British authors and giving blood

So my son had any epiphany tonight. Dad: ‘How do you like The Fellowship of the Ring’? Son: ‘It's pretty good, but there’s some slow parts.’ Dad: ‘That’s cuz the author is British’. Son: ‘I didn’t know JRR Tolkien was British. . . Dad, I just realized something. Did you know that most British authors’ names start with the letter J? JRR Tolkien, and JK Rowling, and. . . Weird huh’. Dad: ‘Well I guess you summed up the majority of great British writing with those two authors.’ When he gets older, I’m hoping he discovers J Rudyard Kipling, John Locke, John Milton and all the other unknown English authors whose names start with J (and maybe even some that don’t).

So the ‘red cross’ came to the Changchun American School last Saturday. I couldn’t turn down a request to see what blood donation looks like in China. So I showed up at 11:00 am at the school and asked what room I needed to go to in order to give. They told me I had to fill out the form first. Now I’ve given blood enough in the US to know how to fill those 20 page forms out pretty quickly (even with the mandatory information pamphlet reading). This one was a bit trickier in that they ran out of English forms. My Chinese is still a bit rusty, so I had a translator help me out. “Name, age, date of birth, sex, occupation, phone #, blah, blah, blah”. OK on to the backside. “These 40 items are a list of things that you can’t do if you want to give blood. Just check the box in front of each one and then sign on the bottom”. Now I don’t normally read the questions too closely in America, but I’ve never filled out an entire form without having any idea what I was checking. I must look like a pretty innocent guy as the translator assumed there was no way I would have to answer ‘yes’ to any of ‘those’ questions.

Also, there was a choice of how much blood I wanted to donate: 300, 400, or 500 ml. This is a bit intimidating. I’ve never been asked how much they could take before. They just take it. I think it’s a pint, but I’m not sure. How many ml is a pint? 100? 200? Are they gonna take my blood until I pass out? Turns out ‘typical’ blood donation in the US and EU is 500 ml, so they were only taking volumes on the low end. Big sigh of relief.

‘OK, form is filled out, where do I go?’ ‘Go to the bus’. ‘To the bus?’ ‘To the bus’. ‘OK, to the bus’. Not sure where I need to go, but sometimes it pays not to ask questions. Turns out the bus in the parking lot was a mobile blood donation center. When you can’t count on the conditions of the buildings you are going to use as collection centers, you just bring your own collection center to the parking lot. Check in area, blood quality test station, reclining donation car seats, and a refrigerator for the final product all in a 1-stop shop. Pretty slick little system really. 3 donors at a time.

The best part of the day for me was the number of people who were rejected during the blood test. Nurse would take a sample, test for this and that and then say ‘you can’t give blood today’ in Chinese. The person would always say ‘why’ and the nurse would always say ‘You are too tired’. Then all the westerners would laugh and the ‘too tired person’ invariably would say ‘what did you test in my blood that told you I was too tired?’ The nurse would smile, say nothing and hand the guy his coat. 16 of 37 donators were rejected for being too tired on this particular morning.

Finally, the other great part of the day was Gerald donating (probably better for me than for him). He made it through the ‘too tired’ screening, but when they put the needle in his arm, the nurse kept trying to get him to lie back in the car seat donating chair. Not sure what Gerald was doing wrong, but they didn’t like his style. Finally they got tired of trying to get him to do it the right way, so they pulled the plug on him. Not sure what went wrong, but he ended up having to lie down on the couch while they cleaned the 6” of blood off his arm. Maybe he wasn’t tired enough.

Dee’s appendix: The editorial

So I apologize if anyone thinks me writing this blog post is inappropriate while my wife watches the bachelor on the slingbox. Sometimes it can be cathartic for me to write. All the content of this blog post has been reviewed by Dee. She has approved of this ad.

So I’m not sure why Dee didn’t go into the hospital on Wednesday after 2 days of a sore abdomen. I think it might be the Sacajawea complex. ‘I gave birth to 4 kids. I’m not going to no stupid hospital because my tummy hurts.’ I know when I asked her if she was going to the hospital on Thursday, she said she couldn’t because Thursday is her busy day at school. You can’t let a leaky appendix get in the way of your busy day. I’m not sure how effective I would be at teaching/counseling all day with a 3 day old burst appendix, but apparently Dee managed. So the doctor had to wait until Friday morning.

On Friday, our driver took Dee to the hospital but got a little nervous when she when to the gynecological wing. In China you don’t go to the hospital by yourself. Not because the Chinese require moral support, but rather because the healthcare system requires a little more participative management by the patients. So when you go to the hospital for ‘woman problems’, your assistant has to help facilitate all the testing and examinations. Our driver knew he was in big trouble.

So he called his wife who was working at the coat store as a coat saleswoman. She left her job and came right over. Need to think about that one for a little while. If you were in America and your husband called you and asked you to leave your job to help his boss’ wife check into the hospital, it’s hard to know what you would say because the request is so ridiculously audacious. Yet there she was 20 minutes later with a smile. Turns out this would not be the most audacious request of her this day (again, foreshadowing)

After Dee spoke to the check in people, it was time to run some tests. In China, money talks. Dee paid the extra 50% in order to get to the front of the line. Not sure how much $$ this actually was, but Dee felt OK paying to cut in line instead of just cutting in line as a matter of course (It’s the American way to appropriately cut in line) The first test was an ultrasound. Easy enough. Except the ultrasound was on the other side of the hospital. It’s the patient’s job to get themselves to their own tests, so Dee walked with the driver’s wife to the other side of the hospital. You would think a gurney or wheelchair would make a lot of sense in this situation. You would not be Chinese if that thought crossed your mind.

So this is when Dee’s day begins to get interesting. It turns out the ultrasound is not the external ultrasound like when you’re pregnant and you want to see junior sucking his thumb. This was going to be an internal ultrasound, which I had never heard of before and I’ve been working very hard over the last week to try and not visualize this process.

This does become an interesting example of Chinese culture being so different from western culture. What we would consider a form of torture prohibited by the Geneva Convention, the Chinese view as efficient medicine. So all the women get prepped for their ultrasound by being disrobed from the waist down and wait in line. Then when it is your turn you get to lie down and have a couple doctors come and give you the ultrasound as well as a pelvic exam and then send you on your way. Mass produced medicine is pretty efficient but it’s normally a little too much ‘community’ for the westerner.

Then came the blood draw. You can’t have a nurse come to you and take your blood in China. This hospital has a ‘blood draw’ walk up counter (think 1950’s soda counter, China style). Which is, you guessed it, on the other side of the hospital. So Dee got to walk back to the other side of the hospital again.

Then it was time for the CT scan. Back to the other side of the hospital. A couple hours later Dee gets to review the CT scan with the doctor, but the scan did not turn out very well. Back to the CT scan room for scan #2. Then back to the doctor’s office to review the results.

So after the ultrasound, blood draw, CT scan #1, and CT scan #2, and talking to 4 different doctors using Google translator, Dee was able to hear from the doctor that she would need to be admitted with a perforated appendix. After a full day of walking around the hospital, Dee was beginning to agree with the doctors. Now this hospital is really large with a new wing and an old wing. So at the end of the walkathon, Dee was told that the new wing was full and she would have to go to the old wing. Dee didn’t care as long as she could at least lay down on something horizontal. But then she found out that the old section was also full and she would have to go to a different hospital that just so happened to be around the corner from our house. Kind of a miracle that hospital #1 would be full. Miracle #2 would be that hospital #3 was open and within walking distance of our home.

So by the time I get to my wife after feeding the kids dinner, she has found a bed. I asked her how she was feeling and all she could say is ‘this has been the worst day of my life’. Which having been married to me for 15 years, I know she’s had some rough days to compare with. So at this point the nurse comes in with an enema suppository. Using hand gestures, she asks Dee if she knows what it is. Dee says ‘yes’. Then the nurse asks Dee with gestures if she knows what to do with it. Dee says ‘yes’. Then the nurse leaves the suppository with the driver’s wife who starts putting on the little plastic finger protector and I begin to realize that she is getting ready to give my wife the enema. Again, the Chinese definition of personal boundaries is just a little broader than ours. Dee did manage to explain that she should take the plastic finger protector and take care of this one herself. I wish I had a video of the driver’s wife’s look of skepticism and then grudging relinquishment of the suppository while still giving some very clear hand gestures to make sure Dee knew exactly where that medicine was supposed to go and how she was supposed to get it there.

Next we had to explain to our driver and his wife that they really did not need to spend the night in the hospital with Dee. That she would be ok sleeping by herself. They weren’t buying it. No one sleeps by themselves in the hospital. Why waste all that bed space with just one person? What if Dee needed something in the middle of the night as there is limited nursing staff at night. We finally got them to accept that they needed to sleep at their homes and could come back in the morning. Early in the morning. So Dee went to sleep with her 2 roommates and their sisters, husbands, and mothers and waited for the driver and his wife to return at 8 am. Of course Dee was already awake against her better judgment due to her roommates’ decision for everyone in the group to wake up at 6 am. You have to make hay when the sun is shining after all.

The next day they moved Dee to a new room with beds that had some mechanical adjustment mechanisms that no one ever used. This is where we again realized that hospital visits are a team sport. Dee had an IV that was running into her hand. But there was no monitor or regulating device. They just expect the patient to watch the IV bag and when it’s empty, you call the nurse. So it was my job to watch the IV bag. I failed. A lot. The other 3 women in the room and their cohorts were constantly hitting me and pointing at the IV. I got to press the nurse call button and then apologize to the nurse for letting the IV run dry so they would have to get all the air out of the line before they hooked up the next bag.

Dee also could not go to the bathroom by herself at this point as she couldn’t hold her IV bag by herself while going to the WC. So whenever she had to go, she had to ask one of the neighbors if they would be willing to walk with her down the hall to the WC and help her. Which they always did. The downside, however, about having all the helpers in the room with you is that makes for a lot of sleeping bodies in one room. Statistics are against you at that point in that the chances that no one snores like a lumberjack is slim. Dee did not beat these odds the first night. But graciously, the husband did not have a repeat performance any of the other nights.
The hospital did a good job of managing sterility at the point of medicine delivery. Outside of the short distance from medicine to IV port, the expectation was a bit lower. Having one bathroom for everyone on the floor led to a lot of ‘community’ in the bathroom. It would seem like soap would be a reasonable expectation, but hand soap is not on the list of hospital equipment. You were on your own for that. When the nurse would change IV bags, she would have to get the stream going a bit before she could connect it to Dee’s hand (see earlier note about delinquent husband letting the IV run out) Seemed pretty clear to the nursing staff that there is no better place for this initial stream than on the floor. They figure it will evaporate and be fine at some point. Also the smoking in the hallway took a little getting used to. And the alcohol drinking. Before last week, I had never seen a hospital that sold liquor in the convenience store in the lobby. From the picture you can see that the soda and water shelves look untouched. The beer and baijiu was pretty depleted.

By Sunday, Dee was looking pretty rough. 3.5 days with no shower doesn’t seem to affect Chinese hair very much. It had a pretty big effect on Dee’s. In the midst of all this craziness it is still amazing to see God’s hands all over the story. We could both feel Him bringing both of us to that point of realizing we are not in control and we needed to trust God for providing his grace and mercy. In this case God’s grace was delivered to us by the hands and feet of a Chinese woman who offered herself as a complete sacrifice to Dee after just meeting her. And for those who have never experienced it, there is something particularly/peculiarly profound about worshipping God when you feel broken with nothing to offer. Having Jessica and Emily praying with us Sunday night will most likely be a more enduring memory than all the other crazy stuff in this blog post; Having a very real sense of God’s presence in the midst of all the madness. (As a side note, this line of thought begs some interesting questions: Did we experience God’s grace because Dee is a good person? For the woman across the room who was not experiencing God’s grace, was she less deserving? If things had turned out badly, would we still remember God’s grace positively? These are all great questions that I don’t have the answer to. All I have is the experience that we had which was one of great peace and joy in celebrating God’s goodness while the world around us was riddled with craziness). (As a side note to the side note, the last thought can be a pretty significant moment of introspection that normally means more for the one who experienced it than the reader. But I also believe God can have a great sense of humor that we can all enjoy. When I finished writing the earlier comments, my IPOD starting playing the beevis and butthead ‘my bunghole’ ditty that I got from Nels Smith. Impossible not to smile about life’s little ironies)

But in the end, you have to give the Changchun hospital credit. Their treatment plan was identical to what we have experienced here in Beijing, and I would guess at 10% of the cost. As westerners we have come to expect privacy in our sleeping and in our restrooms and . . . We expect machines to do things for us. We expect nurses and doctors to do a lot of things for us. When really in the end, we can do a lot of these things ourselves and just need the nurses to provide a sterile environment for medicine delivery and the doctors to provide information on diagnosis and treatment. Everything else is gravy to make us feel like we’re special. Just my opinion. I think I am willing to pay a lot of money for that gravy, but we should never forget that a lot of it is not necessary to our health. Just our peace of mind.

Dee's appendix: Copy of e-mail string

A few people wanted a web site to get updates instead of e-mail, so attached is the e-mail string from the last several days. (newest to oldest so if you want to read it chrnologically you have to go to the bottom)


3-14-12
so no news is good news. Today has been just a nice day of rest for Dee. We have gone for short romantic walks together up and down the hallway of the hospital and have had plenty of time to chat. The best part of our day is having the nurse come into the room every couple of hours and ask 'you go poo poo?'.

This will be the last update until something changes. The current plan is for Dee to continue slowly progressing with her IV antibiotics. If her condition takes a dramatic turn positively or negatively, we will be sure to send out a note.

Thanks again for everyone's care and concern. It means a lot to both Dee and I. Peace.




3-13-12
Kind of a crazy day. SOS arrived at our hospital at 12:30 am. They got us all packed up and to the airport by 2:00 am. We arrived in Beijing and made it to the hospital where we reviewed the CT scans and ultrasounds from Changchun with the on-site surgeon at 5 am. The plan was to have a color-contrast CT scan that afternoon and surgery the next day.

After checking into our room at 7 am, we both took a nap. Dee's current room is a 'bit' nicer than the one in CC as it has a bathroom with a shower and a chair that pulls out into a bed for her husband. It is a refreshing change to be in a hospital that feels like a western hospital and everyone can speak English.

So the good news/bad news. Dee is doing very well. Her temperature and blood pressure are normal. Her whiteblood cell count is less than 10 (in the normal range). Basically her body is no longer fighting the infection. Because she is so stable, the doctor does not want to rush into performing the surgery to remove the growth. Because the growth is near her colon, he wants to have as much material removed by the body as possible before he surgically removes the remaining mass. That's all good news. The bad news is that this means Dee would be here in Beijing for another 7-10 days just sitting in a bed receiving her IV 3X a day (which is exactly what she was doing in CC). If she is still stable at the end of the 7-10 days, they would send her home to take oral antibiotics for a month and then schedule the surgery to remove whatever is left of the mass (and her appendix if necessary).

Things to pray for and be thankful for:
-patience for Dee and I to accept the waiting if this is necessary.
-discernment to know what questions to ask and what course of treatment to pursue/demand.
-Thanks to Haroon who continues to be our sounding board for treatment options in China (Heather and Marie stateside).
-Thanks to all the folks who have offered physical, moral, and prayer support over the last few days.
-Thanks to our kids for rolling with the punches and not freaking out when life throws them a curve ball.

Funny moments:
-When the kids were asked where they would like to go for the next couple of days while mom and dad took a holiday in Beijing, they all thought about it for a little while and made their decisions. Only Caleb was bold enough to listen to his heart. His answer: "Pizza hut"
-When leaving the hospital in CC, the doctor asked Dee if she would be willing to have a catheter for her comfort during the flight to Beijing. Dee let the doctor know that for the doctor's comfort, he should not suggest giving her a catheter again.





3-12-12
Had another ultrasound this afternoon at 1:00. After reviewing the results, the doctor concluded that surgery will be required. The 'mass' near Dee's colon has not changed size at all. Dee's whiteblood count had come down from 17 last Friday to 11 today (less than 10 is considered normal). The doctor said she wanted to wait 2 more days until the WBC was under 10 and then surgically remove the mass (and the appendix if necessary).

After consulting with a few people, we decide to call SOS (JCI international health support team). They were a little more concerned about the mass. They have not seen any of the charts, but were concerned that if the mass was made up of pus, then if the mass were to break open, Dee would go into septic shock. The chances of this happening are low, but if it happens its not good. So they suggested getting Dee to Beijing tonight. Unfortunately all the commercial flights would not work, so we suggested flying out in the morning. They suggested flying a private plane from Beijing to Changchun to pick up Dee and fly her back tonight.

So that's where we are at. I have everything packed for Dee and I to get into an ambulance at midnight and go to a plane where they will be able to handle an emergency surgery in flight if necessary. (We're praying for 'not necessary')

Annabel graciously brought dinner for our family tonight and ended up taking all of our kids home with her. The current plan is to have Emily stay with Britta, Nathan with Wojo's, Caleb with Lepinette's, and Jonathan with the Nelsons. None of them know this yet, but that will be the next set of phone calls.

Dee is still in very good spirits and appreciated visits from Lisa and Ambreen and Haroon at the hospital today. Hongyang and Fu Jia were also very helpful with helping us navigate the Chinese medical system.

The next update will be from Beijing tomorrow. As always, Dee and I are in need of everyone's prayers and thanks again for all the support.



3-11-12
Folks,
I've talked to most of you at some point over the last several days, so I thought I would just send out 1 e-mail to get everyone up to speed. For some this will be mostly new and for some there will be no new information here.

This past Monday, Dee started to complain about a tender abdomen. We had Indian food for supper, so this was easy to explain. On Tuesday the soreness was worse, but Dee hoped that Wednesday would be better. By the end of Thursday she became convinced that she was not getting better on her own.

On Friday morning at 8 am she went to the hospital by culture square (wen hua chang yi yuan?). They ran a lot of ultrasound and CT scans. After they reviewed the scans, they determined she had a 'perforated appendix' (although I'm still not entirely sure what that means). They did not have any rooms at this hospital so they moved her to hospital #3 which is a short walk from our apartment (no small amount of grace involved here as I can easily walk there and back several times a day). By 8 pm, she was admitted to her room. She was exhausted, but at least she was now receiving antibiotics for the infection in her abdomen.

On Saturday they moved her to a new room and continued to give her antibiotics both orally and through the IV. When I was with her today, she continues to improve quite a lot although her movement is still very slow and deliberate.

Monday, she should receive a review of her diagnosis and a recommendation for a plan of action. We will hopefully have a translator with us this time so we should have a better understanding of what they are recommending. At that point we'll have to make some decisions on what to do next. If surgery is required, we'll have to decide when and where and and and. . .

So Dee and I might need to ask for some favors in the coming days/weeks. Many of you have already offered your support and we consider ourselves blessed to be surrounded by friends who are willing to give of themselves to help. We would also appreciate your prayers as we navigate through this event in our lives together. And I apologize for under-communicating these past few days. Our family has a long tradition of under-reacting to medical situations. It's not that we don't covet your friendship and your concern, its that we were not really very concerned until much later than we should have been. This is the same defect that led us 2 years ago into telling our daughter to 'suck it up' for 10 days before we brought her to the hospital and found out she had broken her foot in 2 places.


So things to be thankful for:
-Dee and I are grateful to Wu shi fu (our driver) and his wife for spending all day Friday and most of Saturday with Dee and helping Dee navigate through the myriad of tests and requests for information. Their English is pretty limited, but the care and concern of their actions spoke clearly enough.
-Visitors. Even when Dee is knocked out on a hospital bed, she still likes to talk. So thanks to Catherine, Hongyang, Jessica (and her friend Emily), and Louisa for stopping by to say hello. (It was also nice being able to spend time praying with Jessica and Emily.)
-All the people in the hospital. It is interesting how going to the hospital is a team sport here in Changchun. Many of Dee's neighbors have helped her go to the restroom, held onto used medical equipment when the nurse's hands were full, and generally helped explain how to get things done correctly. They also seemed impressed when I told them that I made fried eggs and broccoli for the kids for supper on Friday night.


Things to laugh about:
-Only one so far. When I told Caleb that we were hoping mom would be coming home from the hospital Monday, he only had one question. 'Do you think she'll bring us presents?'. Apparently the kids think mom is away on holiday or something. I'm hoping age will bring a little more sensitivity to our kids.