Emergency medical care in the time of COVID

During these pandemic times Tokyo hospitals are said to be seriously strained. At the same time I’m pleased to report, from personal experience, that they are still capable of handling emergency situations.

I’d like to use this blog to describe my recent experience with emergency medical treatment in Tokyo. Sorry, but there won’t be many photographs accompanying this post.

I was out on Saturday to do some errands and had a bad fall after catching my foot on a protruding brick on the sidewalk. I quickly realized that not only had I cut my chin when it hit the sidewalk but I had likely broken my arm. I was completely immobilized and going into shock.

Fortunately, two high school girls who were walking behind me were good enough to call an ambulance, which arrived in less than 15 minutes. They also kindly waited with me until the ambulance came. By that time, a small crowd had gathered; five people stood there bowing and wishing me well when I was taken away.

259571497-inside ambulanceThe ambulance attendants wasted no time in picking me up off the sidewalk and getting me onto a gurney. Of course, since I am obviously not Japanese, one of the first things they wanted to know was my country of origin and how recently I had been there, the latter question clearly driven by the pandemic. Satisfied that I had not been outside of Japan for nearly a year, and therefore posed no particular threat of contagion, they moved me into the ambulance and slapped a bandage on my bleeding chin. While one of them began to check my vital signs and perform other basic diagnostic tasks, another asked whether I had a preferred major hospital in the neighborhood. I told them I had been to a Red Cross Hospital not far from my home a few years ago. They informed me that the Red Cross Hospital was a designated Covid hospital so they did not want to take me there. Needless to say, that was fine with me. Who wants to go to a designated Covid hospital if you don’t have the virus?

moving ambulanceIn the end they got permission to take me to the Tokyo Shinagawa Hospital, which was, in fact, the nearest large hospital, and off we went. By this time the pain was such that I could only lie there with my eyes closed. So my first-ever experience traveling in an ambulance consisted largely of listening to the siren wail and the automated voice announcing that we were making right-hand turns. For some reason we wound up making a lot of right-hand turns, but we were soon at the hospital where a nurse was waiting for us at the emergency entrance.

After the attendants wheeled me into the hospital, the nurse asked if I could get off the gurney and into a wheelchair. As I accommodated her request, clutching my wounded arm to my chest, she observed that I was extremely tall. Ordinarily I would have attempted to crack some sort of joke about how my height was probably not diagnostically significant, but this time I was in too much pain to attempt to be funny.

After collecting some basic information, a doctor and a couple of nurses quickly arranged for me to have both an x-ray and an MRI to determine the extent of my injuries. Needless to say, everyone is wearing masks and everyone, except me, slapped on a fresh pair of latex gloves. As long as I can keep still, the pain is manageable. And of course when they have to move me around, it hurts a lot.

Fortunately they are kind enough to let me stay still most of the time, except when removing metal objects from my person, and unbuttoning my shirt, and finally transferring me from the MRI table to another gurney. Even though they’ve left my glasses on all this time, I find I am in so much pain that I simply keep my eyes closed.

I hear the doctor’s voice telling me that indeed I have broken my arm but fortunately not any ribs, although they hurt quite a bit. She also tells me the “good news” that the break is not one that will require any surgery to fix.

I am wheeled into a small cubicle as the nurse explains that they are going to give me something for the pain. She also explains that the fastest-acting pain relief comes in the form of a suppository. At this point, frankly, I don’t care.

While I’m waiting for the nurse to return with the pain relief, I can hear another emergency patient being wheeled into the cubicle next to me. He’s been brought in from the local horse racing track, but as near as I can tell from what they’re saying, the emergency appears to be alcohol poisoning. And I thought tripping on a loose brick was stupid! He and I are the only patients in the emergency room, with at least 2 doctors and 4 nurses.

Pain relief duly administered (I’ll leave out the details), the next step was stitching up the cut on my chin. Apparently it’s about 3 cm. (just over an inch) long, but in the end required five stitches. I’m still in enough pain that my eyes are closed, but the male doctor sounds rather young. First he inquires as to what it was that I cut my chin on, and I tell him that my face hit the pavement. He explains that he will have to clean the wound before stitching it. He apologizes for the fact that, since I am lying on my back, my clothes may get a little wet in this process. (Only in Japan!)

Somehow, even though he never removes my facemask, he manages to thoroughly debride the cut without getting my clothes wet at all. Only after he has done this does he administer a local anesthesia. And then commences to stitch up my chin. I confess, it felt like he was doing a pretty rough job of it. I think he was trying to do it in only four stitches but in the end determined that he needed to add a fifth stitch. Will I have a scar? Inevitably. Once again, I don’t care. Maybe the painkiller has finally started to take affect.

Stitching completed, the nurse explains that I will need to return the next morning so they can check the wound to ensure there are no signs of infection. Then they let me lie there for a little while. Eventually two nurses came in and helped me to sit up. They proceeded to bind my injured arm to my torso with a very interesting elastic contraption, explaining as they went how it was to be properly put on.

They then confirmed that I could get out of bed and walk, and helped me to walk over to a desk where the doctor was waiting. She showed me my x-rays and MRI results. It turned out that the break in my arm was very high on the humerus, near the shoulder. This is a spot where lots of ligaments are attached to the bone, so keeping the arm immobilized will be essential to my recovery. Hence the weird elastic contraption.

The doctor then explained how to look after the stitches on my chin (twice daily cleaning and application of antibacterial cream) and told me I could go home.

“That’s it?” I think to myself. Frankly I still feel a bit shaky and not at all ready to go anywhere, but I remember that emergency rooms don’t like to keep people hanging around unnecessarily; probably doubly true during this pandemic. I can detect only slightly more attention to hygiene than previous hospital visits, but that is more a testament to normal high standards in large Japanese hospitals, than to any lack of Covid precautions. I didn’t ask, but suspect that there are no Covid patients being treated at this hospital.

As the nurse is leading me away to check out, I catch a glimpse of myself in a mirror and realize that my mask is bloody from the chin injury. Fortunately I have a spare mask in my bag so I am able to quickly swap it out and look like a [relatively] normal human being again.

As you can imagine there are a number of administrative steps involved in getting out of a hospital. Japan having a national system of healthcare, the first step is to provide my health insurance card. Because I will need follow up attention from an orthopedist, they also want to know if I have a preferred clinic. Fortunately I had a card in my bag from a good clinic near my train station and the necessary paperwork is quickly completed.

My entire emergency experience costs me less than ¥19,000 ($175) and as I leave I am given a CD of the X-ray and MRI results, an explanatory letter for the orthopedist, and a prescription for three days’ worth of pain pills. I filled the prescription at a pharmacy just down the road from the hospital (6 pills, ¥720–about a dollar a pill) and caught a taxi home. I told the taxi driver about my accident, partly so he understands why I am moving so gingerly, and he proceeds to give me lots of advice on how to deal with a broken bone, including a warning that sleeping tonight may be difficult. Tokyo taxi drivers are always so helpful!

I arrived back home just after 4:30 and by my estimation I must have taken my fallen between 1:15 and 1:30 so this entire experience has lasted less than three hours.

Well, to be precise this entire experience is going to last for several more weeks as I am told that my right arm must be immobilized for at least 4 to 6 weeks while the bone begins to knit and my arm will be in a sling for at least three months. (Apologies to my blog followers. I may not be able to blog weekly as is my usual practice. But I do have a number of travel stories to share with you so will try to write when I can.)

I have to praise Japan’s modern healthcare system. I have received swift, professional, and affordable care using modern equipment and practices. My follow-up visit to the hospital on Sunday morning was quick and easy and cost about ¥820 ($7.50). My visit to the orthopedist on Monday morning was quick (in and out in less than 30 minutes) and incurred similar cost.

If one has to have emergency medical treatment during a pandemic, there are a lot worse places to be than Tokyo.

© 2021 Jigsaw-japan.com and Vicki L. Beyer
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