Apologies for the lack of updates, but things have been fairly non-stop since I started in the hospital on Monday. People generally don’t walk very far around these parts, and Katsu insisted I took a taxi on my first day so I wasn’t late, but in the busy morning traffic it proved impossible to hail one. Instead, he leant me his bike. I was somewhat apprehensive, as I had no way how cycling worked in Tokyo, but it turns out this is a great city for cycling. Bikes are allowed on footpaths and the road, and nobody seems to mind you weaving around pedestrians. I still got lost with the bike, but at least I got lost faster, and managed to find the hospital with plenty of time to spare. What really amazed me was the almost total lack of security for bicycles. Most bikes have a lock on them, but only the back wheel is locked to the frame, so they could be easily picked up and carried off. Even the locks are about as heavy duty as cable ties. Most of the bikes aren’t worth stealing, but I have seen a few valuable examples left unlocked around the city. So I arrived early, and ran into French/German student who was studying a Jikei University for a few months, who kindly showed me where to go. I was quite early, but that was probably expected of me on the first day. First impressions are even more critical in Japan, but my status as a foreigner provides a bit of slack where traditions are concerned.

Registration was a great example of how efficiently systems work in Japan. After confirming details and filling out a few forms, I was whisked away to get my ID card made and given an impromptu tour of the hospital. And as far as great starts going, it doesn’t get much better than being given the morning off on your first day. I spent the time exploring the surrounding area, and made my way to a 7-11 to do some printing. Branches of 7-11 are everywhere you go here, and sell almost everything you could want or need. The Kachidoki station 7-11 even sells white shirts, for shirt-related emergencies. It is strange to see an American chain filled with only Japanese products. It was a bit like being in Tesco in Hungary many years ago. In addition to all the products you can buy, 7-11 also has a printing service for documents and photos. If you can navigate the entirely Japanese website (which I was able to thanks to a guide online), then you can upload documents to print when you get to the store. It’s a really good idea considering the space is so limited in Tokyo, and people may not have room for a bulky printer. I was back in Jikei for the international lunch meeting, where I met the professor in charge of the elective programme and another professor. They were excellent at English, thankfully, so I didn’t have to embarrass myself with my ultra-basic Japanese skills. One of the students brought me to the canteen to get a bento box for lunch, which was an interesting experience. I tried everything, but I still have no idea what half of it was, and I thought I was relatively well versed in Japanese cuisine.

After lunch, I was brought up to the vascular surgery ward by a doctor who spoke little English, then abandoned for some time. I attempted chatting to a few of the doctors, but the language barrier made it a challenge. Time passed slowly, but thankfully I was rescued and brought to coffee by a couple of more senior doctors who spoke English well. We discussed healthcare systems in our respective countries and why I was interested in Japan and vascular surgery. Then came the indecipherable ward round. Ward rounds are not the greatest in English, let alone Japanese. I was also told I would have to introduce myself to Professor Ohki at the 7.30 morning conference, who is the equivalent of a god in vascular surgery, with a worldwide reputation. This was a rather daunting prospect, and not something I was looking forward to. And 7.30 is a ridiculous time to have a meeting. The rest of the day was taken up by a visit to a yakitori place with Katsu. Yakitori is grilled meat and we had different kinds of chicken kebabs. All food items and drinks were 280 yen, so it ended up being a cheap night out. I’m not sold on chicken cartilage kebabs though. I’m having flashbacks already.

The next morning was tough to get out of bed. Nerves were getting to me already, and I didn’t feel like eating breakfast. Nor did I have time for it. I got showered and went straight to the hospital instead. This was a bad move. I had bought a sandwich to have for breakfast the previous evening (the Japanese have strange ideas about breakfast), but I didn’t get time to even attempt to eat it. After forgetting which floor it was on, a kind person showed me to the conference room, which was buzzing with activity. Now the fear started. I had no idea where, to sit, who to talk to, if I could get coffee, or what was going on. Eventually I made it to the front row, and took an awkward seat. It turns out medical students are meant to be at the very front, aside from the chairperson, and the higher your grade, the further back you sit. I was sitting with the resident doctors (probably a social faux pas, but this was all new to me). The doctors must have been getting up for coffee in order of grade, so I’m glad I didn’t get up till the end. There was none left, and professor Ohki began to speak, so I ran back to my seat. He introduced me in Japanese, and speak to me. I told him (in Japanese) that I didn’t speak Japanese, which got a laugh from the room. I got to introduce myself in English following that, and explained why I was there and what I hoped to get from it – which I made up on the spot. Then came a round of applause, which was reassuring. Maybe I hadn’t screwed up completely.

The Long Operation

The meeting was one thing, but before I got a chance to eat anything, I was led off to the operating theatre to see my first vascular surgery case. In a normal theatre, you wear scrubs and a gown and gloves if assisting, but because vascular surgery uses X-ray imaging as a key component, lead vests are mandatory, along with lead around your neck to protect the thyroid gland. In a cold theatre this would be fine, but standing for six hours without having had breakfast or much to drink is brutal, and I was almost about to feint. I asked Kanaoka-sensei (doctors are given the sensei honorific) if I could sit down, and he sent me and another doctor for a break, and paid for lunch (sesame soba noodles) and coffee! This case happened to be extremely complex, hence the operating time which finished up over eight hours long. After an extended break and recovery, I returned for the end of the operation, which was a shame because it looked interesting. I did, however, get to make the first incision and also suture skin, which was more than I ever got to do at home. The doctors are keen to get students involved if you show any sort of interest, and the vascular team has been so helpful and friendly. Exhausted, I pretty much collapsed into bed when I got back to my room. I was in around 12 hours, which is too long in my book. People here are workaholics.

Wednesday brought a much more reasonable day, with a more straightforward operation. I met more of the team, and had udon for lunch. Again, the doctors paid. They don’t let you pay for anything here, even after insisting. I left fairly early to get back and move my things to my homestay in Kachidoki. My case seemed to have gotten even heavier since last time, but I made it to the apartment with plenty of time to spare. I was sitting on the bench outside when I heard my name called. There was Masaco and her two little girls. I don’t know what it is, but Asian kids just seem so much cuter than European kids. And the five year old knows more English than I know Japanese! Masaco’s apartment was worlds apart from Katsu’s room, with all the prerequisite Japanese technology. Modern and minimal, but still with a luxurious feel. I was in heaven. My own room, not a room shared with two other people, and a real shower. Masaco made me pork katsu for dinner, then we went out for a walk around the neighbourhood. It is a great area, with the most bikes I’ve seen in any public space. They even have an underground bike parking area which I unwittingly walked into the other day. Better yet, they live just across the river from Tsukiji fish market, so I’ll be paying it a visit one of these days.

These are much earlier days than I’m used to at home. Breakfast is at seven o’clock, so I get up at 6.45 to get ready for the day. Thursday had only one short operation with Kanaoka-sensei – angiography and a toe amputation. I had an impromptu knot tying tutorial, and got to tie one of the sutures after the amputation. Then to top it off, I was given some opened sutures to practice with. Lunch was tempura, as recommended by Kanaoka-sensei, and I was invited to dinner on Friday and for tofu at the end of the month. The team have been trying their best to explain things in English for me, which has been very helpful, and have been letting me help where I can. I spent the evening playing with Masaco’s little girls then relaxing, then went to bed early. Staying up late isn’t a good idea with 6.45 starts.

That was a mammoth post, but there’s more to come! That brings us up to Friday, where things got really crazy. It’s hard to keep up with everything going on here.