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A Tale of Four Hospitals: A First-Person Perspective into Chinese Emergency Care (Part 1 of 2)

Editor’s note: In part one of this two-part series, Yichi Zhang recounts his experience as a patient in China’s emergency medicine system.

I woke up early on a May morning with a slight discomfort in my upper abdomen. Not thinking much of it, I splashed some cold water on my face and stuck my toothbrush in my mouth, all the while thinking how to fit all the gifts I bought into two small suitcases for my flight tomorrow. It had been a wonderful month in my hometown of Beijing; the spring weather had been so far quite welcoming, at least more amicable than the ferocious waves of heat that attacked me during my previous visits to family in the summers.

Man, I thought, I should not have eaten that extra piece of fatty pork last night. I dug out two Alka-Seltzer tablets, popped them into a full glass of water and quickly downed it in spite of the growing pain. I started burping non-stop without relief. It’s going to work soon, I comforted myself, like the hundreds of times before. Today’s abdominal pain, however, seemed quite persistent as I sat and waited for relief. A wave of nausea soon sent me back to the bathroom.

As I curled over the toilet bowl, I asked myself, Okay, so maybe it was food poisoning instead? It won’t be a pleasant purge, but it’ll soon be over. But after almost an hour, I still sat restlessly on the ground with nothing accomplished. Thirty minutes and one suppository later, I started to perspire heavily as the waves of pain crashed into my abdomen, each successive one stronger than the last. I filled up a hot water bag, lied down and pressed it to my stomach as my exhausted self drifted off to sleep, desperate for comfort.

The pain that woke me in cold sweat was like a train wreck; it was no longer concentrated in my upper abdomen and its fire had spread, radiating across all parts of my stomach and reached even my back. I knew right then that something may be seriously wrong and that I needed to go to the emergency room (ER) immediately. My mother and I quickly flagged down a cab. The nearest hospital to my apartment was the PLA Rocket Force Hospital, a medical institution attached to the Chinese military but also open to public patients.

Once inside a Chinese ER, the first thing to do is to register and pay the registration fee. This happens even before the patient is formally triaged by a nurse. One must pay in advance of any medical consultation in a Chinese hospital, including emergency cases. The nurse took a brief look at me and sent me down the hall to the on-call surgeon’s office. Thankfully, I was the only patient there, and I did not have to wait, which was atypical for any large hospital in Beijing. I sat down, still guarding my stomach and grimacing, and told the doctor about the history and details of my present illness. She instructed me to lie down on the cot and started palpating my abdomen quadrant by quadrant.

“It’s pretty soft.” She turned her head towards me and asked, “You said that the pain is mainly associated with the upper abdomen?”

I nodded. She pressed her hand firmly down on my lower right quadrant and then quickly released the pressure, her eyes fixated on my face for any reactions.

“Did that exacerbate the pain?” she asked.

“Yes, but not too bad,” I responded, now gasping for more air. “I’m also feeling tingly  in my fingers and getting a little dizzy.”

“Then stop breathing through your mouth.” She left me to start typing on her computer. “You are hyperventilating and you’ll develop alkalosis if you keep it up.”

I quickly tried to recompose myself, counting my breaths and slowing them down. “What do you think is the problem, doc?”

She did not answer my question directly. “Let’s do an ultrasound on you first. Pay the fee and then go to the fourth floor.”

My mother hurried to the payment booths again, now with two short lines formed in front of each. She signaled that I sit down on a nearby chair to wait for her. I cradled my stomach and wobbled over, slumping down onto the orange bench.

My mom rushed back to me, having paid the bill for the ultrasound, now with what seemed like a dozen more pieces of receipts and papers in hand. “You think you can still walk, or should I go rent a wheelchair?”

In Chinese ERs, patients are expected to move themselves around to receive diagnostic tests. It would truly be a daunting challenge for those without a loved one. But, thankfully, my mom (as always) had my back. I shook my head while squeezing out a wry smile at her: “It’s okay. I think I can manage without being wheeled around.”

I pushed off the chair and struggled to stand, and my mom gave me a hand. The pain converted to pressure, pushing upon the walls of my stomach. I took small and rapid breaths to avoid exacerbation. “You’re sure?” Mom looked at me with concerning eyes. I nodded slightly, not wanting to speak more.

Fortunately, ER patients receive priority at imaging. It wasn’t long before I got my ultrasound report and wobbled back down to the ER, using my mom as a walking stick.

“It looks like a case of acute gastritis,” said the doctor reading the report, “there are no signs of internal bleeding or any fluid build-up, so that’s good.”

“Do you think any further tests are needed, doctor?” my mom asked anxiously.

“No, not really. I will give you an antispasmodic to stop the stomach cramps and ease the pain and then IV antibiotics to curb the infection.” The doctor wrote the prescriptions.

“Can we come back at night for the IV drugs?” Outpatient IV centers at Chinese hospitals are notoriously crowded during daytime.

“Sure, I don’t see a problem with that.” His eyes were still fixed on the prescriptions.

“Also, would he be able to get on a long-haul flight tomorrow? Maybe he should take some oral antibiotics with him?” My mom followed up with more questions. I had been blinded by the pain and had all but forgotten about my upcoming 20-hour trip. “Oh great,” I thought to myself, “nice timing, Yichi.”

This time the doctor looked up, clearly a little startled by the previous question: “Oh… he’s going on a flight? Um, yes, he will be able to travel, but make sure he receives at least two units of IV antibiotics today and tomorrow, and I will prescribe him some more by mouth.”

“Thank you, doc!” My mom finally showed a slight hint of a smile, “I will go pay for the prescriptions now.” She hurried out again, back to the payment booth. With the receipt from the booth, she then ran across the hospital lobby to the pharmacy to pick up the antispasmodic.

In outpatient services at Chinese hospitals, patients and/or their relatives are responsible for picking up all prescribed drugs from the pharmacy themselves and taking them to a nurse for administration, even drugs to be injected intramuscularly like antispasmodics in the gluteus maximus.

Relief came about twenty minutes after the shot. My gut no longer violently expanded and contracted. I was finally able to walk out of the hospital without help from my mom thinking that the roughest episode was over.

I took the subway with my mom to join a friend of hers for dinner. The blissful freedom from clenching pain made me so euphoric that I voluntarily gave up my seat on the ever-crowded Line One. My mom looked up at me with confusion — surely my fetal curl with all the twists and turns on the hospital bench just an hour ago had quite impressed her.

We arrived quite early at a chic, fusion Jing-styled restaurant, whose booming reputation regularly drew two or even three-hour lines at prime time. I browsed through the menu and my euphoria quickly plateaued, despite appealing dishes. Every item looked exquisite, its fragrance apparent from the menu photo, bombarding my brain with sweet fantasies. However, that day I would watch others enjoy the delicacies.

I dreamt of how the multitude of colorful dishes on the table tasted; my chopsticks even wandered over them multiple times but were stopped by my mom’s piercing, ever-watchful eyes. The other guests were confused at first but, upon hearing the circumstances, smiled at me apologetically. I considered protest but I knew she was right. Alas! My last dinner in Beijing, I thought in great self-pity, would consist of just some fish porridge.

On my way back to the hospital after dinner to receive IV antibiotics, I felt another slight cramp, this time lower in my abdomen than the previous pangs. My anxiety spiked again, but I quickly managed to convince myself that it was just the effects of the antispasmodic finally wearing off a bit. I’ll just ask the doc to refresh the dose, I thought, leaning against the taxi window and admiring the neon-lit skyscrapers and the bustling traffic around me.

The on-call doctor at the ER had changed by the time we arrived, at around 10PM. He looked at the note the previous doctor had left for him and nodded, “Before I get you the antibiotics, let me just take one more look. Lie down for me please.”

I got onto the cot and lied down.

“Curl your legs up for me.” I watched as the doctor sanitized his hands. “It might feel a little cool.”

The slight pain I had felt on the taxi had become constant by now, dull but looming. It felt as if the medication dam was minutes away from crumbling and unleashing gargantuan waves of pain to bring me back down to my knees.

The doctor palpated around the upper abdomen, the origin of my struggles. Surprisingly, the pressure no longer made me grimace. I was astonished by the lack of excruciating pain and he moved onto the lower quadrants. He pressed his palm firmly into the right lower quadrant and rolled laterally with his fingers.

“Wow, any harder than that and my bladder might burst!” I jested, trying to make light of the situation.

Then I saw the serious look on the doctor’s face and realized that he certainly wasn’t as amused as I was.

“You don’t think I have appendicitis, do yo–”

Before I had the chance to finish my question, he lifted his hand. The resulting pain was almost unbearable, like a bullet ripping through my back, through my pelvis and out the front.

I wasn’t getting on that flight.

Part two of this series will be posted later this month.

Yichi Zhang Yichi Zhang (8 Posts)

Contributing Writer and Social Media Manager

Tulane University School of Medicine

Yichi Zhang is a third-year MD/MBA student at Tulane University School of Medicine in New Orleans, Louisiana. He graduated from Tulane University with a B.S. in Cell and Molecular Biology and a minor in Psychology. In his free time, Yichi enjoys playing tennis, teaching Chinese, and practicing Kendo. After he graduates medical school, Yichi wishes to pursue a career in Internal Medicine, with a focus on personalized medicine, all the while building more connections between the American and Chinese medical communities.