Friday 28 December 2007

hi everyone. i have a holiday off from work for the new year until friday 4th january, so you won`t be hearing anything from me until then. don`t worry though - i will have a number of posts ready to go, including about my christmas and new year in japan.

i hope everyone has a very happy new year!

Wednesday 26 December 2007

整形外科 はだいすき - I Love Orthopedic Surgery

Nothing can make my day like watching a fractured clavicle being screwed back together. I finally got to watch some seikei geka (orthopedic surgery) today. I had been waiting for this for four months and it was certainly worth the wait. There were scews and titanium pins and electric drills and screwdrivers and wire cutters... They actually bored the grooves into the bone for the screws! Come on, how awesome is that?! Oh man, it was excellent. To quote Christina from Grey`s Anatomy, it was "like candy, but with blood, which is so much better!"

I love Seikei.

メリークリスマス - Merry Christmas

Here are a few photos from around Nagasaki during the Christmas season. I thought I would share them with you. Also, it saves me writing a real post.

Sorry this isn't really a very good photo. This is Hamanomachi anyway – the main shopping district in Nagasaki. There are actually tons of festive decorations all over the place here, but apparently, not visible from this angle.

This one is a bit more obvious, huh. Even if you miss the giant snowflake light display on the wall in the background, you would be hard-pressed to miss the 25 foot tree in the centre. Japan is a Buddhist country.... that fact and what we're looking at here really doesn't seem to add up, does it?

The “Japanese McDonald's” is called Mos Burger. This is an advertisement for their Christmas menu. Let's take a closer look...

Yes, the sign does read “Merry X'mos!”. (Sorry that it's blurry, by the way). At first glance I thought it was a misprint, just some poor English, but the Japanese continue to surprise me with their rather clever advertising. What is a little funny though, is that 'Xmas' is not pronounced here as 'Eks-mas' but 'Ek-ku-su-ma-su'. You try saying that quickly... it's really difficult.

I know this one isn't very festive, but I couldn't not share it with you. That is indeed a 3D illuminated human heart model plastered to the side of that building. The hiragana beneath it reads “Nagasaki haato kurinikku” ('Nagasaki Heart Clinic'). What you can't see in this picture is that the heart is lit up so that it appears to pump blood! How's that for innovative? God Bless the Japanese and their advertising genius! It might have been a little wasted in this case though. I mean, if you need to go to a heart clinic, whether it has a giant illuminated heart model on the front of the building is of little importance to you really, isn't it. Would you choose this one over a clinic that didn't have such a display? Hmm?

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Well, that's all for now, folks. I hope everyone had a smashing Christmas. See you in the new year.

Tuesday 25 December 2007

リハビリ - Rehabilitation

May and I have worked our way down to the fourth floor of the hospital for the second time now. However, because the fourth floor is all orthopaedic, there is only one ward (4F) on the east side of the building and a rehabilitation centre on the west. Last time we were on this floor, I went to work on the 4F ward for two weeks and May spent the first week in Rehabilitation and the second with a nurse doing home visits. So, this time I got to go to Rehab. Compared to the work on the wards rehab is a piece of cake – in the literal sense too, since you get a daily tea break, complete with your choice of okashi ('confectionery').

It was very inspiring working in rehab. At first I was quite anxious during my time there because a lot of my responsibilities involved talking with patients – all in Japanese, of course. One patient changed my perspective a little though. She came and sat down next to me part way through her walking laps of the centre. All I said to her was, “Tsukareta desu ka?” (“Are you tired?”) and she launched into a whole story about her knee replacement. Within minutes she had lifted up her trouser leg and shown me her six-inch scar too. She didn't care that I clearly wasn't understanding everything she was saying; she just wanted to say it to somebody. I was less shy about talking to patients after that.

The patient I interacted with most though was an eighty-nine year old woman. I don't know what was wrong with her (she came down each day from 6th floor, so not an orthopaedic patient) but she was clearly very old and very frail. Unlike most Japanese people, she looked older than she was. She came to rehab every day for both a physical and metal workout. I was given the task of keeping her word association up to scratch. I would show her a picture on a card and ask her what it was and she had to answer. This was quite difficult for us both. She couldn't always remember the word and I couldn't always understand the Japanese. She was your stereotypical Japanese woman though: she could remember the names of every different type of flowers I showed her but she couldn't remember the difference between a fork and a spoon. At the end of the week, the tables were turned and she got to ask me what the picture on the card was and I had to tell her in Japanese. Even at 89, she totally kicked my ass at it!

I noticed that most of the people in Rehabilitation were elderly. I thought how it would be bad enough for a young, fit person to go through such dramatic surgery and to be faced with a long rehab program, but add onto that old age... that's tough. I broke my little finger playing netball when I was eleven and it still aches to this day. I have noticed it more recently due to the type of work I am doing here in Japan. Any task that involves splaying my fingers or moving the little one independent of the adjacent finger and it'll become all stiff and painful. And that's just a broken finger from eight years ago. These people are recovery from broken pelvises for goodness sake! It was very clear how great a job the orthopaedic surgeons do. It seemed impossible that these people were walking at all and yet there they were, striding through the rehab centre with their walking sticks permanently raised from the ground. Yes, Rehabilitation was very inspiring. I realised though, that physical rehab is a lot like yoga – very beneficial to your health but it makes, at times, passing wind impossible to avoid.

Monday 17 December 2007

Tabi

Here is one of the pairs of tabi that Yamaguchi-san gave me. I love them. The Japanese really know how to decorate their feet.

ぼねんかい - Bonenkai

It was Bonenkai (the hospital end of year party) last Friday night. There is no denying that May and I looked great. She wore a green dress that she had bought on Wednesday and I wore a red top that I'd bought the week before; Our hair was pretty; We had make-up on. All of these things were massive improvements on how we normally look at work – tired, uniform-clad and a little sweaty from all the bed-making. I think we surprised people a little actually. "Wow, they scrubbed up well, didn't they?" It turned out to be as formal an occasion as people wanted it to be - some of the staff wore suits, some wore jeans - so May and I felt nice and comfortable somewhere in the middle.

The party was at the hotel that is right next to the hospital. We pass it every day on the walk to work and it turned out to be very nice indeed on the inside. One thing I didn't like about the evening was that you had to pick your seat number out of a box at random, meaning you could wind up sitting next to complete strangers. That was half the reason for doing it, also there was a raffle at the end of the party based on seat numbers. It didn't really matter though because Kumiko-san arranged for May and me to sit with her at table 7 by talking a few members of staff into switching with us.

Once seated, the food promptly started to arrive, all of which was delicious. There were a lot of dishes that I didn't recognize, but that has never stopped me before from digging in and it didn't then. There was quite a lot of debate between a few of the doctors at our table over what the English name was for the meat in the soup. We had everything from 'seagull' to 'whale' put forward as suggestions. I think it might have been goose, but who knows?!


Part way through the meal, the performances started. Half a dozen or so of the departments gave a 5-10 minute performance and the senior members of staff had to judge the best for a prize of ¥50,000 (£214 – the same amount May and I get per month from the hospital). After the Kumamoto trip, I knew what to expect: Semi-nudity, group-participation and on-stage consumption of alcohol. Oh, and also wigs and cross-dressing. Needless to say, it was very entertaining. Mariko-san dressed up as a reindeer and threw a mango at a doctor in drag, with the aim of him catching it on a fork. He managed it two out of four times, in case you were wondering. Oka-san was up there, Nakashima-sensei and Imamura-sensei too. You would never think that such respected doctors are so willing to make complete fools of themselves in front of a room full of their work colleagues and friends, but apparently it is the complete opposite. Anyway, 4F won. I can't even bring myself to tell you what Imamura-sensei had to do to get the victory for his floor. *Shakes head in disbelief*. All I will say is that it involved a dominatrix. Enough said.

A sample of 7W's performance:


Yamaguchi-san (assistant nurse, 6E) came over to our table part way through the proceedings and gave May and me each a present: two pairs of tabi (Japanese split toe sock). I had yelped with delight at the inter-departmental volleyball tournament a few weeks ago when I had seen her wearing the most beautiful tabi I had ever come across. She obviously took note. You gotta love Yamaguchi-san :-)

Kumiko-san was very drunk by the time the party ended at 10:30. It was quite funny to watch her giggling to herself and tripping over her own feet. She asked us to forget this occasion in the future and although we won't be so cruel as to bring up her embarrassment again, there's no way I could forget her singing "All I Want For Christmas Is You" over a sobering cup of coffee in Mos Burger after the party.

Friday 14 December 2007

Bossy Me

I actually got to be somebody else's boss on Tuesday. Okay, sure, it was to a fourteen year-old high school student doing her work experience at the hospital, but still. It felt great. I got to order her around a bit when we were making beds but then, showing that I can also be a very nice boss, arranged with the chief nurse on 5W for me to take her on a quick tour of the hospital. I had forgotten what it is like not to feel as though you are at the bottom of the pile. Shame she was only here for one day.

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Bonenkai party tonight. Very, very excited.

Monday 10 December 2007

New Schedule

There are only two new departments in my revised work schedule for this month: the nursery and the operation room. I worked in both of them for the first time last week, so I can tell you a little about them now.

Before my timetable changed, I worked on the wards every day of the week. Now, with the nursery on Wednesday mornings I have a break from that, a 'weekend in the middle of the week' as May called it. It made a huge difference. How could it not have? Instead of changing bed sheets, folding towels and making oshibori, I am playing with a dozen children under the age of five. They were all very cute and very shy at first, but after about half an hour they were jumping all over May and me – literally – and trying to out-do each other in impressing us. The teachers were great too; they didn't even laugh when they had to show me how to change a nappy.

The highlight of the morning was watching the children's Christmas concert rehersal. I felt a little sorry for them though. They must have been petrified performing to a couple of foreigners instead of their parents. To my surprise, they didn't show any more fear than you might expect from a toddler singing a solo to an audience. It was a great little show. The costumes were wonderful too. And because this was a Buddhist Christmas concert, there was no mention of the birth of Jesus or telling of the nativity story – as you would expect – just lots of singing about Christmas time... and food, for some reason. I can't wait to go back there on Wednesday.

Second, the operation room. You're probably wondering what work two un-trained volunteers could possibly do on the surgery floor. Unfortunately for me, it turned out the answer didn't involve anything inside the theatres. We were doing behind the scenes stuff – packaging sterile equipment mainly, for both the OT's and the wards. I thought it was quite satisfying in a way, knowing that this medical equipment was soon going to be used by a surgeon or doctor. Maybe I was grabbing at straws though; I wanted to be observing surgery.

Anyway, that's about it. My timetable will change again come January. I will no longer have a free Wednesday afternoon but will be working in Nutrition and then Radiology. Although I will obviously miss my free afternoon – especially considering that is the only time I have been able to watch surgeries so far – it will be nice going back to Radiology. I already miss it after only a week without it. There's such a great atmosphere there, one that seems to be unique to Radiology. Plus, May and I have made some good friends there. Matso-san stands out for both of us. He is a similar age to us (he's 24) so we feel like we're on a similar level to him. I am the youngest employee on the hospital staff so, according to Japanese culture, everyone else is essentially my boss, including May. Matso-san treats us more like equals though, maybe because if it weren't for us, he would be the youngest on the staff. I also miss the chief Radiologist, 'Ojiisan' ('Grandfather' – not his name, just what everyone calls him). He shows me the coolest x-rays, MRI's and CT's that he can find and then lets me try and work out what they are of. At least we will see all the Radiology gang at Bonenkai on Friday. Yay.

げか 2 - Surgery II

I went back into surgery on Wednesday. It was only the third time I have been in there but it felt like the hundredth. I feel like I have been watching surgeries all my life, but each one is still just as amazing as the first one I saw.

I watched two operations on this visit: a Cholecystectomy (removal of the gallbladder) and a skin graft.

Cholecystectomy:
This was an endoscopic (or laparoscopic) procedure. Several small incisions are made at strategic points on the patient's abdomen and then the surgeon detaches the gallbladder and pulls it out through one of the holes. This particular patient had a rather bad case of gallstones, so his gallbladder was very enlarged. It was about the size of a pear, and the incisions are roughly the size of grapes, so there was quite a bit of tugging and twisting when it came to pulling it out. It reminded me of birth, only the result isn't a cute baby but a diseased sac of bile. Oh, speaking of bile, the surgeons accidentally punctured the gallbladder while they were detaching it from the liver, and this caused some of the bile contained within to gush out into the patients abdominal cavity. It was quite a sight!

This procedure was particularly impressive because the surgeons can't see anything they are doing directly. They have various long instruments stuck into their patient, which they are enthusiastically moving around, thrusting them into the far corners of this poor man's stomach, all time while looking at a TV screen. It must take a lot of practice. Obviously.

Skin Graft
Now this one was very interesting indeed. Whereas all the other procedures I have observed have been fairly routine, a skin graft can never really be routine, can it? I mean, if you need some of your skin replacing... how often does that happen?

The patient had had a malignant melanoma on her foot. The cancer was very aggressive so the dermatologist had to remove a lot of skin from the foot around the tumour to ensure there wasn't a single cell of it left that would spread. That happened several weeks ago. Now, the patient was well enough to undergo a second surgery to repair some of the damage sustained to her foot as a result of the first surgery. A large section of skin was removed from the patient's abdomen – about the size of a mango, to continue the fruit sizing system – and while an intern and resident took to sewing up this huge hole, the chief of dermatology started preparing the skin for grafting. This involved carefully cutting off the inch of fat – which is a delicious, bright yellow colour by the way – that was present and then smoothing the underside of the skin by cutting away any imperfections. When she was finished, the skin looked so thin and shrivelled I was just hoping that it was stretchy, otherwise it would never cover the wound. It turned out to be remarkably stretchy; The skin really is an amazing organ, you know.

Once the skin was loosely attached with just enough stitches to hold it in place, a blue dye was injected into the tissue around the would, presumably to track the blood flow to the new skin over the next few hours/days. That's when it happened.... the foot moved!!! Ha! The surgeon stopped what he was doing and gave a rather amused look to the anaesthesiologist, who quickly made a few adjustments to the station at his end of the table. Aw man, the foot moved.... awesome :-)

Wednesday 5 December 2007

Truffles & Blood Clots

With too many truffles to handle even between the two of us, May and I decided to hand some out to a few of our friends at the hospital. This included our friends in Pharmacy and Radiology, Kimura-san, Kumiko-san, Oka-san and Nakashima-sensei. Everyone was really impressed, exclaiming "Oishii!" ("delicious"), and I think they they won us a few brownie points too. Now we're not just the GAP volunteers, we're the GAP volunteer who give them confectionery. Who couldn't love us?!

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Ide-san, the woman who met all of the Gappers in Tokyo back in September, came to visit Nagasaki last week to check on May and me. Since everything is fine, it was a short, concise visit, only lasting for more than an hour because we broke for lunch. She gave us a piece of advice though that has really stuck with me: be less shy and more active when it comes to asking for more things to do. She said this in the context of asking to watch a birth, but I have already applied it at work in a different context. Yesterday in the Test Department I asked if I could help take the clots out of centrifuged blood - something I see the other lab tech's doing scores of times a day. They didn't even hesitate and handed a blood-filled test tube and a tooth pick each to May and me. They were so impressed they gave us our tea break early and then let us leave for lunch early too. Ide-san's advice really worked! I wonder what else this could lead to? With less than three months to go now, I really have to try to make the most of this.

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I watched surgery again last week. I didn't mention it before because I took May in with me so we only stayed for an hour. She was very impressed but said that once was enough. Me? I'm going back in this afternoon. It will never be enough :-)

Monday 3 December 2007

クリスマス – Christmas

It is getting rather Christmassy here. May and I agreed 1st of December would be a reasonable date to start celebrating Christmas so we spent the day putting up a little tree that one of the previous Gappers left in May's room, watching a movie ('Notting Hill', in case you were wondering) and making chocolate truffles. The truffles were probably the best thing I have ever made. They were divine. Seriously. However, it was slightly depressing eating them since we knew exactly what was in them. Our truffles contained only four ingredients: chocolate, cream, butter and cocoa powder. Yeah, we're going to give some away as presents to prevent us from eating them all. Anyway, guilt aside, it was a great day. We each made our own advent calendar back in November so of course, we got to start those too.



The landowners put up a tree in the entrance of our apartment building too. It is especially nice coming home after work now, being greeted by a Christmas tree with twinkling lights. It does make me a little homesick though, all this Christmas stuff, since it is my favourite time of the year back in England. Oh well, this will certainly be one to remember in years to come.

ふくふぐ – Happy Fugu

Well, I am alive. The fugu dinner was excellent and, given that none of the attendees died, could be considered an all-round success. It was actually a retirement party for Hamano-san, the lady who works in the Medical Office where May and I spend Friday afternoons 3-5pm. It is so sad that she is retiring; she is like a mother to everyone in the hospital, including all the surgeons who use the office as a break-room. It was an honour to be invited to her retirement dinner, it really was. I am going to miss her when she leaves at the end of December.

The meal consisted of fugu sashimi, then fried fugu, battered fugu, fugu soup and finally, fugu risotto. The window to the tiny little restaurant we were dining at doubled as an aquarium for the (live but soon-to-be-dead) fugu; by the time our party of six was done with all that food, I kid you not, the tank was half-empty. Given that each one of those fish contained enough poison to kill 15 fully grown men, I must commend our highly skilled chief separating the 'safe' parts from the 'deadly' ones. The battered fugu tasted remarkably like battered cod from the chippies back in England, so that obviously had to be my favourite. We fried the pre-sliced chunks of fish on little grills in the centre of the table, which wasn't anything special in itself but what was endlessly entertaining, the pieces of fish were doing that post-mortem death-twitching thing. They kept twitching for about five minutes too. I thought it would last only a few seconds after death but apparently not. They were really strong muscle contractions too.... amazing.

Here's my plate of sashimi. The sashimi is the pale pieces of meat laid out to cover the plate; the white and grey pieces in the middle are some of the fish's skin. Yum. And yes, my lips did go quite numb after just a few pieces. Way to go, chef!


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I got my new work schedule last week. Monday and Tuesday are the same as before, but here are the changes:

Wednesday
am. Day Nursery
pm. Free time

Thursday
am. Pharmacy
pm. Nurses Station

Friday
am. Nurses Station
pm. 13:00-15:00 Operation Room
15:00-17:00 Medical Office

Also, starting in January after my Japanese classes finish at the Brick Hall, we won't get free time on Wednesday afternoons but we will spend 13:00-15:00 in the Nutrition Section and 15:00-17:00 back in Radiology. Overall, these changes are pretty pleasing, although I don't know yet what May and I will be doing in the new departments. I'll let you know.