Saturday, September 28, 2013

The Motorcycle Accident, and the Aftermath

This may end up being a massive, boring post, but I think it is somehow relevant to the "sometimes useful" nature of this site. There is a massive lack of information on the net about the surgery process and recovery of an open reduction internal fixation (ORIF) procedure to fix a broken tibia and fibula. Nay, there is a massive lack of information from a fit 35 year old. Anything Google would turn up was from people in their 50s, who probably live their day to day life like I have for the last couple months; sitting on a couch doin' nuthin. So, um, if you are a dude with a relatively healthy body who breaks your leg and needs ORIF in Japan, this post is for you!

Also, I'll talk about how the cops suck and how to get your Japanese national insurance to work for you.

The Crash. I should just lie about the crash. But it was nothing bad-ass, nothing glamorous. I wasn't on some twisting mountain road in scenic countryside Japan. I was just driving home from work, a few kilometers from my house, when the driver next to me, who probably didn't see me, changed lanes suddenly. I slammed on the brakes, he clipped my front tire, and I went down. It was a hit and run, though there is a chance he didn't even know it. My bike has stock exhaust. And though the engine is 999cc of pure power, it runs kind of quietly.

So I'm lying in the road. A quick body check reveals that the entire inertia of the bike crash went into my lower leg. The crash was probably 20kmph, but it was enough to snap the bone up something awful. I also fractured my accromion process, one of the bones that connects stuff on your shoulder. I think I night have broken my right wrist a little, but decided to just keep that one to myself.

I was only half dressed for riding. It was a hot day, so I left the proper motorcycle jacket at home. The jeans and boots were sanctioned riding wear, though the low speed nature of the crash meant that road rash wasn't a concern.

My Kevlar-lined riding jeans. Made by Draggin Jeans, I recommend a pair. I will be wearing some armor under them from now on, though.

My armored jacket would have prevented the broken shoulder. Probably.

My knee-high off-road boots would have negated any injuries, but you can't really wear those on the street.

So this is where the fun began. Lying in the street, some nice people helped me to the side of the road. Then the cops came. If you've read my site for a while, you'll know that the cops tend to ignore problems when a foreigner is related. I don't feel like going into great detail, but the dude who knocked me down got away clean. This is a busy Japanese road, with cameras somewhere down the line, but the cops would rather I just disappear. They weren't dicks about it, they just didn't really even try to help.

The ambulance. So, ambulances in Japan are basically just expensive taxis. They are not trained like the EMTs of other countries. They aren't allowed to give any sort of medication. They don't treat, they don't stabilize, and they don't run red lights. But they will phone all the hospitals in the area to find one suitable for you. We nixed the first available one, a pricey boutique place that only had single rooms. Fancy room fees are not covered by your insurance, and a single could easily cost $500 a day. The next choice was up in Asagaya, about 15 minutes away. Yes, we discussed my budget before deciding on a hospital.

Oh, my foot is pretty much dangling from my leg, bones and nerves playing a nice little game of tag every time the ambulance slams on the brakes to let a taxi merge. The pain was intense, though nothing like what was to come.

The hospital. I should preface this. I've never been in a hospital in my life. Never broken a bone, never needed something removed, never. My assumption of the way this exact type of accident should go down is this:
  1. Quick visual assessment by the doctors.
  2. Massive amounts of pain killers given. Morphine and what not.
  3. X-Rays, followed by emergency surgery that day, or maybe the next.
  4. Hospital stay of a week or less.
How it went down:
  1. No medication.
  2. The most horrific X-Ray / torture room, something I couldn't even imagine. They needed multiple angles of my leg, obviously. Instead of slowly and carefully getting me into different positions, the technician simply called in a few dudes to roll me, spin me, and flip me whichever way they felt. The pain was unexpressable. I know, even with my lack of medical training, that if they had gone a little slower, supporting my dangling-by-a-nerve foot, the pain would have been at about 50%.
  3. The severity required a CT-scan.
  4. Consultation time. I was informed that I would need surgery. They could do this the following Tuesday; 4 days time. But first they took some blood. I held out my arm. Nope, we're taking it from the artery on the inside of your thigh, by your nuts. I would need to be put in traction.
  5. Imagine, dear readers, a needle inserted into your heel bone, followed by a discharge of liquid magma. This was to dull the pain of what came next. The drill. Through my heel. For the wire. Memories of the medieval torture museum I went to in Germany years ago come to mind.
  6. Weights were hung from my heel-wire, 7kg to be exact, and I was wheeled up to my room.
816 Leg.jpg
The leg on the day of the accident.

816 Ankle.jpg

Below you can see the fractured accromion process. It felt like something I would have walked away with if this had been the only thing wrong. Painful, but bearable. Hurt like a bitch to sneeze though!

826 Shoulder.jpg

The traction, aka torture device. When my foot was perpendicular to the bed, I could bear it. But it would naturally turn to the side. At about 45 degrees, the pain shot through me, and I would have to call the nurse to 治す it. Fix it. Rough.

816 Traction2.jpg
Here you can see the wire through my heel.

The CT scan is freaky!

Insurance. The doctors were, once I had been stabilized, down to business. They matter-of-factly informed me that if I didn't have surgery, a costly endeavor, that I would never walk again. You do have insurance, right? Ummmmm. . . maybe. You see, I signed up for the National Insurance Plan, as required of everyone in this country, some years ago. Then I moved. Then I moved again. Three times, maybe four. In all the hustle, I lost my card, and they lost track of me. It turns out, in this country, that you are meant to re-register every time you move. So, ummmmm, let me get back to you about that surgery.

I was given a Monday deadline to sort it out (the accident happened on a Friday), and surgery was tentatively scheduled for Tuesday. I remained calm, quietly thinking of who I could ask for the un-insured cost if need be (as much as $40,000 I was told), and waited for the ward office to open on Monday, when I had a trusty friend, a long-time expat, was ready to go to battle for me.

While I lay in traction-induced agony, the battle was won, provided I pay the previous year's monthly insurance premiums, about $800. If you live in Japan and have National Health Insurance, the fees of which are based on your salary, then you will know how little I earned last year.  But that doesn't matter! I'm insured!

I'll cut right to the chase about the cost. The National Insurance, for cases of very expensive procedures, has a co-pay of $800 + 1%. Otherwise they cover a straight up 70%. So for the month, with an un-adjusted bill of about $15k, I had to pay something like $1400. Not bad. And though I took a huge hit by being out of work for a month and a half (the life of a freelancer!), I won't have to sell the bike.

Here is the itemized bill. I was in the hospital for a few days in September as well, and that came to about 35,000 yen.

I'm curious how the costs compare to other countries. I know in the USA everything is dependent on your insurance; a good job means no hit to the wallet, no job means maybe you don't walk again.

The surgery. Pure bliss. As soon as they hit my spine with the nerve blocker, my lower extremities, if the entire lower half of your body can be called an extremity, went numb. They also gave me an IV of pain meds, against my wishes, that made me sporadically nap throughout the next few hours. The moments I was awake, watching the surgery on an overhead monitor, were fascinating. I know they put me under because some people might freak the fuck out at seeing drills and screws and blood, but once that leg was numb, I was as content as anything.

Two plate and about 20 screws.

820 Leg.jpg
The above is immediately after. Below is a month later.

923 Leg.jpg

After the surgery, I was wheeled back to my room and given an IV of pain/sleep meds. Thus began my 12 hours of hellish mind-fuckery.

It wasn't the pain coming back that was the main problem. It was all the factors of annoyance, things that kept me from relaxing in any way. I was thirsty beyond belief, having drank nothing for the past day. My back was sore, like I had been sleeping on an old mattress for a few days. And my brain was on another planet. If you ever want a good time, take ambien or eszopiclone or zaleplon or doxepin, and force yourself to stay awake. You'll be trippin' balls, son! Well, if you've just come out of major surgery, you don't want to be on a drug trip in any way.

For real, my brain had no control. I would try to form a thought, and then I would start thinking "purple bananas in space!" or "I can fly if I flap my hair", things that make no sense, but my brain was thinking they made sense. I've never had a bad drug trip before, but maybe it is something like this.

It was hella frustrating. I would have a crazy "I should paint the bedposts with razzleberry juice" thought, then my normal mind would kick in, trying to figure out why that was a good idea.

The nurses told me this was all normal.

No cast, just a bandage wrap for a few days.

The recovery. Skip the accident and traction and day after the surgery. On Wednesday I was pain free. Such is the magic of surgery. From then on, I can say that I felt totally fine, apart from the restlessness an active body feels when confined to limited movement. I even started stashing my pain meds. Laughingly weak, I figured they would serve me better in the future, after a night of clubbing or maybe the next time I do a really long motorcycle ride.

The recovery schedule was generic. One week and the bandages can come off. Two weeks in the hospital bed. Four weeks later and I can start bearing weight on the leg. I've read very mixed accounts of others with a similar injury, ranging from a couple nights in the hospital and leaving with an air cast, to months and months of bed rest. Not surprisingly, most information online is written by people with a negative story to tell, and most forum posts at medical websites are full of pain, and not something I recommend reading.

My friends are both awesome and jerks, at the same time.

Surgery scars just above my ankle. The wound the bottom, did my bone break out a bit there? I don't remember looking. This photo was taken about a month after the accident. Open wounds like this are of concern, as an infection here could seep into the bone and surgery, causing some horrific complications.

The feet, a month in.

The leg brace. After paying about $1000 for this thing, I showed it to my American doctor friend. She started laughing, quickly snapping a photo to send to all her doctor friends back in the States.

"I haven't seen something like this since our History of Medicine class! In a black and white photo!"


And there is a reason; this thing sucks. But it lets me walk. Remember, I broke my left shoulder, so the standard two crutch system wasn't going to cut it. I could go with a crutch on the right, and . . . this . . . on the left.

How does it work? Molded plastic pushes 100% of my weight onto the little divot below my knee. That tender little spot that is sometimes lovingly referred to as the funny bone. Funny because it feels kinda funny when you lightly tap on it. Not funny when rigid plastic jams into it with every step.

My friend giving it a try.

But practice makes perfect, and after a few weeks of use I can stand about 30 minutes with this before I need an ice pack.

Oh, and the guy who made this thing added a 2 inch heel to my Nikes. Dude, did you just ruin a pair of my favorite kicks!


I asked some American doctors, and they said that standard practice in the States is to stay off the leg, then start walking with a fracture boot. I didn't want to spend another $300 on another device, but these things are only about $40!

Product Details

So that sums it up. I'm still not walking, though I was given the OK at week 5 to put 10kg of weight on the foot. Next is 25kg, then 40kg the following week. It really, really feels like I could walk unassisted, but you don't want to be ignoring doctor's orders.

Stay safe out there everyone.

Tuesday, September 24, 2013

Sushi - Summer 2013

The rainy season ended in Japan, and a particularly mild summer rolled in. I know the stats tell otherwise, that this year was the hottest on record, but it felt a bit cool to me. Probably because I was in a hospital room or confined to my apartment for 2 months, both places being air conditioned and shielded from the outside world.

As for sushi, I was able to sample a few spots out in Kyoto. West Japan has it's own style of sushi; a more traditional and functional fare than your refined Eastern style. Preserved in vinegar, the fish is then pressed with rice. This heavily seasoned dish can be stored much longer. Functional.


A no-name shop in the wooded forests north of Kyoto. Just a little shack with a little old lady selling nothing but this one thing.


Awesome. This is saba, the most common of the preserved fish. Look for the 鯖 kanji. Apart from saba, other popular fish prepared in this style are ayu - 鮎, tai - 鯛, and hamo - 鱧.


A massive festival in Kyoto meant that it was tough to find an izakaya with seats.


But when we did, some more 鯖 was definitely ordered. Lots of restaurants will take advantage of the oiliness of this fish and slightly roast the skin on top. A traditional edomae sushi shop in Tokyo would never think of using a blowtorch in their kitchen.

There is a secret izakaya in Kichijoji that does this. You should go.


Gion Izuju was lauded as the best Kyoto sushi shop over at the most prominent English foodie website for the region. I don't recommend this spot. I'll explain.


Situated in the heart of Gion, right across from Yasaka Shrine, this place gets a ton of foot traffic. Suffice it to say their clientele is probably 80% tourists. When I walked in the shop, the staff stared at me for about 15 seconds with the kind of stare reserved for someone who owes you money. Then she did the universal hand gesture for eating and said, "Eat?" It was awkward.

The menu is long and full of interesting kanji. When I was deciphering, they came by and threw an English menu down, nothing spoken. Lame.

I know that due to the touristy nature of Kyoto, everyone assumes that white boys don't speak a lick of Japanese. So this might be more of a Kyoto problem than just a problem at this shop.


The sushi was tasty and cheap, though. About 1500 yen will get you a couple fish. Ayu and saba for me.


If you want to try it out, get a to-go pack and go enjoy it while you people watch in Kyoto, and skip the random service this place had.


See you in the fall!

Friday, September 06, 2013

August 2013



The first week was spent at camp. The 2nd week being lazy in my apartment because it was hot. The 3rd and 4th in the hospital.


September is looking to be a lot of downtime as well. Such is life.



Still haven't cracked this one. It is from one of the coastal towns that was wiped out by the tsunami 2 years ago. Support these towns by drinking their product.



Traction. Yeah, they drilled a whole clean through my heel, then anchored 7kg of weights to it to keep the fracture from healing. The second they hit me with the nerve blocker to the spine was the happiest I've been in years.

Traction, people.


All better!

Wednesday, September 04, 2013

Hospital Food in Japan

Driving home from a private English lesson on Friday the 16th of August, a random black car decided that they deserved to be in the right lane instead of me. I slammed on my brakes, they clipped me, I went down, they drove away. It was a low speed accident, but when the onlookers asked if I was ok, I pulled up my jeans to check. Not ok. Not at all. Fractured Tibia and Fibula (or is it Tibula and Fibia?) The kind of visual that induces vomit.

What followed was two and a half weeks in the hospital, surgery, and a lot of down time.

So if you were every wondering what hospital food in Japan is like, I took some photos. It was surprisingly tasty. Breakfast (not pictures) was crap. Two pieces of white bread, some margarine, some jam. Edible though, with the provided milk. Lunch and dinner was always rice, soup, and a protein sort of thing.



On occasion the lunch was a noodle dish.


I'd say fish was a good 2/3 of the time.



Portions weren't the best for my 80kg frame. I quickly lost 5kg.



By the 2nd week, I was able to move around, barely, in a wheelchair. Did I mention I also fractured my shoulder? Well I did.


So all movement was restricted to 100% right leg and right arm. Try it sometime!



By the way, hospital food isn't covered by the insurance, but it was pretty cheap.


I only paid about $120 for almost 3 weeks of quality meals.


Don't ask me how much the surgery came to.


(15 grand)


I'm back home now, blogging from the comfort of my own room.


I'll try and write up something more substantial, as the whole experience was new to me. From another encounter with inept cops (hit and run? Sorry, there aren't any cameras at this intersection), to the joys of Japanese ambulances (they aren't allowed to administer medication), to the Japanese public health insurance system (I'm out some cash, but nothing life changing).