Hospitalization & surgery in Japan: What I went through with cancer
By Brody Nixon
The Japanese medical system has a bit of a mixed reputation, especially with foreigners. The medical technology and know-how here are certainly among the best in the world, and the social welfare system makes it relatively affordable for everyone. But issues of privacy, medicines that can be weaker than Western ones, inexperienced young doctors, and the occasional questionable diagnosis make a trip to the hospital/clinic a generally frustrating affair. I recently had a rather serious, in-depth experience with the Japanese medical system, which included surgery and a five-day hospitalization. I’m writing about it here to give you an idea of what to expect, should you ever have a medical emergency pop up like I did.
First, a short background. As a fourth-year JET I’ve had more than a few visits to the hospital. Before this January, the worst thing I’d had happen was coming down with a case of Mycoplasma Pneumonia a few years ago. At that time, I initially went to a small, privately-owned clinic to be seen on a Sunday. Despite the harsh symptoms, the doctor diagnosed it as a mild cold, gave me some antibiotics, and sent me on my way. A week later my condition had worsened significantly, and I had the highest fever I’d ever had. An inquiry into reliable, professional health care in Hiroshima led me to the Hiroshima Red Cross Hospital (日赤病院 nisseki byouin). I was quickly diagnosed with pneumonia, given proper medication, and got better in days. This experience made me wary of any small medical practice, and now I will only go to the Red Cross Hospital.
At the beginning of January, I was diagnosed with a malignant tumor in my bladder, after having several invasive tests done. Needless to say, being unexpectedly diagnosed with cancer is incredibly shocking, but my doctor gave the diagnosis to me in a professional, matter-of-fact way, as if it was the most routine thing in the world. Without really giving me time to think or recover from the shock, he told me that surgery needed to be performed as soon as possible, and suggested a few dates within the next few weeks.
The next step was to come back to the hospital the next week, and have a few tests done to make sure I was physically up to the surgery. The tests were successful, and on the same day, I visited the hospitalization check-in office to go over the procedures for my hospitalization.
The Hiroshima Red Cross Hospital & Atomic Bomb Survivors Hospital. (Photo by Broxy Nixon)
Growing up with the American health care system, I was totally unprepared for how different everything would be here. First of all, a hospitalization period in Japan will typically be much, much longer than it would be for the same procedure in the United States. For example, the surgery that I underwent, which was laparoscopic and only involved local anesthesia, is typically an outpatient procedure in the U.S. — no hospitalization. Here, they wanted me to stay for one week.
One of the reasons they wanted me to stay for so long was because of the timing of my surgery. I was to be operated on on a Monday. They wanted me to be there starting Sunday night to control my diet ahead of the operation, but since Japanese hospitals are “closed” on weekends, I had to begin my hospitalization on Friday morning. After checking in on Friday I was allowed to leave, and spend the night at my own home as usual, until Sunday. But the catch is that once you’ve checked in, you’re paying for every night until you check out — even if you aren’t actually there.
Another surprising difference is all of the things that you have to bring with you to the hospital. Basically, being hospitalized here is like staying at a ridiculously bare-bones hotel, or perhaps a hostel: you must provide everything for yourself. A short list of some of the things I had to bring with me: clothes (including robes/yukata for wearing after the surgery, when there were still IV tubes and whatnot sticking out of my body (read: you only get a hospital gown while you’re in surgery), towels, toiletries, eating utensils (chopsticks, fork, spoon, knife), tissues, and probably a whole host of other things that I’m forgetting. Should you forget/fail to bring these things with you to the hospital, you can purchase them there… for an exorbitant price.
As for your room: the kind of room you get depends on how much you can pay (I suppose this idea isn’t exclusive to the Japanese system). I was in one of the most basic rooms, which I shared with three other patients. My quarter of the room could be closed off with a large curtain, which provided some welcome privacy. My “cubicle” consisted of a short, uncomfortable bed (with one tiny, terribly uncomfortable Japanese soba pillow), a tall locker that didn’t lock, a chair and a cupboard unit. That unit had a small safety deposit box for valuables, a slide-out tray for meals, and a TV and mini-fridge, both of which could only be activated by a pay-card system, with a vending machine in the lounge selling the cards (anyone who has stayed at a budget business hotel here should be familiar with this system). The furnishings were spare, but everything was clean, and I found it livable enough for my short stay.
To stay in a private, single room, you must pay a nightly charge that isn’t covered by your health insurance. At the Hiroshima Red Cross Hospital there are four types of single rooms ranging in price from 6,300 to 18,900 yen per night.
On the Friday before my surgery, I checked in, was shown around my room and floor, and met the nurse who would be in charge of me until I left. Anyone who has some experience at a major Japanese hospital has probably noticed that the nurses on the lower floors, where you first get looked at and get your blood tests and everything done, are typically not the most pleasant people in the world. They’re not unbearable by any means, but they’re not as faultlessly kind and wonderful as you might expect, given the level of service you receive anywhere else in this country. But, the nurses upstairs, in the hospitalization wing, are a different breed entirely. They have different jobs with different qualifications, and the ones who took care of me during my stay at the Red Cross Hospital were exceptional, fantastic people. Without their loving help and support, my time at the hospital would have been far more difficult.
I couldn’t eat or drink for 12 hours before my surgery, so I had an IV inserted a few hours before the surgery. My family and other visitors were allowed to stay with me until 30 minutes before the scheduled surgery time, at which time I had a mild general anesthetic injected, and was put on a gurney to go downstairs to the surgical wing. To enter the sterile surgical wing, my body was placed on this strange conveyor belt-like machine, and passed sideways through a small door to the waiting surgical team. I was too tall, and had to pull my knees to my chest to fit through the small opening.
For the surgery itself, I was given an anesthetic that was injected directly into my lower spine to completely freeze the lower half of the body, so I was awake during the procedure but felt nothing. My arms were tied down, but I was told that they could untie them at any time if I asked them to. The surgery was fast and over in less than an hour. I was quickly shuttled back up to my room, but not before seeing my family, and seeing the doctor, who told me that the procedure had gone very well.
The first 16 hours or so after the procedure are a bit of a blur. I definitely experienced some pain, and after the pill they gave me did nothing to alleviate it (as I had anticipated), I complained loudly enough and got a rather strong shot of relief into my shoulder. The nurses helped me constantly throughout the first night, checking my vitals and making sure I was comfortable. The second day, I ate my first meal, took my first steps (with some difficulty), and had the IV removed.
I’ll take this time to talk about the food. Hospital food has a pretty terrible reputation anywhere in the world, and some Japanese people warned me before going in that I’d have a hard time with it. But I found it to be inoffensive at worst, and legitimately tasty at best. Other than breakfast it was a mostly Japanese affair, with lots of rice, fish, udon and soba. If you’ve eaten kyuushoku at an elementary/middle school before, or perhaps at an English summer camp for students, you’ve probably experienced a similar diet. The portions were not very big, but I found them to be just right given my weakened state. Breakfast was usually bread and some kind of fruit and/or yogurt. The bread can be toasted… if you’re capable of making your way to the lounge and using the toaster there.
A typical lunch at the hospital: seaweed rice, udon with dipping tsuyu and toppings, and fruit in yogurt. (Photo by Brody Nixon)
Aside from my family and my stoic JTE, I got my first visitors on the second day — four of my first-year girls (I work in a senior high school). I was very happy to hear that they had come, except for the fact that I hadn’t cleaned myself up in a couple of days and still had some awkward tubes sticking out of my body. I voiced my concerns to the nurse, and before the students came in the room, she covered everything with a dainty cover that they keep around for just such an emergency. Smashing!
All tubes and such were out by the third day, and on the fourth day — Thursday — I was given the green light to go home. After six nights (two of which I wasn’t actually there), one operation to remove what actually turned out to be two tumors, lots of medication and a few days’ worth of meals, my bill, after my insurance kicked in 70 percent, was about 101,000 yen. Not a small chunk of money, but probably a lot less than I would have paid in the U.S.
As for my school, I had no problem taking several weeks of sick leave (byoukyuu) for this, although special paperwork was necessary to approve it, and to make sure my insurance would kick in from the beginning. If you have surgery without filing insurance paperwork first, you have to pay 100 percent of the cost from your own pocket, and then you’ll get reimbursed for that 70 percent sometime later.
One long-term effect of this cancer is that, for the next several years, I have to go to the hospital once a month to get various tests done — some of them simple, some of them pretty terrible. This will also cost me a lot of money in the long run, and will become a major complicating factor in deciding what to do after I finish my fifth year on JET next summer.
Looking Back On It
When I first broke this news to my family and friends, and started working out the logistics of getting it taken care of, a lot of people told me they were surprised I didn’t want to go home and get everything taken care of there. My principal told me he was relieved, because when he heard that I was diagnosed with cancer, he feared that not only would I want to go home to get treated, but I’d want to stay there, and leave the JET Program for good.
But for me, it was not a difficult decision. Despite having had some issues with the Japanese medical system in the past, I was confident in the doctors and staff at the Red Cross Hospital. In fact, several Japanese friends who are doctors in other parts of the country told me that the Hiroshima Red Cross Hospital is one of the best in Hiroshima, and particularly renowned nationwide for its cancer care. Staying in Japan, and having my surgery done at this hospital, allowed me to get well for much less money than it would have cost me at home. What’s more, it allowed me to stay close to the school, students, friends, and social world here that I’ve come to love so much, and get back to them sooner.
I hope this article was an informative read. I tried to make it as much about the experience as I could, as opposed to just about me. If you have any questions about the Japanese medical system that I didn’t answer here, please post it as a comment. If there are a lot of questions, I might do a Q&A article later on. Thanks for reading.