Dr. Eric Freeman writes from China
Pictures from China by Dr. Eric Freeman
5/6/08
11pm
Tea Time
Near the entrance to the operating room is a little area cornered off with a large table surrounded by chairs. Dr. Cui escorted me over there where we were to have lunch. The hospital prepares “boxed lunches” for the anesthesia department every day. Today was chicken with vegetables. There were two large pots; one with rice and one with some soup. I searched for some soda but there was none. I will have to bring some to work every day. Lunch was great. Apparently I was holding the chopsticks a little too far done, which I quickly corrected.
Back to work? I was rather curious about the anesthesia machines here in China. Taking a stroll around the OR? I walked into a few rooms. There was a Datex-Ohmeda Aestiva and Aespire model. Another machine from the UK with the O2 knob being the color white. Two Drager machines with the names Julius and Fabius were before my eyes. Sounds like something out of the Roman Empire period. As learned, the flowmeters usually have Oxygen to the far left to prevent the delivery of a hypoxic gas mixture. Not here. I have seen O2 on the left and right. N2O on the left and right. Air on the right. We have N2O in the middle. Guess it doesn’t matter as long as one is vigilant. We are used to O2 being the color green but white is the universal color internationally. No RGM to be found or mass spectrometer to analyze the anesthetic gases. The inspiratory and expiratory limbs are reversed. None of the machines had an O2 tank behind it in case of main pipeline failure. Circuits are changed once per day, not after every case. The face masks are rarely discarded. Only the filter between facemask and circuit is changed for every patient. The CO2 absorber is only discarded when there is complete color change. The scavenger is connected to a wall suction via tubing. So what I gathered was that the machines all operated with the same principles; to deliver positive-pressure ventilation, oxygen and anesthetic gases safely. This was no different than getting from point A to point B in either a 2008 Jaguar or 1982 Volvo with 225,000 miles on it.
I guess we are pretty high-maintanence back in the USA. Anesthesia techs? Non-existent. The residents function here in a “get it yourself mode.” After intubation, we cleaned the laryngoscope blade first with soap and water, followed by a quick scrub with some antiseptic liquid. As mentioned, supplies are limited here. Anything that might be needed for a case required searching it on your own. No nextelling anyone for a bear-hugger or esophageal stethoscopes. Speaking of which, neither are available. Maybe they are, just not in this hospital. Monitors in the operating room are your standard blood pressure, pulse oximeter, and ECG. There is one never stimulator which they rarely use. I asked Dr. Cui about this. He brought it out for me and I used it on our next case. It was pretty cool. A little different design that the one I am used to. There is an added force transducer monitor that you put into the patients hand. This way, one can measure both T4/T1 and T1/Tc to measure the degree of receptor recovery from the nerve blockade. For such a fancy device, I would have thought it would be used more often since all of the patients in the PACU are intubated and reversal agents are not rountinely administered.
The schedule was out for the next day. I would be working with Dr. Rong. Her English was pretty good but I had to speak rather slowly when interacting with her. We went up to the patient floors to do our pre-ops. It was quite an interesting site for me. All of the nurses had neatly pressed white outfits/dresses and a little white hat in the shape of a triangle. Expecting to see all of the charts scattered around and wasting time searching for them as I am accustomed to was not the case. All of the charts were neatly in a rack and each was in a clipboard that you flipped over. I recognized a few lab values and could read the ECG’s but that was the extent of it. Walking towards the patient rooms was another shock. There were patient beds in the hallways. Not empty beds. Each room had 4 patients. So much for privacy as there were no curtains dividing them. Additionally, anesthesia obtained their own consent separate from the surgical team.
At the end of the day, Dr. Cui asked me how everything was going. I said great. The only issue was that I could not get coffee for breakfast at the hotel. He told me not to worry.
Leaving the hospital I decided to head to the Starbuck’s Coffee place a few blocks away. It was really nice out and I wanted to sit outside and relax. I really dislike their coffee as I feel it was such a strong and bitter aftertaste. My favorite is Dunkin Donuts but I don’t think that I will be finding any here. I do like their frappachinos so I ordered a large one which pretty much cost the same as in NYC. As I reflected back on my first day of anesthesia here in China it was a bit like my first day of residency; a lot thrown of things thrown at me at once. The only difference is now I am almost an attending anesthesiologist and I can see this experience making me more well-rounded and adaptable to different situations and environments.
When I got to work the next day, I found a box of 50 instant coffee packets on my desk. That was so nice and unexpected. Every day around 10am is tea time. For me it is my coffee loaded with milk and sugar….