DESTONED at last! Having Emergency Gall Bladder Surgery in Tsukuba, Japan!
By Avi Landau
It is well over ten years ago now, that I found out that despite the fact that I was still living the single life, I had not been actually living alone. It was on a night that I had recieved a very welcome gift- a whole laquer box full of TEMPURA- probably enough to feed 3 people. But I was young, and slim ( back then)- a growing boy- and I gobbled it all up in a minute.
A couple of hours later, I felt a strange sensation near my bellybutton-something I had never experienced before. It was not a pain- but a tingling. In an hour or so, this turned into a strong pressure just below the ribcage on my right side. Though disturbed and discomforted, I remained calm. Being so high up, I knew it was not appedicitis, and with no nausea or fever, I also discounted food poisoning.
However, neither the over-the-counter stomach medicine that I had at home, nor long bouts of sitting on the toilet gave me any relief- in fact things got worse. Much worse! If you`d like to know how it felt, imagine some tiny ferocious creature sewed up inside your body that was desperately trying to bust out. That is what is was like.
Still I did NOT call an ambulance. Why not? Well, its a little hard to explain. I might not understand the real reason myself. It was most probably because I REALIZED what was wrong with me- from a combination of two things- first a medical guide that I had, and then the fact that I remembered that my father had had a similar attack when he had been the same age that I was.
I was having a gall stone attack!
I recalled how my father had had surgery, and how miserable he had been for about 3 weeks after the operation. And since my medical guide told me that the attack would not be life threatening ( right away) and that it would eventually pass, I decided that rather than being taken to the emergency room for surgery ( and a long layup) I would endure the pain and ride it out- until the attack was over.
I did this mostly in the shower, and by slowly, ever so slowly, pacing around my house ( laying down was unbearable as when I did so the only consciousness was one of pain- walking was a distraction!).
Finally after about 6 hours, when the sun began to rise, the agony suddenly, and thankfully disappeared. A sense of relief that I will never forget ( and one which I would patiently and prayerfully await several more times in the future).
The next day, a visit to a local clinic ( here in Tsukuba) proved that my self diagnosis had been correct. No, I was not alone- I had a friend- or rather a NEMESIS, lodged inside me. A large gall stone- which I could see clearly on the video screen of the doctor`s echogram machine.
When I asked what I should do about the stone, the doc recommended surgery. Sure, I could keep it inside me he said, but eventually, I probably WOULD get more attacks. Why not have the problem taken care of permanently- there would be almost no danger involved.
I said I would think about it and left his office.
I knew that I did NOT want to be operated on, though. I had read up on gall stones and learned that many people lived to ripe old ages with stones inside them. I thought that by watching the foods that I ate, that I would be able to get along just fine.
And maybe I wishfully believed that the stone would somehow get ejected from the gall duct or would maybe disolve and flow away. Anyway, I never did seriously look into surgery.
One thing that really helped me throughout the years was a suggestion from a fellow sufferer that I always carry BUSUKOPAN (ブスコパン), an over the counter muscle relaxant which I would take whenever I felt an attack coming on. This would avert the attack if taken soon enough ( usual pain killers are completely ineffective when it went into full force).
And though I did in fact eventually have a handfull of later attacks, for which the muscle relaxant was to be of no avail, for all the years ( remember that it must have already been in my body for a long time when I had the first attack) I WAS able to lead an extremely active life- visiting more than 100 countries, playing in a couple of rock bands and always working and playing HARD- without really any hindrances.
I guess you could say that for all my experience in Japan- the shrines, the temples, the hot springs,the sacred sticks and stones, the festivals, the inns, the capsule hotels (the love hotels!), the woods, the flowers, the birds, the fields, the crowds, the food, the drink, the pubs, the parties, the IZAKAYA, the libraries, the community centers,the concrete jungles, the rustic villages, the off-shore islands, the bookstores………….. and all the great variety of people- all so intense- I had been STONED!
All that has changed, however, since last week ( the end of February 2011) when I was suddenly and finally hit by an attack that just didnt go away ( despite my quick ingestion of BUSUKOPAN)- not even with the sunrise- or the next days sunrises either.
Still I did not go for help right away. Again, I cannot explain exactly why- maybe just because of my stubborness- but I just couldnt imagine myself breaking out of my very full schedule- so many jobs, so much to research, so much to write about ( for Tsukublog!)- I just didnt want to give it all up. I couldnt imagine doing so.
I guess you could say that I was a creature of inertia.
At the 3rd day, however, I knew something was very wrong with my body- and I went to the Tsukuba Medical Center, our city`s state of the art healthcare facility.
I got there on foot ( now you know just how stubborn I AM)- a forty minute walk ( which would have been much shorter if I were not having an attack!).
I arrived at the reception area at about 8:30 am, about half an hour before opening time. Already a couple of dozen elderly people were waiting patiently in the waiting room chairs.
Now once again, inexplicably, I acted the tough guy. Instead of asking for emergency care, I went to register with the regular patients. I had to fill out a form describing my symptoms ( I did this in Japanese), and then answered some questions- maddeningly, I was asked several times if it hurt!
Still I told them that I could bear the pain.
The kind staff told me that I would have to go upstairs and wait my turn at the outpatient clinic.
I was shown upstairs to a corridor filled with older people who once again could only be described as PATIENT- all sitting calmly, nearly motionless, without showing any sign of stress or fear.
I, on the other hand, couldnt relax for a minute, and slowly paced the floor, like a caged lion, for MORE THAN ONE HOUR!
When I was finally called in to see the doctor, I put on the most cheerful face I could muster, and told him that I was having a gall stone attack. He then immediately sent me down to have a blood sample taken.
That means I had to walk back downstairs, wait my turn, get my blood taken ( this was done quite skillfully and painlessly), and then wait more than an hour again for the results to come back.
When they did come back they indicated that I was showing signs of sepsis (ensho) and the doctor insisted that the situation was dangerous if I were not admitted to the hospital.
He also showed me, with the echo machine, an imagine of the stone- now much larger than the last time I had seen it!
But with so much planned for the week, I could not imagine myself suddenly cancelling everything. I insisted that I had work to do. The doctor, a charismatic and intense character, expressed his concern, and stressed that if I were not hospitalized AT LEAST I needed some rest. In other words- he thought I was a complete nutcase!
I said again, however, that I was OK and asked for some medicine. I still believed, or wanted to believe, that the attack would just go away.
At a loss of what to do, the doctor prescribed some antibiotics- but no pain-killers. And told me to come right back to the hospital if I felt worse.
I left the hospital and went into the pharmacy next door where I again waitied for what seemed like AGES before I got my medicine.
( I want to stress that for me the ONLY problem with the EXCELLENT care I received throughout this story was the long waiting I had to do at this OUTPATIENT stage)
You might be surprised to hear this, but on that day I worked as usual. I even wrote an article for Tsukublog!- despite the fact that I hadnt slept at all in at least two nights. The next day I went out to work again.
But now I had started to feel something more frightening than mere pain. I could feel an infection within me. I imagined that this was what it was like before an appendix burst and spread poisons throughout the body. I realized that if I didnt get help I would die.
At about one thirty in the afternoon, after having worked half the day, I slowly walked towards a clinic that I had been to several times before for colds and checkups, etc. It was lunch break time and would not open for another hour. I rang the emergency buzzer, and the doctor came out. I told him how I felt and he told me to go to the Medical Center. Thats what I did.
After all the years of being STONED, I had finally resigned myself to having surgery.
It was a good decision. The ONLY decision!
This time , back at the Medical Center, I went straight to EMERGENCY. Surprisingly, I still had to wait for a while before being called.
When I WAS ushered in they already had my records from the previous day`s examination and had me lay down on a stretcher. A nurse inserted an IV into my vein. I waited- and waited……
One funny memory I have of that time was of the doctors and other staff trying to figure out what to CALL ME. Like many Americans I have a first name, middle name and family name, and on my Japanese health insurance card these are all strung together into something unintelligable. Untill I later explained that everyone always simply knows me as AVI, everyone who dealt with me was really at a loss ( it seems that ALL those involved in treatment always address patients by there names whenever they approach).
I was left like this, with IV in arm and in a semi-conscious state for what seemed like a LONG TIME. Other emergency patients were being treated around me.
Finally I was told that I was to be admitted immediately, and operated on in two days. I did not resist. The inertia had shifted.
I was taken in a wheel chair up to my room, which I would share with 3 other patients, and was given my all important wrist band with my name on it ( the full name- not Avi!), which would be checked countless times each days when I recieved my Meds or was examined.
One outstanding thing happened when I was put into my room. There was a man in the bed across from me, an old farmer who was being very dutifully looked after by his wife. When the wife saw that a foreigner was being put into the same room as her husband, and realized that probably more foreigners would be coming to visit, she started to get all paranoid about their SICK VISIT MONEY ( it is customary for patients in hospitals to recieve gifts of cash from friends, neighbors and relatives in rural Ibaraki), It seems that she was worried that with a foreigner in the room, this money ( quite a large sum as I overheard) was not safe. Of course they didnt realize yet at that time, that I could understand what they were saying, so later, after she had asked the nurses to CHANGE ROOMS and she found out that I was a Japanese speaker, she would often drop by to chat with me and ask how I was doing.
Anyway, this didnt make me feel bad- who could blame her?! And I was two delirious to feel insulted.
The evening of the day I was checked in, my family was called in for a meeting with the team of doctors who would be treating me ( a first rate group I would soon appreciatively learn) in which all the details and dangers of the procedure were explained very clearly, concisely, and patiently.
The two days leading up to my surgery would be spent limiting the sepsis with anti-biotics, fasting ( no food or drink, though I was on iv) and a series of tests which would help the doctors safely carry out the operation.
The three tests which stand out ( comically now) in my mind are the MRI , the EKG, and the lung capacity test The MRI because I was stuffed into a narrow tube for twenty minutes while given orders to breath in and hold my breath for 20 seconds at a time, as the machine banged and clanged cacophinously.
This was not easy AT ALL with the gall stone pain ( and claustrophobia!), and two or three times I was on the verge of pushing the PANIC BUTTON they had provided me with.
The EKG was notable for the fact that the technician was leaning over and pressing down on me with her body as she carried out the long examination. This might had been quite pleasant if it werent for the fact that she was pressing right on my gall stone. OUCH!
The lung capacity test ( which was necessary as I would be hooked up to a breathing machine while under the anesthesia) was also quite humorous ( and painful) since I just could not take full breathes while I was having the attack. Stll, the technician had me inhaling again and again.
When my doctor saw the MRI images he came to my room to inform me that my stone was HUGE and that they would probably have to cut open my stomach ( instead of using a newer and less invasive technique). I gulped and told him he should do whatever he had to do.
I was surprised and comforted on the day before my surgery how EACH PERSON INVOLVED came to my bedside, introduced themselves, and explained to me exactly what they would be doing. The most embarrassing of these was the operating room nurse who waited until the end of her long explanation to tell me that she would be putting a catheter into my penis to extract the urine. My face turned crimson red and tingled with heat.
I was told to take a bath ( though I just showered in fact) and to brush my teeth before I would be taken into the operating room ( this is so no food particles go down your windpipe while you are under the anesthesia).
Of cultural siginificance was the bellybutton cleaning that all patients go through before such surgery. A nurse came by and filled my navel with olive oil. When she came back later to scoop out all the grime she was surprised to find that mine was clean. Amazed, she asked me if foreigners cleaned their bellybuttons. Well, I couldnt speak for all foreigners, but I told her that I often cleaned mine. Apparently, Japanese people do NOT clean out their bellybuttons in the belief that it is not good for ones health.
Anyway, all spic and span, from head- which my buddy Rick helped me shave , to bellybutton which had been cleansed with purifying oil, I was ready for my surgery.
I was helped into my gown and given a big puffy hat ( though my head was clean shaven!) and walked into the operating theater- a star at last!
It was an almost festive atmosphere, and I was greeted by the whole staff, all of whom I had already grown friendly with. A gas mask was placed over my mouth. We chatted, joked, and I SANK AWAY…..
for more than SIX HOURS! Which is how long the procedure took! I later found out that the doctors first tried a less invasive technique, using four wires inserted into my abdomen, but could not succeed in dislodging and removing my massive stone in this way.
They then decided to switch over to more traditional methods and SLIT OPEN my belly ( not unlike HARA KIRI). When they did this, however, they ran into the abundantly excessive body fat which I had amassed over the preceeding months. This made for very slow going, I heard.Well, its as I told you- IT TOOK SIX HOURS to complete the procedure.
When I heard about that later, I couldnt help but feel bad for giving the doctors so much trouble.
When I finally CAME TO, my dear friends ( more like family, I guess) Rick and Nobuko ( who were so helpful to me throughout) were standing over me. I remember it all in a haze- Rick , a mere sihouette, was holding my gall stone, which the surgeon had handed to him. He was dangling it in front of me – its all a blur now really. We chatted a bit…… and then they were gone.
I dont remember the chronology clearly, but I think it was already then that I was told to WALK! That is not exactly what I wanted to do at that moment, but the doctor recommended that I get up and WALK! He said that that would be the best way to avoid developing pneumonia.
Well, you already know how stubborn I am. I decided that I would walk, and walk I did! For the next four days thats about all I did!
My first trip was downstairs for some x-rays, but then it was mostly just around and around the hospital corridors- pushing my i.v. pole along with me.
That first i.v. pole that I had was another problem. Not only for me but for everyone on the floor. You see, it was always beeping. The nurses would come over to fix it, but it would start beeping noisilly again just a few seconds later.
On my second day of WALKING, I heard one patient say to another, yesterday he was pi pi pi-ing and today he is poo poo poo-ing! I wish he would be quiet!
Finally they gave me a new iv holder, and some other poor guy got my noisy one!
Besides the i.v. tube I had in my arm, their were some other tubes coming out me as well when I got out of surgery. But, to tell the truth, I really DIDNT want to know what they were for and tried to ignore them and the strange fluids which were seeping through them.
On the morning after my surgery, one of the nurses very skillfully and subtly, after some small talk , said that she would now remove the catheter from my penis. No sooner had she said this than it was GONE. I hardly noticed ( though there was a quick deflation, a pull, and a slight burning sensation that quickly passed) and didnt even have time enough to be embarrassed.
By this time without having drunk anything in a few days amd having had the respirator down my throat, my mouth was beyond partched- it was leathery dry. I ask if I could have a drink. The affirmative reply pleased me to no end, but not as much as the actual sensation of the little sips of cold water that I took trickle down my throat- HEAVEN! I never realized water could have such deep flavor.
The next day I went to the vending machine for some POCARI SWEAT ( a Japanese sports drink) and the taste sensation was explosive ( apparently the four day fast had cleansed out my system making my taste buds and nose many times more sensitive than they had been before. I seemed to have developed dog-like powers of smell! It was as if I had developed a third nostril!
On my endless walks it was the various scents which left the greatest impressive, and unfortunately most of them were not very pleasant!
I have already told you how I had trouble with my beeping i.v. holder. but it was not only the noise which gave me trouble. Naturally clumsy, my KLUTZINESS was magnified ten-fold with the various tubes attached to me. If I had been filmed while I was trying to get in and out of bed and move around the hospital all hooked like that the resulting footage would probably rival the comedy of Mr. Bean for hilarity. Imagine Woody Allen in the hospital. I definitely had the other patients chuckling sometimes.
One adverse affect of all the tugging on my i.v. tubes was that the needle had to be often re-inserted into my vein- each time in a different place. I found out that my veins run deep and are hard to find. The younger nurses had to poke me a few times before they finally succeeded. Knowing that repeated poking with needles was not much fun, these less experienced nurses GAVE UP trying to do me, and would then either call for a surgeon, or even better ( for me) a veteran nurse (named Koba-San) who after much feeling, rubbing and SENSING were able to insert the needle in one shot.
An important part of the gall bladder operation experience in the focus put on PASSING GAS and BOWEL MOVEMENTS ( as my grandmother used to say when referring to taking a crap!).
Time and again, doctors, nurses, just about anyway who happens to cross your path asks you- have you passed gas? Have you moved your bowels?
Passing gas I did, shortly after surgery, but sitting on the toilet seemed a bit scary right after surgery ( I mean still by the day after), and I hesitated to do so even though I had the urge.
When all those who had been inquiring heard about this state of affairs, their faces grew grim with concern.
But the urge that I had was NOT strong enough, The main reason for that being ( besides the fear that my inerds would be blown out of my butt ) was that I hadnt eaten a thing in four days ( I was was being nourished by the i.v.).
When I was served my first meal- some rice porridge and broccolli, I once again experience the mind-blowing rainbow of flavors that I had encountered with my first post-operative sips of water.
Breakfast and lunch the next day were just as wonderful ( though to an ordinary person it would have been just bland hospital food).
All this food in my system made it impossible for me to hold out any longer.
When the time came, I headed for the men`s room which was always kept spotlessly clean, despite the fact that it was constantly being used by sufferers of various abdominal ailments ( like myself).
I let myself drop down on the seat and without any effort I was finally able to relieve myself- a noisy, watery outburst, which to my newly sensitive nose smelled frightening in its UNFAMILIARITY. It was like nothing that had ever come out of me before.
Still I could not help being pleased and feeling that I had made some progress on the road to normalcy. And with a fierce determination to recover as quickly as possible, I continued to ( incessantly) do what the doctors had advised me to do- walk.
Sometimes fellow patients joined me in my wanderings, which in the limited space covered as well as the repetitiveness could be compared to the pacing of a caged tiger.
And since just about all the other patients in the ward with me were cancer patients, I had a chance to have some deeply thoughtful and philosophical discussions ( unlike the usual talk of food and weather which is the staple of Japanese conversation), with some people who were seriously interested in throwing around ideas in regard to WHAT ITS ALL ABOUT.
One dangerous aspect of talking with fellow patients, or friends who came to visit was laughter. That and sneezing and coughing were definitely THE things that I wanted to avoid in the first few days after surgery, as doing anyof them was extremely painful and frightening. Whenever I could not stop myself laughing, sneezing or coughing it would immediately turn to groaning and grimacing and checking to make sure I hadnt blown open my stitches.
But, I will have to describe another frightening phenomenon which I experience while recovering from surgery- SEEING GHOSTS! Well, at least that is what it seemed like, though Im sure that it was only some sort of side effect from the anesthesia.
Anyway, whenever I closed my eyes, people seemed to come to me. I mean I could vividly see them, as if in a strong and clear dream. These visions were frightening and I would immediately open my eyes .
In other words, I could not get ANY sleep, no matter how tired I was.
TO BE CONTINUED………….. tomorrow