Random Thoughts: Encounter With the Japanese Medical System (Part 3)

(continued from parts 1 and 2)

The third day (second day after surgery) was one that I knew would be the hardest. I woke up at 5:00 a.m. And paced the lounge for about a half hour. Considering how small it was, I'm surprised I didn't wear a groove into the floor. At least I was going to get solid food this time, though the doctor said breakfast at that hospital was “only bread”. Only bread sounded like ambrosia to me at that time. I also started taking copious notes in my little blue notebook so I could remember everything in detail and took pictures of various areas. It may seem silly, but I did want to remember it all, not merely as an experience in Japan, but a life experience in general.

The scene of my crime, the communal shower. Note the clip board hanging on the door where I foolishly recorded my crime for all to see. 

My sleep deprivation was accumulating and I knew I was going to feel quite a bit better by Thursday, though not particularly good. In fact, it was very boring and I had a hard time being patient remaining there past this point. I decided that I'd kill some time by taking a shower in the communal shower room. Since the nurse who showed me around when I checked in went out of her way to point it out and tell me to write my name on a sheet so they'd know what time I took one, I figured that I could just take one when I wanted. So, I did, though I was very careful not to get my bandages wet.

Several hours after coming back to the room, a nurse noticed my moistened hair and said, “oh, you washed”, and I said, “I took a shower” (in English). Her English wasn't great, so her response was, “No shower!” I said, “I already took a shower”. To this she made an “X” with her fingers and more emphatically said, “No shower!” I said, “Okay, no shower.” Triumphant, she departed in satisfaction. Though the hospital is well-known for its English-speaking staff, particularly the doctors, not every nurse was very good with it (though they tried and I always respond in whatever language I'm addressed in). Mind you, the burden was on me to deal with them in their language, but some things, like the fact that I'd taken a shower when I wasn't supposed to, weren't worth trying to explain because it would have only made matters worse. In this case, my life was made easier by not clarifying in Japanese, and it's not like I could undo the illegal shower anyway. 

When the doctor came by to change the dressing on my incision and remove the hated drainage bottle, I tried hard to hold my chin up as high as humanly possible, but they still managed to attach it too high on my neck. I had to tear it off at the top and re-position it if I didn't want to develop a cervical spinal problem. I also asked the doctor if I could just go home then, and he said the hospital didn't allow people to leave in the afternoon. Harrumph. I would have paid for the next day if they would just have allowed me to escape right then and there, but no dice. They got to spend another night finding out how often I went to the toilet and taking my blood pressure and temperature again and again. I got to spend another night not sleeping, and this one was even worse than before.

A little Christmas decoration hung above the room number. The colored circles indicated which areas were occupied. Note that visitors sometimes roamed the halls trying to find patients because there was no way of knowing who was where from outside. I don't know if this is usual everywhere or was just the way it was at this hospital. 

Two people were added and left our ward in less than a day, much to my surprise. I envied them both their quick escape. I figured they must have received simpler procedures, but I had no way of knowing. During my husband's visit on this day, I suggested we hang out in the lounge. This was because it wasn't about 85 degrees there like it was in my room, and it would leave my suffering ward-mate in peace. Also, I no longer needed to lie in bed all of the time so the courtesy to both my husband, who hates super hot places, and the poor woman on the other side of the room, wasn't costing me any pain or added fatigue. I left a note on my pillow telling them where I was and we talked, got stared at by other visitors in the lounge waiting with cell phones from the hospital in hand, and played Monopoly on his iPad until the doctor showed up and asked me to head back to the room to deal with my bandages.

You may think I'm exaggerating about the heat, but it was extremely warm. The beds came equipped only with heavy comforters and no light sheets so I had to sleep uncovered most of the time. This caused some consternation for the nurses, who would try to cover me up when they saw the squished up bundle of pinkness at the bottom of my bed and I'd have to say, “chotto atsui” (a little hot) to get them to leave me alone. Of course, I should have said “totemo atsui” (very hot), but I feared they'd try and offer me ice again for a fever.

Later Thursday evening, a nurse with almost zero ability to communicate with me and something strange and complex to tell me came in. The only thing I could figure out without difficulty was that she wanted to know if I wanted breakfast Friday morning because I was supposed to leave. I figured that, though I was supposed to bust out at 10:00, I didn't trust that it'd all work as planned. I didn't want to sit around with low blood sugar to couple with my frustrated escape attempt if that was the case so I said 'yes' to breakfast. The other half of the communication was more puzzling.

This nurse was also talking to me about tomorrow being a holiday and the bill, but it didn't make sense to me. My husband and I had already gone down to the reception area during his visit to iron out how much we were likely to have to pay because you can't leave the hospital in Japan until you actually pony up the dough. I'm not sure what they'd do if you couldn't pay, but visions of holding someone hostage with an inserted catheter to torture them into encouraging their relatives to pay the ransom so they can escape came to mind. We also asked if they'd take a credit card so we wouldn't have to worry about the cash. They told us that, because it was a holiday (the winter solstice, Dec. 23), we couldn't use a credit card, but it'd likely cost 120,000 yen (about $1,543 U.S.) that we should pay in cash.   (We went back a few days later and settled up - it was 103,000 yen ($1,324 U.S.), which is pretty reasonable.)

Since we'd already ironed out the whole pay thing, what the nurse was trying to say made no sense. It was at this point that my ward-mate's English skills were fully revealed as she volunteered to be a bridge between my crappy Japanese and the nurse's crappy English. The nurse was saying we couldn't pay at all on Friday because of the holiday and would have to sign a promissory note saying we'd pay next Monday when the office was open. Since we'd already discussed this and been told something else, I found this eleventh hour rush to confuse me on a matter we'd already covered very irritating. If we couldn't pay, why didn't the front desk tell us when we asked about paying? In the end, it turned out to be one of those “different rules for gaijin (foreigners)” situations. Japanese could sign a note, but foreigners had to pay a deposit which was a ballpark figure of the cost for which they'd receive a receipt and then come back and settle up properly on Monday.

Through this exchange facilitated by my ward-mate, I learned also that she was told about this situation because she, too, was leaving on Friday. Given her continued poor condition, she stood there with an I.V. still attached to her and holding her lower abdomen as she translated, I was shocked to hear she was being released. I was whizzing about the hospital and pacing the halls trying to fill my time. It was happening with great sleep deprivation and soreness in my throat and pain in my neck, but I was definitely okay to finish recuperating at home whereas she appeared to need the full Borg treatment so she wouldn't have to get up out of bed. She told me that there were two kinds of doctors and one type was “rough” (her word choice) and gave patients the boot as rapidly as possible and then there were ones like mine who were cautious and kept you there, perhaps longer than necessary. I felt incredibly bad for her and wished our doctors inclinations had been swapped for both of our sake, though not our actual doctors. I liked my doctor and thought he took good care of me. 

Upon hearing this, I thought about some of the things I've read by other foreigners who have been in hospitals in Japan and my gall bladder removal experience and how it never jived with what they said. Many foreigners say that Japanese hospitals keep you in for a long time to ensure that you are very well before you go, and because of that I wondered how I convinced them to admit me, operate, and release me in the span of about 8 hours when I was in the hospital 20 years ago. I don't remember fighting too hard, though I may have made a strong request. It turns out that you can't generalize from one experience. Some doctors will kick you out and some will hold you. It's not a universal experience or rule in this country that you'll stay in for a long time.

I have heard, however, that it is a contrast to American care in which people are booted out as rapidly as possible all of the time because insurance companies don't want to pay for any but the shortest stay. Even my doctor mentioned the fact that care in the U.S. is handled as one overall package price covered by the insurance company so that the hospital has an incentive to get you out to reduce their costs and keep as much profit as possible. In Japan, it's really in the doctor's hands because you're going to pay by the day anyway so the hospital doesn't care either way.

That final night, a new person was admitted after 11:00 p.m. so there was noise and there were lights to keep us up again. What was more, the new person didn't seem to care about how her actions bothered other patients and she crinkled plastic bags, loudly crunched on snacks, and opened and closed dresser drawers for about a half hour after arriving. Though that doesn't sound too late in the evening for normal folks, we were awakened between 6:00-7:00 a.m. Around midnight, a nurse with a flashlight strode over to my area, opened my curtain and looked in and said, “You're not asleep”. If I had been, she would have woke me up again. I've heard this is something that the sisterhood of nurses worldwide shares as they all like to sneak around with a flashlight and awaken any patients who may have accidentally fallen asleep. I'm sure it's something they learn in nursing school regardless of their country of origin.

The view from my room on my last sleep-deprived morning in the hospital.

The next morning, the nurses woke us at 6:40 a.m., though a malfunctioning monitor had roused me at 6:00. I'm not sure I have ever been quite as exhausted as I was after my 4 days in the hospital and I was dying to get out of there and go home where I could actually rest. I had my final meal, a slice of bread, strawberry jam, a small cube of cheese, vegetarian minestrone soup (very tasty), fresh pineapple, and whole milk, and then counted the minutes until I could call my husband to wake him and have him come and bust me out of there.

I packed my bag and got checked a last time. Apparently my blood pressure and temperature, which was often a degree or two high for their tastes was a cause for concern most days, didn't qualify me for delayed release. I kept getting asked (ridiculously) if I wanted ice for this marginal condition. Incidentally, foreign bodies are usually a degree higher than Japanese ones. That's why we're always too hot and they're acting like a snake in the Arctic when we're both in the same room. I may have been on the warm side, but it was because I'm not Japanese and I was pacing like a caged animal every 15 minutes. When the clock struck 10:00, I figured that, when the doctor said I could leave “after 10:00” that that meant I could actually leave after 10:00. It would seem it's not so simple to escape a hospital.

Neither my husband nor I recall having so much trouble getting out of the hospital 20 years ago after my gall bladder surgery, but this time it seemed that many people had to be satisfied before we could leave. A pharmacist came up and gave me “pain medication”, which my husband felt I should have and I believed didn't matter since I only had one pain killer directly after surgery. However, he just wanted to be careful on my behalf so I said I'd take it. I was given two blister packs with 10 tablets each and said, “They're samples, so you have to take two and they're just like Tylenol (yes, she actually said “Tylenol” even though I don't think it's sold in Japan).” Thank goodness they had a pharmacist deliver them because you wouldn't want some nurse or lackey dealing with such powerful drugs.

As part of the departure sequence, I had already filled out a survey in which I praised my doctor, the nurses, and the food (it was pretty good after the liquid stuff was out of the way), but mentioned that it was noisy and hard to sleep, but I knew it might not be something they could help. I had also signed a couple or documents that the doctor had also signed which I thought were releases. I bid my ward-mate goodbye and thanked her for her help and my husband and I happily bid the room adieu. However, when my husband and I went to actually leave, a nurse stopped us in the hallway.

The nurse wouldn't or couldn't explain what the deal was, but she got very upset that my husband was carrying my bag and insisted, more frantically as we resisted, that both the bag and I return to my room and remain there while he go off and do something else. She really didn't want him to take the bag, as if it was as much a ward of the hospital as me (though it was spared the catheterization, lucky bag). He went down and paid the deposit and got a receipt with a note saying we'd settle up for real next Monday. He returned to the room and we thought it might be over, but we were told to keep waiting. I put another note about heading to the lounge on my bed and we headed where it was comfortably cooler. A nurse intercepted us and brought two more pieces of paper. One was the appointment to have the staples removed from my now Frankenstein's monster neck next Tuesday and the other was another “bye-bye” document of some ilk. After that, with unconcealed relief, we fled the premises.

I have been told since that this sort of inability to go based on red tape is hardly confined to Japan. Who knew hospitals worldwide were the inspiration for the song “Hotel California.” In America, I've been told it is also difficult to get out due to their need to conduct things “just so”. I can understand the need to dot all the “i's” and cross all of the “t's”, but it'd be nice if people had all of their ducks in a row for people who are being released and if they explained the situation more clearly.

Rather than tell me to just go sit in my room with my bag and my husband could go take care of things elsewhere, they could have said, “There are more documents to sign”, but they just got weird and said, “Go sit down like a good girl”. This is very Japanese. They expect people to passively wait to be told when, where, how, how long, and in what manner to do things and to not complain about it, especially when the authority is a doctor or hospital. The idea that I would push to leave because I wanted to leave rather than lie in my bed until they were good and ready to deal with me in their own sweet time simply doesn't occur to them. After all, that's what my ward-mate was doing. She was just lying there, unpacked and lying back in bed watching television when I bid her farewell and told her I hoped she'd recover soon. Clearly, she was in the know about the way things were going to work and figured there was no use trying to break out before the warden issued a proper release.

I've been here in Japan for a long time and adapted to a lot of things, but I will never be okay with lying in a hospital bed far past the time to leave when I should have left a day earlier while people lollygag about deciding they're ready to get their finger out and bring me a few papers. Of course, I guess this would be par for my course as a “bad patient”. I ate solid food when I wasn't supposed to. I showered when I wasn't supposed to. And, in the end, I left before I was supposed to. While I'm all for reasonable cultural adjustment, I'm okay with being a bad girl sometimes if it means I get to put as much distance as possible between me and peeing through a tube again.

Final (very important) notes:

Though I exaggerate for comic effect at times, and express some genuine feeling regarding how little sleep I got and the discomfort at being hooked to machines, it would be irresponsible of me not to conclude by making it clear that I feel that I was very well-cared for. The truth is that receiving any medical care is never pleasant, especially when you're undergoing something as serious and invasive as surgery. It will never be a walk in the park or enjoyable. The best one can hope for is that it is as comfortable as possible given the circumstances and that one is treated well in the process.

Regarding this particular  hospital, the nurses were polite, kind, friendly, and well-meaning. My surgeon/doctor was excellent and I feel fortunate to have had him handle my case. Doctors often receive gifts from former patients, and now I know why they send them for years after successful treatment. I sort of want to do that, too, but I know from talking to doctors and their wives that they get so much of that crap already that they don't want anymore. Still, my gratitude is such that the impulse to send gifts is there just as a way to say, "thank you."

I have no doubt whatsoever that the quality of medical care I received at this hospital was as good or better than that which I would have received back home. I would go there for treatment again in a heartbeat and I feel nothing but respect and warmth for the people who helped me. If you are a foreigner and live in an area close to Ogikubo in Tokyo, I would not hesitate to recommend treatment at the Adventist Hospital. They really are great (as are the dentists at the dental clinic). I've also been told that they are one of the few hospitals in Tokyo at which women can opt to use drugs to kill pain during childbirth (I cannot confirm this as I've never had a baby nor do I plan to, but if you're planning on having a baby, it's worth thinking about). 

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