Japanese Surgeon's Daily Life

A Relaxing Duty

     Today is a national holiday in lieu of Japanese National Foundation Memorial Day that falls on a Sunday (Feb. 11). My hospital is closed as well as most other hospitals. However, as for me, I'm in my office now. Today is my turn to stay in my hospital for hospitalized patients.
     Fortunately all the hospitalized patients are stable. It means that I have a lot of time to spend freely. Although it's duty hours now, I'm going to read some books and learn German, one of my hobbies.

(Vocabulary)
in lieu of   ～の代わりに
fall on 《常に＋[副]/[前]》 〈祝日・記念日などが〉 (ある曜日などに) 当たる
fall on a Monday/Wednesday/Friday etc.  月曜日［水曜日，金曜日］に当たる
My birthday falls on a Friday this year.
今年の私の誕生日は金曜日に当たる．

A Tailor

     A tailor has been attending my hospital to get physical therapy once a week for more than 2 years. I have heard many times that he sometimes selects casual wear for a massage practitioner who has eye trouble and can't choose his clothes by himself. The massage practitioner's co-workers always say, "That tailor is very good at choosing clothes that look good for him at a reasonable price."
     I asked him about his work in the consulting room today. He was more talkative than I expected. I knew that he likes sailing dinghies like me and we were on the same wavelength. He was going to the US for about a week to stock merchandise for his shop. I asked him to select my casual wear in the US. I'm looking forward to seeing him next time.

(Vocabulary)
stock  〈商品〉 を店に置く, 在庫を置く
The store stocks a wide range of kitchen equipment.
その店は台所用品の品ぞろえが充実している．

Korean Student

     A Korean student saw me today. She cut her little finger accidentaly with a kitchen knife. She tried to stop the bleeding in vain. After the treatment I tried to talk with her using some Korean words. I'm eager to use Korean now, but my speaking ability turned out to be very poor. Something must be done to become a good Korean speaker. I'm thinking of asking her or her friends to see me once or twice a month in a cafe or something like that and talk in Korean.

Inside of An Ambulance

     The photo shows the inside of an ambulance. There is some sophisticated medical equipment at your right hand. When the emergency lifeguard is unable to make a decision, the data of the patient is transmitted to the emergency hospital and they can get the doctor's advice. You can see other medical equipment; a heart monitor, an oxygen saturation monitor, cardiography equipment, a blood pressure monitor, an emergency oxygen cylinder, an aspiration device,,,. They eliminate redundant storage space and the ambulance is designed to be very functional and easy to use. In anticipation of frequent emergency calls, the location of the ambulance is always automatically sent to the central fire department. The commander can allocate ambulances properly.

(Vocabulary)
redundant  冗長な、重複する、不必要な、余分の、余剰の

Inside of an Ambulance

     I had seen the inside of an ambulance in the US about 20 years ago. I was surprised to know that the equipment was good and sophisticated. Though the Japanese ambulance crews were barred from practicing medicine by the Doctor's Law at that time, the American crews could do some technical procedures; endotracheal intubation, electrical countershock, insertion of an intravenous line,,,. These treatments were allowed for the doctors only in Japan at that time. Needless to say, the first aid at the scene is the key to whether the critical patient can survive or not. For such a reason, the Law Concerning Emergency Lifeguard was issued about 15 years ago. By this law, the emergency lifeguards were allowed to do some treatments and their role is getting more important now. Consequently the ambulance is fully equiped for first aid. The photo shows the ambulance just before going back to the fire department after moving the patient into the emergency care unit.

(Vocabulary)
bar  〈人〉 を締め出す, 除外する
bar somebody from (doing) something
＜人＞が＜…＞（すること）を妨げる［禁じる］

Ambulance

     A surgeon who works in a Mid-Eastern country asked me to show him a Japanese ambulance. I took a few snaps of an ambulance that came to my hospital today. He is not in Iraq, but he seems to have experienced the treatment of the injured by the terror. TV news tells us almost every day that many people died or were injured at the same time by simultaneous explosions. I've never thought how the ambulance crews select patients who are transferred to a hospital among many injured or dead until I received his e-mail. The Japanese ambulance is made for first aid and transportation of only one patient. It has only one stretcher in the ambulance. I took snapshots of the inside of the ambulance and am going to show them later.

Late-Night Snack

     Today is Sunday. It's a holiday, but I'm in hospital now and I'm on duty now, though today is Christmas Eve. I have to stay here until tomorrow evening. If there aren't any acute changes in the hospitalized patients, I have some free time. I wonder what to do today.
     I'm going to have a hospital dinner that the patients eat for now. This dinner is a little small in amount for me. The photo shows my late-night snack.
http://kumo.typepad.jp/weblog/2006/11/todays-lunch.html

Waste of Time

     Today is a national holiday, the Emperor's birthday. I was on night duty last night. My hospital is open all day, including at night, every eight days. (See http://kumo.typepad.jp/weblog/2005/12/every-eight-day.html) Though the last night was not the due day, I had to stay late at the ward. Three epilepsy patients are hospitalized now, and two of them brought on a fit last night. I couldn't go to bed until three o'clock. About ten patients saw me this morning. All of them had some wounds and those wounds need daily gauze exchange. I had to get up by eight o'clock. I got back home at about ten o'clock. I was so sleepy and took a long nap. I felt I wasted time. I'm very sorry. I don't like wasting time.

(Vocabulary)
bring on 〔病気・発作・惨事・危機などを〕起こす、引き起こす、招く
fit  《医》〔てんかんによる〕引き付け、発作

Norovirus

     Acute infectious gastroenteritis caused by Norovirus is running riot in the western part of Japan now. It was the first time I had heard the name Norovirus. I scoured many papers and found that Norovirus was SRSV (Small Round Structured Virus). SRSV is well known and was written-up in the textbook when I was a medical student. I don't know why, but the name of SRSV was changed to Norovirus in 2002. I experienced the outbreak of rotavirus infected enteritis about 20 years ago in my resident days but didn't know how serious the infection of Norovirus was. If the patients are aged people, some could die from dehydration. I gave some treatments this week.

(Vocabulary)
run riot  〈人が〉 暴れ［騒ぎ］回る  〈植物が〉 はびこる
scour  …をくまなく捜す［調べる］

Two Parties

     Two end-of-the-year parties coincided with each other last night. I attended the hospital end-of-the-year party at first, then attended another party of my rally team.
     I had a little hangover this morning. Every time I have a hangover, I regret drinking too much and my wife says, "You just never learn, do you?"

Today's Lunch

     According to the Medical Care Law, every meal for the inpatients must be checked by someone just before serving it to the patients. I usually check ordinary lunches for the patients who are hospitalized. Besides, some special meals are prepared for the patients who suffer from specific diseases; diabetes, hypertention, kidney or liver diseases,,,and so on. I check the ordinary lunches and fill in the form (shown in the picture) as follows. The time I check the lunch. How about taste; excellent, good, bad. How much the rice is; too much, moderate, too small. How hard the rice is; hard, good, soft. How it looks; excellent, good, bad. I think the kitchen staff of my hospital are excellent. Every lunch is satisfactory to me. I took a snap of today's lunch shown in the 2nd picture.

New Job

     I was asked to be a teacher at a high school by the Matsuyama Surgeons' Association. The former teacher resigned abruptly and the board of the high school asked the head of the Matsuyama Surgeons' Association to have someone replace him. The high school has a professional course to be a registered nurse. I'm going to teach them general surgery. I've had a pain in my neck.

Re-Ope

     I wrote about a patient who suffered from mesenteric panniculitis and had surgery on October 27th. I'm going to report his passage afterwards today. After his last operation on Oct.27th, the patient was getting better and his mental status showed remarkable improvement. I felt that he overcame the illness.

     However, I found swelling of the wound on his abdomen today and I performed ultrasonography on his abdominal wall. To my regret, I found fluid collection in his abdominal wall just beneath the wound. I and my colleague neurosurgeon thought that the VP shunt tube had come out of the abdominal cavity and must lie in the abdominal wall. The cerebrospinal fluid (CSF) coming out through the VP shunt tube was surely the cause of the swelling. As we thought like this, we performed the operation again with use of a local anesthetic.
     We were surprised to see the tip of the VP shunt tube. The tube didn't come out! It stayed in the abdominal cavity as we had set it in the previous operation. The CSF coming out of the tube formed the cyst in the abdominal cavity and wasn't absorbed by the peritoneal membrane. Overflowing CSF came out of the cyst and formed a fluid collection just under the wound.
     After all, we fell into the same rut. Abnormal granulation was formed around the VP shunt tube and interfered with the drainage of the CSF. Although we prevented these granulations from causing intestinal obstruction this time, out of necessity we are performing external drainage to remove the extra CSF at present. We have to figure out the solution.
     I know that mesenteric panniculitis is benign, never malignant. Nevertheless, it always bothers us.

Continued from :
http://kumo.typepad.jp/weblog/2006/10/vp-shunt-operat.html

(Vocabulary)
rut　車（輪）の跡、わだち
fall into the same rut　轍を踏む、前人と同じ失敗をする

(This blog service shows me how and from where visitors read my blog. It says about 10 people came here via search engines searching with the keyword "mesenteric panniculitis". All of them maybe want to solve these problems. If you are such doctors, email me! Not only surgeons but also physicians!)

VP Shunt Operation Again

     We performed a VP shunt operation again. We induced the shunt tube, which was cut and ligated, and embedded in the abdominal wall in the 2nd operation, into the abdominal cavity. The length of the shunt tube in the abdominal cavity is only 5mm. It's an unusual procedure, but there was no other way to avoid excessive adhesions and intestinal obstructions. But I don't know whether this procedure will be successful or not. I hope the patient gets better.

Continued from : http://kumo.typepad.jp/weblog/2006/10/the-mental-stat.html

The Mental Status

     The mental status is getting worse. We argued where to guide the excessive cerebrospinal fluid into. Into the blood vessels?, thoracic cavity? or the abdominal cavity again? The conclusion is up in the air.

Continued from : http://kumo.typepad.jp/weblog/2006/09/steroids-break.html

Convinced Criminals

     Last night a gangster came to my hospital because of a self-inflicted injury. He chopped off his left little finger with something. I didn't ask him the real reason, but I sometimes hear that when gangsters make a mistake, they'll cut their fingers as taking responsibility for their mistake. I thought this case would be like that. In such a self-inflicted case, I have to call the police by the rules of the Medical Practitioners' Law.
     However, he insisited that the cause of injury was his mistake. He said that when he shut the window he got injured by the steel sash of the window. He denied a self-inflicted wound. He seemed to want to be away from the police. There was a big difference between the status of injury and his explanation but I decided to take his explanation. My hospital didn't want to have anything to do with such people and wanted him to go back as promptly as possible. My boss gave him a plastic operation of the cut end of his finger. After everything was done, he refused to pay the treatment fee. He had no money, and he said he would be back with money the next day. On the next day, he didn't show up. Needless to say, his name, address and phone number which he signed on the paper at the front counter of my hospital was false. He wasn't going to pay from the very beginning.
     According to the Medical Practitioners' Law, hospitals in Japan must not refuse medical treatment due to the lack of treatment fee. Medical staff members must take care of people who come to hospital for some treatments. It's ok if a patient is really in serious financial trouble. But some people use this law in an underhanded way, just not wanting to pay.
     The number of such people is increasing. The treatment fee for such convinced criminals is charged on hospitals now. The courtesy of hospitals has limitations.
     Please do something Mr.Mayor!

(Vocabulary)
inflict  〈苦痛・損害など〉 を与える, もたらす
underhanded  〈取引・政治活動などが〉 不正な, 汚い

Loitering

     Today was a really comfortable day. I wanted to clean my room up and take a long walk with my dog, but I was called from my hospital. Today's duty doctor was a physician and she couldn't give a surgical treatment. I had to go to my hospital to care for the inpatient. Though the distance between my hospital and my house is 15 minutes' ride, I loitered around on the way back home being enticed by the autumn breeze. I spend almost 2 hours on the way home. I'd received more than 100 e-mails from abroad before now, but nothing from Japanese who had ever lived in Matsuyama city before. If you have lived in Matsuyama city or around here before and live abroad now and want to see some specific site, it's my pleasure to take snapshots where you want and post them here. I'm glad to be a journalist or photographer for you. Don't hesitate to send an e-mail to me!

(Vocabulary)
loiter  (目的もなく) ぶらぶらする, たむろする  のんびり歩く, のろのろ進む
loiter in/around something  ＜場所＞の中［周り］をぶらつく
[同意]  hang around
entice
entice somebody to do something  ＜人＞をそそのかして＜…＞させる

(KW: 愛媛県　松山市)

A Nightmare

     I'm in my hospital now at 3 o'clock in the morning. I became very drowsy last night, earlier than usual, and hit the hay. I was going to sleep deeply until the morning, but I was troubled with nightmares. A serious patient showed up in my dream, saying "Do something! Remove my pain!" He is the patient who I was worring about. I have just done some treatment now.

Replacement of Telephone System

     Today, the total replacement of telephones was done in my hospital. Besides, doctors, head nurses, and some representatives of each section have got to have PHS all the time. It's a thorny issue for me. When I was tired, or wanted to take a nap for a while, I made it a rule to stay at some places except in my private room in my hospital. To tell the truth, I hid everywhere in my hospital.
     Sometimes the X-ray room, sometimes the rehabilitation room, sometimes the cafeteria. If I am in my room, I'll be surely caught by the phone. It's why I stay in other places. Though my co-workers may search for me, I can get some relaxation for some time. However, such relaxation time has become kind of a dream from now on.

(Vocabulary)
thorny  《通例[名]の前で》 (問題・事態などが) 厄介な, 扱いにくい

 

Steroids Break

     I tried to stop giving steroids. Just after that, severe constipation occurred. Besides, the high fever started. Consequently I restarted giving steroids and was unable to stop giving them. At the 2nd operation I removed the shunt tube and the symptom of hydrocephalia seemed to appear. What a pickle we are in!

Continued from : http://kumo.typepad.jp/weblog/2006/09/defecation.html

(Vocabulary)
pickle　〔野菜の〕漬物、ピクルス、酢漬け　〈話〉困った立場、苦境