On Sunday April 11th I arrived home from the economically decaying environs of rural Japan, and the next day I went to Kappatani Hospital for the first time to have a consultation with Dr. Lux. I had already seen Dr. Lux at a small clinic, but she thought it would be better if I started coming to the hospital where she usually worked, as the hospital had all the resources which would be needed to check out my medical condition.
Visiting a Japanese hospital as an outpatient really helped me with my Japanese, and cured me of a very bad habit. I'd gotten into the habit of just smiling any time someone said something in Japanese that I didn't understand. However, I figured that in a hospital it wouldn't be safe to just smile and pretend to understand. Not understanding might potentially get you killed. I would have to really understand.
So I broke the passive smiling habit and began aggressively pushing for comprehension -- asking for repetition, asking for explanations, asking what the opposite of Mystery Word X might be and asking if the meaning might possibly be such-and-such.
The "guess and ask" technique is very powerful, and one that I routinely teach my English students. If someone says something to you in a foreign language and if you can guess the probable meaning then you can ask, using a combination of simple grammar and basic vocabulary which is in your range, "Is the meaning such-and-such?"
(In Japanese, this is "Imi wa such-and-such?")
If it happens that you've guessed wrong, at least the person to whom you are talking understands that you don't understand. And, if your hypothesis proves to be correct, the communications problem is solved.
I personally find this "hypothesize then ask" technique to be particularly useful for handling unscripted telephone calls from strangers.
Anyway, on all my visits to Kappatani Hospital, I paid very close attention to anything that was said to me in Japanese, and did my best to understand it. And this habit of paying attention may at one point have saved me from serious injury.
In June of 2004 I ended up undergoing a procedure known as a gallium count. This procedure involves two separate steps. In the first step, you show up at the nuclear medicine department of your hospital and get yourself injected with a radioactive isotope of a metal known as gallium. Then you go away. A couple of days later, you return to the hospital. By this time, the gallium has circulated through your system, and your entire body is radioactive.
In step two, you lie on a kind of stretcher, and various photographic negatives are brought into close proximity to your body. The radioactivity in your body causes a photographic image to form on the negatives. This procedure takes about thirty minutes.
Regardless of your state of health, an image of the interior of your body will form on the negatives. However, gallium has a particular tendency to accumulate in areas which are inflamed or malignant. Consequently, the photographs will tend to reveal the presence of inflammations or cancers.
Until I was scheduled to have a gallium count, I had never heard of this procedure, and I was very impressed by the concept, which struck me as an exceedingly cunning way of getting a photograph of the interior of the human body.
When it came time for me to undergo step two of my own gallium count, I laid myself down on a stretcher, closed my eyes and put myself into waiting patiently mode. After about thirty soundless minutes, one of the hospital technicians told me that the procedure was finished.
I was still lying on the stretcher and I still had my eyes shut. It would have been the most natural thing in the world to just swing my legs over the side of the stretcher, without bothering to open my eyes, and get down. Fortunately, I thought to ask (in Japanese) "Can I get down now?"
The reply, also in Japanese, was a little complicated, and I didn't properly understand it. But it seemed to be negative, and I got the impression that the gist of it was something like "We've lifted you up high." That didn't seem to make sense, but, even so, just in case, I opened my eyes and looked around.
To my surprise, I had indeed been lifted up high. I had thought that I would lie in one and the same position and that the photographic negatives would come to me. But, evidently, the stretcher had been hoisted up so it was well clear of the floor, perhaps so some photographic negative could be maneuvered into position at my back. It had moved so slowly and so silently that I had been given no hint that I was voyaging not just in time but in space also.
If I'd unthinkingly got off the stretcher without bothering to open my eyes, which is what I had come close to doing, then I would have fallen to the floor, and might have ended up staying in the hospital for longer than I had anticipated.
My adventuring into the Japanese hospital system, then, was in part an adventure into the Japanese language, though I never needed to use my Japanese when face to face with Dr. Lux, whose English was flawless, native-speaker level. (Yes, rumor to the contrary, there are Japanese people in Japan who can speak excellent English, and I have personally come face to face with a number of them, since one of my occasional assignments involved twenty-minute interview tests designed to test the higher verbal limits of students who had scored excellent results in pen and paper tests.)
Anyway, On Monday April 12th I put my Japanese language skills to the test when I went along to Kappatani Hospital to see Dr. Lux. On this visit, my first ever visit to Kappatani Hospital, the first step was to register as a patient, which involved filling in a Japanese-language form. This required me, amongst other things, to state my date of birth using the TSH system.
The English letters "TSH", which occasionally crop up on Japanese-language forms, stand for "Taisho Showa Heisei", these being three different imperial eras. The Taisho Era was from 1912 to 1926, so if you were born in 1912 then your year of birth would be "Taisho One" and if you were born in 1913 your year of birth would be "Taisho Two", and so forth.
The next era was that of the Showa Emperor, which ran from 1926 to 1989. This was the era in which the reining emperor was Hirohito, who is known posthumously in Japan as the Showa Emperor. (It is a standard custom for Japanese people to have posthumous names which are different from those they used in life, and this custom applies not just to emperors but to ordinary citizens such as my wife's late father, whom I never had the pleasure of meeting.) I was born in 1956, which was the thirty-first year of the Showa era, so my year of birth was "Showa Thirty-one", or, in Japanese, "Showa San-juu-ichi".
The Heisei Era began in 1989, so 2004 was Heisei 16. In Japan, the Western dating system is often used but not always, and train tickets and the like issued in Japan in 2004 commonly stated that they were issued in the year 16 rather than the year 2004.
Before arriving at the hospital I had figured out that I might be required to know in which year of the Showa Era I was born, so I had checked it out. This was easy to do because diaries printed in Japan often have conversion tables printed at the back, allowing one to convert a year in the Western system, such as 1956, to the corresponding year in the rein of the appropriate Japanese emperor.
Having found out that I was born in "Showa San-juu-ichi" I then committed this datum to memory. A smart move. While attending Kappatani Hospital I ended up regurgitating my date of birth at frequent intervals as the staff were supposed to request it so they could check that they had the right patient.
I have to say that the checking was a bit sloppy at times and I wasn't always required to confirm that I was who they thought I was. That said, they didn't have many Westerners in the hospital system -- in the course of my many trips to Kappatani Hospital, I only noticed a handful of Westerners.
Having filled out the form I took it to the appropriate counter, along with a letter of introduction in Japanese which Dr. Lux had provided me with. If I had not had the letter of introduction I would still have been accepted as a patient but I would have been required to pay an extra fee which the law specifies should be paid by those who show up without letters of introduction.
At a certain point I was provided with a hospital ID card, though I cannot now remember whether I got it on the spot or whether it arrived later by mail. I've done a complete data dump on this point.
Having registered as a patient, which was pretty simple, I made my way to the eye clinic, where I expected that I would get to see Dr. Lux.
True to my expectations, I did in the end get to have a very brief consultation with Dr. Lux. However, I saw a lot of other people before then.
I went through a process rather like an assembly line, various people each doing their own little part of the eye check thing. So I had a history taken by one underling (in Japanese), then had a standard eye test (look at the chart and say whether the gap in the circle you are looking at is pointing up, down, left or right), had photos taken of my eyes and so forth. The procedure made me think of gadgets being assembled on a production line, with each worker being in charge of one small part of the process.
I ended up sitting outside a room marked, in Japanese, with a laser hazard sign, and the thought that went through my head was "The next step must be to point a laser right into my eye".
In Japan, explaining things to the patient didn't seem to be a habit, and I formed the opinion that they've ever heard of the notion of informed consent. Later, I found out that this was not entirely true, and I did end up having a couple of experiences with informed consent procedures, Japanese style. However, as a rule, though I was intimately involved with the procedures being carried out, I, rather like a chicken in a chicken soup factory, got nothing much in the way of an explanation.
Anyway, when I was summoned into the laser hazard room, sure enough, it was laser-in-the-eye time, which was pretty weird.
I sat down at a big machine and looked into the depths of some unknown universe. Far away in the distance, there was a green rectangle. The green rectangle floated, without any visible means of support, in a field of red. Inside the green rectangle was a little red signal light. I focused on the red signal light.
Then a succession of tiny little red-orange suns rolled across the visible universe, a procession of suns, making their way along an invisible horizontal line. This was totally bizarre, unexpected and out of my experience.
My assumption was that they were mapping the interior of the eye, but that's just a guess.
They mapped (I think they mapped) the interior of the left eye, then they tried the same thing on the right eye. But they gave up on the right eye in about five seconds. Why? Because the right eye was junked up with a mist of problem cells. Lasers do not work well when confronted by smoke or mist, and the inflamed cells in my right eye created a garbage environment which defeated the inquiring laser.
Nobody ever explained to me what the potential dangers of this procedure might have been, but presumably the dangers were non-zero, because the following year an attentive ophthalmologist working at a New Zealand hospital noticed some signs of laser scarring in my right eye.
Having failed to map the right eye with the laser they took me into another room, told me to close the right eye and started massaging it with a little hand-held gadget. By this time I was getting a little tired of being treated like a chicken soup chicken.
Because I had recently seen an ultrasound machine being used to snoop on my baby in the womb, it occurred to me that the gadget might be a miniaturized ultrasound device. I asked and was told that, yes, it was an ultrasound device.
After a couple of hours of this kind of stuff, I finally got to see Dr. Lux. Briefly. She gave me paperwork for some more tests then sent me on my way. Paperwork in hand, I explored my way through the hospital.
In New Zealand, Dr. Kiwi had told me that one test I should have was a chest X-ray, and Kappatani Hospital gave me one of those. I also had a tuberculin test for tuberculosis. I predicted that there would be a reaction, since I'd been vaccinated against TB, but the hospital said that if I happened to have active TB then the reaction would be larger than usual. If I correctly understood what I was told, then it seems it's usual in Japan to have a reaction since in Japan most people have been vaccinated.
I was instructed to measure the size of the reaction in millimeters forty-eight hours after the tuberculin injection, and to fill in a form, which I would eventually give back to the hospital.
I also had a bunch of blood tests. What they were for I have no idea but the person taking my blood drew seven separate vials of blood. Dr. Lux had said that she thought the likelihood of my eye problem being caused by parasites was very small (I don't work with animals and I don't eat raw chicken and so forth). Even so, she planned to test for parasites. So, presumably, at least one of those seven vials of blood was for some kind of parasite-related text.
I also had a urine test and an ECG.
And, when I left the hospital, I had an appointment scheduled for May 10th. An appointment for a magnetic resonance imaging scan. I had to wait for this because the MRI machines were fully booked until then.
It was possible that the tests done on April 12th would throw up some kind of simple cause for my eye problem, such as tuberculosis. If not, then the MRI scan scheduled for May 10th would look for lymphoma of the brain. As Dr. Lux had made clear right from the start, lymphoma was one possibility. The cancer starts in the brain and then spreads to the eye, the presence of a few cancerous cells causing many healthy cells to become inflamed.
I went to the hospital on the Monday and on Tuesday evening I got on a bus and went out to a hotel near Narita Airport, where I was scheduled to stay for a few days while teaching English on an intensive basis -- the students were to start studying early in the morning and to continue all through the day and into the evening.
The hotel catered for, amongst other guests, the flight crews of one particular American airline, and it served an American-style buffet with, amongst other things, an unlimited supply of bacon. I had recently been reading a Stephen King novel featuring an alien which became addicted to bacon, and I found myself, like the alien, thinking "More bacon! More bacon!"
In between teaching English and eating as much bacon as I was physically capable of eating, I found time to measure my tuberculin injection, precisely forty-eight hours after it was given. The reaction was circular and was six millimeters in diameter. The color was a uniform red. There was no blistering.
I filled in the relevant details on the form with which Kappatani Hospital had provided me, and, in due course, posted it back to the hospital. And that was the end of my hospital experiences for a while. Or so I thought. But I was about to have a trip into hospital hell and to see for myself what can happen when institutional priorities are allowed to outweigh patient needs.