Table of Contents
Introduction
Chapter 1
Vietnam
Chapter 2
New Home
in Kofu
Chapter 3
Hong Kong
China,
&
Korea
Chapter 4
Yamanashi
Chapter 5
Society
Chapter 6
Hospital
Chapter 7
Nikko
Chapter 8
Holiday
Greetings
Chapter 9
Culture
Chapter 10
Holiday
Trip:
Kansai
&
Kyushu
Chapter 11
Mores
Chapter 12
Hankos
& Brush-
writing
Chapter13
Friends
Chapter 14
Festivities
Chapter 15
Okinawa
&
Nagasaki
Chapter 16
Hong Kong
&
Australia
Chapter 17
Special
People
&
Events
Chapter 18
Coming
to
Japan
Chapter 19
Letter to
Editor
Chapter 20
Teaching
English
Chapter 21 Hamamatsu
Chapter 22
Women's
Relation-
ships
Chapter 23
Reflections
on
Education
Chapter 24
Nephews'
Visit
Chapter 25
Thailand,
Korea
&
Home
Chapter 26
Taking
Stock
Chapter 6
Hospital Stay
November12, 1995
Dear Friends,
It is a beautiful fall day here in Kofu. Although winter officially arrived in Japan one day last week, it is about 70 degrees today. Some trees are still green; roses, azaleas, mums, and many other flowers are still blooming and today we bought a poinsettia. Fuji has been snow-covered for a couple of weeks and some of the higher mountains in closer regions are also snow-capped. However, the mountains closest to us, and lower than the others, are still green, yellow, and orange.
The last couple of weeks we have had a cultural experience that we would just as soon passed up. Tom has been in the hospital for eight days now, but his troubles began about two weeks ago. We made five trips to the hospital the week prior to his admission - four of them on an emergency basis. Tomorrow he is supposed to be discharged and everything is okay, so now we have the energy to write about what happened
November 14
Guess we didn't have as much energy as we thought. Now it is two days later.
Today is Tom's first day back at school. Yesterday he was discharged from the hospital as planned. The bottom line is that he is okay and he had nothing life threatening, but during his ordeal we didn't know that. During that time they suspected colon cancer and a number of other problems. We didn't know what was going on until the last few days of his hospitalization, when we got the results of his numerous tests. It turned out that he had kidney stones, an obstructed colon, an infection, and his blood pressure shot up. We don't know if he was kept in the hospital longer than usual because of being a gaijin, or if Japanese health care is just different. We are simply grateful for good care and devoted friends.
Hospitals certainly are different here, as is health care in general. When people have any health problem they go directly to the hospital, where physicians see them in the order they arrive. As far as we can tell, there are not separate physician's offices, and people do not have family doctors. When a person arrives at the hospital, they register, and wait in a large waiting room until they are paged and told which examining room they are supposed to report to. Physicians have hours on a rotating basis at the hospital and their schedule is posted. They may see patients at different hospitals, but they don't have their own offices.
We learned later that if we hoped to see a particular physician, that we should only go to the hospital on a certain day. Also, because of our special status (English speaking, Eiwa staff, or whatever reasons -- we could not fully understand), we had more freedom in requesting a particular physician. However, we learned most of that in retrospect.
Yamanashi Hospital is just around the corner from us, and we walked by it many times without realizing it was a hospital. However, prior to our personal experience, we had noticed patients, in their blue and white striped hospital pajamas, often with their IV contraptions in tow, walking around the area. After we discovered what hospitals look like, we realized that there seem to be hospitals all over the place, many of them small. We couldn't figure out the system, so we asked Mr. Nakayama who owned all the hospitals. He jokingly said, "Parents of Eiwa students." Actually, some are public and others are privately owned. Some are owned by physicians, and at least one is owned by the father of an Eiwa student!
Yamanashi Hospital
When Tom first starting having serious pain, we called Mr. Nakayama (who lives 40 minutes by car in Yamanashi City) and asked for help. It was 11:00 PM on a Sunday evening. He decided that it would be best for us to try to find a doctor at Yamanashi Hospital since it was so close to us. (And he has a good friend who works in the office there.) He managed to have a doctor awakened to see Tom. After that we made four emergency trips as well as one scheduled visit, over the next few days before Tom was admitted. Each time he saw a different doctor, each had a different hypothesis about what was wrong, and each said to come back if there was more pain. (That part is not any different from what one would expect in a US hospital.) Also, each time it was a challenge to communicate. Most of the doctors spoke some English, some better than others. When it was time to admit Tom, the physicians had a meeting and decided among themselves who would be his sole physician. The chosen physician seemed to have the best command of English and we thought that was probably the primary reason he was selected.
Both of us have health insurance that is provided by Eiwa. It costs us nothing, and it certainly came in handy. We were amazed at the cost of health care. In this country where the price of everything else is sky-high, health care is very reasonable. During one emergency visit, which cost us approximately $16, the total cost on the bill was $165. This included several x-rays, a sonogram, blood work, urinalysis, examination, hospital and doctors fees. The total bill for the hospital stay (eight days) was about $2250, including the room, numerous procedures, doctors' care, medications, etc. Altogether, all of our visits to the hospital cost us a total of about $100, and we filled out no paperwork! We pay four times that amount for one month's coverage of health insurance in the US, with benefits, which aren't nearly as good. (Although we have to continue to pay that premium for the time we are out of the country, we have no real coverage. Basically we are paying more than $5000 to US Healthcare for the privilege of waiting in line!) We don't know how Japan can provide medical care for what they do. We have heard that insurance is high for those who have to pay their own premiums, but we don't know what "high" is, and we think that most people are covered by their employers.
In studying the bill, it appears that food was $54, the room was $1297, numerous x-rays & a barium enema $429. The doctor's fee was either $319 or $193, and medications were $13.50. Our initial share of that bill was 10%, (just over $200) but that was refunded to us by Eiwa. We were told that it had something to do with his length of stay and the cost going over a certain limit. However, we wonder if it had something to do with Tom's status at Eiwa. We have no idea if it was special treatment or not.
The personal care we received throughout was wonderful. Mr. Nakayama made certain we got good care and his friend who worked in the hospital office checked on us regularly. The head nurse came to Tom's room soon after his admission and introduced herself to us, saying, "I am the head nurse of the hospital. I am taking English conversation classes. I want to do everything I can to help you. Please let me know if there is anyway I can help." After that she checked with us first thing every morning when she arrived at the hospital and last thing before she went home in the afternoon, as well as sporadically during the day. The day Tom left, she told Marie that if Tom had any more pain, he was to come back to "our hospital".
The medical care was good as far as we could tell. The doctor who was assigned to be Tom's primary physician was very thorough, explained everything clearly and told both of us exactly what to expect. He obviously had planned his presentation very carefully in order to cover all the bases, and it seemed as if he had rehearsed it. If we tried to interrupt to ask questions, it seemed to throw him off. So we learned to listen to him until he was finished.. We were amused one time when we were waiting to see the doctor and Tom was attentively listening for his name in Japanese and the examining room to which he was supposed to report. Instead we heard, "Mr. Thomas Grant, please report to room # 14." Everyone in the waiting room looked at us. Those kinds of experiences are humbling. We continue to feel badly that our Japanese is so limited and everyone tries to talk to us in English.
Nurses, in general, were a trip. They were exceedingly good-natured and energetic. They were a little nervous about the English problem, but dealt with it with good humor. They made a chart for Tom so he could point to let them know what was going on. Most body functions were on it (kanji with the English translation) and the English was more indelicate than we would normally use at home. However, it served the purpose. Overall, we found the nurses to be great and very friendly and helpful, but quite different from those we know at home. They giggled a lot, even when dealing with some terrible problems with other patients. (Giggling is often a sign of nervousness in this culture.) They ran up and down the halls. They almost never wore rubber gloves, even when drawing blood or otherwise working with needles, and they usually left the syringe for Tom's IV laying on his tray in between administrations of his medication. Many things we saw in the hospital would have been considered highly irregular in the US. One night when Tom developed a high fever they brought an old-fashioned water bottle with a clamp, filled with ice water,to apply to his neck to help bring down his temperature.
The biggest difference we found in patient care was the role of the patient's family. When Tom was being admitted, Marie was given a list of things she should bring for him. This included towel and washcloth, slippers, personal care items, a basin for washing, chopsticks, teacup, and some other basic items. Hospital pajamas were provided. Throughout this experience, Marie learned many more kanji, as it was quite a challenge to read all the signs in the hospital, and it helped to relieve stress to have something difficult to study.
Wives, family members, and "less-sick" patients do much of the basic nursing care, as well as general maintenance. For instance, when the meals are brought to the rooms, the more able patients serve the less able ones. When patients are finished eating, the more able patients return their plates to the cart. Patients, or their families, are expected to do their own personal laundry and hang it on the roof of the hospital to dry. The sheets in Tom's room were only changed once while he was in the hospital. We figured out much later that Marie was probably supposed to wash the linen and change the bed. One day a very sick man was put in Tom's room. The first thing his wife did was scrub the floor, bed, table, and other surfaces in his area of the room. There were hospital housekeepers, but they did minimal cleaning.
One patient insisted that Tom should drink beer for his problem. He pantomimed what would be the effect of drinking beer and how much better Tom would feel. (We will leave that to your imagination.) After we spent several days humoring him by listening and smiling and agreeing, he became more insistent. Marie asked the head nurse about it and was told to bring beer to the hospital and put it in the group refrigerator. She said that Tom's was a special case and beer would be good for him. He felt peculiar about this but complied.
Patients are given quite a bit of freedom to wander about and are encouraged to go to the roof for exercising. From the roof there are beautiful views of all the mountains around Kofu and a panoramic view of the city. But to get there, one had to ride the elevator for one floor, climb one flight of stairs, step over a high door frame, and maneuver around discarded hospital furniture. Sometimes that was a little difficulty with the IV equipment. (There are many reminders around us that this society is not as litigious as the U.S. and that part we like. It seems that people are expected to take more responsibility for their own behavior and the consequences of that behavior. This has led us to speculate about how much liability insurance has driven up the cost of so many things in the US.)
Special rules were made for Marie. Although the normal visiting hours were 1-7 p.m., she was informed that she could visit from anytime in the morning until 9:30 p.m. Many people seemed to be concerned about both of us. Mr. Nakayama said that in Japan there is a saying that the caretaker needs to be taken care of. One evening on arriving home from the hospital, Marie found two flowering plants by the door. Another time there were two bottles of wine.
We got a call from New Jersey, asking how Tom was doing. One of the earliest exchange students called to say that her parents in Japan were very concerned about Tom and wondered what they could do to help. Since they didn't speak a word of English they were frustrated. Another call came from Kyoto. It was the sister of Marie's calligraphy teacher, Mrs. Ogawa. She had spent some time in the US and could speak English. She asked for information about Tom' condition that she could convey to Mrs. Ogawa.
The next evening Mrs. Ogawa came to the door, carrying her English-Japanese and Japanese-English dictionaries and a gift of fruit for Tom. She communicated that Marie must feel lonely and that she was concerned. This was a wonderful, touching gesture, which was truly amazing. Mrs. Ogawa had no idea where we lived prior to that time, and she did not know the name of the hospital Tom was in. Marie had only had a couple of calligraphy lessons and could not imagine that anyone would go to that much trouble for her. (But we would soon learn that Kaoru Ogawa seems to have unlimited energy and resources and often goes well out of her way to help. It was not long before she would become a "sister" to Marie.)
Other visitors to the hospital brought fruit, flowers, and baked goods, and much concern. The food was especially appreciated, since the hospital food was truly awful. (Even the Japanese patients and staff who were used to eating raw fish and other traditional foods made that assessment.) We're certain that it must have been healthy, as bad as it tasted. (Tom did enjoy an occasional Snickers bar and Oreo cookies, and even a Big Mac from time to time.) He did enjoy the barley tea that was served several times a day and is considered to be very healthy.
It is also a custom in Japan that groups to which the sick person belongs give "get well" money. Mr. Chiba, Eiwa's principal, and the school's business manager paid an appreciated, but pro forma, visit and gave Tom 5000 yen. Mr. Chiba made a short speech and then gestured to the business manager who removed the envelope from his pocket and handed it to Tom. People with authority do not handle money. Later, Mr. Nakayama came with an envelope from the English department, which contained 10,000 yen.
Now that the whole experience is behind us, we are really touched and grateful for all the care and concern we received. However, at the time we were both pretty numb.
Because of Tom's medical problems we had to cancel the Eiwa/PV reunion plans for this week, but plan to reschedule, probably in the spring. Also we had to miss some other things we had planned, such as the Ray Brown/Benny Green jazz performance, and at least one holiday. However, just prior to his hospitalization we did make one memorable trip. Mr. Nakayama had planned the trip very carefully, and well in advance. He wanted to take us to Fuji, to a special onsen (hot spring) and to have dinner at his favorite noodle restaurant. We didn't want to pass that up or disappoint him so we went in spite of Tom's increasing discomfort. In retrospect, we probably should have tried to reschedule, but hindsight is 20/20.
Fuji is more impressive from a distance. It has so many different personalities and fantastic views as it changes with the seasons, or it is viewed from various vantage points. It is always awe-inspiring. But up close it looks like we would imagine a moonscape. It is pretty bleak - mostly volcanic ash. We are hoping to hike Fuji before the end of our stay. But right now we have to concentrate on Tom's continued improvement and on getting back to our day-to-day living.
Since winter is upon us and the nights are starting to get cold, we need to begin using our kerosene heater. Very few homes have central heating in Japan and the tradition is to heat only the room you are using, not the entire apartment. At Eiwa, there are large kerosene heaters in the faculty room. Those nearest the heater roast and those farthest away have cold feet. Each classroom has a radiator on one side of the room. Back at the apartment, Tom has requested that Marie turn on the heater when she goes to the kitchen to make coffee in the morning. (Marie is trying to become a Japanese wife, but it's tough work for her) ---- Yeah, right! ----
Thanksgiving is next week, already. You probably will not be receiving this before then, so we hope you had a wonderful Thanksgiving. We plan to invite Jackie Rives, the only other American at Eiwa, for Thanksgiving dinner. We're going back to Tokyo this weekend, and plan to go the American grocery store. If we can find a turkey breast there, we will try to have a semblance of a regular holiday meal. (The toaster oven is large enough to roast a small turkey breast) Otherwise, we will fix lasagna -- Jackie's favorite.
This weekend we plan to go to Nikko and spend one night in Tokyo.
Also, during the past week, we finalized plans to visit Thailand during the Christmas vacation. We will leave Japan on December 26 and return on January 6th.
Enough for this letter. Hope our next letter is a more cheerful one. Hope all of you are well. Thanks for the correspondence. Please keep writing.
Warm Regards,
Tom and Marie
P.S. Hope that by the time you get this letter, the U.S. government is back in operation.
Update 1999: We recently read that patients give monetary or other gifts to their physicians after being treated, to help compensate for the low income that Japanese physicians receive. We did not know that at the time and wonder if we should have done so. Marie did bake muffins to take to the nurses to thank them for their good care, but now we wonder if that was enough. No one clued us in and we simply don't know.
