Reading the Air

The Japanese are a very homogeneous culture - in physical appearance and attitude. This means that they do not share our discomfort with nudity, and they often dis-robe at drinking parties or bathe naked together at public onsens or hot springs. There isn't the same mystery to nudity as there is in the States because there isn't such variety.

But this homogeneity also breeds somewhat of a group-think mentality. On our outing on Sunday (over breakfast at Denny's), Dr. G asked the resident Eri to explain the idea of kukioyamu to me.

She sighed, "It's very childish. It's like, if a group of friends are all going to dinner, and three people want to go to Chinese, but one friend says no, he wants sushi. That person... people will stop talking to him."

"For how long?"

"Months," came the unexpected answer.

"Maybe even until he finishes his residency," Dr. G adds.

"He is shunned," Eri continues. "That's kukioyamu," which literally translates as reading the air. "It's very childish," she repeats.

It certainly is. It reminds me of my friends in the States who learned not to be know-it-alls in elementary school if you wanted friends. But that was when we were kids, not adults. Plus, in America, even if you went against the grain, you could still hang out with the fat kid, or the boy with glasses, or the minority child, or the girl who's too tall. There is a frightening lack of oddballs here to keep you company. Kukioyamu is a powerful concept.

It encourages students who are good English speakers to keep quiet during English lessons so as not to show off. Residents are unwilling to criticize another's idea or they change their minds at the first word of dissent from a superior, rather than defending their idea, building on it, making it stronger. I haven't been able to engage someone in a good, solid philosophical argument here. As a former debater, it can be frustrating.

Even more maddening is how it affects morning rounds, which can go on for hours, often taking a rambling course and never coming to a consensus on what is the final diagnosis and the plan of action. Because it is uncouth to take credit for the best idea or criticize a poor idea, so the discussion just sort of peters out to a quiet, unsatisfying end.

But it would be unfair to not recognize also what society gains from this mentality. For instance, there is art everywhere here. It is in the ceramic tiling on their houses, the well-manicured gardens in the yards, the precise wrapping of a gift. Art, music, an appreciation of beauty, is a natural part of life that all share. In America, society tends to encourage us to drop out of activities when we don't possess "special talent". Rather than recognizing that, despite your level of talent, sketching a scene or playing an instrument can be an ordinary, but enriching part of everyday life.

A Date with Rebecca

Pouring tea at a real Japanese restaurant.

This Sunday, I had dinner again with the junior resients. A real Japanese place this time where you take off your shoes and everyone sits on the floor. We all sat at one table, and there is something about sitting on the floor together that brings a real sense of comfort and familiarity to a group.

One of the residents asked me if I had met all of the male residents, and wondered if I had a favorite? I told him that wasn't fair and this conversation somehow morphed into every male present having to introduce himself to me and tell me where he would take me on a date. Quite embarrassing, but also turned out to be fun.

Some male residents looking cool.

One resident said he would take me scuba diving, another to oyama sen maida (the 1000 rice fields). One would take me to a musical in Tokyo. One would drive me to his family's house on a private island. But my favorite was Tomo, who said he likes photography and would take me to a scenic spot for photos followed by dinner at his favorite chinese restaurant. The boys were surprised by my pick until one caught on that Tomo's was the only date that included food. Of course.

The obligatory food pic: tempura AND sushi-zen.

Princess Rebecca

Every visiting student here gets a nickname. Dr. Gremillion was apparently dubbed Gre-chan, which is a shortening of his last name combined with chan, which translates as "silly, like a little girl." He asked Hitomi what my nickname was and she said she calls me hime, or "princess". "Princess Rebecca," she laughs. I was really touched.

Hitomi's nickname among the male reisdents is "snake" or "octopus". It is meant as a playful teasing taunt, but I can't seem to make sense of it. It has something to do with her walking like a snake or an octopus' tentacles. Today, Brian-sensai even gave her a note with a picture of an octopus on it. She glared at him and then laughed. She told me it was alright because at least it was a cute octopus. I don't know. Perhaps the joke is just beyond translation.

The octopus and the princess.

I had a similar boggling encounter with a student at the conference last weekend. After shaking my hand, he remarked that it was cold. A little embarrassed, I explained that I was just holding a cold bottle of water. "In Japan we have a saying," he said. "Cold hands, warm heart," then he laughed heartily. I smiled, trying to understand. He went on to say that in Japan, many women have cold hands. "What about women in America? Do they have cold hands?" I really had no idea how to answer that.

One thing that does seem to transcend countries and culture, however, is the reputation of our former president. Dr. G took Hitomi and I out to dinner on Friday night. Noticing the untouched broccoli on Hitomi's plate, he remarked that she must not like it very much, and she agreed.

"You know who else doesn't like broccoli?" Dr. G asked.

She shook her head.

"George W. Bush."

Hitomi grabbed that piece of broccoli with her chopsticks faster than I thought possible and ate it in one bite. Then she nodded her head decisively at that.

Turning Japanese

So I keep getting compliments on my pronunciation. Almost every other day I will have someone new respond to me in Japanese after an ohiogazaimus or konichiwa and then apologize, but my pronunciation was so good that I sounded fluent. Apparently, my year of Japanese in sixth grade rubbed off somewhere. It's making me really regret switching to Spanish, which I continue to lack any skill or proficiency at. Of course, it could also just be that I have a five word vocabulary in Japanese, which isn't very hard to master. But truthfully, it's the first time in my life that I have really wanted to learn a language, not out of necessity, but for the shear thrill of being able to say the words.

Breakfast at the Bakery

MikoMiko, the hospital bakery.

I have gotten into the bad habit of buying my breakfast from the hospital bakery. In my own defense, it is not just because fresh-baked cream and chocolate filled pastries are so enticing, it is also because the Japanese just don't do breakfast. The Japanese breakfast looks much like the Japanese lunch, which looks much like the Japanese dinner. Rice and miso and maybe even nato (mmm). Cereal was introduced to the country but never really caught on.

Mmm...pastries...

So if you don't eat a home-cooked breakfast at home (which I don't since I don't have a Japanese cook in my apartment), most residents just buy pre-packaged pastries from the mini-mart. I decided to go with the slightly healthier and much more delicious fresh-baked pastries.

My only mishap with the bakery was when I bought one pastry that appeared to be filled with a novel green and maroon fruit that turned out to be... beans. Yes, beans in a pastry. It didn't taste all that bad after I figured out what it was that I was actually eating. But it didn't taste that good either.

Japanese Flower

"A Japanese woman only pours sake for men," Dr. G explains after we visited a local sake brewery. "But that's not what Mamiko here did," he continues. "We just saw Mamiko pour sake for herself."

Indeed, during the sake tasting, Mamiko had poured herself a tasting cup when the woman had accidently missed her, apparently a taboo in Japan where one never refills their own glass and women are expected to pour whenever they notice an empty cup. Mamiko, the senior nephrologist who had accompanied us on our tour and provided Japanese translation, laughed and answered, "Somtimes I forget."

From left to right: the owner of the sake brewery, myself, Sealy Harris, Dr. Harris, and Dr. Mamiko Ohara.

The role of Japanese women in society and medicine in particular seems to be a topic on everyone's lips these days - at least, when you are tagging along with Dr. G, the American who likes to stir things up. It was part of the discussion at our fancy dinner with the dignitaries, there was a scheduled "Women's luncheon - not just for women" at the ACP conference, and it was a very real concern for Eri, one of the junior residents here who toured the region with us this weekend.

The Women's luncheon was a formal meeting, discussing the various barriers to women practicing medicine in Japan. Their handout had a neat little chart, outlining the age of a woman during the stages of medical training and showing how it overlapped with the prime years of child bearing and rearing, a very serious task in Japan where children are highly revered.

The American female physician in attendance explained how, in the States, many women now job-share. This is when two women agree to work part-time in the same position. One of the Japanese women then asked if many females in America have paid housekeepers, and the American laughed and answered, "Yes, in fact, I have an au pair."

A yamato nadeshiko or "japanese flower" is the term here for an ideal housewife - a beautiful, quiet woman who knows how to keep old customs and a good house. In Japan, housekeeping is an integral part of the female role and seems to encompass much more than vacuuming and laundry. The society is complex and one of the mother's most important roles is to teach her children to navigate the various unspoken customs. This is one of the reasons that childcare is less successful here. Nonetheless, childcare is also less available and "part-time" is still a novel concept.

Myself as a yamato nadeshiko.

Part of the problem is the shortage of physicians, which also feeds the residents' long hours. The idea of someone working part-time is... not ideal. But the problem then becomes women quitting the profession altogether. In the group of 16 junior residents, there are only three females. I have only met one female attending here and two female senior residents. I have come to realize how lucky I am at UNC to practice with so many women - maybe still not enough, but enough to feel comfortable most of the time. As long as I'm not on urology.

Snacktime

The hospital's 24-hour mini-mart.

Lawson's is the 24-hour mini-mart in the hospital, where all of the residents go for their off-hours snacks and caffeine fixes. Believe it or not, it is a Japanese chain, despite it's English-sounding name. The most interesting purchase I have seen a resident make is a packaged hot dog bun filled with strawberry jam and whipped cream, eaten for breakfast. Stores here also offer a boggling array of caffeinated drinks that I have never seen before, most some combo of coffee and milk or tea. They aren't that into soda.

The caffeine aisle.

My first Lawson's purchase turned out to be one of my bests. Two different flavors of o'nigiri. O'nigiri may be one of the best food inventions ever! At its most basic, it is a ball of rice wrapped in dried seaweed - a perfect utensils-free and filling lunch. But usually, the rice is filled with something (these fillings are often a bit of a surprise for me each time since I can't read the wrappers). I prefer my o'nirigi filled with pickled seaweed or fish roe. Not a fan of the ones filled with canned tuna and mayo.

My first Lawson's purchase.

A delicious bite of o'nigiri.

My first goal when I return home is to learn how to make sticky rice to create my own o'nigiri.

My other favorite Lawson's meal is make-it-yourself noodle salad:

Pre-packaged salad, unopened.

Opens into three compartments - noodles, toppings, and dressing (creamy ginger).

Composed salad - o-mai (translation: yummy yummy).