46
members were periodically trained
to perform the elaborate, quasi-Zen
tea ceremonies in order to encourage
calm, sustained, and profound atten-
tion to detail. Elderly patients were
also encouraged to participate in the
tea ceremonies as part of their occu-
pational and physical rehabilitation.
Elderly patients with terminal
illness are simply not kept alive by
any means necessary. High-profile
euthanasia is not tolerated either. In-
deed, the terminally ill and extremely
feeble are approached rather differ-
ently in Japan than anywhere I have
seen, especially in the United States.
Where the American system tends
to keep people alive unless people
specifically ask for a DNR (do not re-
suscitate) order that is witnessed and
approved by a health care provider,
the Japanese tend to use a much more
conservative approach to care. The
chronic-care facility where I worked
never ran codes and fully expected
people to pass away. And there was
no separate hospice care facility, at
least in that province. To my initial
surprise, I saw more than one doctor
firmly explain to families that aggres-
sive life-sustaining measures were
not in some patients’ best interests.
On the other hand, those patients
with any chance of benefiting from
rehabilitation were quickly provided
with well-staffed, caring physical
therapy and placed in surround-
ings the Japanese believe encourage
rehabilitation. In short, patients were
well-fed, well cared for, well-kept,
and entertained.
I also saw something that at first
sounds inefficient but makes unbe-
lievable sense and works perfectly
in practice. Doctors literally wait for
patients to arrive rather than making
patients make an appointment and
wait for the doctor in a waiting or
exam room. In the case of inpatients,
there is always a doctor available for
those that wish to be seen. In the case
of office visits, it is understood that
the doctor will be in the office during
normal business hours, and that a
patient may walk in at any time on a
first-come, first-served basis.
Disaster Zone Visit
Proves Instructive
As for my visit to the disaster
zone, I thought my return to survey
the tsunami and earthquake dam-
age was going to be a challenge.
The region was now fenced off and
patrolled, and only restricted access
was allowed. My preceptor, how-
ever, also wanted to see the area, as
did his friend—a former national
health insurance administrator from
the region. After significant wran-
gling, they had all our names placed
on a government pass list, and sev-
eral weeks later I found myself driv-
ing with my preceptor past multiple
sites where radioactive dirt was
bagged and piled up the lengths of
football fields.
We then drove past checkpoints,
where all our IDs were repeatedly
checked. Finally, with Geiger counter
in hand, we entered the restricted
area around the nuclear reactor,
followed by a car trip up and down
the coast through the areas hardest
hit by the tidal wave. We saw eerie
ghost towns and pulled up to peer
into a vacant 7-Eleven store, noting
that the shelves were fully stocked
while a relatively new car remained
parked in a driveway.
With our Geiger counter slowing
rising and showing low but still unac-
ceptable levels of radiation for long-
term habitants, we drove deeper into
the restricted zone. Soon, we did see
the radiation levels rise, particularly
in areas where the air was more still,
but it never reached severe levels.
That is, it was never as high as the ex-
posure one would get from a CT scan.
As for the tsunami damage, it was
much better than I remembered—and
yet was still beyond words. On the
one hand, the Japanese have done
amazing amounts of repair, rebuild-
ing, and relocation when you consid-
er the thousands of square hectares of
damage these prefectures faced. They
have now added large berms along as
much of the coast as possible to act as
wave breaks against future tsunamis.
But that does not change the fact that
a region famous for rice production
was turned into a salt marsh, and that
several kilometers inland one can still
find large fishing boats sitting aban-
doned on their sides.
Memorable Trip Elicits
Profound Reflection
I wish I had some catchy anec-
dote or meaningful transition with
which to round out this story. Of
MAKING A DIFFERENCE:
Dr. Joshua Kretchmar
COM Outlook . Winter 2015
