I was in the OR to view my first ever cardiac surgery. (Come to think of it, my first ever surgery viewing, period.) Wow. What an incredible experience.
There is a very intense and complicated dance that goes on. Cardiac surgeons, perfusionists, anesthesiologists, nurses… And everyone is constantly preparing for the worst, and hoping for the best. The activity, clearly, centers on the patient. But the activity around them is immense. Scrub nurses are constantly cleaning or preparing instruments, should the surgeon need something. An additional nurse is getting supplies and refilling them. Perfusionists are monitoring and administering the heart-lung bypass machine, which the patient comes off of and goes back on at different times in the surgery. Anesthesiologists keep the patient sedated and ensure they are doing well.
Surgery did not go as well as hoped for today. Which is extremely sad to me. I met this patient last night – a 17 year old boy – bright, articulate (more than passable English), hopeful. His parents were sweet and appreciative. They were not destitute and looked like a lower middle class family – well dressed, well spoken. Only a portion of what they hoped for occurred. He will require another surgery to get to the portion they could not. It is late for this child to be having this surgery, which adds a complication.
I gained a great deal of understanding, and appreciation, for the work done by the surgical teams. And I have a much greater understanding of how the ICU team takes care of the patient and is really the lifeline for them. Surgery (generally) takes a few hours and is critical, but the post operative care is essential if they are to survive. My understanding is that pediatric cardiology requires more teamwork and multidisciplinary work than most other specialties. Without exception, the people I have met – from the Toronto team we brought and the local team – are caring, hard working, down to earth individuals who care deeply, and respectfully, for their patients.
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In China there is a deep seated cultural reverence and deference to the more experienced members of society. This cultural more goes back many thousands of years, probably in part because if you managed to live into your 60’s, you must have done something right.
The implications of this and the ways it expresses itself is interesting. On a simple level, when walking down a street, people move to the side for the elderly. Slightly deeper, this is still an apprentice society – you learn your trade at the feet of a more experienced elder. Whether that trade is woodworking or medicine, society is structured in ways that require patience and waiting. While I have not yet been able to figure out the medical training system here (and neither have my colleagues), it is very different from the United States. You get a “medical degree” and then work for several years with more experienced doctors before passing a large examination and then studying to become “a doctor”. Along the way, it seems, you get “sponsored” by an existing physician who oversees your training and development.
And in China, you never just enter a room for a meal and take a seat. There is, for every dining experience, and order and hierarchy to the seating. The most senior person sits in the center of the table, facing the door, with the next most senior (or important or an honored guest) person on their left, and the next most senior (or important or an honored guest) on their left, and so on. Where you are asked (or told) to sit is a clear message to others in the room. And someone joining the party in the middle of a meal can result in a significant reshuffling.
This reverence and honor of elders is extremely deep seated. While it can be confused with a deference to authority, it seems to me that that is actually secondary due to the nature of life – older tends to be senior. You don’t question your elders, you wait for them to unfold their plans or share their thoughts in their own time. And because you did this for them, you expect the next generation to do the same for you.
I do not know how modernity will impact this age old tradition. There is something calming and assuring about knowing your place and the expectations of you. The reverence feels like it comes from a place of love and respect, not some expectation that is forced on society. And it is deeper than “It has always been done this way…” With the change to city life and the fast paced nature and get ahead mentality that often associates itself with it, I am unsure how, or if, this cultural and historical norm will be affected. I am not sure it will last. It may be like Tevye - a lonely milkman pushing back against the ever growing crush of modernity. But certainly something will be lost from the world.
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