Thursday, 6 June 2013

Informed Consent and Electrocuted Boobs

If you haven't read this book, rectify the situation immediately. I'll wait.

I held a hook-like implement in each hand, pulling my lips out and forward while a girl with hay-fever tried to position a mirror inside my mouth and a large digital camera just outside it. I tried not to breathe on the mirror but it was taking forever because she kept turning away to sneeze. It occurred to me again that had me from ten years ago suddenly been dropped into this situation, she would have been extremely surprised. The last time I had thought the same thing was during my first annual medical examination, when, having no idea what was about to happen, I had followed instructions to remove my bra and lift up my shirt. A no-nonsense doctor had slapped cold slime onto my breast and attached a number of suction cups to it, before unceremoniously pulling down my stockings and attaching a clamp and wires to my ankle. I had no idea if this was what she was supposed to be doing or not, so I just lay there passively, thinking: “I’m pretty sure I’ve seen hentai that started more or less just like this…” and then she ran an electric current through me. It was an EKG, apparently. Mum and Dad, if you’re reading this at the library, please don’t google “hentai”. Actually, even if you’re not at the library...
Japanese medical practitioners are very comfortable with causing discomfort. I’ve written about the ‘flu test before, but it isn’t just doctors. The first time I visited a Japanese dentist I explained in very clear detail how sensitive my teeth are and insisted that I would need a lot of anaesthetic. He was flabbergasted. It was just a small filling, he said, and surely I could がまん? No, I said, inject away. As soon as he began drilling I knew that whatever he had given me wouldn’t cut it. I waved my hand in the air but he didn’t stop. I yelled as much as I could with a drill, hand and suction tube in my mouth. He stopped. I need more, I said. He couldn’t believe it. “You know you have to pay for each injection, right?” Whatever, I insisted, do it and don’t come near me with that drill until I’m numb and drooling. He injected me again. I could still feel the drill but I thought I’d be able to endure this much. I couldn’t face trying to stop him again. It turned out that I couldn’t endure it after-all… I woke up to a very confused room of dentists, hygienists and even the lady from reception, all of whom had never seen anyone pass out in the chair before, let alone after not one but TWO injections (I’m not generally speaking a wuss, but my teeth are crazy sensitive. It-takes-me-hours-to-eat-an-ice-cream kind of sensitive). With this experience under my belt I’ve avoided visiting a dentist for the past four years, even though basic dental care is included in the national health insurance. I “splurged” on Australian dentists and their delightful drugs when I visited home, cost be damned. Unfortunately that isn’t possible anymore, so I headed to a local dentist who was recommended by a friend as pain-free. He was certainly very good about drugging me, but the whole camera in the face thing was quite an experience.
Then there are the kind of medical procedures doctors choose to perform and how they go about them. Tracheotomies are only done in emergency situations in Australia. They are quite uncommon, because there is almost always a less invasive and dangerous way to open the airway. In my schools here in Japan, I have at least one child in every single class with a tracheotomy scar. I don’t even know how that is statistically possible (I teach at seven schools).

Injections are frequent and large (See Tofugu: Scary Needles), even when delivery via needle is unnecessary (vitamins, for example, are often administered as injections not taken as pills). Suppositories are a common delivery method for medication. Last time I was at a clinic the person before me was requesting that her oral medication be changed to a suppository. Seriously. Even if you do manage to get your drugs in an oral form, they are more likely to come as a bitter tasting powder than as a pill or capsule. Japanese friends have told me that they find pills harder to swallow, but I think more significantly, some have also said that taking a pill just doesn’t feel like you are really taking medicine. You need the bitter taste. Studies have shown that the placebo effect becomes stronger the more invasive a “treatment” is. Give someone a pill with nothing in and they won’t get better as quickly as someone injected with nothing. My personal suspicion is that this is the real reason behind the invasive procedures. It feels more satisfying, somehow.

Of course, the other factor is the enormous power of the medical establishment. If a painful and invasive procedure is easier for the doctor, the patient just has to endure it (obviously this isn’t unique to Japan… for an Australian example, the idea of spending labour on one’s back was obviously not one had by a labouring woman). There’s no shopping around in Japan; even seeking a second opinion risks offending your doctor. Back in the 1990s it was reasonably common for doctors to lie to a patient about their prognosis if they felt the patient was better off “not knowing”. This included telling terminally ill patients that they'd "be fine". Tofugu has an article that touches on some of these issues. Hospitals that had used contaminated blood lied to HIV infected patients and told them their tests were negative, leading to their partners and in one particularly sad case I studied at uni, their subsequently born children, becoming infected. When looking online for a clinic near our new house I noticed that the newer fancier looking clinics and hospitals now prominently display notices about “informed consent” policies. It is possible they are using the English phrase just to sound trendier and high class, but I suspect that there may just be no analogous concept in simple Japanese. One of my favourite novels, Secret Rendezvous by Abe Kobo, is set inside a labyrinthine underground hospital. An ambulance arrives one day and takes the protagonist’s wife away, although she is healthy and they haven’t called an ambulance. He goes to the hospital to try and find her, but is confronted by a Kafkaesque bureaucracy and encounters increasingly bizarre experiments and treatments. While the novel is surrealist, the hospital is believable in the impunity with which it uses and abuses its patients. This is the old world of the Japanese medical establishment, and the phrase “informed consent” is a magical term that distances modern medical practices from it.
For some interesting posts by foreigners about their experiences with Japanese medical procedures, see:

Gaijin Smash 1
 Later that night, I was having my wife take care of the wound as instructed. She removed the gauze…and nearly fainted. “Have you seen what your leg looks like?” she asks, while trying to resist the urge to vomit. Why no, that particular area of real estate just happens to be outside the area of my brain’s Google Maps. She gets me a mirror, and for the first time I’m allowed to see for myself what’s going on back there.
It really was a hole in my leg.
It was roughly the size of one of those small Haagen-Daas ice cream containers. For those who lack perspective, let me put it this way – upon seeing this chasm in my leg, I could clearly picture the Roadrunner and Wil E. Coyote running down my ass, with the Roadrunner stopping abruptly before the hole and Wil E. running past it. Wil E. stops, defies gravity for a few moments as he realizes he’s no longer on terra firma, silently holds up a sign illustrating just how fucked he is, then drops down the hole for a few seconds, complete with the “THUD!” and small puff of smoke at the bottom.
Literally, it was a hole in the back of my leg.
“Is this something doctors are supposed to do?!” The wife asks, shocked. I too am a little taken aback my having a new Grand Canyon carved out below my ass, so when the wife insists I go to a late-night emergency room (*cash register sound* $300…), I don’t put up a fight.
We arrived a little after 3AM. Luckily, there weren’t too many people there, so I was seen fairly quickly. The on-call doctor was a young guy who looked like he was fresh out of med school. The wife explained the situation, and upon showing him the leg his response was “Yup…that’s a hole all right.”
Thank you, Detective Holmes.
Gaijin Smash 2
Apparently in Japan, doctors only specialize in a specific part of the body. So, I had to find the Penis Doctor. Luckily we did, and on one of the two days said Penis Doctor was in.
The ex and I went to the hospital, and after navigating some hallways we found ourselves in the Penis Clinic (I don’t think it was actually called that, but that’s what it was for). They gave her an information form to fill out, and I had to pee in a cup. If you ever find yourself in a Japanese hospital, you WILL be peeing in a cup. It doesn’t matter why you’re there, the peeing in the cup is non-debateable. I don’t know why. I took a quick survey of the other patients in the waiting room. Mostly middle-aged and older men. Heh, you don’t have to think too hard about why they’re here. There was another young couple, and I wondered what kind of sea animal-named maneuver had sent him here. The Sea Horse? The Jellyfish? The Manta Ray? I decided I didn’t want to know. There was also a high school girl. By herself. Yes, just a high school girl, all by herself, there to see the penis doctor. I decided I didn’t want to know about that either.
Tiffany on Paediatric Care

He called the oxygen chamber they plugged into the wall a dinosaur, and the mask he had to wear the first day was his dinosaur mask.  He even wore it voluntarily one day when he didn't have to:  "Dinosaur mask, on!"  The breathing machine was called fever-gone-asaurus and the thermometer was called the beep beep.  We had as much fun as you can have during quarantine. In addition to Knox's hospital adventures, the staff suggested that Peter and I get tested as well so that we can all be healthy and stop passing cooties around.  We both got blood tests and we both have bacterial infections.  Peter has been really sick, but I haven't been feeling too bad.  Either way, we are both on antibiotics now.  Again.  What is it with me and Japan and bacterial infections?! Five nights in the hospital and around the clock care cost us about $50.  You gotta love National Health Insurance. 

The doctor decided in that moment a vacuum extraction would be best and the next thing I knew he was squirting some kind of numbing liquid on me, then I felt a needle stab my crotch, followed by a sharp cut. I actually did scream at him at that moment, "WHAT ARE YOU DOING!!!???" We had discussed beforehand that I did NOT want an episiotomy unless absolutely necessary. It was necessary, in this case, but even my husband, who had no idea the doctor was going to do that until he did it, was a bit angry that he didn't say something before cutting. [Just to clarify, it was necessary, and I'm glad he did what needed to be done, though I'm still not thrilled about the fact I had an episiotomy.]
Surviving in Japan (Post-Birth Care)
As for the rest of the stay, during the day each day they did things like show us how to change a diaper, how to give baby a bath, etc. (Well, they had my husband practice everything). I've had extensive experience in childcare so for me what was most interesting about this was observing the cultural differences, but rest assured if you have no experience doing anything, they will show you how to do things.

Laura on Pregnancy Ultrasounds
Another semi-related, side note complaint was finding out the gender of the baby. My doctor informed me that it is "impossible" for her to tell the gender of the baby before 28 weeks pregnancy. Considering that I found out that I was having boys for both of my previous pregnancies at 20 weeks and have access to the internet, I am not sure how she was expecting me to swallow this one. In Canada, there are private businesses that specialize in 3D/4D ultrasounds where you can book a session to get photos of your baby and find out the gender if it wasn't possible during your 20 week anatomy scan. Unfortunately, there are none of these private ultrasound businesses here, or at least in Fukuyama, so I had to book a secret appointment at a different clinic and pay out of pocket for the extra ultrasound. Secret, because I am almost certain my doctor would have been offended if she found out that I booked an ultrasound with another doctor.
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  1. I found this post to be halarious and alarming. There's a good dentist in Yufuin I can recommend if you're ever this way. The doctor is very good also. He doesn't believe in throwing too many meds at you. My dentist will clean your upper and lower teeth in one visit. No need to make two trips because of insurance.

    1. That does sound good, and possibly worth the travel time!

  2. The medical establishment is, by and large, absolutely nuts over here. My most recent experiences with it have been during our children's' births, so I've been relegated to an even more 'impotent bystander' role than normal (figuratively speaking only, obviously).

    You take the dodgy medical ethics, multiply by the antiquated conception of gender politics and it's a carnival of wrongheadedness from start to finish. No drugs during labour because they 'reduce the mother's love for the baby'. And you measured that effect how, exactly?

    That aside, the suppository thing is actually one of those occasions when it's Western mores that are a little ass backwards. So to speak. A mate of mine did his post-doc on drug delivery methods and there are a huge number of common medicines that are more effectively absorbed through the lining of the lower intestine. Apparently. And the best way to ensure that is by sticking them up your arse, but we're all a little squemish about that so take them orally and trust to luck they'll work their way through.

    He was a riot down the pub.

    1. You make a very valid point.

      I'm sorry you didn't have the experience you would have wanted with your children's births. That's a big thing to miss.


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