Epic Journey

So my trip to Shanghai was... well....

I made it here, that's the first thing. I made one little mistake, though -- not buying a train ticket far enough in advance -- and my 9-hour high-speed train trip turned into a 15-hour slog.

Words of wisdom -- buy your train tickets well in advance, two or three days instead of the day before, like I tried to do. Once I got mei youed on that one, I got the next available ticket... on the night train, which left at 4:30 pm and got in at 6:30 am the next morning. No problem.

Except that all they had were hard seat tickets. It was shaping up to be both a long trip and an uncomfortable one. Which, frankly, it was. While I'd love to be able to regale you with a tale of a romantic jaunt through the Chinese countryside, with scenery and a stop where people were selling everything from food to livestock to herbal medicine through the windows of the train, culminating with a fight between myself and a gongfu master underneath the train and in a nearby barn (a la Chan Long in Legend of Drunken Master), alas, it was not to be.

Instead, I was in the aisle next to two other people on a five-foot wide seat, interrupted every ten minutes by the staff who were selling food and snacks, every five minutes by someone walking down the aisle and jostling me... and once at 1 am by someone in a uniform who walked down the aisle and asked people questions in a voice loud enough to wake the dead. I got the impression he was being a thug just for the sake of being a thug, though I could be wrong.

Before I go any further, I want to point out that this was ultimately more entertaining than upsetting or distressing. If I'd thought that this was representative of China, it might have been different -- but few people are at their best while traveling, and some people just become jerks when they put a uniform on.

Then there was a 45-minute delay at the last stop before Shanghai. So my 6:30 arrival time was nearly 7:30, and I only met Ole (the new friend I'm staying with) through the grace of his flat tire before he had to go to work.

But Shanghai is nice. It's very big, but easy to get around here. Bicycles are everywhere, and it's a very walkable city. Hard to find a taxi sometimes, but that's only relative to China -- I've never had to wait more than five minutes. And there are a TON of Westerners and Eurasians. A lot of people speak English, and Caucasian faces are so common that I don't get stared at. That was something that I had hardly noticed until I got to Shanghai -- being stared at was more noticeable, at least this far into the trip, by its absence.

Now, I'm planning my last two weeks... and Huangshan might be back on the schedule, since I've had it so highly recommended. I'll keep you updated!

Leaving Tianjin

I'm finding it hard to motivate myself to write this post -- a lot of the reason for that is that six weeks is an awkward amount of time. It's just long enough to start making friends and see the potential in those relationships; it's not long enough to actually realize the potential of those relationships. You don't normally stick with folks you know for less time, unless there's some intense experience (say, backpacking in the wilderness, or being on a bus that's wired to explode if it goes under 55 miles per hour) that forms a bond.

But I've been having to say good-bye to friends today and yesterday -- Wang Ting, Natasha, the foreign students who were likely to become the "usual suspects" with me, and so on. We've exchanged e-mails and so forth, and making just these kinds of contacts (along with the professional ones which didn't deepen either) was part of the reason I came here in the first place.

But I'm not reluctant to leave. A little sad, maybe, but not reluctant. Would I like to stay longer? Yeah, probably, if finances and life and my desire to start practicing didn't interfere. Six months would be ideal, but even one semester (16 weeks) would be enough to really get into the pattern here. Like I've said before -- Tianjin isn't the prettiest China has to offer, but there's something about the whole experience that I'm really enjoying. It's a gestalt thing.

That said, I'm off to the Pearl of the Orient tomorrow morning, taking the train because I've got the time and I'd like to see the countryside. I'm almost all packed up, and ready to get to the train station as early as possible tomorrow. We'll see how that goes.

I was planning to post my last Chinese medicine post for a while -- but Friday was actually pretty slow in that respect, and therefore I really don't have a whole lot to talk about. Going out to dinner to the Richmond (a -- get this -- German-style bar and restaurant) and then dancing is much more of a highlight -- but more because of the company. And my camera died on me (again), so I don't even have many good pictures. But they'll come... just be patient!

It's been cold here -- in the teens and single digits (Centigrade) the last couple of days. No other weather yet, but I have a feeling that when I head back to Beijing, I'll be looking at snow. Unfortunately, I lost my blue-and-orange striped scarf somewhere -- I know I packed it -- so I'm making do with a fleece jacket and gloves. Who'd have thought, after such heat only a couple of weeks ago?

See you in Shanghai!

Conference time

The last couple of days, I've been attending a conference at the Tianjin Hotel (about a ten-minute drive from the school). I think I mentioned it before -- it's the school's 50th anniversary. It's also the 11th conference on acupuncture, the 5th on herbal medicine, the first on TCM education.... anyway, it's a lot of to-do. But I sat in on some of the sessions -- mostly presentations of clinical research. It was interesting, what I could understand of it, since the interpretation (with the cool UN-style headphones) was at times terrible. But there were some good presentations on stroke recovery, emergency acupuncture using 人中 (Renzhong, Du 23) in the treatment of shock, and so on.

Yesterday had its moments. The morning was entirely consumed with the opening ceremonies and speeches -- no surprise there -- and I got to hear both Dr. Goto speak, and Dr. Shi, who went on for a good while about the Xingnao Kaiqiao (Clear the Brain and Open the Orifices) theory of treating stroke. Although I never did get to see him clinically, from his speech I can see that the First Teaching Hospital at Tianjin University of TCM is continuing his work and research. It was actually quite good, even if a bit redundant.

Then came lunch -- which, although there was a banquet for the attendees, I was technically there on the employee plan, apparently. So I got... a Big Mac.

Ten years or more since my last Big Mac, and I have to go all the way to China to get it. And it tastes almost exactly the same as I remember it, for whatever that's worth. Since a Big Mac costs about the same here as it does at home (15 元, a little over $2 US), I don't think I'll have another. That's what I spend on three meals, some days.

Today, though, that was not meant to be. Breakfast -- chicken in flatbread. Lunch -- a couple of different dishes, and an egg. An afternoon snack of those seafood aebelskivers -- still odd, still strangely tasty, I'll get to those in another post. And for dinner, Ting and I went to have 火锅 at a relatively hot restaurant near here. More on that later -- but 火锅 roughly translates as "hot pot". But this isn't like the Taiwanese hot pot that you find at Koryo or something else in the Bay Area. This is... real broth. A divided "pot" with spicy on one side and mild on the other. Chinese herbs in both broths. Very nice... and Ting and I ate ourselves silly. It was nice, and she insisted on paying for me.

One last thing about that. Dinner cost 163元, a little over $20... and we had four-star service throughout the meal. Attendant in the washroom, refreshed hot towels, as much or as little attention as we wanted, complimentary snacks while we waited for our table. Amazing what you can do in a country where labor is still dirt cheap.

Anyway -- last day in clinic tomorrow, probably my last post on Chinese medicine for a while coming up, too.

And definitely the last word on politics for a while in this space right now.

I feel truly honored to be alive to witness how the election went, and to be a part of that moment was just amazing. I'm having trouble finding a working set of headphones, so I haven't listened to any of the speeches, but I will... and for the most part, it was a good day for civil rights in the US on Tuesday. I'm not going to let the Prop 8 vote get me down much. There's always one more thing to think about, and I'll just enjoy what I've seen, and worry about what I can't directly affect some other time. Even folks over here are pleased to hear that Obama won... read what you like into that, but most people are just happy to see some change in the US.

Last week in Tianjin!

So it's the beginning of my last week here in Tianjin.... and I finally got to go to the Andryny specialty of the Psychosomatic department! So, the good news is that, unlike a Western Urology department (which is a rough equivalent), I don't have to look at dribbling urine and limp penises all day. I might have to hear about them, but at least I don't have to look at them!

My supervisor, Professor Wang (stop giggling, Discourser), reminds me of my maternal grandfather -- if he'd been a doctor. Oh, and if he'd been Chinese. A little bit gruff, but generally warm underneath that -- and Professor Wang has the same hair and face as Ham did.

Now that everyone not related to me is yawning, let me get back to clinic. It's a lot of prostatitis -- mostly men in their 20s and 30s with dysuria, ultrasounds that often (but not always) show an enlarged prostate, and a history of antibiotics not doing much. Here, we're taking a three-pronged approach -- acupuncture (of the six-to-eight needle variety), herbal medicine by mouth (usually raw and customized), and herbal enemas. (I said, stop giggling, Discourser!) Both of the last two are administered by the patient at home.

I've also gotten treatment plans and formulas for a bunch of the other men's issues, including BPH, ED, prospermia, and so on. Surprisingly (to me at least), using lu rong/ lu jiao jiao (deer antler/ deer antler gelatin) is pretty uncommon for these conditions... but there's a lot of wu gong (centipede) being used insead. I'm going to have to hit the books when I get home and get a good idea of why... and what I can substitute, since in the US wu gong is tough to get and hard to talk people into taking.

As an aside, I do plan to do a quick photojournal for folks who keep wondering about what it is that I'm eating. So far, seafood Æbelskivers are the most interesting, though the guy who makes them is a bit of an ass.

The pace in the men's clinic is a bit slow. But on the other hand, the professor handed me a couple of needles and told me to puncture 足三里 (Zusanli, ST 36)! So I took a deep breath, and....

No guide tube. I'm working with a 3-cun needle (about 50mm) with no guide tube. And okay, so it's thick (diameter of 0.30 mm) -- for an acupuncture needle. But there's no guide tube.

I manage to get it in anyway, and with only the slightest of winces from the patient. Then Professor Wang goes ahead and gives me a crash course in flying needle technique! Okay, you'll have to indulge my acupuncture geekiness a little... it was totally cool. I get it -- and it makes a bunch of the other techniques make a little more sense. Now, it's going to take a year or so of practice before I'm comfortable with it, but that's neither here nor there.... I'm thrilled with the experience. And it makes bulk packs make even more sense, since you don't have to stop all the time to reload your guide tube with a needle -- and I'm convinced it can be as painless as using a guide tube, given good enough technique.

Okay, enough of that. Looking to the future.... tomorrow marks the celebration of the 50th anniversary of the Tianjin University of TCM, and it coincides with an international conference held here every year. So I'm going to be going to that tomorrow and Thursday. Then another day in clinic, and then off to Shanghai!

Happy Election Day, everyone. Get out and vote, those of you in the US (which I imagine is pretty near everyone reading this blog), unless you already have. I don't plan to turn this into a political space, but let me mention a few ballot measures in California that matter to me.

YES on Prop 2. Be nice to chickens! The way we produce our food is, as many of you know, one of my pet causes, and this includes humane treatment of the beings we get our food from, whether animal or vegetable (or, I suppose, mineral, though with veggies and salt it's more of an environmental issue).
NO on Prop 4. Too many people involved in healthcare care too much about this issue for me to think otherwise... restrictions on the right to an abortion costs young women their lives and health far more than abortions do.
NO on Prop 8. This is the biggie for me... I've got far too many queer friends to even question this one, and I missed a wedding because the parties involved were too nervous about the result of this.
And lastly, I'm pro-Obama. I doubt anyone's surprised by that one... letting the geriatric generation run the country hasn't been so good for us young 'uns.

But just let your voice be heard. If you knew the hoops I had to jump through to vote overseas, you'd want your readers, friends and strangers, all to take advantage of this basic right (which I've had to explain to several people here in China). Talk to you after it's all over.

Halloween again.

So events conspired to make a liar out of me. I ended up going out with some friends who I ran into in the hotel lobby.

This is the sign in front of Broadie's... I was not prepared to be impressed -- although they had a mini-haunted house in the front, with a strobe light and fog and big hairy spiders and people dressed up making scream-like-you're-in-hell noises.

Once through that, I'd say that the place had about 80 people in it -- just about enough for all the tables to be filled, without too many having to stand. And about half the guests were expats of one stripe or another -- from all over. I heard Korean, Spanish, and German, and caught an English accent from a girl who was almost too drunk to stand unaided. About half of the expats, and all of the staff, were dressed up in one capacity or another.

There was live music, and the band was pretty decent. All Chinese including the singer (who had legitimate stage presence and a great set of pipes), they did jazz interpretations of popular songs from the last, well, 60 years or so. From Buddy Holly onward, including a surprisingly decent version of Michael Jackson's Billie Jean. But no Thriller, despite the fact that there were zombies on staff.

I mean, there were people on the staff dressed as zombies. Not actual zombies. Sorry, The Warden, you'll have to save that plan of yours for another day.

Anyway, I don't think we could have gotten them to dance properly. They were clearly having fun, but not THAT much fun. So anyway, the music was good, the company was good, the beer was imported, and the food was -- get this -- actually good. I mean, Western-style food, actually tasting good here in China? The mind boggles. I had a hamburger that was recognizable as such, with mushrooms (actually sauteed before being put on the burger) and cheese that was no worse than what I'd expect from pub grub in the US. (Although definitely processed cheese food, not actual cheese.) And bacon, also decent, and fries that did the potatoes credit. The folks who had pizza were also impressed -- again with the processed-looking cheese, and the crust had that funky curled-up edge that you get when the pan's sides are too high and the yeast isn't really active enough, but I'll stop geeking over the food science and say that the food was expensive, but decent enough for a splurge. I mean, I spent 100元 on two 500 ml Carlsbergs and a burger. That's my food cost for about four or five days normally, but, you know, maybe $15 US in the grand scheme of things. I've spent more on that in the US and gotten the same result, only without the live music (no cover charge).

So -- pop quiz! Guess the nationalities of the folks around the table. These were my companions last night -- folks I'd seen around the school and hotel, but last night was the first time I'd really gotten to know any of them. Prizes and adulation to the one who guesses the most correctly. One hint -- there's only one American at the table besides me, and I'm not pictured.

Along those lines, I have to say that my experiences of the worldwide expatriate community have been amazing. I don't know what it is -- maybe the psychological makeup of people who leave home for work or study, maybe just the shared experience of an unfamiliar culture -- but the expats I meet are almost invariably good people. One of my friends from last night also mentioned that people who study TCM seem to share a common bond, and are generally good people. I tend to agree.

One last picture, for those of you who know the pubs along Clement Street in San Francisco. I couldn't help myself -- although the small print underneath says "Tianjin's only Irish band", it still reminded me of home. Since the banner was left over from St. Patrick's Day, I didn't figure I was going to get any more information.

All in all, it was a decent way to spend a Halloween night, considering that I was half a world away from the usual haunts. I wish I could be there tonight with some of you guys, but that's the way things go.... I wouldn't miss this experience for the world.

Halloween 快乐!

This post is almost necessarily a quickie -- I posted last night, and there isn't a whole lot to report. But I couldn't let my favorite holiday go by without some kind of mention.

Not that it's much of anything here in Tianjin, so far as I can tell. I imagine that some expats are having a party, somewhere, but since I haven't met any American expats who are still here.... I guess I'll have to go around the rest of the night dressed as a 洋鬼子 (yang guizi, "devil foreigner").

So much for my attempts at humor for the evening! Anyway, today I was in the psychosomatic department -- but not the Andryny sub-section. Working on that for Monday or Tuesday, but the real problem is that most of the translators are women, and the guys don't want to be confessing their sexual inadequacies in front of women. Go figure... it's really not all that different from in the US.

But this was a total change of pace. The patients are mostly insomnia or depression cases... sound familiar to any US-based Chinese Medicine practitioners out there? It's mostly being treated by the doctor with a combination of Western medicine and Chinese herbs, with occasional acupuncture thrown in, instead of the other way around. Here's one of the places where Chinese is a lot easier, since it's 西药 (Xiyao, "Western Medicine") and 中药 (Zhongyao, "Chinese Medicine") to differentiate the two. When I explain the regulatory environment in the US to folks here, I get amazed looks that (a) anyone can prescribe Chinese Medicine and (b) a licensed TCM practitioner can't prescribe ANY Western meds.

The patients were mostly repeats, so the pace was pretty quick -- 57 patients between 8:00 am and 12:30 pm, to be exact. That's almost 13 patients per hour! And the new patients took some time -- 20 minutes to half an hour each. Good thing we only had about three of those.

Anyway, I'm off to haunt the streets for a little bit. Give some candy to some kids for me.

Minor changes in plans...

So I went to talk to the head of the Foreign Affairs department at the school today, and she told me that there could be a slight change in plans. Instead of going to the 8th floor tomorrow morning (Friday), where I'd see the stroke inpatients again, I'd be going over to the Psychology department -- where I'll be following one of the doctors who's in the Andryny specialization. That's the men's health angle that I was thinking about when I came here in the first place. Of course, because of the acupuncture focus of the school and the stroke service, I pretty much went with the flow, to (I think) very good effect. But this is something I was hoping to see while I was here.

Treatment is a combination of acupuncture, Western medicine, and Chinese herbal medicine, so I'm totally going to have to be on my game if I don't want to look like a dummy. But that's no problem. The only problem is that the doctor I'm supposed to be following tomorrow is only available Monday and Friday of next week -- and that's supposed to be my last week in Tianjin! I'll see if I can get another doctor to follow on Tuesday, at least. Then there's a conference that has some interesting lectures on Wednesday afternoon and Thursday morning. So I'm just busily remaining flexible!

The afternoons upstairs are generally pretty slow, so the instructor takes some time to go over specific treatment protocols with me for different conditions (besides stroke). These aren't the same as what I got in the textbooks in school -- they come from one of the doctors here at the school. So I've gotten a little list of things to try based on other people's experience, too.

One of the things that's a little frustrating is that the computer system they use here to place doctor's orders is interminably slow. It literally takes half an hour to update anyone, so if (like today) a patient needs something for her cough, interns who can't read the Chinese (and consequently can neither help nor learn) have been stuck doing, well, nothing. But the last couple of days, the instructor has brought a book of research papers published at the school, so I've gotten additional notes on treating obesity, manic-depressive disorder, prostatitis, and, of all things, conversion of atrial fibrillation with acupuncture.

Good stuff. Stay tuned!