A Kanzaki Country Doctor

One of the best books I have read lately is called, “An Irish Country Doctor” by Patrick Taylor. It tells a quaint tale of how a country doctor in Ireland becomes deeply entwined in the lives of the people in his community.

Today, I will tell of my experience with a Kanzaki country doctor. A bit of history: Kanzaki, in Saga prefecture, is where I live. It is far from the hustle and bustle of the big city of Fukuoka where I teach. I live there by choice. When my husband’s job moved to Saga City, we considered living there, but found our home in the more affordable town (now city, though nothing seems to have changed) of Kanzaki. We have now lived in Kanzaki for 6 years and have visited some of the small clinics for various family ailments.

In February, I visited the small clinic of a gastroenterologist in Kanzaki for the first time. I was having some bothersome stomach pain and was given some very effective medicine with the promise that “next time we can take a look inside your stomach.” I was suddenly very apprehensive because I had experienced the incredibly uncomfortable and embarrassing procedure of having a photogastroscope—a tube with a tiny camera on the end—inserted down my throat through my mouth and into my stomach 20 years before when we lived in Kumamoto City. The discomfort and embarrassment stemmed from the fact that my gag reflex went into overdrive when I had the camera stuck down my throat and started trying to vomit the thing out. On top of that, the disgusting sound of gas being belched up from my stomach was loud enough to make everyone in the waiting room lose their appetite. I certainly didn’t want to go through that again!! After that test, 20 years ago, I was convinced that I would rather die than go through that procedure again. However, 10 years later, the stress of being in graduate school and having two kids (aged 2 and 5) drove me back to the gastroenterologist in the City of Minamata, where we lived at the time. This time, the doctor told me that they put all of their patients under general anesthesia before using the photogastroscope. I gratefully slept through the entire procedure.

Fast forward to today. I’m over 40, so it is recommended that I have a yearly test with the photogastroscope to check the health of my stomach—and that nagging pain is back. I called yesterday and made an appointment to have my stomach “literally” looked at. The doctor has assured me that he uses the latest procedure, which means the scope is inserted through the nose rather than the mouth. He explained that it is much more comfortable than the oral way. He also explained that he doesn’t use general anesthesia because there is a risk of heart attack (myocardial infarction) for patients undergoing the procedure that way. I find myself inadvertently becoming very impressed with the doctor for his thorough explanation, and somehow I’m beginning to feel at ease.

Why? What is this phenomenon that takes place between a doctor and patient that causes the patient to begin to trust?

Well, dear students, let me tell you what it is. It’s communication. Yes! We were communicating. He was gaining my trust through his gentle manner and communication.

After checking my heart with the stethoscope, I was led into another room where the nurse took my blood pressure. “Ninety over seventy, quite low. Perhaps I can stay calm during this procedure since my blood pressure is so low,” I begin to say to myself. And then “Oh, please God, help me to relax and not gag! Please make the nasal entry an easier way for me! Amen.” I’m given a shot. I don’t know what the shot is for, but when I ask ,the nurse kindly explains that it’s to stop my stomach muscles from contracting during the procedure. She takes me into another room where she uses a nasal spray that will prevent my nose from bleeding followed by anesthesia through my nose that flows through and coats my throat. She’s very kind and thoroughly explains what she’s doing as she adds comments like “Oh sorry! That tastes bitter doesn’t it. Take another tissue.”

By the time my nose and throat are numb and we’re ready to start, I feel calm. Strangely calm. I feel completely confident that everything will be OK. Then the doctor starts the procedure. He deftly explains every step of the procedure. His voice is like a narrator telling the story as we go along. We’re in the right nostril, now the throat, there is the pharynx. We’re going down the esophagus, now entering the stomach.” I find myself translating his Japanese narration into English in my head and imagine myself teaching my students to communicate this way. It’s so smooth and natural. It’s just right. Once in a while I gag and the nurse rubs my back and the doctor says “go ahead and belch, it’s OK.” But the belching and gagging is very minimal compared to the traumatic experience I had 20 years ago. After the scope is out, the doctor explains each of the pictures he took. My stomach, and everything else we see is pink and healthy, aside from a few tiny spots of blood. Hooray! Diagnosis: “acute gastritis from stress, take these pills for one week, then take only when you feel pain. A very simple thing, I could have taken over the counter (OTC) meds for it, but I’m happy and relieved to know for sure that everything’s fine. And I’m happy to have met a very fine country doctor.

As I wait for them to call my name to pay and get my prescription, I look around at the other patients waiting their turn. There are many elderly people and I can hear the doctor raising the volume of his voice to be heard by a hard-of-hearing patient. He speaks to the patient like he knows her. Surely he does. He is a part of this community—an important part.

Before I leave, the doctor walks by and says “there is a lot of French Lavender growing in the garden outside. You can pick some if you’d like.” And my heart is warmed.

So, dear students, wherever you find yourselves in the future—whether it is a big busy city hospital or a tiny village clinic—you have the possibility to become a very important person to those you help. I hope that you will be an excellent communicator and a comforter. Because if even one person a day is comforted by you, you will have done more than many people get to do in a lifetime.