Can I Get a Mulligan?

On Saturday, March 10, at 8:20 in the morning, it had just begun to snow in Shenyang. Tim was off to play a round of spring golf at the indoor simulator. I was thinking about what I could check off my to-do list.  But it became a day interrupted.  Well, it became a spring interrupted.

Tim slipped on the ice twenty feet outside our apartment building. The way he tells it, his left foot slipped forward, his right foot planted, and his rear end came straight down on the side of his lower right leg.  Our friend, Danny, said he should embellish the story … something about a Chinese golf cart, aka rickshaw, tipping over on the back 9.  By the time I answered Tim’s call, changed out of my pjs and got downstairs, his golf buddies, Emmanuel and Jerome, were already beside him and his golf bag was holding up a very shaky leg with the foot dangling at a strange angle.  We’ve been through a lot in nearly 18 years of marriage, but this was a new one.

This is the long-awaited lengthy novel-like blog entry that most people won’t completely read, accompanied by a wmv file on youtube that most people will get bored watching.  But it is a part of our life in China, so we’re sharing.  Also know that it is Julie writing this, despite my attempts to get Tim to write his version.  He said he is contributing the material and that’s enough.  So you get Julie’s sarcastic perspective.  Read what you want. Watch what you want.  For the photos and video of this unexpected chapter in our adventure, click here: Part 1-  and Part 2 – Warning: This slide show is also a bit lengthy and contains some photos of incisions, stitches, etc.  Also, please forgive that some of the video is blurry. That’s just the way it goes.

Emmanuel’s driver, Zhang, called the ambulance at 119 and called our driver, Pan. The ambulance arrived about 15 minutes later, at which point this story moves from being called “Tim breaking his leg” to “The Experience”.  There were 4 people in the ambulance.  One is a driver – he does nothing else, not even answer questions.  Another did the paperwork and seemed to be leader.  The other two were the techs.  They were the ones who applied the make-shift splint to Tim’s leg.  The thin splint part of it looked like pieces of veneer from a bookcase I had in college.

I might have dropped the F-bomb on the ride to the hospital when I realized that people don’t stop for ambulances in China.  Sirens blazing, going through an intersection, and at least 6 cars turned left in front of us.  WTF took on a whole new meaning.  When arriving at Shengjing Hospital (Hospital #2 of China Medical University), ambulances pull right up to the front door.  The ER entrance is in the back of the building, but they don’t use it anymore.  The techs had to lift the gurney up 3 steps to get Tim inside.  And everyone was staring at us.  Yes, I mean everyone.  You’re snickering when you read that part, I know, but just imagine what that would be like in a difficult situation.  They took us inside, through the lobby, down the hall, and at the door of the emergency room, they asked for payment.  131RMB, about $20.  It was a 10 minute ride.  Emmanuel and Jerome kept rolling Tim into the ER, and I was hunting for my wallet.  You don’t get a bill in China; it’s pay as you go.

Pan got us checked in at the hospital.  I think the registration fee was 7RMB, $1.  Just like in the US, we waited and waited.  After about an hour, they sent Tim for an xray.  We’d heard about hospitals in China; where family members have to do everything.  We didn’t quite realize what “everything” meant until now.  We (Emmanuel, Jerome, Pan, Zhang and I) wheeled him to xray and into the room.  The tech stood there and said, “zai zheli” – “here”.  The Westerners in the group stared back at him. What do you mean?  WE have to move him to the xray table.  Excuse me?  Okay, I admit another F-bomb here and some harsh words in Chinese, possibly in French as well.  When the asshole, I mean the tech, told him to move his foot back and forth, I may have pushed his hand out of the way and gave him my most intimidating American stare, with which I do not need an Fbomb.  But Tim was a real trooper, using all his arm strength and his left leg to move over with our help.  Then back to the gurney and back to the Emergency Warehouse, I mean, the Emergency Room, to wait for the xray.

At about 10:30am, a doctor finally came to see Tim’s leg with the xray.  By this point, others from Michelin had arrived, including Tim’s boss, Benoit, with his gracious wife and son.  I had removed Tim’s shoe about 30 minutes before, but his sock and the veneer splint were still on.  Because Pan and Zhang were with us, along with Michelle from Michelle HR, the doctor hardly spoke to Tim.  There was no hello, no “how did you do that?” No friendly banter.  No “well, we’ll take care of you.”  Another cultural difference.  The ER doctor contacted orthopaedics, and I was sent to another building with Michelle and Dr. Xiong, the Michelin doctor who had recently arrived.  Back out the front door, through an alley, through the back parking lot all the while paranoid about the ice on the ground, and into the other building that would soon become our home for a week.  The doctor asked if there was any blood, because at this point, no one had actually looked at Tim’s skin. They had no idea if it was an open wound or not.  I said, “mei you xue”, “no blood”.  The doctor looked at the xray and asked me, in Chinese, if I spoke Chinese.  I said “a little”, which he took to mean I could understand advanced medical vocabulary, and proceeded to explain the options.  He lost me on the 2nd syllable.  Through translation, I learned that Tim had two options; surgery, which would be best, or casting it.  Surgery is a big deal in my book, so I asked a question.  Another cultural difference – Chinese people don’t ask questions of doctors or educated people in authority positions; they just accept it.  Later, in conversation with Pan, he said if someone asks “why?” the doctor will say, “it’s how it is – you don’t need to ask why.”  So I asked a question about the surgery, listened to the orthopaedist talk for about 5 minutes to Dr. Xiong, and all I got was “they will put Tim in a room and another doctor will see him on Monday.”  This is like that bad joke in a movie where someone speaks in a foreign language for several sentences, then the subtitle just says “yes”.

We went back to the ER to tell Tim and wait.  And wait.  This was the part that was just like the US – waiting in the ER for a room, except here everyone is looking at you and some people will walk right up to your gurney and stare.  At this point, I had to ask Pan to go and buy Tim a urine bottle just in case he had an urge for the bathroom.  I guess in the US a nurse or tech would help you with this.  Here, it is buy-your-own-bottle; something to do while we wait.  And Emmanuel called International SOS for advice, and just in case Tim would opt not to stay in Shenyang.  SOS was very quick to respond, very professional.  Michelin maintains a contract with them for expat employees, and we certainly can vouch for their consultation services.  The SOS doctor told Tim that he had confidence the orthopaedists here would perform the surgery quite well, but that the conditions of the hospital would not be comfortable.  He told Tim that, if necessary, they would transport him to a “center of excellence” in Seoul or Hong Kong.  Ultimately, Tim decided to stay at #2 for the duration, but continued to consult with SOS with questions pre and post op.

We were told at some point that the hospital was waiting for us to pay up front.  I went with Pan and Dr. Xiong to put 10,000RMB on deposit (about $1500).  At this point, I will tell you that we have an insurance company. The Global Doctor direct bills them.  And we had heard that we could use the same insurance card at Hospital #2.  Not really though.  Only in their VIP department, which is open M-F for mild cases and by appointment.  So when we got to this money window outside the ER, and I handed over my insurance card, the clerk waved NO and handed it back.  I asked why we couldn’t use it, and was told it was because it is the weekend. Then we were told that we didn’t need to be at that money window anyway. We had to go back over to the other building.  Out the front door, through the alley, in the iced parking lot, and into the building where the ortho floors are.  Another money window.  Then there was a problem with Tim’s last name, of course.  Then the clerk wanted me to verify that Tim had this accident himself, that no one had hurt him in the process.  If one person hurts another one here, the one who causes the most damage is criminally culpable.  Yes, please arrest the dirty ice on the ground outside our apartment building.  This must be why the xray tech won’t help you get on the table; they might hurt you and have to go to jail.  Anyway, the clerk wanted me to verify this by writing it in Chinese on the form, and at first, had a big issue that Dr. Xiong was to do it for me.  Maam, either she is going to write it for me, or I’m going to write it in English.  Forms done, 10K paid, back to the ER.  Wait.  (We would later put another 40,000RMB on account prior to the surgery.  Turns out it wasn’t the weekend that was the problem with our insurance card – we just couldn’t use it in the hospital outside of the VIP area.  In the end, the total was a little more than 32,000RMB, so we got the 17K+ back after Tim checked out.)

When they finally told us about a room, I was worried we were going to go back out the front door, through the alley, etc.  Uh, no, there is a special passageway for patients.  Down the elevator, through the hallway next to the parking garage, through the bowels of the building, passed the kitchen storage area and drying cabbage on the floor, up the get-a-running-start ramp, through the construction, down another small ramp, up the elevator and on to the lucky 13th floor for orthopaedics trauma.

Tim and his multi-national posse remained in the corridor for maybe 20 minutes.  Pan left to go buy a foam mattress because Dr. Xiong said the bed would be very uncomfortable otherwise.  The staring/ogling increased here since it was closer quarters.  I was asked to sign 8 or 10 pieces of paper and I have no idea what they said.  They were all in Chinese characters, of course.  After I asked what the first full page was and heard a one sentence answer, I decided it was just the standard hospital paperwork.  Sign away and get Tim to his room.  But, oh yeah, they have to do something about his leg first.

Have you experienced a loved one having their bone set?  Held their hand and felt helpless?  Asked the doctors to stop moving the f*@$ing gurney while they held the leg straight?  Tim was strong, and unlike his raucous wife, did not shout any F-bombs.  This was about 1:00 in the afternoon.  We’d arrived at the hospital 4 hours earlier.  This was when they moved him to a treatment room and out of the hallway. And this was when they took off Tim’s pants and cut off his sock.  This was their first look at his leg.  They rolled the casting materials out on the floor.  Benoit was guarding the door because we were sure someone would just walk right in to see the broken American leg.  One Chinese man walked up to the door and Benoit told him he didn’t need to go in; no need to see what’s going on.  The Chinese man walked away and came back a minute later wearing a white lab coat, only to tell Benoit in English, “I’m a doctor.”  Nice.  It was over in about 20 minutes, though Tim asked later if we were in that room for several hours.  Then we moved him to one room, then another room.  It was a triple with a bathroom.  They told us only one other person was in that room, and he would only be there for a treatment one hour each day.  He lived close to the hospital so he would just go home for most of the days and nights. In China, you can pay for the room, even if you aren’t there all the time, and they hold the bed for you.  Tim asked if we could do that too, but no.

Then it was just a waiting game.  In a Chinese hospital, nurses administer medicine and take your temperature once a day.  Someone comes in to clean the room, well “clean” is subjective, once a day.  A doctor might come in once a day.  Other than that, you’re on your own.  Meals, sheet changes, baths, supplies, even supplemental ibuprofen because the pain medicine seemed to be quite weak.  Family members and friends do everything for a patient while they are in the hospital.  So you see why it was easier for Tim’s roommate just to go home every day and night.  You also have these people who come in with advertising about 10 times a day.  I’m not exaggerating.  Menus, medical equipment sales, a lawyer, a massage therapist – all with flyers that they put on your bed.

The #2 hospital has a VIP department that most expats hear about.  I mentioned it earlier when talking about payment.  It is supposed to be fancy and new, heavily invested in by the BMW group that is here is Shenyang.  We can also use our insurance card there.  But only Monday-Friday for milder cases.  Tim was in the real hospital, not fancy and new, just basic and exactly what we should have expected actually.  Look at the pictures.   On his last day, the head nurse offered him a private room, still not in the VIP area, but what was the point with less than 24 hours to go.  We both chuckled and said we’d stay in our luxury suite.

The break happened on Saturday.  On Monday, as promised, other doctors came to see him.  The head of the ortho department, who, in translation, was called The Professor.  We think his name was Dr. Wang, but he will always just be The Professor.  He came in the room with two other doctors.  He explained the same two options we had heard on Saturday; cast or surgery.  He said Dr. Gu, head of ortho trauma, would be doing the surgery and could answer any questions we had.  At this moment, Gu’s phone rang.  Following the norm in China, he answered it, then walked out of the room.  And never came back.  So we didn’t ask our questions, and hence, didn’t give an answer about cast or surgery.  Another day wasted because we didn’t understand what the hell happened.  Tim consulted with SOS.  They assured us that the doctors would perform the surgery to a very high standard, but they recommended getting the surgery as soon as possible and check out as soon as possible after that.  The greater risk would have been the conditions of the hospital, the sheer number of people you come in contact with, and the risk of contracting something else.  ASAP was not in the immediate plan though.  On Tuesday, we sorted out the issue about our decision, and Dr. Xiong began to coordinate things for us.

A foreigner in this hospital was a pretty big deal.  Pan kept joking that Tim was famous.  As the surgery coordination continued, we learned that The Professor would be doing the surgery.  Fancy.  But he didn’t have any time on his schedule until Thursday.  Great.  There were antibiotics, a PET scan on Tim’s lungs to be sure he didn’t have TB, and a legendary ECG that made us laugh.  Those suction cups on an old ECG machine don’t stick to a hairy American bear like they do on a typical chest-hairless Chinese man.  There was shaving involved there, and shaving involved on the leg too.  More nurses, more advertising, more time to wait.

On Thursday, the day of the surgery, we got ready early.  Someone arrived with a gurney and to take Tim downstairs.  Pan was there, of course.  Dr. Xiong wasn’t able to be there this day, but they had arranged for Michelle and Sophia (HR) to be with me in the waiting room while Tim was in surgery.  We got to the waiting room, which was fairly calm at 8am, but after a while, was crazy as I should have expected.  I waited for about 30 minutes, and then someone from the ortho floor arrived to tell me that the anaesthetist needed to go over the risks etc.  So we went to the nurse’s station for this.  The anaesthetist would tell Michelle and she would translate for me.  On the first sentence, Michelle’s response was, “Shi shenme?”  – What is that?  Awesome.  My translator doesn’t know #1 on the list.  The anaesthetist kept talking and put her hand on the small of her back.  Oh, I know what that is; an epidural.  It was especially interesting since we had been told there would be a different kind of anaesthesia.  Oh well, okay, #2.  Again, “Shi shenme?”  The anaesthetist showed Michelle the Chinese character of what she was referring to.  I heard Michelle say, “Wo bu renshi…” – I don’t know that one.  This was going to be a long conversation at this rate.  But we got there and I signed the piece of paper.

We were in the waiting room about 5 hours.  At one point, I noticed that nurses and doctors would come to the desk, yell a name into the microphone, then the family would rush up and talk to them.  Sometimes, if it was post surgery, the nurse or doctor might have a sealed plastic bag in their hand so the family members could see what had been removed from their loved one.  Watch the video if you want to see.  I heard later that this practice is because people don’t trust the doctors, so they want to see a tumor or whatever else was removed.  This is so strange to me considering how much they revere status and education and don’t ask questions in advance.  But it is among many things I don’t fully understand here.

The other interesting practice is the calling of family members when the patient is finished in the operating room.  There is a locked door and family members gather closely to wait, although “gather” infers that it is peaceful waiting – not so much.  A nurse unlocks the door, opens it about 3 inches to yell a name, while everyone rushes to look in and get in.  They let in one family member to talk to the patient for a few minutes, locking the door behind them.  After a few hours, I asked Pan what they would do when Tim was done.  Obviously, his last name is difficult in most countries.  Pan told me they would just call “laowai”.  It is an informal version of the term “waiguoren” – foreign country person, or foreigner, and is usually used for Caucasians in China.  Some foreigners might say laowai is a negative term, and we could argue about that, but I will just say this.  Pan, along with Zhang and TR who had showed up to help, would not have allowed them to use a derogatory term for Tim, so laowai it is.  And when Tim was done, that’s what he heard them say when they unlocked that door.

Turns out the epidural was all that Tim had.  It was all he needed for the actual surgery, but it meant he was awake for the entire thing.  He heard the hammering, drilling, metal on metal, the occasional beeping of the portable xray machine.  The doctors and nurses didn’t speak to him and just went about their work.  Some patients might freak out hearing all that noise and knowing their leg was cut open.  In the US and other countries, I believe they would also give a patient a mood enhancer to get through it.  Tim just laid there and wished he’d had his iPad.

After the surgery, he had to lay flat for 6 hours.  This was okay when the epidural was still working its magic.  He swore his leg was bent at the knee and found the non-feeling sensation very weird.  When the anaesthesia started to wear off and he could wiggle his toes, this was a very good sign.  But eventually, the pain and uncomfortable feelings set in.  These, combined with the fact that the hairy American bear hadn’t eaten or drank for 24 hours, made for a grouchy patient, justifiably so.  We had to ask for some extra pain medicine that night, but they don’t seem to be forthcoming with the good drugs.  My feeling was that they are a suffering people; that they accept pain and hardship more than we would.  Another friend also said the doctors are tentative about using too many strong painkillers because they wouldn’t be able to manage the addiction side of that.  Illegal or excessive drug use doesn’t exist much in China; the penalties are too great.   In any case, they gave Tim a shot in his bum and that helped, though he still didn’t get much sleep that night.

Friday was better, and we told the doctors that he would be going home on Saturday.  They were shocked.   For them, the norm is about a 10 day hospital stay post-surgery.  So, one xray on Friday, plus another one Saturday morning because they forgot to take the knee picture on Friday, and we were off.  Oddly enough, it was snowing the day we took him home too, but all the ice was gone within a week.  Within 30 minutes of being home, he was on the couch, watching TV, and Drs. Bandit and Daisy were doing their part for the recovery.

I know this post is lengthy and perhaps boring for some.  It was important to write because it will always be a huge memory of our time in China. There are a lot more details, if you can believe it.  So if you are ever in the same situation, feel free to contact us and we can help you for your week-long stay in a Chinese hospital.