform his colleagues that everyone in the UK having this operation would not be forced to stay in hospital??? ‘A general anaesthetic? ’ This was the first time I heard of this… The anaesthetist had indeed popped into my VIP room on Saturday to discuss the options, only no one had mentioned to him that as an in-patient, I was definitely OUT for the weekend!! ‘Which one carries the least risk?’ I mused.. We settled on the epidural after all, the method preferred in China for an arthroscopy.
All the needles in the spine out of the way, I was being attached to the usual O.R. paraphernalia whilst numbness slowly spread along my lower limbs all the way to my toes.. Dr Li and his team started their preparations. The patchwork of my MRI scans was beautifully illuminated. Swathes of blue cloth covered all but my left leg and obscured my view of the action. I was connected to an assortment of drips. ‘Did I want to watch the surgery on the monitor?’ Dr Wang eagerly anticipated; I had been asking questions, lots of questions and he was keen to unravel the mystery of my knee life on camera!! ‘I can give you something to sleep throughout the surgery if you prefer,’ the anaesthetist piped up… ‘Yes, please…’ To Dr Wang’s disappointment, I took the squeamish way out… Although an epidural may well have blotted out all the pain, I did not look forward to all the tugging and prodding I might still be aware of. Somehow oblivion sounded the better option!
I only have a vague recollection of my trip back to the ward. I was briefly woken before leaving the OR and then drifted in and out of wakefulness in the recovery room and on the way back to the orthopaedic floor. Clearly the anaesthetist’s sleeping draught worked a treat! As soon as my trolley was pushed into my room, a motley assortment of nursing staff, porters and cleaning staff wafted in. Grabbing hold of my surgery garb – my legs still in definite inaction – the multitude of enthusiastic hands hoisted me unceremoniously onto the bed. I refused the oxygen, surely it was the lower part of my body that had been paralysed, not my brain. And as for lying flat on my back??? I insisted on having the bed gently raised and demanded a deliciously plump pillow to support my back and head before catching up on a few more hours of well deserved sleep courtesy of the anaesthetist’s potent concoction. It made the six hours vanish quite quickly and finally I was allowed to eat and drink… Lukewarm water never tasted more delicious!! And boy, was I ready to try out those crutches…
‘Was I in any pain,’ Nurse Sherry enquired. Her shift came to an end and she wanted to make sure I was comfortable. I might as well not have bothered to answer her question, as my smiling ‘No’ immediately went out with the wind. She set to work, hooking me up on the prescribed bag of antibiotics and a brew of post-surgery medication including plenty of pain relief… I did not argue as perhaps it also contained some anti-inflammatory and anti-swelling drugs. The Western approach of icing the knee to reduce pain and swelling was unlikely to have any effect because of the massive bandage, and just maybe my body was still luxuriating in the residue from the anaesthesia and sleeping medication..
‘Was I in any pain?’ the band of surgeons wanted to know in the morning on their daily ward round. I pointed to the little chart behind my bed showing a big smiley face: ‘No pain,’ I declared. ‘No need for pain killers…’. I might as well not have bothered. A few minutes later, the nurse appeared with new drips, full of Ibuprufen and other undisclosed drugs. As the patient, I was clearly rather irrelevant in the whole process. China knows best and better and makes decisions on your behalf. Sedation and unnecessary pain relief would certainly make for placid and cooperative patients… I spent the day killing time watching kings and would-be kings killing each other as I amused myself with numerous episodes of Game of Thrones.
Wednesday finally arrived, the day when Dr Li and Dr Wang would decide on my discharge from hospital. As long as the incisions were not infected and looked clean, there was no medical reason to keep me in hospital. I had already passed all the other milestones Dr Wang had listed: my kidneys were back in action and as to answering the nurse’s daily question of ‘Do you have shit today???’…. ‘Of course, my life is full of shit every day. I am a teacher in China..’ almost escaped my lips before dissolving in fits of giggles and laughter. Some translation apps have a lot to answer for!!
Wounds carefully inspected, disinfected and covered with smaller dressings, Dr Li and Dr Wang declared me ready for release… but not without the obligatory photograph session. They did not have the opportunity of treating many British patients in their hospital, the surgeons intimated as I dutifully produced a smile for the camera. Next the nursing team appeared and I could not part without having my picture taken with Nurse Sherry, who indeed had taken wonderful care of me. I even managed to get the complete surgical team to pose for a photograph…
Talking of photographs, Dr Wang had a confession to make. Would I like to see photographs of the surgery?? As I had been knocked out completely and sound asleep, he had felt it his duty to document the proceedings so he could show me the damaged area inside my knee. ‘Great,’ I thought, and, ‘Yes, please, I’d love to have them…’ Maybe in the Western world, taking these photographs without my permission may well have been frowned upon, but under the circumstances, I was very grateful to have a lasting record…
To be honest, I do not think that my experience was entirely representative of an ordinary stay in a Chinese public hospital. I certainly experienced the VIP version with plenty of allowances made to accommodate my Western whims and wishes…
Hope all is well with you now and your recovery is complete. Have a good Christmas.
I do not know whether it is due to my general level of fitness, or having the benefit of mixing Chinese methods and practices with a healthy dose of Western methods and practices, but I am almost walking normally. Crutches have been retired for some time now…. I am just not walking as fast and as far yet, but it will not be long before I will be back to hiking and cycling!!
Very well done indeed. I’m recovering from surgery on a broken/shattered wrist – so much for keep fit on a treadmill! Treadmill 1 me 0! As you say though, complimentary methods and medicines are definitely helping. I’m a firm believer in a mix of both. Keep it up!
I hope your wrist will recover soon… Yes, treadmills can be dangerous, but I do miss going to the gym…
Gald you can still ride on a motorbike. Would suggest a matching belt for the stipe pjs-would look rather good. So what was actually wrong with the kneee and is it now fixed. As ever brilliant prose. Whatever next. You’re a star. Have a great Christmas and best wishes. xx
What is wrong with my knee(s)… ?? Undeniable overuse of the joints; comes with having been around a little while… In the meantime, I shall carry on cycling, hiking and running until a more drastic measure is needed (knee replacement ) AND definitely learn to ride an e-bike as preparation for something more powerful… Let’s have some FUN!!
I’m honestly so surprised by this – why was it so difficult and different from what you would get in a UK hospital? It seems like they were making it up as they went along, do they not do procedures like this regularly? You’d think lots of people all over the world have dodgy knees….
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The consensus about the different approach in China seems to focus on getting the most out of MY insurance… Unnecessary tests, unnecessary medication all have to be paid for and although I ended up contributing a small percentage of the cost, most of the treatments and tests were covered. So it was in the interest of the hospital to make the most of my visit…
However, from the conversation I had with the surgeons and anaesthetist it would appear that things are done differently in China, for instance the difference between using a general anaesthetic or the epidural. Whereas in the West, patients are encouraged to be active and mobile as quickly as possible, the Chinese firmly believe in REST, long periods of rest and keeping things WARM. The Western approach is to promote healing by applying ice packs to reduce swelling and keeping the knee elevated; in China I had to ask for an ice pack but the amount of padding around my knee made it rather ineffective… After childbirth, women do not leave their home or bed for about 1 month and keep warm and REST… Compare that with giving birth in the UK where most women leave the hospital the same day their baby is delivered…
Although I did not agree with a lot of what happened in the hospital, I have no doubt that the treatment I received was excellent and I would not hesitate to use that hospital again… I just would be more prepared for what was in store and be more vocal about avoiding unnecessary interventions and tests… and set the boundaries before being admitted to the hospital.
It is all part of experiencing cultural differences and approaches…
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I see! Kind of, better safe (and warm and rested) than sorry? Which underestimates the benefits of getting moving again… a different approach, as you said 🙂 thank you so much for this detailed answer, I’ve been telling my friends about this all week so now I can keep them updated!
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