Cast of Characters
Matsumura Rina - surgery consult
Maehara Yoshiro - consult
Mandibular left wisdom tooth cavities 4th degree
On Wednesday, January 25th I checked in to the National Center for Global Health and Medicine hospital (“kokusai kokumin iryo kenkyu senta”) in Shinjuku Ward for surgery under a general anesthetic scheduled for the next day, 8:45 a.m. on Thursday, January 26th. The surgery was done, there were no complications, and I was discharged around 9:30 a.m. on Friday, January 27th. The purpose was oral surgery to dig wisdom tooth roots out of my jaw bone following a botched extraction last October. Since October I have not been in pain, but my dentist and the dental surgeon (a young-ish 32-year-old woman with a pony tail) said that eventually I would be. Two attempts were made to get the roots out with a local anesthetic. Both attempts were aborted (for blood pressure reasons, I think. I was freaking out so much that the dentists in both attempts worried I would have a heart attack right there in their chairs) and the general anesthetic option was recommended. I didn’t like being in the hospital for 48-hours over three calendar days, but as usual I was told “This is how we do it in Japan.” They insist on a 24-hour pre-op observation period followed by a similar post-op observation period.
This was my second surgery in Japan under a general anesthetic. The first was in December 2014, a cataract surgery that took 48-minutes (much longer than the usual 15-20 minute cataract procedures commonly done under local anesthetics). On that occasion I had some trouble, the ophthalmologist (another woman) urged the general anesthetic, and there were complications during the operation itself. I don’t like general anesthesia. The feeling of losing consciousness is uncomfortable. Plus I have experienced long hours of nausea during post-op recovery both times.
On January 25th I checked in (“nyuin”) to the hospital. Admissions is immediately to the left inside the building’s main entrance. The hospital knew that I was scheduled to check in and Admission telephoned me on Monday 23rd to confirm that I was coming. This hospital is a major ‘international’ hospital in Tokyo - there are many English-speaking staff - and I was equipped with English-language paperwork: Admission information; credit card information to guarantee deposit; permission for surgery; permission for anesthetic; permission for blood transfusion (if necessary); and a statement about who I would allow the hospital to admit as visitors. I paid my 50,000-yen deposit in cash with the intention of paying the remainder in cash upon discharge as well, so I voiced my desire that the hospital not use my credit card information. No problem.
After processing I was given a Japanese-language document to present to the nurses’ station at Ward 10W - the West Wing of the tenth floor, which I did. The nurses welcomed me and they prepared a wrist band for me while an administrator walked me around the ward to show me and explain everything (in Japanese): day room with vending machines; showers; garbage receptacles; emergency call buttons; my room (Room 1054) with four beds, closet space, toilet, sink, small refrigerator and television. To operate the TV I would have to buy a TV card from a vending machine in the day room. I knew that already from my previous hospital stay, but I brought my laptop computer with me this time and three DVDs that I planned to watch for entertainment (which I did). Each bed had its own LAN cable port for internet access. But I didn’t have a LAN cable with me, so I spent the time without checking my Email or surfing the internet. Those would have to wait until discharge (“taiin”) on Friday 27th.
On that Wednesday afternoon I had a meeting with the anesthesiologist. After explaining the procedure and risks of general anesthesia (blood clot, stroke, death) to me (in pretty good English) we both signed the document saying that he had done so, and that I was giving permission to receive it. Then I had a meeting with a pair of women dental surgeons who would be performing the procedure. I knew them both, so no surprises. They don’t speak English, so I needed the interpreting skills of Nurse Futami from the Infectious Disease department, who is the hospital’s official foreign patient liaison. (I was not the only foreign inpatient. I asked her.) Blood sample taken. I also had an appointment at the 3rd floor Dental department for a routine tartar cleaning (“shisheki jokyou”), part of the surgery prep. Then I had a meeting with three of the day time nurses headed by Nurse Watanuki (no English, so again with Futami’s interpretation) explaining my "Inpatient care plan": meals; meds; regular blood pressure, temperature and blood sugar checks, and post-operative meds. My operation was scheduled early, and I was prohibited from consuming any solid food after 8:30 p.m. Wednesday night, and not allowed to consume any liquids after 6:00 a.m. on Thursday.
When I entered my assigned room there were two Japanese men already there, and one bed was empty. That empty bed was filled the next day, so there were three of us there that first night, but four of us on the second night. We all kept our curtains drawn and didn’t interact with each other.
No visitors. The day shift nurses were replaced by a smaller night time shift. The shift leader was Nurse Yamashita. As soon as I met Yamashita I could tell she was uncomfortable with the language barrier. By comparison, Nurse Watanuki in the daytime shift was more comfortable even though she couldn’t speak English. She was game for any eventuality. Yamashita was okay, but I felt she was afraid of me. Wednesday night I stayed up late watching DVD movies. I couldn’t sleep. I caught only short naps interrupted by long spells of wakefulness and wandering around the ward.
Thursday morning. Up early. Nurses checked in on me. Around 7:00 a.m. both dental surgeons plus Dr. Doushita, my anesthesiologist, poked their heads in. Nurse Futami wasn’t on duty yet, so they spoke in Japanese that I could only barely follow. But I did my best.
Nurse Futami came round at 8:20 a.m. Chatting. Ten minutes later we walked together to the elevators and went down to the operating theaters which are all on the fourth floor of this hospital. Instead of being led directly into a theater I was directed to a staging area where nurses and doctors were already gowned, but not yet masked or capped. Other surgery patients were there undergoing the same final confirmations that I now had to go through: what’s my name and birthday? Check my hospital wrist band. Do I know the date and what hospital I’m in? Do I know what surgery I am having? Is there any metal on my body? Have all piercings been removed? They visually confirmed that, because they know I’m pierced up the wazoo. Do I have any dentures or implants? Okay, down the hall to theater number 7. Remove shoes. Remove T-shirt so now I’m naked from the waist up and covered with a paper apron. My hair is covered with a paper cap. Adhesive heart and lung monitors are applied to different parts of my torso. They’re cold on my skin. Doctors and nurses are not masked yet. I’m on the table. I’m wearing compression socks for blood pressure control. I know I have to receive an IV for the anesthetic to be administered, but I know that’s going to be a problem because my veins are hard to find. Simple blood tests make me feel like a dart board. The doctors knew this because I told them. They checked both arms, looking for a vein. I warned them: not my hands. Wrists and elbows okay, but not my hands, please. They decided to put me to sleep with gas first and then once I was asleep poke around for a vein. It was my first time with gas. The anesthesiologist told me to breathe deeply through my mouth. This is vulnerability. This is helplessness. This is like being prepared for execution by lethal injection.
This is vulnerability. This is helplessness. This is like being prepared for execution by lethal injection.
I breathed once and said, “It’s not working.” I breathed a second time and said, “I feel dizzy.” I breathed a third time and said, “I feel real dizzy.” Then that uncomfortable feeling when I know I’m falling into blackness. No dreams, just total nothingness. Then I woke up and it was finished.
While I was asleep they intubated me. I knew they would do this, but despite the fact that I knew I was having oral surgery I never imagined anything except a breathing tube down my gullet. Of course, that was impossible. During recovery in my room my cheek felt tender and a bit swollen from the cutting, but my throat also was a little sore and felt a little swollen. It was only then that I realized they has inserted (and removed) a tube into my nose and sinus cavity and down my throat. I’m glad I wasn’t awake for that.
They rolled me back up to the tenth floor reclining on the operating table. I shifted myself onto my bed. I was conscious but disoriented and I felt nauseous. Lunch? Forget it. The thought of food made me want to throw up, which I proceed to do several times over the next ten hours. I had an IV dripping a yellow liquid into my right elbow. It wasn’t saline. It was a coagulant to retard bleeding in my gums. The two dental surgeons Drs. Imamura and Hakata dropped by to check on me. They gave me in a petri dish as a keepsake what they removed from my jawbone. Jiminy Cricket!! I asked the nurses how long it will take the IV ("tentenki") to finish so it could be removed. Nurse Watanuki from Wednesday’s day shift was back. Her familiar face was reassuring. She estimated that by 8:00 p.m. or 8:30 p.m. the bag would be finished. So I spent the day looking forward to that.
Throughout Thursday afternoon I was in miserable shape. Occasional bouts of vomiting mixed with brief periods of strolling around the ward. The room was stuffy and hot. It felt hard to breathe. The water was tepid and ugly to drink. Thinking of drinking made me feel worse. My stomach was empty, so bouts of nausea were only dry heaves that left me exhausted, flushed and sweating. My face poured with sweat. I wanted to breathe fresh air. (I couldn’t until I left the building on Friday morning.)
By late afternoon I felt more stable. More vomiting about an hour before dinner, but I figured I ought to try to eat dinner since I hadn’t eaten anything all day. I nibbled away at my dinner, worrying that it would all come back up. That didn’t happen. Instead, after dinner I fell once more into a short nap. When I awoke I could see from my bedside clock that only about 20-minutes had passed. I was happy that I could sleep at all without being sick. I felt marginally better and I decided I felt good enough to rise and go to the toilet, dragging my IV stand with me. My IV tube was quite long, and as I lay in bed it was dangling over the side of the bed out of my sight. I raised my right arm to prepare to grab the IV stand and then swing my legs over and onto the floor. But when I raised my arm three large drops of bright red blood dropped onto the bed’s white linen. I was stunned. I looked at the IV line which was red with blood, not yellow with the coagulant flowing into me. Then I looked up at the IV bag and saw that it was totally drained, sooner than I expected from Nurse Watanuki’s prediction. Then I looked down over the side of the beg and I saw that my IV tube had come apart in the middle, at a connecting valve, and what had happened while I was napping after dinner is that the IV bag emptied out onto the floor and since my IV line was hanging down below the level of my body and the valve was open I was in the process of bleeding to death.
I had never seen so much blood! Like something from television. The floor under the bed was covered with it! I knew my black sneakers would need a lot of cleaning in the room’s sink. (Even now there is a blood stain on my right sneaker that hasn’t worn off. I get a kick out of showing it to people and telling this story.) Blood is a fluid, not a liquid, so a puddle of blood is not like a puddle of water. It’s kind of gloopy-gloppy. How much blood had I lost? Was it time now for a blood transfusion, like what I permitted by signing the consent form on Wednesday?
I pressed the call button. But it was the night shift, not the day shift. The day shift has ten or more nurses in the ward, but the night shift has only three. It took five minutes for a nurse to arrive. It took so long that I stood up preparing to go into the hallway looking for a nurse. So when the girl finally arrived I was standing, not sitting or lying. “Doushita no?” “What’s wrong?” I showed her the end of the IV line, then she looked down and saw the floor.
I was surprised. She was a petite girl, but she immediately became Dominant Action Woman, ordering me (in Japanese) in a commanding voice to lie back down. Never mind that the bedsheets were stained with bright drops of blood. Lie down. Okay. She did four things immediately and in quick order: closed the valve at the end of the IV line from which I was bleeding; took my blood pressure; took my body temperature; then called for backup. Backup arrived. She telephoned downstairs to the Emergency Room to talk to a doctor, because there was no doctor on the ward. The doctor asked about my blood pressure. It was a little low, but still normal, so the IV line was simply removed from my elbow and bandaged. Then the two nurses cleaned up and even changed the bedsheets while I was still lying in the bed, the way they are trained to do. Apparently I lost about 700 ml, like a small bottle. Wow. What would have happened if I hadn’t woken up from my post-dinner nap and noticed the broken IV line?
It was still only around 8:30-8:45 p.m. when all of this happened. I was looking forward to 9:30 p.m. when I was on the list for shower time down the hall. I didn’t want them to refuse to allow me to shower by insisting that I remain resting in bed. They didn’t, so I showered and there was no more excitement. No visitors.
Friday morning awake early again. The two dental surgeons again popped in early to remind me that I had a 9:00 a.m. appointment in Radiology for a 180-degree mouth X-ray, to confirm that they got all the roots out of my jawbone, and then another appointment on the morning of Friday, February 3rd to have the stich (stiches?) removed from my gum. After that I didn’t see them again. I thought the liaison Nurse Futami might come around again but she didn’t. After breakfast I dressed in my street clothes and went down to Radiology on the 2F. Maybe they had it on their computer that a foreign patient had a 9:00 a.m. appointment because when they saw me they immediately asked to see my wrist band rather than the appointment card that an outpatient would be carrying. Once more the usual identity questions: what’s my name and my birthday? I feel kind of stupid answering those same questions all the time. It bothers me, too, that the hospital has not written my name properly in Roman letters, so whenever I confirm my name I have to confirm it the way they’ve written it rather than speaking my true full name. Oh, well. The hospital transcribed my name as “PIPER GRAN STE,” so unless I make the effort to get Administration to change it that’s what my name is at this hospital. What I say has to conform to what they have in their records.
X-ray finished. I returned to my 10F ward and reported to the day nurses at the nurses’ station that I was checking out. We said good-bye, I thanked them. Then before I went to Accounting on the 1F to pay my bill I went to the Infectious Disease department to find Nurse Futami and say good-bye to her. That done, I went to Accounting, paid my bill. Cash or credit card? Cash. I cost only half of what I feared it would cost. I still had time to go home and drop off my hospital gear before going to my regular Friday work, 12:00 p.m.-to-7:00 p.m.
The fresh air outside felt so good. My body felt bloated and kind of out of touch with my environment. I got over that. In the hospital I felt special and pampered, but outside it was a bummer to be just an ordinary guy once more. Until the next time.