Japanese Healthcare Redux, the ER

May 13, 2010

In case you are wondering why I haven’t posted anything in Mysterious Orientations for a few days, it is because I have been spending a leisurely time in the caring hands of the Japanese healthcare system, specifically the Horinouchi Hospital of Saitama. It seems that some poisonous insect took an intense disliking to the outside of my left knee, and chose that moment go out in a blaze of glory. At least I hope he was one of those insects that bites the dust after he bites the knee, but I don’t really know, as I didn’t see the little charmer. All I knew at first was that my knee was painful, in the sort of way it might be if I had to play catcher for three innings at the company softball game. Also, there was a tiny weeping puncture mark just to the left of the kneecap.

By day two it had gotten worse: my leg was pink (like an annoying, but by no means dangerous, sunburn) from the knee to about halfway down the calf, and somewhat swollen as well. It hurt, too, with the intensity of what used to be known as an Excedrin Headache. I thought it might be time to visit a doctor, so I asked a Japanese-speaking friend if she would help (which, to be fair, basically meant her doing the whole thing) set up an appointment with a general or family practitioner the following day. “A what?” I explained the system of a family physician in the US, a “gatekeeper” who, if he or she is unable to treat you, refers you to the appropriate specialist. “Why not just go to the specialist?” my friend asked. But what if you don’t know what is wrong with you? Well, it turns out that you go to the ER of your local hospital, an alternative that is typically a) not covered by insurance stateside, unless it turns out to be a real emergency, and b) far and away the most expensive of all medical venues to obtain treatment. Still, no other answers were forthcoming, so I bicycled (painfully) to the hospital which, conveniently, is located about a half-mile from my apartment.

By this time, the girth of my left knee was about 4cm more than its sibling, a not inconsiderable amount, and quite warm to the touch as well. The doctor who examined me let out a grunt of surprise, that great Japanese catch-all exclamation, “Hwah!” He told me, through my trusty translator, that I would have to have a brace of blood tests, and an IV drip of some strong antibiotics. Additionally, I would require an assortment of pills, some cold compresses, and daily visits to the ER for the near future to monitor my progress. Oh, and no strenuous exercise, and lots of bed rest, two things I am fairly good at. So now I am on day four, and I am showing marked improvement, both to the doctors and to myself. My CRP, whatever that is, dropped from an astronomical 9-point-something down to 3-point-something (it is supposed to be 0-point-something…); two other of the critical factors were out of whack as well, but they smartened up quickly, and fell into line by day two. It’s only that cranky CRP that is still outside its prescribed limits.

The good news: day one, including the physical exam, a half-hour of face time with the doctor (a specialist, by the way), an IV drip, blood work, and all my prescriptions, set me back a bit less than $120 (I had raided my ATM for $400, my daily limit, and was concerned that it might not be sufficient). The encore visit, which was a shorter time with the doctor (albeit a happier one), plus the IV and blood work, was only $55. Days three and four, which as far as I could tell offered the same regimen as day two, ran $36 each. That’s the “retail” price, not the deductible or co-pay, but the whole enchilada. Are there really people left in the US who think that the American healthcare system doesn’t need an overhaul? If so, please have them phone their nearby medical center and request a quote on the above-referenced services.

In closing, I would like to upload a picture, to show you that even if I have not been able to blog for the past few days, I have not been a total layabout. Well, okay, I have been a layabout, but at least I have been a multi-tasking layabout:


Happy Mother’s Day

May 9, 2010

My mom passed away in 1992, on US Thanksgiving Day. It wasn’t Thanksgiving Day for her, as she was in Canada, where they celebrate the holiday about a month beforehand, due to the earlier harvest. She died, if not when she wanted to, at least where she would have wanted to, in the old family homestead, Version 2.0: a newly-built house with all the modern conveniences, at the water’s edge in rural eastern Prince Edward Island, just next door to the fifty-some-year-old cottage that had served as the site for many a childhood holiday for my extended family.

My mom was a huge fan of flowers, and our family homes both on the East Coast and in California were a riot of colors from early spring until the first snowfall. I was never a big devotee, I have to say; instead, I was an indentured servant, required on a weekly basis to weed, prune, water and dig, routinely jarring my arms and shoulders on hidden rocks, or smarting from an unexpected encounter with a cactus spine. I swore that if I ever graduated from high school and made it out of my parents’ house, I would never lift another shovel, rake or hoe. I did indeed graduate, and for several decades held firm to my senior-year oath.

My mother must have done most of the planting at the PEI house on her own, with a hand from my stepfather when heavy lifting or rock removal was required. Sadly, she didn’t get to see the fruits of her labors, as she died the first winter she was there. My stepfather kept the place for years, but failing health prevented him from being there much of the time. The house was falling into disrepair from being used only a couple of weeks a year, if that. In late 2004, around Christmastime, he told his five kids that he was planning to sell the place, and wanted to offer it to us first, if we were interested. It wound up that I was the one who bought it. My mother had wanted it to stay in the family, and I was ready for an abrupt midlife change of direction. We transferred the title at the end of December, braving an epic Cape Cod snowstorm to make it to the bank before it closed for the year.

And so, a month later, I found myself looking out across my new front lawn, my new snow-covered front lawn, in the dead of winter, in the dead of night. Just me and my good buddy, an English Cocker Spaniel by the name of Astro, the two of us surveying our new digs and marking our respective territories.  It wasn’t until several months later that I realized just how much planting my mom had done in her short time there. At the front door were a hydrangea bush, azaleas, morning glories, daffodils, and purple irises. Outside the kitchen window, overlooking the water, were lilies, some tropical-looking orange flower whose name escapes me, more daffodils, peonies, and probably some others I am forgetting. Like the house, the garden had fallen into weedy disrepair, but it had some of that faded elegance that you can find in, say, Tuscan ruins if you stray off the highways from time to time.

When I first came to Japan, I was completely flabbergasted by the proliferation of flowers, which seemed to grow out of every crack in the sidewalks or walls, in rich shades of crimson, tangerine, and ochre, and seemingly year round. I visited Nezu Shrine for the annual azalea festival, and I had a flash memory of my mother that was so strong I could actually smell her perfume—or perhaps it was just a trick of the flowers. It seemed that everywhere I went, her ghost snuck up on me, reveling in my newfound appreciation for all things floral. In Ashikaga, an hour or two outside Tokyo, there is a wisteria park, featuring the fragrant flowers in all the colors of the spectrum. There are dense tunnels of wisteria to walk through, with the blossoms hanging down from trellises just at nose level (actually that would be nose level for the Japanese, which meant that I had to duck to walk through them). And the piece d’resistance is a pale purple wisteria that is said to be the largest in the world, stretching some 600 feet from tip to tip.

My mom would have been in her element. She would not have enjoyed the subway and train trip to get there; she was always a bit claustrophobic and enochlophobic (no, I didn’t just rattle that word off the top of my head, I had to look it up; it means a fear of crowds), but once she arrived, she would have appreciated it in ways that will be forever elusive to me. So, here are some pictures, Mom. I think of you often.

Happy Mother’s Day!

The Queen of Patpong

May 8, 2010

When I first reviewed a Tim Hallinan book, the second in his series featuring gonzo Bangkok-based travel writer Poke Rafferty, I said: 

“OK, call me a sucker for thrillers set in exotic foreign locations, particularly ones with rampant corruption, triple-digit humidity and lazily seductive ex-bargirl protagonists. Guilty as charged; please let me serve out my sentence in the Thailand depicted by author Timothy Hallinan in his wickedly atmospheric new work, The Fourth Watcher.” 

I received an email shortly afterward, posted from Suvanabhumi Airport in Bangkok, from one T. Hallinan, thanking me for the review, and commenting that after waiting all night in the terminal for his crack-of-dawn flight, the review was “better than a quart of coffee.” 

Over the next couple of years, we traded emails, discovering along the way that we had a number of things in common: a fascination, bordering on obsession, for Asia; a group of writers whose work we both eagerly devoured as soon as it hit the stands (or in my case, often before it hit the stands); and a penchant for the bizarre and wonderful flavors of KitKat chocolate bars that show up in airports and convenience stores all over Japan (Apple Vinegar; Soy Sauce; Wasabi; Red Pepper; Roasted Corn; Baked Potato with Butter, I’m just scratching the surface here).

Tim’s latest Poke Rafferty book, The Queen of Patpong, will be out over the summer. I have read it and I can tell you this: it delves more deeply into the characters of Poke’s wife Rose, daughter Miaow, and friend Arthit than previous series entries have done. For more detail than that, you’ll have to wait for the review in the print issue of BookPage (or online at www.bookpage.com). I do have a bad self-shot photo of the cover of my well-thumbed ARC (Advance Reader’s Copy), which nobody has said I cannot use; so, in the time-honored tradition of asking for forgiveness after the fact rather than permission beforehand, here it is:

A couple of days back, I sent Tim a few questions about his connections with Thailand, and how they influenced the writing of the series; here’s what he had to say:

Where did your interest in Asia come from?

I think it’s genetic.  

My wife is Chinese , I write about Thailand, and Asia is my preferred continent.  A long time ago in Phnom Penh – maybe 1996, when not too many Westerners had found their way back into Cambodia – I was eating a croissant in a really good little French bakery on the riverside.  It was a dump, the walls cracked from the Khmer Rouge’s attempts to level the town, but the croissant was amazing.  The owner and sole employee – at least, the only one I ever saw – was a French woman in her seventies, white hair tied back so tightly it looked like it hurt.  I asked her what she was doing there and she said the revolution had driven her out but the moment she could return, she had.  I asked why, and she said, “Ah, Monsieur, I have a yellow heart.”  

That was the first time I knew there was a name for it.  I’ve had it since I was a little kid.  In fact, I gave my whole story to Poke Rafferty, my protagonist, in THE FOURTH WATCHER – how Poke learned, as I did, to read upside-down by scanning his father’s paper across the breakfast table and how the words ASIA and CHINA and JAPAN sort of blinked on and off for him (and me).  When I went to school I had to be taught to read right-side up.  Also in THE FOURTH WATCHER, Poke’s father, like mine, had spent years in Asia he never talked about, and I mean never.   

When I got a chance to go to the Philippines to work on a movie, I jumped at it.  Then I went on business to China and Japan, shooting shows in both places. 

How did you wind up in Thailand?

I was in Japan, working on a PBS documentary about the first Japanese tour by a Western symphony orchestra, the LA Philharmonic.  After touring with the orchestra for a couple of weeks, I was ready for a vacation in Hokkaido, where I’d heard I could sit up to my nose in hot water and watch it snow, since this was February.  I shared my plans with some of the people on the tour, and it sounded great to them. They wanted to go.  This wasn’t what I had in mind – I’d actually had enough of pretty much everyone – so I called my travel agent and had her book me somewhere in Asia where I didn’t need a visa.  That limited it to the Philippines, where I’d already been, Taiwan, which didn’t really interest me, and Thailand.  I got off the plane in 97-degree weather wearing a quilted jacket and a hat with earmuffs, and halfway across the terminal I saw the immigration guys falling off their chairs laughing at me.  I fell in love with the place.  I took an apartment within days.  

That was in 1981, when Thailand was much more open emotionally to foreigners.  Now we’re not so exotic, not so interesting, and also, of course, we’ve sent them some of the worst possible specimens of our culture, so the welcome mat has been sort of rolled up.  That’s mainly in Bangkok and the major tourist areas, though.  In the real Thailand, the people are still sweet beyond all expectation. That’s why it’s so infuriating that they’re governed so badly.  

Now I’m there between four and six months most years, but I’m actually living now in Phnom Penh, which has the advantage, for a writer, of not being so distracting.  If there were an annual World’s Most Distracting City award, Bangkok would win it year after year.  In Phnom Penh, I’ve got nothing to do but write.

How similar in character are your wife and Rose, and is there a Miaow-Mia in real life?  

My wife is a college-educated, American-raised Chinese and has nothing in her background, other than a brief stint as a Playboy bunny, that approximates in even the palest way what Rose went through.  But over the three decades of our relationship, I’ve learned what it means to be in love – something I knew nothing about, in retrospect — and whatever depth of emotion there is between Poke and Rose in the books comes directly from my life with my wife.  My family was devoutly WASP and while we all liked each other pretty well, direct displays of deep emotion were silently regarded as being in bad taste.  I never would have dared to try to write Poke’s marriage without without having had the good fortune of experiencing my own.

There was (and probably still is) a real Miaow, and that was her name.  In the 1990s I wrote a series of six books about a Los Angeles private eye, and I wrote them mostly in the Tip-Top, a restaurant/coffee shop on Patpong Road.  A little girl – maybe seven or eight – who sold gum in the evenings would come and press her nose against the glass, just completely entranced with my laptop, which was more of a rarity then.  After a while I waved her in and bought her a Coke, then put Pinball on the screen, and left her alone for half an hour or so while I walked around and tried to plot my way out of whatever box I’d written myself into.  Over the course of a few years, we got to the point where she’d show up once a week and I’d buy her gum and she’d eat something, play Pinball or whatever new game I’d installed, and then I’d give her the gum back and she’d disappear back into the crowd on the other side of the window.  Around 1997 I stopped seeing her, but I used her name and her physical description – and that fearsomely parted hair – when I began to write the Poke books.

I closed out my BookPage review of one of Tim’s books with the following paragraph, and it is every bit as apropos today: “As a book reviewer, or as a Japanese immigration agent referred to me, a “rittererry clitic” (soon to be the new job title on my business cards), I get countless new books to read, and never have to pay a cent for them. In fact, I have been known to become somewhat cranky at the notion of having to shell out my hard-earned cash, particularly at pricey international airport bookstores, where I most often find myself short of reading material. Tim Hallinan is highly placed on the short list of authors whose books I would happily pay retail to read; if you think about it, that has to be just about the highest compliment a book reviewer (or rittererry clitic) can pay.”

Left Side, Right Side

May 7, 2010

One of the first things a visitor notices upon arrival in Japan is that the locals, for the most part, drive on the left side of the road. I say “for the most part” because that custom clearly does not apply to bicyclists, who drive on either side of the road, down the middle of neighborhood streets, and quite often on the sidewalk. Somehow, accidents are rare, and everyone seems to proceed with a degree of caution unimaginable in the West.

Understandably, when you graduate to a motorized vehicle in Japan, you are expected to stick to the left side of the road, and of course driving on the sidewalk is out of the question, probably a good thing, on balance. So it was with some trepidation that I embarked on my first motorized Japanese experience last fall, as the pilot of a freshly minted Honda Today scooter, 50cc of raw unbridled power awaiting a mere flick of the wrist to achieve warp speed. Um, make that “walking speed.”

My previous two-wheeled conveyance had been a Honda as well, albeit a somewhat more manly one, a Nighthawk of exponentially more engine displacement and power, but I thought I would err on the side of conservatism this time around, and you just can’t get much more conservative than a 50cc scooter.

The left side thing proved to be less daunting than I remembered. For my premiere “a gauche” performance back in the early 1980s, I drove a then-new Jaguar XJ-6 from central London to Paris (fittingly, to the Left Bank), first dealing with driving on the wrong side of the road, then once in France, steering from the wrong side of the car. For a first-timer, this is akin to, say, driving from the back seat. I was borderline catatonic upon arrival in the City of Light, and I have little doubt that the effect spilled over onto my passengers and nearby traffic as well. I didn’t have another chance to test my left-side mettle until the mid-1990s, at which point I motored around Bermuda at the stately speed of 20mph, limited both by the legalities and by the hair-dryer-sized engine of the moped I rode. Clearly, this was the place (and the velocity) for learning about the vagaries of opposite side driving. It’s weird, though, the first time you come to a roundabout; every instinct is telling you “go counter-clockwise” and all the other traffic is doing exactly the opposite. My mother’s words echoed in my ears: “If everybody else was jumping off the Brooklyn Bridge, would you have to jump too?” Funny how those things crop up at the most inopportune times.

Anyway, as I  became a bit more used to the notion of driving a motorized conveyance in Japan, I got to thinking: how many places are there where folks drive on the left? And what percentage of the world’s drivers consider that the norm? Obviously, England and Japan jump to mind. If you look at a Mercator Projection of Planet III, by far the heaviest concentration of left-side-driving countries falls in the lower right sector, a broad strip extending from southeastern Africa to New Zealand, encompassing Pakistan, India, Thailand, Singapore, and Indonesia, some of the most populous countries in the world. From a population perspective, as of 1996, right-siders outnumbered left-siders by about two-to-one worldwide. Those are just gross numbers, though, not taking into account how many people in each country are actually drivers. As countries like India and Indonesia become more prosperous, the stats will likely tilt a bit more toward the left-hand-driving side of the balance.

Confusing the whole issue is that US cars are known as “LHD” (left-hand drive), because their steering wheels are on the left. UK and Japan home-market cars are “RHD” (guess what that means…and why). Go figure.

A few interesting factoids about left-side drive:

In my home province of Prince Edward Island, the change from left-road to right road drive took place in 1924. My grandmothers were both kind of scary drivers at the best of times, and all things considered, I am pretty happy not to have been on the road in PEI that day.

In Sweden, they changed from left-hand to right-hand drive overnight, at 5am on a Sunday. “Wow,” a friend of mine commented one evening over beers in a London pub, “that must have been strange, you know, to have it happen all at once like that.” We considered that for a moment or two, and then I replied, “Yeah, maybe, but it really isn’t the sort of thing you can roll out over a couple of weeks, on a road-by-road basis…”

The last two left-side-driving holdouts in the mainland Americas are Guyana and Surinam. Several Central and South American countries made the switch at the time of the construction of the Pan-American highway (Belize and Argentina, among others).

Colonies don’t always follow the leader: China drives on the right, Hong Kong and Macau on the left; the US drives on the right, Virgin Islands on the left; the UK drives on the left, Gibraltar on the right.

Bucking the trend to driving on the right, in September 2009, the Pacific island of Samoa made the switch to driving on the left, to allow Samoans to source cheaper RHD cars from Japan and Southeast Asia, and so that Samoans living in Australia and New Zealand can drive on the side of the road that is familiar to them when visiting their homeland.

Communications Breakdown

May 1, 2010

My brother Thane just sent out a Facebook post with a link to an eye-opening article from Slate, decrying the sorry state of broadband internet service in the US. http://www.slate.com/id/2252141/ . It seems that we have slipped from first place to somewhere in the mid-teens in just over a decade, behind Korea, Japan, Canada, and even Taiwan and Sweden (who both offer broadband access for under $20 per month!).  To remedy this, the FCC has a strategy in place, The National Broadband Plan, which delineates a set of goals to be met by 2020. Problem is, those goals have already been met and surpassed by several other countries, and more will be added to the list by the close of 2010. As Slate writers Sascha Meinrath and James Losey rather pithily point out, it is “the equivalent of the United States entering the Grand Prix with the goal of finishing last.” They go on to carp about deceptive advertising on the part of the providers: “We’d never buy a package of ‘up to a dozen eggs’ at the supermarket, so why are broadband providers allowed to systematically promise more than they deliver?” Anecdotally, I can add my two-cents’ worth: internet service where I live in Japan is far faster than any I have ever experienced stateside, and it costs about $25/month for unlimited usage.

Of all the areas in which it is possible to fall behind, this is one that America strongly needs to avoid, as the instant exchange of information grows more critical with each passing day. And, at the end of that day, the winners will be determined by the quickest reaction times to an ever-changing set of circumstances and challenges. The technology is in place; all that is needed now is a lot of loud yelling at the internet service providers to step up their game!