K: So, if you follow us on Twitter, then you know that I’ve been going through some health stuff. And I thought it might be cool to talk about the differences between American hospitals and Japanese hospitals. Because we’ve talked superficially but mostly about cost. We haven’t talked about, like, the difference of checking in or going in. Emergency rooms. Like, you know, the nuts-and-bolts of it kind of thing.

C: Yeah. I think cost is a nuts-and-bolts issue, but I think it’s also clear what you were saying.

K: Okay, cost is where you locate from.

C: It is. Beyond the terror of, “okay, if I go to the E.R., I’m looking at $5000” versus $50. Like, once you – once you put that aside, totally different nuts and bolts on top of that.

K: Yeah.

C: And it’s more like the Danish system, which we only went to…

K: I’m furrowing my brow because my husband just said the Danish system.

C: We went to one hospital in Denmark when we were on vacation.

K: Yes. We did.

C: Yeah.

K: Because Denmark is the capital of hereditary coproporphyria experts except for that they’re only experts – it’s not actually hereditary coproporphyria. It’s something different but similar.

C: Yes.

K: And so, it’s one of the ongoing health things that I have.

C: Yeah. So. How did you find the – the experience – because not all of our listeners are American. So, what do you think of as the essential structure of the American hospital?

K: So, the American hospitals, I think that the underlying structure is… massively long wait time.

C: Mm. Yeah.

K: Like, be – so, you go into triage. So, triage is when you first check in in an emergency room. So, I’m going to do emergency room in America versus emergency room in Japan because I’ve been in both. An emergency room – for me, the quintessential thing is wait time. Like, nobody’s – you’re the only one there. Nobody else is in the waiting room. There’s nobody else in the lobby, and for some reason it still takes 45 minutes – between 45 minutes and 3 hours – to see a doctor.

C: Depending on where you’re at, yeah, because I’ve been places where it’s been 8 hours. Because I do have memories of when I was a kid, like 8 or 9, going to the military hospital a lot for asthma.

K: Mhm.

C: And we go to the E.R., and I think the longest we ever waited was 4 hours. But after we’d been there like ten times, when I’d come in, the nurse would see me and say, “okay, we know what this is.” And the doctor would say, “he’s mine. He’s serious.” And get me back there in 20 minutes rather than hours.

K: Yeah.

C: So yeah, wait time is definitely…

K: Yeah. And so, in Japan, the wait time is not to see the doctor. It takes forever to pay. So, another major difference between Japanese hospitals and American hospitals is that you pay the same day. And… so, like, if I would go to the E.R. in the United States or see my doctor in the United States – or just go to the hospital for any reason – they would bill my insurance, and then my insurance would bill me. Whatever I was supposed to pay. And, in Japan, it’s the other way around. You pay the same day – like if you go to the emergency room, or if you have surgery, or if you have – or if you see a doctor – you always pay the same day. Like… if you get released – if you’re admitted – you pay the day that you’re released, and it’s really transparent. And, usually, going to see a doctor and having an MRI and all of that, we’ve covered before, is usually less than man en. Less than 100 bucks U.S., roughly.

But the wait to pay is long. And they have machines where you can automatically pay, but if you’ve done something different than what you were checked in for, you can’t use the machine.

C: Right.

K: And you don’t know whether or not you can use the machine until you try to use the machine. And then sometimes you try to use the machine, but you have to go over to the front – over to the pay station, you have to stand in line, and then they clear you to use the machine.

C: Yes.

K: So, we never know. So, the way that we do it is now we just skip the machine, we just get in line, and… if they tell us to go to the machine, great. If they don’t, great. And after that, you also have to put your parking ticket into a machine that does not validate it. Which is the most bizarre thing in the world to me. Like… really? Like, when I got the ticket, it should be time stamped. But when we put – we have to put it into a machine and like, checking out of… the parking lot. It’s so weird to me. I don’t understand it.

C: That’s weird because I’ve never been there for that part. Because you’ve started going in a car since Covid.

K: Yeah.

C: And… I can’t go with you because… Rasta

K: Covid.

C: Yeah, because Covid. So, Rasta can go with you as your interpreter, but just the one person. So, I didn’t know anything about this checking out the car.

K: Yeah, it’s so bizarre. And so… I’m really happy that, when I have my surgery next month, that I’m not gonna be having it at the main hospital that I usually go to because they’re going to be doing construction on the parking lot.

C: Mm.

K: And so, for us – big yawn coming (yawn sound)

C: Oh no, a yawn.

K: Yeah, right? So, for us, we live across the street from a subway station. And that subway takes us to… across the street from the hospital. And so, it’s really easier to go by subway, but because of Covid, I can’t ride public transportation.

C: Right.

K: As a precaution.

C: Right. Because, usually, you go to Nagoya City Hospital, which is right by the Sakurayama station.

K: Yeah.

C: Which I used to teach at the Nagoya City University, and its’ their hospital. So, I didn’t teach at the hospital, but I taught across the street from it for… I think, two semesters.

K: So, going to the hospital – I’m going to talk about the ways I’ve gone, and then you can talk about the ways you’ve gone.

C: Okay.

K: I’ve gone to the hospital emergency room. And… that was for pain management and… it was really quick. Really easy. The longest wait time isn’t to the see the doctor. The longest wait time is to pay. And then I’ve gone to the hospital where I’m sick, and I just need to get a scan or something, and I don’t feel like getting a referral from my doctor because it’s actually faster if I don’t have a referral. Which I think is so bizarre. If I just walk in off the street, it’s way faster, but if I have a referral it takes forever. So, you can’t just walk in off the street without an appointment, but you can call and make an appointment for yourself without a referral.

So, I would just have Rasta call. Make me an appointment without the referral. And then you check in at the information desk, and then you check in upstairs at another desk, and then you go and get your bloodwork before you see the doctor. And then you have to wait an hour because it takes an hour for the – the bloodwork to process. And wait time for the blood draw is about 15 minutes. So, I know it’s going to be at least 90 minutes before I see the doctor on average. And then I see the doctor for maybe 5 to 10 minutes and get whatever other tests are ordered and then come back in two weeks to get the results of that test. That’s not referraled. Referred is a little bit different because I had paperwork from a referring doctor. And they always give us a C.D. or D.V.D., so, like – this time around I went to see my regular doctor, and he was like “ohh, we need to get you a scan.” I got the scan. That took two weeks… to get the scan. And then two weeks to book an appointment. So, it’s – and then I had another scan, and that was another 2 weeks. So, now we’re at like the 6 or 8^th week… from…

C: Yeah, I’m having trouble keeping track.

K: The beginning of the process. And… it’s pretty scary and pretty gnarly. Because I don’t know for sure when I’ll be having surgery.

C: Right.

K: Like, I know my consultation is on… April 5^th, but I don’t know – and I’ve tried to book hospitalization on Monday – the surgery on Monday – but they weren’t… sure. They just know I can have surgery sometime that week, but they’re not sure… like, the following week after my consult. At the particular hospital I’m going to. Which is sort of the “English” – air quotes – “English” hospital. So… that’s weird. But I don’t know what that procedure’s going to be like. We’ve just read the website so far.

C: You know one thing that I find fundamentally different about them is the… décor.

K: Okay.

C: In the U.S., there’s a big distinction between, like, city hospitals and… religious hospitals.

K: Yeah.

C: And here, I don’t know that there are any religious hospitals. There are Red Cross hospitals.

K: Yeah.

C: And there are university hospitals and city hospitals, and they’re all slightly different.

K: Yeah.

C: But the treatment that you will receive, and it’s often the same doctors who will work at multiple hospitals. Like, on Monday and Wednesday might be at one, and on Tuesday and Thursday and Friday, they might be at another.

K: And sometimes, like, Monday morning they’re at one hospital, and Monday afternoon they’re at another.

C: Right. So, most of them, you can’t get an appointment… you can’t get a non-appointment in the morning – in the afternoon, rather.

K: Right.

C: So, it used to be before Covid, you could just go. Now you have to call and get the same-day appointment. But it closes at like 11. If you’re not there by 11 am, you’re not being seen that day if you don’t have a referral appointment.

K: Yeah.

C: So, I think my experience going – I went to the E.R. a lot when I was a kid because I had really severe asthma because I’m allergic to ragweed. So, living in Texas – where ragweed is endemic – was not great. And then… a lot of time at the hospital in Alaska because my mom was sick and in the hospital for like a year. And then… military hospital again when I was enlisted for

K: Mhm.

C: Four weeks before they said, “oh, hey. You have asthma related to Texas. Maybe sending you to San Antonio” – well, to Lackland Airforce Base – “was not great because you have asthma again.”

K: Mhm.

C: Even though I hadn’t dealt with it for ten years.

K: Well, and you still have asthma.

C: I still have asthma, but it’s mostly allergic rather than exercise, so even though I’m fat, I can exercise as much as I want without an asthma attack. But you get me around certain plants, and I stop breathing. So, I do have medicine for it.

K: So, I think like the religious hospitals in the United States tripped you out the most

C: It did.

K: With my grandfather.

C: Yes. They did.

K: Do you want to tell them what your perception of it was? And then I’ll talk the skinny of it.

C: My perception of it was just that… like, there were more crucifixes than lights witches.

K: (laughs)

C: Like, everywhere you looked, there were just crucifixes. It was a catholic hospital, and you’ve gotten great treatment at catholic hospitals.

K: Yes, I have.

C: But I know they don’t do certain kinds of… treatments, and it was, for example, a really huge problem for you to get a hysterectomy at a catholic hospital.

K: Yeah. It was.

C: Because they just did not want to do it. And the only reason they agreed was because it was life-threatening, and I already had a vasectomy, so there was no possibility you would get pregnant – even if it would kill you.

K: Yeah.

C: They were like, “okay, so there’s no possibility to get pregnant?” “It’ll kill me.” “Kay, but is there a possibility?”

K: And, “you have cancer, but we’re not sure which way it’ll go”

C: Right.

K: “Like, are you sure you really want to get rid of your womb?” And I’m like, “yes, please. Hello. No more babies happening here.”

C: Yeah.

K: And like – come to find out, I’m allergic to estrogen and progesterone.

C: Yes. As part of your porphyria.

K: Yeah. And I didn’t know that, so I had a lot of emotional problems based on having too much progesterone and too much estrogen. And now my body’s like actually better. I’m not on hormone replacement therapy. If your doctor prescribes HRT for you, please talk with your doctor about it. But, for me, it’s not affecting my bone density, and I’m actually much more emotionally stable and less erratic and in less pain.

C: Yeah.

K: So, it’s like win, win, win. So, for you, it was weird for you the first time… like… you checked my grandfather in, and I was like – I don’t know if we told this story before because I have wicked déjà vu. You checked my grandfather in, and I was like, “did you tell him that he’s a knight. That he’s a lord, that he’s paid, that he tithes? That he’s catholic.”

C: Yeah, your grandfather’s catholic, and he was part of the Knights of – I forget what – but a particular catholic order.

K: Yeah. Like, he knows the bishop – the local bishop – and all of that. And you were like, “what are you saying to me?”  And I’m like, “my grandfather is a VIP at this hospital, what are you doing? Why are we waiting?”

C: (laughs)

K: I was so offended. And I walked up, and I said, “excuse me.” And then I said my grandfather’s name. And I was like, “he’s a knight. He has tithed his entire life. He should be in your records.” And they were like, “we’re so sorry, oh my gosh.” And they apologized to him, and they took him back right away. And you were like, “what?” And I was like, “yeah.” And he got a massive discount for it, and it was just – you were like, “this is so weird.” I’m like, “there are benefits and perks to being catholic if you go to a catholic hospital.”

C: And, growing up Mormon, I knew there were benefits to… college tuition. If you go to BYU, and you’re Mormon, it’s massively discounted compared to people who are not Mormon because the assumption if you’ve been paying all this money and tithing.

K: Yeah.

C: Bop bop bop. But, yeah, it was just weird because

K: But the Catholics keep track. If you don’t tithe, they will know.

C: The Mormons keep track, too. Every year, you have to sit down in something called Tithing Settlement and go over your income statements and assure them that you have paid them 10% of your income in tithing.

K: Yes. Yes. But because of the program my grandfather was in, he got some money back from his tithing when he was older.

C: Interesting. Okay.

K: You know he got checks. I kept it from the rest of the family.

C: Yeah.

K: I’m the non-Catholic in the family. I don’t go to church, and I’m the only one that knows all the Catholic rules.

C: I know that he got checks, and that he would go and spend them even though the lady was just trying to make him mad.

K: (laughs) Yeah. With his gambling.

(laughter)

K: Because my grandfather had a gambling addiction.

C: So, he’d go to the nearby casino, and he said that the blackjack dealer was just trying to make him mad by giving him bad cards.

K: Yeah. Because he had a total gambling addiction and, like most gambling addicts, he lost more than he won. But his addiction wasn’t so bad that he was ever homeless or ever took out bad loans.

C: Right. Right. So, it was more like a… like, “this is not great, but it’s not actually materially affecting your life, so it’s kind of amusing.” Because he was a terrible, terrible cheater.

K: Yeah.

C: At dominos. He and I would play dominos.

K: Yeah. (laughs) The only way he could ever win at dominos was if he kept score.

C: Yeah.

K: And my cousins and my uncles would take turns – everybody would take turns keeping score. And my grandfather would keep score first. And then someone else would get a chance, and then he would keep score again.

C: Yeah.

K: It had to be like every other time he kept score, so it was interesting. It was interesting.

C: So yeah, the Catholic hospitals – the religiosity there was… disquieting to me. Because I grew up being told, like, Catholic – Catholicism is the Whore of Babylon.

K: Yeah.

C: And that’s just what the Mormons called it. And I think now they’ve taken, like, a slightly less aggressive tack, even though that phrase is still in the Book of Mormon. But when I was growing up, they were like, “the Whore of Babylon means Catholics.”

K: So, for me, what I thought was most disturbing at the Catholic hospitals is that they would always look at my neck to see if I’m wearing a crucifix.

C: Mmm.

K: Before the priest decided whether or not to talk to me. And it was so weird. And, like, sometimes I wished the priest would talk to me because he was just in there talking to my grandfather.

C: Right.

K: But then he would come out and look at me and kind of make a face and just… like, you could tell he wanted to bless me and cross me but didn’t really know what to do beyond that.

C: But your grandfather’s final stay, which was like three weeks, you were there so often that the priest was finally like, “okay. You are the one to talk – you’re the non-Catholic, but you’re also the one that actually cares what’s happening here.”

K: Yeah.

C: “And that I should talk to about care and who’s got things in order.”

K: Yeah.

C: So, Japan, the hospitals I find are much more… secular. Obviously, because they’re not religious. But they have their own rituals.

K: Yes. They do.

C: In the way that the Catholic hospitals did. And the rituals are mysterious and… strange. So… I experienced going to the hospital because I broke my heel.

K: Mhm.

C: And… I’ve broken – like fractured – a lot of bones over the years that I kind of just don’t do anything about.

K: Yeah.

C: But my heel just became too painful to walk on, so I went there…

K: Before we got married. Since we’ve been married, every time you’ve fractured something, you’ve gone to the hospital.

C: Once I tell you about it, but I don’t always tell you about it. So, this

K: Or I notice. Like, you try – you so – ohh, I’m gonna tell on you right now.

C: (laughs)

K: You so tried to pull a fast one with your shoulder. So, you have something called a frozen shoulder. It’s thawing. We talked about it last week, I think.

C: It’s nearly cleared up, yeah.

K: Yeah. And you were like, “no. I’m just sleeping wrong.” And I was like, “this has been a week of you sleeping wrong. And now you can’t move, and your back is almost locked up. What day are you going to the doctor’s?” Not are you going to the doctor’s – what day are you going to the doctor’s. “Do you want to decide, or do you want me to pick a day? Because you’re going.”

C: Yeah.

K: And I’m like, “and I will so have Rasta come get you.” Which is so funny. Like, if you ever saw Rasta – our son- (laughs) slight. Y’all know we call him slight. So, like, I don’t know why me being like, “Rasta is going to come and get you.”

(laughter)

K: Rasta hates being in those situations where, like, you don’t want him to do something, and I don’t tell him you don’t want to. I tell him, “I’ve decided this thing is happening.” And then he just kinds of like stands in the entryway awkwardly, and I’m like, “you are going. It is happening.”

C: Yeah. It’s like…

K: Because I will have Rasta call your doctor, make you a same day appointment, and then come and get you. Because this is the benefit of being married to somebody who’s autistic. Once you have an appointment, you go.

C: I thought that. I thought, “ohh. Yeah. If you make me an appointment, I can’t miss the appointment.”

K: (laughs) You cannot. And so

(laughter)

K: That’s how I get you – I like bully you into taking care of yourself. I’m like, “Rasta. Make your father an appointment. He’s going to be pissed when you come pick him up, but I don’t care because he needs to go. And if you love your father” (laughs)

C: Yeah. Because it’s not about physicality because I’m, what, six inches taller than Rasta and… double his weight, literally.

K: Yeah.

C: But, yeah, if I have an appointment, ohh, I’ve gotta go.

K: “And you know he likes to arrive ten minutes early, so you better be on time.” And he’s like, “okay.” And then he just comes, and he’s like – the first thing he says when he walks through the door is, “mom told me to come.”

(laughter)

K: That’s his way of coping. Is like – he’s going to be 27 this year, but he’s like – he’s been caught in the middle since adulthood.

C: Yeah.

K: So, when he was young, and when we were in the United States, I could drive.

C: Yes.

K: I can’t drive here in Japan. And I would just tell you, “come on. You have an appointment. Let’s go.” And I think a few times, I would tell you, “come with me to my appointment.” And then you’d be like, “wait a minute, why are they calling me back?” And I’d be like, “because you need to see the doctor.” And you’d be like, “ohh. I’m so mad at you.” Because you’re like, “do not make me an appointment.” And I’d be like, “come with me to mine.” And so, in the United States, I was much more duplicitous.

C: Yeah.

K: And our doctor knew that you were a reluctant patient.

C: Yes, he did. So, when I went for my heel, I went the first time to the same hospital that you usually go to. Went by subway because I’m stubborn like that.

K: Yes. With a broken heel.

C: Yeah. And they… gave me this – they checked me in, and they said, “what’s wrong? What are you doing?” And they gave me this schedule. And I think they’ve done this to you, too – I think this is standard procedure – they gave me a schedule of, “first you’re going to do this, then you’re going to do this, then you’re going to do this.”

K: Yeah.

C: And then the nurses and the other people just kind of direct you around. “Go to this waiting area, when your number is called go to this door.”

K: Yeah.

C: And it was very specific. Like, “at 10:15, you’re gonna get an x-ray, at 10:30 you’re going to have a consult about the x-ray” and with the location for each. And a little scan thing.

K: So, it’s an actually printed out sheet.

C: Yes.

K: And so, you go to the – the lobby information desk, and then if you have a referral, you have to go see the referral person. And you go to the referral desk, and from the referral desk, you go to the floor of your first – you go to the floor that your doctor’s on.

C: Right.

K: That you’re going to see. And then they give you a printout of what your day – what your schedule for the day is going to be.

C: Yeah.

K: And that’s the itemized printout that you’re talking about right now.

C: Yeah, it is.

K: It’s an actual printed piece of paper.

C: Yeah, with barcodes so they can scan it to say that you’ve been moving through the system to keep track of it.

K: Yeah, because you have to like put your paper under the bar scan when you go to get your blood drawn. You have to put your paper under the bar scan when you get your C.T., but you don’t have to bar scan it when you go to the doctor.

C: Yeah. Which is… yeah because I think the doctor – because you’ve scanned at the other places – can pull up the records.

K: Yeah. It’s all in the computer.

C: Because by the time I got the records, they had the x-rays and everything already. And they said, “okay. You’ve broken your heel.” Which is not what I was expecting. I thought I had planter fasciitis. I thought I had, like, strained my tendon. They were like, “no. You broke your heel. This is why it hurts so much.” And they referred me to the… person who fits orthotics.

K: Yeah.

C: And they are not in the system, so they were like, “this person is not in the system. They rent this space from us. They’re not part of the hospital. You’ll have to arrange payment with them separately.” So, it was interesting that they still had the outside specialist because they’re not a doctor, they’re running like little orthotics business.

K: Yeah.

C: And they gave me paperwork to get reimbursed from insurance.

K: And so, another cool thing is like, if you pay full price for a hospital stay, you can claim it on your taxes, and you get a tax break for it. And if you make under a certain amount, they – everything is based on how much money you make. And so, like for example, for my surgery, I’d like to order a private room. And the private room can be anywhere between… I think as low as $50 a night to as high as $300 a night.

C: Yeah.

K: And different hospitals have different rates for the private room. And I’ve been tweeting about why I need a private room, so I’m going to talk about bodily functions a little bit here. I have the worst nighttime gas. Like, I – I used to joke with you and say, “I think I’m gonna kill you in my sleep, my gas is so bad.”

C: (laughs)

K: But Chad does not have a good sense of smell at all, and I’m like, “I’m sorry the house just really smells bad.” And you’re like, “I can’t smell it.” And I’m like, “you’re a keeper.” (laughs)

C: You know, for me, if I’m in my office every day, and I just forget to shower for three weeks or something, there will be a day I walk in the office

K: You forget to shower for three weeks.

C: No, I don’t. But

K: Oh my gosh. You are just telling yarns.

C: But every once in a while, I will walk in my office, and I

K: Are you jealous of the drama of my gas right now?

C: I think so, yeah.

K: And so, you’re trying to – you’re trying to like make up some bad smell for yourself?

C: Yeah, I think so. Because there are nights that

K: Shameful. Your jealousy is shameful.

C: There are nights that the sensor on my phone has alerted the U.N.

K: (laughs)

C: It’s been like, “there’s been a chemical weapons violation here.”

(laughter)

K: Yes. Yes, there has been. Because it’s so bad. And I’m not bragging. I’m not bragging. It’s so bad, and I can’t help it. And… we’re hoping that once I get on the other side of my medical stuff – it’s actually probably going to be worse, but we’re hoping that it gets a little bit better. Because I have to take GasX every single day because my body is just producing way too much gas. And they don’t know why. So… you know. That’s part of it. But it’s really bad. It’s been like really bad.

C: I barely notice. Like, there will be times that you wake up and you’re like, “ugghh.”

K: Yeah.

C: “How can you stand it?” I’m like, “how can I stand what?”

K: Yeah. Like, it’ll smell so bad it’ll wake me up.

C: Yeah.

K: And so, that’s – because I have a really, really sensitive nose. And I’m like, “dammit.” But usually now I’m waking up as soon as my pain medication wears off because I go all day without taking any pain medication, and then I take my first dose at night. And then I’m usually awake and like, my pain has gotten so bad that we’ve actually timed it. It takes between 90 and 110 minutes for my pain medication to take effect.

C: Yeah.

K: And then I get between 3 and 5 hours from it depending.

C: Yeah.

K: So, I’m sleeping in 3- and 5-hour cycles, which is why this podcast is not as laugh-filled and as jokey and such. Because I’m just really stressed out and… not doing well.

C: Too tired to laugh.

K: Yeah. And I’m – I am really tired. And I have a migraine. But I’m not hungry because I did eat before the podcast.

C: See, this is good. You’re remembering.

K: But now I’m thirsty.

C: Hey, thirsty. I’m Fridee.

K: Really?

C: Yeah. I didn’t expect a laugh. I was just demonstrating how humorless you are today.

K: By being not funny?

C: By being very funny with a

K: If y’all are laughing, you’re just encouraging him.

C: By being very funny with a traditional joke. We don’t call them Dad jokes around here. We call them traditional jokes.

K: No, this whole “we” is the royal we, just for the record.

C: Thank you for knowing I’m a king.

(laughter)

K: You rule my world.

C: (laughs)

K: So,

C: And then I ha – so, that was my experience with my heel.

K: Yeah.

C: And then I had a bicycle accident.

K: So, what do you think about the service?

C: I think the service is really efficient. And I find a lot of comfort in that.

K: Yeah.

C: I feel like the nurses do not

K: It’s so predictable.

C: Yeah. I feel like

K: I really love it.

C: I feel like the nurses do not care about me personally.

K: Yeah. Because

C: They have kind of

K: In the United States, I – I offended nurses.

C: Yeah. And I feel like Japan

K: By existing.

C: And I don’t – I don’t think it’s religious, but I think that… the expression of Buddhism in Japan has got the same kind of thing because I think it’s cultural. There’s this like universal… affection that’s at a certain level. Like, “we will treat you to this level nicely. No nicer, no worse.”

K: Yeah.

C: “And you’ll get this every time from every person.” So, it’s very predictable.

K: Yeah. I like that my doctors always, like – so, there’s a thing in Japan – I think we’ve talked about it before – where they pat you without touching you. It’s like three pat pat pat, but it’s like right above – and it’ll be right above my knee or right above my back. And it’s just the motion of, “I’m soothing your aura” is how I (laughs) think of it.

C: Yeah. Yeah.

K: Because it’s like – it’s a… it’s a, I don’t know, maybe two-inch gap between their hand. But I do find it very comforting. Whereas the nurses in the United States would just manhandle me. And be super rude. And the… nurses in Japan, they’re certain sounds they make. Like, when they see you, they go “ah.”

C: Yeah.

K: And then they say your name, and then they look at you, like acknowledge your name, and so…

C: And that depends on place, too, but it’s consistent among the nurses at a particular place. So, when I was going to “rihabili” which is rehab. But in Japan it means physical therapy and that kind of thing.

K: Yeah.

C: It wasn’t the, “ah” it was always the “doudesuka?” Like, how are you?

K: Ah.

C: Just, like, real gently because they know you’re there after a serious injury for, you know, therapy that’s not necessarily going to be pleasant. So, I had a really bad bike accident, like, 2014. And I had to go to the E.R. via ambulance. So, me walking myself home just before calling an ambulance

K: Yeah.

C: Was a whole thing that maybe we’ll talk about another time, but… they came in the ambulance and picked me up here and took me to the E.R.

K: Well, and here’s something peculiar about you. I joke that I’m a bad wife, but I’m actually a very good wife. You don’t like me to go to the hospital with you. And it was like freaking the person out that I wasn’t going.

C: Yeah.

K: And I was like, “no.” For one, we’re both two really big people, and everything in Japan is made small. So, I don’t think I would’ve fit, so I think what what would’ve happened is I would’ve went down, and then they would’ve given me instructions on how to get there by car. And I don’t have a car. And then me being there is just going to make things more confusing.

C: Yes.

K: Because our Japanese levels are very different, and our – we don’t have – there’s a lot of synonyms in Japanese like there is in English, so my comprehension of what’s being said is seen through the lens of emotionality and body language.

C: Mhm.

K: And yours is based on verbatim translation.

C: Yes.

K: And… you cannot verbatim interpret Japanese to English or English to Japanese. You have to – it has to be contextual. It’s really complicated. And so, we tend to… experience what’s being said in Japanese very differently.

C: Yes.

K: And that causes a lot of stress because, if we disagree, then that’s tension. Because I’m wanting you to get the best, and the questions that I ask are not the things that you’re interested in.

C: No.

K: And so, it just – over the years, we’ve just decided that you don’t like me going to the doctor with you because you feel like it makes it take three times as much time because I have tons of questions.

C: Yes. And I’m just like, I’ll do whatever the doctor says. So, going to the E.R. in an ambulance didn’t really change it much.

K: Was it as spacious as an American ambulance?

C: I don’t know. The last time I rode in an American ambulance, I was 17, and there was another patient in the ambulance with me. So, I think the answer is no.

K: That’s how you – yeah, like hello. There’s only room for one.

C: Because that was – that was Lackland, and there was another… enlistee who was also having an asthma attack because the pollen was really bad. So, we rode together.

K: Mm.

C: And we were scolded for talking to each other. “You two should not be talking.”

K: What do you mean “you two should not be talking”?

C: Because it was a girl – like 17 or 18. I was 17.

K: Uh-huh.

C: And we were talking, and we got scolded for talking to each other because we were fraternizing.

K: What is that – what are you talking about? This is like one of the most bizarre things I’ve heard. Like, you’re in an ambulance together, you’re both having an asthma attack – “don’t talk”?

C: Yes. Don’t talk to each other, specifically.

K: That doesn’t make any sense to me.

C: It didn’t make any sense to me at the time, either. But they ruled my whole life, so I was like, “okay. I won’t talk.”

(laughter)

K: So, when we got the – so, we’ve been doing a lot of research online, and they gave a paper – they gave me a paper. And of all the information that we received about going to the hospital in Japan, what’s the thing that freaked you out the most about being checked into the hospital? The one thing that’s like a bridge too far for you?

C: Having to bring your own towels I think is the thing too far for me.

K: Yes. And I was like, “the towel? You’re freaking out about the towel?” I’m freaking out about no wi-fi. No internet at the hospital.

C: Okay, but I haven’t stayed overnight in a hospital since wi-fi was a thing.

K: Okay.

C: So, I haven’t – I know that you were – but even then, wi-fi wasn’t a thing for computers. Because we had mobile phones, and you had your mobile phone

K: Yeah.

C: But… wi-fi wasn’t – and especially wi-max, like a mobile wi-fi – it just didn’t exist yet.

K: So, something that’s also unique about Japanese hospitals is that they have vending machines. And they have vending machines for slippers, bath clothes, toothpaste

C: Yeah, I think the contents of them.

K: Any toiletries. Anything you don’t bring, they give you a two-page sheet of what you need to bring with you to the hospital, and so to go for a 3-day hospital stay, I’m taking… a major suitcase – like, a big suitcase like I’m going on a flight for three days.

C: A trip. Yeah.

K: And I have to bring my own pillows because Japanese – traditional Japanese pillows were filled with beans.

C: Yeah.

K: And now they’re filled with little plastic things, and they’re tiny. Tiny, tiny little pillows. Like… smaller – about the size of a plushie. So, like, the poop emoji plushie is – a large one of those is about the size of a Japanese pillow.

C: It’s interesting that you choose that one.

K: Because that’s the one I saw in the video.

C: Okay. So, the thing that was most disturbing to me about going to the E.R. was that I had avulsed my skin – which meant all of the skin on my wrist had been ripped off, and my palms had been ripped off.

K: Yeah.

C: And they made me wash my own wounds. That was the thing that was like, “what is going on here?”

K: (laughs)

C: That was so incredibly painful.

K: Yes. I’ve had open wounds cleaned, and it is incredibly painful to have it done.

C: They were like, “you have gravel in them.” And my thing was, “yes, so wash it out.” They were like, “you have to do it yourself.” “WHY?”

(laughter)

C: “Why do I have to do this myself?”

K: And where’s the injection of lidocaine, yo?

C: Yeah.

K: (laughs)

C: But beyond that, everything was, you know, kind of as I would expect it to be. I got an MRI to make sure I didn’t have a concussion. Like, everything else was normal until it came time for me to leave – which it was like 6 hours later. The police came by to check on me because any bicycle accident has to be recorded.

K: Yeah. It’s a traffic accident.

C: Yeah. So, I talked to them. And no, it was just solo. It was me having a seizure and falling on my bike. Not a car hitting me or anything.

K: Yeah.

C: But when I went to pay, they were like, “okay. It’s going to be this much. Please give it to us.” “I just came in an ambulance; I don’t have any money.”

K: Yeah.

C: “Oh, you don’t have any money? How come you don’t have in your pocket the amount to pay for an E.R. visit?” “Why would I?” “Well, you came to the E.R.”

 K: The expectation in Japan is that you’re rolling around with 300 bucks in your pocket all the time.

C: Right.

K: San man.

C: So

K: Which is a little bit less than 300.

C: So, I had to sign a thing and give my fingerprint promising I would pay them when they sent the bill.

K: Yeah.

C: And then they sent the bill, and I was like, “ohh. 75 dollars. Do I really wanna pay this?”

K: (laughs)

C: So, that was my E.R. visit. That was pre-Covid. But… yeah.

K: So, I think everyone should like seriously google – if you’re a youtuber – I love youtuber, and if you’re into YouTube, everyone should seriously YouTube staying overnight in a Japanese hospital. Being hospitalized in Japan. It’s so different visually.

C: Yeah.

K: It’s just a different visual experience because every hospital in Japan has a convenience store. And a cafeteria. And a

C: Well, the ones that provide overnight stays. Because there’s a lot of medical centers that are

K: That are not hospitals. They’re medical centers.

C: But in Japanese, they’re still called, “byouin.”

K: Yeah.

C: They still use the same word. So, in English, we’ll say “medical center” or “hospital.” But in the Japanese, the distinction isn’t made.

K: They say, “senta” on the outside of the building.

C: Some of them. Like, down near Ozone there’s Mitaku Byouin which does not have overnight stays. And even the ones with overnight stay, they close at like 5pm. If you’re staying overnight

K: Yeah, most of the hospitals in Japan close, and there’s one designated E.R. for nighttime admissions.

C: Right.

K: Nighttime emergencies.

C: And there’s a number to call to find out where you can go.

K: Yeah.

C: So

K: So, they don’t expect you to have emergencies at night.

C: Right.

K: Like, you need to get it together. Okay?

C: Okay?

K: (laughs)

C: If you have an emergency at night, you need to come in an ambulance because if it is so serious that you need to see a doctor at night, you need an ambulance.

K: So, I’m really looking forward to going next week to get my tour of the… hospital. Because, as part of -from what I’ve seen on YouTube – part of the thing when you go and get your consultation, they give you a tour of the hospital to show you where the conbini is and show you where the cafeteria is. And it’s so weird, the conve – sorry that I’m saying conbini. It means convenience store. The convenience store has better food than – so, there’s also vending machine food.

C: Right.

K: So, the hierarchy of like good food in Japan – like, the hospital cafeteria has the worst. And then the pre-ones, depending on your taste – I feel like the pre-ones and the convenience store food are on par, but I’m more of a convenience store person. Like, I don’t really like vending machine food.

C: Yeah.

K: I do like the cup noodles vending machines only because of the novelty of a cup noodles vending machine.

C: Yeah, which is like, “oh my goodness, who would have thought of a vending machine that could dispense hot water?”

K: But I think it’s because it’s completely closed and sealed, and part of the vending machine opens it for you. So, you still have your tab so that you can close it to keep it heated.

C: Yes.

K: So, I do – it’s not like a coffee vending machine.

C: (laughs)

K: It’s a completely different vending machine. Like, google ramen vending machine – they have them everywhere in Japan, at least in Nagoya.

C: Yeah.

K: But we’re kind of inaka, so… countryside.

C: Yeah, we don’t get the banana vending machines, but we have the ramen vending machines.

K: No, we don’t get the banana vending machines. Which they do have fruit vending machines. We just don’t have any here in town.

C: Yeah.

K: So, I’m really excited to go and see and look at what the hospital looks like. Because I’m really curious – I’ve never been to this hospital. It’s billed as the “English-speaking” hospital, which means I have no expectations that they’ll speak English, but the wi-fi thing that we ordered has an interpreter on it. There’s one drawback to being an ex-pat and going to the hospital. Is that they tend to kind of… bug me. They talk to me too much.

C: Yeah.

K: Like, they want to soothe me and comfort me.

C: They want to reassure you, like, “even though you are in Japan, you are receiving adequate medical care.” We know. Japan has one of the world’s highest life expectancies. Medical care is part of that.

K: Yeah.

C: Like, it’s not all done like the U.S. is, and it doesn’t have the most experimental stuff, but if you’re having standard problems, you are going to receive excellent care for those problems.

K: Yeah. Even if you’re having non-standard problems, they’ll go the distance to try and figure it out.

C: Right.

K: Whereas in the United States, they’ll just be like, “you’re screwed.”

C: Mhm.

K: (laughs) “We don’t know what it is.” But the Japanese will send you from doctor to doctor to doctor to find out what it is, and you’ll have like – I have a whole team of doctors that are working together. And so, it’s really weird because it’s not like the American consultation where all of your doctors converge and convene and talk about you in front of you.

C: Right.

(Automated voice in background): Nimotsu todoiteimasu

K: That’s a thing notifying us that we just got

C: “Nimotsu todoiteimasu” means “you have a package.”

K: Yeah. So, we’re leaving that in. Enjoy the Japanese.

(laughter)

K: And so, like – I don’t see all of my doctors at once.

C: right.

K: I go from place to place to place to see my doctors, and then they all tell me what they’ve been talking about. And… like, right now, my designated doctor said that – my surgeon may or may not be there on the day that I do my consultation. And I’m like, “what? But I just made an appointment with you.” And he’s like, “yeah, but I’m not guaranteeing that I’m going to show up there. But a surgeon will show up.”

C: Yeah, I think that comes down to liability in Japan. So, if a doctor makes a mistake, they’re not personally liable, but the medical system will take liability for it.

K: Well, and they don’t make money in the way that they do in the United States.

C: Right. So, I think we’ve talked about before if you’re in Japan, and you’re a doctor, to become rich, you have to run a really good business.

K: Yeah.

C: You can’t just get rich by being a doctor.

K: And so, surgeons do get like a bonus when you check in, and they get a bonus when you check out, but it’s not considerable. It’s not a – they don’t get more money. The hospital gets more money if you have a private room versus if you’re in a non-private room.

C: Right.

K: And all of that.

C: But it’s incentivized for them to keep you in the hospital the standard amount of time rather than a very long time.

K: Yes.

C: They actually get less and less money as time goes by if they are keeping you.

K: Yeah.

C: Which a whole topic I know way too much about from my editing time.

K: Well, and there’s no “against medical advice”

C: Right.

K: There’s no threat of your insurance not paying it.

C: Right.

K: And so, if they wanted to keep me for a month, and I started crying and saying, “I just want to go home” they would try to talk me out of it, and then they would let me go home.

C: Yeah. Because they’re not medically liable if something goes wrong.

K: Correct. They’ll be like, “I don’t think it’s a good idea.”

C: And they’re not medically liable for… malpractice. Like, malpractice is its own topic, but basically if a doctor does something that harms you that they weren’t supposed to do, it’s the system that pays you, and then they discipline the doctor separately from that, so you’re not trying to sue individual doctors to get the money.

K: So, in between now and my surgery, it’s not going to be all hospital, hospital, hospital. This is the one… podcast that we’re doing on it, and then after my surgery, we’ll do – once I process my surgery, and I’m comfortable with it, we’ll do an episode about having surgery in Japan.

C: Yeah.

K: Compared to – versus having surgery in the United States. And so, we’ll have like a content note on those for if you want to skip them. I hope y’all listen. I don’t think we’re being too gory or too pessimistic.

C: I don’t think so.

K: And today, we’re going to talk about how the literary world is impacting – on the take two – how the literary world is impacting… the way Chad’s book is being received. And so, we hope that you follow us on over to the take two, and we’ll talk to you next week.

C: Bye.

K: Bye.