A China hospital stay

This entry addresses one aspect of my experience in China – a hospital stay. Before detailing that process, it’s vital to address a few caveats. These caveats are first and foremost a gratitude to the planning and awareness of the folks at GEEO prior to the trip and to David while the trip unfolded. First, plan for the unwanted and unanticipated by getting travel health insurance. This $52 pretrip expense saved mother and me thousands in the long run. Even if you are a teacher traveling with high school students, make this insurance mandatory and keep a list of the health policy numbers for everyone on the trip. I’ve heard too many stories about high school students and their passports (or temporary misplacement of said document.) I would not trust high school students to be organized enough to find insurance information quickly. Guard the list of these policy numbers like you guard your own passport! One never knows when sickness or a broken bone may side track an individual. Second, have an adequate number chaperones. Expect that one adult may need to stay with a sick or injured traveler. Make sure that your ratio for supervision will be able to accommodate one less adult with your group. Fortunately, in our group mother and I were a team. When she was sidetracked, I was with her. If a hospital situation happened to another person in our group that person would have either had to have a second group member stay with them or hire a private nurse. American medical standards are very different than those in China. Much more about that later. Third, be aware of the health of your group at all times. We experienced this on our trip in several ways. The mantra “hydrate” still rings in my ears to this day. David and Matt were quietly monitoring our individual fitness and health along the route. By the time David suggested that mother see a doctor, he had already researched medical options and knew the most effective way to access those options. David clearly explained both medical options and trip itinerary to mother. The prospect of traveling to a place with dormitory style facilities and lack of easy access to medical care helped mother make the decision to seek medical care when she did.
Mother selected the Global Doctors practice as her initial foray into the realm of medical care in China. Johnny, our tour CEO, helped us navigate to the office. Global Doctors is true to their name. Mother was greeted by a physician who not only spoke English, but came from Arizona! Dr. Jessica listened to mother’s cough, checked our itinerary, prescribed some antibiotics and scheduled a follow up appointment for the next day with the full expectation that we’d rejoin the group for the Yangtze trip. While the Global Doctors medical practice was on the travel insurance company’s recommended list, they required payment at the time of the visit. Fortunately, an American credit card was accepted.
We returned to the same hotel that we had checked out of earlier in the day. The hotel required cash to cover the room for the 2 nights that we expected to stay. One of the hotel staff members was kind enough to walk me to a nearby ATM to get the vital cash and all was well. That evening, mother’s congestion had worsened. She chose to employ a strategy that has worked for her in the past during times of a compromised respiratory system: she slept sitting up. Our room had a comfortable easy chair which she settled into for the evening. I contacted home and my researching fanatic husband informed me that mother’s prescribed antibiotic was the recommended protocol for her condition…however, the side effect of that particular antibiotic was heart problems. I honestly could have rested a lot more comfortably without that fact, that fear, pounding in my mind. I slept with one ear open to every breath that mother struggled with that night…if one can call an experience like that “sleeping”.
The follow up appointment with Dr. Jessica did not go as earlier anticipated. Dr. Jessica administered a series of breathing treatments then pulled me aside to recommend hospitalization. We got on the phone with my sister who holds mother’s medical power of attorney to discuss this option. We were aligned with Dr. Jessica’s recommendation. There are a number of hospitals in Chengdu. I later learned that the #2 rated hospital in China is located in Chengdu. This was not the hospital that Dr. Jessica thought would be a good match for us. She instead recommended a “quieter hospital where we would be likely to arrange a private room.” Dr. Jessica then explained some of the differences between U.S. and Chinese hospitals. Chinese hospitals have a much lower level of nurse staffing (there is only a skeletal overnight on call staff and they are sleeping!) A relative or friend is expected to stay with a patient during hospitalization. Chinese hospitals do not provide meals. Dr. Jessica instructed one of the Global Doctors’ office staff to guide me to the local Wall Mart so I could stock up on some food items for our hospital stay. Wall Mart in China has a few things that we won’t expect to see in the U.S. anytime soon: prepared duck’s heads, several kinds of fresh seaweed, live fish and frogs (in the food section) and some more palatable items that I did select for our hospital stay.
Dr. Jessica ordered a chest X ray. It confirmed the diagnosis of pneumonia.
A bilingual nurse from Global Doctors accompanied us to the hospital. The hospital required a 2000 yuan cash deposit for admission. Payment was resolved and an MRI was ordered. The MRI confirmed what was obvious from the X ray: mother had pneumonia.
Mother settled into her room and was immediately given a round of IV antibiotics. Global Doctors offered private nursing services if we wanted. Mother and I agreed that an extended private nurse was not necessary. However, we asked the private bilingual nurse who accompanied us from Global Doctors to remain with mother at the hospital while I returned to the hotel to collect our things and check out. Mother’s Chinese respiratory physician anticipated a 10 day hospitalization. We were hoping for a MUCH shorter stay.
The next morning, a nurse came in and put pills into a small three part container. “Morning” she said and left. I’ve been trained in medication administration in the U.S. where pills are only administered straight from the container and given directly to a patient. It seemed very polite for the nurse to inform me that mother was receiving morning medications. In the afternoon, the bilingual nurse from Global Doctors checked in on mother. She looked at the IV line and called the hospital nurses to replace the drip. In China, hospital nurses did not keep a vigilant eye on the IVs. They do respond to the call button to change a drip. Patients or their accompanying care givers are responsible for monitoring IVs. Also, the bilingual/bicultural nurse informed me that I was the one expected to administer medication. Hospitalization was quickly turning into as much of a cultural experience as a medical one.
There was a corridor at the end of our hospital hallway. The left corridor led to a huge 20+ gallon steel container of boiling water. Caregivers and staff members alike used this large communal tea pot for food preparation and clean up. Knowing about that convenient resource on our floor gave me some additional options for my next shopping trip.
Oh yes, shopping. Remember, food is on your own in Chinese hospitals. The BYO theme extends to other necessities like soap, towels and nightgowns. No half exposed bodies hanging out of hospital gowns in China. Bring your own gown and you have yourself covered. Back to the supply your own food aspect of hospitalization, there is a hospital cafeteria but my Mandarin is inadequate to order from a text only, non picture menu. Our hospital was conveniently located across the street from a shopping mall with a large food court. We’re in Chengdu, the land of spicy hot pots. At this point neither mother nor I had much of a stomach for spicy food. My attempt at communication with the food court vendors yielded little success when I asked for a broth with tofu in English. The pictures that vendors used to entice new clientele all featured spicy, meaty hot pots. Fortunately, the Metro Department Store included a food section. I found tea cups, tea, soap, towels, fruit and some peanut butter and crackers. In China, most financial transactions occur over the phone, not with cash. I get to the register and the cashier seemed confused. No phone, actual money. I did not understand what I was being asked and no one around was able to explain it to me. I just stood at the register with my items and cash in hand, insistent that I would pay cash. It wasn’t until about a week later that mother’s bilingual/bicultural nurse informed me that Metro is a shopping club, like Sam’s Club, BJs or Costco in the states. Fortunately, the Metro cashier asked another member for their phone app ID card to help me get through the checkout process and all was well. Metro would be my go to shopping source for the next few weeks. Cashiers quickly accommodated the American and her cash whenever she showed up in the checkout line.
Communication was a challenge at the hospital, too. My internet and apps were limited. Nurses, however, seemed quite competent in this regard. Many had a translation app on their phone that translated between Mandarin and English. Mother’s bilingual nurse did check in for a short period each afternoon and that helped even more but the regular contact with nurses who had good translation apps was a godsend. Doctors were less competent with the translation piece. Few had translation apps available but they waited for our bilingual nurse or, at times, contacted Global Doctors directly for translation assistance. Accurate translation is vital. At one point, a physician came to me and asked if I knew about hormones. I said yes and thought to myself that we all have hormones operating internally at all times. Then the doc clarified her statement and said “steroids.” Steroids is a very specific application of hormones and there are many steroids, all with significantly different side effects. When I got the specific name of the steroid that the hospital was requesting permission to administer, mother wanted to reach out to both her primary care physician from home and Dr. Jessica from Global Doctors before agreeing to the treatment plan. It took a few hours since the time differential between China and the east coast is exactly 12 hours but all care givers approved the treatment plan and mother then gave her consent.
Communication in China required a bit of adaptations. For the first few days in Beijing, I was able to send group texts with embedded pictures. When one has 5 siblings who all are concerned about their 84 year old mother traveling half way around the world, group texting is a communication boon. Everyone gets all the information and no one feels left out. After a few days in China, texts with pictures were delayed days (even a week!) Texts that were too long also created a hiccup. Group texts just didn’t go through. By the time that mother was hospitalized in Chengdu, the only effective electronic communication was short individual texts. Whatsapp worked for a while. When the rest of the NCTA group was cruising the Yangtze, David’s texting wasn’t getting through. Brittany used whatsapp to send fabulous pictorial updates from the river. I could send hospital picture updates back to the NCTA group and to my one sister who downloaded whatsapp. About the time that the NCTA group moved on from the river, whatsapp stopped working for me. David’s texts were working again and we stayed in touch with him as the group logged their time in other southern China locations.
My siblings and our NCTA group were not the only people concerned about mother’s situation. I received and sent multiple communications to GEEO, possibly daily texts to Brenda Jordan with Pittsburgh NCTA and multiple daily phone updates and clarifications to the travel insurance group. Then TMobile sent a text threatening to suspend phone service. They noticed I was making international calls. REALLY????? Before leaving the states, I informed TMobile I would be traveling. At that point everything was fine. While in China, TMobile decided that additional payment was due despite the fact that the bill was paid in full. I called TMobile to explain the situation, their explanation was that they are a U.S. company and it looks like I’m not in the U.S. Therefore, I was ineligible for their phone service. I explained that they were alerted to my travel plans ahead of time and now I am out of the country with a medical crisis on my hands. I require effective communication. The situation seemed to calm down from crisis mode until two days later when TMobile sent a second text threatening to suspend service. My second call to customer service met with little resolution: “The text you’re getting is a routine text automatically generated in this kind of situation. You will probably get the same text again.” This was NOT an acceptable response on their part. I felt inadequate problem resolution and called my husband for his assistance. If our account gets suspended his communication is impaired, too. He negotiated through several levels of customer service to reach someone who understood the challenge that I was going through across the globe. Dunning texts from TMobile ceased. This was not the only financial issue that popped up during hospitalization.
One of the nurses’ non medical responsibilities is bill collection. A posse of nurses showed up to mother’s room with a bill expecting cash payment of 4000 additional yuan. Full hospitalization was covered under our travel insurance policy but it was taking time for the hospital and the insurance company to communicate. I took the bill and went off in search of an ATM that accepted my American bank card. That seemed to settle the nurses for the time being (even though I was unsuccessful in finding that magical accepting ATM machine). On her next visit, our bilingual nurse spoke with accounts receivable and explained that insurance payment was pending. I knew that insurance would be covering all expenses and wasn’t overly upset by my lack of success in coming up with additional cash. Several days later, I had been gone for a food shopping excursion and returned to the hospital to find mother upset. The posse had returned and, in my absence, presented her with a bill. Now it was up to 7000 yuan. Mother was ready to call her financial advisor and move money to cover her stay. All mother heard was 7000 and she knew that was a lot of money. I assured her that 7000 yuan is very different from $7000 and, besides, the entire hospitalization is covered by travel health insurance. It’s just taking time for the hospital and insurance company to connect. Mother’s retirement accounts were safe and she seemed relieved.
We’re still in the hospital and still trying to locate non spicy food in Chengdu. We asked the bilingual nurse to write the characters for “broth” so I could explain to food court venders what I wanted. The folks in Chengdu could read the script all right, most just didn’t prepare that style of mildly seasoned food. I finally found someone who accommodated the request. We got such a bland broth that neither mother nor I wanted a repeat of that experiment. Then nurse Nancy made a special recommendation from the cafeteria: “good for Chi chicken soup.” This soup is made from silky chickens, a special breed that has naturally black meat. Mother was willing to experiment. Black chicken meat was ok, but what was hard to stomach was the chicken head with beak, eyes, and cox comb still attached looking up at her from the soup bowl. We clearly experienced cultural issues with food during this hospital stay. Thank heaven mother was getting sustenance from an IV saline solution with her antibiotics.
One morning mother awoke with the biggest gusher of a nosebleed that I have ever observed. Nosebleeds can be a side effect of either excessively high or low blood pressure. In her case, pneumonia exacerbated a pulmonary hypertension condition. Three doctors appeared, including an ENT specialist. Mother was taken to the ENT unit where the bleeding was finally stopped and her right nostril was packed with gauze. I rubbed her back during this process until I started feeling faint. It wasn’t the blood that I was reacting to. I was famished and most likely dehydrated. Fortunately, there was an empty exam table where I could lay down. My fear at that moment was that I, too, might require medical attention if I fainted and blacked out on the floor. I needed to do everything I could to avoid creating a second medical situation. It was clearly time to pay more attention to hydration and sustenance.
That afternoon mother assessed her blood soaked nightgown and clearly realized that she could use a backup in the nightie portion of her wardrobe. My shopping list got a little longer that day. Again, we were right across the street from a mall. I was able to easily locate much of what we needed. The nightgown request was a cinch to fulfill. Back in the hospital, the corridor at the end of the hall that was home to the huge teapot on the left side was also home to what I affectionately called the “Chinese hospital laundry” on the right. Relatives totally moved in with their hospitalized loved ones. Tasks included doing laundry by hand in the hospital. The right hand side of the corridor had a clothes pole running below the ceiling. Folks hung wet laundry on the line and retrieved it later after it had dried. I finally accepted my full responsibility as a hospital relative, washed mother’s nightgown, and hung it to dry. We Americans might not be aligned with the food in Chengdu but we are aligned with the importance of clean clothes.
The hospital nurse came by later in the evening, shook mother’s pill container and said “night time.” Oops. I had missed reminding mother to take her evening pills. Mother looked at the nurse, took the pill container from her hand, grabbed some water and downed the pills. “It’s night time,” mother said, looking the nurse in the eye. Mother’s sense of humor stayed strong through the whole experience.
When I spoke with my husband that evening and shared my feelings of physical depletion, he recommended the go to remedy that I use for him: miso soup. “But we’re in China, not Japan!” I protested. Then I recalled that there appeared to be a Japanese restaurant in the mall. Why hadn’t I considered that sooner? My itinerary for the next day was clear. Miso mission.
Our bilingual nurse stopped by in the afternoon with a wad of cash. Insurance payment was finally approved. We were reimbursed for two outpatient hospital visits and for medications that had been charged to my credit card. We were also reimbursed the 2000 yuan initial cash payment to the hospital. Financial issues with insurance were finally clear. The accounts receivable posse should not make a return visit to our room.
I was now free to investigate the nearby mall for its miso potential. Triumph! There was a Japanese restaurant with both miso and another favorite of mine, seaweed salad. I felt nourished by something more than snack food for the first time in a week. I reported my success to mother. “Do they have sushi?” she asked. It looks like we finally stumbled upon something that we were both interested in eating.
On the health front, mother was still feeling weak but much better physically and just waiting for the 10 days of IV antibiotic treatment to be completed so that her respiratory specialist could sign off on flight readiness. By mother’s second day with IV antibiotics, she felt well enough to sleep lying down rather than sitting up. She last experienced significant respiratory impairment about 3 years ago when she went through a period of sitting up to sleep for 7 straight weeks. Mother and I both felt hopeful that the follow up MRI on day 10 would show all good news. Dr. Jessica felt hopeful. She visited mother in the hospital to evaluate mother’s general strength for the long flight home. Day 10 MRI showed a clearer left lung and significant congestion now in the right lung, too. Mother required a new, different round of IV antibiotics. And a longer hospital stay. We were disappointed but not defeated. It was clear to both of us that mother’s health was improving. We just had to wait a bit longer for the physicians to concur. From day one of this hospital stay, mother’s Chinese respiratory physician diagnosed her with “pneumonia and COPD.” I looked at mother and said there’s a difference between pneumonia and COPD. Based on mother’s general health and level of mobility, I’m disputing the COPD diagnosis. Mother agreed. Maybe the language barrier worked to our benefit in this instance. The doc never understood our conversations questioning his diagnosis.
After 4 more hospital days, mother was finally cleared for flight. She required in flight oxygen and a nurse to accompany her home. This was all covered by travel insurance. Nothing came out of our pockets. It took about 2 days for the insurance company to hire a nurse, get her to our location in Chengdu, and secure tickets for our return flight. Mother’s return trip was business class. She discovered that business class was her preferred option for long flights. A health experience like this is a totally unrecommended strategy for a seating upgrade.
Mother disembarked to a greeting from 3 generations of her offspring. The smile on her face was broader than everyone else’s combined. Mother was greatly relieved to be back in the U.S. Ambulance transport to the hospital of mother’s choosing had been prearranged by the insurance company. The insurance company established effective transition from Chinese to American medical care. Mother’s nurse stayed with her until all medical questions were addressed. During our flight, the folks at Global Doctors translated the Chinese medical records and forwarded them to mother’s flight nurse, my sister and me. We made certain that mother’s American caregivers would be fully informed about her overseas treatment. Additional healing time was still ahead. The Chinese medical system had been successfully navigated.