Emergency Care

Having lived in the US, where medical care is not a given civil right, and in Switzerland, where I had to pay for medical insurance to be chosen from a dizzying array of options that had to be reviewed every end of November, I now live in a seemingly more forgiving country, which provides universal health care.

The government covers basic procedures and otherwise pays 70% of the medical visit in Japan. I can choose my own doctors. It all sounds good.

Unexpectedly, I had the chance of exploring the medical system on my third bike commuting day, a Friday, in the evening, on the way home after a long week. In short, it all ended well, but only after my recovery, I realised that I had been lucky that I had managed to get care.

 

 

Where I work is right by the river.  As the drivers in Osaka seem to be even crazier than in NYC before bike lanes came into existence, I mapped out a route on the river bank. Door to door, it’s about 40 minutes riding at a nice, but not a clipping pace. Every morning, I see the sky and the river. I have enough time to shower before I start work after I arrive. Perfect.

There isn’t much traffic to and from the river bank path. I have my helmet, and my lightening reflector backpack cover. I have a headlamp, and a back blinkie. I had just bought new touchscreen biking gloves. My fingers are too short for me to actually make contact with the conductive thread to use it on my phone. Regardless, it is cute so on that day I wore it anyway.

I was happy to be going home. It was after sunset. My colleagues wished me a safe bike ride home. I was one-third on my way back, where the path dips below an overpass. There are small steps, and a slope in the middle of the steps, so you can get off the bike, and roll it down. Except I didn’t. I tried to bike down. I had done it before. Others do it too.

All in slow motion, my bike somehow slipped to the right, I flipped and jammed my thighs against the handle bars, and I landed with minor, but not so pretty gash where I bit into my lip on one side. I remember my backpack following some stretched milliseconds later, adding another rebound dull impact.

Lovely.

I had about 30 minutes of riding to go.

I wasn’t sure if I lost a tooth, but I felt some loose canine and front tooth. I looked like nosferatu when I checked in selfie mode.

Vanity under all circumstances.

Then I called the dentist. Well, I called A dentist that I found online, whom I thought to be the dentist I’d been going to several times to redo my old amalgam fillings from years ago. Dental work is also covered. Imagine that.

“Yes, I just fell over on my bike, and I want to come tomorrow, to have my teeth checked.”

“May I have your patient number on your patient card?”

“Let me find it…. it is 64*?”

…

“Excuse me, but there is no patient by that number”

“I’m sorry but that’s what it says on the card. I really need to see the dentist”

So I left my name with the kind voice on the other end, and made an appointment for 13pm the next day, Saturday.

In all the meanwhile, I was bummed I had to cancel my much awaited boat tour of Osaka with my friend.

I call my only family member in the region, my father, and he doesn’t answer after multiple calls on his cell phone.

 

Fine.

 

I picked up my bag, and bike, and checked that it could ride, and I rode home.

 

I had just moved into an apartment in Osaka, and I had no first-aid kit at home. So I was relieved to find a 24h convenience store that had also a pharmacy. I parked and double locked my bike, and I entered the bright fluorescently-lit store (who knows, it may have been LEDs, but it had that bluish white light).

I walked around the aisles aimlessly, hiding my face with my hand, but finally, I went up to the counter, and asked the on-call pharmacist lady. She looks at me, and tells me first, go wash my face. Thank goodness, the convenience store bathroom was spotless.

I now faced a mirror, and washed blood and any grime off my face. The wound was pretty clean. My inner lip had a nice layer of mucus membrane floating like a tiny piece of glistening fish sperm sack.

I cleaned the sink, and walked back to the counter. The woman saw my wound again, and then started offering this and that to clean the wound. I got some iodine concoction used here for gargling, makiron (Benzethonium chloride, allantoin, and chlorpheniramine) some Q-tips, a bag of ice, and then rode home.

I cleaned my wound, finally got in touch with my father (who was at some wine-tasting still), and then saw how hard my thighs had taken the impact, and with a ziploc bag of ice for my lip, and one for my thighs, I went to sleep.

The next morning, I woke up with a melted bag of ice, sore, and puffy.

I waddled to the toilet, saw the nicely developing internal bleeding that had swelled into handlebar-shaped inflammatory speed bumps on each of my thighs.

I saw myself in the mirror. I was puffed up on the fallen side.

I crawled back into bed with fresh ice baggies and slept some more.

Having been awakened by the alarm on my phone, I got dressed to go to the dentist.

Fortunately (again vanity), I could cover up my injury using a 3-D mask that is readily available again, in any convenience store.

 

I got there at 13pm.

I entered, and there was no one – the staff were taking a lunch break. Hearing me enter, the receptionist/hygeinist came out, and was suprised to see me there.

“What brings you here?”

“I have an appointmet at 13pm. I called right after I had my accident when I feel off the bike. I want my teeth to be checked.”

“No one called last night, what time was it?”

“around 19:30 pm”

“But we are closed at that time”

…this is when I realised I had called some random dentist’s number and had made an appointment. No wonder they didn’t have a patient with my patient number.

 

I was at a loss as to what to do.

I didn’t know where to go, what to do.

The dentist agreed to see me at 14pm before the other clients. So I waited in the waiting room.

 

He saw my wound, and asked if I’d seen a medical doctor.

I hadn’t.

External scratch looked slightly infected.

The diluted Japanese disnfectants! I was thinking.

 

I was feeling more desperate.

I had no idea how to navigate through this medical system.

I asked if I find a walk-in clinic (they have those in Switzerland open all hours if you don’t have a true medical emergency). Or do I go to an emergency room?

Having taken pity on me, the dentist said he’ll write a referral for an otolaryngologist in the nearby hospital. He often refers his patients who need minor surgery there.

 

So the referral and my medical history was written, and I was given the instructions to walk over less than 10 minutes to the emergency room. There, the security guard told me to enter the emergency area, a quiet sitting room painted in mild seafoam green. There was a lday sitting in a booth who took my referral letter, told me to fill in my form, took my naitonal insurance card, and told me to wait for the doctor. Soon after, a doctor called me in, looked at my situation, and gave me a mild antibiotic regimen and some ointment to enhance skin healing.

 

I came back out into the waiting room, and the attendant, now joined by another colleague, told me it will be 10,000 yen (around 100 USD). They told me to come back during the week, so I can be reimbursed for the difference of what I need to co-pay and this amount. The hospital isn’t in my usual area of activity, and I told them I don’t think I can come during business hours to this hospital. Apparently, I need to call so they can arrange for the reimbursement outside of those hours.

 

I went home.

I eventually healed, with some minor only detectable-to-me scars

My dentist rounded off the canine and told me to wait til my front tooth stabilised itself.

 

When I chatted with Dentist and the assistant to thank them, I learned that I need to have seen a resident doctor, or have had a referral (by another doctor, or the ambulance operator) before I can be admitted into the emergency room in a hospital.

This means, if you are an otherwise healthy person, and you need to be hauled into an emergency room at a hospital where you do not have a medical record, there is a possibility you can be rejected from admission. Hospitals aren’t open to new patients on weekends and holidays.

My father says that sometimes people don’t pay for the emergency bill, and this is why I have to go through this reimbursement process.

 

What???

 

So, now, I have to find a local family physician (I guess I will take the one of my father in the suburbs), to refer me to a hospital near my apartment and my work, so that I can go there for minor things (like checking my moles, or about a complaint of a sore arm), so I can have a pre-existing medical record in case I need to be admitted for a real medical emergency.

 

Is this the case of skew from a medical insurance system? Or the aged general population filling up the health care system? Or just the lack of people available to work in the hospitals (shrinking working age population)?

I have no idea, but I need to find out more.

Also, I need schedule to get my moles, and my sore arm checked.