Visiting the doctor in Japan is like navigating a labyrinth in a horror movie. If you survive, you come out a beaten and bloody shell of your former self. Ok, that’s probably not how it feels for most people, but I am so incensed after appointments that I have written two Substacks on this very topic. One regarding the dentist and one about the gynecologist. Just this week I had an appointment with a cosmetic dermatologist. He grunted, said two words, then shooed my sensei and I out of his office leaving the explanations to his medical assistant.
There is no privacy when I see a physician in Japan as I am accompanied by my sensei who assists with the interpretation. By “assists” I mean does all the speaking and translating for me as I understand basically no Japanese. An appointment is not just one appointment. Somehow it is always necessary to comeback for, and pay for, a follow up appointment - even if you were only seeking a teeth cleaning.
Because of the tedium, frustration, and rudeness; I try to avoid the doctor’s office at all cost. However, there are some things for which even I go to the doctor. Like having a lump in my right breast for over six months.
At first, I was not concerned. Given the location and size, I assumed it was a swollen lymph node that would go away. When it didn’t, and considering my extensive family history of breast cancer, I was forced to reconsider my prohibition on seeing Japanese doctors. Like all intelligent and educated people who are trained to perform in-depth scholarly research, I Google it. Turns out even if it was only a swollen lymph node, since it lasted longer than a few weeks, the know-it-alls at Google recommended that I “seek medical advice.”
Thus, I made an appointment for a mammogram. By “I made an appointment,” I mean my sensei made me an appointment. While on the phone interpreting for the receptionist, my sensei asked if I had any symptoms. I was hesitant to say, but I decided to disclose that I had felt a lump in my right breast, even though I still thought it was a swollen lymph node. After hanging up the phone, my sensei commented that it was fortuitous to have symptoms because otherwise insurance would not cover the appointment. Useful information before getting the receptionist on the phone. And also, why the hell aren’t routine mammograms covered by insurance in Japan?
The physician I saw decided to do an ultrasound first and a mammogram only if needed. I disrobed from the waist up and laid on a hospital bed while the doctor performed the ultrasound. Meanwhile, my sensei stood behind a curtain shouting the translations to me, not that the doctor said much. After I was clothed, the doctor conveyed to my sensei and me that he could feel the lump, but he could not see anything on the ultrasound. He stated it was necessary to proceed to the mammogram. With that, I was banished to the waiting room again.
At this point, I started to think that it may not be a swollen lymph node. My mind was running faster than Secretariat at the Kentucky Derby. Can I go through cancer treatment in Japan? I don’t speak the language. I couldn’t even book my own appointment. Aaron works long hours and there is no one on the continent to help with Franny or housework. I decided to take a moment and retreat to the bathroom.
Perhaps I should have been paying more attention to the task at hand. As odd as it may sound, Japanese toilets take a bit of concentration since they offer numerous bidet and flushing options. In this case, all of those options were written in kanji. Since I can’t read kanji, I hit the big green button and proceeded to wash my hands. As I soaped up, a nurse rushed into the room. Apparently, the big green button was an emergency call button. That settled it. If I received a cancer diagnosis, I was going home to the US for treatment. How could I possibly be treated in Japan? I can’t even flush a toilet in Japan!
The mammogram was cold, embarrassing, and painful. So, a normal mammogram. Well…other than the nurse commenting that I have large breasts. Normally, a comment like that would be uncomfortable, even offensive, especially since I heard it interpreted to me through my sensei. But in this case, I kind of expected it. Despite what anime would have you believe, most Japanese women are small chested as they are tiny and probably weigh under 100lb soaking wet. Let’s just say I weigh over 100lbs dry.
Unfortunately, the mammogram results were inconclusive. Thus, future humiliation and disgrace were inevitable as the appointments were to continue with an MRI. Since I was asked repeatedly repeatedly repeatedly by my doctor and everyone at the hospital where the MRI machine was housed if there was any metal in my body, I disclosed that I have an IUD. I knew that IUDs were rare in Japan, but I underestimated how confounding it would be for Japanese male medical professionals.
I learned that after speaking with me, my doctor alerted the hospital to my IUD prior to the day of my scheduled MRI. Together, these medical men decided I should have an x-ray to determine if the IUD could be seen. If the IUD showed on the x-ray, the MRI would be canceled. Of course, no one felt the need to convey any of this to me. Only after waiting, having a blood draw, and waiting some more was I told that I needed to go to a different part of the hospital for the x-ray.
This time I disrobed from the waist down and laid on the hospital bed. Multiple x-rays were taken as the male technician could not understand the T-shaped object he was seeing near my abdomen on my x-ray. Spoiler alert, it was the IUD.
“Is this it?” he asked referring to the x-ray of my uterus.
“Yep. That would be the IUD,” I responded.
At that point I was told my MRI was cancelled. Hell no, I thought. I called again on my old friend, Google, who quickly determined that MRIs are safe for women with IUDs. There is one rare exception, a copper ring IUD that some Chinese women were given decades ago. Knowing that I am not an elderly Chinese woman with a copper ring in my body, my sensei and I started showing the male medical staff scholarly articles from elite universities like UC Davis and Oxford that found IUDs are safe in MRIs. My sensei even found language on the Mirena website that stated patients with the Mirena IUD can have MRIs. I also found on their website an explanation as to why the IUD is visible on x-rays.
“Are you sure you have a Mirena IUD?” asked one of the male medical technicians through my sensei.
“I am 95% sure. The only reason I may not have Mirena is if a generic option was offered and was cheaper,” I said.
“You have to be completely sure,” responded the technician.
I decided to get confirmation by logging onto the patient portal for my gynecologist in Ohio. Since it has been nearly two years since I have even thought about him, it took a minute to remember his name. From there I found the name of his clinic. Then I attempted to log onto the patient portal. Password. What the fuck was my password? Meanwhile, the hospital technician hovered over me impatiently watching my hands fly across the keyboard of my phone. I had enough. “Please back off,” I said. “I am doing the best I can.”
Eventually, I logged into my patient portal and found the list of my medications. There in beautiful big black letters it said, “Mirena.”
“We will do the MRI,” said the technician.
As we waited, my rage at the situation steamed and boiled over. I started to rant, “If they had just communicated any of this to me prior to this appointment, I could have gotten all this information before today. I could have printed the Mirena website. I could have logged into my patient portal without that guy watching me. If they said they wanted to do an x-ray, I could have been prepared with the Mirena page that explains the IUD will show on an x-ray and why. We could have avoided this whole thing. But no one said anything to me! No one even bothered to ask me about my own body. All these men just decided without including me.”
After waiting for a few emergency MRIs that took precedence, it was finally time for me. This time I disrobed completely. The technician explained that I would be lying face down on the table with my arms extended over my head. “The Superman,” I said indicating that I understood the instruction. Apparently, not many Japanese patients make this connection as the technician thought my description was hilarious. With his thick Japanese accent, he used the term “Superman” a lot after that.
Lying face down on the table of the MRI machine, my breasts were carefully placed into two holes. My face rested on one of those centerless donut-shaped pillows like what is used during a massage. The MRI machine was loud and uncomfortable. Since moving would only make the process take longer, I decided it was the perfect opportunity to practice yoga breathing and meditation in order to stay calm. Apparently, all that crap works, because the 30-minute MRI seemed to go by relatively quick.
When it was over, the technician and my sensei came back into the room. I tried to push myself up from the bench while simultaneously covering my breasts. Although at that point, modesty was rather meaningless. My back was stiff from having my arms above my head for 30-minutes, and I groaned as I sat up. “Worst massage ever,” I said.
Nothing from the others in the room. Not even a smile. “That joked would have killed in the US,” I quipped.
It took a week before I returned to my doctor’s office for the results of the MRI. It was a week that lasted a year. I became convinced the results were not good. Twice my mom had breast cancer along with my grandma, my great-aunt, my great-grandmother, and my mom’s cousins – one of whom died from it tragically and far too young. I decided I would immediately return home and be treated at The James Cancer Center at The Ohio State University. If this could be life or death, then I needed an oncologist who spoke English, and I needed family around.
The day before the appointment I was driving Franny home from swim lessons. I was deep in my own thoughts. I started thinking about how in my 20s being large chested was an asset. Arguably my two biggest assets. But now, my boobs were betraying me. From asset to betrayer. Et tu, boobte.
The day of the appointment, the doctor’s waiting room felt busier than Grand Central Station. Women were sitting and standing everywhere. Meanwhile, hovering above them on a television screen was a topless woman, with very perky boobs, giving herself a breast exam. Surrounded by breast and drowning in my own fear, I waited over a half an hour to finally see the doctor.
“There is no cancer,” translated my sensei. I could see the relief in her eyes as she delivered the good news. I felt so much lighter I thought I might float off the stool on which I was perched. I finally exhaled the breath I had been holding for a week.
Being me, however, I immediately went into interrogator mode. I mean, I paid for the law degree, I might as well use it. “What caused the lump?” I asked.
“A hormone imbalance,” responded the doctor curtly.
“A hormone imbalance that lasted over six-months?” I asked.
I do not believe this question was ever posed to the doctor. My sensei just kept repeating, “it is not cancer. It is not cancer.” And we were unceremoniously ushered out of the room.
Back in Boob Central Station while I was waiting to pay my bill, I told my sensei that I still have some questions. “A hormone imbalance that last this long seems like a problem,” I said. “I want to ask the doctor if I should talk to an expert about my hormone levels. I am 40-years-old after all. Maybe I should be on medication.”
“It’s not cancer,” she repeated. Evidently, I would not be asking those questions to the doctor today.
During one of Aaron’s Japanese lessons, he was taught the proper way to speak to a Japanese physician. The patient must not diagnose themselves or even suggest that they have a diagnosis in mind. They simply recite their symptoms and allow the learned doctor to make the diagnosis. Apparently, asking follow up questions is also not permitted, at least in my experience. Actually, in my experience, hoping the doctor will talk to you like a human with knowledge of your own body is even a bridge too far.
Japan is a gorgeous country, with a rich history, and friendly people (excluding the doctors). I highly recommend visiting Japan on vacation. However, if you should get sick while you are here, I recommend immediately getting on a plane and seeing a doctor in the US. Strike that, see a doctor in Canada.