I was at the port buying a ferry ticket to the mainland when I first heard the news. “The doctor died last night in his bed!” someone said to me. “Komatta, ne!” Yes, it was problematic, but not necessarily for the immediate reasons you’d think.
There is only one medical clinic for the population of 550 people on Shiraishi, our island in the Seto inland Sea. Our very kind doctor, who was known to dispense medicine without requiring a medical exam, was 78. A darling diminutive man with a robust head of hair and a frail voice, he donned a suit every day and led a relentless life of doctoring, which may very well have done him in. Two days a week he visited outlying islands with declining populations where there were no longer medical practitioners. While he served our local populace four days a week, two of those days were open to patients from the island next door (of 200 people), patients who came over on the ferry as necessary.
More than a medical doctor, he was a prescriber of medicines and distributor of mental salves. When I went to him for a sprained ankle, he could offer only pain medication, and I had to wait a full week before I was mobile enough to get to a mainland clinic with an orthopedic surgeon, X-ray machines and crutches. When I went to our dear doctor for body aches, he prescribed rest. When I went to him with a bout of lateral epicondylitis (tennis elbow), he suggested nothing more than elbow R&R.
Every morning the faithful elderly under his care would line up outside the moldering clinic, a structure that doubled as his house. The islanders are prone to waking up early, and there was always a line of elderly, bent over like fishhooks, leaning on their canes or carts, waiting for the doors to open. It would take the doctor all day to work through a waiting room full of patients with tractable conditions. The waiting room possessed a social life of its own, as islanders from here and there ebbed in and out, gossiping among each other, each aware of the risk of becoming the victim of denigration themselves.
The doctor’s wife, who suffered from mental illness, had long ago moved off the island, but the stalwart professional continued to serve his people, even into his retirement. After all, if he didn’t do it, who would?
Indeed, now that he couldn’t do it, who would? Komatta, ne? Almost immediately, the mood had shifted from pity to alarm at the prospect of there no longer being a doctor on the island. I was startled and incensed that the islanders only had their own needs in mind. The absence of a doctor — the very thing that this kindhearted man had indefatigably worked so hard to prevent — had soon eclipsed the death of the man himself as the prime concern among his followers.
But in a polite society, hindering others is not looked upon keenly. The most inconvenient thing you can do is die, especially if people depended on you not to do so. It’s the patients who usually die, not the doctor.
It has been months now, and at the town meetings the old people are demanding to know why it’s taking so long to get a new doctor on the island. Why can’t they send a temporary medical professional in the meantime? Authorities from the local hospitals attend the meetings to try to explain things — the process of finding a qualified and willing candidate, the selection process, the board meetings, the red tape, the paper work, all to help appease the islanders — but the islanders are having none of it. The raddled residents are angry, and I expect that tomorrow they’ll have created a picket line outside the old clinic demanding our dear doctor be brought back to life.
In that circumspect Japanese way, rather than evaluating the current situation, the residents are focused on projected circumstances, asking “What if … ?” and “What about when … ?” — things that haven’t happened yet. I suppose that the elderly take worrying to a whole new level because their future is tomorrow and their distant future is the day after tomorrow.
The immutable fact is that the residents can still see a doctor; they just have to take a 20-minute ferry ride (with government-issued discounted, or free, vouchers for the elderly) to a clinic on the mainland. Is anyone actually in need of urgent care here on the island? No. If they did have a serious health condition, they would have to move to the mainland anyway in order to have access to hospitals with up-to-date equipment, not to mention doctors. Even a bad cut or wound requires a chartered ambulance boat ride (albeit free) to the mainland and the nearest hospital, which, in this maritime nation, has its own pontoon for arrivals by private boat.
In addition, the government-dispatched “hospital boat” carrying a crew of nurses and doctors to do routine health checks (exams for stomach and intestinal cancer, breast exams, X-rays, etc.) would still come to serve all islanders, the way it always has. The health boat offering o-bentō boxed lunches and hot baths for the elderly would still come once a month. And caregivers would still call on certain houses twice a week.
Sitting at the town hall meeting and listening to the residents spar with local authorities, it occurred to me that the issue here was not the sanctity of readily available medical care. What these newly orphaned patients were upset about was something deeper. They hadn’t just lost their doctor, they’d also lost their friend.
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