In China, day twelve

Thursday was the last day of operating for the team in Changde. With only two cases for the entire day's schedule, I had the day to myself, after checking in on the patients in the morning.

One of our translators, a very smart and spunky girl named Zhong, wanted us to try lamb noodles - and she knew just the place, a very short walk from the hospital.

Breakfast was never so good. The meat was sliced thin, cooked perfectly tender without any of that gaminess that often plagues lamb cooked in the States. The soup was spicy, of course, but not mind-numbingly so.


Quite a few members of the team raved about a beautiful lake they had been to during the week, easily accessible by hopping on the bus just outside the hotel for 1RMB and riding it to the end of the line. It sounded like "New Year Lake", with pagodas and weeping willows and boats.

With my bad Mandarin and the help of an assortment of English-speaking locals (everyone, it seemed, had a friend they could dial up on their cellphones), Heidi and I eventually made it to Liuye Lake.

The AC on the bus was lovely, and we were treated to a motley parade of sights through the windows. Changde is a medium sized city, but even within city limits, there is still a surprising amount of rural character.


Even though it was a hot summer day, the breezes off the lake kept it bearable. Apparently Liuye Lake is another famous area in Changde, developed as a resort complete with a five-star hotel.

We were surprised by how few children there were at the lake's grounds. The ones we did see, though, were definitely having a great time.


Heidi and I had heard that you could take a boat out to an island in the middle of the lake. These ones clearly weren't going anywhere.


We eventually figured out how to purchase a ticket for a boat ride, provided by this politely curious gentleman.


Passing some of the other boats. With all the haze, it was a little hard to see to the distant shore. The internets tells me that there are several beautiful mountain peaks hiding back there.


We eventually "docked" at a rough stone pier, where our boatman gestured we could get off. Heidi and I looked at each other, and as we climbed a rustic path away from the boat, hoped that he would still be there when we returned.

The island was small, and we were immediately accosted by a family, who appeared to be the caretakers of the island and its small temple. A man offered us the most giant stick of incense I've ever seen, as thick as a baseball bat but longer; we politely declined. He eventually gave up.

Wandering around, we found this grove of trees, perfectly spaced for hammocks. A woman was taking advantage of the quiet setting, peacefully reading a book.


I don't know why I love chickens so much.


Our friendly boat man was indeed waiting for us, and he ferried us back to shore, taking a leisurely course past a large pagoda where men were fishing.

Heidi and I bravely tried out a tandem bike. I must say we were pretty successful - riding to the pagoda and back. Although we did get dusted by a mom with her young daughter.

In China, day eleven

The mission was nearing its end; today was my last day of operating. For me, it was a full day of working hard to piece together both revisions and a "fresh" cleft lip.

This gentleman was 20 years old, and he just wanted whatever could be done to make his lip look a little better. His initial bilateral cleft lip repair was done some time ago and looked fairly good - just a few minor adjustments needed.

He seemed pleased by the results - realignment of his upper lip border, and a tiny little flap of tissue tucked to give him a little more fullness where a notch had existed before.


This six year old girl had also had a bilateral cleft lip repair done previously. She had extremely wide "train-track" scars, and as you might be able to tell in the photo above, she had some bulkiness on either side of her upper lip.

The orbicularis is a muscle that circles the lip and allows us to do things like pucker and whistle. In children with cleft lips, that muscle is discontinuous and misaligned. If at surgery, the muscle edges aren't approximated well, things can look a bit off.

After surgery. Her wide scars have been excised, and the muscle aligned properly.


My last patient of the mission was perhaps the most remarkable of the trip. You can see the little 7 year old guy in the photo above (courtesy of my new friend, William Zhao), sandwiched merrily between his parents. In Tibet.

This incredible story (and the photos shared above and below) was told to me by William, whose kindness and dedication will become evident shortly.

Word of the Chinese Agape mission in Changde had somehow made it to this little boy's family. With a lot of help and planning (and William, who lives in an entirely different city in China far from Tibet, was instrumental as guide, translator, and friend), the little boy and his father made the fourteen day trek - mostly on foot, but also via donkey, bus, and train - from their village in the mountains of Tibet to our hospital in Changde.

The brave little fellow, before surgery. I was only allowed to repair his bilateral cleft lip; despite the team's pleas, the hospital would not allow us to perform the repair of his palate as well.

Resting the next morning after surgery. When he was shown pictures after the repair, it took him a long while before he seemed to recognize himself.

With William and the patient's father at his bedside. His father was so happy. And I'm happy to report that everyone made the long journey home safely from the hospital.
















Another day ends with dinner. This night, our graceful translator, Anita, organized an outing to a more "homestyle" restaurant that her family has enjoyed frequenting.

Just a few of the many dishes we enjoyed. Left: a bowl of cold fermented rice soup. Refreshing with effervescent rice grains, this dessert-like soup was about two steps away from becoming shochu. Right: flavorful fish soup. The girls were so sweet and insisted on finding the big chunks of meat to serve us.

In China, day ten

Another day at First People's Hospital in Changde. Johnny and Alfred with one of the local nurses.

Steph, modeling the latest and greatest in gown couturewear. The attached muff is a brilliant idea - handy, convenient, stress-reducing for hawkeyed circulators breaking in new medical students... We should get these on all our paper gowns in the States. Who do I have to call?


All right - caution signs and blinking lights here, for all of you with weaker stomachs. Photos of a slightly more invasive surgical nature (two, to be exact) are next in the lineup.



One of my cases of the day: a big kid (17 years old) with an unrepaired cleft palate.


In a way, working on the older patients is easier in terms of cleft work. The structures are bigger and easier to see, and often their tissues are a little more generous when you're trying to get holes closed and covered up.

Unfortunately, if patients wait too long for surgery, you do lose a lot of the advantages of early repairs, like bony molding and speech development (which I mentioned briefly in an earlier post). There are always trade-offs in surgery.



Dinner that night: a barbecue and hot pot place. Off to the right of the photo, behind where everyone is congregating, is the open room where the grilling was done, over a charcoal brazier. Notice the hot red glow.

The young man who tended the fire was also the one who schlepped all of our food up to the second floor. Shirtless and sweaty, he seemed astounded that we would attempt to eat all of it.


Left: fresh lotus seeds, which you shell and eat. Right: butterflied chicken drumsticks, fresh from the coals. I had no idea you could butterfly a drumstick. It was tasty. Part of a seemingly endless parade of grilled foods - squid, lamb, peppers, potatoes.


"Uncle Johnny" and his women. The young translators all adored Johnny, as you can see in the photo. They also called him "opa", which Korean girls use to address an older brother. Some of the rest of us started calling him "opa" too.

In China, day nine

Laundry day at the hospital. Actually, every day was laundry day - each morning you could see a different assortment of clothes hanging outside windows and on railings. With the degree of humidity in Changde, I'm surprised anything was able to dry...


In the secret elevator with Johnny and the daytime operator.

He had a stool and a pack of cigarettes, so he could wait patiently until summoned. But he wasn't this friendly to everyone. When called to a floor, the operator put on his stern face, eyeballed the waiting crowd, and refused and even kicked out anyone who didn't look like they belonged in the OR.


Another day, another tube. Paul, making his work seem effortless.


This little girl was six and a half years old. She had her bilateral cleft lip and palate repaired previously, but there were some minor touchups that could be performed.

Playing in her bed after surgery. A few minor revisions, to narrow the nostrils, redo the widened scars, and line up the pink of her upper lip a little better.


Charles, focusing. He is assisted here by Heidi, who is a fourth year medical student in Colorado, applying for residency in general surgery. She was incredibly smart, hardworking, and helpful; I'm trying to convince her to come to Stanford...


The famed shoe lockers, as demonstrated by Johnny.

In the bottom right hand corner of the photo, you can see a slightly askew cabinet - inside lie all those rubber slippers, arranged from smallest sizes at the bottom to largest (which, as some of the team found out, weren't all that large) at the top.


For dinner that night, most of the team went to a Western-style restaurant. The menu was vast - everything from steaks to salads to pasta to Korean rice pots to waffles.

I opted for the restaurant's special steak, which was in a word, interesting. You can see Carin's reaction in the photo above; she had ordered the same thing.

The steak was a little different from what we're used to in the States; it was thin, either extremely tenderized or cobbled together from lesser parts, and drowned in a black pepper sauce. The plate was garnished with part of a corn cob (also very different from what we get here: rather than supersweet kernels, Chinese corn is very chewy and starchy) and a fancy-cut hot dog.

The drink is fresh-squeezed Chinese pear juice, which was a refreshing change from the usual breakfast-time watermelon routine.

And let's just say that the pizza was pretty different, too.

In China, day eight

Another hot and humid day in Changde. On our way in to the hospital, posing out front from left to right: Alex, me, Charles, Alfred.


Johnny, on rounds on the first floor.


Operating, with a helping hand from Stephanie and Alfred.


Finally, a chance to see the town in the daylight.

We were all warned about the traffic in China. Although there are crosswalks, those painted lines on the street just demonstrate a convenient place to be run over. Pedestrians do not have the right of way on these streets.

We learned that when crossing, drivers of scooters will generally slow down when they see you, whereas drivers of cars and trucks will actually accelerate and aim for you.

Scary at first, by the second week in Changde, we were all darting through traffic like locals.


A foray to "RT Mart", which was explained to me as being bigger and better than the local WalMart (which was located in a central city plaza, flanked by the KFC and McDonald's).

I always think it's so interesting to see what is being sold in local markets. Here, baskets and baskets of dried seafood - little fishes, shrimps, and other shellfish.


And rice - bushels and bushels of all sorts of different varieties.


The scatterings of English phrases were always stunningly insightful, whether intentional or not.

It made me think about the popularity of getting Chinese character tattoos here in the States - which, when shown to a native reader, turned out to be jibberish, or even worse. Does the converse occur in China? Are there thousands of Chinese punks or hipsters with funny English phrases tattooed on their parts?


Dinner that night was another test of our spicy tolerance. Here, we sampled crawfish, crab, and frog bathed in chili peppers. Once we had picked out all the succulent pieces of meat, a waitress poured hot broth into the metal bowls, creating a spicy hot pot - perfect for cooking trays of sliced meat, fresh cut vegetables, spongy tofu, and slippery noodles.


So much work for such a tiny, delicious morsel of meat. Totally worth it.

In China, day eight

And Saturday was our "day off". After checking in on our babies in the hospital first thing in the early morning, the team packed on to yet another bus.

Inexplicably, we took a quick detour to a bus depot first.


Two and a half hours on the bus. In a matter of minutes, leaving the crush of the city for more bucolic landscape.


I think our driver tried to pop in a DVD of some dubbed German martial arts B-movie, quickly rejected and replaced by a series of Chinese pop music videos that revealed an alarming amount of gyrating pre-pubescent flesh. Thankfully, that didn't last long either.


Most of us either dozed or became entranced by the scenes framed by the bus windows. As we traveled through Hunan Province, we got to see a little more of the "real" China. So much farmland, so many shades of lush green stepped into the earth, dotted with bent backs and water buffalo.





















We stopped for a delicious lunch - loads and loads of banquet-worthy food.

Left photo, top to bottom: braised pumpkin, the ubiquitous green bean and eggplant, incredibly tasty five-layer pork.

So called five-layer pork, because the cut displays these gorgeous ribbons of thick fat alternating with a relative scarcity of soft-cooked meat, sitting on a bed of braised salty greens. It's a delicacy in Chinese cuisine. I must admit, I do love my food, but I usually carefully dissect away big chunks of fat. On this day, I gobbled up every bit of that unctuous pork. I don't think I've ever had any better.

Right photo, top to bottom: whole chicken stewed in broth, a different (!) kind of fatty pork, creamy eggs scrambled with Chinese chives, and a perfectly crispy green onion pancake. And that rustic wooden bucket filled with steamed rice.



The bus finally arrived at our destination, Zhangjiajie. A famous scenic area of Hunan, the scale reminded me a bit of someplace like Yosemite here at home. We had a single afternoon; we could barely scratch the surface of the park.

I'm here with Sarah, one of our sweet translators for the day trip, in front of the ticketing area for Zhangjiajie.


The start of the scenic nature walk. Bravely, we turned down the tram that took you past the whimsically named rock formations. Instead, we walked. And sweated.


Jen and Alex, helpfully pointing out the "Tourism Etiquette Rules for Chinese Citizens". The particular phrase they're highlighting: Don't go barebacked in public places. If the resolution on your screen is good enough, you can zoom in on the text; it's chock full of gems like that.


The other part of Zhangjiajie we did get to see was the cable car ride to the top of one of the mountain peaks.


In the cable car: Stef, Alex, and Faith. The look of terror on Faith's face is absolutely genuine. She had a terrible fear of heights, but our stalwart young translator from Nashville stuck it out and lived to tell about it.


The views from the top were absolutely worth it.


The way back down was a bit rougher on the spirit. Two hours of creeping towards the cable cars, trying to keep cool, and defending our personal space. Then back on the bus, homeward bound.