Japanese Hospitals and You

The unthinkable has happened: you’ve landed yourself in the hospital. Either you were launched from your bike after the chain caught, you broke your ankle rock climbing, or you suddenly developed a 39.6-degree fever. Regardless of what started the process, there are two paths you can take to find yourself unexpectedly assigned a hospital bed.

One, go to your normal doctor. If he decides you are in bad enough shape, he’ll ship you off to the closest hospital.

Two, go to the ER. This path can be a bit more convoluted. First, you need to find out which emergency room is open. This can be challenging because the local hospitals do not always have an easily Google-able phone number. Once you have located an ER that is open, you have to figure out how you are going to get there. If you need an ambulance, keep in mind that the ride is likely free, so do not let the stress of an unplanned expense make your current situation worse.

You might not need an ambulance. In fact, the owner of the rock climbing gym might, in fact, be a part time firefighter who, with the help of two other climbers, is perfectly capable of carrying you out of the gym and loading you into his car. In this case, the ride to the hospital is probably a good time to agonize over if you should text your parents / siblings / significant other and let them know what has happened, or if it would just be better for everyone if you waited.

At the hospital, you will need to be checked in. If you have a Japanese person with you, depending on your condition, it may be best to just give them your foreign resident card and sit back while they fill in the form and just ask the occasional question. If you have been to the hospital before, you likely have a card and will get to skip this step as, unfortunately, you use the card as often as your T-Point card.

Now that you have reached the ER, through either path, you will have to wait a bit until the doctor can see you. This is fairly standard practice at any doctor’s office. If an injury has landed you there, you will then be taken for an X-ray, an MRI, etc. If you are there for an illness, you get to skip this step. Finally, you get to meet with the doctor. However, beware. Emergency room doctors are not the kind doctors you meet in the daylight for your colds and prescription refills. No, these men have been worn down by the seemingly never-ending march of patients before you.

These men have no desire to lower their speaking speed or their vocabulary level to help the clearly struggling foreigner who really meant to review the medical vocabulary chapter of her textbook but never found the time. Eventually, though, they will give you a very brief, unlikely to be satisfying, diagnosis. They will give you a prescription but will not explain the exact problem in detail. For that you have to come back another day to meet with another doctor who has the patience to talk about such things with you.

If you have broken a bone, you will be fitted with a temporary half cast and given some painkillers, then told to come back the next day when the doctors are seeing patients.

The bill for this visit will vary according to what tests were done. If you just had a meeting with the doctor, it may only be around 1000 yen. If you had an x-ray, expect it to be closer to 5000 yen. If you do not have cash on hand, do not worry. Some hospitals are pretty generous when it comes to paying your bills. Some hospitals may even call you two weeks after the fact, for a bill you thought you paid last time, and politely inform you that you have an outstanding balance and it would be nice if you could pay when you had a chance.

For some people, the trip to the ER might be all it takes.

For others, there is still a long way to go.

If you need surgery, the topic of anesthesia is going to come up. For some major procedures, general is the standard, but for minor ones, the doctors may be more reluctant to use it. Instead, they may opt for local anesthesia or epidurals. However, it is important to remember that this is your body and ultimately it is your choice. You may have to push for general when your doctor wants to give you an epidural. As long as you have good reasons for doing so, your doctor will likely hear you out. For example, if you have a history of back problems and do not want anyone sticking a needle in your spine, general may be the way to go, even if more tests are required ahead of time to ensure your asthma will not interfere with your breathing during the procedure.

If you need surgery, you are probably going to spend time in the hospital. Being hospitalized can be stressful, but making sure you have everything prepared (if your situation allows) can make your stay a lot easier. Before your hospitalization, you will meet with a hospital representative. She will then walk you through the forms that need to be filled out, and you will choose your room for your stay. At a certain hospital in northern Miyazaki, there are a few options:

  • General room- Four people in a room, shared bathroom down the hall.
  • Double room- A little more expensive, about 2,500 yen a night. Shared bathroom down the hall. Awkwardness can ensue if your roommate does not speak anything other than advanced-level old person Japanese and insists on doing nothing but staring at you when you forget to pull the curtain shut. However, you can end up getting a private room if said roommate is transferred.
  • Private – Private room without a bathroom.
  • Superior Private- Basically like the apartment some people wish they had. Private bathroom and shower, fridge, couch for your visitors, as well as a superfluous curtain behind the door. Can cost around 5,000 yen a night.

She will also go over what you need to bring with you when you finally check in. Most of the things on the list are standard for spending the night somewhere, but some you may overlook. (Of course, this list can vary from hospital to hospital and even from room to room.)

  • PJs
  • Slippers
  • Toiletries
  • Towel
  • Trashcan and trash bags
  • Entertainment that requires to you expend exactly zero energy as well as some things to do when you occasionally have energy spikes
  • Depending on your level of Japanese, a dictionary app will make your life a lot easier

Either you are checked in right there, on the spot, or you are given a time to come back later to get checked in. After that, there is not much you can do but wait and try to think of ways to distract yourself from your impending surgery. If you have had surgery before, you know the rules: no eating after a certain time, no drinking after a certain time. If you have asthma, you will be told to stay away from cold drinks after a certain point as well.

At some point before the procedure a nurse will come in with a gown for you (Japanese hospital gowns wrap in the front, thankfully) and, if you are going to be unconscious for the procedure, an adult diaper. I hate to break it to you, but that will end up on you by the time you wake up, but you will not have to be awake for when they put it on. So at least your pride is saved from that much.

Once you have changed into the gown, they will place the IV. Depending on a variety of factors, this may take one try, or nine tries, four nurses, and twenty minutes. All that matters is that, in the end, it will be placed. From there you are either wheeled to the operating room in your bed, or in a wheelchair. Unlike the US, (as that is the only thing I can compare to) you will not be sedated prior to getting the general anesthesia pumped into you. You will be wide-awake and it will not be pleasant. The good news is that this is very short and soon enough you will be blissfully unaware of what is going on.

How long it takes to recover from the anesthesia depends entirely on your body chemistry and how long your surgery was. During that time you will be hooked up to:

  • A heart monitor
  • A blood pressure cuff
  • A cuff around your leg (or cuffs around both legs) that periodically squeezes your legs to prevent blood clots (also known as economy class syndrome)
  • An IV
  • An adult diaper
  • Potentially a catheter

The surgeon will have set rules on when you are allowed to sit up, when you are allowed to use a wheelchair, etc. You may be ready to be awake and do things, but you may not be allowed to sit up or eat for another seven hours. (If you are not allowed to eat, the nurses may advise you to just drink as much water as you can stomach. However, this ends up being a pain for the nurses because you may take their advice and therefore have to be disconnected and wheeled to the bathroom every hour for the next five.)

During this period, before you are allowed to move about independently, there are a few phrases that you may want to know (there may be better ways to say these in Japanese, but this way has definitely worked for me in the past):

  • はきそう- haki so -I think I’m going to throw up. (General anesthesia can have some nasty residual effects.)
  • カテーテルを脱ぎってもういいですか?—kateteru o nugitte mo ii desuka? – Is it ok to remove the catheter?/ Can you remove the catheter?
  • 自分でできます。-jibun de dekimasu- I can do this by myself. (Useful when the nurses try to follow you into the bathroom.)

Once you are declared able to move about freely (excluding the IV that may still be attached to you until they switch it over to a port), you can more or less relax. You may start rehabilitation / physical therapy at some point, but otherwise your schedule is free. If you are going to be in the hospital for a while post-surgery, try to arrange for one or two people to visit you every day. Even the shortest visits can make the days go by faster.

While you are recuperating, your supervisor can start working on getting things ready for the JET Accident Insurance claim. The insurance covers up to sixth months after the accident so do not submit the form until your treatment is complete. Once you submit the claim it can take anywhere from a week to two months to reimbursed.

Regardless of what happens, remember three things:

  • Stay calm. The nurses especially want to help you understand what is going on and are probably the best people to look to for help. They may not speak English, but they will try to explain things as best as they can.
  • Save all of your receipts! This includes taxi receipts, any clothes you may need to buy due to normal shoes not fitting over your swollen Hobbit-foot, as well as all the clearly medical expenses. You will need these for filling out the JET Accident Insurance form. The accident insurance covers you for anything related to the accident up to six months. That means if you break your ankle at the end of May, you are covered for your surgeries and physical therapy sessions all the way through the second week of November.
  • Life in the hospital is much easier than life in the real world will be if you have an injury that limits your mobility. This is especially true when you live alone. If your doctor suggests that you may want to stay one or two more days, it may be a good idea to hear them out.

Disclaimer: The author of this blog was hospitalized twice for surgery following a severe ankle break: once to install some hardware and once again to remove the hardware. All information included in this blog is based on her experience and as such, might be different from what you experience. However, this is meant to give you an idea of what could happen and hopefully make the prospect of hospitalization and surgery in Japan somewhat less frightening.