It’s the second week of a two-week break.  You’ve been to Mount Fuji, you decided a few days in Hiroshima would be too expensive after checking the cost of booking buses at short notice.  You’re also a little worried about the typhoon that’s about to rip through the west of the country, right over Hiroshima.

You are pondering other day trips around Tokyo and have a few ideas what to do with your few remaining days of freedom.  What do you do next?  Of course, you dislocate your shoulder.

It happened while I was returning up the stairs to my room with a cup noodle, at about 1am.  I had bought a steak and was going to cook it up but felt tired earlier in the evening and dozed off.  By the time I woke it was too late to cook but I was hungry.

I think my foot caught one of the stairs and I fell forward onto the wide step where the stairs change direction.  I was trying not to drop or spill the noodles, but they were in my right hand, I had to move my left arm forward into an unnatural position to break my fall.  It did, but popped out of my shoulder as I fell on it.

I knew straight away.  I’ve done it before, twice, in the same arm, maybe once a decade.  I managed to save most of the noodles but a few bits of food had jumped out and a little bit of sauce had splashed.  Normally the first thing I would do would be clean it up but I was in a lot of pain and only had one functioning arm.  After assessing the situation a few moments I gingerly retreated back to my room.  And, waste not want not, I ate the noodles (I was hungry after all, and figured I might be in for a long night).

I did feel guilty about the mess I had left and holding my hanging arm I went back out with a few pieces of kitchen roll to see what I could do.  But this is Japan.  Someone had already cleaned the mess up in the half-hour or so I had been in my room.  I don’t even know who it was to thank them.

I decided the pain was sufficiently great to consider this an emergency, and considered my options.  Luckily I had the wealth of the internet available to me and online translation facilities.  Unfortunately it was the middle of the night on a public holiday and everywhere was closed.  I tried the English Language Medical Emergency number I had written down and placed prominently in my room, but it only operates to 7pm.  I checked a map for nearby medical establishments but they were mostly closed.  I checked a couple of websites about how to access the emergency health services in Japan, and then called the ambulance.

In Japan, ambulances are despatched from fire stations.  The guy on the line had some difficulty understanding me, and I him, and things were further complicated when he couldn’t find the address I gave (which I knew was right according to the post office!) on his map.  He could find the building but the address I gave didn’t match.  He sent the ambulance out anyway.  He called back a little later to check the address again and asked if the ambulance had called me.  I said no, but they can’t call when I’m on another call.  I decided to just assume they were outside (there’s no windows from my room that I can check from), and very slowly walked down the stairs.

Oh before I did that, I made sure I had money, my ID card, my health insurance card, my phone, my passport and put on some outdoor trousers.  What I should have done was charge my pre-pay Visa card with more cash, because the 4000 yen remaining wasn’t going to get me very far.  But I was in a lot of pain and just wanted to get moving.

At the bottom of the stairs outside the apartment entrance three confused looking men in khaki uniforms were having some sort of conference, bathed in the red glow of an emergency vehicle light.  They stared up at me, shuffling down the stairs like Quasimodo, and I called out my name just in case they still weren’t sure they had the right person.  They opened up the back of their ambulance and had me sit down inside, I found a position where I could hold my arm without too much pain and started answering their questions.

They took my ID card and health insurance cards, which obviously had most of the information they needed.  I had also translated “dislocated shoulder” so I was able to say “dakkyu” so they knew it wasn’t broken (you don’t really need the word for shoulder when you can just point).  They took my blood pressure and pulse and checked I had no other problems or previous medical conditions.  They also established that I had dislocated my shoulder before in England, twice.  They didn’t really speak English but they had a medical emergency phrasebook to refer to and I’m getting quite good at predicting what people are saying in any given situation.

Two of them seemed to be checking which hospitals were open and had facilities for my type of injury – I don’t know if they were also checking which hospitals had English speaking staff, but I guess not, I didn’t meet anyone with even intermediate level English all night.  They said they would take me to the Tokyo Bay Hospital in Urayasu – at least I knew the way home from Urayasu and that it was only two stops along the metro.  Two of the men went into the front of the ambulance.  I grabbed a rail before the vehicle started and the third man smiled and said something and mimicked a rocking motion.  I guessed he was saying don’t worry, the journey will be quite smooth.  A few moments after the ambulance had started I reassessed that, and said “not smooth!”.  He chuckled.

It felt like a long ride but wasn’t really.  The third ambulanceman accompanied me into the hospital and gave all the forms they had been filling in in the ambulance.  I waited in a hospital waiting room – this process is no different from hospitals in England and presumably anywhere in the world – and eventually a triage nurse called me into one of the exam rooms.  The ambulanceman who had been standing behind me like a bodyguard came in too and had a word with the nurse.

This was my first experience of Ipad translation.  The nurse would speak Japanese into his tablet, and the tablet would translate it into a written English sentence.  About 50% of the time the nurse would look at the Japanese sentence and abort the translation – I guess the voice recognition software is just as fallible for Japanese as for English.  He generally just confirmed the information I had given the ambulance drivers.   He also gave me a green plastic folder with my patient details in, apparently it was my responsibility to keep hold of this and show it to each new department I saw.

I waited outside again – there were a few other people waiting with me, a couple of mothers with young children, an older man with a limp, someone with a bad cough.  There was a TV to look at but it was a Japanese show, I had no idea what was happening. Eventually I was called in to see a doctor.  Once more the ambulanceman came in too, but this time, after speaking to the doctor, he made his goodbyes.  I gave him a very heartfelt “arrigato”.

The doctor spoke a little English, but slowly and hesitantly.  For important questions and information he would use the tablet.  After the usual confirmation questions he said first he would give me some painkillers for the pain.  He told me to wait and came back with three pills which I downed easily – the accompanying cup of water was more welcome as refreshment than to help swallow.  He said they would take an X-ray to confirm the injury, and asked if I could lie down.  I misunderstood and moved to the bed – he said not now, later.

I kind of wished he would just push the chair I was sitting on to the X-ray room (it had wheels), but I had to stand up and follow him which was a little painful.  They took the X-rays – again, no different to the procedure in England, with the radiologist standing outside the room to avoid cumulative radiation.  Then I was directed back to the waiting area.

I noted they had 4 examining rooms, numbered 1-5, but no number 4.  This is another example of Japanese superstition with numbers.  4 is considered unlucky because the word for 4 sounds like the word for death.  I suppose if you are going to be superstitious about death, a hospital is as good a place as any.

After a longer wait this time, the doctor called me in again, showed me the x-rays and confirmed what I knew instantly, that it was dislocated.  He said they would put me on a drip to give me analgesia.  He didn’t tell me what would happen next, but I think it was obvious.

He led me into the ICU and had me lie down on a stretcher-bed.  A different nurse came and started fussing over me, putting a towel over my legs, checking I wasn’t too cold, taking my blood pressure and hooking me up to a respiration monitor.  He then hooked me up to the IV.  I’ve had a lot of needles in my arm from 30-odd blood donations, this wasn’t the most painful but more painful than most.  But after the analgesia started flowing I didn’t notice so much.  When he asked if it was painful I said “a little, but it’s ok”.  I didn’t want to be a baby about it!

They said I would want to fall asleep.  The question on the tablet was “Do you feel fuzzy?”  It seemed to me as though I was actually getting more alert the longer I lay there, although the pain from my shoulder was definitely reducing.  Even though one arm was dislocated, and the other hooked up to a drip and a pulse monitor, I managed to get my phone out of my pocket and grab a couple of pictures to add some colour to this blog.

I alternated between trying to make myself fall asleep and looking round to see what was happening.  There was a clock just within range of my neck movement so I knew it was about 5am.  I don’t know if I was dozing or just lost in thought about something but I suddenly sensed a presence on my left and flicked my head round.  I think this was a new guy – I’m going to go with “consultant” based on the tablet referring to “teacher”.  He seemed a bit surprised I was awake but started manipulating my arm – basically moving it around like a windmill.  It did get painful at certain moments and while I wasn’t screaming I doing the “tchatchatchatchatchatcha” thing to try and get through it.

At one moment there was a strange little snap-sensation and I yelped – I think that was the moment my shoulder went back in.  I can’t remember clearly but I’m pretty sure I was unconscious both previous times they put my arm back in.  He kept manipulating the arm and clearly wasn’t happy with it, and called over another colleague who helped him with pulling, pushing, stretching, until it was back the way it was supposed to be.  Straight away the pain went right down, and I knew it was back to normal – I wanted to use my other hand to feel it to make sure but that wasn’t possible with the drip attached.

They saw me lifting my left arm to test the feeling and movement and they told me to just relax and rest it.  They would shortly take me to x-ray again to check it had set properly.  I spent the next half hour or so just lying still, thankful that the painful part was over.  This time they wheeled me to the x-ray room on the bed, though they made me stand up to take the x-ray.  I had to use some hospital slippers that didn’t fit my feet, I commented “small Japan feet” and that got a laugh after a second or two!

After the x-ray they let me rest a bit longer, then came to take out the drip and put me in a sling (they had a bit of difficulty with that word, but I understood them from “triangular bandage”).  The doctor told me to wear it for 4 weeks, and ideally I should visit an orthopaedic clinic – they were closed this week for the holiday but I should go next week.  He would write me a letter of introduction.  He also said I had to pay for the bandage – it was 400 yen (£2.50?) and I should get one from the vending machine in the waiting room.

The first time I dislocated my shoulder I was given a sling and told not to use it for 4 weeks.  The second time I was told I didn’t need a sling, I could go back to work the next day, and I should use the shoulder normally to build up the muscles (though obviously avoid putting lots of pressure on it at once).  I presumed the different approaches were due to changes in medical guidelines based on what worked best.  But now I’m not so sure, as we’re back to 1990-advice.

The final part of the process was the billing.  I had to wait while the administrator calculated the cost.  The amount I would have to pay (excluding the bandage) was a little over 16,000 yen – roughly £130.  This is 30% of the actual cost of treatment (detailed on the bill), because of my health insurance cover.  For context, that is more than the entire cost of my trip to Mount Fuji and Hakone, but less than the cost of a one-way Shinkansen ticket to Hiroshima.

At least I have got a blog post out of it.  I didn’t have enough money on me and my card wouldn’t cover the cost, so I asked if there was an ATM nearby.  They directed me to one about 5 minutes away in a convenience store (in the circumstances it seemed churlish to worry about the 108-yen withdrawal charge).  They asked me if I wanted to book a taxi, but I felt fine walking (I was wearing my crocs) and established the station was only 10 minutes away.  Even at 6.30 am, the temperature was high enough to leave me sweating on the station platform.

I made my way home and after updating my social media, I suddenly felt ready to sleep.  I woke at about 2pm and decided I was ready for that steak.  I cheated and didn’t use the sling for the cooking and washing, but rested my arm in it when I wasn’t using it.  This time, I decided to eat the meal in the kitchen.  Better safe than sorry!