報道 - Take Your Shoes Off, Watch Your Head: 2012

There are defined groups of foreigners living in Japan. I'm sure this is the same in most foreign countries, but it's a bit of an inside joke within the community here.

1. The Prepared
These are the people who have prepared themselves for years. They've studied Japanese through high school and college, memorized kanji, read Japanese literature, and can tell you about various battles between noble families during the Japanese feudal period. They are prepared to find their ideological version of Disneyland when they exit Narita International and mold seamlessly into Japanese society, find a wife, and surrender the Mr. title to live as ____-San in the suburbs or mountain villages until the end of their days.

2. The Fanatics
A large portion of my fellow gaijin fall into this category. They love anime, ninjas, katana, karate, J-Pop and karaoke (usually in Japanese). They read every hiragana or katakana sign they see out-loud and are fueled by photos of neon lights and arcades they find on Tumblr and Kill Bill . Tokyo, Osaka, and Nagoya are the Meccas for these travelers. Most speak Japanese well and easily find their niche among the like-minded, but rarely stay for more than a few years.

3. The Idealists
This group is very pleasant to be around. They may or may not have planned to land in Japan at some point, but have always admired Eastern philosophy. This country is a place of solace; a place to escape the corruption and selfishness of their home countries. You'll find these people in rural areas, Kyoto, Nara, and other locales where tradition and honor remain strong parts of local culture. They see beauty everywhere and seek deeper meaning in all their experiences. Strength comes from shrines, temples, zen gardens and The Last Samurai .

4. The Wanderers
This small group of people are the globe-trotters. They've visited 165 countries and are in Japan for a short time to experience something different before moving along to their next exotic locale. They usually get along with everybody else and try not to step on any toes while they're here. After all, they aren't passionate about Japan in particular and are happy to admit that groups 1-3 are far more knowledgable. They'll pick up some of the language, just because they think it's fun or they want to be polite, travel extensively, and then quietly move along after a generally pleasant stay.

5. The Opportunists
These individuals have found themselves here for other reasons. Sometimes it's a job opportunity, the strong currency, or a significant other living in the area. Their reactions to Japanese life vary greatly from person to person. Some will migrate into another category over time, some will become cynical as the "microaggressions" (see previous post) grind them down over time, and some will eventually open a language school or import business and settle down.

When deciding whether or not Japan is right for you, it's important to consider the country's many faces. Everybody comes here with some notion of what they expect to find and all will be disappointed in some ways and thrilled by others. Think about which category you fall in so that you can find the best location for your taste. That will make or break your experience. Big cities feel like big cities and offer little of what groups 1 and 2 might be looking for. Small towns and villages have held more tightly to their ways, and offer an experience more tightly bound with the country's traditional past. Doing research online will help, but take advantage of any opportunity you have to talk to people in the country to get a feel for where you best fit in.

I’m currently in the middle of one of the more unique experiences I’ve had abroad. It’s something that is a real risk to all people living overseas, but it’s something I hope none of you have to experience during your travels.

Sunday afternoon footie

For the past year, I’ve been playing both club and pickup basketball on Saturdays and afternoon soccer on Sundays. Every weekend, I drove out to a little junior high school in Shinshiro for some casual pickup games with the local ballas. Many months ago, I wrote a bit about Japanese basketball and how this country’s formality manifested itself in sportsmanship. I loved this friendly, relaxed atmosphere. In early June, I drove out and suited up for one of the exciting nights when club teams joined us to up the competiveness a bit. We played for about 3 hours then decided to call it quits before we were challenged to one final game. During the last minute, I was chasing a break-away at full sprint when another player ran directly across my path. I planted my right foot to stop and avoid the disastrous collision of an American minivan and Japanese kei-car. As I planted, I felt my knee begin to slip outward. It felt as though the bottom of my femur was moving down alongside my knee joint. Fearing the worst, I took all weight off my leg and went tumbling to the floor. As most basketball, football, and soccer players do, I knew that ligament damage was likely to happen at some point. Not having heard a pop, I assumed by kamikaze dive had saved my knee from serious injury. I did a little practice driving in the parking lot to make sure I was able to get myself home and then made the trip without a problem. It was swollen but, all things considered, it felt pretty good. It was easy to be optimistic.

No size 14

The next day, I called my boss to tell him about the injury and ask if we could visit a hospital as a precaution. On Monday, his wife and I went to a little local clinic for a basic exam. I expected the doctor to tell me that my knee was hyper-extended or that ligaments were stretched or only slightly damaged. The doctor didn’t have access to an MRI machine, but was able to do a light exam. He asked if it was ok to drain the knee before the exam so that he could get a better feel for the damage. I agreed, expecting to see the normal fluid extracted. To my surprise, he drained a few giant syringes full of blood. It was at this moment I began to worry. He allowed my knee to rest for a few minutes and then did what is called the Lachman exam. The knee is placed at 30 degrees and the femur is stabilized. Then, the doctor places his hands behind the leg and pulls upward on the tibia. If the lower part of the leg moves upward, it’s clear that the ACL has been torn or ruptured.

uh oh

Two days later, I went to the city hospital for an MRI. The results confirmed the first doctor’s Lachman exam. My ACL was ruptured and my meniscus torn in two places. This particular injury doesn’t require surgery if a person is happy living with a weak and unbalanced knee. Walking, climbing stairs, and sometimes jogging are still quite easy when the swelling fades. For an active person or someone requiring any kind of rotating or pivoting during activity, reconstructive surgery is important to avoid the knee slipping and causing more permanent damage to cartilage or the meniscus.

It is important to note the difference between and ACL tear and ACL rupture. A rupture requires that a new ACL be built from either the patellar tendon or hamstring. Choosing the hamstring is more common for women as the patellar tendon is often too thin to take a proper graft without risking rupture. Some men choose this approach as well. The most famous example in recent times is Tiger Woods. The surgery requires tunneling through both the femur and tibia, placing a button at the top of the femur tunnel, and looping the piece of hamstring through the button. The patellar approach requires that a piece of the tendon be cut including a piece of the knee cap and piece of the tibia on either end. Again, a tunnel is drilled through the tibia and femur and the new ligament is threaded into the hole to take the place of the ruptured ACL. Having small pieces of bone on either end allows for the ligament to naturally take hold as the bone heals together. Famous examples of this procedure include Derrick Rose of the Chicago Bulls and Mariano Rivera of the New York Yankees.

The obvious choice to me was that I would return home for surgery. American hospitals offer some kind of solace to travelers and their families because they are understood. Medical care quality varies greatly from country to country as does the style of treatment. Japan, of course, offers a high level of care but follows a very different philosophy. I discussed my home hospitals surgeons with my mother (a nurse at said hospital with great insider tips) and met various surgeons in Japan simply as a means of keeping an open mind. Japanese hospitals are, for lack of a better word, very Japanese. They are structured, plain, and slightly militaristic. All patients shard a waiting room and slip behind a single door into the exam room when called. There are different wards as in American hospitals, but all are clumped together. It’s a chaotic scene for foreigners used to calm, manicured waiting rooms.

The two surgeons in Japan I chose as my favorites both had backgrounds in sports medicine and had spent time abroad studying in America, Britain, or both. After a long decision process, I elected to remain in Japan and have my surgery at Aoyama (Blue Mountain) Hospital with Dr. Oikawa. Not only was he my favorite surgeon in either country, but he had an extensive background in sports medicine as well as experience operating on foreigners and even spoke English, a bonus I hadn’t expected to enjoy. A little more than two months after my injury and following more than a month of preparatory physical therapy, I checked into the hospital on August 19^th and had my surgery the following day. The procedure lasted almost 4 hours. I awoke in my room expecting severe pain. Having had a nerve block inserted into my hip during the operation, my leg was completely numb. It was this way for about 12 hours. However, when feeling returned, I was surprised to find I only felt pain where the bone had been cut. It felt like a deep bruise inside the bone but was easily bearable.

I spent 3 days in a large, soft brace so that the swelling could recede to a manageable level before returning to my hard brace I had been wearing since July. I spent 9 days in the hospital going to physical therapy (li-ha-bi-li in Japanese) once a day and using the CPM (Constant Passive Motion) machine twice a day for 30 minutes each time. This was the first major departure from the care my younger brother had received for the same injury in America. He kept his leg at a slight angle for weeks before beginning to bend it. I started using the CPM machine two days after my surgery at 60 degrees. I moved up 5 degrees a day, each time waiting to feel the pain I was told to expect and each time being pleasantly surprised by the relative comfort and relaxation I felt. It was wonderful to able to see progress so soon after the operation. Eventually, I was able to get myself out of bed and use a wheelchair to get to the bathroom or to the rehab room. I spent those 9 days cruising the hospital in my chair enough that the nurses stopped calling me Coccia-san or Sesu-kun and began calling me Sanpo Sesu (Sanpo meaning “strolling”).

Mr. Seth

The week after my surgery, I check out of the hospital on crutches to spend another week in bed at home before returning to work. It was difficult to get around and I began to realize how spoiled I had been in the hospital. Slowly, I started to feel a bit more confident about putting a little weight on the knee.

Now in week 9 post-op, walking remains difficult and I often feel pain on the outside of my knee. This is likely hangetsuban (meniscus) pain I’m told which is less than comforting to hear. All in all, my recovery appears to be moving along just fine. Between 3 or 4 months, I’m told I may be able to start swimming slowly and carefully but all real athletic activity has been put on hold for at least a year. Next August, I will need to have another MRI to check that some kind of blood vessel filled membrane has covered the new ligament. It is only when this slow-moving membrane completes its embrace that the knee will begin to resemble what it was before. Until then, it is important to focus on regaining and maintaining as much muscle strength as possible as the leg muscles can also protect against further injury.

I was lucky to find a doctor that I felt I could put my complete trust in as this can be a challenge in any country. I’m happy I chose to remain in Japan. The care offered has been wonderful and hospital time offers you a great chance to practice Japanese. I may not be able to tell you about anything of real substance in the language, but I tell you a ton about the knee joint. People in the medical field, you’d like to think, all have some kind of caring personality. Being in Japan, this is only enhanced further. The people in the hospital were and continue to be wonderful. My operation night nurse worked a 19 hour shift starting mid-surgery so that she could ensure I was comfortable and had everything I would need until she saw me again. Even after celebrating my Japanese anniversary, this kind of selfless sacrifice still blows my mind.