Karoshi in Action

One of our patients died last night. So Hitomi and Koji have not slept. Even though they were not on call, they had to be here because hospital policy requires that you come in when one of your patient's dies. This means that Koji, who was on call two nights ago, has now not slept for over 58 hours.

I try to explain that in America, the doctos on call cover your patients, even when something bad happens, even when they die. I admit that this might be why patients don't like us much in the States - we are always leaving the hospital and sending in people they don't know to take care of them.

Koji laughs a little, then rubs his eyes. "The system here is very difficult on doctors," he says, "but it is much better for patients and their families."

American that I am, I have trouble giving up the argument. "But in this system, we now have a doctor who hasn't slept in over two days," I come back with. "We consider that dangerous. Dangerous for the patients. You can't make good decisions like this."

He nods and says nothing. It is an argument that doesn't seem to hold much weight in Japan. However, on my part, it is only later, upon talking with Dr. G, that I realize the meaning I had been missing in Koji's statement about their ways being better for patients...

In Japan, when a patient dies, the doctor is not present in order to make the call and do the necessary paper work, as they might in the States. Every person that has been involved in that patient's care is present - from the most senior physician to the most junior staff member. These people stand in a row before the family, and are present when the now deceased patient is rolled away to their next place.

"A moment straight out of National Geographic," Dr. G says. Unfortunately, I was not called in the middle of the night and did not witness the scene, but it sure sounds powerful. To be part of an experience like that would be something special. I am still not convinced that it is special enough to warrant 50 hours without sleep everytime a patient of mine passes away, but I think I now have a glimpse of what we might strive for within our own limitations.