Have to start off the day with breakfast, right? I have to confess - every evening, housekeeping left two meal tickets on my nightstand for the following day's breakfast - even though I didn't have a roommate. On more than one occasion, both tickets were redeemed. What can I say? I like to eat.Clockwise, from the bowl. Chewy glutinous rice flour balls filled with a sweet black sesame filling, cold seaweed salad and seasoned bean curd skin, pan-fried wide rice noodles, mildly spicy cabbage, cold cucumber pickles, a slightly sweet white flour bun, and another bun filled with a savory pork-chive center.
My first and only patient of the day - a very handsome 18 month old boy with a cleft palate. He was very attached to his shoes.This trip was interesting in that there were a plethora of surgeons; depending on the day of the trip, anywhere between 5 and 7 very capable cleft lip and palate experts were available. Since we had three excellent anesthesiologists on the team (along with a surprising amount of local assistance - a number of Chinese anesthesiology residents and techs helped out), we were able to keep three rooms running pretty much all day. But with more surgeons than operating rooms, we tried to divvy up the workload fairly. I think everyone was pretty happy in the end.
A word of warning: the next few photos are a bit more surgical in nature. Not for the faint of heart - scroll down quickly, past the blood, guts, and gore (just kidding, but not really about the blood part...).
A fairly typical cleft palate. Imagine yourself looking up into the roof of a child's mouth. You can see the two pendant shaped things, hanging on either side of the middle gap; those are the uvula - that funny thing that you see in the back of your throat when you say "aah". So clearly, those are supposed to be one structure in the midline - along with all that other tissue above it, the soft and hard palates, extending forward (or up, in this photo) to the back of the teeth.Now imagine yourself doing surgery to fix it. You're almost working upside down and backwards to fix some smallish structures in a small, deep, dark hole. You do have a little help, from this friendly looking medieval torture device called the Dingman retractor, whose metal attachments help keep the tongue and cheeks away from the area of interest.
And, if you're smart, you bring your own operating headlight - so that light actually goes where you're looking. And if not, you're at the mercy of the circulating nurse - especially if the light handles are not sterile, as was the case in Changde.
It all seemed to work out okay. You can see the giant hole in the middle has been closed, by bringing the tissues from the sides together. The gaps on the sides quickly fill in with tissue in the days after surgery. When the cleft palate is repaired, the babies are able to drink and eat without liquids or food regurgitating out of their noses.The most important part of this operation, which you can't particularly appreciate in this photo, is bringing the muscle of the palate back together. A good muscle repair - in a child who hasn't started vocalizing yet - can eliminate many of the speech stigmata associated with clefts.
After palate surgery, the babies are usually a little miserable. But they're pretty thirsty and hungry, and the most amazing thing about the whole process is how they bounce back so quickly.This guy seems a little suspicious of me now.
All is forgiven. Here I am, with the family.
The moms of the babies were so sweet. They happily assembled to pose for me, but only after a few of them fussed a bit in the mirror.
Lunchtime. I've eaten in a lot of hospitals over the years. Hands down, the grub we got in Changde was the best hospital food ever.Clockwise, starting with the seaweed soup in the bowl. Slightly curried cauliflower, greenish strips of a crunchy vegetable no one could think of the English name of (I'm thinking it might have been kohlrabi?), softly cooked slips of wintermelon, beef and peppers, a mildly spicy white bean condiment, spicy pork and red peppers, and braised eggplant with green beans.
One of the most peculiar hospital customs that the medical team had to adjust to was the wardrobe ritual.I know a lot of us who work in the OR become a little more particular about our garb as time goes on. Speaking for myself, I often hoard and launder my own sets of scrubs (as another surgical resident confessed to me once, "The hospital-washed scrubs are just not as soft!"), and my OR shoes of choice are clogs that I've broken in over the span of my entire career, which are incredibly comfortable while standing all day, now. You get attached.
We had all brought our own scrub tops and pants and shoes, but the lady standing guard at the front desk to the ORs stopped us soundly. We finally figured out that we were supposed to change into their green scrubs, wear their disposable hats, and change into these flip-flops.
The flip-flops, as you can see in the photo above, turned out to be non-negotiable. But we obnoxious Americans slowly pushed to have our way with the scrubs and caps.
Wearing slippers in the OR was, to say the least, a new experience. At least I had packed socks.
Johnny's grinning in the blue scrubs; he will join the ENT staff at Loma Linda later this year. Stephanie, one of our awesome scrubs from Utah, is assisting a surgeon, whom I believe to be Alex. Notice he's got the headlight on. Smart man.
Jen, on the left, flanked by some of the Changde hospital locals. He was consistently surrounded by a local anesthesiology crew, who were eager to pick up some American terminology and tips. I think they really appreciated his proficiency in Mandarin.
The back table setup. Rather than the usual sterile blue field, all the drapes were this unforgiving whitish cloth.I tried to learn the Chinese names for my most frequently requested instruments: mie tze (pickups), dao (knife), jien dao (scissors). The most frequently seen reactions from my local scrub? Gentle laughter or confusion. How do you ask for "6-O fast absorbing gut, on a small needle driver please" in Mandarin? I often resorted to pointing and grabbing...
That thing in the back, which you would hope to be an air conditioner? It wasn't.
It turned out to be some sort of air purifier. The heat/humidity was pretty amazing in the ORs, especially after you put the thick, heavy cloth gown on. When we felt the sweat dripping more than usual, we'd ask the nurses to turn the A/C (which, thankfully, did exist) back on.
I'm sure we thought we were crazy; I started to notice the staff wearing additional layers under their scrubs by the end of the first week.
A typical scene in the ORs the first week. The guy with his mask down, hands to head? That's Pan, one of our incredibly kind, generous, and patient translators. That turned out to be a very common pose for him during our stay in Changde.
Dinner. We coerced Pan into taking us out to eat that night. He brought us to one of his favorite noodle restaurants, right by his old high school. In the center photo, you can make out two giant pots of noodles, sitting on burners (not Sterno, but some white waxy block wrapped in flammable plastic). The bowl on the left was the non-spicy option, a very tasty chicken broth with delicate, chewy noodles. The bowl on the left was the full-spice option, as you can see from the dangerously dark red oil floating on top.
Pan also ordered up a parade of small dishes for us to try. Some of them seen here: (left photo) crunchy seasoned wood ear fungus, (right photo) top plate of smoked ducks' necks, bottom plate of fried whole fish, possibly anchovies.
Some local color on the walk back to the hotel from the restaurant.
Everyone's ready to be the next Yao Ming.
One of the spots Changde is most famous for is the poetry wall along the river - I believe they have the world record for length. On the other side of the retaining wall lies the famed poetry wall - all these beautifully carved slabs of polished stone, inscribed with Chinese calligraphy retelling ancient poems of Changde's history.And then there is the skating rink. So the river's not just about the poetry wall - at the riverwalk section very close to our hotel, there is a social area, where a lot of the young people of Changde seem to hang out. In the photo above, you can see the rather talented teenaged boys going all out on their roller skates.
There is also a rickety suspension bridge. I guess the local custom is for young lovebirds to inscribe their names or wishes on a padlock, and clamp it onto the bridge. Another local custom seems to be grabbing the side railings and jumping fiercely up and down, to scare the Americans.Johnny and Carin, in the photo above, apparently unperturbed.
What a good looking group!
Alex, at the end of a long day, sums up many of our thoughts.
