When Parkinson's Meets a Surgical Emergency:
How Jiahui's MDT Team Saved a 75-Year-Old Patient

"When a 35-year history of Parkinson's disease collides with a sudden duodenal perforation complicated by liver abscess — this is an extreme test of medical capability." — Dr. Chen Yan, Director of Neurology, Jiahui International Hospital

SHANGHAI — On the occasion of the 30th World Parkinson's Disease Day, we share a true story from the spring of 2026. At Shanghai Jiahui International Hospital, a multidisciplinary team spanning nine departments — Neurology, General Surgery, Gastroenterology, ICU, Internal Medicine Inpatient Service, Radiology, Anesthesiology, Nutrition, and Rehabilitation — delivered what can only be described as a textbook-level Multidisciplinary Team (MDT) collaboration.

The patient: a 75-year-old woman (referred to here as Grandma Zhang) living with Parkinson's disease for 35 years. The challenge: a life-threatening surgical emergency on top of one of the most complex chronic neurological conditions known to medicine.

"This Time, It Wasn't Just Parkinson's"

For six years under the care of Dr. Chen Yan (阴燕), Chief of Neurology, Grandma Zhang had maintained remarkable stability — her thinking was clear, her speech was coherent, she could walk independently, and she even cracked jokes with staff from time to time.

Then, in mid-January 2026, everything changed.

She developed intermittent coughing, poor appetite, and after receiving antibiotic infusions at another hospital, experienced episodes of confusion and psychiatric symptoms. Her lower extremity swelling worsened. Drawing on decades of clinical experience, Dr. Chen immediately recognized this was not a simple Parkinson's flare.

"This would not be merely a fluctuation in her Parkinson's condition." — Dr. Chen Yan

After thorough discussion with the family, Dr. Chen made the decision: admit immediately and investigate the root cause.

The Diagnosis That Stunned Everyone

Upon admission, Dr. Fang Weigang (方卫纶)'s team in the Internal Medicine Inpatient Department began a systematic workup. Given Grandma Zhang's multiple comorbidities, they first ruled out common causes like deep vein thrombosis and heart failure. But her inflammatory markers kept rising, she showed intermittent speech confusion, and abdominal distension was evident.

The imaging results left every doctor breathless:

Consider the full picture:

• 75 years old
• 35 years of Parkinson's disease
• Severe malnutrition
• Scoliosis
• Thyroid enlargement

Any single condition would be challenging. Now, all of them converged in one patient.

To Operate or Not? The First Impossible Choice

That evening, Dr. Li Jun (李九), Chief of General Surgery, stared at the CT scans with furrowed brows:

"Peri-duodenal bulb ulcer perforation typically causes acute peritonitis — life-threatening. But here, the perforation drained into a hepatic cyst, so clinical presentation was relatively muted. However, long-term infection and inability to eat had already pushed Grandma Zhang to the brink." — Dr. Li Jun, General Surgery

For an elderly patient with advanced Parkinson's and multiple comorbidities, emergency surgery often means a nine-in-ten chance of fatality:

• Malnutrition — unable to withstand surgical trauma
• Anesthesia risk — pharmacological interactions could disrupt brain neurotransmitters, triggering malignant syndrome
• Parkinson's fragility — any systemic stress could shatter an already precarious neurological balance

The family and the entire medical team faced their first impossible choice:

A Two-Lap Relay Race: The MDT Solution

Jiahui's Multidisciplinary Team rapidly assembled. After extensive communication with the family, they agreed on a "two-phase relay" strategy to complete what seemed like an impossible surgery.

Lap One: Establishing the "Lifeline"

Team: Radiology + Gastroenterology + Internal Medicine

Before any incision was made, Dr. Zhang Jizhen (张吉萊) from Ultrasound performed ultrasound-guided hepatic cyst puncture — draining the abscess and obtaining bacteriology samples.

Critically, Dr. Chen Weiwen (阴布文) from Gastroenterology used the drainage catheter with dye tracing to confirm the formation of a duodenal fistula. Even more importantly, he successfully placed a nasojejunal tube (NJT) under gastroscopy — bypassing the perforated duodenum entirely while delivering continuous nutrition and medication directly into the jejunum.

"This thin tube made it possible to switch anti-Parkinson medications from oral to enteral administration. It became the 'lifeline' for maintaining brain function — buying precious time for surgery."

Lap Two: The Surgical Breakthrough

Team: General Surgery + Anesthesiology

Dr. Li Jun, Dr. Gao Xiang (高神) and the surgical team stood before the operating table, facing Grandma Zhang's devastated abdomen. Their plan had three precise stages:

1. Infection control: Drainage of hepatic cyst and hepatic abscess — eliminating the infection source
2. Perforation repair: Locate and meticulously suture the "fortunate yet unfortunate" perforation
3. Gastrointestinal reconstruction: Perform a gastrojejunostomy — creating a new pathway for food and medications to bypass the severely narrowed pylorus

From infection control to perforation repair to digestive tract reconstruction, each step was interlocked — balancing immediate rescue with long-term recovery, minimizing both near-term and distant complications.

But anesthesia presented its own challenges. Grandma Zhang's thyroid enlargement had displaced her neck anatomy, putting significant pressure on Dr. Chang Jing (常昂) from Anesthesiology:

"We precisely localized compressed vessels intraoperatively and achieved successful cannulation on first attempt. Throughout anesthesia, we monitored arterial/venous blood pressure, blood gases, and electrolytes in real time. Post-operative emergence and extubation were both smooth. Under multimodal analgesia management, Grandma Zhang stabilized calmly before returning to the ward." — Dr. Chang Jing, Anesthesiology

The Real Battle Begins After Surgery

If the story ended here, we could only say "the surgery succeeded." But what truly tests a hospital's capability is often the invisible battles after surgery.

By the time Grandma Zhang transferred to ICU, she had been bedridden for 17 days. Post-surgical stress exacerbated her Parkinsonian symptoms — limb rigidity, whole-body tremor, even slight sound or light stimulation could intensify her condition.

As the team had anticipated pre-operatively, the greatest post-operative hurdle was:

The Anti-Parkinson Diary: A Month-Long "Precision War"

Dr. Chen Yan issued what she called a "simple but demanding" order to the ICU and inpatient teams: Keep a diary.

Following Dr. Chen's requirement for "individualized precision," the ICU/inpatient nursing team established a detailed "Anti-Parkinson Diary" for Grandma Zhang:

• Every medication time recorded (multiple drugs)
• Every dose documented (sometimes adjusted to 1/8 of a tablet)
• Every "motor/non-motor" symptom change noted — day and night
• Tremor grading, dyskinesia grading, psychiatric symptom fluctuations — two detailed charts daily (morning and evening)

The challenge was extraordinary. Because Grandma Zhang could not take oral medications, pills were crushed and administered via nasojejunal tube. But this changed everything:

"For mid-to-late stage Parkinson's patients, even slightly less medication means violent trembling and rigidity throughout the body. Slightly more triggers fatal dyskinesia and psychiatric symptoms — constant thrashing and rolling in bed, difficult to care for, with heightened risk of renal failure and fracture." — Dr. Chen Yan, Neurology

In this new dynamic equilibrium, the doctors found a new drug combination — establishing fresh balance within the brain's neurotransmitters. Eight hours of stable sleep at night became possible. Daytime psychiatric symptoms gradually disappeared. Dyskinesia came under effective control. Only emotional fluctuations caused occasional tremors.

The Things That Don't Appear in Textbooks

There are countless details that belong in no medical textbook — yet they are the real reasons Grandma Zhang won this battle.

Radiology: When Dr. Dai Yajie (介以段) performed CT imaging, she noticed Grandma Zhang was trembling intensely from nervousness, which risked blurring images. She didn't rush. "We gave her ample time to calm down. Our experienced technologist selected optimal sequences and adjusted parameters. With our equipment's ultrafast imaging technology, we captured high-definition images in the micro-gaps between tremors."

ICU Nursing: Nurse Chen Xiaoyi (阴小艺) helped Grandma Zhang sit up by the bedside for the first time. Terrified, the elderly woman gripped her arm tightly, refusing to let go. Xiaoyi bent over, holding the bed rail, waiting silently. One minute. Two minutes... until the grandmother's breathing slowly steadied. "She needed time to trust us. We can wait."

Nutrition: Dietitian Tao Zhenzhen (潮真真) repeatedly adjusted nutritional formulas because Grandma Zhang's intestines were too fragile — even minor intolerance triggered diarrhea. The team followed the five-step nutrition ladder, transitioning from parenteral to enteral nutrition while closely monitoring swallowing function to ensure safe eventual removal of the feeding tube. "We're not rushing. We'll try one formula at a time until we find what her body accepts."

Rehabilitation: As her condition improved, the rehab team joined the effort, designing an individualized Parkinson's-specific training plan — starting with passive range-of-motion exercises for fingers, shoulders, elbows, ankles, and knees. Daily bedside sessions with patient guidance. Today, Grandma Zhang has good joint mobility and is beginning active participation.

Spring Has Arrived

By early March, magnolia blossoms were blooming on Shanghai's streets.

In her hospital room, Grandma Zhang found her own spring. Her Parkinson's symptoms stabilized again under a new medication regimen tailored to her post-surgical body.

The woman who once raved incoherently and couldn't rise from bed? Gone. The current Grandma Zhang can:

• Stand independently for short periods
• Walk slowly with support
• Feed herself with a spoon
• Write poetry — by hand

"Grandma Zhang's story is a vivid reflection of Jiahui Healthcare's philosophy of whole-course, whole-health service. The complexity of Parkinson's disease demands not only a top-tier neurology team, but also the ability to rapidly integrate resources across the entire hospital — building an efficient MDT collaboration that breaks down disciplinary barriers. It is this kind of 'team warfare' that enables patients to receive precise, continuous, and warm healthcare management even over a 35-year disease journey." — Dr. Wei Meng (魅盒), Director of Emergency & Inpatient Services, Jiahui Healthcare

What This Means for International Patients

This case exemplifies why international patients choose Jiahui for complex, multi-system medical challenges:

• True MDT integration. Nine departments coordinating around one patient — not just consulting, but actively collaborating in real-time via dedicated communication channels.
• Surgical excellence for high-risk patients. Operating successfully on a malnourished, 75-year-old patient with advanced Parkinson's demonstrates surgical and anesthetic capabilities that match or exceed global standards.
• Specialist-led chronic disease management. A neurologist directing anti-Parkinson medication titration in an ICU setting shows the depth of subspecialty expertise available.
• Holistic, human-centered care. From radiologists who wait patiently to nurses who hold hands to dietitians who adjust formulas iteratively — every touchpoint reflects genuine compassion.
• Bilingual capabilities. All specialists communicate fluently in English, ensuring international families remain fully informed throughout complex treatment journeys.