(Note: This is the second of two parts. The first described events leading up to my daughter’s hospital stay. The second examines more details of problems with Japanese pediatrics and the public hospital care system. Yes, this story is a bit long.)
The doctor at the private hospital arranged for the needle to remain in place for our daughter, taped down carefully so that she wouldn’t be able to rip it out or damage herself, in the hope that the next hospital could simply insert the IV tubes without having to stick her with a needle again. However, he did warn us that we might have to wait a while in the emergency room and that the doctor at the prefectural hospital would determine whether or not our daughter needed overnight hospitalization.
After paying the bill (2900 yen, about $26, which was 20% co-pay with the national health care system), we set out by car, in the dark, having no idea of how exactly to get to the prefectural hospital. Luckily, we had recently purchased a car navigator device, so we were able to locate the hospital on the map. On the other hand, we hadn’t gotten the more expensive real-time update plan, so because of various road construction projects not on last year’s map the navigator directed us to highway exits and interchanges that no longer existed. We spent an extra half hour circling around trying to find the entrance to prefectural hospital, finally arriving at around 6:30 p.m.The building was in a state of extreme disrepair, with ancient light-green paint peeling off all the walls both inside and outside, surrounded by a concrete parking lot with no green plants or living things within two hundred yards. The place resembled more a bomb shelter than a place for the ill and injured: a square-shaped concrete building with endless plastic seats in rows like airport departing gate lobbies; a main reception area near the front entrance, but no maps, no signs; wide concrete stairs connecting the five floors of the building, with vending machines directly beneath the stairs. Not even fake plastic plants for decoration. Barren.
We entered the hospital from the main entrance near the parking lot and had to walk along nearly the entire length of the building before we located the emergency ward, which had its own entrance near the back. There, a group of male retirees sat in a glass-enclosed booth and took the doctor’s recommendation letter from us, asked us to fill out more paperwork, and then directed us to a narrow, cushioned bench at the entrance to the emergency room. No indication was given of how long we would have to wait. I was later told that public hospitals typically hire local retirees on a part-time basis for reception work, since they’re cheaper than full-time staff.
Fortunately, we waited outside the emergency room for only about fifteen to twenty minutes. We were called in to see a young doctor who had us place our daughter on another old, green cushioned cot for a cursory examination. We explained the situation all over again, as if the doctor hadn’t read the previous doctor’s recommendation letter. Three or four nurses spent several minutes cooing over our daughter, saying how cute she was before they foolishly attempted to take her temperature for the umpteenth time that day. She still had no fever. She did, however, have a temper.
The decision was made to continue the IV and keep her under observation to see whether her condition improved or deteriorated. It might be a while before a decision might be made whether she would be admitted to an overnight stay, we were told. We reluctantly acquiesced; staying a while was something we knew would probably happen, but we had hoped to have our daughter admitted to an overnight stay immediately, given the seriousness of her illness as outlined by the previous doctor in his letter.
We were then led to an adjacent open room that consisted of little more than two hospital tables. One of the tables had a small green coffin-shaped padded area in the middle that was ringed by tiny metal pegs evenly spaced apart. Our baby was put onto this padded area. Her arms were left free, but the rest of her body was covered by what appeared to be a blue tarp, and then a string net was attached over top, latched down to the metal pegs, to prevent her from moving.
We were escorted just outside of the immediate room area, and an orange plastic curtain was pulled across in front of us, preventing us from seeing anything.
Our baby started screaming. We could hear nurses talking and laughing. Some of them tried to console the baby. It felt like an out of body experience. I was numb, and furious. My wife knew this, and I sensed she felt helpless. “This is their way,” she said, or words to that effect. “What can we do?”
After a space of some time, perhaps ten to fifteen minutes, we were allowed back into the room. Our daughter now had two needles, one attached to each arm, heavily taped down to prevent her from ripping the needle out. The nurses explained that the blood had already clotted in the first needle and they were unable to attach the IV to it. They didn’t explain why they had left it in.
I had to carry my daughter as a nurse led the IV stand (and us) to the outside corridor and into a nearby room. The room was tiny and poorly lit. There were two or three room dividers randomly standing about. Two old green padded cots were placed against two walls…and the walls were nothing more than doors to other rooms that had been sealed off by plastic. The green cots were not covered by sheets and weren’t even sanitized with alcohol. Directly behind my daughter’s head on one end of the cot was a blanket with a quarter-sized blood stain. An old metal bureau desk lay against a third wall, covered in random junk (including two alcohol spray bottles which I used without asking). A medical cart was shoved between two of the room dividers (upon which was a tissue box whose contents I used without asking). Right up against the bureau, on the floor, were two small plastic boxes with labels. One read “old used needles.” The other read “contaminated influenza cloth materials.”
The nurse said quickly that the doctor would come in and check on our daughter condition soon. She then left. I went outside the room and looked again at the sign on the room door. “New-type-influenza examination room,” the sign read in Japanese (shingata infuruenza kensa shitsu). Next to the Japanese in parentheses the English read “(SARS 2002)”.
To make a long story short, we stayed in the SARS room, with our sick daughter bandaged up like Edward Needle-hands, from 7:30 p.m. to 11:30 p.m. My wife and I took turns holding the right hand of our daughter at a specific angle so that the IV would work properly. The doctor came in once around 9 p.m. with the results of the blood test and said that some of the numbers regarding liver function were a bit high. She wanted to continue “monitoring” our daughter’s condition before allowing us to stay overnight. When asked when this decision might be made, she was noncommittal. “In a while.”
At 10:30 we got tired of waiting and called a nurse. I demanded to know whether or not our daughter would be allowed to stay overnight. “The doctor still wants to monitor your daughter’s condition,” we were told. I had seen precious little “monitoring” that entire night. I told the nurse so. I also complained (as in polite, yet forceful, Japanese as I could muster) that the room was filthy, totally inappropriate for a sick person, let alone a baby, that we had not eaten since noon, that we had not slept in three days, and that we wanted a decision pronto. “This is the only room available,” the nurse said in a low voice (obviously irked by my tone of voice). “There are vending machines in the basement if you’re hungry.”
The nurse then disappeared, and a more senior nurse returned, along with a different doctor. They told us that the doctor would let us know as soon as she was done checking on already admitted patients. “If we can’t stay overnight, when will we be allowed to leave?” we asked. To which the reply was, “The doctor will decide when you can leave.”
At 11:30, we left. We were finally asked by the first doctor whether or not we wanted to stay overnight, and by that time we had both had it. We wanted to go home. The doctor requested that we return at 9 a.m. the following day for another check up. From the very beginning, it seemed to us, the prefectural hospital had done all it could to prevent us from staying overnight.
We agreed to return the following morning. And the next morning we went straight back to the private hospital. It took the doctor almost an hour to get another needle into our daughter’s hand (he tried both feet as well). After a couple of hours, we were sent home. He didn’t think she needed hospitalization, but he asked us to come back if the vomiting and diarrhea persisted.
On Saturday morning, we returned to the private hospital. We were determined to get our daughter, finally, into a hospital stay. The doctor offered to contact the prefectural hospital again to inquire about admittance for a few days. I immediately said that I wanted to avoid the prefectural hospital at all costs. He tactfully offered to call two different hospitals instead. We were fortunate to find that, although a local university hospital had already filled the beds in its pediatrics ward, the city-run (as opposed to the prefectural-run) hospital had plenty of beds and doctors available. We went there, our daughter was admitted immediately, and she stayed from Saturday afternoon to Tuesday afternoon, making a full recovery. My wife stayed overnight for three nights with our daughter. I went home, pale and nauseous, on Saturday afternoon and ate little but soup for two days due to exhaustion. My mother-in-law flew in unexpectedly during this time and was an incredible help to us.
The moral of this long story? “Stay healthy in Japan.”
Or maybe, “Don’t get sick after noon.”
Now, with all the trouble we had getting a single sick baby into a hospital in a relatively rural and sparsely-populated prefecture, imagine what it must be like for elderly people (who now comprise over 25% of the country) in a major city like Tokyo…