Thursday, April 29, 2010
Addendum for below post
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Rural Lunch
Anyway, the researcher to show his appreciation took Lee and I by van to a restaurant just outside the city for traditional rural Cantonese food. I haven't spent too much time detailing it, but I love the way groups eat in China. The food is ordered ala carte and brought out staggered and placed on a glass circle in the middle of the table. The glass rotates so we have easy access to the food items. This includes a chicken (with head and feet attached), some fish (a whole fish laying on a plate), some of the biggest oysters I've ever seen, fried tofu, and some other things. It was great.
The scientist's name is Benquiang, and he was quite a character. He did a brief fellowship at Yale in immunology. Furthermore, he was in the Chinese military and apparently rescued the president of Liberia some years ago with 2 comrades, both of whom were KIA. Or maybe captured him? Ill have to find out the specifics in a future correspondence.
Anyway, Lees friends from Purdue, Mike and Adam, arrived this morning. We are going to spend the weekend in Guangzhou and then go to Shanghai on Sunday.
Cheers,
Nick
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Tuesday, April 27, 2010
Hong Kong, Traditional Chinese medicine
the problem is that when we were in Hong Kong last weekend, our
cellphones weren't getting Internet data. Anyway, here is a brief
synopsis of Hong Kong. Its a very impressive city, and sits right up
there with London and New York in that respect. Hong Kong is
definitely a really unique blend of East-meets-West. Since it was a
British colony, most people can speak English. But in the shopping,
restaurants, and culture you can find authentic Chinese, you can find
authentic Western, and you can find mixes of the two. I for one was
thrilled to have the first real burger I've had in weeks! Anyway,
there is almost too much to write and I don't really have the time
right now, but if I was going to describe Hong Kong in one world, it
would be "capitalist". There is so much emphasis on wealth
production, finance, consumption, and really there is a lot of
extravagance there as well.
Physically, Hong Kong is a very clean city, very well organized,
gorgeous buildings, and the best transportation that I've seen in any
city in the world. Its just very easy to get around, whether it be on
the subway, or the double decker buses, the light rail trolleys, ferry
across the river, and really cheap taxis. Great place to visit, not
super expensive. Additionally, just across the harbor is Macau. A
former Portuguese colony, Macau is a tiny island with 500,000 people
packed on. It is considered the Las Vegas of Asia, and has some
pretty cool historical sights to see as well. I was really hoping to
see Macau and feed my gambling addiction, but unfortunately we aren't
going to make it. We were originally going to go this coming weekend,
but then we found out that Lee's friends did not get re-entry visas,
meaning once they leave the PRC they cannot come back in. And I guess
since Macau is a special administrative region, going there counts as
leaving the PRC. So someday in the future I will definitely come
back, and Hong Kong / Macau will be a leg of that trip for sure!
We came home to Canton on Sunday night. The ride back on the bus had
to be the bumpiest ride I've ever experienced in my life. Hong Kong
is very close to Canton, but due to border crossing et cetera it is
actually kind of a pain to get there. What should take 1.5 hours
actually takes 3.5 hours. Fortunately, they are going to be building
a high speed rail between Hong Kong and Canton, which should make the
trip take all of 20 minutes. This week, Lee and I started our
traditional Chinese medicine rotation. We've seen acupuncture and
some various other techniques that we will describe in more detail at
a future date. We finish in Guangzhou this week and Lee has some
friends from Purdue flying in on Friday I think. We will spend one
more weekend here and then its off to Shanghai and the World Fair for
several days.
Cheers,
Nick
Sunday, April 25, 2010
Friday, April 23, 2010
Hong Kong
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Wednesday, April 21, 2010
Esophageal Cancer
As a result, I've seen a lot of esophageal cancer cases, a few lung
cancers, and one breast cancer. The esophageal cancer cases in China
are intriguing since some of them are more proximal (IE closer to the
mouth) than ones we have in the United States (which are closer to the
stomach). I was talking to one of the senior thoracic surgeons today
and he was telling me he actually doesn't think it is the spicy food
(which I had posited as one cause in an early blog post). The reason
he thinks the cancer is not spice related is because in Sichuang
Province, the food is the spiciest in China (and incidentally some of
my favorite food here) and they don't have higher rates of esophageal
cancer. He thinks a contributing factor could be the extremely hot
tea that people in the southern areas of China regularly drink,
perhaps burning their throats frequently. Another possibility is that
eating pickled foods causes it.
Anyway, when a patient has an upper esophageal cancer, the tumor has
to be removed but something has to connect what is left of the throat
to the rest of the digestive tract. In the first step of the case,
the patient is on their right side and the surgeons go in from the
left rib cage, removing the section of the esophagus with cancer.
Then they go into the abdominal cavity, and remove half of the
stomach's blood supply (the less important half), and pull the stomach
halfway out of the body. Then with a specialized staple gun they can
actually turn the stomach into a tube. They then feed the
tube-stomach up through the chest underneath the sternum and directly
attach it to what is left of the esophagus near the mouth.
I've included three pictures. The first has a view of the stomach
after it has been turned into a tube. The second picture is of the
small section of esophagus that was above the tumor, which still
remains and needs to be attached to the lower section. Finally, I've
added a photo of a removed esophageal tumor. Keep in mind the entire
object isn't tumor; a good chunk of it is, but other parts are
actually just collateral fat and esophageal tissue.
Tuesday, April 20, 2010
Three Gorges Dam update
Rail Station to Wuhan. Wuhan is a city of approximately 8 million
people, and is a major locale in central China. Lee's friend Li Lei
picked us up from the train station in his new car - a GM Cruze. We
went to get hot pot for dinner and then Li Lei took us to one of his
favorite local bars where we had some drinks. Saturday morning we got
the standard beef and noodles for breakfast (a dietary staple for me
here) and we started driving to the dam which was 300 km away.
Unfortunately, we got a flat tire about 30 minutes outside of Wuhan.
After replacing the tire with a spare we drove to a local village
where conveniently one guy had a tire repair shop. We joked that he
had left nails on the road to get more business. It was interesting
for me to see a tiny village in China; Lee said the street reminded
him of the one he grew up on. I also noticed there were random
chickens walking around the fields by the village. Lee told me that's
because the chickens belong to someone. They will walk around freely
during the day, eating bugs or whatever. But at night they will
return to their coop and they lay their eggs in the same spot, so the
owner knows where to look. Lee also told a funny story of when he was
little, living in a similar village. He and 3 other boys teamed up to
capture one such chicken and then sold it to a restaurant for five
bucks. Apparently they can be tough to catch and it requires teamwork
and coordination. Furthermore, it was Lee who had to carry the hen
under his shirt and do the dirty work, but since he was younger he was
only given 50 cents of the 5 dollar bounty, and the older boys split
the rest. Clearly this incident has scarred him.
Anyway, the local tire shop owner actually didn't have what we needed
so we left and drove back to Wuhan to the GM repair center. After
waiting for a bit while the tire was replaced, we finally got back on
the road. The whole episode ended up delaying us by 4-5 hours, so we
didn't get into the city by the Three Gorges Dam, Yi Chang, until
late. We got hot pot again for dinner and then played a Chinese card
game in the hotel room. The game is like a supercharged version of
War, pretty fun, but I clearly didn't understand it well as I ended up
losing almost 100 Yuan to Lee and Li Lei (which is like 14 US
dollars).
On Sunday morning we woke and drove to the Three Gorges Dam which was
bout 30 minutes away. The geology approaching the dam was very
interesting. Moderate to small sized mountains but really sharp,
steep cliffs. It makes sense that a chose a site like this to build a
dam. I included a good example of the geology approaching the dam via
a photo of a crossing of a bridge approaching the site.
After arriving at the dam site they put you through security and then
you go on a tour bus. It drops you off at one location, and you get
back on and go to the next spot. Unfortunately, we didn't get to get
a close view from the base of the dam, so it was pretty hard to
appreciate how huge it was. It was also quite foggy the day we were
there so we could only barely see the other end of the dam (which is
over a mile long, anyway). Anyway, I've included two photos. In the
first one, you have a far away view of the downstream side of the dam.
In the second dam photo, we are much closer but we are upstream, so
its hard to appreciate how deep (175 meters or so) the dam is.
One of the most impressive things about the dam experience was a
painting that was drawn by a Chinese artist (this is the fourth
photo). It was a panorama of the entire upstream region of the
Yangtze that was to be affected by the construction of the dam. This
painting must have been over 100 feet in length, and it took the guy
15 years to paint it. I got a video of it and included only one frame
for this blog post. The painting, more than the dam itself, gives an
appreciation for exactly how much water the dam is holding back. The
reservoir stretches back for miles, and is quite deep.
The Three Gorges Dam is the largest power plant of any kind in the
world, supplying 3% of China's electricity needs (which are enormous).
The dam also increases navigation on the Yangtze by keeping water
levels up downstream during the dry season as the reservoir of the dam
is slowly allowed to drain. Most importantly, the dam provides flood
control for the downstream cities along the Yangtze, including Wuhan,
Nanjing, and Shanghai. One flood in 1954 in Wuhan killed something
like 30,000 people. There is a memorial to the flood, with a poem
written by Mao Zedong*, although I did not have the chance to see it.
I found a photo of it on Wikipedia, if any Mandarin speakers want to
translate it for me.
http://en.wikipedia.org/wiki/File:Wuhan-Flood-Memorial-0218.jpg
Even though over 1 million people were displaced by the dam, it is
hard to say it wasn't worth building. The number of lives that will
be saved by avoiding floods, the amount of energy generated (which
will pay for the dam before a decade), and the increased economic
activity are all huge factors. Not to mention that the energy
generated is not from fossil fuels, another great advantage in terms
of reducing pollution and keeping oil prices lower than they otherwise
might be. It's hard to argue against progress like that.
* Henry Kissinger (Secretary of State under Nixon, coordinated the
diplomatic opening between China and the USA in the 70's) described
Chairman Mao has a poet and philosopher, with Zhou Enlai being an
administrator and executor of Mao's vision. Kissinger described Enlai
as one of the two or three most impressive people he had ever met,
which is a pretty remarkable statement considering who Kissinger met
during his exploits. At any rate, I'm curious to read Mao's poem
after learning that Henry Kissinger thought of Mao in this way.
Friday, April 16, 2010
Let's take the train!
Pic 2 = Some parts are still under construction
Pic 3 = the fastest train in the world (it goes 210 mph)
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Wuhan
Wuhan is a smooth 600 miles from Guangzhou, roughly the distance from Indianapolis to New Orleans. We made the trip in less than 4 hours for about 70 bucks. The train from Guangzhou to Wuhan is the fastest train in the world. It was completed only this past December, and is the first leg of a chain that will connect all the way to Beijing.
I've got video of the first 5 minutes of takeoff, ie the train picking up speed to its max of about 350 km/hour (about an Indy500 car). Its really really fast.
Wuhan is situated on the Yangtze River and Li Lei is picking us up from the train station (also brand new and very impressive to put it mildly). Later this weekend he is taking us to the Three Gorges Dam, which is the biggest dam in the world by a huge margin.
I especially was thrilled about the train ride because it would give me a chance to see the rest of the country. Two things really struck me. One, it is remarkable to be sitting on the worlds fastest train and see farmers working giant rice paddies with their bare hands; this is another testament to the contrasts of China. The other thing that struck me is how much construction is going on absolutely everywhere. Its unbelievable. With the amount of construction I've seen we could build indianapolis dozens of times over.
Its a shame that we have such limited transit options in the states. China is larger than the US mainland, but certainly their population density makes it more economical. Still, we gotta start somewhere. Why not a modestly fast midwest corridor connecting Cincinatti to Chicago via Indy?
Pics next week if you're lucky, or if Lee uploads a few from his camera phone :).
Cheers,
Nick
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Thursday, April 15, 2010
Pizza Hut: Sharing Good Time.
Nick
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Breakfast of Champions
sell well in the United States, is a dish called "chaun fin".
According to Lee, the name literally means cow intestines. And the
reason it is called that, is because it looks like cow intestines
(specifically, the folds in the food are reminiscent of the rugae
found in mammalian digestive tracts).
Anyway, chaun fin is just rice noodles. The cook has a small shop on
our street with this bizarre oven that holds four trays in it. The
cook takes a tray and pours the liquid rice mixture on it. Then he
can add meat (rho) or egg (daun). He puts the tray in the oven and a
minute or two later pulls it out and the rice liquid has hardened a
little bit into a spread out layer. He then takes a scraper and
scrapes the food off of the tray and into a bowl for you.
I have a video of the guy doing this, its pretty impressive how fast
he is when he has a lot of customers. Anyway, here are a couple of
pictures of it.
Nick
Tuesday, April 13, 2010
A few more pictures of the temple
actually still clips from video that I recorded with the IPOD Nano
that one of my girlfriends gave me for my birthday. The IPOD videos
are pretty cool though, as they contain ambient sounds of the
surrounding forest. If I figure out a way to upload them to the blog,
I will.
Monday, April 12, 2010
"Tiger Country"
This patient is a 65 year-old female presented with headaches, nausea and vomiting. CT, MRI and angiogram revealed a very vascular cystic lesion in the posterior fossa, which is most likely hemangioblastoma given its hypervascularity, appearance and location. This case went on for 11 hrs yesterday. It was a very tricky resection because the feeding artery of the tumor was actually hiding underneath the draining vein. The patient's blood pressure was very unstable (going from 90/50 to 160/120 in just a few seconds) during the last part of resection because the tail of the tumor was very close to the medulla. In the last photo you are actually looking into the 4th ventricle at the posterior aspect of brain stem (medulla). The patient was awake, alert and followed command this morning. This is pretty amazing since many patients with this type of surgery would be left unable to breath on their own (damage to respiratory center) or in a permanent unconscious state.
Lee
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Baiyun Mountain
Mountain, which literally means White Cloud Mountain. It has been an
important site in China over the centuries. We walked up it via a
roadway and stairs (shut up Kim) and took a gondola down. Anyway, the
neatest thing on the mountain was a Buddhist temple that is found
about 3/4 of the way up. I don't think the temple is very old,
however, or at least it has been recently renovated. Here are a few
pictures from the trip to the mountain.
Nick
Sunday, April 11, 2010
Esophageal cancer in China
The interesting thing is that esophageal cancer in China is flipped from that in the US. In China, most cases are squamous and in the upper or middle third. In the US, most are adenocarcinoma and in the lower third, close to the stomach (gastroesophageal junction).
A diet high in spicy food and perhaps smoking and pollution explain the Chinese esophageal cancer. The American cases are caused by obesity and overeating. Those things lead to acid reflux, which causes cellular change in the lower portion of the esophagus into cells that are more resistant to acid. Unfortunately this change (called Barretts esophagus) also predisposes to the cancer that we see in the USA.
Nick
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Elevators
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Saturday, April 10, 2010
Guangzhou taxis
Two, they are extremely unsafe in my opinion. Why? For starters, the back seats don't have seatbelts. Its like they went out of their way to remove them actually b/c the belt is physically there, just the buckle is removed.
But its worse than that, because not only are there no belts, but there are solid steel barriers between the front and rear seats. These are designed to protect the driver from mugging I guess. But in any sort of accident, even one that wouldn't normally have the force to throw the unrestrained driver from the car, a person will be thrown headlong into the steel bars right in front of them and crack their skull like an eggshell falling on a tile floor.
Oh, I forgot to mention a third thing. Everyone drives aggressively, at least by my standards. Also, lanes are more of a suggestion than anything resembling a traffic law.
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Friday, April 09, 2010
Fyi
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a Guangzhou Artist
was painting on the street. He was a double amputee and he was
painting very pretty Chinese watercolor pictures (thats what Lee
called them). He was selling them for 20 Yuan each, which is about 3
US dollars. That is relatively expensive by Guangzhou standards for
something that is relatively abundant and easy to come across.
However, from a Western perspective, I've hardly seen anything like
them and I thought they were really pretty. So it occurred to me that
they are worth much more to me than 3 dollars, so I went back
immediately to buy more.
As it turns out, the local police had booted him and his wife from
their spot near the Martyr's Park. He was walking toward me and his
wife was still behind, yelling at the police. He smiled as I passed
but I indicated to him that I wanted more. Getting his wife to stop
yelling at the police took him a bit and then she let me look at the
stack of paintings they had. I got to choose the ones I wanted, and I
bought 5 more watercolors for 100 Yuan. Additionally, he had
watercolors of people and animals that were more complex but were
selling for 50 Yuan. I offered to buy one for only 20 Yuan as that
was about all I had at that point. While the man quickly agreed
(after all I had just bought 6 of his other ones), his wife kept
insisting on 50. I finally showed her that I
only had pocket change left and the man hushed her and agreed to my 20
Yuan offer for a nice watercolor of a farmer.
Honestly, I would have bought his entire stack if I knew I could get
them all home safely. I am worried that they will bleed into each
other or that they will get damaged; Lee says they won't bleed, but
they are very fragile. I will try to find a way to protect them. At
any rate, 7 beautiful Chinese paintings for 17 US dollars, each of
them very frame worthy. In fact, if I was more of a capitalist, I
would have gotten his contact information and had him mail these
paintings to America and I would sell them for 100 dollars each and we
would both get rich. Anyway, I've attached a photo of him painting
one of the watercolors. Very impressive.
Thursday, April 08, 2010
The other great thing about travel
It can be a humbling experience. Its good practice perhaps for being a surgical intern in a year.
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Wednesday, April 07, 2010
Spine tumor case
*No HIPPA violation here, all identifying info have been removed, you got a 1 in 1.3 billion chance to figure out who it is.*
Lee
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Tuesday, April 06, 2010
Nice
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Ordering food
Nick
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Walk sign
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Monday, April 05, 2010
Hot pot
Hot pot is basically Chinese fondue. We went to dinner last night and had it. Its basically a bowl w two sides (spicy and mild) over a heat source. Full of all sorts of goodness, like garlic and peppers and herbs. Then they bring out raw stuff and you heat it in the boiling pot w chopsticks and enjoy. For example we had beef, lamb, seafood dumplings, Chinese mushroom, and some other vegetables and things that I'd never seen before but that were good.
It was a lot of fun, but its a very communal and slow way to eat. People share the pot and the trays with food. People can go to get hot pot in groups as a fun social occasion. I'd love to find a restaurant in the states that does it.
We had beer with the hot pot. An interesting thing I learned is that the beer stems from the early 1900s. When western powers invaded China during the Boxer Rebellion, the Germans came too. And they built breweries, from which the Chinese picked up the beer thing. I am grateful for that, as good beer is enough to keep me happy anywhere!
I've also learned to be more careful when I chew and swallow. Chinese food here is almost universally spicy (and if it doesn't come that way I make it that way). But while not super hard on the tongue, the particular spice that they use will absolutely decimate your throat if it gets anywhere near the windpipe, and you will be coughing and burning.
Nick
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Day one continued
After the mall, we then decided to go to another shopping district. We got back on the metro and went about 8 stops west to one popular shopping district there. This place was pure insanity. So many people. So many shops w/ ridiculously cheap shoes, clothes, or whatever else you'd want. There were also restaurants, food markets, thousands of people - and this went on for blocks and blocks, on multiple streets.
Through the entire day I must have seen hundreds of thousands of people, but I saw exactly one other caucasian westerner. It drove home the point that Guangzhou is not a tourist destination (it will be in several years I predict). Its not that it isn't safe or welcoming, because it is both.
The city just hasn't experienced a tourism boom yet. While many people speak some English, it seems like the less educated residents don't, which is fine. But they're the ones running the shops, restaurants, and transit. I've been travelling around thus far with three other fluent mandarin and english speakers but I feel like without them I'd be having an extremely tough time. This is all a good thing of course. I feel like I'm getting an incredibly unique experience here, really feeling how culturally powerful a huge city in China can be. But I know it is an authentic experience as well, since there aren't any watered down tourist havens that I've been in yet.
Anyway it is 7 am and my first day in the tumor hospital is today. The hospital is one of many and is absolutely gigantic. Will post pics soon hopefully :)
Nick
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Day one in the markets
We then met our SYSU medical friends who have been showing us around: Kristina Lee and Jue Wang. We boarded the metro stop at Martyrs Park and took it two stops east to the Tee Mall, which was the biggest in Guangzhou. It puts Circle Centre thouroughly to shame. It is a very nice mall from an infrastructure point of view. If I had to guess I'd say its 2-3 times the size of circle center. The contrasts were stark: some shops had expensive imports that wealthy Americans can't afford, others had very cheap wares.
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Sunday, April 04, 2010
Supporting the Chinese Economy
Thank you Sallie Mae!
Lee
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Saturday, April 03, 2010
Finally in Guang Zhou!
Lee
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Test
Nick
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Mmmmmmmm
Cheers,
Nick
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Seoul
Leaving for Guangzhou in 5 hours.
Lee's birthday was yesterday (april 3) but it only lasted for 12 hours. Mine is today. Cheers!
Nick
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Friday, April 02, 2010
Hello Chicago!
Lee
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Lee will be posting too!
Cheers,
Nick
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And we are off!
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United Airline
Lee
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