Adventures in Health Care

In March 2020 I had a long-awaited surgery to repair a left inguinal hernia. The hernia had been a bother since the Autumn of the previous year so finally getting it done was a relief. The surgery itself was rather straightforward; I was given anesthesia and while I was out the surgery was performed via a laparoscope. After a requisite few hours to recover from the anesthesia I was given a fistful of opioids for the post-surgery pain and two days later, I was back to my regular routine save for yoga stretches and resistance training that I needed to wait for a few weeks before I could resume. My out-of-pocket expense for the surgery was about $200 and my employer-provided health insurance covered the remaining $7000 cost of the surgery. From diagnosis to surgery took approximately 3 months.

Fast forward to the late summer of 2022. We had been in Japan for about 6 weeks when I noticed symptoms not unlike my previous hernia but this time on the right side. I had just received my kokumin kenkou hoken (National Health Insurance) card which costs about $80 a month for coverage. Armed with my newly acquired health insurance, we sallied forth to the hospital around the corner from our home where after some poking and prodding by the attending physician and an ultrasound a right inguinal hernia was diagnosed and surgery was scheduled for 14th December at the nearby Shonan Byouin in neighboring Kamakura. I had pre-surgery consultation 2 days before the operation and on the morning of the 14th, I dutifully arrived at the hospital 90 minutes before the surgery start time so I could be prepped.

It is at this point the differences between my previous hernia surgery and this one began to emerge. I  was guided to a changing room so I could don my surgical apparel. Once suitably attired I laid face down on a gurney so a spinal anesthesia could be administered. The net effect was to completely paralyze me from the waist down, a very strange experience and one which granted me greater empathy with paraplegics.

Once the anesthetic had firmly taken hold, I was wheeled into the operating room, flipped over onto the operating table and prepped for the coming surgery. Since I was wide awake, pains were taken to make certain I could not observe the surgery even though I had asked out of curiosity if I could watch. After a final consultation between me and the attending surgeon, a young woman named Doctor Akiyama, the surgery began. 

As the surgery began I became vaguely aware of tinkerings in the area around my nether regions. The sensation wasn't painful but I was certainly aware of something. The operation continued and after approximately 90 minutes the surgery was completed and post-operative clean-up was performed, after which I was wheeled to the recovery area.

The prerequisite for leaving the hospital on the same day as the surgery was that I would have to be able to walk on my own power and urinate. If I was unable to do either then it would have meant a night in the hospital. I was very much motivated to go home the same day as I had spent a few sleepless nights in the hospital and did not want to repeat the experience. The anesthesia began to wear off an hour after the operation and after about 4 hours I was able to move my legs and become mobile once again.

I should point out that Japanese medical institutions are very conservative when it comes to the administration of pain meds. Unlike in America, where opioids are freely dispensed, in Japan such medications are only given in extreme circumstances. Since my condition was deemed not as such I was given loxoprofen, a non-opioid pain killer not unlike ibuprofen but stronger. 

The moment had come; the anesthesia had worn off and I could move my legs enough to get up and walk. I gingerly edged my way off the gurney and with Ikuko's assistance, I stood up and began to walk. It is no understatement to say the level of pain I felt at the moment was the most intense I had ever experienced. I forced myself not to cry out and tears were streaming down my face with the effort. I slowly made my way to the lavatory and was just able to urinate. Both prerequisites had been met so I would be able to go home to convalescence. After a few hours of waiting for the release process to be completed and pain medications to be prescribed, I was given the OK to go home.

Both surgeries had their pros and cons. In California, the surgery was seamless and post-operative pain was kept in check by the opioids I had been prescribed. The primary reason I was able to have the surgery though was because I had employer-provided health insurance. In Japan, post-operative pain was more acute but the out-of-pocket cost for me was just what I pay per month for health insurance. (This amount is based on one's ability to pay, btw)

For those who are interested, here is a video of a right inguinal surgery: Right Inguinal Surgery