A Tragic Comedy in Ass Surgery

Some narative was inaccurate and corrected on the instruction of the author — Curzon

My post from last summer criticizing Japan’s medical system is still generating comments, so I thought it an appropriate time to share this guest post, authored by a friend and reader on his recent adventure through Japan’s medical system.

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Back in August, I began to develop a massively painful cyst under the skin situated above my buttock and wanted to see a specialist. The ordeal was a real pain in the ass.

My first mistake was going to a local dermatologist. Without diagnosing me, the doctor bent me over, lanced my cyst and squeezed a bunch of push out of it, then told me to stop by anytime! She’d be happy to drain out the pus that accumulated when it became too painful to tolerate. Nothing was mentioned to a permanent cure until I pressed her for a better solution. She seemed surprised — if I actually wanted the problem fixed, I would need to have the cyst excised. They would not be able to do this at the local clinic, so she then referred me to a university hospital.

The university hospital I visited is comprised of different specialty units. You begin at the central reception desk. Upon arriving, I filled out a pretty standard form at the reception counter and waited for about 30 minutes to hand it in. After handing it in, I had to wait for another 30 minutes before they processed it, finally handing me a patient card and referring me to the dermatology center — where I had to wait, again, for about an hour.

The dermatologist said that the only way to cure my problem was through surgery, in which I would come in, have the cyst removed, and then be sent home. I booked the surgery at the next available appointment. By the time of surgery, my cyst was about half the diameter of a golf ball.

You won’t be surprised to hear that ass surgery isn’t fun. The removal of the cyst means you have to be opened up in a humiliating position as if you are giving birth. During surgery, I couldn’t help myself from staring at all the cracks in the ceiling of the Soviet style architecture. If a major earthquake struck surely the building would collapse and leave me dead, with the added humiliation of firefighters discovering my naked body in the rubble in the position for ass surgery. When I wasn’t worrying about that, I was wondering in what decade the device they hooked up to stop the bleeding was manufactured — late 1980s, if I was lucky.

The doctor, with my ass opened up, began by saying “sugoi naa.” There are about a million things wrong with that. First, that’s not reassuring — it sounds like my problem is really bad, which is the last thing a doctor wants his patient to think. Second, it’s not professional. Third, it’s pretty humiliating. He then spent the next hour hacking away, removing chunks of ingrown hair and flesh, then stitching me back up and sending me on my way.

The wound itself seemed to heal fine, but the original problem was not fixed. Before long, the incision split open in two locations and started to ooze black pus. Charming. So I went back the following week, this time waiting for about an hour outside the dermatologist office before being called in. When they finally called me in, I was greeted by yet another doctor, whom I had not even seen up until this point, who told me that I would require even more extensive surgery, including a skin graft. A freaking skin graft. He then proceeded to explain that skin grafts are too hard for the dermatology section to take care of, so he referred me to the Plastic/Reconstructive surgery unit in the same university hospital.

I feeling a little nervous about the whole thing, but decided to go talk to the doctor in the plastic surgery division they recommended. After all, it was the same hospital, so it shouldn’t take that long, right? Wrong. I had to go back to the central reception desk, fill out much of the same paperwork again, wait three hours (all while sitting on my very painful ass) to meet a random plastic surgeon for all of five minutes who instantly said yes — you need surgery, skin grafts, and two weeks of hospitalization — when do you want to come in? I was taken aback by the lack of any explanation or reassurance to this procedure, and had him confirm that I did in fact hear everything correctly. He looked at me like I was a total idiot: ‘Yes. Two. Weeks’.

I have no medical education, but even I could see my problem wasn’t that bad. I went looking for a second opinion, and fortunately, a contact in the pharmaceutical industry in Tokyo recommended me to a specialist clinic, Aruto Shinbashi Proctologist Clinic. These guys do branding right — aruto is the Japanization of ART, which stands for Anal Rectum Treatment. (Imagine putting that on your meishi.)

This doctor was a specialist (finally) who seemed much more knowledgeable about butt boils. He even had pictures and explanations for my condition — he said that I most likely had developed a pilonidal cyst. In brief, through prolonged periods of sitting (I have a desk job), the sinuses in the area become infected, and masses of hair just curl up again and again underneath the skin producing massive amount of pus and eventually a cyst develops, primarily of ingrown hair and skin, that turns into a blister or wound on the surface of the skin.

He also came to me with a much better deal for a cure — he could fix my problem by surgery, without skin grafts, and only one week hospitalization. Sold! I had a much better feeling about this place, and decided that a week in hospital wouldn’t be fun but I had to have my ass problem solved.

Everything seemed to go fine, but there were typical careless accidents after the surgery that reminded me that when you are in the care of a Japanese doctor, even one who you trust, you have to fear for your life. The catheter they shoved in the shaft of my penis hurt like hell after they removed it. And they evidently pierced through a vein when they hooked me up to an IV, as the solution drained into my arm through the night and I woke up to see my forearm puffed up like a balloon.

But other than that, the surgery seems to have gone well, and I am currently recovering, trying not to sit for extended periods of time.

13 thoughts on “A Tragic Comedy in Ass Surgery”

  1. Truly painful anecdote. The ingrown hair / black pus combo almost spoiled my breakfast….

    Sometime after the original post had died down, I ended up looking into issues of comparative medical problems and found some points in a 2000 Journal of the American Medical Association article by Barbara Starfield at John Hopkins. The article generally praises Japan and has some scary statistics about the United States –

    12,000 deaths per year due to unnecessary surgery
    7,000 deaths per year due to mistaken provision of medicine in hospitals
    20,000 deaths per year due to other hospital errors
    80,000 deaths per year due to preventable infections in hospitals
    100,000 deaths per year due to mistaken prescription of drugs

    This is just deaths, the number of people disabled or debilitated is thought to be several times higher.

    This puts medical errors as the third highest cause of death in the US behind cancer and heart disease.

    Part of the problem is electronic records at hospitals (prevents drug perscription mistakes) – in 2007 Japan was 80%, the UK 89% and the US 28% electronic records.

    So unless things things have improved since 2000, I’m going to need to see something better than anecdotes to convince me that Japan is some kind of unique medical abattoir where people need fear for their lives.

  2. Ass surgery..what a pain in the butt.

    Many people don’t realize there are drawbacks to 100% government run healthcare. People think it great, everyone has free healthcare. Well, it’s not free and it often is poorly managed and has poor quality.

  3. Yes, yes, let’s bring current American political issues uncritically into a thread on Japan, Tornado. Right after M-bone provided us with some peer reviewed work that suggests we take anecdotal evidence with a grain of salt.

    I could tell you stories about poor service I received at some restaurants. What would that tell you about the free market? I could also tell you about the generally good treatment I’ve had in publicly-funded hospitals in Japan and elsewhere, but I doubt that it would convince you of anything.

    I very much enjoyed reading this post just for what it was.

  4. I’ve had really good and really bad experiences in the Japanese medical system. My main problem with the story here is that he took the recommendation from the original doctor. I would’ve done some independent research before taking advice from a doctor I didn’t trust. This is what happened in the end (no pun intended), and it seemed to turn out OK.

    I’d like to see a comparative cost chart to see what would’ve been paid in the US (and other countries) and Japan.

  5. It is a missunderstanding to say that Japan has a 100% government run healthcare system. Japan has a combined system with both government run and private clinics and hospitals, and a heavily govermnment guided private/public insurance system that pays for treatment. This kind of system, also used with variations in many continental european countries, generally do well in cost/ result analysis. Looking at the cost/result of a totally private system like the US, I think you willl find the Japanese system does quite well on both counts. I have generally good experience with Japanese healthcare (of course you have the occasional incomptetent doctor, but I’ve met those many places), and the cost is very reasonable compared to anywhere else, even if you have to pay yourself. They do however precribe way to much antibiotics, which results in many serious hospital infections. This problem has however only been successfully handled in some (almost) 100% government run systems like Norway.

  6. Well, the ass infection sounds unpleasant, but as far as his experience with the Japanese medical system goes, I’m not sure what he has to complain about at all. In the end he was treated effectively, relatively promptly, and although he doesn’t mention it, we can assume also at low cost. Yes, his initial doctor wasn’t great, but he went to another one and got good treatment. Well, he should have gotten a second opinion in the first place. Getting any kind of surgery after seeing only a single doctor is just dumb, sorry.

    He also complains about waiting a couple of hours in a university hospital to see a specialist as if this is an outrage. Well, boo hoo. Do you know how long it takes to see a doctor in the US without an appointment? Yes, being made to wait is always annoying, but let’s not forget that in the US you CANNOT see a specialist without an appointment, at all.

    I don’t want to make light of his actual medical problem or discomfort in general, as I know full well how a seemingly minor problem like that can spread, lead to larger infection, and get increasingly serious, and while he did have a bad experience with a single Japanese doctor, I don’t see a single thing in his story that can actually assign any blame to the system – which it sounds like worked very well for him – but rather the individual doctor.

    But the fact is, in Japan you can see a specialist whenever you want, if you are willing to wait around a little while – in the US you usually need to see a primary care physician and then wait several weeks to see a specialist, wasting a lot more time. And the part at the end – “there were typical careless accidents after the surgery that reminded me that when you are in the care of a Japanese doctor, even one who you trust, you have to fear for your life.” That’s true of ANY doctor. ANY surgery can kill you if it goes wrong, and EVERY doctor makes mistakes at some point. If you are going to imply that Japanese doctors are more likely to kill through malpractice, I want to see some actual statistics, as M-bone said, rather than just anecdote.

    That said, I appreciate you sharing your story as an illustration of the hospital experience in Japan, and as a lesson on how one needs to be more careful about an initial diagnosis before having even minor surgery.

  7. @Roy Berman

    “He also complains about waiting a couple of hours in a university hospital to see a specialist as if this is an outrage. Well, boo hoo. Do you know how long it takes to see a doctor in the US without an appointment?”

    Does that make it any better? What’s the point in saying “in other countries it’s even worse!”? Of course it’s always worse somewhere but that doesn’t make this situation good? I am from Germany and I am shocked that waiting in an hospital for hours if you want to see a doctor is considered normal.

    When I was in Japan, I developed some kind of cough and breathing problems. I went to an English-speaking hospital and when I finally got to the doctor I said “I have this cough and problems with breathing. Don’t know, maybe I have asthma?” and he just said “Oh! You have asthma! I’ll prescribe you something!” and that was about it. I got lots of different pills and sachets from the hospital and had to take all this medicine of which I had no clue what it was (it didn’t help either). That really puzzled me. He didn’t even examine me or asked any other questions to find out what my problem might be. Also he didn’t tell me what it was that he prescribed me. In the end I had some asthma spray sent over from Germany which actually helped. But the treatment in the hospital was just weird.

  8. “Does that make it any better? What’s the point in saying “in other countries it’s even worse!”? Of course it’s always worse somewhere but that doesn’t make this situation good”

    That’s a totally valid point in general terms, but since the people making these particular complains tend to be Americans, I think they deserve to be reminded how things actually work back home. Both (in fact, all) countries have plenty of problems with their health care systems, but those problems tend to be very different. It’s true that a small minority of people with great coverage in the US can get better care than in Japan, which is what privileged expats tend to be used to (and I should add, is what I grew up with due to my parents’ government job provided medical insurance), but I think it’s very fair to say that the average level of health care in Japan is higher – and is unquestionably FAR, FAR cheaper for the patient.

  9. Coco – this post is a direct follow-up of an earlier post that was an explicit comparison of the Japanese and American medical systems – so fair game.

    “a small minority of people with great coverage in the US can get better care than in Japan”

    I’m not even 100% convinced that is the case – I think that you roll the dice in both systems no matter what sort of coverage that you have. People with great insurance might not be any less vulnerable to incorrect prescription, for example. Larger hospitals may indeed have more mix ups and mistakes.

    One scary figure that I saw when I was looking up those numbers for the first comment was that only about 15% of New York doctors who have been the cause of FIVE or more malpractice payouts have been disciplined by the state board. There is no guarentee that these individuals are not working at “good” hospitals and, as has been controversial lately, “bad doctor databases” are not available to the public in most of the United States. You just never know.

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