End of Week 3

This week was a rotation through Cornea, but it's been really light. I think the total amount of time observing can be condensed to about one full day's worth. This is because the majority of the doctors have been away starting Tuesday for a national ophthalmological convention thingy.

So here are some pictures for your enjoyment until I can put up a proper update:

This is the front of the new wing and it's linked to the old wing through a skybridge of sorts. There's also a separate wing that houses the ER, cafeteria, laundry room, and other administrative offices. There is also a second location within 5 minutes walking distance that is the Optometry building.

If you've ever hated waiting in a doctors's office, be glad you are not one of these people:

Left: taken before 8am as people line up to get a number to be seen.

Right: another waiting area, in the new wing. I'm not sure what they are waiting for though. On the floors with the testing and consulting areas, there are more scenes similar to the picture on the left.

In Chinese there is a phrase "People mountain, people sea" which is what I would use exactly to describe the waiting areas of the hospital. Most of the time people are very orderly and I must say, extremely patient. Once in a while arguments break out (and these Shanghai folk are known for verbal arguments) and it can get reallllllly chaotic. But these Chinese docs have concentration like it ain't no thang. And there's also a loudmouthed women stationed outside the exam rooms to make sure people are seen in an orderly fashion. They have no qualms about yelling at unruly patients or shoving them out of the exam room if it gets too crowded. There is almost always at least one other patient (and often with one family member in tow) in the room along with the patient being currently examined. There is no privacy in the exam room. Good thing we are just looking at eyeballs!

This post is dedicated to Cathy Dau's Chinese Roommate

Not me. The one from UF.

First, thanks for all who asked about my health--I am doing much better. I took a day off on Tuesday and slept all day long and voila! healed.

On Monday since I was feeling quite ill, I wanted to eat something lighter and not fried or spicy. So I walked to this restaurant on my street that is set up cafeteria style. You can order whatever you want--they have cold and hot appetizers, entrees, sides, soup, and complimentary all-you-can-drink soymilk. So I chose some greens, some tofu & fungus deal, and a side of plain rice. 18rmb plus I took a cup of soymilk to go. I was really happy with myself for scoring such a healthy dinner at such a low price that I decided to reward myself with the soymilk before taking my food back to enjoy in the privacy of my apartment. I took one sip and something from above splashed into the cup. Soymilk down. Well, at least it was free. At home when the lids came off, my food smelled pretty good so I got down to business. The tofu and fungus turned out to be liver and fungus. I like fungus, but I don't like liver much. Weird, yes I know. The greens turned out to be swimming in oil. If you look at the middle picture you can see the actual demarcation line between the juices of the greens and the oil. So I just ate the veggies from the middle and built a little wall of greens to keep my oil moat happy. But at least the chopsticks they gave me had pointy ends and were not the dumb stuck-together square ones I hate, because I can never break them apart equally. *Special aside: notice the pink object in the top margin of the 1st picture? Prize for the first person to email me the correct answer.

On Tuesday since I already spent all day sleeping in my apartment, I saw no reason for me to step out for dinner. Well, I was just being a lazyass. After the previous day's meal, I was REALLY hankering for something fresh and I remembered this place that a friend introduced me to a couple weeks ago: Element Fresh. The more I thought about it, the more I thought to myself, "Goshdarn maybe I will get my butt out of the house at least one time today." I went online to see how to get there when lo and behold! they DELIVER! After filling out the order form I was super worried they would not be able to find my apartment so I even included two landmarks near the alley I live in...and then even added a remark, "Maybe I should just meet you downstairs" because the gate hasn't been working lately. I ordered a laffa bread salad which was a mixed green salad with cucumbers, tomatoes, red onion, grilled chicken breast, green olives, and goat cheese with laffa bread and yogurt-mint dressing for 68rmb. The wait time was 45 minutes and delivery was free of charge--although, I was afraid there was some mystery charge like they like to do in the US. A little while later, someone rings my doorbell and I think it's the building manager come to ask me more questions I don't understand, but in fact, it's my salad! 10 minutes early! Right at my door! I'm so excited that he actually found me because no one had even called to confirm my order! And then the delivery boy even gave me exact change right away because he had the presence of mind to foresee I would pay with a 100 rmb bill! I don't even have to tip cuz it's China! My hands are shaking like crazy as I tear off the lid because I haven't eaten anything all day and the food smells delish! And it tastes as good as it smells! Even better! And for the next 15 minutes it's just an explosion of !!!!!

I wish there were scratch n' taste jpegs. These pictures do not do justice.

Moral of story: $10 salad pwns $3 liver n oily greens.

I just had to stop and snap a shot of this window display. A total WTF mate? moment at 9am. Let me introduce you to the world of massage in China. Well, to be honest, I have a very biased experience of Chinese massage--having never partaken of oriental table showers nor dragon massages nor entered those kinds of bathhouses. At least, I don't think I have.....err.

To be fair, there is at least a 30:1 ratio of pictures of half-naked women laying on their stomachs with a mysterious pair of slender hands pressing on their soft-skinned backs. I just couldn't resist these homoerotic adverts so at the risk of looking like a total CREEPER, I present these to you.

Am I in Shanghai or a SF Muni terminal? Bwahaha. (We have giant adverts in our bus terminals of half-naked men embracing. And at the bottom there's a reminder to get tested or use proper caution etc, I can't rightly remember).

Anyway in China, massages can be ridiculously cheap for the basics to $$$ for super high-class treatment. You can pay between $4 to $200+ for an array of services (I can't comment on how much those services cost). An interesting fact: some places advertise their blind masseuses because supposedly they can really suss out the trouble spots given that being sightless allows the other senses to be enhanced. Also, it gives them a job here in a country where most "troublesome" aspects of society are largely ignored or the services for them are much lacking.

My first day here in SH I sought out a place that looked pretty decent, plus it was only 40rmb (~$6) for an hour-long massage. This involves laying fully clothed and being rolled, kneaded, chopped, and pressure-pointed from my head to my ankles--foot massage was separate. I always like to go for the basic packages where you are still clothed, but they normally give you some clean pajamas to change into. The lady applied the amount of pressure I liked, the private room was relatively clean, I was offered hot tea, my masseuse left the TV on some Chinese nature channel so I got a soothing narrative about ground squirrels....BUT the pillow smelled like cigarettes and the sour sweat of the patron before me! I overlooked this last part since it was HELLA CHEAP and the lady almost made me cry--which is a good thing bc I like my massages near tear-inducing. I don't like paying $100 in the US to have someone caress me for an hour. And I don't like when people are afraid of applying pressure in fear of breaking my bones. This lady, when she asked if the pressure was ok, murmured approvingly, "Doesn't look like it, but you sure can take the pressure" and went to work on my back. **If you want an interesting aside, email me privately hahhaa**

The 2nd time, we found a nicer place but also twice as expensive: 88rmb for an hour. Service was nice enough, but I just felt like the lady never got close to the right points. Like she was always pressing exactly riiiiiightnexttoit. Well, at least the pillows smelled fine.

This last time, I think I found the best place so far. 1) It's within a 5-7 minute walking distance. 2) I paid 88rmb for 90 min of back, shoulder, AND feet. 3) They wash my feet for me. 4) They roll a bag of hot stones on your back and 5) There's free food and drinks. Afterwards, you can chill in the room by yourself enjoying the food and presumably watching TV, but that flat screen was never on when I was there. Also interestingly, they gave Jimmy a chick, and me a dude, who looked remarkably like Jimmy Chen--I kept staring down at his head when he was washing my feet and thinking, "Dang how can I take a picture of his hair w/o seeming like a creeper?!!?"

Drip Drip Drop

This is not a shot of SF on a fog-filled day...speaking of which, I could really use some Bi-Rite

right now. This is Shanghai at 3pm on Sunday afternoon, and most afternoons lately. That gray mist-looking stuff is what happens when the heavens are rent in two and a deluge of water tries to swallow the earth whole. When it rains like this, there's no point in trying to walk anywhere. In 30 seconds you will be soaked up to your thighs.

It's pretty depressing-looking and I chose this shot because for the first time since I arrived I feel pretty miserable. I could tolerate the heat, the crowdedness, the occasional waftings of sewage-tainted air, but I've caught a cold since Saturday and it sucks. First I thought it was allergies, but I was scratching my cheek the other day and lo, (+) PAN. I was told that everyone who visits long enough in SH will get this cold around the 2 week mark, and what do you know...I'm due!! Being sick sucks already, but being by yourself and sick sucks more. Being sick and having to cancel your exploring plans sucks the most. This week should be a pretty light load so hopefully I'll have time to take it easy for a few days.

To end on a lighter note, check out this guy's furry friend perched just inside his ear. I tried to get as close as possible and the angle isn't the greatest. It was a lot hairier and bushier in person.

Surgery

WARNING: Very graphic photos at the end of this post! NOT FOR THE FAINT OF HEART!

We're just about finishing up our rotation through glaucoma. I feel like I can perform a trabeculectomy/filtering surgery now cuz it all starts to look the same after awhile. I kept forgetting to bring my camera those first few days but Jimmy has got some pretty cool pictures and even video footage.

Here's a few photos I took in the surgical suite:

Ready for prepping.

Prepped like a mummy and ready to go!

Front row action--that's Jimmy's head up there. I couldn't get any actual pictures of the surgery bc the the glare of the light was really bad (though we could see perfectly) and I didn't want my annoying red target light thingy to be in the way of the doctor.

Random instrument I saw laying around in the suite. It looks like it's some type of hole punch for donor corneas...is my guess. It reminds me of those little hole punch things you use for arts and crafts that come in different cute shapes like butterflies and teddy bears.

*******WARNING IT GET'S NASTY****************

After the filtering surgery we heard there was some retinoblastoma sugery going on in suite 10 so I mosied on over. Of course, all the kids are always put under general anesthesia. All of the surgeries I've seen thus far are under local anesthesia. The patient's eyeball can move around but they don't feel any pain during the surgery.

The kid had undergone radiation by scleral (?) plaque and then actually had the left eye enucleated. What they do afterwards is implant a fake eyeball to keep the integrity of the orbit intact. I always thought that people with fake eyes just had this round ball put in with an iris and pupil painted on it. Actually the colored part is more like a giant scleral/contact lens. It goes over the actual fake globe. You pop off the lens to clean it, not the whole eyeball itself. (This is what the doctor told me, but anyone who knows otherwise please shed light on this topic). Up until around 2000, docs in China used fake globes made from CORAL of all things. This is because it is most similar to the composition of human bone and is less likely to be rejected by the host body. Now coral is no longer used but some type of plastic material instead. The surgeon will attach the muscles to the ball so that at least the eyes can move in synchrony. It is very difficult to do this properly so normally they will choose a ball that is larger than the child's original globe so that they don't have to change sizes/have another surgery as the kid grows.

In this kid's case, the globe part somehow came exposed through the conjunctival sac, so they had to go in and affix it properly to the muscles. This picture shows the sac area. I guess this is where you pop that lens part in for cosmesis. I don't know all the details too much bc I'm not in this rotation yet. At first I was told they were going to laser some retinoblastoma so upon first viewing the screen, I felt dumb because I couldn't figure out where the cornea was. They normally view through indirect and then laser it. Then I found out they had already enucleated the eye and were just doing repairs, so that explains why all I saw was a bloody pulpy looking mess.

Hotness

This is how I feel like at the moment. Not only is it hot outside (worse on days the sun actually pierces through the thick smog layer), but it's warm in my apartment as well. The other day the electricity went out in half of my apartment because we have two AC units hooked up to the general electric line (excuse my non-technical terminology, I'm making things up as I go). I guess you're supposed to have a separate circuit just to accommodate AC units since they use up a lot of power. After my landlady's SO came to fix it, the unit in my room only blows out tepid air with occasional bursts of slightly cooler air. I might have to resort to what I used to do in Davis--go to walmart/Carrefour and enjoy the free AC there. Even though the weather here is comparable to South FL, the difference is there I am always scuttling between oases of AC'd air and I am never walking around outside in the sun longer than 20 minutes for entertainment (unless at the beach). Here the heat seems magnified--maybe bc there are around 20 million bodies all moving around and exhaling hot breaths. Well also because I've forced myself to wear long jeans everyday to avoid getting sacrificed to the mosquitos or "wen zi" here. Those suckers get me through my jeans even!

I saw this kitty yesterday morning and thought it was dead. It didn't move a muscle even with my foot hovering right over it (in an attempt to step over it, not ON it mind you). Nope, it was just too damn hot to bother getting out of my way. I feel ya puss, I feel ya.

Nooooo Reservations

So, I think I did mention in my first post that I would put up some pictures of delicious food--so sorry to disappoint!! I will attempt at this point...first a conversion factor: 1 USD = ~6.8 yuan or we just call it "kuai"

My favorite: Beard Papa's 7 kuai/puff of yum. That's just about $1-ish for one. So, less than half the price of a US BP cream puff. If I could find a closer location to me I'd eat one every other day.

The lettering is sort of difficult to make out under the winking lemonhead but it says "Happy Lemon". They've got boba, and fruit smoothies, and teas, and lemon drinks etc. I got the Lemon Pineapple with Nato de Coco. I kid you not, I stood and waited for more than 15 minutes for this beverage and although refreshing, I don't know if I want to stand and wait that long again. My camera had died right after this picture so I can't even show you the huge crowd waiting for their orders. 7 kuai for my drink.

This one is for Susan Tran. Shanghai egg custard tarts or "dan tat/dan ta". SO fricken good. Custard part is creamy and smooth and not egg like (is there even egg in this one?) and the pastry is flaky and crispy and not oily like Golden Gate Bakery in SF--maybe that is blasphemous--but I say these are so much better.

I was trying to avoid this place but this morning I tried to go shopping at 9am and found out the stores in that area wouldn't open for another hr at least--so to avoid heat stroke I headed to a surefire spot: Starbucks. I've heard it said that they don't sell coffee--they sell the "Starbucks experience" and I have to say I'm almost grateful for the fact they are everywhere. Here I sat for an hour in deliciously conditioned air. It wasn't too hot, and it wasn't too cold...it was juuust right. The cushy chairs and soft global beats playing in the background are the perfect respite from muggy and sometimes stinky SH air. All this, if you are wiling to sell your soul or pay 30 kuai for a tall latte. You can bet I sipped this bad boy down to the very last cold sour drop.

Today's lunch: 1 bowl of spicy beef noodle soup for 5 kuai. Yah my coffee cost 6x this much!! There's a lot of these tiny no-nonsense eateries where locals usually eat. It's very bare bones, most of the times you sit with strangers at your table, but you get very fresh food prepared quickly and it's dirt cheap! I saw this man kneading dough for the noodles this morning and made a mental note to come back for lunch. If you've never had fresh noodles, the texture is nothing like the dried kind. It's very..."kew" is what my mom calls it and I think it means something like al dente, chewy in a good way, or sometimes Van likes to call it "bouncy," but not in the way where you have to chew for a long time or have it stick in your throat. This place had a giant picture menu as well as one on the opposite wall that was even more comprehensive but all in Chinese script. Guess which one I used?

I don't know why I like ramen so much...I think whenever I watched Naruto sip those bowl of noodles so noisily it just seemed to appeal to me. I've never tried Santa Ramen but I did make my dad drive me to San Mateo for my birthday to eat at this other ramen place, whose name escapes me right now. This Ajisen chain is very popular in SH and I liked it enough that I ate there for 2 dinners in a row. It's in the 18-30 kuai range--a lot pricier than the noodles I had for lunch, but still under $4 USD for dinner. The one in the pic is spicy sour ramen and it's a lot yummier than the name sounds. I'll probably end up eating here once a week.

I had loads more yummy things to eat but frankly most of the time I'm so excited that I forget to take pictures until the plate/bowl is already half empty...then it just looks ugly. Also snapping pictures of food really doesn't help my attempt at blending in with the locals, but screw that, I promised delicious food posts right? :)

Who wears short shorts?

When I was packing for China, I knew the weather was going to be steamy at least till the end of August...but I was worried my South Floridian standards of dressing would be too scandalous for Chinese sensibilities. Today at the mall my fears were laid to rest.

Shorts are a comfy option in this humid sweat bath but I draw the line at showing butt cleavage.

Yah I took this picture creeper-style.

Week #1..so far

Disclaimer: this post is all about eye and hospital stuff. If you've no interest in eye jargon or how a Chinese hospital is run, wait for my next post :)

First of all, I'm on rotation at the Eye and ENT Hospital of Fudan University. The facility is separate from the medical university. There are other eye hospital/clinics in Shanghai, but I'm pretty sure this is considered the best one in the city. People come from neighboring cities to see the doctors here. As I expected, the hospital is somewhat of a zoo. But it's actually a very organized zoo, somewhat akin to a themepark I guess. You stand in a line for a very long time, the exam portion is over before you know it, people argue over line-cutting, and there's also snacks available for purchase. I don't fully understand the structure of healthcare here in the PRC and maybe this just underscores my lack of awareness, but I thought for a communist country everyone is supposed to have equal access and equal coverage. However, still when it comes down to it, if one can't afford surgery here you're just screwed it seems. Just yesterday I saw a 10-year-old with congenital glaucoma in his left eye. The eye was so swollen from the high IOP that his cornea was bulging out of the socket. It looked like a large grape--the large korean kind that you have to peel the skin off of. The texture of the cornea looked exactly like grape-flesh. The kid had a trabeculectomy when he was a baby but I'm guessing after that since he was symptomless, the parents probably thought the problem was fixed and 9 years lapsed until the boy had a grape for an eyeball. The doctor said that surgery would yield a 30-40% success rate and that most likely the globe would burst. Even if they were able to make a cut into the eye, upon decreasing the IOP there would be a high chance of serious intraocular hemorrhage. For now the high pressure is squeezing the blood vessels--once you open up that tap, the pressure of all that blocked up blood is going to cause massive bleeding. If the surgery goes badly (60-70% chance) they will obviously enucleate the eye. If the boy doesn't get surgery now, at some later point after he's done growing, he will need to have the eye enucleated (taken out, for you non-eye folk). Jimmy tried to get a picture of the boy but his sister was highly suspicious and didn't let him. I can imagine he's already gotten a lot of flack from his peers so I didn't want to push it. The surgery would cost over $1k USD or 8-10K RMB. My monthly rent is already $400, I can't imagine these people having $1000 of petty cash laying around, especially since it seemed they had traveled a ways to this hospital.

This week Jimmy and I have been rotating through glaucoma and have gotten the chance to shadow some really great doctors. All of the doctors here can speak English, of course, with varying levels of proficiency. One doc, Dr. Cheng, has been really great with explaining things to us in English and letting us look at anything we want. The mornings here start at 7:30am with a staff meeting, grand rounds, and then some quick post-op exams. After that it's been something different everyday. Since there are crazy numbers of patients each day, every exam element is pretty much performed in stations. The patient gets a number, sees the doctor for a quick slit lamp eval, and then the doctor either prescribes some meds or tells them what tests they need to get next. Tonometry, visual field, OCT, GDX, pachs, ultrasound biomicroscopy (UBM), FA, fundus photos are all performed in separate rooms. Patient goes through whatever tests they need (which can take several days because they have to wait in line for each one) and brings the results back to the original doctor for an assessment and plan. Patients here are responsible for their own record keeping--so they have a little booklet for doctor's exam notes and for all their printed test results. Something different from Nova is that they use the Octopus visual field which provide a color printout, in addition to the regular Humphrey VF. They also do the Goldmann perimetry which measures your true peripheral fields. Another cool thing is that since it's a big huge hospital they use UBM a lot to visualize the angle. You can see plateau iris and bowing easily.

70% of glaucoma patients in China have angle closure glaucoma. This makes for very interesting, and often sad, cases. I've seen a couple cases of neovascular glaucoma where probably the best bet is to freeze the ciliary body. For cases detected in the earlier stages, an LPI is pretty much the treatment of choice. If that's not possible it's a trabeculectomy. Dr. Cheng let us play around with the YAG laser and I got to make some LPIs on a piece of paper :) We also get to see any surgeries he performs. Most of the surgical suites are hooked up to 3 flatscreens in the lunch room. Yep, people lunch while some eyeball is being slit open or some neck tumor is being hacked off. It's a little unnerving to watch these surgeries to a backdrop of slurping and lip-smacking. You can see exactly what the doctor sees through his scope, as well as other views of the surgery room ie while a patient is being prepped. Literally less than 30 seconds after a surgery is done, the next patient is being laid out on the table. I assure you this is all done in a very sanitary and up to health codes fashion.

After watching 1 or 2 trabeculectomies, it's all the same...so I was ready for something more exciting. On Wednesday we followed Dr. Cheng to the ER since he was on call. A man came in with a corneal laceratin from some steel thread. When the gauze was rolled back, I could see he also had a vitreous prolapse. Since the ER doesn't have monitors hooked up, Dr. Cheng let us observe table-side as he stitched up this dude's cornea. T'was super cool but the downside is owing to the large number of patients they get each day at the hospital, it's unlikely I'll ever be able to observe that guy post-op cause I'll never find him.

I think that's enough eye mumbo-jumbo for now. Here's something that prompted me to post this update:

I walked past some pho joint and it made me think of you Florida folk...shout out to Judy for inspiring me to write about eye stuff at 12am in the morning ;)

Test post

My building that I live in. It's right off a major road so there's easy shopping nearby. On my street corner there's a 24 hr mart and a produce stand where I also get breakfast in the morning occasionally. One cup of fresh soymilk and a "dan bing" or egg pancake is less than 50 cents. Theres also a Carrefour nearby, which is like a Chinese Walmart. I spent 1 hour walking around in there on Sunday, right after I got the keys to my apartment.

I'm ALIVE!

BAH HUMBUG! I just typed out this nice update post and it got deleted! Well, anyway, suffice it to say I've really missed having access to facebook, blogger, etc. The Chinese govt blocked a lot of sites such as twitter and fb because of the recent rioting in Xinjiang.

I'll have to do this update justice and post one with pictures etc another time.

The point is: I'm alive and well and pretty much settled in. I didn't suffer too greatly from jetlag and I've been starting my rotation at the hospital for the last 2 days. More details to come.

I'm going, going, back, back

to China, China

Thanks for reading past the lame title. I couldn't stop myself! Anyways, for those who don't know what this blog is for...well I'm not quite sure either. But here's the essentials:

I'm going to be in Shanghai for the next 3 months interning at the Fudan ENT and Eye Hospital. There is only one other classmate of mine coming with me to this internship, so it's going to be very interesting. I've always wanted to study abroad in undergrad, but I don't know anyone who's ever accomplished that with a science major other than Van (props).

As to how much I'll be updating this blog and with what content...that remains to be seen depending on internet access and just how exciting or not exciting Shanghai life will be. At the very least, I'll try to update weekly and provide visual interest with pictures of delicious authentic Chinese food.

If there's a new post here by Monday, that means all is well. Until then.......