Mike

Journey to the East
2010-06-19 14:33:03 (UTC)

June 17

Today was my first day in the hospital. At breakfast I was
once again first in line, and after eating my slices of
bread and drinking my steamed milk I headed over to the
inpatient building to meet Tiger. He would be my preceptor
today.

The public areas of the old hospital are in bad shape. The
hallways are narrow and dark, paint is peeling from the
walls, and there is a wet, mildew smell. But once we walked
up to the second floor things were better maintained. This
building has six floors; each has two wards, one for men
and one for women. Tiger works on the second floor women’s
ward and, together with one other attending psychiatrist,
cares for 50 patients.

We arrived on the ward at 8am after many of the patients
were already awake. This ward has a very different style
from Canadian hospitals. The nurses wear modest starched
white dresses and wear the old fashioned style nursing caps
that have to be pinned to their hair and make them look
like milkmaids. The patients also have a distinct
appearance. As I said all are women, most with
schizophrenia and most quite heavy, likely due to their
medication. They must all wear striking bright pink
pajamas. My arrival this morning created quite a stir, so
anyone who was still in their room hurried out into the
hallway to have a good stare. The fifty of them together is
quite a sight.

The morning report was difficult for me to follow but it
was a good chance to meet the team. In addition to the two
psychiatrists there were eight nurses and five residents.
This high number of residents explains how only two
psychiatrists can follow so many patients. The residents do
the routine care and assessment of patients, and on some
days check -in with their disinterested attending staff.
Though in other ways things here work differently from
Canada. For example, psychiatrists wear white lab-coats.
Why not? Anyway, I had been warned about this and had
bought a spanking new, bright-white coat in Manitoba. But
when I took it out of its wrapping I was upset to discover
they had sold me the wrong size. However, this was no
problem because Tiger was happy to lend me one of his. And
it has short sleeves (“for the summer heat!“). Actually,
every long lab-coat the doctors wear around here has short
sleeves. I told myself that if everyone was doing it I
didn’t look ridiculous, pulled it on over my long-sleeved
shirt, and got started with the work day.

First we assessed several patients. Patients are
interviewed in their rooms by several doctors at once.
Rooms are narrow and rectangular, approximately 10 feet by
20 feet. Each room contains four large steel-framed beds
along one wall. Patients sit patiently on their bed and
wait to be spoken to. The few meetings that I observed were
brief, and the patients seemed to be doing well. These
patients are for the most part elderly and well behaved.
After the morning interviews most residents spend their
time endlessly entering orders into the computer system (I
still haven’t learned how they enter chinese characters
with a roman keyboard). While this was happening I was
lucky enough to be given a tour of the inpatient services.

The wards are similar on every floor. Wards consist of long
hallway with patient rooms on both sides. In the middle of
the ward is a large square area that is used as the eating
room and, on the mens’ wards, the smoking room. Women are
not permitted to smoke, of course. Patients spend most of
their day wandering the hallways and chatting with each
other, but for several hours a day take are brought to the
recreation areas for therapeutic activities. These
recreation areas are very large square rooms, large enough
to comfortable hold 100 patients, and have doorways
connecting to both the womens’ and men’ wards. The rooms on
each floor will have a theme such as “music” or “exercise”,
although they all have an open space that can be used for
any type of activity. Patients rotate rooms throughout the
week in order to take part in a variety of activities.

Approaching the first of these rooms, the exercise room, I
was met by an unexpected sight. On the large double glass-
doors that lead to the room, someone had taped two large
Santa Claus faces. Very large Santa faces. At least four
feet high. The resident guiding me saw that I was confused,
and when I asked her why Santa was there she said “Oh, I
guess they just forgot to take it down”. I couldn’t think
of a better reason for Santa to be on a doorway in June so
I didn’t press her. But when we went in the room it
happened again. On every column in the place is a huge
Santa face with rosy red cheeks and snowy beard. He is
winking and “Merry Christmas” is written under his chin. I
should have been prepared later in the tour, when Santa
was also on the other five wards as well. Santa overlooking
the craft table. Santa gazing out over the dance floor.
Twin Santas flanking the large-screen television screen of
the therapeutic karaoke machine.

Besides these enormous Santa face collection the recreation
rooms were rather strangely equipped. The music room had a
huge selection of dusty guitars that the therapist told me
nobody every played, and also a few pianos, rattles, and
the very popular karaoke setup. The exercise room had a few
exercise balls, a sit-up apparatus made out of many small
slats of wood on a metal frame, and dozens of strange
cardio devices that seemed to be primitive elliptical
machines, made only of thick steel bars. No patients were
on the machines in this room; they seemed to prefer
lounging on the couches. The crafts room was more popular
and had a lot of painting and weaving happening. In the
dance room everyone was actively moving but there was no
music and it didn’t seem like a dance.

I do honestly think that the recreation program here is
impressive. The therapists there did a good job showing me
around, although all of them tried to get me to buy crafts,
and they claimed proceed went to the hospital. My parents
will read this blog, and I really don’t want to spoil
Christmas again, but I will tell you that my mom will be
getting a crooked vase made on the pottery-wheel by a
schizophrenic woman from the Szechuan province, and my Dad
will be getting a mostly red shirt tie-dyed by a manic
fellow from Nanjing.

After lunch I came back to the hospital and headed to the
ward. As I entered the front doors of the building I
realized that there were also two large Santa faces there
that I had somehow failed to notice earlier. I continued to
reflect on this after I arrived at the ward and the other
doctors and I went to observe the patients being
given “social rehabilitation therapy”. Social Rehab is a
strange thing. The patients were lined up outside of the
door of the room when we arrived. A severe looking nurse
opened the door to the therapy room and all of the pink
ladies shuffled to their tables. They sat up very straight
in their chairs, staring forward expectantly as the nurse-
therapist began the specific therapy session, the title of
which translates as “the benefits of antipsychotic
medications for you.”

Therapy is delivered in the following way. A video of a
patient having an appointment with their doctor is shown on
a television. The patient is told by the doctor that he
must be on antipsychotic medication. The patient then
begins to speak, asking questions like “why do I need to be
on medication?“ This seem to bother the nurse-therapist who
is now teaching our class, because before the doctor
answers she angrily pauses the video and tells one of our
patients to answer . After being called upon a patient
stands up very straight and recites the answer “your doctor
has determined you have an illness and you must follow his
directions for the benefit of your own health.” The patient
then quickly sits down and the entire room, including the
doctors, gives a brisk round of applause. This process
repeats itself for the rest of the session - a half an hour
or so, followed by a short break. After the break two pairs
of patients are instructed to take part in a role-play that
will re-enact the previously viewed scene. Both do very
well. The patient who plays the psychiatrist speaks to
their fellow actor with a great deal of force.
The “patient” however is far more agreeable than the
patient in the film, and gives the doctor an easy time.
Both of them smile as they return to their seats. We all
applaud.

After such an interesting day I enjoyed a walk to a nearby
commercial district. Tomorrow I think I’ll use the subway
to explore the city.




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