A Second Chance: An American’s Unexpected Journey in China’s Healthcare System
In the late afternoon of late June 2019, Sarah was informed that she had a tumor in her body.
Living in China for half a year, Sarah had made it a habit to have her annual gynecological check-up, just as she did back in the U.S. Her sister-in-law, whom the Chinese affectionately refer to as “Diyime,” is Chinese. Diyime helped Sarah schedule an appointment at a clinic in Hangzhou.
The ultrasound results revealed a massive tumor in Sarah’s pelvic cavity, comparable in size to a fetus of four to five months, nearly filling her entire abdomen. “I couldn’t believe it when I saw the results,” Sarah later recalled. “It felt like a nightmare.”
A Complicated Journey to Diagnosis
The female doctor at the clinic advised Sarah to seek immediate care at a specialized hospital. “You need to go to a gynecological hospital right away,” the doctor told her.
Three days after leaving the clinic, they visited the obstetrics and gynecology department of Zhejiang Women’s Hospital. The doctor was stunned by the size of the tumor as shown on the ultrasound and recommended an MRI to determine the nature and precise location of the tumor. However, the hospital was swamped with MRI requests, and Sarah was told she would have to wait ten days for the procedure.
“We can’t wait that long,” Sarah said, feeling the urgency. They decided to go to another top-tier hospital’s international medical center, where Sarah was promptly scheduled for an MRI and received the results the following day.
To Stay or to Go Back?
On the way home, Diyime began reaching out to her network, asking if anyone knew a doctor at Zhejiang Women’s Hospital who could expedite Sarah’s admission.
Her friends all insisted on reviewing Sarah’s medical reports first and stressed that unless it was an immediate emergency, personal connections would not help much. “Sarah, we need to be realistic. Your situation is serious, and we need to act quickly,” Diyime told her.
However, Sarah wasn’t in a rush to be admitted. The biggest dilemma for her was whether to stay in China for the surgery or return to the U.S. immediately. She shared her situation with her friends back home, and most of them, who had never been to China, naturally suggested that she go back to the U.S. “American healthcare is the best in the world,” they said.
This was a difficult decision. Sarah was very familiar with the American healthcare system, but had limited knowledge about China’s. “In the U.S., it would take weeks just to schedule an appointment, get test results, and then schedule surgery. Here, everything happened so quickly,” she explained to Diyime.
But Sarah was concerned about the speed of the process. She worried that the quality might be compromised, and that the Chinese doctors might prioritize saving her life over preserving her ovaries and uterus, potentially removing everything to avoid any future complications. “I don’t want to lose my ovaries and uterus. I haven’t had children yet,” she confided in Diyime.
Crying Before Admission
The next morning, Sarah noticed vaginal bleeding, even though her period had ended less than ten days ago. Her body was no longer allowing her the luxury of time to think and choose. “This was the moment I realized I had no choice,” Sarah said.
They rushed to the hospital’s emergency room. On the way, Sarah received a call from the admission office, informing her that a bed had become available, and she needed to prepare for admission immediately. Additionally, one of Diyime’s friends called to recommend that they see Dr. Chen, the head of the oncology department, as the reports indicated an urgent need for hospitalization.
The speed of both the system and personal connections was almost identical, and the personal connections were still operating within the system’s rules. “We are so lucky,” Diyime remarked, but Sarah burst into tears. “I just can’t believe it. I haven’t even met the doctor who will perform the surgery,” she said.
Sarah’s friends in the U.S. had advised her differently. “In the U.S., doctors would explain my condition in detail, outline the next steps, and inform me of all possible outcomes before admitting me. Here, everything is so rushed,” she explained to Diyime.
Meeting Dr. Chen
Diyime tried to reassure Sarah. “In large public hospitals in China, doctors are extremely busy, often seeing dozens or even hundreds of patients a day and performing several surgeries each week. Their time is limited, and being able to get admitted quickly is a stroke of luck,” she said.
Sarah’s doubts didn’t fully dissipate until she met Dr. Chen. Dr. Chen reassured her that she should be admitted immediately and that she would perform the surgery. When Sarah asked if her ovaries could be preserved, Dr. Chen looked surprised and replied, “You’re so young and haven’t had children. We will certainly do our best to preserve them.”
After leaving Dr. Chen’s office, Sarah felt a sense of relief. “I believed in her professional judgment. She understood my desires as a woman, not just treating me as a patient whose life needed to be saved,” Sarah said.
The Best Outcome
The preoperative discussion the day before the surgery lasted nearly three hours. One of the doctors explained the various possible outcomes in great detail. The worst-case scenario was that if both tumors in the ovaries were malignant, Sarah would need to have her uterus and ovaries removed and undergo chemotherapy afterward. The best outcome was that the tumor would be benign, and only the tumor would be removed, preserving all her organs.
With her limited Chinese, Sarah struggled to understand everything. At around 8:30 PM, another doctor, who had just finished a surgery, spent over an hour explaining the procedure to Sarah, using hand-drawn diagrams to ensure she fully understood. “I was so grateful for the doctor who stayed late to explain everything to me,” Sarah recalled.
By the time she had signed all the necessary documents, it was nearly 10:00 PM. Sarah had never believed in any religion, but at that moment, she felt a profound sense of gratitude. “If there were a God at that moment, I would have reached out to Him,” she said.
The next day, the surgery lasted over three hours. It felt like a long nap, and when Sarah woke up, a doctor informed her, “The best outcome.” The tumor was not only benign but also located outside her ovaries, on the outer wall of her uterus. It was a benign uterine fibroid. Her ovaries and uterus were both intact.
The tumor, measuring over 20 centimeters, was successfully removed from her body. “I was overwhelmed with relief and gratitude when I heard the good news,” Sarah said.
On the sixth day of her hospital stay, Sarah was discharged. The total cost for the entire treatment, including the surgery, was about 13,000 RMB, less than 2,000 USD. If she had undergone the same treatment in the U.S., it would have cost about seven times as much.
Sarah carefully reviewed the most significant cost in her treatment: the surgery. In the U.S., surgical procedures are where doctors’ value is most prominently reflected. The surgery she underwent, which lasted three and a half hours and involved six or seven doctors, cost only about 5,000 RMB in total, including all medications and materials. The surgical fee, broken down into two procedures, was only around 3,000 RMB. If divided among all the participating doctors, each would receive just a few hundred RMB.
“It was truly hard to believe. The costs were so low that it seemed almost unreal. I felt that their labor deserved better compensation,” Sarah reflected.
She wanted to thank Dr. Chen and the other doctors and nurses who had taken care of her, but when she was admitted, she had signed a document prohibiting the giving of red envelopes (cash gifts) to medical staff. “I wondered if buying a gift for Dr. Chen would be considered appropriate. If so, I would like to buy her a bracelet. In the face of disease, there is no divine hand; it was her skilled hands that saved me,” Sarah said.
Note: the story in Chinese was published on public media 2019.