Editors’ Note: This is the conclusion of the two-part series of Yichi Zhang’s experience as a patient in China’s emergency medicine system.

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

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

I squinted in agony. The pain had seemingly drowned out all noises around me for a brief second. I was only vaguely aware as the doctor spoke with my mom about further imaging and possible surgery.

The throbbing and twisting inside my abdomen had returned in full force as my mom and I stumbled to the CT, the definitive tool for diagnosing appendicitis. But as the emergency medicine doctor raised one of his eyebrows to look at the images, I knew there must be something tricky with my case.

“You ate dinner, didn’t you?” he asked, eyes still focused on the black-and-white image of my intestines.

“Yeah — some porridge — around 7 p.m.” I avoided speaking in full sentences in a vain attempt to quell some discomfort.

“Well, see, that is the problem.” He turned to me with a wry smile. “I can only tell that the appendix is slightly enlarged, but I can’t confirm appendicitis because of the digestive emulsions in the way.”

“So, we can’t do surgery right now?” Mom joined the conversation, uneasy about this new development.

“I’m sorry, but we will have to wait until a radiologist takes a closer look and produces a detailed report.” He took out a pen from his chest pocket. “Meanwhile, I will get you on antibiotics and fluids to prep for the possibility of surgery.”

We were told that the radiology report would take two hours because there was only one on-call radiologist in the emergency department at this late hour. So, my mom and I settled down in the waiting room with the IV bottles hung above me. I tried to read but, too restless, ended up just shutting my eyes instead, twisting and turning from side to side.

Around midnight, we finally heard rapid footsteps coming toward our room. My mom stood up nervously and peeked down the corridor.

“It’s him,” she said. “The doc is coming.”

I let out a long breath. I could not wait to get anesthetized and have my rebellious appendix removed as soon as possible.

The doctor put both his hands on his waist, slightly out of breath after running all the way over to us. “Hey, I did not forget about you guys.” After a slight pause, he continued, “The images do confirm appendicitis, and surgery is indicated for you…”

My mom squeezed my hand a bit, but something told me that the doctor was not done speaking.

“But I am sorry to tell you that all of our on-call general surgeons are currently working on a difficult case together.” He looked at me apologetically. “The patient has multiple duodenal bleeds, and they are scrambling to stitch him up.”

“Can we wait until they’re done?” My mom asked.

“I don’t recommend that — they might not be done until morning. I am really, really sorry. But I think it’s best if you find another hospital.”

Mom let out a long sigh; I took her hand and stood up shakily.

“I understand. Thank you, doc,” I slightly nodded back at him. “We will go to another hospital.”

Another excruciating twenty-minute cab ride left me soaked in cold sweat as I wobbled toward the ER entrance of People’s Hospital, an affiliate institution of Peking University School of Medicine. Mom had already rushed in ahead of me to register.

“We don’t have any inpatient beds left.”

I could barely believe what I was hearing. My mom slapped her hand across her forehead in frustration as the doctor explained the situation to us.

“We can’t perform the surgery for him if he has no bed to recover in afterwards.” The doctor was not unfriendly but spoke rather tersely and shrugged his shoulders. “I wish I could do it here, considering his situation.”

That situation, or at least my perception of it, was deteriorating fast. The pain was no longer dull, but writhing and pulsating in my lower abdomen, putting what felt like significant pressure on my bladder with each exacerbation. The main risk of continued inaction would be my appendix rupturing and spilling its infectious contents into my abdominal cavity, potentially causing peritonitis, distal infections and even septic shock. My one advantage was the dose of IV antibiotics I received at the previous hospital, which helped fight the infection, but surgical removal was still an immediate priority.

As we flagged down another cab, my agony had risen to a new level. There were, I envisioned, thousands of little cuts in my intestines being violently grabbed, twisted and ripped in a vicious tug-of-war. I began to hyperventilate, gasping for larger and larger breaths. My mom managed to calm me down a bit, but my fingers became numb and cold, tingling nonstop.

Both the hospitals we visited had been accredited 3A by the health ministry, the highest rating any hospital could achieve in China, yet I had to leave both with confirmed acute appendicitis.

The third institution on our “tour” was Peking University’s First General Hospital, also a 3A institution and affiliated with the same medical school as the last one. I essentially collapsed onto the chair at the triage station as my mom went to register and pay the triage fees.

“Do you have any imaging results?” I opened my eyes to a deep voice. It must have only been minutes, but it felt like I had been sleeping for days. As soon as my consciousness returned, however, so did the pain.

“Yes, we do!” Mom quickly took out both the ultrasound and CT images received earlier in the night, “Please, doctor, perform the surgery for him. This is our third hospital tonight already.”

The doctor didn’t answer the plea; rather, he pointed at the images. “Where were these taken?”

My mom relayed our story.

“I do not think I trust these images one hundred percent, they-”

“But they were taken just an hour ago, by another 3A hospital!” Mom could not contain her frustration.

“We have different equipment.” The doctor pointed towards a room down the hall. “At least let us perform another ultrasound.”

It is common for Chinese hospitals to be skeptical about others’ diagnoses, and some would argue in favor of these second opinions. I, however, certainly didn’t appreciate the added time in agony. The new ultrasound results revealed that my appendix had enlarged to eight millimeters.

“Let me call inpatient really quick to see if they have beds,” the doctor said, dialing up a number with my reports in hand.

“Oh no, not this again.” I looked around; the ER was packed with patients and their families. The lucky ones had a single bed in six-person rooms, while many others had to rest on temporary cots set up in the hallways. Many patient relatives had simply put some newspaper or cardboard on the ground, laid down on top and were now sound asleep, not even waking as nurses and doctors bustled past them with heavy footsteps.

Such is the reality in many top hospitals in China; there are simply too many patients and not nearly enough resources to take care of all them comfortably. It is difficult for the patients and their relatives and even more challenging for the overwhelmed doctors and nurses trying to divide their attention among hundreds in need.

The doctor finally got off the phone after vigorously fighting for a bed for me. “I’m sorry. They just simply do not have room up there.”

“Not even in the hallways?” My mom clasped her hands together. “Just a temporary bed would work for us!”

Before the doctor answered, I grabbed her arm, got her attention and pointed around us at the overloaded corridors. The doctor sighed and shook his head.

“At this point, you ought to try smaller hospitals or international hospitals.” He patted me
on the shoulder and said, sympathetically, “Again, I’m really sorry but I cannot do anything more for you here.”

Smaller hospitals may often have beds because fewer patients seek care from their providers, concerned about their standard of care. There exists a great gap in medical skill between China’s top hospitals and lower-ranked regional hospitals.

As a last-ditch effort, my mom and I headed to the international division of Peking Union Medical College Hospital, the most renowned medical institution in Beijing. Still curled up in the backseat of the taxi, I had concerns about the high costs but was rightfully shut up by my mom, who reasoned that my student insurance had international coverage. Even if it didn’t, she said, she would take me there without hesitation. After all, what is the worth of money compared to that of a life?

Upon arrival, I was once again subjected to an ultrasound that confirmed acute appendicitis for the third time. By this time, it was 3 a.m., almost 19 hours since I suffered the first epigastric cramps.

“I will talk to my attending about your situation, as we do have a shortage of inpatient beds,” the young emergency medicine doctor said, sitting down beside me. “Surgery does seem like the best option.”

My mom and I both almost fell out of our chairs upon hearing that patient beds were scarce even here, at an international hospital. Unlike the crowded conditions considered normal in public hospitals, lack of capacity at this hospital was probably just bad luck. I recall mocking the situation: “All the foreign tourists in Beijing must have stomach flu at the same time.”

Waiting for the doctor’s phone call was torment all on its own. I simply didn’t know what I would do if they weren’t able to admit me. I was, perhaps, as anxious as a high-schooler waiting for a college acceptance letter, with an additional burning ache in my abdomen.

“So, I just spoke with Dr. Cao.” The doctor hung up and turned to me; for that moment, I forgot about the pain. “He believes that your situation does warrant proactive intervention.”

He proceeded to explain in detail the risks of the surgery. Even though I understood his thoroughness, I could not help but feel unbearably anxious. I wanted to ask him if a bed had become available, but by that point I felt too sick to speak. My mom, knowing me, cut him short: “OK. I get all that, but can Yichi ultimately get admitted here? Are there beds available?”

We both nervously awaited his answer.

“No, there aren’t any beds up there now.”

I tilted my head back in despair and closed my eyes. Mom put a hand on my shoulder.

“But — we will be able to find you one after surgery.”

I opened my eyes, almost bursting into tears. “Thank you doctor!” I bowed my head.

Twenty-four hours, four hospitals and a whole heap of pain later, I was finally wheeled into the operating room. As I breathed in the anesthetic gases and gradually started to lose consciousness, I smiled. Despite the self-pity I felt at many times, I was happy too for the precious lessons learned first-hand as a patient in the Chinese medical system. It was, perhaps, the most roundabout teaching I will ever receive. I’m happy to have been there and done that, even if it meant three small cuts on my belly.