Wednesday, August 30, 2006

stomach problems

Since moving to China almost six months ago, I have had “stomach problems” nearly every day. At first, I assumed I was simply getting used to a new environment. Then I assumed I had food poisoning. After a dozen such incidents, I came to wonder whether it was possible to get food poisoning so many times in a row, especially when I tried to be so careful about my food and water.

I mentioned my ailments in a roundabout way to my close friend Joanne, a first year medical resident, over Google Talk. After a few delicate parries, she asked me to describe my symptoms directly. I explained that I had digestive problems (I wince even to write the phrase). With some kindly prodding, I laid out all my painful and mortifying symptoms.

“Do you have muscle cramps?” she typed.

“Yes, actually, I do!”

Joanne explained that often chronic stomach ailments can lead to potassium loss, causing muscle cramps like those that gripped my legs and feet without warning in the evenings, causing me to rock and writhe until I was able to unknot myself.

“It sounds like you have giardia,” she suggested. I went and looked up giardia on WebMD and it was like reading an exact account of my illness. I Googled “giardia” and read a few harrowing travelers’ tales, including some from China. Perhaps giardia, or some microbial cousin, was the cause of all my suffering. I was determined to get a clear diagnosis. In the meantime, she suggested I drink Gatorade.

* * *

Calling hospitals is not very helpful. I figure that arriving in person will allow me to persist where a phone call would end with the first receptionist hanging up. I have been to the international clinic before, and I know they are no good, so I opt for a list of local hospitals instead.

The first hospital I chose specializes in gastrointestinal diseases, but when I arrive, I find that no one there speaks English, and no one is willing to listen to my broken complaints in Chinese. At last, a receptionist points to the list of local hospitals I clutch in my hand. “Here, they speak English. Go there.”

Something about the way she carelessly taps the paper makes me suspect this is entirely fabricated, just a clever bid to get rid of me. Nevertheless, that hospital is the only other on the list to cite gastrointestinal diseases as a specialty, so I make my way over there.

The second hospital is on a pedestrians-only street, so the taxi drops me as near as he can and then leaves me to my own devices. I point at a large building to our left.

“Is this it?”

“I can’t drive here,” he says again, and that is that. I pay my fare and wander down the narrow street through the hot, heavy humidity that is almost rain. A bicycle rickshaw driver follows behind me, offering his services in a lilting sales pitch like a lullaby backed by the cicadas' long, mechanical howls.

In my painstaking beginner Chinese, I explained to street vendors and security guards, “I am going to the doctor. I am sick. Do you know, where is the doctor?”

I find the building at last, but not before sweat adheres my jeans to my body until I feel I am swimming through a murky pond wearing a denim wetsuit. Inside, I proudly deliver the following declamation to the ground floor secretary: “I am sick. I have a stomach illness. I am here to see Dr. W--. Is he on the fifth floor?” Some scuffling and murmuring ensue. Three or four other secretaries come over. It is decided he is indeed on the fifth floor. I know from previous trips to Chinese hospitals that I am supposed to get a card or slip from the first floor counters, but I recklessly press on for the fifth floor without one. I figured once I find Dr. W--, I can always return downstairs for whatever paperwork is required.

On the fifth floor, I repeat my speech about stomach sickness and Dr. W— to several nurses and receptionists. I notice that this hospital is one of the very few places I have been in Shanghai that does not have a single English word or even Roman character displayed anywhere in the building. It is clear no one speaks a word of English. The nurse asks me to be seated.

I sat quietly on one of the plastic seats lining the corridor and wait for someone to discover me. Everyone is acutely, obviously ignoring me, hoping that I’ll eventually go away. The corridor rings with the unmistakable sound of a dentist’s drill, which seems eerily out of place in the gastrointestinal department. What are they drilling? I shudder to think.

Eventually a nurse comes by and tells me to move to a different chair. There is some talking, and pointing, and I repeat my same set speech to every person that approaches. Eventually, my patience reaches its limit. I returned to the first desk. The receptionist, a doctor, and a nurse are all conversing in a desultory fashion, apparently speculating about the cause of an open wound on the doctor’s ungloved hand.

I rehearse again my monologue: “I am sick. My stomach hurts. I am here to see Dr. W--.”

“You are foreign,” the receptionist explains wearily. “Go to the foreigners’ hospital.”

“The foreigners’ hospital sent me here,” I attempt to say.

Unfazed, she repeats, “If you are foreign, you go to the foreigners’ hospital.”

Outside, I wander over to a large intersection to catch a taxi. I am defeated enough to consider going to the international clinic despite my earlier grievances. I wait for an empty taxi to pass, watching a man across the street bathing in the stream from a broken fire hydrant. Soap and grey water run along the sidewalk and pool between the cement slabs. Occupied taxis zip by. I consider moving on to a bigger intersection with a better chance of finding a free cab, but I am in the grip of a superstitious belief that if I move from my spot, a taxi will immediately zip over. With a great rumble and crack, rain breaks over the city. Once it’s raining, finding a taxi is all but impossible. I walk six soggy blocks to a larger street, ducking inside a taxi as the driver is discharging his last passenger, and make my way to the foreigners’ hospital.

I arrive at the foreigners’ hospital under a heavy downpour. There are several buildings on the medical campus, and taxis dart in and out between them. I approach a security guard to ask him where the foreigners’ hospital is located, but before I can even ask, he breaks into a broad smile. “Foreigner?” he asked in Chinese. “That building there, 15th floor.” As I rush across the flooded driveway, several other security guards spot me and give the same friendly directions, beaming with delight at putting things in their proper place.

The wait at the foreigners’ hospital is not much better than at the previous two hospitals. Doctors, nurses and receptionists trundled in and out in groups of two or three, ignoring me entirely. The one man whose attention I was able to catch tells me pointedly to go stand at the other desk. The other desk wants nothing to do with me. While I wait, I read the price list posted on the wall behind the counter. There is a list of medical procedures with two prices next to each, for “first class” and “second class” treatment. The priciest item on the menu is 21,800 yuan for “resection of severed finger.”

At last I am handed my registration paperwork. No sooner do I begin to fill out the forms than a nurse approaches me from behind and sticks a thermometer into my ear without a word of warning. The thermometer beeps. “Perfectly normal!” she declares in aggrieved tones, as if she’s already found me out as nothing more than a time-wasting hypochondriac.

A long time passes before I am ushered into the doctor’s chambers. The doctor is a diminutive elderly Chinese woman with clear, clipped English and thin wispy white hair. I sit next to her and began my litany of complaint. I describe symptoms I blanch to write here, summoning all my courage to speak directly and without euphemisms.

“I moved to China almost six months ago, “ I begin, “and almost since the beginning of that time, I have been ill. I have had diarrhea every day. Sometimes it is very severe and I am so sick I can hardly walk and can’t leave the house at all. Other times, it’s not that bad, and I can get around okay. But when it is very severe, I am extremely sick.”

I continue to describe the conditions of the illness in yet more graphic detail as the elderly woman gazes at me placidly and occasionally makes notes in Chinese.

“When you are very sick, how many times per day do you have diarrhea?”

“Ten, twelve – sometimes even more. Maybe fifteen times.”

“And when you are not that sick?”

“Once or twice, maybe three times.”

I continue to explain my condition, noting the times and conditions which prompt the illness. I want to mention the muscle spasms, but I hold back for fear of sounding melodramatic.

“Have you lost weight?”

“Yes, I have lost a lot of weight. Ten pounds, maybe fifteen.” Pausing, I say again, “Maybe five to seven kilos.”

“So your clothes are loose on you?”

“Yes, definitely. I can no longer wear almost anything I brought here from the States. My pants especially are so big they fall off, even with a belt.”

With the flourish of a triumphant prosecuting attorney brandishing exhibit A, she reaches out and tugs on the snug waistband of my jeans. “But these pants fit fine!”

“Yes, these do, I just bought these. But my old clothes don’t fit at all. I can’t wear them.” I know I sound like I am whining.

The doctor asks me to lie on the examining table. She pokes around my abdomen, and I report that I feel no pain after each little jab.

“Where you sick today?”

“A little, not that bad.”

“Did you have diarrhea?”


“And yesterday?”

“Two or three times. But last weekend I was extremely sick…” I begin.

“But now you are okay.”

“No, I am still sick. I am still having diarrhea.”

“Just once, though, today.”

I am beginning to realize this woman is not on my side.

The doctor regards me gravely. “The problem is, you eat too much. If you eat too much, you will have diarrhea.”

I suddenly feel as though I have wandered into the psychiatric ward by mistake.

“But no – I mean, I eat almost nothing. I have lost more than ten pounds.”

“You need to not eat so much. Are you under stress at work?”

“I guess - yes, a little.”

“Stress also causes diarrhea. Try not to have too much stress, and do not eat too much. Probably you eat too much.”

I don’t know whether to laugh or cry, so I do neither. Instead, I deferentially nod my head, gather my belongings, and follow the doctor to the front desk. As I prepare to pay, she touches my arm lightly. Looking down, I notice for the first time that I am nearly a foot taller than she.

“Do you drink milk here?’


“The milk in China is not like the milk in your country. There is no lactose. It will make you sick. You should not drink milk here.”

I feel my voice breaking as I manage a meek “okay.”

I ask her if she would evaluate a medical sample, and she grudgingly agrees, provided I gather the sample at home and bring it in before ten o’clock in the morning. I ask if they have containers for the purpose, and she says they do not. I can bring a sample back tomorrow, maybe, in my own container.

The rain is still falling when I leave the last hospital. The shopkeepers and street vendors have all rolled down their awnings or set up large green beach umbrellas. Two orderlies push a stretcher across the pockmarked parking lot, the patient completely covered with a blue tarp. I wonder if the patient is dead, or if they are just moving him that way because it is raining. A nurse walks up and down the covered walkway, guiding a young boy whose head is wrapped in bandages. The boy shuffles slowly along, pausing now and again to breathe in great, ragged gasps.

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