Japanese Surgeon's Daily Life

Palliative Care Workshop

　　I'll write about my job, the medical service in Japan, this time. As most of you know, it is almost totally under the control of the government. The uniform services are available for everyone, no matter how high-profile or poor he or she is. As far as I know, this system is one of the best kinds of medicine in the world.

　　When the government wants to put an emphasis on a special issue, they have only to raise the National Health Insurance (NHI) point of the issue. For example, the number of obstetricians diminished in recent years and the government advanced an NHI point of obstetrical procedures at that time. Consequently the number is now recovering.

　　Today's topic, "Palliative Care", is quite simply the issue that the government intends to concentrate on these days. It's the notion that medical staff remove the agony from terminal patients suffering from incurable cancers and lead them to a peaceful end of their lives.

　　The Japanese Government increased the NHI point of this field last year and it had a condition. That is, it must be under a specialist's direction, having the license of a medical doctor and having attended and got through the palliative care workshop.

　　I joined this workshop today and successfully finished. It was really useful and I acquired lots of knowledge and procedures. I will take advantage of these acquired skills from now on.

(Vocabulary)

palliative care  緩和ケア

palliative

〈治療法・効果などが〉 (根治するのではなく) （症状［苦痛］）緩和の, 姑息(こそく)な

〈対策などが〉一時しのぎの

orientation  [C,U] (政治的・宗教的な) 方向性, 信条

sb's political/religious orientation  ＜人＞の政治的［宗教的］信条［方向性］

uniform 〈外見・性質などが〉 同一の, 均一［均質］の

The country needs a uniform legal system. 国家には一貫した法制度が必要である．

National Health Insurance  国民健康保険          NHI point  保険点数

obstetrician  産科医                                        gynecologist  婦人科医

quite simply  まさに                                        direction  [U] 管理, 指揮, 監督

under sb's direction  ＜人＞の指揮のもとに

     

Aging Population

My hospital plays a part in the emergency medical service in my city. It's open to the public for 24 hours on one of eight days. Lots of people come and see doctors on this day, and some of them are hospitalized.
Now, there is an issue on accommodation. We have to have some stable or chronic state patients leave hospital in order to newly undertake emergency cases under the limitation of the number of beds. For instance, most CVA (Cerebral Vascular Accident; infarction, bleeding etc) patients are likely to become feeble and are sometimes in a vegetative state. Though these patients should be transferred to nursing homes to keep the function of emergency hospitals normal, troublingly there aren't enough facilities. This problem is getting more and more serious day by day.

(Vocabulary)
an aging population  人口の高齢化
play a part in the international effort led by the United States
アメリカ主導のその国際的努力の一端を担う
vegetative  (人の) 植物状態の
a vegetative state  植物状態
instance [C] (出来事の) 例, 事例, 実例
instances of discrimination  人種差別の実例
for instance  例えば
troubling  心配な, 悩ましい
troublingly  困ったことに

Tonight's Meal

     The picture shows my midnight meal for tonight. I'm ready for medical emergencies now. To my surprise, this bread cost 120 yen, coming to 1.40 US$ converted at today's rate. Furthermore, my toaster cost only 20 US$. I'm worrying about having too inexpensive prices for goods. See also http://kumo.typepad.jp/weblog/2008/01/toaster-oven.html

(Vocabulary)

come to __$ converted at today's rate  今日のレートで換算して＿ドルになる

 

Assistance

     I have lots of acquaintances who run the clinics, some of which accommodate a few dozen patients. If the practitioner got ill and was hospitalized for a long time, whatever would become of the patients and employee of the clinic?

     I was asked to stay in my friend's hospital two nights a week. Several doctors patched days and nights up like mosaic tiles for a sickly practitioner. It's a kind of mutual aid system. As for me, I have two night duties in my hospital per week regularly and had to undertake two more. The above was one of the reasons for my hectic days.

(Vocabulary)

mosaic tile  モザイクタイル

sickly 　病弱な　病気がちの

mutual aid 互助

(Jan. 8th 2010)

Recession

     The serious recession hit Japan as well as other developed countries. Lots of workers have been laid off or many companies have scheduled the voluntary redundancy packages. I'm working in a middle-sized hospital as a surgeon. Most of my co-workers have special licenses or abilities, so they, including me, are supposed to be resistant to the economic stagnation, in other words, we are the last people to lose our jobs.

     My hospital has about 70 staff members except for the outsourcing workers such as in the pharmacy, the dietary department and the maintenance service. Several recruits join us occasionally. The tendency of them seems to have changed lately. They are eager to get some licenses. They switch jobs and get started newly in the field of medicine or welfare service. It might be because this kind of jobs are unaffected by the economic depression. The previous job of our most recently coming recruit was the processing of fish meat. He was standing by the line that made dried bonito shavings in a factory. He is going to enter the school of nursing next spring that is open in the early evening. He works in the daytime until 16:00 at my hospital as an assistant of the care workers, and goes to school after that. It takes much longer time to get the license in this type of school, but he has to make money as well. His age is just 30. His late start as a full-fledged member of society, compared to the people of around his age is apparent. His next five years would be hard. I really wish he will get to the destination as soon as possible.

(Vocabulary)

redundancy  [C,U](英) 余剰人員（の解雇）

voluntary redundancy   希望退職

dietary department （病院などの）給食部

company recruit / new recruit  新入社員

occasionally  たまに, 時々, 時折

very occasionally  めったに（…ない）

dried bonito (shavings) かつお節

- / full / full-fledged member of society  社会人

Japanese Herbal Medicine, Boohuutuusyoosan

     Generally speaking, there are two types of medicine in Japan, though they were categorized into various groups by lots of viewpoints, in short western medicines and oriental medicines. I didn't learn any remedies by oriental medicines in my college days, because they were not acknowledged to be sufficiently effective. Only a few physicians used to believe in the effectiveness of them at that time.

     Originally, these medicines were developed in ancient China. Numerous plants, trees, stones, soils and animals were used as medicines, and those materials had been mixed or thrown away for a few thousands years. They were imported into Japan long ago and were developed individually by the efforts of Japanese researchers.

     You might be wondering why they hadn't been used in modern medicine. It's because they haven't any scientific evidence. They had been created through a trial and error process. I imagine that a huge number of people would have been killed in this process. In western countries, evidence is the key to medicine, and so this type of medicine hadn't been used. However, a famous medical journal, "Surgery", adopted a research paper about one of the Japanese herbal medicines several months ago and it was epoch-making.

     Boohuutuusyoosan in the title of this entry is well known and one of this kind. It is said to be able to remove excessive adipose tissue. I started a human experiment on me. Japanese herbal medicine is really mysterious.

(Vocabulary)

through a trial and error process  試行錯誤して

(KW: 防風通聖散)

Generic Drugs

     I often dither for confidentiality reasons when I'm going to write about a topic concerning the medical field. I've written about them as general issues. Today I'll write about generic drugs.
     At first, I'll explain generic drugs. When a pharmaceutical company successfully develops a new medicine, it is given a patent of the medicine and other companies can't make it for the term of the patent. It costs a lot to create a new profitable medicine, so this issuance of a patent is natural. After the patent ends, other companies get to be allowed to produce a generic copy. These patent-ceased generic copies are called generic drugs. In general, the price of generic drugs is far lower than that of the original one.
     Original drugs have to get through lots of strict tests before getting a patent and the results of those tests ensure the safety and efficacy of the drug. However, newly-made generic copies aren't required to be tested. The generic companies just say it's the same as the original ones, but I feel it's wrong and there's something different between them on my empirical basis. I have not used them for my patients, but now the number of patients who want generic drugs has increased. Is it due to economic stagnation?
     I'm afraid that if the sales of the original drugs goes down, the development fee for new drugs would be cut in high-profile companies.

(Vocabulary)
dither  躊躇(ちゅうちょ)する, 迷う
for confidentiality reasons  守秘義務上の理由で
confidentiality  守秘義務
generic  (製品などが) (登録)商標のない, ノーブランドの, ジェネリックの
pharmaceutical company  製薬会社
issuance of a patent  特許の発行
ensure the safety and efficacy  安全性および有効性を保障する
on an empirical basis  経験的に
empirical  経験による, 実証的な

A Dog Vandalize

     I put on my favorite rain jacket and took off for work in the sign of rain this morning. The rain jacket was one of my climbing gears and I really liked it. I hung up my jacket on the steering of my scooter after parking it to dry it up in the garage at my office. A few hours later, I was called and knew the situation of my scooter as you see in the picture. It was done by a dog that my boss kept.
     While a staff member was away from the dog, leaving the dog free in the garage, the dog did that. The dog seemed to have pulled my jacket on my scooter. It started to rain outside and he must have cut corners to walk the dog.
     I was so upset, but that was what was done by a dog. Besides, the damage of my scooter was minimal. It looked like the most fragile part was protected by my jacket. However, my rain jacket was miserable as you also see in the pictures. I guess that it can't be helped.

(Vocabulary)
vandalize 《[他]通例受け身形で》 〈公共物など〉 を故意に損壊［汚損］する
hang up a coat  コートを掛ける
can't be helped  仕方ない

Japan Surgical Society

     I was in Fukuoka City to attend the meeting of the Japan Surgical Society on Apr. 3rd. I have joined this meeting every several years. The purpose of attendance was naturally the absorption of the up-to-date techniques and knowledge, but I had another goal this time. It was a kind of a reunion.
     I'm a general surgeon and spent several years as the resident at a few hospitals. The staff members or fellow residents of these hospitals became separated now. Our occupation and/or our age are so busy that we can hardly take long enough days off at a preferable time. If we wanted to get together somewhere, it's almost impossible that a dozen people can arrange their schedules. Actually, a few people just met each other for the first time in the last 20 years.
     By the way, though our schedules are usually tight, it's easier to take days off in order to join the annual meeting of the congress. A friend noticed it and planned the reunion in Fukuoka City, where the surgical congress would be held. The date was set on Apr. 3rd, and the place was determined to be at Yahoo Dome Stadium, where the opening game of professional baseball would be played. You can see where we were seated at the game.
     The result is, the franchise team, Soft Bank Hawks won the massive victory. We and people around us got carried away. I'm not a fan of the Hawks, but I couldn't help being an instant fan of the Hawks.

Meal Coupon

     I went to Fukuoka City to attend the Annual Congress of the Japan Surgical Society on Apr. 2nd. When I was waiting for my flight in Matsuyama Airport, it was announced that my flight had been delayed more than one hour and a meal coupon was delivered to the passengers. It was the first time I'd seen this kind of coupon. It was because it took more time than expected to check the plane before depature, but anyway I felt bad for the company.

(Vocabulary)
feel bad for 　気の毒に思う

(KW: お食事券)

Today's Dinner

     A practitioner that has about fifty inpatients asked me to stay 24 hours at his hospital, because he had to visit his daughter's dormitory in Tokyo. He isn't allowed to go out of the hospital without a substitute doctor. He earns big money, but I felt sympathy with him. He is deprived of his free time.
     The picture is of my dinner tonight. It is the dinner for ordinary patients. I'm supposed to have a breakfast for patients with cerebrovascular disorders tomorrow. Salt is removed from it and the breakfast will taste awful.  (Mar. 21st.)

Today's Dinner

     You might think that this dinner is a bit cheap or poor, but actually, this is my dinner today. I have to check out the dinner for hospitalized patients before service. Since I started working as a surgeon twenty some years ago, I've tasted meals prepared for hospital feeding at least 10 times a week. These meals are strictly controlled by nutritionists. While eating this dinner, I thought that my health might be kept by these meals, because I have nothing wrong in my health now. On the other hand, I thought like this as well. We, present advanced countries' people, might be taking in too many calories compared with the ancient people who were making a precarious living because people might not be able to get foods for the next day.

（Vocabulary）
make a precarious living 　　不安定な生活をする

Bowling Game

     An event of the Matsuyama City Medical Association was held and I've reported it in this blog before. (http://kumo.typepad.jp/weblog/2006/03/bowling-meeting.html) 20 staff members from my hospital joined the event this year and I won  18th place out of more than 200 people. I was in incredibly good condition. Moreover, I got 2nd prize in my hospital. I'll show you both prizes in the picture. One is a domestic humidifier and another is an assorted "Tsukudani (佃煮)", foods boiled in soy sauce from a long-established company in Kyoto.

Briefing in My Office

     The general concern for the outbreak of new types of influenza is growing in Japan. Public facilities such as airports, seaports, train stations, city halls and places like that carry out exercises in a variety of mock situations and emergencies, like the outbreak of new, unknown contagious diseases.
     The picture was taken in the briefing about sterilization. My hospital holds such briefings regularly to inspire us. Every lecturer is invited to the hospital from outside companies and today's lecturer is from a pharmaceutical company.
     These briefings begin after our daily work and are a bit of burden, although a box meal is offered to everyone. However, medical science is constantly advancing so I believe it's our duty to refresh our knowledge day by day.
     Some of my friends e-mailed me the other day. They said, "your topics in the blog are nice and interesting, but nothing medical. Are you working seriously?" They are joking, naturally. So, I chose this topic this time. (grin)

 

Yokaro, Fugu Restaurant

     The end of the year party is an annual event in Japan. People from the office, people interested in the same subject, or just friends get together and enjoy eating, drinking and chatting.
     Today, I attended one of the parties, the members of which were unusual. The common interest of them was a desire to eat "fugu", balloon fish. There were OPD nurses, care workers and some patients too. One of us recorded the dishes in the following URL: http://homepage2.nifty.com/zebo/etc/2008-12-21/index.html
     Fugu has the poison that could kill people and I sometimes hear the news that tells us of an accident when someone died after eating fugu. It is delicious, though. If it was prepared by a qualified and registerd cook, fugu is safe food.
     Have you tried it?

(Vocabulary)
balloon fish / blowfish / puffer fish / puffer  フグ

(KW: 与加呂　よかろう)

Portable Bath Unit

     The rapid aging of the society and falling birthrates are causing issues on the burden of nursing care of the aged. Some people are obliged to stop working for their parents or someone like that. Some aged people with dementia frequently get lost, or eat anything even if it isn't food. After using cooking utensils, some people never mind the fire of the stove burner. It might lead to a big fire. From the viewpoint of human rights, we are not allowed to peg them down to their beds. Finally, someone has to keep their eyes on them 24/7.
     In order to overcome these strains, several kinds of assisted-living facilities have been built across the country in the last 10 years. People who find it hard to live in their own home are accommodated into these facilities by the degree of their handicaps. On the other hand, some people don't want to farm their parents out and take care of them in their house.
     When I made a house visit to one of those patients, I saw a portable bath tub and took pictures. This bath tub consisted of two parts. It was easily built up in front of my eyes. The sealing at the joint was perfect. The hot water was boiled in the van as you can see in the last picture and was sent to this tub. Three care workers help the patient take a bath. These run-of-the-mill services makes me feel that I was lucky to be born in Japan.

(Vocabulary)
stove burner  ガスコンロ
keep/place under restraint / peg down    拘束する
strain  負担
assisted-living facility / care facility / care home〈英〉  介護施設
by the degree of   ～の程度により
farm sb out  （人を）預ける

Bingo

     We are coming up to the end of the year 2008. I attended the annual event, the end of the year party, this year too. The picture shows the party. Some people who are standing in the picture were waiting to call their bingos after getting four numbers.
     I looked for some words about bingo in order to write this entry. When you hit a jackpot, you would shout "Bingo!". Then when you got four numbers in line, how do you express the situation? We, Japanese call "Reach!". Additionally, my dictionary says that the bingo game is one of the gambles and for aged people. It usually is held in Catholic churches or Indian reservations. Is that right?

 

Midnight Shopping

     I'm just on duty now. The clock on the desk shows 2:30 in the morning. I'm taking a short break away from the noisy opd. I didn't realize that I would be hungry during the rough hours in the opd and the ward, but now I'm really hungry and need something to eat. I went out to the nearest shop, which is a 5 minute walk from my office, and got the foods like I'll show you below. I found two instant noodles that I've never seen before, and I took them. What are they like?
     New types of noodles are coming up every month and some of them disappear. I imagine the harshness of the competition in the instant noodles' industry.

Hungry !

     I'm on night duty now. I had a simple meal about seven o'clock, but the work has been hectic and it made me hungry and dehydrated. I need something right now. I usually keep something to eat in my room, like breads, instant noodles, or frozen food that would be ready after a few minutes in the toaster oven. However I ran short today.
     I'm deadly hungry. My blood glucose level must be below normal. What should I do? Reflecting of the anguish of the starvation that lots of people are suffering from, should I put up with it? I know that a meal in the middle of the night isn't good for my health. I had an internal struggle for a while, and finally I lost.
     I rushed out to the nearest convenience store and bought foods that are shown in the picture below. A bottle of coffee, instant noodles, breads, and a big rice ball are on my desk. I can survive this night with them.

 

Two Days Off

     I got two days off this week. It was only two days, but I felt lucky to have them. I have been on the go these days. My work has been really hectic. Next Thursday and Friday will be holidays. Now I wonder what I'll do.
     Driving into the country, seeing what pops up around the next bend, is one of my hobbies though. Thinking of the high price of gasoline, it's not a good idea. How about caring for my garden? It's extraordinarily hot. Off the top of my head,,, nothing!
     I decided to play it by ear. If one of my family wanted to go out, it would be ok. A movie? it would be ok. Shopping? It would be ok. Anyway, I'm fixing to have no advanced schedule.

(Vocabulary)
play it by ear  臨機応変に行動する　楽譜なしで演奏する
be fixing to do sth　～するつもりだ。（話)
Off the top of my head,  とっさに思いつくのは

　今週、２日間の休みをもらった。たった二日ではあるが嬉しい。このところ忙しく過ごしていたから。今度の木曜と金曜が休みだが、何をして過ごそうか。

　田舎道を走るのも良いが、ガソリンの高値を考えるとあまり良い考えとも言えない。庭いじりでもするか？いや、それにはあまりにも暑すぎる。とりあえず、、、何も思いつかない。

　結局何も予定を立てないことにした。家族が何か言えばそれに従おう。