Best, Wang Shi Kai Email 5 Part 2

This post is part of a series we are calling "Best, Wang Shi Kai." Dr. Rich is an Emergency Medicine Physician from Los Angeles who picked up and moved to China where he is currently practicing. He was given the name Wang Shi Kai by the Chinese Medical Board. In this series of posts we feature his emails sharing his unique experiences practicing medicine in China. Here are the links to his first email which gives some background Email 1 Part 1,  Email 1 Part 2, Email 2 Part 1, Email 2 Part 2, Email 3 Part 1, Email 3 Part 2, Email 4 Part 1, Email 4 Part 2

The following is the conclusion of Email 5. Click the link for  Email 5 Part 1

The Pediatricians here are not well-trained to see anything more complex than fever, URI or vomiting and diarrhea. I frequently get consulted for everything else. The other night, I could hear a 9 year-old boy down the hall screaming in pain. A nurse told me that he had presented with chest pain and she thought it was just anxiety. Shortly thereafter, the Pediatrician asked me to look at an EKG that she had ordered. She really didn't know how to interpret it, even though it only showed sinus tachycardia. I went to evaluate the child and suggested a chest x-ray. The Pediatrician had only ordered a CBC, CRP and the EKG. The CXR showed a pneumomediastinum. I spent the next 10 minutes teaching the Pediatrician, Nurses and the patient's parents what a pneumomediastinum was, and why a 9 year-old boy might have one. I recommended admission and observation. Later I found out the patient was signed out AMA after the inpatient Pediatrician wanted to get a chest CT, which I don't think was necessary.

I often find myself getting caught in the middle of a fight amongst specialists when I have a complicated patient to admit. For example, I saw 60-year old woman with CHF, acute on chronic renal failure and pancreatic cancer who presented with dyspnea. Obviously, there were many diagnostic possibilities but she was in moderate distress, hypoxic and clearly needed to be admitted. The Cardiologist refused the patient because he said it was a kidney problem. The Nephrologist said that it was a pulmonary or cancer-related problem. The Oncology and Endocrine services said that dyspnea was the main complaint, and the Hospitalist said the patient was "too complicated"! I ended up managing her in the ER for 5 days.

Despite all this, I believe I am making a small difference in bringing Western-level standards of care to Beijing. I was recently voted "Teacher of the Year" by the doctors in our Fellowship program and it was quite an honor. And I have received far more "Thank you" compliments from patients than threats. I think things will get better over time. On a personal note, I have a cute Chinese girlfriend. We've been dating for 5 months. She's an ICU and ER Nurse and did some specialized training in Singapore. Her late father was a medical doctor who worked hard to support his family and provide an education for his children. He died at the age of 63 from hypertension and an intracerebral hemorrhage. I visited the family home in Wuhan, Central China, in June. We had to take a 10-hour overnight train ride to get there. I was the only non-Chinese person on the train and it was quite an interesting experience. The home was in a dismal housing complex. Pure poverty, but probably better than what most people live in. My girlfriend's Mother seemed to like me because I ate all the food she prepared, including fish balls, duck tongue, chicken feet and stinky tofu. She only said 2 things to me over the course of the 2 days that I stayed with her: 1) "When are you coming back", and 2) "When are you going to marry my daughter"!

Stay tuned...

I hope you all are doing well!

Wang Shi Kai

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