Sleep is wonderful. Not having sleep is the opposite of wonderful. Not wonderful? No…it’s a lot worse than that. Perhaps I’ve waited so long to write about this particular experience because of how much I wanted to forget the time around it. Sleep deprivation does not make a me a happy person. And keeping a sleep deprived me in the hospital till after 8 pm is not a good idea. I normally shut down all non-essential functions like conversation with others and consciousness.

It all started with a long day in the hospital. I was in the hospital for about 9 o’clock, like any normal day. I should say that I have added -ish to all the times doctors tell me to be places now. I was early the first few days and nothing happened for at least half an hour, so about 9 o’clock was probably closer to 9.15 by the time I got scrubbed in for theatre. One operation had just started when one of the students came to the theatre and said professor Ohki had called for me. There was some confusion, and I didn’t even know what that meant. It sounded like he was outside waiting initially, but it transpired that he was upstairs in another theatre performing open surgery. It was the first open abdominal aortic aneurysm repair I had the chance to see, and I wasn’t going to pass on it. Because the surgery was open, it also freed me from the horrendous lead vests that we have to wear when working around X-rays. I felt unusually light, like I had forgotten something and couldn’t quite figure out what it was. It was a welcome change from endovascular surgery. I didn’t get to assist much because of the complexity of the case, but it was amazing to watch and I did get to staple the skin closed and practice suturing a graft-graft anastomosis. My time at Jikei as made me realise how little I knew about vascular surgery before coming to Japan. That operation took six hours (a short one in my book), but the time flew by. A whole six hours of the day gone just like that. I’ve lost entire days of my life, with twelve hour operations, watching people fiddle about with wires and catheters in arteries. It has been immensely interesting, but I feel a little bad for not making the most of the evenings I was free.

After lunch – a regular 5 pm lunch – Dr Kanaoka had arranged for me to receive a presentation from Medtronic representatives and a hands-on stent deployment demonstration. It was fun, but I’m sure I wasted several thousands of pounds worth of equipment. I’m not sure what exactly Dr Kanaoka told Medtronic, but in my mind it was something along the lines of, “This guy is from Ireland, and these stents are made in Ireland. He has a god given right to deploy these stents. They’re part of his heritage,” All I asked him was if the surgeons were trained in new devices as they are released or if they figure out on the job, and the next thing I knew he was on the phone organising a session. People here are incredibly generous and helpful. Then when I thought the day was over I was whisked off to the operating room to practice coiling some aneurysms. Stryker Neurovascular had some people there to guide me through the process, but its fairly straightforward. Many of the endovascular devices are intuitive, and the hard part is getting the right size and getting them in the right place. Hence students are allowed to deploy stents in vascular surgery operations. I found it interesting that several of these devices were made in Ireland – the stents in Galway, and the coils in Cork.

This was all great, but I was still in the hospital at 8 o’clock and thought this was a reasonable time to slip off into the night. How odd then that there were lot of staff hanging around the operating theatre. Was there another demonstration organised that I didn’t know about? No, something far worse. An emergency operation! No mention of going home, I was instructed to scrub in and watch. I was so close to escaping but it was not to be. It ended up being a difficult case, and I left the hospital at 2.30 am, having been told to take a taxi back. I walked out into the night air, shattered, and made my way to the taxi rank. At that time there were no taxis to be seen and all was relatively quiet. I started to contemplate walking back when I had a brain wave. Perhaps an ill advised one, but it was an idea at the very least. I wanted to go to Tsukiji fish market to see the tuna auctions but I didn’t want to get up in the middle of the night. Here I was, awake in the middle of the night and Tsukiji was on my way home to Kachidoki. It seemed like a perfect plan. Pop in for 3 am registration and then grab some food and come back for the tuna auctions at 5.25 am. This wasn’t to be the case. I was handed a less than stylish green safety vest and pointed towards the floor of the fish information centre where a gaggle of tourists were already assembled. Oh great, this was to be my home for the next 2 hours and 25 minutes, along with 119 other people. Two groups of 60 people are allowed to see the tuna auctions each day. Now the “why the hell did I do this?” feeling was starting to take hold. I was already sleep deprived from earlier in the week and now I was going to forgo it completely. Everything was becoming a haze, with no definition between the end of one day and the start of the next. In the 36 hours surrounding this particular experience, I had about two hours of poor quality sleep. The lack of sleep was becoming distressing, and all I wanted was to collapse onto a bed.

After drifting in and out of consciousness, wedged against a wall of the fish information centre (a literal tourist trap), we were let loose on the market. I use the term loose rather loosely, as it felt more like we were prisoners of war being marched to a camp rather than a tour through Tsukiji. The market was positively frantic with activity. Trucks flying about the place, little transporters almost running us over, and bikes everywhere in between. For the fishermen and other workers it was business as usual, and we were an inconvenience, holding up proceedings. Not that we had much opportunity to – stopping for photos was not an option, as screaming security guards promptly informed us. Following a long and perilous walk, we were guided through a set of doors and into the narrow tourist viewing area in preparation for the auctions. The first thing that hit me was the cold. The place was freezing, but it was easy to see why. All around were huge frozen tuna fishes, and crates of other tuna cuts. Potential buyers walked from fish to fish, testing them with picks, and trying to pick out the best specimens.

The auctioneer began to ring a hand bell in an elaborate fashion, and the auction began. I had no idea what was going on from this point – auctioneers are hard enough to understand in English, let alone Japanese. It was worth the wait to see the chaos of the market, and to see the tuna up close, but I was slightly underwhelmed by the auction itself.

People rave about it, declaring it one of the best things to do in Tokyo, and while it was interesting, it was too long to wait in a featureless room. I had intended to get sushi after the auction but my stomach told me otherwise. It was too early to eat, and I was too exhausted. I made the slow walk back to Kachidoki knowing that I was expected in at 9 o’clock the next morning. At least I would only have to stay in for a short while…or 8 pm for a conference, whatever. These have been long days.

At least I have ramen.