But Ruiter points out that marriages can be in trouble before they land in the exciting pressure cooker of contemporary China, "People just bring their problems where they are further exacerbated." The mixed Chinese-foreign marriage and the Chinese marriage are no exceptions. Fully a third of Ruiter's practice is Chinese-foreign couples, and their anguish is both similar and different from that which plagues the foreign marriage. "There are cultural differences and unspoken expectations that couples don't even begin to deal with until after the honeymoon is over."

Ruiter's general feeling is that people in trouble are learning that they must be more flexible and adaptable, especially in this place and time. The extraordinary foreigners this column has been highlighting are people who did just that. Ruiter had his own epiphany while counseling people in Canada who kept telling him what they were going to do when they retired. Then they retired and were soon in the grave, plans buried with them. He took the opportunity to work abroad and after other Asian sojourns, came to "where the action is," in 2004. He concludes, "People in trouble need to recognize being here is an opportunity – if you are not here for that good China job, there are other ways to be responsible for one's own happiness."

Adaptability to change is becoming a Chinese forte, and it is as important for the foreign physician as the foreign patient. One clinic acknowledged some of its doctors have been in China for 10 years, but others leave after six months, simply unable to fit in. Again, this is not a disconnect peculiar to China. Physicians coming to work in international clinics must be willing to learn from each other or clash with their management, colleagues, and the society at large. If these good doctors in Beijing have their way, making the most of health care will become easier for everybody.