Interesting day...

...in ophthalmology today, my first day (I took yesterday off due to my illness).

It started this morning, when we saw 40 patients in half a day. I thought that it was crazy-busy at the Beijing University ophthalmic center, but it was decidedly crazier here at PUMC's eye clinic. The clinic consisted of one hallway lined with multiple exam rooms. Here, one room contained one professor, one resident, one medical student, and sometimes four to even six or seven patients and their families (and one visiting medical student...me!) in an area of no more than 100 square feet! Privacy is definitely not something that is thought about terribly hard. I saw some interesting cases: one patient had a visual field that was classic for a homonymous hemianopia (she likely has an infarct in the right temporal-occipital area of her brain); a little 7-month-old girl had likely bilateral retinoblastoma (she has leukocoria, and a B-scan shows masses in her eyes that have calcifications); and there was a man with retinitis pigmentosa.

In the afternoon, there was a 50-year-old man who had had a stroke 9 years ago, with left hemiplegia and moderate dementia who came in to clinic. My resident had seen him in the ED yesterday, and today, we were going to examine his fundus. When the patient was wheeled in in his wheelchair for the exam, my resident took off the patient's sunglasses. The patient got mad and said, "Give back my glasses!" and proceeded to start hitting my resident with his right (good) arm! My resident got backed up into a corner for a few seconds and couldn't escape, but he eventually sneaked out the door behind the wheelchair. The patient then proceeded to get up out of his wheelchair (keep in mind only his right leg works), and he picked up a short metal stool that patients sit on for the slit-lamp exam. The professor smartly took the stool away, as it looked like the patient was going to threaten my resident some more. Now disarmed, and with the resident out of arm's reach, the patient had one last stand and spit at him! My resident retreated down the hall. Needless to say, we decided not to examine the patient today. My resident took it well (at least on the outside), but I have to say, I would have been really freaked out had I been in his place. Afterwards, we took turns trying to lift that stool with one hand, and it weighed at least 25 pounds. That patient was really strong, and had he thrown that stool at my resident, or something, that would really have caused some serious damage. It was quite the eventful end to an interesting day.

One thing that I will never get used to is some of the bathroom habits in China. A lot of the little kids and babies here wear what my classmates and I call, "no-butt pants." Basically, they're pants with a slit in the crotch/butt area that allows for peeing and pooping without dropping their drawers. It can be cute when they're walking around with their naked butts showing, but I often wondered what happens when they're indoors and need to go to the bathroom. I found out today, and it was gross. I saw the little girl mentioned in the last paragraph being held awkwardly over a wastebasket in the hallway, and then I suddenly noticed a stream of fluid, some of which was going into the wastebasket, but most of which was spewing out into the middle of the hallway floor!!! And then sort of pinkish-purplish poo started coming out, too, but thankfully, that mostly ran into the wastebasket. And everyone went on as if nothing had happened. I'm sorry, but if China is going to improve its standing in the world, people need to educated on simple public health issues such as these. It's dirty and unclean, despite the fact that it may be "culture" or "custom." Cloth diapers are not expensive and are reusable. Use them. But that's just me. I'll get off my soapbox now.