The Emergency Room

CHINESE CASE STUDY #1

An elderly, Asian-looking man is admitted to the emergency room with chest pain; difficulty breathing; diaphoresis; vomiting; pale, cold, clammy skin; and apprehension. Three people, speaking a mixture of English and a foreign language to one another, accompany him. The nurse tries to speak English with the man, but he cannot understand anything she says. Accompanying the elderly man are two women (one elderly and very upset and one younger who stands back from the other three people) and one younger man.

The younger man states that the elderly man, whose name is Li Ying Bin, is his father; the elderly woman, his mother; and the younger woman, his wife. The son serves as the translator. Li Ying Bin comes from a small village close to Beijing. He is 68 years old, and he has been suffering with minor chest pain and has had trouble breathing for 2 days. He is placed in the cardiac room, and the assessment continues.

Mr. Li is on vacation, visiting his son and daughter-in-law in the city. His son and daughter-in-law have been married for only 1 year, but the son has lived in the West for 7 years. Mr. Li’s daughter-in-law looks Chinese but was born in the United States. She does not speak very many words of Chinese.

Further physical assessment reveals that Mr. Li has a history of “heart problems,” but the son does not know much about them. Mr. Li had been to the hospital in Beijing but did not like the care he received there and returned home as soon as possible. He goes to the local clinic periodically when the pain increases, and the health-care provider in China used traditional Chinese medicine, herbs, and acupuncture. In the past, those

treatments relieved his symptoms.

Medications are ordered to relieve pain, and Mr. Li undergoes diagnostic procedures to determine his cardiac status. The studies reveal that he did sustain massive heart damage. Routine interventions are ordered, including heart medications, anticoagulants, oxygen, intravenous fluids, bedrest, and close monitoring. His condition is stabilized, and he is sent to the cardiac intensive-care unit.

In the cardiac unit, the nurse finds Mrs. Li covering up Mr. Li until he sweats, and Mrs. Li argues with the nurse every time her husband is supposed to dangle his legs. She complains that he is too cold and brings in hot herbal beverages for him to drink. She does not follow the nurse’s and physician’s orders for dietary restrictions, and she begins to hide her treatments from the staff. Her son and daughter-in-law try to explain to her that this is not good, but she continues the traditional Chinese medicine treatments.

Mr. Li is a very quiet patient. He lies in bed and never calls for help. He frequently seems to be meditating and exercising his arms. When he does talk to his son, he speaks of the airplane ride and the problems of being so high. He believes that may have caused his current heart problem. Mr. Li also wonders if Western food could be bad for his system. Mr. Li’s condition gradually deteriorates over the next few days. Nurses and physicians attempt to tell the family about his condition and possible death, but the family will not talk with them about it. Mr. Li dies on the 5th day.

Study Questions

1. If you were to go to China on a business trip, how would you design your

name card so that the Chinese would not be confused?

2. If you wished to have a meeting with a Chinese delegation of health-care

providers, would you expect them to be on time? Why?

3. If the meeting included a meal with Chinese food, what kinds of food

would you expect to be served? How would it be presented? If something

were served that you do not like, would you eat it anyway?

4. Compare and contrast the Chinese meaning of life and way of thinking

with the Western meaning of life and way of thinking.

5. What are the common health risks for the development of chronic

obstructive pulmonary disease among Chinese people?

6. What are some of the reasons that Mr. Li waited so long to enter the

hospital?

7. Mr. Li did not complain of chest pain in the cardiac intensive-care unit. Is

this a common behavior? Why?

8. True or False: The Chinese family will expect health-care providers at the

hospital to provide most of the care for Mr. Li.

9. Why must the physician be careful with the amounts of medication

ordered?

10. Mrs. Li is curt, demanding, and disagreeable toward her daughter-in-law.

Why does she act this way?

11. Explain why Mr. Li blames the airplane ride and the Western food for his

heart attack. Why does he meditate and do exercises?

12. Is Mr. Li’s stoicism during dying surprising? Why do the family members

refuse to discuss his health and possible death?

13. What is the preferred method for handling the remains of a deceased

Chinese person?

14. Describe common mourning rituals for the Chinese.

15. Describe bereavement in a Chinese family.

16. Describe a common view of death among Chinese.

JAPANESE CASE STUDY #1

This case study is a composite of actual situations. Marianne, who is American, and Ken Shimizu, who is Japanese, have worked in Tokyo for over 30 years as Methodist missionaries. They have annual furloughs and occasional sabbaticals, during which they visit relatives and sponsoring organizations and engage in continuing education in the United States. They met as college students in the United States, and their three grown children have established their own careers in the United States.

Ken’s 98-year-old mother resides with Marianne and Ken. She is not Christian but has always been extremely supportive of Ken and Marianne’s work. Ken teaches at a large Christian university, whereas Marianne has served in various church-related positions over the years. As missionaries, they live in subsidized post–World War II housing near Ken’s university. Marianne has been a frugal housewife, preparing local foods in the Japanese style for her family.

Ken, who is nearly 60, recently learned that he has glaucoma. By the time it was discovered, he had lost a significant amount of peripheral vision. Although Marianne delivered all three children at a Christian hospital in Tokyo, she gets her annual physical examination when visiting relatives in the United States. She has never believed that the Japanese health system is as proactive as that in the United States. On her most recent visit to the United States, Marianne learned that she has hypertension. Her physician prescribed a medication that is readily available in Japan, but the physician was concerned about the level of stress in Marianne’s life. Mother Shimizu is quite confused and requires considerable care, but it is unthinkable for Ken, the only child, to put his mother in a long-term-care facility. Even if he would, the

quality of facilities in Japan leaves much to be desired. Most of the responsibility for Mother Shimizu falls on Marianne, in addition to her work. Marianne’s relatives are urging her to consider placing Mother Shimizu in a church-related life-care community near Marianne’s family in the United States, where Marianne and Ken would like to retire. Marianne’s own parents lived in this facility at the end of their lives. She is considering these issues as she returns to Tokyo.

Study Questions

1. Identify some of the cultural issues that may lead to conflict in this international family.

2. What are the family resources for this international family?

3. What factors within the Japanese health system may account for the late diagnosis of Ken’s glaucoma?

4. What practical issues might arise for the Shimizus if Mother Shimizu were placed in a long-term-care facility in the United States?

5. What dietary factors may contribute to Marianne’s hypertension?

6. In what ways might you consider Ken to be countercultural as a Japanese man?

7. What social pressures might Marianne have faced, given some of her choices, as a housewife in Japan?

8. What pressures will Ken likely experience as he considers how to meet the needs of both his mother and his wife?

9. Compare and contrast the fertility and mortality rates of Japan and the United States.

10. Do the traditional Japanese maintain sustained eye contact with strangers? Why or why not?

11. To which drugs might Japanese people have greater sensitivity than that of white ethnic populations?

12. How do most Japanese people meet their need for calcium?

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