Monday, May 2, 2011

Spending Time in a Taiwan Hospital

When considering the possibility of living abroad, Erin and I discussed the importance of health care.  I had been in the hospital before for a flare up of ulcerative colitis (UC) and we wanted to make sure that wherever we went I would be able to be treated for this chronic condition.  As we considered Taiwan we saw that they had advanced, affordable health care and doctors that had helped patients with UC.  That said, health care in Taiwan has some differences that I've experienced first-hand as I was recently admitted to the hospital here for another flare-up of UC.

After getting back from Spring Break my condition took about a week to deteriorate to a point where I needed to see the doctor.  Meeting him at his clinic in the hospital reminded me of the efficiency of the hospital.  Instead of an appointment time, a friend at school helps me get an appointment number, kind of like when you are at the DMV and asked to take a number.  I imagine that the doctor sees one patient after another based on their number, but even though I arrived with my number 44 to see number 22 being served I didn't have to wait long before the nurse was ushering me in. 

With some discussion and a brief exam the doctor scheduled me for a colonoscopy the following day sending me out to take care of the necessary pre-work which included a blood draw, chest x-ray, anesthetic screen, and laxative pick-up.  First I pay for all of this, including the doctor visit, which with the national insurance comes to about $40.  I go to the blood-draw station in the hospital, take a number, immediately get called to a booth, get the blood drawn, and are asked to sit for a few minutes (10 min).  Next I stand in line for the chest x-ray around the corner, get a room number, change out of my shirt in a booth, get the x-ray, change back again (15 min).  By this time my number for my prescription (the laxative) has already come up so I go up to the booth and they have it ready so they give it to me and then give me the directions in English (5 min).  Before long I'm back home preparing for the colonoscopy.

The next day the language difference makes things a little difficult.  When I get to the OR they remind me I need to do the anesthetic pre-screen which makes me late.  I should have done it the day before, but missed it in all the directions.  The pre-screen doesn't take long though and I'm soon back in the OR, changed into their pajamas, and on a wheeled bed.  I'm promptly wheeled in to the OR to see my doctor and the anesthesiologist.  The next thing I know it's about 30 minutes later and I'm waking up from the anesthesia.  I spend another hour recovering and hoping to see the doctor, but he's doing more surgeries so I pay for the surgery (about $100) and take a taxi home.  It's not until the next day back in at school that I'm able to ask my friend to call the doctor to see what's going on.  She tells me he's in surgeries again that day, but that I should be admitted to the hospital.  With her hand-written Chinese note and Erin by my side I head back to the hospital.

Admission to the hospital is weird.  We go to the ER with the note as instructed.  They understand the note and after talking to a young doctor I'm getting an IV in my arm and the doctor is helping Erin check me in.  With the IV in I'm not allowed to leave a seating area which contains three rows of hard-backed chairs surrounded by a steady stream of people receiving urgent care.  Erin comes back and asks what kind of room I want.  There's the 3-person room which is covered by insurance, the single room which is about $100 a night, or a single special room which is $120 a night.  Thinking of all the times I'll need to use the bathroom I opt for the single room and she goes back.  She's back a few minutes later to let me know there are no single rooms available.  In fact, there aren't any rooms immediately available and we may have to wait in the hard-backed chairs for up to 48 hours for a room to become available.  We are finally able to get a wheeled bed in some sort of temporary room where my doctor shows me pictures from the colonoscopy.  My colon looks pretty bad, but he doesn't know how soon I'll be admitted and I can't start getting treatment until I am.  After a call to our Chinese-speaking friend (who also happens to be married to a major surgeon at the hospital) I'm soon off to a double room.

I'm glad to have a room, but there are some interesting differences to a hospital room in the US.  First off, the bathroom doesn't include any toilet paper (or even a place to put a roll).  Instead, for the first couple of days I use tissues that my roommate had in there.  There are also no towels and the only trash can in the room is by the toilet for the tissues.  The cleaning guy, seeing my trash in the "wrong" trash can brought me a loaner and Erin brought in fresh towels and tissues.  There are a few roaches that come out at night, but at least there aren't very many mosquitoes.  The bathroom is raised about 6 inches with a short ramp which means I need to lift my IV stand every time I go.  One nice thing is that there are no limits on visiting hours (which many of our friends from school have gratefully taken advantage of).  There is a chair that pulls out to a cot and my roommates have always had someone spending the night.  For the most part they've been quiet and there haven't been too many conflicts with using the bathroom.

This past weekend Erin and I had one of the strangest experiences at the hospital as my rheumatologist, Dr. Chen, came for a visit with his assistant and two nurses in tow.  He is a nice older man with a bit of a religious streak as he has concluded previous visits with talking about a medical Buddha.  With my other medications having little effect we had started on a treatment called Humira just before the weekend.  Humira is usually used for arthritis (not UC), but we had read online that it had been successfully used for UC in the US and UK which is why I was seeing Dr. Chen.  After discussing that the drug can take a while to have an effect and the need to start tapering of the steroids it didn't seem there was anything else.  That's when it got weird. 

Dr. Chen motioned to examine my legs and I said okay thinking he would check for stiffness.  Instead, he starts gripping deep into my legs as he explains the acupressure/acupuncture connection that these "prime meridians" have with my colon.  As I squirm in pain he asks if it hurts and though I confirm it does he just goes on prodding and gripping.  Erin said I looked like I was going to hit him.  Feeling like a really deep-tissue massage this went on for several minutes as he talked about the different connections like a lesson to everyone in the room.  Telling him that I work on computers he presses deep into my feet saying the point is connected to my eyes and that it hurts because I have eye strain.  The most bizarre point comes when he shows me his pen, presses it into my ear and asks if it hurts.  "Of course it hurts," I reply, "your pushing a pen into my ear!"  Finally he pulls out a book in Chinese on the medical Buddha he's talked about before and asks if I can read a section in English for him.  At this point I'm willing to do anything to get rid of him so I just read what is obviously a prayer, turn down his offer of the prayer book for me, and finally say goodbye to him and his entourage.  Afterward, all Erin and I can do is laugh at the pure ridiculousness of the whole situation.

I'm trying to keep an open mind on the experience.  While I grimaced and moaned, I didn't ask him to stop.  The day after, my legs were a bit sore, but my condition did seem to be improving.  How much of the improvement is from the new medications and how much is from the acupressure is anyone's guess.  Either way our hopes are lifting as my condition continues to improve.  It is a frustratingly slow improvement as I miss my internet connection and think about all the work back at the school.  One of the harder parts to accept is the toll this is having on Erin as she struggles to take care of me on top of her already high work load and the friction of living abroad.  She is an amazing woman who has made this foreign experience more manageable and given me hope when I was feeling down.  I'm looking forward to the time, hopefully soon, when I will be out of this hospital, and we can enjoy our summer together.