Karoshi

"He says you are beautiful," Hitomi translates with a smile. I blush and mutter an harigato-gazaimus to the elderly man in the hospital bed. "He likes you," she explains for another patient, a pleasant monk who touched hand to forehead the first time we met. "You see that, Rebecca?" Dr. G asks as the very old, very sick woman we had been examining tried to rise from the bed and bow her head. "That's a Japanese woman, sick in the hospital, but still trying to bow to show her respect."

I feel honored to meet the patients here at Kameda who are all smiles and respect. I am amazed as they allow themselves to be examined - poked, prodded, undressed and dressed again - each morning on rounds in front of a dozen residents with no sense of discomfort. I am equally surprised to learn that patient compliance is never an issue here - patients always take their medications as prescribed and never argue over why they need to be stuck again for blood.

I asked Koji one day, "Do you ever have difficult patients?" He looked confused, and it turned out to be a hard concept to relate. Patients here have deep respect for their physicians. But unfortunately, this trusting relationship comes at a price.

Doctors here feel bound to their patients. Like the nurses who used to not be allowed to marry in the States, or the old country doctor who makes house visits and is always on call. Doctors in Japan still hold to the view that a career in medicine is a dedication of your life to the caring of the ill. You are always on call for your own patients. Even on your days off, you must still come in to check on your patients.

This dedication is admirable, but exhausting. Residents here work at least 6 days a week, often from 6 AM until midnight. Some residents spend months where they never leave the hospital - crashing in a call room or a matress in the workroom for some of their few free hours each night. When they have overnight call, which can be as often as every other day, they are expected to work a full day the next day. And then again the day after that. That's 42 hours without sleep, maybe 4 or 5 hours of sleep-like-the-dead, then 18 more hours of work.

I recently learned that when a resident says that another resident "looks tired", they actually mean that he or she looks sad. Suicide is a very real risk in Japan as young doctors lose their hobbies, stop visiting their families, and are perpetually sleep deprived.

This attitude of working hard is not unique to the medical profession in Japan. The Japanese have a word for "the syndrome of dropping dead at work", called karoshi, as it is just so common here. But as much of Japan is modernizing their work hours and responsibilities, the idea of reasonable duty hours has not yet reached the Japanese medical system.