I was 44 years old the first time I died.
On the morning of Saturday, 8 August 2009, I had a heart attack. It passed fairly quickly.
In the afternoon of Sunday, 9 August I had another. It, too, ended fairly quickly.
On Tuesday, August 11 2009 at 3:00pm, I had another heart attack. It didn't end.
There are a lot of great things about living in Japan. There are also some inconvenient things, annoying things, and downright stupid things. Overall, the good aspects of living in Japan far outweigh the bad aspects, though, and I dearly love living here. (Working here is a different beast altogether.)
Naturally, one of the annoying aspects of living in Japan is the language problem. Japanese is a remarkably difficult language, and even after years of study, even though I know an impressive amount of Japanese, I still have trouble with simple conversations with my neighbors. The chit-chat with my neighbors isn't the problem, of course. I can just nod my head and mumble some common Japanese acknowledgment phrases, and they're happy to keep babbling away in language that I mostly don't understand.
The problem comes with important things, like the post office, the bank, or (in this particular case) the hospital. If I'm at the convenience store and the cashier asks me something I don't understand, I can always just gamble and say yes or no, and see what happens. "Would you like a bag for that single piece of gum?" What did he say? Ummm, "Yes!" I know it's my fault, but I can't help thinking "What kind of dumbass would think I want a bag for a single piece of gum??" If you go to the hospital, you have to be a little more careful. There's always the chance that someone just asked "Would you like us to amputate your leg to get rid of that hangnail?"
Another problem is that everyone I work with is busy beyond belief. It's not uncommon for people I work with to work through the night, go home at 7:00am, take a shower, and come back to work at 9:00am. On a normal workday, my office has about 50% of the people still working at 9:00pm, 12 hours after the official start of the work day. People are usually still in the office at midnight. I know this because I'm one of those people. The problem this causes is that it's hard to find someone who speaks both Japanese and English to escort you to one of the Japanese hospitals to translate the more difficult Japanese words for you. When you learn Japanese, they teach you the common vocabulary that you use in everyday life (no, Rona, I didn't learn to ask where the library is first), not medical terminology, so you really need someone to escort you. The best I could do was have someone to escort me on Saturday morning. I would have been dead for over two days on Saturday morning.
Wednesday morning, after not being able to sleep all night, I started searching for a hospital that could speak English. Most hospitals that advertise that they can speak English have a single person on staff who is bilingual. When I had my yearly physical, I was escorted by a young woman who spoke English very well. She was the only person in the hospital who spoke English, and she had worked there for 3 months. She worked in medical records, entering data into the computer. The point is that the hospital's "English language ability" was really just from the chance hiring of a bilingual person to work at the equivalent of a minimum wage job. At any rate, I found a hospital that advertised English language ability, navigated the maze of side streets to get there, and found, again, a single staff member who could speak English. In the hospital's defense, the woman actually worked at the reception desk, so they didn't have to call her out of the dark windowless back room to help me.
One of the annoying aspects of living in Japan is that there is only one way to do things. In America, there's an old saying that goes "There's the right way, the wrong way, and the army way." In Japan, there is only the Japanese way. If you try to do something the wrong way, it disrupts all of Japanese society, and I'm sure the prime minister and the emperor in Tokyo both hear about it. It creates a real problem if you have a situation that the Japanese have never faced before, which is surprisingly common if you come from a different country. It usually ends with around a dozen or so Japanese people standing around scratching their heads trying to figure out what to do. The hospital is no different; there's a rigid set of procedures that you have to follow, in order, when you go to the hospital.
First, you have to call before you go to the hospital. They don't open until 8:00am, so I called as soon as they were open. Too early, call back at 9:00am. Okay, I called back at 9:00am. "Just come down to the hospital." Okay... so why did I have to call first??
When you get to the hospital, you check in at the front desk. Then you go through a series of tests that works like this: Get your height and weight checked, go sit down and wait for 20 minutes. Get your blood pressure and pulse checked, go sit down and wait for 20 minutes. Pee in this cup, go sit down and wait for 20 minutes. Lie down here and we'll take an EKG, go sit down and wait for 20 minutes. You can see how this is going. Eventually, I got to speak to a doctor and he could speak English reasonably well. He had my EKG in his hands.
The interview process is pretty universal. Tell me about your lifestyle, how active are you, what's your family history, what do you eat, drink, smoke, etc. I've always been pretty active, and I told him I walk nearly every day for about 45 minutes (I walk down to the beach to feed the stray cats of Akebono), and I usually go out on the weekends for a bike ride of at least 30-40 kilometers (18-24 miles). I eat reasonably well, and don't really drink very much, although that's mostly just because I don't have enough free time. If I ever retire, I'm likely to be the weirdo that the neighborhood kids talk about who sits in a lawn chair in his back yard and drinks beer as the sun sets. I also don't smoke, do drugs, or any of the stuff that will really mess up your body. My doctor said I was one of the healthiest patients he's ever had, and that my EKG said there was nothing wrong with my heart. ...but just in case, he wanted to run a blood test to check my blood enzymes. That was fine with me. I suspected I may have picked up some kind of respiratory infection from my recent vacation in America where I was camping outside in record cold temperatures.
Off I went to a new office where they drew my blood, and sat down for my next 20 minute wait. About 15 minutes later, the door to my doctor's office burst open, four people came running out, grabbed me, strapped me onto a stretcher, and poked IVs into my arms. My doctor was nearly white. He said "You're having a myocardial infarction!" (Let me tell you, "infarction" is an extremely difficult word for a Japanese person to pronounce.) One of the arteries that supplies blood to my heart was completely blocked. As it turns out, I might be a little too healthy. The rest of my heart was compensating for the part that wasn't receiving oxygen, so nothing out of the ordinary showed up on the EKG.
Shortly thereafter, I was shoved into an ambulance that took me to a different hospital that specializes in cardiac care, with all the pretty flashing lights and sirens wailing. I went in through the front door and straight into surgery. You hear stories of people who are involved in serious accidents and are on the verge of death, and the only things they think about are "Did I turn off the coffee maker?" or "Is there enough tuna in the cupboard?" I knew I had turned off my coffee maker. But as I was lying on the operating table and having my clothes pealed off me, the significance of being driven across the island to a different hospital struck me. The only thought that was going through my head was: "Nobody knows that I'm here."
Actually, there were a few more things that I thought about. Like, "does anybody know about that Citibank account? Or the ING account? Could you guys stop for a few minutes while I transfer some money around?" One of the consequences of the financial meltdown is that financial institutions frequently change your interest rates by a fraction of a percentage point to suck a few extra pennies out of your pocket. Fortunately, the electronic age and the internet make transferring money between accounts pretty easy, and I'm ruthless about moving cash assets around. When Citibank drops their interest rate by 0.1%, I immediately transfer my $47 over to ING. When ING drops their rates I move it somewhere else. Sadly, this results in a bunch of financial accounts, mostly with a fairly small balance, but I'm sure that Citibank noticed that I moved my $47 as soon as they dropped their interest rate by 0.1%, and I'll bet they're sorry now. I'm sure they'll call any day begging me to transfer the money back.
At any rate, there are a few other profound thoughts that go through your mind when you're in that situation, but they're probably not that interesting, or not for general consumption.
They started surgery almost immediately when I arrived in the operating room. To most Americans, all Japanese people look very similar. After you've lived here for a while that changes of course, and you notice an amazing amount of diversity in the people around you. That all changes when the people around you are wearing surgical masks, though. To my left was a huge array of monitors, and to my right was a small army of Japanese eyes above surgical masks. I couldn't tell the difference between any of the eyes. At least for the most part. I don't think I'll forget the eyes of the young Japanese woman who was shaving my nether regions to prepare me for surgery. My thought at that time was "this wouldn't such a bad memory to die with."
With that said, I didn't really think about dying much during this whole ordeal. Nobody wants to die (yeah, yeah, there are some exceptions to that rule, but bear with me). Nevertheless, even at my age I think I've led a pretty interesting life, and although I'm not ready to give up all the wonders that I have yet to see, I wouldn't be heartbroken if it all ended now. My last thoughts would be "Wow, that was really a kick-ass ride. Too bad it all had to end, but I can't wait to do it all again!"
The monitors next to me showed assorted piles of information about the surgery; not only my pulse, blood pressure, etc., but continual X-ray images of the surgery as it progressed. I watched as they inserted wires into my femoral artery and vein and ran the wires up beside my spine and finally into my heart itself. Honestly, it's one of the coolest things I've ever seen. ;) As soon as they came over the top of my heart and cleared the blockage in my cardiac artery, all the pain was gone from my chest and I felt perfectly normal. I was ready to get up and walk home.
Of course, they wouldn't let me go home right away. They sent me off to the Intensive Care Unit (ICU).
That's probably enough of the story for right now. I'm home now, my stray cat (Ake-chan [ah-kay-chan]) is sleeping on the chair, I've had breakfast and the five pills I take afterward, and I'm going to take a walk down by the beach to see how my other stray cats (the Cats of Akebono) are doing. I'm sure they're a bit hungry since I've been away for the past week. I'll pick up the story when I get back (and take a nap).
If you haven't read the first part of this story, please skip down and read it here.
After the surgery, I got wheeled in to ICU, the Intensive Care Unit. There's nothing really special about the intensive care unit aside from how often they check you. I think the schedule was about once an hour, and it was a huge room with a pile of beds so the staff could monitor everyone at once. I think it's pretty standard for an ICU. Before I get into the details of ICU, I need to back up just a bit, and step outside the story for a moment.
As you probably know, people in Japan tend to be small. Certainly, the average Japanese person is smaller than the average American person. In fact, quite a bit smaller. People in Okinawa tend to be a bit larger than a standard Japanese person, most likely a result of the American military presence after World War II, and the introduction of such delicacies as McDonalds and SPAM to the local menu. Okinawa has the largest concentration of centenarians (people over 100 years old) in the world, although it is rightfully feared that the current generation will be the end of that trend. Anyway, the real point is that I'm quite a bit smaller than the average American myself. When I entered the hospital, I weighed 160 pounds. Still, the medical people seemed to have a hard time as they moved me from table to strecther to operating table to bed and (seemingly) hundreds of other transfers. Sometime during all those moves, one of the muscles in my back got twisted just the wrong way. Honestly, it hurt like Hell, much worse than any chest pain I had.
That brings us back to ICU, and the "Japanese Way" of doing things. When I was moved to ICU, they left the long stainless steel tubes in my body just in case something didn't go quite right and they had to operate again in a hurry. Those wily Japanese think of everything, don't they?? Well, everything aside from how to transfer someone from one table to the next.
Since I was in ICU, and in Japan, and I still had the wires and tubes running from my groin to somewhere halfway up my body, I wasn't allowed to move while I was in ICU. I had to lie flat on my back, and if I twitched or even thought about rolling over loud enough, a small army of nursing staff would come over and scold me. I also couldn't bend my right leg, but that was a reasonable demand considering the stainless steel tubes running through me. I'd hate to have those removed if one got kinked. Eeek!
The back pain and the inability to move presented quite a problem, though. Fortunately, as an American, I can always pretend not to speak any Japanese, and people are more than willing to believe me. I spent the first night in ICU in pretty severe pain, not from the operation but from the twisted muscle in my back. Yes, I cheated and rolled over, but I got caught every time.
Here's where the "Japanese Way" comes in. The next day, after some wonderful Japanese cuisine of rice and preschool paste, I was given a schedule of how I could move, and at what times. As I recall, it went something like this: at 2:00, I could roll on my side, at 4:00 I could sit up (but only to 60%), and at 6:00 I could bend my left leg. Again, I was under the hawkish gaze of the nursing staff, and when I tried to roll over a bit at 1:56, the little army of Japanese nursing staff came over and scolded me. I told them their clock was slow. Sadly, I told them in Japanese, and was never again able to feign ignorance of the Japanese language. The most unfortunate thing about that is that when someone thinks you can speak Japanese, they think you're fluent. They didn't start talking to me in simple sentences. They started talking to me in long droning scolding sessions. At least I think they were still scolding me; they may have been showing me how well they could recite Tolstoy's "War and Peace" from memory.
One interesting thing that they did to me during surgery was to put X marks on my hands and feet in permanent marker. I wasn't sure why they did that. At first I thought they meant "This guy's as good as dead, don't waste your time scolding him!" but after I got to ICU, I realized that couldn't be the case. It didn't take long to figure out why the X marks were there. They had marked the arteries that went to my extremities, and once an hour somebody would come by and check each X mark to make sure blood was flowing to each of my hands and feet. Clever little Japanese people, they are!
Another item of note is that when you're in ICU, you don't get to do anything yourself. There's an aspect of that that's really scary for a boy who knows even the smallest amount about medical technology. As I looked around at the other people in ICU with me, I noticed that most people had a little bag next to their bed to collect urine. I can tell you without a doubt, when a boy sees that, the only thought running through his head is that it would be better to die than to have a catheter inserted in the last place you ever ever ever want it inserted. I didn't remember them doing anything like that, but I still checked by the side of my bed to make sure. The nursing staff promptly came over to scold me for rolling over.
Another unfortunate item to note is that there was only one person in the hospital who spoke English. Not the receptionist like the first hospital, or the nice young woman who worked in medical records when I had my physical. In this hospital, the only person who spoke English was me. Even drawing on my vast knowledge of the Japanese language, I couldn't figure out how to ask them how I could pee. Fortunately, a couple of people from my office showed up. Zamami-san (Ms.) and Tanaka-san (Mr.) stopped by, and I was able to ask the question (to Tanaka-san, not Zamami-san of course). As it turns out, they have a special little bottle with an odd shape (so it doesn't accidentally roll over) for just that purpose. Whew!
I'll spare you the rest of the details of how they dealt with the things I wasn't allowed to do, including taking a shower. I'm sure it's mostly the same as any hospital anywhere else in the world. The Japanese are always very efficient at doing things, and the hospital is no exception.
I'm not sure if it's just because I'm not Japanese, or if they treat everyone the same in Japan, but the staff was exceedingly good to me. They were always very polite, and (seemingly) went out of their way to make me comfortable. As an example, they brought me a television so I wouldn't get bored while I was lying on my back, unable to move. Actually, I had the nicest, largest flat screen television in the room. Of course, the television itself doesn't matter much. It's still Japan, and all the channels are in Japanese. All except one, which is the Armed Forces Network (AFN) station. The reception here is notoriously poor, and my fancy television didn't make any difference. Nevertheless, they sent a technician to work on the television, and after 45 minutes, I had a snowy picture of some kind of American television. I didn't have the heart to tell the technician that I usually watch children's programs in native Japanese so I could hear simple Japanese being spoken. Whenever he came back to ICU, I switched the channel back to AFN so he would feel good. My doctors and the nursing staff that it was quite entertaining to see me watching children's television, though.
ICU is also where I started taking my medications. This is another example of the "one way" to do things in Japan. If you go into the hospital for a cardiac problem, you get assigned a specific set of medications. At least I think that's the case, and since this is Japan, I'm sticking to my story. My medications included the normal things you would expect, like anticoagulants to keep my blood from clotting and clogging up my heart again. It also included medication for high cholesterol and high blood pressure, even though neither of those was a particular problem for me. My cholesterol has always been a bit high, but not in the danger zone, but my blood pressure has always been fine, even during periods of very high stress. Nevertheless, there's only One Way to do things in Japan, and only one set of medication that you take after a heart attack. The result is that my typically normal blood pressure suddenly became dangerously low. This fact didn't change my medication; there's still only One Way in Japan.
In some respect, this isn't so different from America. In America, if you have any kind of serious incident like a heart attack or stroke, your doctor tells you something along these lines: "Well, you had a close call there. Now it's time to change your lifestyle to make sure you're still with us long enough to provide a continuing revenue stream from your insurance company. From now on, you can only eat bunny food. No alcohol, smoking, television, or anything else that you might have enjoyed before. Now your life will be constrained to eating bunny food and walking endlessly in circles. Walking is so healthy for you." It shouldn't be surprising that someone who has spent their life eating McDonalds, drinking cheap wine, and sucking down a pack of smokes while watching television 16 hours a day can't keep to that regimen. Here's where Japan diverges a bit from America. When you get released, they actually give you a reasonable lifestyle to follow. More about that later. I'm just whining now.
ICU isn't called ICU for no reason. Aside from my twisted back, I felt fine. The rest of the people in ICU were there because they were were most certainly not fine. With nearly all the patients in a single room, it tended to be a noisy place. Not only because the nursing staff was running around checking everyone once an hour, but also because most of the people there were really not well. I'm not sure why the guy next to me was there, or what the nursing staff did to him when they pulled the curtain, but his howls of pain rattled the windows. After one night in the shared room, I was moved to a (semi) private room. It was at the end of the big shared room, separated from everyone else by a door and windows (with blinds that could be drawn for privacy).
Having a private room is kind of a double edged sword. It's nice to have a little insulation from the noise of the big shared room, but you suddenly feel very isolated. I was only in the room for a single night. I think they rotate people through the private rooms just before they get transferred somewhere else so they can get a good night's sleep. Anyway, after a single night in the private room, my doctors came in and removed the tubes and wires from me. I could finally move my entire body again. I guess I shouldn't be surprised at the amount of blood that came out as they pulled the long tubes out of my body, but it seemed like quite a bit anyway. They promptly shipped me off to the general ward in the main hospital.
More later...
If you haven't read the first two parts of this story, please scroll down and read them first: part 1 and part 2.
I got rolled into the general ward of the main hospital in the same bed I had in ICU. It wasn't far away, and I found myself in a much smaller room. The room was big enough for about six beds (three on each side of the room) plus a little room to walk between them. Mine was the sixth bed in the room. In this case "a little room to walk between them" only applies if you're a tiny Japanese person. The room was very tight, but it was mostly comfortable. Again, I was the youngest person in the room, but at least the guy next to me was a bit closer to my age. I would guess he was around 50 years old. The next youngest person in my room was at least 70. All the beds had little privacy curtains that you could pull around the bed, and as soon as I was wheeled into my place, my neighbor pulled the curtain between us. That didn't strike me as terribly neighborly, but I didn't complain. My bed was next to the window, and it was nice to be able to see outside.
The general ward seemed to be a lot quieter. There weren't any loud howls of pain, mostly just the occasional moans and groans that I would expect. The only exception was my (relatively young) neighbor. If you're an American, you know this guy. He's the guy you see on Sunday afternoons drinking a beer and watching the football game, wearing a jersey from his favorite team and a baseball cap to match, and still hoping he can get his teenage years back. He's loud and, although he's a likable guy, he frequently borders on lewd, crude, and disgusting. That was the guy next to me. All day long I could here him stretching, or at least the resounding moans, groans, and sighs of satisfaction resulting from those stretches. No doubt there was some scratching involved as well, and I was ever thankful for the thin privacy curtain that separated us. I thought that I would at least get some peace and quiet when the lights went out. That's when he started farting. He didn't stop until the morning. That's not an exaggeration. Really.
I also discovered a bit of hospital envy. When I got to my room, I was wearing a fairly standard hospital johnny, although it was Japanese style. In either case, it essentially a dress, and you have to be a little careful about how you position your legs when you're lying down and rolling over. Honestly, I don't know how women do it every day. The neighbor directly across from me (without an acute gas problem) had a hospital outfit that included pants! Wow, I considered mugging him in the night to steal those pants. In fact, everyone in my room had pants except for me. ...so envious. One day, a little Japanese woman came to my room and started passing out clean hospital jammies. Here's your Japanese lesson for the day. Onaji means "same" in Japanese. The answer to the hospital jammies woman should be "Iie! Zubon!" which means "No! Pants!" Add a little "onegaishimasu" which means "I beg of you" and you, too, can have hospital jammies complete with wonderful, glorious pants.
I was in the general ward of the hospital for a few days, and after the first day of being bored silly (during which I learned the Japanese word "taikutsu" which means bored), people from my workplace started showing up. In fact, a LOT of people from work showed up. It doesn't say much for the ability of my workplace to keep health information private (apparently Japan doesn't have HIPAA laws), but it was nice to have some visitors who could speak English. In fact, I was the most popular person in my room, and I think I was the most popular person on the entire floor. My coworkers brought me piles of gifts and loads of flowers, books, music, towels, headphones, food, and other assorted goodies. Most of the food I couldn't eat, of course, but some of it I could (thanks Kuniki-san!). The other guests were happy to eat some of the sweets that were left for me, so everything worked out well. I read two large books, a couple of magazines, and studied my Japanese more than I had in the previous 12 months combined. That wasn't just because of boredom, of course, it was also a necessity for communicating with my medical staff.
I also had daily visits from my heart surgery team which included three young doctors. My primary heart surgeon was Dr. Kobayashi, who was 30 years old. I think the next time around, I'll be a heart surgeon. Average salary in America for a heart surgeon is $350k. It didn't seem that difficult when I was on the operating table. Besides, I could always be one of the doctors that just watches, right?
One of the consequences of technology advancing so fast is that we don't realize just how serious things are any more. My heart surgery was simple and painless, and I was ready to go home as soon as I got off the operating table. It's hard to keep in mind how close I was to losing my life. It's not just me, either. The people around me don't really seem to have a good grasp on exactly what happened to me and how serious it was, and still is. Having a heart attack is a permanent change in your life. I'll be on medication for the rest of my life. For the three months following my surgery, I'm not allowed to do anything strenuous; the only exercise I get now is walking. Lots of walking.
Which brings us to my physical therapy. While in the general ward, I wasn't allowed to go to the bathroom by myself until I started physical therapy. The heart attack may have been serious, but the surgery was quick, painless, and instantly successful. I felt great, so not being able to walk to the bathroom was a significant annoyance. I had three days of physical therapy. On the first day, I walked to the end of the hall and back. That was it, but at least it gave me the ability to walk to the bathroom and shower. The second day, I walked the entire length of the hallway twice. That was the extent of my physical therapy. The third day was just a stress test where I got to ride a stationary bike for a while.
After a few days in the general ward, I was moved to a new room. Like ICU, this was a semi-private room, and when they wheeled me in, there was nobody in the bed next to mine. I thought I might have the room to myself. I had delightful visions of sleeping through the night without the sounds of my neighbor keeping me awake. After a few hours in my new room, I got a roommate. It was my neighbor from my old room. When he saw me, he brightened up and yelled "Ah! Konnichiwa!" Then he farted. I knew I was home.
During my stay in the hospital, I wore a wireless cardiac monitor all the time. All of my information was sent to a computer in the hallway, and I could peek at my details as I walked the hallway. The downside, of course, is that when I want to take a shower, I have to have someone disconnect me and make a note on the computer or people will come running. I know this because I rolled over once and one of the wires got disconnected, and people came running to check on me.
There's an odd thing that happens once in a while to foreigners living in Japan. Sometimes, when you walk up to a Japanese person and try to talk to them, even if you're speaking perfect Japanese, they get scared and run away. No kidding. It's happened to me a few times on the mainland, but it had never happened to me on Okinawa. I asked the attending nurse if I could take a shower that night, and I could see the panic in her eyes as she told me (in Japanese) to wait a few minutes. She never came back. I knew it was time to go home.
The next day, I made it clear to my doctors that it was time for me to go home. They seemed okay with that idea, so we went through all the normal checkout procedures. Naturally, part of the exit process is finding out the things that I should do and can do at home. In my broken Japanese I tried to find out what I could eat, drink, and do for exercise after I left. Our conversation went something like this:
Me: What about dietary restrictions?
Dr.: (look of bewilderment at the complicated English)
Me: How about takoyaki?
Dr.: Should be okay.
Me: Beer?
Dr.: No probrem. Not too much, though.
Me: Woohoo! I love Japan! When can I go back to work?
Dr.: Tomorrow.
Me: Oooo, I'm feeling a bit woozy.
Dr.: One week vacation?
Me: I'm feeling better again.
Dr.: Goodbye and good ruck!
If you're wondering what takoyaki is, let me explain. Most Americans think all Japanese food is raw fish on top of rice. While sushi is indeed popular, there are a lot of other Japanese foods that don't seem to have made it to America. Two of the greatest foods in the world are takoyaki and okonomiyaki, and I think the Japanese keep them secret on purpose. Takoyaki is a bit difficult to explain, but it's essentially a small piece of octopus that's cooked inside a little ball of batter, and then topped with takoyaki sauce, mayo (the Japanese love mayo), pickled ginger, dried seaweed, and who knows what else. Despite how it sounds, it is truely a heavenly food, and you should hunt some down if you ever come to Japan. Maybe I'll tell you about okonomiyaki some other time.
At any rate, I escaped from the hospital and headed back home, happy to be alive and back in familiar surroundings.