I am a very trusting fellow. When I cross the street I trust the driver of the approaching vehicle to suppress whatever rage or hatred my appearance may inspire and not mow me down. I walk down the street trusting those within knife-range not to have a knife, or whoever has one not to be in the grip of an unfocused murderous passion, stoked by economic discontent, political discontent, social discontent, insanity or simple morbid curiosity (“What does it feel like to kill someone?”). I enter my neighborhood supermarket trusting no one has planted a bomb under the lettuce. I trust the lettuce not to be soaked in carcinogens. And so on and so on.
This is childishly naive of me, I know — but how else is one to live? It’s a terrible dilemma we’re caught in. A quick scan of any news outlet on just about any given day proves (if you trust the news outlet) that nothing can be trusted: Institutions are corrupt, individuals are unpredictable, nature is angry and getting angrier.
The dilemma is that, simply in order to live, we must trust what we know we cannot trust. We leave our houses knowing there are murderers and terrorists out there. We enter our houses, and our office buildings, knowing the walls may give way, the construction industry being rife with cost-cutting corner-cutting. We buy products that may not be sound, board trains knowing nothing of our fellow passengers or of the driver’s health. We frequent restaurants without knowing what goes on in the kitchen. If we’re ill we go to a hospital. Knowing nothing of medicine ourselves, and little of the medical professionals attending to us, we nonetheless commit ourselves to their care, generally without a second thought.
How can we?
In September, two patients died at Oguchi Hospital in Yokohama while receiving an intravenous drip. The drip was later found to contain toxic disinfectant. Accident? Murder? The investigation proceeds. There may be more to investigate than had initially been supposed — 48 deaths on the same floor in three months. Even for a geriatric ward, that’s a suspiciously high death rate.
Sunday Mainichi magazine reports strange goings-on at Oguchi Hospital. Between July 5 and Sept. 20, it says, Yokohama City Hall received five anonymous emails referring darkly to dark happenings: nurses’ aprons ripped, patients’ charts misplaced, drinks laced with bleach. Who would do such things? A disgruntled employee out for revenge? Who would expose them? The perpetrator taunting the authorities? A whistle-blower alerting them?
It may be that there’s a lot of emails like this in circulation, and if busy officials took them all seriously they’d have no time for anything else. In any case, “We took a wait-and-see approach,” Sunday Mainichi hears from Tetsuo Hama of the Yokohama municipal medical safety bureau. “I didn’t take the matter up with my superior. My assessment of the situation may have been too lenient.”
Whether the sordid malice the emails reveal has anything to do with the patients’ deaths is not known. What is known is that there’s a lot of sordid malice out there — a lot of disgruntled employees. It’s hardly surprising, with some 40 percent of the nation’s workforce stuck with part-time status and the accompanying seething frustration of going nowhere, no matter how hard they slave.
Malice and social issues aside, a hospital is a symbol par excellence of an institution whose workings are utterly mysterious to the uninitiated. Unless you’ve studied medicine you have no idea what they’re doing to you. Lately there’s a growing tendency toward explanation and “informed consent,” but the awesome complexity of what’s involved is a formidable barrier to serious lay understanding. So what do we do? We trust. We have to.
“They know what they’re doing,” we tell ourselves. Very likely most of them do, most of the time. On the other hand, the weekly Shukan Gendai, over the past several months, has been running an ongoing series of articles around the theme “Operations you don’t need; medicine you shouldn’t be taking.” Sometimes the point is surgeons’ alleged over-eagerness to practice their craft; sometimes it’s practitioners of very high expertise disagreeing among themselves as to what’s necessary and what’s not. What happens to you in your extremity could depend largely on whose hands you happen to fall into.
Gendai’s current issue (Oct. 15-22) mentions a squabble that’s not without its comic aspects. It pits university hospitals against private ones. The former, say the latter, treat patients as guinea pigs, value research over individual lives, are obsessed with novelty in the name of progress, and so on. The latter, allege the former, wallow numbly in old, established ways, are out of date and out of touch, and frequently inaccurate in their diagnoses.
“They know what they’re doing,” we say — yes, but who’s “they”?
Whoever “they” are, they are all facing an imminent threat to their own continued well-being, the magazine says. So, in consequence, are we to ours. Technological and pharmacological progress amaze us but raise a disturbing question or two: How much is life worth? Is it affordable? For whom? If for some but not others, what then? Is government-financed universal health care sustainable when, for example, the estimated cost per patient per year of the promising cancer drug Opdivo is ¥35 million? In two words, probably not. “Japan’s medical system,” says bowel cancer specialist Makoto Akaike, “is on the brink of collapse.”
What can we do but trust it not to happen? Overwhelming problems, paradoxically, seem to deepen rather than weaken trust. Mistrust is a luxury the floundering cannot afford. “Someone” will find a way out; “something” will turn up. Often it does; sometimes it doesn’t. Will it now?
Japanese voters, in two elections 15 months apart, accorded their government a remarkable show of trust, giving it a two-thirds “supermajority” in both houses of the Diet. What policies this trust rewards or seeks to encourage is unclear. It’s an extraordinary gift, conferred by a democracy upon an unabashedly illiberal government. Interestingly enough, the strongest support — the deepest trust — came from voters in their teens and 20s, the very segment that used to regard just about any serving government, let alone a conservative one, with cynicism. If cynicism has given way to trust, so much the better — unless it’s blind trust.
Michael Hoffman is the author of “In The Land of the Kami” and the recently released “Other Worlds.”
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