A couple weeks after my first-ever ambulance ride to my first-ever hospitalization, I found myself thinking, “In an overwhelmingly frightful situation, what do I wish I’d known?”
Following several months of mononucleosis caused by the Epstein-Barr virus starting in May, I came down with febrile neutropenia — a condition where your white blood cells reach critically low counts, accompanied by a high fever. While mono is generally more of an “ugh” kind of sickness, it can on rare occasions cause dangerous complications such as EBV hepatitis and neutropenia (and I contracted both — lucky me!). In the latter case, the doctor determined the virus had killed 95% of my white blood cells, leading to my immediate hospitalization in a special clean room at the National Center for Global Health and Medicine in Tokyo. It was very much a “Bubble Boy” kind of situation.
In total, I spent six days on this forced holiday in the blood diseases ward. While I was fortunate to have a relatively short hospital stay, it was also a frightening time to feel my body flying off the rails.
Much like a legal will, a visit to the hospital is the last thing for which you want to prepare — yet doing so will save you stress and worry. The following do’s and don’ts are a couple tips on how to clear your plate, relax some anxieties and get down to the business of healing.
The do’s
Call an ambulance.
This seems like a basic task, and yet for many of us — especially us Americans who have been conditioned by hospital bill horror stories — the idea of calling emergency services feels mortifying, even selfish. My roommate and I called 119 for an ambulance once my fever had reached 41.6 degrees Celsius (107 F), an ambulance-worthy event by any measure, and yet I remember my shame, imagining I was taking an ambulance away from someone suffering a heart attack or a broken leg.
In the words of my roommate: Don’t wait until you are dying. You, the average Jane or Joe, are exactly the person for whom these ambulances exist (and ambulances are free, even for international visitors). Additionally, EMTs often have a hard time finding available hospitals due to overcrowding, so you might find you have a long, slow journey to actually seeing a doctor — another reason not to wait.
Bring a written and translated timeline of your sickness and any allergies.
Preparing a timeline of your illness, symptoms, diagnoses and allergies in both English and Japanese can be a godsend. Even if it's just to help organize your thoughts, a written timeline can help streamline your communication with your doctor and prevent anything from being overlooked.
In my own case, my illness had gone through so many strange secondary stages and complications that I felt I’d written a whole novel. But this is all the more reason a document like this can get you the help you need.
Check if your hospital has Wi-Fi.
Many Japanese hospitals lack Wi-Fi — particularly those in the countryside. Meanwhile, facilities in urban centers like Tokyo are more hit-or-miss. While there’s not much to do about a Wi-Fi-less hospital (except perhaps to ask a friend to bring you a pocket Wi-Fi), a hospital with Wi-Fi means you can stay in contact with the outside world and even entertain yourself with movies and digital books. Do check the Wi-Fi situation while getting admitted, and bring earbuds and chargers for your devices.
Bring shower and bathroom supplies.
Staying at an average Japanese hospital is a bit like flying with a low-cost airline: The staff are nice, but they’ll charge you for everything — even the water!
Bringing your own toiletries, shampoo, conditioner, body wash and towel will shave off extra costs, as well as preserve your own sense of dignity and normalcy. Showers in general can be a bit of a luxury in some hospitals (where sponge baths are the default). If you’re physically able to shower, I recommend making your wishes clear and bringing your own shower supplies.
Get a Payment Limit Application Approval Certificate (a 限度額適用認定証, gendogaku tekiyō ninteishō)
This is one of the most important and fundamental tasks a Japanese hospital inpatient must undertake. While most have to apply for it after being admitted (assuming it’s a surprise hospital visit), life is far simpler if you have one in hand before checking out and paying your hospital bills. The payment limit is provided by your city ward and will cap the overall medical expenses of the hospital trip according to a sliding scale determined by base fees and emergency services. Unlike other countries with nationalized health insurance, Japanese hospitals can be rather expensive (though nowhere near the ballpark of hospital bills for the uninsured in America!).
While I still ended up being set back over ¥100,000, this number would probably have been double if I hadn’t received the payment limit. Depending on your situation, payment limits can be applied for directly through the hospital or by a representative at your ward office. An approval certificate will reduce any medical fees for the entire month, so keep it until the end!
The don’ts
Don’t get sick on the weekend, and definitely don’t get sick on a holiday.
I say this half-jokingly — obviously, we can’t choose when we get sick or have accidents, yet I also remember with bitterness the extra complications from being admitted on the Saturday of a three-day weekend.
Most hospitals in Japan don’t take new patients on the weekends and don’t have 24-hour emergency room services. I could not find an ER or urgent care that would take walk-in patients. Calling an ambulance was my only way to access a hospital and see a doctor. Also, you often can’t see specialists until regular working days resume, which can mean a holiday-long wait.
Don’t go without an interpreter if you’re a non-native Japanese speaker.
This is aimed at the proficient-to-strong Japanese speakers like myself; the true beginners, I know, will think of this as a no-brainer.
Those who have studied and spoken Japanese for years can find it hard to ask for interpreting help. For me, being able to communicate competently at my bank, local police station or city hall is a matter of pride.
That said, you must understand you’ll encounter specialized medical terms in a Japanese emergency room, including words over which even a native Japanese speaker might stumble (I myself had never heard of “febrile neutropenia” before in English). Moreover, at this time there’s a good chance your language skills will not be at their best. I was a total baked potato when they wheeled me in; my brains were buttered mush.
Bring a friend to interpret (or arrange for your own personal interpreting service) and emotionally support you, making patient intake as smooth as possible.
Don't reveal your marital status if you have a companion helping.
I’m someone who is single and queer in a country that prohibits same-sex marriage, and who also lives with a masculine-presenting friend and roommate. There are many situations in Japan where, for convenience, we choose to masquerade as false fiances — or allow people to assume such. Finding an apartment to cohabit is one such situation; tackling the hospital is another.
My roommate was the true MVP of my entire escapade because, as my fake fiance, they had the same access as a legal spouse: signing documents, bringing clothes and bathroom supplies, applying for the payment limit on my behalf. Theoretically, if I’d been incapacitated, they could have made decisions by proxy, a role I very much trusted them with. They were also welcomed into the examination room soon after I transferred hospitals, a perk I’m unsure a regular friend would receive.
Being an out-and-proud queer individual in most avenues, I feel this is a necessary evil in a country without adequate LGBTQ support, and ultimately it preserved my dignity and expedited my hospitalization.
Don’t ignore the bedsore problem.
Bedsores are skin ulcers that develop after wearing a cast or lying in bed without changing position for too long. Severe bed sores are painful and even life-threatening.
I was shocked when, four days after I entered the hospital, bedridden and sleeping for much of the day and night, I began developing my own bed sores on my inner knees. I had imagined bedsores only afflicted the very old or weak: people in comas or nursing homes or the physically immobile. It further drove home the lesson of how fragile our bodies are.
Take care if you are hospitalized to keep active. Having a small pillow or other padding can help protect particularly bony areas.
Don’t go without seeing your friends and family.
My last advice is to stay connected with your support network, no matter how short and silly the visitation times may seem.
In the post-COVID era, many Japanese hospitals have either eliminated or severely reduced regular visitation hours. At the National Center for Global Health and Medicine, I learned they had only recently begun allowing visitors — albeit with a 15-minute time limit per person.
When three of my closest friends wanted to visit me, I discouraged them. I told them that they would spend more time filling out paperwork at reception than seeing me. My friends were adamant.
“There’s a ritual to seeing your friend in the hospital,” one told me. “It’s just what you do. Even if it’s just 15 minutes. Think of it as symbolic.”
That short time with my friends was one of my brightest moments throughout hospitalization. Recovering from medical trauma is a journey not just for your body but for your mind and spirit as well. Keeping in touch with your loved ones — through phone calls and texts if not visitation — is one of the most difficult and important tasks for a foreign resident in the hospital.
My first moments leaving the hospital were disorienting: I remember seeing the outside of my hospital for the first time, brushing by people, wandering into the noisy subway and lying in the grass in my local park. Even during a major illness, it’s good to remember that, outside, life goes on, and it’s waiting for you to come home.
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