Monday, August 1, 2011

My imperfect father - Part III, the stroke

According to my father, there is no need for doctors. His teases everyone who believes in doctors, "why go to see doctors? For serious diseases, they cannot cure, yet for general problems, we don't need them." When people fall ill, he says to them, "Drink water, plenty water. It is the best medicine!" It is with this belief that he rarely goes to see real doctors. I said "real" because in China, doctors in hospitals are usually the real ones who see patients. My father does not go to see those in the hospital, he goes to see the ones in a small clinic that is owned by the place at which he used to work before his retirement. The "doctor(s)" in such unit-owned clinics are so out of practice that they can hardly make any true diagnosis. Their job mainly is to hand out cheap medications to people in need. Unfortunately, when it comes to hypertension, cheap medicines may not do the trick and my father recently found this out with a great price.

In early September last year, I received a suspicious email from my young stepmother Hui. "Father fell few days ago. He had a bit of hematoma on the forehead above the right eye but it is mostly gone. He is in the hospital now but nothing is serious, don't worry". Hui never writes me email in her own voice, she only sends me emails from time to time in my father's tone - he dictates and she writes. I smelled things must have been more serious than sounded. A simple fall would not require hospital stay, especially for my father. I made my intercontinental phone call at once and got my older brother Bing who was at the hospital taking care of the old man. Bing told me that a few days ago, our father got up with a bit of dizziness but he did not pay too much attention since he had experienced such dizziness before. He went ahead for his routine morning exercise. Just few steps outside the main gate of the residence, he fainted and hit a stone. Fortunately, he was sent to the hospital immediately and he was fine now. "The doctor found a small leak in the brain blood vessel, which was caused by the high blood pressure and led to the fainting. The bleeding is under control now." Bing said.

I called everyday in the next few days monitoring the recovery process. My father's could speak through the phone to me, although his voice was very weak and barely audible at the first, but it progressively became louder and clearer from one call to the next. Soon, he sounded like a normal, healthy, and strong father who I knew again. "We are going home next week." He told me confidently. The doctors told him as soon as he could stand up on his feet to walk few steps, he could go home, since his blood pressure was already under control with the new medication that they prescribed him. "We are expecting a full recovery." The doctors told my father. They were optimistic.

True, I trusted the doctors based on the amazing clarity and strength in my father's voice when I talked to him on the phone. It improved so much in just few days. It's just the matter of time now to have him walk again, I believed. I felt safe and went to a conference in Canada. The conference was intense, I did not call my father until I returned to the U.S. 6 days later.

"He lost memory, could not recognized Hui, me, or anyone any more." Bing told me this when I called. I asked to talk to my father, Bing said, "He has not opened his eyes in the last two days. He has not had much food lately." I was in disbelieve. His condition had gotten much worse. It was not at all the direction it should go. "What went wrong?" I demanded to know. "We don't exactly know. We are transferring him to GXMU today." my brother said. That was not a good sign because that meant the current hospital was good enough for his condition. "MRI revealed a big hole in the center of the brain." Bing continued, "The doctor thought there was a clot blocked the fluid in the brain to circulate. The clot could be caused by the anticoagulant used earlier to stop his bleeding." He tried very hard to control his fear of the worst consequence. "The hole (hydrocephalus) had been seen before but we thought it had been resolved since father had seemed so much better. However, it has a size of an apple now."

Bing is usually a calm and confident person. He is the oldest among us three siblings and the only one currently living close to our father. He had been taking care of the old man for a whole month now by sleeping/resting in a chair besides our father's hospital bed every single night ever since the stroke. When he goes to work in the day, Hui, the wife of my father, was taking over since she does not have a job anymore, she quited her job in order to accompany my father to come to the U.S. in the end of 2009. My younger brother YH was/is living in Xingjiang province, which is 36 hours plane and train ride away. Bing did not let us know our father's stroke at beginning since he did not want to worry us. The situation now was different.

"I am coming back home." I said. I was worried to death. GXMU is the best in town and it is the same hospital at which my mother lived in and out for 4 years and then eventually died 24 years ago. I started to imagine that my father was dying there soon. I needed go home immediately to see him for the last time.

Later Bing told me that he had noticed that my father's condition took a turn from okay to bad, because his dizziness had not gone away and he could never stood up on his feet without assistance. He had looked for new doctors in GXMU before but was not in any big hurry to move my father since my father was treated like a King in the current hospital. First of all, people in his rank don't usually come to this hospital. Second and most importantly, the head of this hospital is my little sister-in-law's father. He came by to check on our daddy frequently. It was him who had helped Bing to transfer the old man to GXMU once he found a bigger hole in his brain.

By the time my father arrived the new hospital, he had lost consciousness completely and was directly admitted to the neurological ICU. New doctors seemed great, they told Bing the doctors in the previous hospital did everything correctly. The big hole in the brain indeed was excess CSF (cerebrospinal fluid) and it needed immediate attention - "It had to be drained surgically." They told Bing. They offered few options, such as to drill a tiny hole in the skull to drain the CSF outside. But this wouldn't last. If the clot could not be resolved after that, the CSF would build up again. Another was to put in a shunt to drain the excess CSF from the brain to the belly. The shunt would remain inside of my father and it would function whenever needed to. My brother thought this latter choice was more sensible. But the doctors thought it could be too invasive to someone of my father's age. "He is already 79 years old, you need to decide whether this surgery is necessary." The doctor told Bing. "What are you suggesting, do you have other better ways to save his life?" Bing began to be upset by the coldness of the neurosurgeon. Seeing my older brother was so determined to save the old man's life, the surgeon agreed to schedule his surgery as soon as my father's general health condition was confirmed to be able to sustain such a procedure. "It might take a few days for us to schedule him." The surgeon said. "Could it be sooner, the old man could die anytime from now!" Bing was desperate and angry at this point. The surgeon did not seem to be willing to negotiate. "Well. your father is not the only patient in this hospital. Plus, we will have to check his heart, kidney and other vital organs to make sure there won't be any surprises."

After ending the phone with my brother, I called the Continental and booked my ticket right away and then I called back to tell Hui and Bing my detailed itinerary.

"We were told to get ready for Daddy's surgery, the first thing tomorrow morning,!" My brother was excited to inform me. "What? did you bribe him?!" I was certain that he finally caved. The longer we waited, the more damage the CSF would do to the neurons inside my father's skull. "No, your sister-in-law called someone." Bing told me. That someone called someone else. And that someone else finally reached the very top of the hospital and then the top person told the neurosurgeon that this patient (my father) could not die. If that had happened, he (the surgeon) would be fully responsible.

I am sure the details are a bit different. Because my little sister-in-law's father, the head of another hospital, was also calling everywhere to help in the same time. Although he was out of town for a business trip then, his connections just a phone call away. I believe the surgeon may have received pressure from multiple sources. I also would like to believe that moving my father's surgery ahead was a medical necessity not just a simple result of these phone calls. The surgeon should have made this decision at the begin with.

"The neurosurgeon obviously was trying to make me pay him extra money." Bing said this to me when he was on his way to meet the surgeon to go over the details of the procedure next morning. "Why do you say that?" "Well, otherwise, why did he ask me what do I do for living? He must have wanted to know whether I have the means to pay him." "Or he wanted to know why you suddenly could get so many people to give him order." I offered different explanation since I imagined the surgeon must have been annoyed by those phone calls that he had received. "I would have reported him if he had delayed father procedure." Bing said to me angrily. He had not changed a bit. My brother Bing was a very successful computer engineer/businessman in early 90s. He belonged to the first generation of rich people in China. It was him who paid my first semester's tuition for my graduate study 19 years ago when I first arrived the U. S.. Unfortunately, his richness was short lived because he refused to follow the "codes" - he did not bribe anyone above him at work and he also had not taken any money from his customers, while most of the others did both. "Give the money to sister-in-law and let her give it to the surgeon after he is out of the operation room." I tried to persuade him. He did not answer me directly. "Ok, I am at the hospital now, the surgeon will come soon. Call back later." He was going hang up. "Could you please leave the line open so that I can hear what the surgeon has to say?" I begged and Bing agreed.

Love the modern technology.

The surgeon sounded quite neutral and objective to me. After explaining what kind of a procedure it was and how it was done, the surgeon said to Bing, "As I said before, nothing is guaranteed. He may or may not recover completely after the surgery. Given your father's age, we cannot promise anything." He then asked Bing to choose which type of shunt to use. "Some of them need to be paid by the patient, regardless which type of insurance policy the patients have." The doctor said. "Choose the best you think it's necessary." My brother Bing answered quickly with the clear willingness to donate one of his kidneys.

The surgeon might have left soon after that to get the procedure started. Bing said to me, "The surgery is going to be finished by the end of today and your coming back now may not help that much." Bing was right. It would have been a big hassle for me since it would be just 20 days away from our scheduled vacation to China. My husband Fabrice and I had already planed this trip long ago. If I went home now, that would mean I would have needed to fly back to the U.S. again to get the kids in two weeks. "Should we hold our trip to China this year?" Fabrice asked carefully when he saw me torn by the dilemma. He was also worried about if my father had passed away, it would not be a good idea to have the kids home only to experience the sadness.

I have to admit that I was not at all ready to accept the fact that my father, a strong and healthy man who was just here a year ago living with us for 4 months, would die anytime soon. To calm myself down, I consulted a neurosurgeon in Fabrice's swimming team. "The surgery itself is simple, safe and the best way to reverse the situation." The neurosurgeon told me. He was still in his swimming trunk; I caught him right after his swimming training on the Saturday morning. "Clearly, the facts that your father is 80 year old and in ICU now indicate that his risk is quite high." He was not willing to advice me whether I should go back to China immediately. But it was important for me to know from an expert in the U.S., a country has best medical doctors in the world, that he was confident that our Chinese surgeons had made best treatment plan for my father.

After that, I decided to call my cousin, who is the family member that I can rely on in such situations. She echoed Bing. So, I decided to take the chance and trust my instinct. My cousin and brother were right, I would have missed him anyway if he would have not survived the operation. "Okay, I will cancel today's ticket to China." I told my older brother and Hui both, "Please tell Daddy that ZhuZhu and NiuNiu are on their way to see him."  Hui was then living full time in the hospital with my father ever since he was transferred to the new hospital. I was wishing that my Daddy would hold himself for his two lovely grandchildren. "Be sure to show him the photos of ZhuZhu and NiuNiu when he wakes up." I begged them.

The next week following the surgery was the slowest days of my life. We were told that the surgery went very smoothly and my father survived. Bing, Hui, my two sisters-in-laws, my father's youngest brother and his oldest son who came that very day from Hunan province were all anxiously waiting outside the OR. But they were asked to go home staying by the phone after the surgery. "We will let you know when you can come back to visit him." The surgeon said. My father was in critical condition and would be wheeled back to the ICU after a stop by MRI. At that point, only trained nurses could go in the room. He turned to Bing and my cousin (my uncle's son) that they could follow the nurse to get the MRI done since they may help to move him.

The hospital's phone call was delivered to Hui 18 long hours later. She needed to change her cloth and wear protective masks to avoid bringing bacteria to the ICU room. "He was in his deep sleep. I did not wake him." Hui told me. Bing and sisters-in-laws were also allowed to see him later that day, but only few minutes per person and one person at a time. They said that my father could open his eyes, move his lips, but no sound, still. Two days later, he could eat tiny amount of liquid food. Three days after, he was transferred from the neurological ICU to cardiovascular ICU. The doctors allowed him to stay in N-ICU longer than regular patients because he was then with a new label as an important figure. The cardiovascular ICU was not medically justified. The nurses told Hui. But regular hospital rooms don't provided specially trained nurses, the hospital allowed him to stay few more days there, just in case.

It turned out that our Chinese doctors did a great job in saving my father's life. My father slowly gained his senses. He even could tell stories to his visitors few days after he was out of the N-ICU. "He made up a lot of childhood stories. He also told us that his youngest son was in a farm in Beijing to grow cottons." Hui told me. My little sister-in-law said, "Daddy said 1+1 equals 5." She is an elementary school art teacher who likes to tease the old man. Her job was to teach him simple maths. About a week after the surgery, I heard my father's voice again on the phone, although he could not tell who I was at that time. I put ZhuZhu and NiuNiu on the phone and he was very excited hearing them calling him "Lao Yie (grandpa in Chinese)". However, he did not remember their names.

Three weeks after the surgery while everyone in the U.S. cerebrating their Thanksgiving holidays, our little family of 4 showed up in front of my father in China. He was lying in the bed, peacefully. We did not want to wake him, but he heard us and opened his eyes, slightly. It was 1 a.m. and we retreated soon after the quick stop by. Next morning we came back, he was already cleaned and lifted to a sitting position trying to eat his food in bed. He had not gained back his appetite for food yet. He looked much older than he had been a year ago while in the U.S.. He lost tons of weight and his legs became two sticks wrapped in a dry skin. Hui told us the details of their adventures in the last few weeks, "We have moved from neurological ICU to cardiovascular ICU, then to regular hospital room (two patients per room) and finally this luxury suite in the hospital rehab center." I was so used to the U.S. hospital rooms that did not even notice how "luxury" the suite was! It is huge and has one bed for the patient, one sofa bed for one family caretaker (Hui), a shower and a toilet room, a TV, a dinning table, two quest chairs, a large and tall dresser, a night stand. These rehab rooms are not open to general population, as you can easily imagine. If it was not my sister-in-law's connection or his social ranking (we don't know which one was more important), my father would have been sent home to recover all by himself.

So our vacation to China in 2010 was spent mostly in a rehab center to witness my 79 year old father transforming from a zombie a semi-healthy person. He went back home the second day after we left China to the U.S. to continue to learn how to walk by himself. The little ones did not know what grandpa was doing in the bed all the time, but both of them loved running in the corridor of the rehab center. The hospital doctors and nurses were thrilled to have these two little hybrids showing up energetically every morning. If one day we came late, they would come to ask my father when we were coming. The doctors even spoke to Fabrice in English whenever he was in the room. They had become a family! ZhuZhu occasionally would ask Lao Yie to go home with her, but NiuNiu always requested him to go back to sleep. "Do Do, (sleep in French), Lao Yie!" He commanded each time Lao Yie was practicing his walk in the hallway.

My father spent more than 3 months in the hospital. He survived. "The only thing bothers me now," he said to me, "is the shunt that I am carrying. I was not born with this tube and I want to get rid of it."

It's almost a year ago since my father had his stroke. Knock on wood that he won't have another one any time soon. He is now able to walk in quite a distance without any assitance. He also can talk and argue with people, two things he enjoyed the most. Thanks to the neurosurgeon and the medical advances, we are enjoying having him back! . 

"I started to write a book. I dictate and Hui is typing for me." He said to me last time when I called. I requested him to write about his childhood stories. I also asked him to write about my childhood stories. I need these stories so that I can tell them to ZhuZhu and NiuNiu. He no longer can hold a pen steadily to write. This may not be a problem for many other 79 year old man. But for him, a pen was his best friend and sharpest weapon. Although a stroke did not cripple him, it certainly ended his ability to write with his own hands.

P.S., Bing finally gave 3000 yuan to thank the surgeon few days after the surgery. He said that was his first and hopefully last "misconduct". I confess that I pushed hard for this since our Chinese doctors are not nearly as well paid as American ones. 

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