Refuge of Last Resort

It is 9 o’clock on a freezing winter’s morning in Sanya, eastern Tokyo, a blighted downtown district that was once famed as a day laborers’ mecca. Now, it is home to thousands of aging men on welfare.

Already at that time, a local eatery is full of gnarled old men clutching cans of booze. Outside, a few others are squatting down, enjoying an early-morning pow-wow. A couple of blocks away past several down-at-heel doya (no-frills boarding houses), a motley group of guys are playing at dice on the sidewalk. All the while, a man in a black, knee-length down coat is quietly tracking the outsider’s movements.

Physically across from that al fresco casino, but light years away in other respects, is Kibo no Ie (House of Hope). Opened in October 2002 by Masaki Yamamoto and his wife Mie, the 21-room hospice is literally the refuge of last resort for people who are homeless, have no family bonds — and are dying. In a final irony, it is a place where residents whose lives have often been devoid of love and sympathy can receive plenty of both before slipping off this mortal coil.

In the mid-1990s, while he was studying theology at Sophia University in Tokyo, Yamamoto first launched a nationwide campaign to build “family houses” — facilities where families could stay while their severely ill children underwent inpatient treatment at hospitals far away from their homes. Now, he says, the four-story Kibo no Ie, which has a tiny chapel on the roof, is the embodiment of his longtime ideals on hospices.

“In Japan, the hospice movement started in the 1980s, with the opening of [palliative care units] at Christian-spirited hospitals in Osaka and Hamamatsu, Shizuoka Prefecture. But I had long harbored more romantic ideals for hospices,” Yamamoto said, adding that he is offering care not only to people facing imminent death, but also to those who have fallen through society’s cracks — or “who have maxed out their social credit.”

Yamamoto jokingly says his hospice is like a “department of diseases,” since he has housed nearly 70 patients with everything from HIV and cancer to heart disease, Parkinson’s and schizophrenia. Most are referrals from “hospitals whose social workers say, ‘Would you please take them? Sorry,’ ” he says.

Kibo no Ie has also served as a temporary shelter for “healthy” people with nowhere else to go — such as a woman with a personality disorder who was pregnant with her third child, but whose family rejected her because she abandoned her previous two babies.

The average length of stay at Kibo no Ie is about six months — and so far, Yamamoto has arranged the funerals of 30 people.

“It’s strange, but you get used to hosting funerals,” he said calmly, as he arrived recently for the funeral of a Taiwan-born man who died of lung cancer at the age of 80. He was taken to a Tokyo hospital by ambulance after being found lying in the street; nobody knew anything about him, except for his name and nationality. Then, when staff cleaned the man’s room after his death, they found a dozen faded photos — including one that looked like him as a young man holding a baby girl.

Indeed, residents of Kibo no Ie come from all walks of life, laden with colorful, though generally heart-rending life stories.

Nobody, for example, can keep track of the jobs that resident Masaaki Shibata has held, because he has simply had so many.

Born to an unmarried geisha, 72-year-old Shibata says he grew up in Tokyo’s downtown shitamachi district of Asakusa, where he was orphaned around the age of 10 during World War II and had been evacuated to his mother’s family home in Iwakuni, Yamaguchi Prefecture.

There, on August 6, he remembers watching the huge mushroom cloud rising in the sky as the A-bomb was dropped on Hiroshima.

Times back then were particularly tough, and Shibata — who has now lost his eyesight and has a severe immune-system illness — says he sometimes subsisted on tree roots. In Tokyo after the war, he also flirted with the underworld. Unfortunately for him, that career option soon saw him being thrown into juvenile penitentiaries after being caught dealing in hiropon (methamphetamine), a stimulant that was popular at the time.

Once back on the straight and narrow, Shibata says that he studied independently to become a licensed barber, and later a certified cook. That led to him owning a makeshift beachfront oden (stewed food) stall in Kanagawa Prefecture, before stints working as a cab driver, a photographer and an extra at a film studio. He even crewed on whaling ships, which took him all over the world, from San Francisco to New York to San Paulo.

Despite his checkered background, Shibata — a short man with a fondness for flashy sports jackets and jeans — is a popular fixture at Kibo no Ie’s weekly tea parties, where residents chat with each other or with staff and listen to the mellow strains of 1950s and ’60s stars like Yujiro Ishihara.

Some residents are more reticent — though that doesn’t mean they lack a story to tell.

One such man is Yasumasa Sato, 87, who was among the many Japanese who once used hiropon — in his case to overcome his fear of heights while working for around three years in the early ’50s as a welder in the construction of Tokyo Tower.

Before that, Sato had been a sergeant in the Imperial Japanese Army, and saw action in Manchuria, the Philippines and Singapore — where he was among the force that captured a heavily fortified British garrison in a surprise attack from the dense jungles of the Malay Peninsula; his enemy had wrongly assumed that no fighting force could approach from that side.

“We were all crazy in those days,” said Sato, a broad-shouldered man who is now blind. As he sat beside his bed, he recalled the war, saying that he spent pretty much most of the time “just thinking about how to kill people.”

“I killed quite a bit, with my bayonet. In hand-to-hand combat, no one could be in a normal state of mind. It was a situation where you either kill or get killed. . . . But now we live in a peaceful society, and I feel a nasty taste in my mouth. I feel the curses of people who I killed; their spirits haunt me. I still have nightmares.”

Sato became a POW at the end of the war, and spent the next 10 years struggling to survive in Siberian camps. Over the years, he says, he has tried to kill himself many times — most recently at the hospice, by trying to hang himself in his closet with a scarf.

“But the knot in the scarf came undone, and he ended up banging his head on the floor,” says Haruko Sato, who works at the hospice and clearly looks on the elderly man who shares her family name as if he were an uncle.

Sato has deep scars around his belly, he says, from the time he tried to commit hara-kiri in front of the statue of Meiji Era War Minister Masujiro Omura at Yasukuni Shrine in Tokyo.

“Why? Because I’m Japanese!” he answered loudly and forcefully when asked why he’d done it. “I was a soldier in the Imperial Japanese Army and I was taught to commit hara-kiri if I ever became a prisoner. I felt guilty for losing the war, and yet coming back to Japan.

“But I couldn’t die. You don’t die from just sticking a knife into your stomach — you don’t even feel much pain. . . . When I regained consciousness, I found I was on a hospital bed.”

Not surprisingly, dealing with many residents’ tangled lives is no easy task for staff at Kibo no Ie such as Mie, who works as a nurse.

As well as attending to residents’ physical and mental well-being, Mie says she has to look after them in other ways, too. Countless times, she says, she has had to stand between residents swamped by unpaid debts and loan-shark gangsters who mail threatening letters and call her looking to collect.

But though she has the smile and the voice of an angel, Mie says she can get tough.

“When a yakuza called us and said he wanted to talk to a resident, I told him the patient was asleep and was going to die very soon,” she said, giggling. “Another time I said: ‘Would you like to take the patient with you?’ “

In reality, though, money is no laughing matter at Kibo no Ie, as the hospice receives no government funding. Instead, it must rely on fees from the residents — who pay around 150,000 yen from their monthly welfare allowances for rent, food and utilities — and on donations of food, clothes and household goods. Nonetheless, expenses still fall short of revenue by around 10 million yen a year.

In addition to donations, the hospice relies heavily on the goodwill of dedicated volunteers like Carol Sack, a Tokyo-based Lutheran missionary who practices “music thanatology” there once a week.

The Minneapolis native is one of only 50 people who have been certified as music thanatologists after passing an intensive, two-year course run by the Oregon-based Chalice of Repose Project. In that program they study how to play the harp to help ease the physical, mental and spiritual pains of the terminally ill.

Sack has had some miraculous experiences with residents. Once, she recalled, she played her Celtic harp to a man with terminal cancer who was known for being bitter and mean to everyone. After she played a selection of tunes tailored to synchronize with a person’s pulse and breathing, the man completely changed, she said.

“I thought he had fallen asleep, so after maybe about 45 minutes, I stopped,” she recalled. “But then he sat up and took my hands, and he was crying and saying, ‘Arigato.’

“He told me, ‘That’s the first time in my life that I have felt so peaceful.’ “

When she returned two weeks later, she was told that the man had died just a few hours before, but that he had undergone “a 180-degree change” after her earlier visit, and was thankful to everybody.

“We never know when God is going to take a small kindness and multiply it 1,000 times,” she said. “That’s what happened that day. It wasn’t me, and it certainly wasn’t my music, because it’s so simple.”

For his part, the hospice’s founder Yamamoto, who lives next door with his wife and their black cat with a deformed leg, says that relationships between residents, staff and volunteers are lateral and personal — not hierarchical. Though he admits he has his bad days as well as good days — and has had three nervous breakdowns since he opened Kibo no Ie — Yamamoto insists that he wants to keep it the kind of home where anyone, he and his wife included, would be happy to spend their last weeks and days.

“We once had a man who went to a pachinko parlor nearby — while he was attached to a drip,” he said. “I think we are probably the only hospice in the nation that would allow such freedom.”

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