Dr. Eric Freeman writes from China
Pictures from China by Dr. Eric Freeman5/19/08 11pm
“Oww…My back hurts!”
Each morning I get in a queue along with the other residents to grab my medications for the day. No big fancy computerized pyxus standing in front of me, which half of the time does not recognize my fingerprint or the med draw is empty.
Instead, the same pleasant woman is there to greet me as I sign out my meds. We exchange “good morning” and I always get a little laugh from her when the Chinese flows out of my mouth. Dr. Cui told me that since I have been here in the department, a lot of the residents and nurses are making an effort to learn a little more English. I told him that was great. I have about 12 phrases of Chinese under my belt. I asked one of the residents about drug addiction and anesthesiologists in China. Apparently, it is a very rare occurance.
The OR’s are pretty interestingly designed here. I think my favorite part is the door. The door of every OR is rather large and metal in design. Instead of pushing or pulling a door handle, towards the floor is a little sensor where you place your foot in front of it. A second later, it slides right open. I am used operating rooms that are chock full of supplies, tables and devices. Basically a lot of clutter, almost like an obstacle course. The rooms here are pretty bare, with just the essentials that are needed.
After my second week here, something seemed a bit strange to me. Ahh… then I realized what I was missing. It was a bit quiet….an almost erie feeling.
No frequent overhead pages to find this doctor, or that nurse, or the X-ray guy. No one was hanging out or roaming the hallway of the operating room. Everyone here has the common goal in mind; to work efficiently and diligently to get the cases done. No queue at 3pm to clock out.
As I mentioned before, 10 OR’s, about 10,000 cases done per year. As for the types of cases, well definitely not nearly as complex as my hospital. A lot of general surgery and ortho cases here. I have seen a lot of gastric cancer, maybe there is a higher incidence in China. Gyn and uro cases are pretty frequent. Not so much peds is done here. A little neurosurgery. All obstertrics is turfed to another hospital. I am told that the there is about a 50% labor epidural rate. I wonder if the OB attendings and residents constantly page anesthesia for the “stat epidural.”
About one open heart surgery case per day and the occasional lower extremity bypass is performed. As for the patients, well maybe I am making too much of a generalization, but they are definitely not nearly as sick as the frequent ASA IV’s that are at Montefiore. Maybe the Chinese just have very good genes, or maybe its something in the rice.
As I mentioned the types of cases, I of course have to mention a bit about the surgeons. They are an interesting bunch. I say that in a good way. The majority are men; I walked into a room one day and was way outnumbered. An abdominal hysterectomy. To me, it was a bit unusual from what I was accustomed to. The room was very quiet. Hands were moving. No massive bleeding and urology was not consulted. The surgeons are friendly; a reticent group. No screaming, no shouting. I have yet to see a nurse or circulator leave the OR ten times during a case to get equipment. Interestingly, as I do cases, I glance over at the mayo stand. It is pretty bare, even for some of the bigger cases that are done. I guess I am used to seeing a huge set up like a buffet spread in Las Vegas. I mentioned this to Dr. Xieke. He told me that “the surgeons pay attention more to their hands than their tools.”
I took a tour of the hospital later in the afternoon with Dr. Cui since all I pretty much am familiar with is the operating room on the 5th floor.
Quite an impressive complex here. The place was buzzing with activity. Dropped by the ER and that was an interesting site. Rows upon rows of people each sitting in a chair. Hanging above was IV tubing connected to each person. Apparently, after one is seen by doctor, they are escorted to this large room and a nurse places an IV. Medications that the doctor ordered are transfused, and then the patient either goes home or is admitted. We walked to a few different floors. Dr. Cui showed me the pain management clinic/acupuncture center where I will be spending time during my last week here. Interestingly, on every floor I noticed a large metal tin on a stand. I was wondering what it could have been. Every floor had one of them, some two. Dr. Cui told me it was hot tea. Of course. I wonder if its green or herbal ??
As was in the middle of my last case of the day, my lower back really started to bother me. I was trying to figure out what might have aggravated it. I certainly have not been to the gym in a few weeks. Then it dawned on me. The bed in my hotel is rather uncomfortable. Basically it is like sleeping on a sheet of plywood. Even at the 4 star hotels for the meetings I attended the past two weekends, the beds were hard as a rock.
I am told that the Chinese just prefer it that way. Hmm… I think there might be a market for waterbeds in China. I might be able to retire early then. I figured out what also triggered my back spasms. During induction, I was straining my back since the OR tables cannot be raised very high and the older anesthesia machines have the reservoir bag hanging down very low. Why make things difficult for myself? As anesthesiologists, we sometimes do get into a habit, whether good or bad. I have always mask ventilated a patient while standing up. Most of the residents here do it sitting down. Solution solved. So that is what I have been doing lately, and I am getting used to it. I was still in a bit of pain. Dr. Xieke told me of a place done the road from the hospital to get a good massage. For 2 hours I had every muscle in my body twisted like a New York pretzel.