Slim Novel 17 - http://adventuresofkimi.blogspot.com - See Homepage
Professor John Edwardes, U.S. expatriate in Tokyo, does his medical care using Eddie's friend Dr Kuriyama, whom he calls Dr Koori. The hospital outpatient system is a full staff of generalists and specialists that are doing diagnosing and dispensing medicines but with the difference in Japan that this is covered by National Health Insurance (NHI). Under it, Edwardes has c.$100 a month deducted from bank account to be a member of NHI and then as a patient, over 65, only has to pay 10% out of pocket of the total bills - dentist, medicines, tests and hospitalizations. Quite a bargain for him compared to USA under Medicare, which essentially covers basic hospitalization fees and often less than 50% doctor fee, and whose acceptance is optional compared to Japanese NHI, which is accepted by all Japanese practitioners.
Edwardes is in good health and with good vision for a very old man due to following Physician's Notebooks: He constantly wore a long visor cap against sunlight and to protect head from banging; he eats a high daily vitamin C to prevent damage from oxidation; he avoids tetracycline antibiotics, tranquilizers of the chlorpromazine type, and unnecessary use of steroids because these are medications known to damage eye lens & cornea; he keeps a low healthy weight and takes a statin pill with each meal to be sure of low cholesterol and a normal blood glucose; and he does regular far-distance eye exercise to keep the internal eye muscles from being overused.
On this sunny day, walking to nearby hospital dressed in usual brown, salt & pepper sports jacket & denim work pants, with his white hair and now large almost overgrown mustache, he looks like an Armenian grandfather. Recently, a strange change had begun to catch his attention. In the bright sunlight, staring, as he usually does, at the girls walking by in colorful dresses, he notes a glare. He mentions it to Dr Koori.
"You got cataracts!" Koori exclaims, as he faces Edwardes across the small table in his office at the hospital. Koori is in usual white coat over shirt & tie and well tailored pants, with carefully combed black hair. He speaks New Jersey English from his 2-year training there.
"I will refer you for eye examination."
This being a hospital in Japan, refer for eye examination, means Koori's picking up his phone and calling the eye department and Edwardes' going downstairs two floors to get his eyes and vision checked by techies, with final consultation by a doctor.
From his reading, Edwardes knew, eye cataracts are in the eye lenses in almost everyone if they live long. A cataract starts as a small grain but slowly grows into a solid. The symptom is a gradually misting vision, in the beginning most noted on very sunny days as a glare. For most persons, getting cataracts is no big deal and the surgery is routine: an overnight stay with both eyes done at same sitting under local eye drop anesthesia. The surgery, he knew, was extraction of the cataract through a slit opening in the lens capsule and then insertion of a plastic lens that restored perfect vision in its place.
In eye clinic, he is given the usual visual tests by young, pretty Japanese female techies in white dresses, emphasizing slim but sexy butts and breasts. Then more complicated but still easy testing of his cornea and retina using laser and advanced photography. The whole takes an hour before he finds himself waiting on a bench to be called in to see the expert.
The wait is only 5 minutes and the sound of his name Edowartzu-sama, with the honorific title suffix sama tells him to go inside the white curtain for his interview with Sensei, or Professor, as all physicians are referred to in Japan.
As he sits down facing, he notes the doctor is an older man, a bit fat. "Will you like me to speak in English?" the doctor asks and Edwardes nods Yes thankfully, for his Japanese is poor.
"I see you are a retired university professor from New York."
Edwardes nods Yes.
"So I shall spend more time than usual. You know you have cataracts and we confirm they are equally developed in each eye." He looks up from the chart at Edwardes "What symptom have you noted."
Edwardes explains.
"Well, to be frank, if I were a commercial eye surgeon, I'd advise you to go in the hospital for an overnight and get both eyes done." He frowns. "But I am a university man and you are a professor so what I say is, You could get the cataracts done tomorrow or later with good result. So if you have no special reason, like driving a car, best to wait until your vision becomes misty enough to start interfering with your enjoyments. That is my advice. A pleasure to meet you." He reaches across the table to shake hands.
Time passes. Edwardes is out walking, sampling the girls in their soon summer dresses. But now it is, like Smoke gets in (front of) your eyes, too misty. If it gets any worse, he thinks, I am blind. Then: To atheist hell with this, I'll have my cataracts done! He goes back to the same hospital and sees the same doctor.
"From your symptoms, I agree it is time for the surgery."
"I want it yesterday!" Edwardes exclaims in a frenzy for surgery. Seeing the puzzled expression, Edwardes adds "ASAP! As soon as possibly you can do it!"
"First, we must check your cornea and retina. At your age it is important." Seeing Edwardes somewhat disappointed, impatient look, he further explains. "There is one worrisome complication of cataract surgery in the very old patient. Cornea edema. It means, a few days after surgery the front-of-eye cornea swells with excess water and vision goes very blurry - worse than you have now. It depends on your cornea endothelial cell count and also we need to be sure your retina is no problem.
An hour later, after tests. Edwardes is again sitting before the doctor. "Professor Edwardes, you have a very low cell count on the insides of both corneas therefore your cataract surgery will result in cornea edema and if you get it you will go from frying pan of misty but tolerable vision where you cannot enjoy the girls in their summer dresses, as you say" he chuckles at Edwardes unusual Americanism - "to the fire of almost total blindness."
"So what to do?" Edwardes asks disappointed, adding with a laugh, "Shall I just wait out my misty vision till I die." Actually, he is thinking, It might not be a bad idea for a soon 100-year-old man.
The doctor says "There is a solution other than not getting the surgery: a cornea cell transplant after the surgery. It is called DSAEK, or Descemet's stripping automated endothelial keratoplasty. I translate from the medicalese, We strip the endothelial cells from Descemet's membrane and replace with a donor's cornea graft containing good endothelial cells."
"Well, I agree to that. When can you? I want it yesterday." Again he emphasizes speed and this time the Japanese gets the American joke and smiles.
"Professor Edwardes, it is a difficult operation because it involves donation of living cornea after donor's death. Only one place and one surgeon does it in Japan: Amano Sensei (Professor Amano) at Todai University Hospital." He writes out the name on a referral paper and hands it to Edwardes. "This will get you appointment."
One week later, Edwardes is sitting before Professor Amano. He is surprised to see Amano, the world expert, is a rather slim and, to Edwardes old eye, young man with black hair carelessly combed and an informal shirt over slacks under his white coat He muses - A college student! Not hippy, I hope?
Amano has a habit of starting off his sentence to Edwardes as though he thinks Edwardes understands Japanese, and then, seeing the puzzlement, switching to perfect English.
He listens as Amano explains: "You have a cell count of zero in both corneas."
"What is my chance of cornea edema after a cataract surgery?"
"One hundred percent; it is certain."
"So what is your advice to an ancient fellow like me?"
"If you were a feeble old man, as I expected when reading your data before I met you, I'd say waiting is best. Your vision is tolerable for activities of daily life. But, seeing you, I will offer you my surgery."
"Thank you, Professor, I'll take it. This Misty is no longer charming like the woman's name. It is getting badly in my way of reading and computer. And I expect another 14 years until my million hours of lifetime is up."
"What million hours?" Amano, like almost everyone, has never heard that concept of the one-million hour life expectancy before.
After Edwardes explains, Amano says. "The way we do it is as follows. I am putting you down for the cataract surgery next month because it takes that long to reserve the surgical suite. We shall do one eye at a time, left eye first. The surgery will be to remove the cataract lens by extracting it from the lens capsule through a small slit, and replace with transparent plastic lens that will give good vision. Then we have to wait at least a month to see if you develop cornea edema. I am putting you on the list for cornea cell transplant. Because of your age, on top of the list. It should not take more than a month to find a donor."
So that was that.
A month later, Edwardes enters hospital and, completely awake and alert sitting under eye drop anesthesia, has the surgery, and he times the surgery at 16 minutes. Amano does not fool around, Edwardes thinks as he leaves the surgical suite.
He stays in hospital a week having the nurses drop corticosteroid and antibiotic into his left eye 5 times a day. His vision when they remove the eye patch the day after surgery is so perfect he can see a nurse's cleavage at 20 feet. But next day, his left eye vision blurs and stays that way. Cornea edema complication as predicted.
A month after that, one morning at 10 AM, Edwardes's cell phone rings and a voice says "I am Dr. Yamagami from Todai Hospital. We have a donor and can do the transplant tomorrow. Please come to hospital today at once ready for admission."
So he came.
Professor John Edwardes had learned to love the eye-surgery hospital ward. Although his young wife Yuko treats him well at home, it cannot compare to the service of the nurses - During the day they are pretty and even at night where they employ the less lovely; they are all, to him, very young, less than age 30, he estimates, although he always guesses Japanese women to be younger than actual. The hospital bed is a France Bed with a perfect mattress for his ancient aching back and, after 24 hours on it, all the aches go away. The food is perfectly planned not to give constipation and to keep cholesterol and body weight perfect. It tastes good too. And he is allowed to use his laptop, with internet WiFi plug-in, and earphone so as not to disturb the other 3 persons of his 4-person room, and so can keep up his email and editing his Principles of Sociology. He had been offered a private room at no extra charge but refused both because it would be a sign of capitalist elitism and because it would isolate him from other patients and from quick emergency medical care should he have a sudden accident of fall or heart stoppage. And by pulling the curtain around his bed, he has privacy.
Although ProfessorAmano tells nothing about the eye cornea donation, it is obvious that in order to donate a living healthy cornea to replace an aging, lack-of-cells cornea the donor must die. In Japan everyone indicates Yes or No on the National Health Insurance card for his organs to be transplanted at time of death so that makes it very efficient because it is always available on every Japanese at time of death and also it obviates the problem of families' denying permission.
Deeper thought, dictates a donor for transplant to be young because the cornea cell count decreases markedly after age 60. And without HIV/AIDs, Mad Cow Disease or other transmittable conditions.
At 3:30 PM, just after the nurse inserted an intravenous into his right arm, the call comes from Operating Room and he is shifted to stretcher and rolled to the nursing station where another nurse connects an IV bottle to his intravenous, and then his stretcher is rolled down the hall and into elevator and then into the Operating Room Suite.
He is euphoric. Here it is, the first cornea transplant!
A new IV bottle is connected and he is wheeled into the surgery room, greeted by Amano, who briefly pulls off his own mask to show face in order to prove who is operating on who, and then the surgery proceeds under eye drop anesthesia. Edwardes clocks it at 46 minutes and in contrast to the cataract surgery he feels discomfort but tolerable. His worst discomfort is needing to urinate and as the op is ending, not wanting to rush the surgeon yet unable to hold, he urinates on the OR table.
"All went well," Amano says and a few minutes later Edwardes is back in bed in his room with instructions to stare up at ceiling for an hour to assure the new cornea cells will be set in place by the small air bubble that is injected at the end of surgery. Then his starving body gets a supper. Yummy tummy.
The surgery is a success. It takes 3 to 4 weeks to start to see the vision clearing in his left eye and 3 months before it is clear like seeing through a cleanly polished glass window. His visual acuity in left eye improves from legal blindness to being able to very clearly see a low front dressed woman's cleavage and the dead-end between her thighs when she sits, in a skirt, carelessly facing him 8 or less feet away.
Before the surgery, the eye vision had become so misty he barely could walk in the street. So its post surgery clearing is a great good. And he still has his right eye with cataract that though it gives rather misty vision still has fair visual acuity in good light, allowing him to use computer.
It is 2 months after the final good result on left eye when Amano says "Now we do your right eye," Edwardes enters hospital, it is done, cornea edema develops 2 days later, and he is immediately put on list for cornea transplant donor. And 6 weeks later he gets the call "This is Yamagami speaking. We have another donor for you. Please come to hospital."
So he does and the cornea cell transplant is done on right eye but by 3 months after there is no good result. His right eye vision continues completely blurry. Why? He wonders.
Talking it over with Eddie, Edwardes goes over the events. And he realizes that he had noted something that at the time had not disturbed him but should have. It happened just after the call had come for him to be transported to the OR for the surgery and he is still in his hospital bed. As with the first - the left side - cornea transplant, a nurse inserts the IV catheter in his right arm vein below the elbow crease while he is in bed, and caps it. Then he is put on stretcher to take to surgery and at the nurse station another nurse connects an IV bottle to the IV catheter in his arm and starts the fluid dripping into his vein. At that point, he recalled, the something occurred. His right arm with the catheter in the vein is covered by the blanket that covered his body. So the arm is out of the nurse's view. The 2nd nurse, instead of checking that the IV bottle tube is actually connected to the catheter in the vein, assumed it was because it looked like it was connected, hanging over his right side and the tube going under the blanket. And then she opened up the pinch valve to allow a slow drip of fluid into his vein, or so she thought. But actually the fluid is running onto the side of his stretcher because of the non connection. When Edwardes arrived in the surgical suite, he now recalls, a 3rd nurse, a surgical one, pulled back his blanket and noted that all the fluid in the bottle had run out off the side of stretcher. At that, he remembered looking up at the bottle and with his good eye reading the big letters DIAMOX written on the bottle he was supposed to be getting but didn't get. The 3rd nurse, did not make a big deal of what seemed a small error. She simply connected the IV tubing of a new IV fluid bottle and this bottle was not DIAMOX but a 5% D/W, which Eddie translates as Dextrose Water. Professor Edwardes recalls, being very relaxed, a bit euphoric and thinking - Well, if the nurse is not bothered by the disconnection, why should I be? So he does not mention it to Amano as he gets rolled into the surgery. And he recalls, surprisingly, this 2nd cornea transplant surgery is twice as long as the first, and now, 3 months later a failure.
On hearing this story, Eddie says: "Ask Amano what Diamox does and why they give it before the surgery?"
A week later Edwardes does ask that and Amano says "It reduces the internal pressure in the eye and makes the surgery much easier than if we did not give it."
This strikes Edwardes like a bell. Immediately he explains the error to the amazed Amano, who says "No wonder I had so much trouble. No wonder the transplant failed."
Edwardes felt terrible. He hates to make even minor mistakes. But worst of all: this was a once in a lifetime that affects his greatest joy in the final years of life - near vision- reading, computer, cleavages and between thighs woman viewings. He sees it as his mistake-of-timing reaction. He should have been alerted by anything going wrong. He should have reacted immediately and called his surgeon's attention to it and then he would have been given a full IV infusion of the Diamox he missed getting, maybe delaying the surgery a little in order to give good result.
Amano, seeing Edwardes expression of dejection, says "Don't blame yourself. It is our hospital error. A nurse's error is ultimately my and the hospital's responsibility." Then after a pause. "But we can do another DSAEK and this time under general anesthesia - you asleep - certainly get a good result.
Edwardes face immediately clears. Uncharacteristically tears come. "Thank you, Sensei! He says, "Thank you!"
Two months later, Edwardes's cell phone rings. He presses the receive and "This is Yamagami ...."
This time the transplant succeeds and, three months after, Professor Edwardes invites Eddie and Ryo to his Homat for a celebration of perfect vision at age 100. It took several months and 5 surgeries but now he has the remaining nearly 14 years of a one-million-hour life to celebrate perfect far and near vision - cleavages, between thighs under dresses, books, baseball games in the bleachers. He can see like a 20 year old man again.
End of Chapter. Next click 17.2
Seminar - The Ending of the Cold War - Good...
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