If I forget thee, Fuzhou
Things I want to remember about this trip to China. A to-be-modified list.

Standing with a section of dissected stomach in the pathology laboratories of the Fujian Tumour Hospital, while smiling for the Fuzhou television news cameras. Later in that same photo op, looking wise and pathologist-y while looking through a microscope at what was, to be completely factual, slides of perfectly normal thyroid. Being asked six times what my opinion of Fujian is. (Uninformed? Naive? "Please get some traffic laws enforced, and quickly too"?)

Strolling round the eerily empty grounds of one of Fuzhou's several gated communities, to which we were invited by a gastroenterologist at the Fujian Provincial Hospital. His house was huge by Chinese standards, and beautiful. A park in the center of the compound is surrounded by statues of Mozart, Schubert, et al. "What do the farmers do whose farms used to be here?" "They work in the development."

Industry Enterprise of Nanputuo Temple Xiamen, Vegetarian Dept. A/k/a the best vegetarian restaurant I have ever eaten at.

The abovementioned Nanputuo Temple, the first Buddhist temple I have ever set foot in. "Zey davenen! [They're davening!]" said Blanca as she watched worshipers with their candles. "Nisht genoy davenen, zey tuen tefile. [Not exactly davening, they're praying.]", I managed to come up with.

Blanca's kindergarten class at four forty-five, pickup time: thirty sets of hands grabbing at the wooden barrier separating them from their parents, while my daughter sits cool as a cucumber in the middle of the room, in her chair. "Oh, hi, Dad," she might as well be saying. "Here you are, then."


Vegetarian restaurants: a taxonomy.
Or: La la la la la! I can't understand you!

There are several kinds of vegetarian restaurants, and each have their place in the world: the restaurants based on the theory that vegetarian cuisine must imitate meat; the homestyle places; and those which manage to break free of the limitating modifier "vegetarian" to sublime deliciousness.

The first vegetarian restaurant we acquainted ourselves with here in Fujian province was of the first type (Fake Meat), and very tasty. We chose it as the site of the farewell banquet we threw last night for our Chinese friends and colleagues.

According to the textbooks, Chinese friendship is fueled by favors. In my brief time here, I've learned that this is true -- but it's not just cold quid-pro-quo'ing. Having to perform favors to keep the wheels of society going means that one is always on the lookout for favors to perform. Sort of like observing the mitzvot. Last night at the banquet we threw I experienced a marvelous balancing of emotions: satisfaction that we could treat our friends, and warmth at the hospitality and welcoming nature of the Chinese that had occasioned this treat of ours. Or maybe the warmth came from the not-bad Chinese beer, and the many times I said "ganbei." (Everyone pretended to understand my toasts -- courtesy of the Oxford concise Chinese-English dictionary and an American soupcon of linguistic chutzpah.)

We took a taxi back to our apartment complex, and the three of us walked around the circular driveway connecting the buildings. In a large, empty room in the middle building, whose windows looked out onto the driveway, we saw a solitary man playing the recorder. His music was beautiful, though I couldn't identify it as anything more specific than "Chinese."

The security guard and the doormen were chatting outside. I managed to ask them, in Chinese, "Does he play every night?", and they said no, just a couple of times a week.

"Is he a musician?" I asked.

They both laughed. "Sorry! We can't understand you! Ting bu dong!" No! I wanted to shout. Give me another chance, please! I can make this sentence work! I can change around the tones!

I have some experience with speaking languages other than English, my native tongue, and I can tell you that Mandarin Chinese has been the one which (in my brief time here) has demonstrated the most frustrating variation in how (or whether) I'm understood by the person I'm talking to. I performed an unintended experiment a few days ago on a street in Fuzhou, going into several establishments and asking, "Excuse me, please, where's the internet cafe?" Of five people I asked, three responded, one looked at me without saying anything at all, and one, a young woman working at a salon, shrieked, covered her face with her hands, and ran inside. Is it my Mandarin, or is it the fact that I'm six-foot-two and blonde?

I tried to ask the women my question again about the recordist, but the great wall of incomprehension was down for the night. I got to understand a bit; that's a tantalizing symbol of my entire trip.

The second type of vegetarian restaurant is typified in my mind by Veg City Diner, in New York (rest in peace!), now replaced by Curly's Vegetarian Diner. In other words, it's been a great trip to China, but it's going to be time to go home soon.

The third type of vegetarian restaurants include the best I've ever eaten in. Ladies and gentlemen, I have been to the mountaintop: the best establishment I've ever slurped a noodle at is right here in Fujian. More information to come.


Passover in Fuzhou: discoveries and reacquaintances

Fish breaded with matzah crumbs, fried in peanut oil. Yum!
Fish soup.
And more fish.
The chocolate macaroons, carried across two continents and a great ocean, from The Sweet Life on Hester Street.
Salted peanuts.
kheroyses (charoset) made with dried fruit from said candy store, doused in red wine, and left to sit. More wine than fruit. Also yum.

Now the wine is used up, so this Shabbos it's pineapple beer and lychee-nut beer. Will report on consequences.


A code on the unit
The resuscitative dance.

MEDICINE MENSCH: Springing Into Action
By Zackary Sholem Berger
April 14, 2006

In the hospital where I spent my critical care rotation, the patients in the intensive care unit ("the unit," for short) weren't as sick as those in some other hospitals. They were all more or less aware and oriented to their surroundings. You could have a conversation with them.

On one not particularly busy day, a team of doctors was standing in a patient's room, chatting. The full-length windows (a common feature of ICU architecture) showed a sunny day. We were talking both to and about the patient, shifting easily between including him in the conversation and cutting him out of it. A nurse popped into the room occasionally, to take care of something or to confer with one of the interns. The other students and I hung out in the back of the room, talking about what residency programs we matched with and about our upcoming vacations. It was strangely peaceful.

Once again, a nurse again came into the room; she whispered to an intern. The intern's face assumed an expression of practiced frustration, and he left the room with a sigh. Purely out of curiosity, we three students followed him into an adjoining patient room. There the electronic monitor showed a grossly irregular heartbeat, and the elderly man in the bed said he felt uncomfortable and couldn't breathe. We couldn't breathe for a second, either — we knew that the heart irregularity we were looking at was deadly, more often than not.

Then everything started to happen at once. Someone called out, "Let's bag him!" and a mask was placed over the man's nose and mouth to help him breathe. He was still conscious and could state his name clearly through the mask, even though the beat on the monitor was still irregular. "He won't be conscious for long with that rhythm," someone said.

Someone else called a code, or a signal over the loudspeaker connoting a medical emergency. More generally, a "code" is the high drama of resuscitation made mundane by repetition. It's a combination of shared concentration, workplace banter and choreography that no one ever should have to witness as a bystander. This was the last code I saw as a medical student, which means it was the last code I could spend flattened against a wall, hoping no one would run into me, and occasionally running tubes to the laboratory or trying to page someone on the phone. I couldn't see the patient from the corner where I was standing, but the elderly man was now lying quietly on the bed as the team maneuvered around him. I hoped for his sake that he was already unconscious.

To the uninitiated, a code is chaos. I'm definitely not fully initiated yet, but I know enough to say that the chaos is only apparent. People participating in a well-run code, like any other piece of complicated teamwork, have their well-defined roles.

But even in this lifesaving drama, people can demonstrate their flaws. One doctor — whose specialty I won't reveal — wasn't able to do what he was supposed to do. And when the senior resident, who was running the code ( i.e., giving orders and directing the choreography), told him to take a minute and do what he should have done, he responded with an expletive.

To everyone's great credit, no one paid any attention. There were smirks and raised eyebrows, but people kept on doing what they were supposed to do. This was the first remarkable phenomenon of the code: Conflicts that ordinarily might have disrupted the choreography only served to emphasize how smooth it was.

One other thing happened, which is horrible to relate. Despite everyone's best efforts, the patient died. Half an hour after the 20 or more people in the not-so-large room had begun their unsuccessful struggle, only a few people remained with the deceased, and it was time for our team to resume rounds. We went back out into the hall and talked about the other patients. Then, finally, we retreated to the on-call room.

But even then, when we were safely out of view of everyone else on the unit, it was not a time to cry or to mourn. We kept talking. The attending physician who was rounding with us said that we should not beat ourselves up about the patient's dying, that everything had been done the right way. He made a few observations about the code, we shared our impressions, and that was that.

In the cold summary of hospital jargon, the patient had "coded." A hospital doesn't allow much deliberation during the aftermath. Perhaps the only lesson to be learned is that best expressed by Robert Frost in his poem "Out, Out," about a horrible accident:

They listened at his heart.
Little-less-nothing! and that ended it.
No more to build on there. And they, since they
Were not the one dead, turned to their affairs.

Except there is a saving grace. The affairs we turn to in the hospital are the saving of other lives. For good or ill, this is the only ritual observed in every hospital on the death of a patient: going back to work.

Zackary Sholem Berger is a frequent contributor to the Forward. He will start his primary care residency at New York University in July.


Two weeks in Fuzhou

My primary thought about being in China right now is: "What am I going to cook for Pesach?" (Answer: Fish soup. The fish are beautiful here, and the produce fresh and bright-tasting. Do I know how to fillet? Not yet. Can I ask for fillet at the store? Already tried that: after fifteen minutes of back-and-forth, I got a fish sans head but otherwise unaltered. So bring me the fish knife, squire!)

My secondary thought is this: I expected totaliarianism to be more . . . evident somehow. A Soviet grayness to everything, a hesitancy to speak about certain matters. It is true that the medical students I have the pleasure of spending time with did at first decline to criticize the government in public. But tonight we went out together, and they asked me what I thought of Chinese democracy. After a few minutes of pursuing the topic, I got the impresssion that they just don't care. It's all politics, one of them said. Would it matter if they believed the horror stories I'm telling them about their government's oppression? Or is economic life in China (for a certain class) just too much improved for the accusations of the disaffected to make much difference?


Tang meets WCW
Not quite Lolita in Teheran.

Somehow, exchanging poetry is even more interesting than typing information on cases of gastric cancer into a database.

As with every conversation with this group of Chinese students (all women), we talked this way.

1. I try to say something in Chinese, after looking up all the words I need in the dictionary. (Preparation time: 15 minutes per sentence.)

2. My interlocutors look blankly at me. Then one of two things happen:

a. "Oh!" The shock of realization, and they repeat the phrase with proper intonation. Or:

b. They grab the dictionary so they can figure out themselves what I'm trying to say.

3. Repeat.

This time we were talking about poetry. (The last time we were talking, I tried to use the phrase "vegetarian restaurant," and one of them asked politely why I needed access to a library. Tones matter, ladies and gentlemen. Don't try speaking Chinese without a high tolerance for non sequiturs.)

"What is the difference between 'poetry' and 'poems'?" they inquire.

Um -- poetry is "writing poems," the art of poem-writing, I responded lamely.

They had favored me with handwritten copies of two poems from the Tang Dynasty. (I'm now in love with Tang.) In return, I gave them a scrawled copy of William Carlos Williams' poem about the red wheelbarrow.

While trying to explain the poem, it became obvious how little I understand it. What is the meaning of "so much depends/upon"? Don't the white chickens (why white?) lend a comic air to the whole image? (A student asked if Williams meant to eat the chickens. Shades of the Koch parody.)

I asked them to bring me a modern Chinese poem. They agreed, but one said, "I don't like modern poetry. It's not beautiful. And it doesn't rhyme."

I suppose it's nice to know that some misconceptions are universal.


Preparing for a Chinese Seder

In thinking about our Fuzhou Passover, I've been trying to avoid the cliche of China-in-bondage. But the facts keep rearing their ugly dragon heads. Did you know, for instance, that Chinese university students are not allowed to marry? Or that the recent unrest in Guangdong province, in which police shot and killed protesters, hasn't even been heard of by the medical students I've talked to here in next-door Fujian?
Allegra Goodman's Science Fiction
A review for the Forward.

In her new novel, "Intuition," Allegra Goodman invokes the world of medical research with the convincing detail of an insider and an outsider's penetrating gaze. The book is a modern epic, a slimmed-down, suspenseful version of one of the 19th-century classics: a narrative about large social forces that is also a tale of unhappy lovers and broken-up research families.

The laboratory of Sandy Glass and Marion Mendelssohn is prestigious but frayed at the edges, in need of intriguing results to push forward a grant application. Cliff, a young post-doc whose previous experiments failed miserably, comes up with surprising new findings. But are they real? His newfound success is met with suspicion, and with accusations of fraud, by Robin, who is a fellow post-doc and his erstwhile girlfriend; the resulting scandal reshapes lives and careers with unforeseen consequences.

The real-life course of scientific scandal can be impossible to untangle — and often dull. Goodman's portrayal, on the other hand, is riveting, calibrating narrative revelation while preserving the ambiguities of scientific dispute. This is moral fiction without moralizing, in the tradition of Jane Austen — and, for that matter, Philip Roth.

Goodman's previous novel, "Paradise Park" (2001), followed a memorable Jewish woman in her search for spirituality. In her new book, thoughtful Jewish characters are found in a different milieu altogether: the maelstrom of scientific competition and its search for truth. Does this make "Intuition" any less a Jewish novel?

Sandy and Marion, the lead scientists of Cliff and Robin's lab, are both Jewish, but in different ways. Sandy (born Sam Glazeroff) is an assimilated Jew; it's his wife, raised Episcopalian, who remembers to light the menorah at the lab's annual Christmas party. He is the self-aggrandizing but charismatic clinician, a straight-ahead publicist for his laboratory's results and a purveyor of hope for his cancer patients. ("In the hospital," we're told, "Sandy could walk from room to room and pull out language tailored for every ethnic or socioeconomic background. Like the magician's endless chain of knotted handkerchiefs, he could evoke Italian meatballs, baseball statistics, sailing stories, even sentimental childhood memories of the High Holidays. No one could Jew a patient like Sandy Glass.")

Marion, on the other hand, is an exacting, idealistic scientist whose uncompromising skepticism in the lab matches her care in cleaning her home for Passover. "There was a stringency about the holiday that Marion enjoyed. She liked the idea of cleansing body, house, and soul. Passover preparation appealed to her as a kind of cleaning of instruments, the periodic check and renewal of materials in order to get better results."

Though Judaism is important to Marion and Sandy, it's their scientific practice that is more akin to faith. When the integrity of the scientific process is questioned, the doubts are as serious, and emotionally charged, as challenges to religious belief. In the final, climactic scenes of "Intuition," Sandy and his Jewish identity, Marion and her scientific fundamentalism, and the difficulties that beset scientific faith are brought together to dramatic and thoughtful effect.

It would be overreaching to say that science is to "Intuition" as religion was to "Paradise Park," and I am consciously emphasizing the Jewish element in this novel. Of course, Goodman is much too subtle and multifaceted a novelist to make explicit this connection between Judaism-as-religion and science-as-Jewish-pursuit. But in a novel of many strands — in which ethnicity, economics, science, love and passion are all part of the tableau — we can't ignore one of Goodman's unique strengths: Like the 19th-century masters, she carries with her a convincing particularism even as she expands her narrative territory to include ever-wider spheres of intellectual and emotional conflict. As Goodman's interests and novelistic accomplishments extend far beyond the Jewish world, she is still — or all the more so — a Jewish novelist, and one to be prized.


Kosher Chinese
More conversations with Chinese medical students.

[My wife, my daughter, and I had eaten at a vegetarian restaurant recommended by the students I'm working with. The students asked me about my dietary habits, and why I wanted to eat at such a restaurant. This conversation, like all others we've been having, is a linguistic smashup between my wretched beginner's Mandarin and their serviceable, though distinctively Chinese, variety of English. Also agreed upon in this conversation: Americans are friendly though their president is incompetent.]

Students' Q: How long have you been a vegetarian?

A: I'm not. I'm kosher.

[Here follows my basic explanation, with much pointing at dictionary entries. The Oxford English-Chinese dictionary's entry for "kosher" means nothing, apparently, to these educated, native speakers of the target language.]

Q: You don't eat shrimp? Or oysters?

A: No.

Q: What a pity! They are so tasty!

A: [shrugs]

Q: Wait! Fish are also living, but you eat them?

A: It's in the Bible.

Q: Oh, the Bible. [This with the same tone that one might say: "Oh, the Articles of Confederation."] We're Buddhist! We eat anything!

A: If you like, you can look up 'kosher" on the Internet. If you care.

Q: We don't care.
Fuzhou Sojourn

Another Western blogger in Fuzhou! Figure the odds.


On Sunday

On Saturday, we rested. On Sunday, we scaled a mountain called Gu San, or Drum Mountain. I carried my daughter uphill - at thirty-five pounds, she was some baggage. The hill rates a matter-of-fact three lines in Lonely Planet which does not capture the spectacle of hundreds of Fujianese, old and young, slackers and Army types, climbing the hill for pure recreation. This time they had the added attraction of giants walking among them -- me and my wife -- and their movie-star daughter. I am not kidding abou the reception she got. People crowded to touch her, women offered to carry her up the mountain, old men touched her face. But even this paled before the stir she has caused at her day care, where against my wife's vociferous protests she is given more than the oher kids, before they are.
My first day at work

My ever-helpful and indefatigable liaison picks me up at the door of my apartment building to take me to the hospital. Since we are late, he explains, we'll go on his motorcycle. I wear a helmet. I think I might die on the busy Fuzhou streets. We arrive safely.

I am welcomed by two distinguished professors and two gastrointestinal fellows. To put this in perspective, remember what sort of treatment the United States reserves for foreign-medical graduates. Then keep in mind that I haven't even graduated from medical school yet (I do so when I return, on May 11th). So you'll understand why I feel vaguely guilty about the friendliness, generosity, and eagerness to please that I have been received with by every Chinese person -- really! -- since our arrival. One of the professors comments that he knows I'm from Israel, since I'm wearing something on my head.

I get a tour of the hospital, which is large and well-equipped. The campus is attractively landscaped, with many patients, relatives, doctors, and nurses bustling about between buildings. The nurses wear peaked pink caps. I draw many stares, and I try to return them in a friendly way rather than by staring down at my shoes.

Later I have a chance to sit and talk with the fellows, who, like their medical counterparts in the United States, seem relaxed, hyper-trained, and underutilized. To repeat the theme: they are friendly and engaging, and really quite thrilled at my fumbling Mandarin. They're patient enough to wait while I keep looking up necessary words.

I am shown to the medical-records room, with sober shelves of manila patient records, and introduced to the medical students that I'll be working with. They will abstract medical records and I will enter the information into a computer. Medical school is five years long in China, but as in Europe and other countries (unlike the U.S. model) it's a course of study that starts at the beginning of university. They ask me questions about China. I ask them if they can criticize the government, and they say not in public. They would rather not talk about politics out in the open, but say they do so among themselves in their dorm.
At the end of a week in Fuzhou

On arriving at the airport I found someone holding a sign at the gate with my name on it -- a first indication of my undeserved status of "foreign expert" which can bring all sorts of special treatment that I am not complaiing about at all. We were driven through the hills of Fujian in the middle of the night; the first song we heard on the car stereo was "Hotel California." We arrived at our fabulous apartment in the middle of downtown Fuzhou. Our apartment has balconies onto which one can step out and view the quite unexceptional downtown of a midsized Chinese metropolis, topped most of the day by a grayish haze. The following typically Chinese characteristics (I think) of this apartment are worth mentioning. Nothing like the mound of paper goods (napkins, paper towels, and the like) which the typical American apartment is outfitted with; we have a small number of pink and green rags. No oven! On the other hand, no oven I will have to kasher for Passover.

The apartment building is part of a luxury complex, and there are security guards hanging out outside at all hours -- tall gentlemen loafing at their ease on the plastic chairs ouside. After the first time they see us, the don't need to ask anything about us. We're the foreigners: a six-foot-two-inch tall blond guy with a head covering, his almost-as-tall wife, and their daughter whose blond hair and white skin have already come close to causing innumerable traffic accidents, not to mention the definitely non-hypothetical spectacle of grown men and women gasping in awe and stooping to touch her cheeks. On my way to work, I meet the stares of many curious passersby.

Before I talk about my work, I should explain why I'm here. I'm participating in a collaboration between NYU and the Fujian Board of Health on the topic of gastric cancer, which is quite prevalent in southern China. Why the high prevalence? That's the research question. It certainly has something to do with diet and environment, but the NYU researchers I'm working with are particularly interested in the bacterium Helicobacter pylori, made famous this year by the Nobel Prize for Medcine -- and whether the interacting genetic polymorphisms (diversity) of people and H. pylori might explain the high prevalence of gastric cancer both in Fujian and in Fujianese immigrants, who make up most of the Chinese immigrant pool to New York.

My goal here is to help with the basic, epidemiological analysis of data collected by chart review. How many gastric cancer cases have there been in Fuzhou (or two particular hospitals in this city) over the past few years, of what types (i.e., found where in the stomach), and with what risk factors have they been associated? I have found out that medical care in China, at least in some sectors, is very much pay-for-service. The Fuzhou hospital I am working at now (about which more below) treats mostly middle-class and wealthy Fujianese. Poorer patients go elsewhere, and this bias in the distribution of gastric-cancer cases I'll be analyzing obviously means something to our results. From a broader perspective, this schizophrenia of the Chinese health-care system -- government funding of all hospitals combined with vast inequalities of treatment -- was examined in a recent article in the New England Journal of Medicine.


Greetings from Fuzhou!

Where I can't see blogs (or Blogger blogs). I hope I can post, though.