Saturday, November 18, 2017

The Great Wall of China
18. The TBI

Dr Chen's story was less innocuous than mine. I presented at the first hospital with little or no indication of trauma. The medical team became suspicious when I started responding to questions with inapplicable answers. The lucid interval was followed by intermittent loss of consciousness. A low GCS score led them to the first CT scan. That revealed the cerebral laceration and subdural hematoma. I was transferred to Beijing Tiantan Hospital, the leading neurosurgical center in China, when the first hospital determined that they could not adequately treat my intracranial trauma. I was unresponsive on arrival and admitted into surgery where the neurosurgical team performed a craniotomy to relieve intracranial pressure.

Much of what Dr Chen said was gibberish to me, but I noticed that he bragged about his hospital. That is very common in China. No matter what city they live in, it is always a leader in some field or has the best of something in the world. No one ever lives in some dirtwater town somewhere. And it is hard to contest their boasts. Is Beijing Tiantan Hospital the leading neurosurgical center in China? How would I know?

But then it started to sink in. Neurosurgery is brain surgery. The word craniotomy meant nothing to me, but -otomy is surgical cutting. Cranium is the skull. My second greatest fear in the entire world is having brain surgery. If the first hospital told me they wanted to cut into my skull, I would have refused treatment. I don't want brain surgery anywhere in the world. And I really don't want brain surgery in China. When I touched my wrapped head, Dr Chen kept talking. The fabric was too close to my scalp. My hair was not twisted underneath. It was gone.

When I asked Dr Chen what a craniotomy was, he explained it in clinical detail. My head was shaved and I was intubated endotracheally. Under general anesthesia, an incision in the scalp was made and a pattern of small burr holes were cut into the skull. The bone was cut progressively between adjacent burr holes and the bone flap was separated from the surrounding skull. An incision in the dura exposed the hematoma, which was irrigated and excised. Following successful relief of intracranial pressure, the dura was closed with polyglycolic sutures and the bone flap restored with polyether ketone plates. The scalp was stapled closed and dressed. An external ventricular drain was inserted to continuously monitor ICP and drain cerebrospinal fluid. An arterial catheter was used to monitor blood pressure.

I was monitored in the ICU and given corticosteroids to control swelling, prophylactic anticonvulsants to prevent seizures, and antibiotics to prevent infection. Sequential compression devices were wrapped around my legs and medicine was administered to prevent blood clot formation. Blood was routinely drawn to determine sodium and potassium concentrations and red blood cell levels. Brain activity was monitored with continuous EEG and follow up MRIs. When extubated, oxygen saturation levels were monitored by pulse oximetry. Neurological checks were performed over the next 72 hours.

In addition to everything north of the border, they also did a pregnancy test, which seemed strange to me. None of my injuries were anywhere near that neighborhood. Not that it mattered. I'm officially and not surprisingly not pregnant. I found out much later that some of the drugs they gave me could have been fatal to any pregnancy. The Chinese government might not want anyone to have babies, but the Chinese doctors routinely check to make sure everything is safe just in case.

Friday, November 17, 2017

The Great Wall of China
17. The Doctors

The next time I woke up, I knew where I was right away. I knew I was in a hospital, at least. I still had no idea where the hospital was or its name. It only took a second of consciousness for the next headache to arrive. But instead of fire, it was a dull throbbing headache. I could live with that.

A doctor came in with a clipboard and a long list of questions. The questions started out easy enough. I knew my name and how old I was. Fortunately, he never asked me what day it was. There were flash cards with shapes and colors. Those were easy. I always had good grades in geometry class, but there was no trapezium on the cards. I don't know those in Chinese.

When Dr Huang asked me questions with both English and Chinese in the same sentence, I pointed out how that was kind of a clever trick to see if I noticed the difference, but asked him how he would know if I knew any Chinese. If I knew nothing in Chinese, that would only confuse me and tell him nothing. He stopped smiling and told me that the first time we did this test, I used Chinese almost as much as English. I then pointed out what was already obvious to him. I had no recollection of ever taking this test before.

When an older doctor came in, Dr Huang asked me why I was in the hospital. I described the accident as I remembered it and how I was brought into the hospital by ambulance along with Amy. When I asked them about Amy, they had no idea who I was talking about, which only made me fear the worst, but said they would look into it.

According to my story, I only had a few minor cuts from the accident. They were disinfected in the ER. Dr Chen asked me if I thought minor lacerations and abrasions would lead me to sleeping in a hospital bed with a towel on my head. It sounded kind of unlikely when he said it out loud. All of my limbs were intact and mobile. Nothing seemed to be broken. The only thing out of the ordinary was how I kept waking up without ever falling asleep and the steady drum beat in my head. Plus, my hair was wrapped up in a towel.

Edit: I just realized this is #17, posted on the 17th, 2017. That is purely coincidental. 17 has no particular meaning in Chinese, but Noah's flood started and ended on the 17th.

Wednesday, November 15, 2017

The Great Wall of China
16. Moments Come and Go Like Water

When I was back in bed after the MRI that I thought was a CT scan, I reached up to fix my hair. It felt tight, as if it got twisted around. Instead of hair, I felt a towel. As soon as I touched the towel, I got my first headache. It was like someone put dynamite in my brain and then waited. It took awhile, but when it went off, it went off with a bang. I immediately expressed my desire to be rid of the explosion in English, Chinese, French, broken Italian and really bad Spanish. I would have tried smoke signals if I thought that might work. The doctor asked me, in English, if I had a headache.

“It feels like a steamroller ran over my brain,” I answered. It did not occur to me until later that I both heard and understood what he said. If the only way to understand people required the headaches, I would have willingly gone back to the trombones.

There were more conversations and people moving around my bed, but I could not focus on anything. My head was on fire. Nothing else anywhere in the universe mattered. When they finally gave me enough drugs to numb my head, I floated away. People were still talking and moving, but I still didn't care. Floating was so much better, flying straight across the great divide. I could almost picture the rocking horse people eating marshmallow pies. That reminded me of the Ghostbusters climax, for some reason.

“See you on the other side, Ray.”

An indeterminate amount of time later, Nurse Xihua gave me breathing lessons. It might have happened much earlier, right after I was extubated. That would make more sense. It might have never happened at all. The point of the breathing exercises was that it improved circulation with more oxygen and blood supply to my lungs, opened air passages, and lowered the risk of pneumonia or other infections. She might have told me that right away, or I learned about it later.

Nurse Xihua had me inhale deeply through my nose and exhale slowly through my mouth. After doing that 5 times, there was another deep breath, but then I held it for a second before exhaling in 3 short bursts. On the third burst, cough out any mucus, phlegm or whatever gooey debris might be swimming around in there. She told me to repeat this several times a day. I only remember doing it once.

The side effect of a medical procedure meant to stave off infection was that I was essentially meditating. When you focus on breathing in and breathing out, you stay in the moment. It is harder to think about all the petty things in life when you are concentrating on something as essential, and usually autonomic, as breathing. For me, it was a nice little Buddhist moment surrounded by modern technology in an antiseptic environment.

I could hear Samuel Jackson. “Om mani padme hum, motherfucker.”

Tuesday, November 14, 2017

The Great Wall of China
15. Dance of the Sugar Plum Fairies

Robot parade, robot parade
Robots obey what the children say

Car accidents can definitely paralyze people. Maybe that is why I never jumped out of the bed and tore out the tubes. There were electronic blankets wrapped around my legs that were plugged into a machine. That frightened me more than any of the tubes that pierced my skin. When you wake up in a hospital with a strange machine on your legs, assuming that something catastrophic has happened is effortless. I'm a dancer. Losing the use of my legs is not an option. Take out my spleen or a kidney, burn my appendix in effigy, but leave my legs alone.

While the doctor talked about whatever he was talking about, I shook my feet, perhaps too enthusiastically, but happy that I could move. The blankets were a mystery, but my legs were moving. The doctor looked concerned, but I was overjoyed that my legs worked. He insisted on whispering, so I ignored him and tested out all of my limbs. I could wiggle my toes like nobody's business.

I was satisfied that I could move on my own, but the doctor had a few people slide me from the bed onto a gurney. I assumed they were taking me to the room for people who were not paralyzed. I didn't care. As long as my legs still worked.

Watching the ceiling lights come and go during the gurney ride, I could hear a bouncy chromatic D minor melody in my head. I wanted to jump off the gurney and turn straight from a pas de bourrée couru in sixth position to a tendu devant in plié. I could just imagine one of the nurses playing a celesta.

I recognized the CT scanner. Maybe it was not the exact same machine that I saw earlier, but it was a similar type of space donut. After the scan, they brought me back to the bed and plugged me back into the machines. I have never seen any of the Matrix movies, but if they have a CT scene, it probably looked like that.

Machine or mannequin
With parts made in Japan
My heart is human
My blood is boiling
My brain IBM
Domo arigato, Dr Roboto

Sunday, November 12, 2017

The Great Wall of China
14. The Second Hospital

When a nurse came into the room, she looked at me, looked at the machines around me, and started talking like an adult in a Peanuts cartoon. That was peculiar. It was only then that I noticed the tubes piercing my body. There were tubes everywhere, even in places I would normally insist on months of dating first. I recognized the IV in my arm and pulse oximeter on my finger, and could guess where the Foley catheter was going, but everything else was foreign to me. My first instinct was to jump up, pull all of the invaders out of me and run away. Something told me that I should probably sit still and wait to see what happened next.

Instead of the unfashionable Uniqlo clothes I brought to Beijing, I was wearing cheap white pajamas. You wear cheap robes with wide open backs in hospitals. These were pajamas. Not something you want to wear in public, but a full covering nonetheless. I briefly wondered who took off my clothes and dressed me like a kung fu padawan, but then I remembered that 99.99% of nurses in China are women. The nurse who did the sponge bath saw everything anyway.

A doctor came in and looked at me and the machines. When he spoke, I could tell that he was actually talking, but it was like he was whispering. I had no idea what he was talking about, but I immediately realized that I was in a car accident. I remembered everything, or at least everything I was going to remember; hitting the scooter, running over the scooter driver, getting hit by the truck, the car rolling over, Amy screaming.

“Where's Amy?” I asked the doctor in English. I knew in that moment that he was Chinese and that I was in a Chinese hospital, but it never occurred to me to speak to him in Chinese.

He whispered something back, but I could not tell what he was saying, or even what language he was speaking. Why was he whispering? Was I deaf? Do car accidents make people go deaf? But I could hear myself and I heard the nurse. She sounded like a muted trombone, but I heard her. I could hear some of the machines around me. Then I heard other people walking and random noises across the room or out in the hall. Obviously, I was not deaf.

Saturday, November 11, 2017

The Great Wall of China
13. And When the Sky Was Opened

I remember waking up in an unfamiliar room. It was either nighttime or all the lights were off. No one else was in the room, but I could tell I was in a hospital. In a hotel, I would have been lying on my side or curled up. Here, I was lying down while halfway sitting up, with my legs stretched out flat. There was a hospital curtain next to my bed and the kind of machines you do not normally see in a hotel room.

A second later, I woke up in a bright room with people rushing around. It was all noise and general chaos. Everyone was talking at the same time in what sounded like a dozen different languages. I would swear that at least one person was speaking Klingon.

The first time I realized that a nurse was giving me a sponge bath, I thought I was dreaming. We call it a sponge bath, but there were no sponges involved. It was also not nearly as exciting for me as it would be for men watching with the remote in one hand. It bothered me that the nurse never washed my hair, but I thought I was dreaming, so I never said anything. I don't want to consider myself vain, but I like to think I have nice hair. I use a Chinese shampoo that gives Asian women that silky shine. Where I come from, my hair color is nothing special, but here, women often dye and fail to match it.

The first time I woke up with any certainty that I was actually awake, I had no idea where I was. It was like the first morning on vacation when you wake up in a hotel unsure exactly where you are for a second. Only this lasted longer. I had no concept of where I was, what time of day it was, how I got there or what I was doing. I could see everything around me, but nothing made any sense. It was like an important system file was missing from my hard drive. When I realized I was lying upright in a bed, it still did not make any sense. It was obviously not my bed or a hotel bed. It did not even feel like a bed.

Eventually, I decided that I was in a hospital. I could not imagine why I would be in a hospital, and hospitals have a distinct iodoform smell. This one did not. But everything around me looked like a hospital. There is a Nicolas Cage movie where he wakes up in what looks like a hospital room, but it's actually a rooftop freight container. He should have been able to smell the difference. But he was part of an elaborate con. I was relatively certain that I was not. The time of day, or even what day it was, felt unimportant under the circumstances. Something put me in a hospital.

Friday, November 10, 2017

The Great Wall of China
12. Wild Peonies Couldn't Drag Me Away

Back in the ER, the doctor asked me about Jeanne Moreau, who had died a few weeks earlier. We discussed her movies and how important she was to the world of acting before ER Doctor asked me if I had ever ridden in a hot air balloon. I knew that I had, but could not remember the last time. It has been too many years. The Great Wall of China would probably be a great location for a float in the sky. The view alone must be amazing.

We stepped into the balloon's basket just before it rose up above the hospital. A nurse stood on the roof of the hospital, chopping chives and throwing them into the basket. When we got higher, there was a young Chinese boy on the lawn dressed like Huckleberry Finn and shooting spit wads from a straw up at the balloon. ER Doctor screamed at him to stop, but I was not worried about it. I did not think a spit wad could hurt a hot air balloon.

I was wrong. When the balloon burst, we fell to the ground. We were maybe 50 feet high, at most, and we fell quickly, but it took forever before we hit the ground. We were moving comically fast, Keystone Cops fast, but the ground was in no hurry to make impact. While falling, ER Doctor looked around the balloon for anything that could stop us. I just watched the scenery. The last time I flew over the St Croix River, it was so beautiful. I closed my eyes and pictured it.

We hit the ground hard, but I felt no pain. When I sat up, I was in a dentist's chair, facing a wall with one of those Hang In There, Kitty posters. The cat was looking at me. It was only a poster, but I felt like it was speaking to me personally. That tenacious little kitten wanted me to know that everything was going to be ok.

I could not see the dentist, but I could hear him preparing the drill. I don't have any particular fear of dentistry, but they should really change the sound of that drill. He pushed the chair back, and all I could see were bright lights in my face. I could hear the drill, but I could not see it or the dentist. All I could see was bright dentist office light flooding the room.

“Step into the light,” a male voice whispered before faintly laughing.

“That's not even funny,” a female voice said as clear as a drum.

Walking in a large field of pink peonies, I could see the Emerald City in the distance. I did not feel at all compelled to walk toward it. I knew the wizard was just another lying politician, but there was nothing else in any direction. It was all flowers as far as the eye could see. I had to decide if I wanted to make my way to the city or just relax right there in the field. After I took my shoes off, I started walking.

Thursday, November 9, 2017

The Great Wall of China
11. The First Hospital

I don't remember getting into the ambulance or most of the ride. I sat next to the nurse and watched Amy for a minute before we pulled into a hospital emergency room. In the ER, they wheeled Amy into an examination area and one of the nurses asked me if I was ok. I had a few little cuts here and there, and my hands and arms looked like I tried to tunnel out of a prison, but no bones were sticking out of me. The doctors rightfully concentrated on Amy. I had a headache, but nothing to write home about. Amy was crying in pain. The squeaky wheel gets the grease.

Amy stopped crying when they gave her some drugs. It was like shaking something that rattles in front of a crying baby. She went immediately silent. It was kind of spooky. I was standing nearby and could see everything. Had I not been able to see that she was awake and moving around, it would have been scary.

While several people worked on Amy, a nurse had me sit on an exam table and rubbed antiseptic all over my little cuts. I thought it was unnecessary, and as an American, worried too much about what they would charge me for a dollar's worth of over the counter ointment.

For reasons no one explained, the nurse had one of the doctors talk to me. The nurse spoke in Chinese, so I talked to her in Chinese. The doctor immediately spoke English, so I talked to him in English. My initial assumption was that the nurse wanted someone to speak to me in my native language, but the doctor just asked me a bunch of basic questions I could have easily answered in Chinese. 你叫什麼名字? 覺得怎麼樣? 你痛嗎? 呼吸困難嗎? 今天星期幾?

I thought my answers were pretty good, especially since I was speaking English. That's a language I like to think I know pretty well. But the doctor wanted to get a CT scan of my head. I objected, but they were unimpressed. On the one hand, I wanted them to leave me alone and concentrate on Amy, even though she had plenty of doctors and nurses with her. On the other hand, there is something authoritative about a doctor in a lab coat with his name stitched on the front. He was too old to be a resident and sounded too experienced to dismiss.

They had me lie down on a stretcher, even though I had no problems walking at all, and rolled me into the radiation room. The scanning process was not the least bit claustrophobic. Most of my body was outside of the giant space donut. It was a painless and simple procedure, but the machine looked exceptionally expensive. I could see American hospitals charging a thousand dollars for a quick ride. I wondered what this hospital would charge and then laughed that a completely unnecessary test was going to cost more than the cast on Amy's arm. None of the people around me laughed, but I thought it was funny.

Tuesday, November 7, 2017

The Great Wall of China
10. The Ambulance

The paramedics were far less impressed with the scene in front of them. They must see traffic collisions every day. Paramedics in China are not the same as paramedics in the United States. They are not even called paramedics. They usually have a doctor and sometimes a nurse in the ambulance, but in general, they have little to no training in emergency medicine. The doctors are fresh out of medical school, putting in their time until they can move on to a residency somewhere. The ambulance is transportation and basic first aid. In an emergency, you want an American ambulance any day, even though it is outrageously expensive. In China, they can't perform any medical procedures, but the ride is free.

After they strapped Amy onto a gurney, I told one of them that there was a scooter driver somewhere in the intersection. He looked at the traffic and said, “不是你的問題.” – That's not your problem. I could not tell if he meant that some other ambulance was going to go that way or if he thought it was none of his business either.

Someone else asked me what hospital I wanted to go to. Ambulances in China are not required to take you to the nearest appropriate facility. They take you to your favorite place. I have no favorite hospital in Beijing, or any city, but I knew that Chinese hospitals often concentrate on one subject more than others. I did not want them to take Amy to a place that specialized in gynecology. There are a million medical terms that I don't know in Chinese, so I used a phrase you never want to use when shopping. 钱不是问题. – Money is no object, basically.

Both Amy and I have health insurance in Hong Kong. Hong Kong is in China, but not everything translates. The government in Beijing controls the government in Hong Kong, but Hong Kong issues its own passports, visas and money. The passports and visas are different from Mainland China, but “中華人民共和國” is stamped right at the top. What I would learn later is that some hospitals in Beijing honor Hong Kong insurance while others do not. Fortunately, the closest hospital to the accident accepted Hong Kong insurance. Even more fortunately, it was an internationally accredited hospital with doctors who studied in various European countries. Amy had a few broken bones. A Chinese doctor who only studied in China could have patched her up. The international aspect would end up doing me a world of good.

Monday, November 6, 2017

The Great Wall of China
9. The First Responders

I was still thinking about what to do with Amy when I crawled out of what used to be the windshield and looked around. We were at the opposite end of the intersection, on one of the relatively smaller streets. I could see the back of a big rig cargo truck parked around the corner. I do not remember ever seeing that truck before, but something told me it might have been involved. It was upright and appeared undamaged, but I could not see the front from where I was standing. The scooter driver was nowhere. I could not even see his scooter. Traffic resumed through the intersection. I want to assume that people were driving around him rather than over him, but I could only see cars moving in every direction.

Even closer to us, there were no bystanders. People slowed down to have a look or take a picture with their phone, but not a single person stopped to help. I'm sorry to say that I did not expect anyone to offer any assistance. That is simply not the Chinese way. Americans look down on most of the world as lower life forms, but in an accident or disaster, we rush toward the people in distress, not away from them. Amy and I are probably on a few Facebook pages. “Look at this terrible accident. I watched and then just walked away like an asshole. Here's what I had for lunch.”

Based on our position and the lower traffic volume on the smaller street, I left Amy in the car. For some reason, I turned on the car's hazard lights. That would make sense in some countries, but in China, people mostly use their hazard lights when double parked. As far as the car being an obstruction, that should have been obvious. It was lying on its side. But obvious is relative. A few years ago, I saw a car honking at the car in front of it to move out of the way. The engine of the car in front was on fire.

When a police car eventually approached, I waved to get his attention. That might sound stupid. A broken and battered car was resting on its side. Any police should notice that right away. But just like every car and pedestrian that passed the accident, you never know if the police might think it is none of their business and keep moving. When the officer got out of his car, the look on his face was pure astonishment. I don't know if it was his first day on the job, but he was clearly out of his league. When I told him that Amy was injured, he looked into the car and stared at her. His mouth was open the entire time, but I don't remember him ever saying a word.