When Dr. Kiwi examined my eyes in February 2004, he saw two keratic precipitates in the right eye. When Dr. Lux examined the same eyes in March, she counted fifteen keratic precipitates. More and more junk was building up, and soon this process was underway not only in the right eye but in the left eye also.
The result? I found myself seeing through a kind of snowstorm of debris, and I wasn't seeing all that much. The question of what disease I might possibly have remained unresolved. My main priority was, more and more, to get relief from my symptoms.
With a whole slew of diagnostic procedures having drawn a blank, I put it to Dr. Lux that it was time to attempt steroid injections. If my eyesight problem went away and stayed away then it could be attributed to an inflammatory condition. Dr. Lux agreed to make the experiment and found a boy doctor who could perform the task. I asked if he had ever done this before. She smiled and said yes.
I asked about the risk of the needle (or, in Dr. Lux's words, the "blunt cannula") accidentally piercing the eyeball itself, which would result, or so I had gathered from my Internet reading, in a medical catastrophe. Dr. Lux smiled and said that they had done "thousands" of these procedures at Kappatani Hospital and had never pierced an eyeball. Yet.
One problem: I was scheduled to teach an English class that night. Could I have the steroid injection and still go teach the class? Sure, as long as I didn't mind showing up with blood in my eye. Which is what I did. (A little blood did gather down toward the bottom of the eye, but it wasn't really noticeable unless you pulled the eyelid down, and none of my students thought to do that.)
We think of the eyes as being very sensitive, but my first steroid injection caused me hardly anything in the way of pain. In fact, the one good thing about my entire course of medical treatment is that I had no pain worth mentioning at any point, except for the pain that I suffered in my left eye after Ms. Josama had been let loose on it.
The steroid injection into my right eye took place under local anesthetic. The problem with using a local anesthetic to kill pain is that the local anesthetic is generally administered using a needle, and the needle itself hurts. For the eye operation, however, the local anesthetic came in the form of an eyedrop.
Local anesthetic eyedrops were dripped into my right eye. And then, after a pause of some minutes, more of the same eyedrops were used. I think (though I'm not entirely certain) that there may even have been a third set of such eyedrops.
It felt very strange to be undergoing a surgical procedure while still fully dressed, complete with the necktie I required to look businesslike when I showed up at my evening class. But being fully dressed perhaps helped reduce my stress levels, because I certainly did not experience any particular anxiety about the procedure.
I was not able to see the procedure myself because my left eye was covered by a surgical drape and all I could see through the right eye was a very bright light. While I could not see much, I could hear the nurse and the boy doctor talking to me, telling me what was going on and giving me instructions. The nurse spoke to me in Japanese, which I understood, more or less. The boy doctor, by contrast, used English, which was painfully difficult to understand.
"Face ... front."
What the hell does that mean? Oh, I get it! He wants me to turn my face, which has currently been tilted to one side, so my nose points directly to heaven.
I needed to understand what was said because the instructions included instructions for moving my eye in a certain direction at a certain stage of the procedure.
I felt a twinge of pain when my eye was poked with something to see if it was capable of feeling pain. It was, and so more eyedrops were used and more time was taken.
Then the procedure was done, over, and I was sent away from the hospital with, if memory serves, a prescription for antibiotic eyedrops.
Well, the vision in my right eye did improve. Which did not rule out the possibility of cancer. If cancer has infiltrated the eye, a small number of cancer cells may be irritating a large number of normal cells, resulting in inflammation. The steroid injection restores the inflamed cells to normal while leaving the cancer cells intact, unkilled. Later, then, the inflammation returns.
And so it was in my case.
The improvement in the vision in the right eye began to reverse itself. Meantime, the left eye was getting so bad that it was approaching a state of uselessness. So a decision was made to go ahead with a steroid injection (a periorbital injection is the term, I think) into the left eye.
This time, Dr. Lux wanted this procedure to be carried out not by the boy doctor but by Ms. Josama, a girl. I was very dubious about this. I think that, technically, Ms. Josama had qualified as a doctor. But the truth is that Ms. Josama had always struck me as a debutante rather than a doctor.
I arrived at this "debutante" assessment without any assistance from the opinions of others. But later my wife learnt something from a doctor friend, a very nice person who lives in Gunma Prefecture. This doctor friend is a woman who has a husband, a daughter and a large collection of dolls embodying the Pingu penguin character. It's handy knowing a doctor, and this one was able to help us out on a couple of occasions with medical advice about our new baby. That nasty soft patch on the back of baby Cornucopia's skull? Don't worry about it. That's standard when a medical vacuum cleaner has been used to help drag the baby out of the womb. It will go away in due course.
Anyway, what the doctor friend told my wife is that Kappatani Hospital, the university hospital where I was being treated, has the reputation for being the place where rich people send their sons and daughters for medical training. Sometimes this works out okay, but then, sometimes it doesn't. Rich kid Josama being a case in point.
By that time I had attended the eye clinic at Kappatani Hospital on a number of occasions, and Ms. Josama had been one of the people who had examined my eyes during those visits. When she did so, she sometimes had occasion to use one of her fingers to raise one of my eyelids, and the clumsy manner in which she did this was what communicated to me, very directly, the fact that she was an amateur at this.
Ms. Josama it was to be.
As I lay on a narrow bed waiting for things to get underway, it didn't seem to me that Ms. Josama spent very much time washing her hands. My perception (which perhaps is not one hundred percent accurate) is that she just gave them a delicate little tinkle under the running water, and that was that. This amplified my mistrust of this young woman. But I thought to myself, hey, it doesn't really matter, it's not as if we're preparing for an important operation here. It's only my eye.
The procedure got underway and went reasonably smoothly, except that I had more difficulty moving my left eye on command than I had when moving my right eye. I have a more distant relationship with my left eye and I wasn't exactly so sure as to which direction it was pointing in.
Then I realized that things were taking rather longer than they had the previous time. Then Ms. Josama started talking to me in her version of English. She asked me if the "fluid" that was being used was the same as the "fluid" that had been used last time.
What fluid? And how would I know? My right eye was covered by a surgical drape. My left eye was filled with bright light. And all I had seen during the previous operation had been that same bright light. I had never had a chance, not in either procedure, to get a look at what "fluid" might be getting used.
Then Ms. Josama started free associating about "tish". What on earth was "tish"? What she was saying didn't make any sense at all. Then I realized that "tish" was "tissue". She was talking about my tissues, my flesh, and I gathered that there was something going wrong with the procedure, and that Ms. Josama was of the opinion that the problem was because I was a foreigner and so had weird foreign tissues, unlike those of a normative human being.
Then I tasted something absolutely disgusting at the back of my throat, and realized that it must be the steroids.
My grasp of anatomy is shaky and I have absolutely no idea how the eye connects to the back of the throat. But, somehow, Ms. Josama had managed to push that hollow cannula of hers into some anatomical structure which communicated with the back of the throat.
That was when I realized that my original intensely unfair judgment, "idiot girl doctor", had not been unfair at all. Ms. Josama should have been in a different line of work. Fingernail painting technician, for example.
Ms. Josama went away to fetch help.
I lay there waiting.
In due course, Dr. Lux arrived and took a look at what had happened. Plainly, Ms. Josama had messed up. In fact, Dr. Lux said that Ms. Josama's work with the needle had left a small hole in my left eye. Dr. Lux planned to personally close up this hole with a single suture and then do the planned steroid injection into my left eye.
First, however, Dr. Lux had a patient to finish seeing.
Dr. Lux exited from the room to finish off the consultation she had been in the middle of. Time passed. After a while, Ms. Josama spoke to me. Wisely, she had abandoned her earlier efforts to speak English, and had reverted to Japanese. Ms. Josama proposed that she, Ms. Josama, should do the necessary suture. It was, after all, a very simple thing. Plainly, Ms. Josama wanted a chance to redeem herself. But, as far as I'm concerned, you only get one shot at messing up my eyes. Screw up the first time and I'm not going to give you a second chance.
"No," I said, in Japanese. "Dr. Lux."
Or, to give my Japanese:-
(Rather than "ie", I could have used a more emphatic "no", the word "dame", which literally means "useless". But this is a bit strong to be using on one of your doctors, even if you think the doctor in question is a dangerous idiot, and it's probably best reserved for arguing with your wife.)
All this time, as we waited, my left eye was still wide open, held open by a clamp. And, although I was not aware of the fact, the cornea, the transparent membrane covering the front of the eye, was gradually getting dryer and dryer.
Eventually, Dr. Lux returned, and then there was a delay while someone went in search of the special suturing material that Dr. Lux wanted, a particular kind of thread which would, in due course, dissolve of its own accord.
Finally, the thread was located, and Dr. Lux put in the suture. Which hurt. Youch!
"It hurts!" I cried.
"I know!" said Dr. Lux. "But lie still!"
Once the suture was in, Dr. Lux said we would skip the business of the steroid injection, at least for today.
"Your cornea has dried up while your eye has been open," she said.
She got a tube of gunky ointment, squeezed a generous amount of it into my eye, patched the eye and told me to keep the patch on until the next day.
My next step was to pay for my treatment. As usual, I took some documentation which Dr. Lux gave to me and I went downstairs to a cashier's desk, where I handed over the documentation and got given a number. As I sat there waiting for my number to come up on one of the LCD screens set above the various payment counters, I was feeling distinctly miserable. Brutalized. Alienated. Weird foreigner with mysterious foreign tissues allegedly not wired up quite like the standard human circuit board.
On leaving the hospital, I went to a nearby pharmacy and filled a prescription which Dr. Lux had given me for eyedrops, then caught a bus to the train station and went home by train. The whole time I felt really sour.
As usual, the pressure of the presence of other people, endless numbers of other people, irritated me. But, in some strange sense, I felt that my irritation was illegitimate. In some bizarre way, the serious nature of my eye problem had disqualified me from getting annoyed at other human beings.
I could not work out the dynamic which led to this "disqualified" feeling, but maybe it was an aspect of depression. Life was piling up on me and I was heading down. Down toward zero.
Anyway, I got home okay, though it was a little difficult to navigate through the subway system with my left eye patched and the right eye in snowstorm mode.
The first night was okay, and I slept peacefully with my eye gunked up with ointment. During the following day, however, irritation built up, and by evening the single stitch in my left eye was causing me sharp pain. Blink! Hurts! Blink! Hurts! Blink! Hurts!
I lay in bed for hours, drifting into sleep then waking again because of the pain. And then, at a certain point, the pain went away. What happened? The stitch pulled out, or what? I didn't care. The key point was that the pain was gone.
That was my one and only serious siege of pain in the whole course of my medical treatment, and I had Ms. Josama to thank for it.
While Ms. Lux had undertaken to do what Ms. Josama had failed to do, and competently inject steroids into some mysterious part of the anatomy near the left eyeball, she never did so. My subsequent visits to Kappatani Hospital became brief confrontations in which Ms. Lux urged me to undergo a vitrectomy of the right eye, and in which I, fearing blindness (the left eye was nearing the point of uselessness, so if something went badly wrong and I lost the use of the right eye I would well and truly be blind) refused.
I have a memory from the final months of 2004 in which I am in Dr. Lux's room at the eye clinic and she is talking to the other people in the room about my refusal to undergo a biopsy. Her Japanese is too rapid and complicated for me to follow, but I keep hearing, very clearly, repeatedly, the word "gan", meaning cancer. And, though there are no sibilants in this word, as I remember Ms. Lux is hissing the word. The word is alive, writhing, hissing.
It is fascinating to everyone in the room, this spectacle of the patient who is refusing to take the next logical step, and who may, therefore, be in the process of killing himself. Volitionally. Knowingly. As an act of free will. Fascinating, and horrifying at one and the same time. And Ms. Lux, who makes it very clear that she keenly feels that she has a duty to keep me alive, if that is possible, is showing her stress more and more clearly. She is starting to become my nightmare, someone whom I fear and distrust, but she is plainly trying to do her best for me, and, clearly, while she is starting to become my nightmare, I am starting to become hers.
I am the cancer patient, potentially, at least, and, at the risk of my life, I am refusing diagnosis.
Ms. Lux wants me to submit to the surgeon's knife and I will not submit. And, as far as she is concerned, I am in danger of killing myself, because the truth may be cancer, and the surest way to get the truth is to biopsy the tissues, to take a sample and to look at it under the microscope, which may reveal secrets that other diagnostic methods have failed to detect.
And I have, from that time, late in 2004, a memory of a dream, a visionary dream in which I have been displaced from normative reality into some kind of Court of Imperial Science. And there I am, standing in front of a huge dais, a complicated stainless steel structure many kilometers high, and enthroned in greatness atop that structure is Ms. Lux, and her power is reaching out to me, and she is saying "Repent, hominid 949! Submit!"
But I do not repent. And I do not submit, either. I am not yet blind, and I can still go forward, one step at a time. And so I do, into the uncertain future.