Healthcare in Japan, part 3

I had no idea I had so much to write about with regard to healthcare, but here goes part 3!

Over the New Year holiday, I finally received word from a customer care representative via email that she would take it upon herself to see to it that I get the information I need to move forward with an MRI in Japan (Thank you, Emily!) .  It takes a few back and forths, but after 2 months of waiting, I get the green light and I head back to the clinic to give Dr. Kotoh the long awaited news.  He is relieved and writes me a referral to a hospital that performs MRI’s nearby.  It’s a 2 week wait, but I get there and get what I need.  Well, I should mention that the technician strapped me in a chest brace and rolled me into the machine head first. I thought it quite strange, but didn’t question his expertise.  A few moments later, he looked at the paperwork and said, “sorry!” repeatedly realizing that I was there for a left knee MRI.  As he unstrapped the chest plate, he repeated “sorry” in English, over and over.  I’m just glad we both realized the mistake before the procedure started.

After the 1.5 hour scan, I head to the waiting room where I paid ￥5000 ($46) and receive the films.  And boy, what films they were!  2.5 ft x 2.5 ft. in a huge envelope and carry bag! And there were 8 of them.  It was a bit tricky lugging them on my bike to Dr. Kotoh’s clinic, but I manage…in the rain.  I tell the clinic that I don’t have time to speak to the doctor since the scans took longer than expected, but I want them to hold on to the films for when I can head back the next day.  When I get to the clinic the next day, I am told that the doctor had an emergency he had to attend to, so I’d have to come back the next week.  The following week, I meet the doctor and he recommends I see a specialist (wait, I thought HE was a specialist).  It will take him a few days to write a referral (referrals include a handwritten letter explaining my situation and an appointment date and time) to a larger hospital in the heart of the city.  By the time I get the referral, another week has passed.  Thankfully, my appointment is for February 3rd, the following week: 1 day shy of 3 months post injury.  I called the hospital ahead of time asking if there was an English interpreter on staff who could help me, but they don’t have such services.  At least Michael will come with me to help understand (use Google translate) what the doctor is saying.

The hospital is a confusing maze of signs, directions and number dispensing machines.  You pull a number (slightly more sophisticated than the ones used at the deli department of a supermarket) after passing the information desk.  When your number is called, you speak with the receptionist who gives you a new number and directions on where to go next.  We head upstairs to the sports medicine reception and go to the waiting area for our number to show on the big screen.  There are 4 sliding doors and 4 screens next to each door.  Your number could be on any of the 4 screens, so we are strategic in our seat selection to ensure all 4 screens are in view.

There is a chime and then a voice announcing the next number.  It felt like we were on a game show or waiting for lotto numbers, so when they announced #48, I almost screamed, “That’s me!  I won!”

We head to the appropriate door and stand in front of it for a few moments.  What is behind the door anyway?  Another waiting room?  A nurse who will take you to a room?  Realizing it is, in fact, not an automatic door, we slide it open to find a small room with an exam table on one side and a desk with a computer on the other.  Sitting in front of the computer is a guy with a lab coat.  I say “konnichiwa” and start introducing myself in Japanese, wondering if we were sent to a research lab by mistake.  The guy responds, “Oh are you the one who called earlier asking about an English interpreter?” in…perfect..English.  I look at Michael with relief.  He closes the Google translate app on his phone. We chat with the doctor about my injury, he looks at the scans and says, “I recommend 2 surgeries.  One to remove part of your meniscus and the other to repair the ACL since it’s loose.”  It turns out, the best results are to perform a partial meniscus removal first, then regain full range of motion before repairing the ACL.  2 separate surgeries have a better outcome than doing both at the same time.  My heart sank hearing the news.

While letting the news sink in, the doctor continues with, “The sooner, the better. I operate on Tuesdays and Fridays.  How about tomorrow?”  Wait…tomorrow?  Like in less than 24 hours?  “I can’t do tomorrow,” I reply, stunned that he would even suggest it.  “Ok, then this Friday it is.  We’ll need to run tests to make sure you are fit for surgery.  I’ll have the nurse draw up forms for you and she will see you in the lobby.  I recommend staying in the hospital for up to a month.”  We exit the exam room completely confused and in a daze, replaying what was said to us.  Our confusion was interrupted by the nurse who has printouts for us to hand to each of the 3 departments we are to visit.  3 tests?!?  We start with Station B on the map, where I pull a…you guessed it…a ticket number, wait for my number to be called, then head in with my printout.  It’s the blood drawing station.  After a few pricks, the phlebotomist is able to find a suitable vein and fills the 2 vials.  I’m clear to head to the next place on the list: Station H.  I am able to read “レントゲン”. Looks like I’m in for an X-ray.  After speaking with reception, I wait for my name to be called.  What you must remember is everything is transpiring in Japanese and although I can get by in normal conversation, I’m at a loss when it comes to medical terminology.  And I’m unfamiliar with the way things are done here.  The technician calls my name, I follow him through a door.  He closes that door and immediately in front of us is another door.  Think of a solid metal phone booth with a door on either side.  He explains what I need to do, points to the gown, mentions some more things and exits the 2nd door.  After I change into the gown, I am about to open the door he went through, but on that door are 3 warning signs.  I read what I can and reach to get my phone to help translate…oh no, my phone is with Michael in the lobby!  I read “Do not enter”, but then I could swear he told me to open the door after changing into the gown.  I touch the handle again, and then see above the door, a red light is on.  My gut tells me that a red light means don’t enter.  I second guess myself, then third guess myself.  At this point about 5 minutes have passed with me touching and releasing the door handle, about 37 times.  Finally, I hear the technician asking “Sutoraikaa-san, Ok?” in English.  “Ok” I yell through the door.  “どうぞお入りください! Come in!” There’s the green light I was waiting for and walked in.  He smiles, knowing it couldn’t have taken me that long to put on a gown.  I mention the “Do not enter” sign on the door, hence my hesitation.  He replies that under the “Do not enter” the sentence continues with “unless you have spoken to a technician.”  Oh, right.  That’s the part I didn’t get.  We laugh at the misunderstanding (the story of my life in Japan) and get the chest x-ray done.  Check that off the list.  Change back into my clothes and off to the final station: D.  I hand the receptionist my paperwork and she walks me through a curtain that leads to 3 monitors separated by dividers with hoses attached.  It looks like the library study room cubbies back in college.  I sit in front of this machine and she says in a mixture of English and Japanese that I am to blow into the hose twice; first a normal exhale for as long as I can and the second a forceful exhale for as long as I can.  All the while the monitor charts the capacity of my lungs.  It was hard to know whether her “hmms” and “ahs” meant I was passing the test or not, which made me nervous.  But afterwards, she said, “Ok, you’re finished” with a smile, so I was hopeful.

We returned to the sports medicine reception when Michael noticed the time.  3 hours had passed and he needed to rush home to get the kids from school.  Finally, I was able to process the news from the doctor: surgery in 4 days; 2 weeks in the hospital.  Could we swing that on our own?  And when I say we, I really mean, can Michael take care of the kids on his own for 14 whole days?!??

My thoughts are interrupted by the number chime, so I head back through the sliding door.  Dr. Kusano reviews the test results and says they look good.  Here’s the exchange:

Dr. K: You are cleared for surgery, so please come to the hospital on Thursday.
         
Me: Wait, I thought the surgery was on Friday.   

Dr. K: It is, but you come to the hospital the day before.                              

Me: Like, the night before?  I don't want Michael to have to take any more days off of work.    

Dr. K: In extreme cases, we allow a 1pm check-in at the latest.  But in your case, you must check-in between 9 and 10am.  We need to prep you for surgery the day before.

Me: And how long exactly will I be staying in the hospital, and why isn't it outpatient?        

Dr. K: If I repair your meniscus, then it's a month long recovery in the hospital.  If I have to remove it, then your stay could be shorter, possibly a few weeks.  We won't know until I get in there and see the damage firsthand.  Most surgeries are inpatient here so you can focus on getting better while we tend to your needs.  We find it leads to better recovery outcomes.

I exit the room and wonder what kind of prep takes an entire day?  And, how much is this potential month long stay going to cost?  As the nurse directs me to the patient consultation room just down the hallway from the entrance, it hits me that this unfamiliar process is making me extremely anxious.  I walk into the consultation room, unconsciously pull the ever present number tag and wait, my thoughts swirling in my head.  When my number is called, I hand the clerk the stack of papers and she returns with an even bigger stack, a hospital handbook and a request to check-in as close to 9am on Thursday as possible.  She also gives me a to do list: visit the dentist, gather items on the checklist for in-patient stays, inform my health insurance of my hospital stay, make meals ahead of time and freeze them for the family.  Ok, that last one might have been a note to self.

The next 3 days are a blur of making phone calls, translating documents, filling out forms and packing for the hospital.  The next thing I know, it’s Thursday morning and Michael and I send the boys off to school and then take the train to the hospital.  When we arrive, we are directed to the patient check-in area, which was full, so we were escorted to the overflow room, which was beginning to fill up too.  I guess they tell all patients to come to the hospital at 9am, not just me.  Since I am the 3rd patient of Dr. Kusano’s to check-in, I am given the 3pm operation time slot.  The nurse asks me if I will be needing a hospital gown (apparently you can bring your own) and says that there is a rental charge of ￥500 per day.  Well, that’s different, being charged for the gown.  Now I’m really nervous about the bill since it seems we are being nickel and dimed for everything.  Then the nurse leads us up to the patient room.  As we get to the 8th floor, she apologizes that my hospital bed isn’t quite ready, so I will need to hang out in a private room.  2 hours later, she tells me that my bed is ready and leads me to a 4-person room where the beds are separated by curtains.  There is just enough room in my curtained area for my little suitcase.  Thankfully I have a window bed (I figure on a plane it’s called a window seat, so I’ve got the window bed, right?) with a beautiful view of the city. 

Soon after I settle in, Michael has to leave to pick up the boys from school. I’m sad he has to go, anxious about the surgery and uncomfortable about sharing this tiny room with 3 strangers. The first night is a restless one.

The next morning, I am awakened by my curtain being pulled back. It’s Dr. Kusano letting me know that he has 2 surgeries ahead of mine, so as long as those go smoothly, he’ll meet me in the operating room at 3p.m. I hadn’t considered that there was a possibility of my surgery being delayed. But even if it was, I’d just be waiting in my bed as opposed to a waiting room. He also tells me that I can eat breakfast, but they won’t serve me lunch since it’s too close to surgery. That’s probably why they have patients check in the day before; for timeliness sake and to monitor food intake. That makes sense.

The next thing I know, it’s surgery time and the my nurse asks me which knee will get operated on. I reply the left. She nods and tells me that I’ll be confirming this to the operating floor staff, the surgical staff as well as the anesthesiologist and of course, Dr. Kusano. She then leads me to the patient elevator to the 5th floor, where the first nurse I see asks which leg, “left, I mean ひだり(hidari)” I reply. I found my arm pointing to my left knee as well, just in case. The nurse looks puzzled, then leads us down the hall to the surgical staff. A staff member asks which leg. “ひだり”I reply while pointing to my left leg. They give me the same quizzical look and walk me to a huge, solid metal door. We wait there. My nurse says the metal door usually opens as soon as you walk up to it and wondered why it wasn’t opening. My mind is racing, not knowing what was happening. Then another staff member comes over and asks which leg, “ひだり” I say, looking at my nurse for reassurance. The staff member asks if I’m sure. I nod. She disappears. My nurse keeps repeating, “daijoubu (it’ll be ok)” I wonder if there is a way to cancel this surgery and try a different day? It all seemed a bit rushed and perhaps a little more time is what was needed. My thougths were interrupted by the loud, mechanical sound of the solid doors being opened. Dr. Kusano emerges with the 2 staff who questioned me about which leg. They explain that in their notes it says “right knee”, but I keep telling them “left knee”. He looks at me and asks, “ひだり?”. I show him my left knee. He then declares “ひだり” and the staff edit their notes and lead me to the operating room. It’s a good thing they have so many check points before the surgery.

Dr. Kusano reviews the surgery with me again while leading me to the operating table. It sounds straighforward and I tell him I’m ready. The anesthesiologist places the mask over my nose and mouth and asks me to count backwards from 20. I drift off at around 15.

I awaken in the recovery room where the doctor tells me the damage was beyond repair, so he removed 2/3 of the meniscus. He speculates it’s because so much time had lapsed between the injury and surgery. The good news is that I can start walking immediately. He’s optimistic that I will be able to go home after about 10 days. I’m disappointed it couldn’t be repaired, and feel frustrated that I couldn’t get the MRI sooner. They wheel me to my bed where Michael and the boys are waiting for my arrival. Seeing those boys’ faces perks my spirits up instantly and I look on the bright side: I get to go home sooner than expected.

My recovery was smooth and by Monday, I’m able to walk around unassisted. Dr. Kusano sees my progress and determines I can go home the next day. I’m thrilled and Michael is ecstatic that his time of being a sole parent is coming to an end. The hospital stay was pretty good. My roommates were quiet, elderly, long-term patients, who I never saw because the curtains were always closed. The food was quite tasty and the care was good. I have to admit it was quite a relaxing 6 days.

Michael comes to pick me up Tuesday morning and I’m ready to head home. We thank the nurses as they hand me paperwork to give to the cashier. We head to reception, hand in the paperwork and are given a number tag. The lobby is full of other patients waiting for their bingo number to be called and shown on the big screen.

They are on number 266 and I’ve got number 304. While we wait, we guess how much the bill will be. When the boys were born, I stayed in the hospital for 3 days and soon after bringing my bundles of joy home, we got a whopper of a bill from the hospital. We paid it and thinking that would be the only bill. Then a bill arrives from my ob/gyn. We pay that. Then a bill from the on-call doctor. We pay that and are convinced that has to be the last bill. Nope! A bill arrives months later from the pain management group and another from the pharmacy and one from the anesthesiologist. I recall the final invoice arrived almost a year later, informing us there was a billing error and we owed more.

With that being our only hospital experience, we remind ourselves we have a $10,000 limit on our credit card, plus there’s an ATM next to the cashier. Our number is called after about 20 minutes and we head to the automatic payment machines and scan the barcode. We brace ourselves for the bill…$1000. Ok, that wasn’t as bad as we thought. The funny thing is that about a month later, we receive a deposit in our bank account from Michael’s insurance. The deposit was for $800. Oh, right, national healthcare–great! Then I get a bill from the hospital—yep, I knew it was too good to be true. I open it and it’s the hospital gown rental fee of ￥500. I pay it at the nearby 7-11 (yes, 7-11’s here are amazing!) . We then got a deposit from the school supplemental insurance: $400! When I calculated all the costs from the injury (clinic fees, PT, MRI, hospital, etc) and then subtract all the reimbursements, it equals -$10. Yes, we came out ahead, which is utterly unheard of in the States. The experience has made us question the state of healthcare in the U.S., where medical debt is real and impacts many unfairly. All I can say is cheers to countries with national healthcare systems that provide for their citizens and residents.