[If you haven't already read Part 1, it's here.]

We’ve been home for a few days now. I wrote most of the following text while flying home. I should mention that Tracie found a factual error in the first part of the story: she did not receive IV steroids in the ER in Tokyo. The doctor decided that pills were enough. (No, that detail doesn’t have much bearing on anything, but sometimes I look back at this blog to refresh my memory, so I might as well make note of that error.)

As you might guess, neither of us slept particularly well in the ICU that night. I probably slept better than Tracie–I usually do, regardless of the circumstances–but I woke up suddenly a number of times. I’d lie there listening to machines beeping softly at different intervals and distances and try to think of the sounds as some minimal/ambient installation piece, but the punctuation of occasional groans and nasty coughing kind of ruined the musical possibilities. I’d try to ascertain whether Tracie was awake or asleep without waking her. I helped her get to the restroom once, and later one of the nurses did the same. I must’ve been sleeping pretty well at that point because I didn’t notice her absence. Fortunately the restroom wasn’t far from her bed, but I have to say that shuffling past other ICU residents, in the semi-darkness in the middle of the night, with Tracie trailing the IV stand and wires for various monitors, was kind of strange. It was a far cry from sleeping in the Crowne Plaza Hotel, which is what we were supposed to be doing that evening.

Backing up slightly, the most interesting part of this entire episode is that it was finally determined what was causing these systemic reactions: it was the carbamazepine. It took three trips to the ER (in three different cities) to figure this out because it’s a somewhat rare reaction. Since Tracie has so many other allergies, it was deemed more likely that she was reacting to something else–something she accidentally ate or some environmental factor. On the first occasion, our best guess was that it was some contaminant on the surface of an apple she ate for breakfast. On the second occasion, Dr. Gunshin’s belief was that the skin rash was triggered by sun exposure, because sun sensitivity is common in people taking carbamazepine. Note, however, that the skin rash had actually started some time ago, but nobody who looked at it thought that it was particularly a concern. It wasn’t until the third reaction that everyone agreed that it pretty much had to be the carbamazepine. The timing was too coincidental, Tracie hadn’t eaten anything that she hadn’t eaten previously that day, and a neurologist in the third hospital confirmed that the rash she had on her face and shoulders looked like a carbamazepine reaction. (He didn’t say a whole lot otherwise, at least not directly to us–his English was pretty limited.)

Once it was figured out what was going on, the question was what to do about it. Recall that Tracie was prescribed carbamazepine in the first place because she developed trigeminal neuralgia, which was excrutiatingly painful by the time she sought treatment. Gee, I guess I never blogged about that event. It was a good one, too: things came to a head on the weekend before Christmas. She described it as feeling like having root canals on all of her teeth on one side, simultaneously, without anesthetic. On Christmas Eve, we ended up in a hospital-lab waiting room waiting for blood-sample instructions to be delivered from the on-call neurologist. I ended up driving back and forth across town to get a prescription filled while Tracie was literally doubled over in pain. The first medication, gabapentin, completely threw her for a loop; she saw “space portals opening in the back yard” during the peak. Eventually she saw her regular neurologist and ended up on a low dose of carbamazepine; the initial dose was effective but completely sapped her of her strength. Good times, that Christmas season.

So anyway, the unanimous decision was that Tracie was to stop taking carbamazepine. I use the word “unanimous” because eventually a sort of committee formed around Tracie’s bed, consisting of four doctors with varying degrees of proficiency in English, ranging from limited to almost none (but still far, far better than our proficiency in Japanese, which is negligible). The one who was the most proficient would talk to Tracie and then act as an interpreter for the others, although sometimes one of the others would chime in when they recognized some random word. I’m fairly sure that I cannot accurately convey the anxiety this caused me, to say nothing of Tracie.

Next it was decided that she’d stay in the hospital overnight–a decision that wasn’t unanimous intially but she realized pretty quickly that it was foolish to do otherwise and consented. We had to make sure that the reaction had really been stopped with the steroids; it would’ve been something of a hassle to get back to the hotel and have everything start all over again after the initial dose wore off.

Finally, we decided that we’d go back to Tokyo because the doctor there spoke very good English and hence was better equipped to care for Tracie if the need arose again. Our original itinerary had us staying in Kobe for three nights, then going to Matsue for a few days, then spending a few days in Kyoto, then returning to Tokyo for a night before flying home. Matsue is a smaller city several hours away by train from Kobe on the other side of Japan’s main island. (Kobe itself is three hours from Tokyo by train.) It’s a delightful city in a beautiful setting, but it has fewer English speakers than other parts of Japan and probably less-sophisticated hospitals than the larger cities. Hence it would have been downright stupid of us to go there, given Tracie’s condition. So, we elected to spend our scheduled amount of time in Kobe–two more nights–then return to Tokyo.

Tracie was reluctant to stop taking the carbamazepine without switching to something else to keep her trigeminal neuralgia in check. Eventually the doctors in Kobe prescribed Lyrica, 75mg twice a day. Tracie tried to explain that she reacts very strongly to most medications, and that taking less than the usual dose was probably prudent. The doctors didn’t much like this suggestion, maybe because of a recognized cultural tendency to believe that there’s one particularly correct way of doing something, maybe because they still hadn’t quite come to terms about how to care for a feisty blonde female gaijin who seemingly knew as much about medicine as they did. Fortunately we received the first dose in a blister pack of three 25mg tablets, so Tracie took one and I quietly pocketed the rest.

That was at about 5:15AM the next morning. The agreement was that she’d take the first dose at 5:00AM, the doctor would come by a bit later to assess her condition, and she’d be discharged at 6:00AM if everything was copacetic. 5:00AM came and went without anyone appearing with the Lyrica, so we pointed out to one of the nurses that someone was supposed to supply us with meds. The lack of attention didn’t bode well.

6:00AM came and went with no sign of the doctor. At about 7:00, breakfast–so-called–appeared. Tracie couldn’t eat any of it; some of it could have killed her, some of it she can’t eat because of other non-allergy restrictions. I was quite hungry so I ate the less-awful parts of it.

By 8:00AM the doctor still hadn’t appeared and we more or less ran out of patience. We’d figured out by then that Tracie was fine. We’d also figured out that we had no internet access and no international phone access. This meant that we couldn’t do several things that really needed to be done ASAP, such as contacting Tracie’s neurologist back in the states, contacting our travel agency so that they could arrange accomodations in Tokyo for us, contacting our friends in Kobe who were going to meet us at a train station near their house early that afternoon, and finding some food for Tracie. The latter was arguably the most important: you can’t very well expect someone to recover from a systemic allergic reaction and continue metabolizing the agent that started it if you don’t feed them. I politely cornered the nurse and got out of her that the doctor had put in Tracie’s record that she was to be discharged at noon! Did I say that we had more or less run out of patience? Tracie was definitely in the “more” side of that statement now.

Thus ensued a rather tense exchange. Tracie informed the nurse that we were leaving, regardless of the doctor’s orders and absence. The nurse said that she couldn’t. Tracie said that she most definitely could. The nurse indicated the IV still stuck in Tracie’s arm. (She hasn’t been hooked to the monitors for awhile; nobody bothered to reconnect the wires after her second trip to the restroom. I plugged stuff back in when I noticed this, but the machine didn’t resume its little beeping and wavy-line activities and I wasn’t about to start punching buttons on it randomly since the UI was in Japanese.) Tracie told her to remove it. The nurse demurred. Tracie said that she’d pull it out herself. The nurse said that she couldn’t. Tracie said that she most certainly could, and knew exactly how to do so, and maybe the nurse would like to fetch some gauze for her so that she didn’t spurt blood all over the place when she did. This wasn’t a bluff, incidentally; Tracie has indeed installed and removed IV lines, and while she hadn’t done so in a long time and generally hadn’t done so on herself, there was no doubt in my mind that she’d have done so that morning if goaded further. I wasn’t happy about how things were unfolding, but I also wasn’t happy about the fact that nobody had delivered the initial dose of Lyrica without our prompting, or that the doctor hadn’t appeared, or that nobody particularly seemed to be paying much attention. I couldn’t see much point in us staying there, and many points in favor of us leaving.

The poor nurse was in a difficult position. On one hand she didn’t have the authority to discharge a patient without a doctor’s consent. On the other hand she had an agitated patient threatening to pull out their own IV line, and it was entirely clear, despite the language barrier, that the patient was serious. At some point she phoned the doctor and told us that he’d be there soon, and then went into some transparent stall tactics. I think that that was when Tracie asked for the gauze. The nurse called the doctor again and he appeared shortly thereafter.

It became clear pretty quickly that either he’d forgotten to drop by or had deliberately decided not to, hoping to slip away when the shift changed, and we pretty much called him on that point. Perhaps that made it easier to get him to agree that Tracie seemed to be in good shape and could be released. A different nurse removed the IV line and peeled off the monitor electrodes. We got Tracie dressed and gathered up what little we had with us while we waited for a prescription for oral steroids and Lyrica to be filled.

And waited. And waited. And eventually got the stuff.

Then we waited some more and had a series of half-conversations about paying the bill. It came to light that we couldn’t be presented with a bill because the accounting office was closed on the weekend. It was proposed that perhaps we could come back on Monday to settle the bill. By Monday we were going to be back in Tokyo, so no, this wasn’t going to work. We tried to convey that we had every intent of paying the bill, once a bill could be produced for us, but no, we didn’t have a phone number in Japan because we didn’t know where we were going next because we hadn’t been able to talk to our travel agent yet. (Recall that we left the hotel somewhat in haste, and did not expect to stay at the hospital overnight.) Eventually it was agreed that we could phone the hospital on Monday to find out how much we owed and how to pay it, possibly with the aid of our bilingual travel agency.

It was close to 10:00AM by the time we were finally able to leave. We found a taxi and managed to get back to the hotel just in time to get to the breakfast room, which we knew closed at 10:30. We self-administered suitable doses of food, coffee, cocoa, etc. while reflecting blearily on the events of the last couple of days.

We saw Dr. Gunshin for a follow-up visit after we were back in Tokyo. By that time Tracie had taken three 25mg doses of Lyrica, and noticed that part of her mouth, throat, lips, tongue and side of her face was going numb. Dr. Gunshin told her to stop taking the Lyrica. That aside, he believed that Tracie was in good shape and wouldn’t have any further reactions, but told us at least twice to call him immediately if anything changed while we were still in Tokyo, and that remaining in Tokyo was indeed a good idea. He also gave her a few doses of gabapentin to fall back on in the event that her trigeminal neuralgia started causing pain again. To date it has not.

During that time, Tracie conversed with her neurologist in Boulder via email. The neurologist suggested that 25mg per day would be a sensible starting dose for Tracie, rather than the 25mg twice/day that she took before stopping. We shudder to think what might have happened if she’d taken the 75mg twice/day that the doctors in Kobe prescribed.

So, while we were disappointed to not be able to spend time in Kyoto and Matsue, we agreed that there are worse fates than to be put up in nice hotels in Tokyo, and the rest of our time in Japan was pleasant, although our activities were somewhat hampered by unusually bad weather due to a convergence of two tropical storms over the region.

Our travel agency, Inside Japan Tours, deserves any amount of praise and gratitude. Besides helping us during the actual crisis times, they were able to get new accommodations in Tokyo for us. This was no easy feat given that we were there during the cherry blossom season and hence every hotel was full or nearly so. We ended up staying in two other hotels before going to the one where we had our original reservations. Both hotels were very nice, however, and it was a happy accident that we got to stay at a couple of places that we hadn’t stayed at before.

Among other things, we struck up an acquaintanceship with the manager of this coffee shop, which is directly across the street from our usual hotel:

Both the coffee and the hot cocoa are excellent if you happen to be in the neighborhood.

That’s more or less the end of the story. The exchanges at the hospital were regrettable–after all, as I mentioned previously, we do everything we can to conduct ourselves with decorum while visiting Japan. On the other hand, the disorganization and lack of attention in the emergency room was appalling, and had Tracie not been carrying an EpiPen, this story might well have ended quite differently. I’m not proud to say that we had to resort to Loud American mode (albeit highly educated Loud American mode) to get the care that Tracie needed, including getting us out of the hospital after remaining there was doing more bad than good. I am, however, proud to say that I saved her life that evening in the emergency room in Kobe, when continuing to be quiet Americans probably wouldn’t have done so.

EpiLog

On the day before our departure, we were sitting in the Dotour in Ginza, having a conversation about stress management, when one of Tracie’s dental crowns fell out.

No, I’m not kidding.

I’m sad to say that I had the worst physical reaction to stress that I’ve had in many years; all I could think was, “oh, no, NOW what?” However, Tracie managed to stick it back in and keep it there, and then, via a series of phone messages and emails (since Japan time is 15 hours ahead of Boulder time), we were able to arrange an appointment with our dentist for the day after we got back.

We also heard later that day that a severe snow storm was expected to hit the Denver/Boulder region on the day we were flying home. This meant the possibility of cancelled flights, impassable highways, etc. Fortunately the storm wasn’t as bad as expected, and fortunately its only affect on our trip home was to delay our connecting flight between Seattle and Denver. This was a good thing because, had the flight left on time, we probably would have missed it.

When we finally pulled up in the driveway at home, I felt that I was more in need of a vacation then than I was on the day that we departed. A few days later I still think that’s the case.

We’re heading home tomorrow. It’s been… well, I suppose one could say that it hasn’t been the vacation which we had in mind. I’ll try to write up the rest of the story on the plane tomorrow.

The weather’s been quite dramatic here in Tokyo during the past couple of days. Yesterday it started raining in the afternoon, and rained like crazy in the evening. Our hotel room in Asakusa looked down on a few of the small open-front restaurants common in this neighborhood. Despite the proprietors drawing plastic curtains over the front, by closing time the floors of these establishments were as soaked as the street itself. The news on TV this morning had lots of video of flooded streets, stores, etc. Today it didn’t rain, but it was very windy. Late in the day we had a lovely view of the Sky Tree with dramatic clouds lit by the setting sun.

I said in my previous post that I’d write up the second half of the saga about our trips to various emergency rooms, but I haven’t done that yet. We were indeed on a shinkansen yesterday, zipping down to Kobe from Tokyo with a quick stop in Kyoto, but I didn’t particularly feel like writing. So, in the mean time, here’s a picture of Tracie and Makino-san:

We had a fine time and an excellent lunch with Mr. and Mrs. Makino. I have more to say about that in another post, but right now we’re gonna head out from the hotel to take advantage of the nice weather, which ostensibly isn’t going to last long today.

So, in short, we’re fine. Thanks for wondering.

It’s 11:00AM local time Monday and we’re on a shinkansen bound for Tokyo from Kobe. [EDIT: That's when and where I wrote the following entry. I'm actually posting it at about 7:30PM on Wednesday, i.e. a couple of days later. I needed some time to get the photos put in.] This represents an alteration of our original itinerary; the original plan was to go to Matsue after staying in Kobe, then to Kyoto, then back to Tokyo for a night before flying home. Circumstances now compel us to return to Tokyo, where we’ll stay for about a week before flying home.
The circumstances, as you might guess, require a somewhat lengthy explanation.
On Thursday night, while happily ensconced in hotel our room in Tokyo, Tracie started developing a skin rash similar to the one she had in the morning several weeks ago which prompted our visit to the nearby fire station and hospital emergency room. While this was just as mysterious as that occurance–and no apples could be blamed this time–the reason was somewhat beside the point. We needed to get her to an ER post haste, which is a slightly complicated undertaking when you’re in a country where English is a secondary language. We got in touch with our travel agency and they directed us to Tokyo University Hospital, and helped pave the way for us by speaking directly to the hospital to inform them of our situation. Tracie’s biggest concern was that she was experiencing a reaction to carbamazapine, the medication she was prescribed in late December for trigeminal neuralgia. One of the adverse reactions to carbamazapine is a histamine reaction which causes a worsening skin rash which can spread to mucous membranes, including those inside the lungs. If something isn’t done before this happens, your lungs stop working and you die. Thankfully Tracie did not seem to be worsening rapidly, so the taxi ride to the hospital was distinguished by concern rather than near panic. (The significance of this distinction will become apparent later in this story.)
The doctor at the ER, one Dr. Gunshin, turned out to speak very good English. (Eventually he mentioned that he had done his residency at UCLA, an experience which presumably had a lot to do with this proficiency.) After he and his “colleagues” (who were probably his students, judging from their relative ages and the context) assessed her condition and listened to her descriptions of her situation, he administered IV steroids to get her immune system to calm down, and prescribed predisone (i.e. more steroids) and histamine blockers to keep things from flaring up again. It was his opinion at that time that Tracie was not experiencing direct side-effects of the carabamazapine, but an allergic reaction to some environmental element, or possibly a sensitivity to sunlight. We had been outside quite a bit that day, and Tracie probably got more sun on that day than she had on any day previously since starting to take carbamazapine. Dr. Gunshin was a very personable sort of doctor and we had a fine time talking with him, even under the circumstances. Eventually, confident that Tracie’s situation was stable and would remain so while aided by the meds he’d prescribed, he sent us on our way. The bill for this visit, including the medications, was about US$125. We paid it using a machine that sort of resembled an ATM, except that it received money rather than dispensing it.
So, we finally got back to the hotel around 1:00AM, feeling pretty confident about the resolution of the situation. Unfortunately we had to get up at about 4:00AM because we were already scheduled to take a train to Kobe for the next leg of our vacation. We left at this early hour so that we could stop in Kyoto en route to poke around the station a little. It’s possibly worth mentioning at this juncture that it had been a long day even before we were compelled to go to the hospital, and I was rather in need of more than three hours of sleep.
Despite the stress of the previous evening and the lack of sleep, we arrived in Kobe in good spirits.
While in Kobe, we stay at the ANA Crowne Plaza hotel, a veritable lap of luxury. Also, we were looking forward to the next evening, on which we were scheduled to have dinner at the home of our friends who live near Kobe.
If this was a movie rather than a blog entry, and I was the soundtrack composer, I’d cue the ominous strings about now.
After we’d settled into our room, and shortly before we were going to sally forth in search of a nearby grocery store to obtain dinner, Tracie’s face turned an alarming shade of red. (Yes, again.) Had we still been in Tokyo, it would have been simple enough to return to the same hospital, but we were now in Kobe. So, same drill: we got in touch with our travel agency and were directed to another hospital, where someone who spoke English was informed of our situation. Also, they’d spoken to the front desk of the hotel and someone there would direct a taxi to the hotel on our behalf.
It didn’t work out quite that way.
It was easy enough, as usual, to get a taxi, but the doorman had no idea where we were headed, and I didn’t remember the name of the hospital well enough to tell him–and I certainly didn’t want us to be taken to the wrong hospital. So, he went back inside to talk to the front desk while I tried not to pace around too much. Once underway, it became apparent that Tracie’s reaction was progressing more rapidly than it had the night before. (Astute readers will now be asking themselves, “what the hell is triggering these reactions?”, but at the time we were far less concerned about the cause than about the effects.) We didn’t want to be rude by asking the taxi driver to do his job in a more expedient manner than usual, but Tracie did eventually ask him how long it would take to get to the hospital. He must have noted something in the tone of her voice because he said, “five minutes”, picked up the pace considerably, and got us there in half that. Nonetheless, Tracie had her Epi-Pen out and we were considering whether it was possible to use it within the confines of the back seat of a Prius that was taking corners somewhat briskly.
Once at the hospital, it took a few tense minutes to pay the driver, get her wheelchair out of the trunk, put the wheels back on the wheelchair, and get to the ER. Once there it became apparent that there wasn’t anyone handy who knew who we were, or who spoke much English. Hence it wasn’t at all easy to convey the gravity of Tracie’s condition to the person at the desk who was asking us to fill out forms that we couldn’t read, or a lengthy multiple-choice form in both languages with numerous check boxes for numerous complaints and ailments. I was trying to play along for the sake of harmony, but Tracie took the pen away from me, scrawled ALLERGIC REACTION across the top of the form, and handed it back. We were directed to wait briefly.
So we waited.
Tracie got worse, and told me that I was going to have to stick her with the Epi-Pen because she wasn’t sure that she had the strength or coordination to do it herself. Drat that MS.
If you’re not familiar with them, an Epi-Pen is kind of like an oversized marking pen, but instead of ink it has over a gram of epinephrine, and instead of a fiber tip it has a spring-loaded needle. They’re carried by people with severe allergies and used only in the event of a severe reaction. They’re what you use to tide you over long enough to get to a hospital. To use one, you hold it with one hand and ram it against the side of your thigh, holding it for ten seconds while the needle goes right through your pants and injects you with something that’s more or less like adrenaline. Tracie has described this process to me on more than one occasion, but has never needed to use one during our 13 years together.
I’m not wild about needles on good days, but there wasn’t much else to do. She showed me where to aim, I read the directions twice, and verified the target with my own finger. She then mentioned, somewhat causually, that she might scream when I stuck her with the thing. I thought about the dozen other people in the waiting room, ranging in age from infant to elderly, considered that if she did scream, at least it would get some much-needed attention from the staff, and punched it against her thigh.
She didn’t scream.
She did kind of go rigid, though, and sort of reared up out of her wheelchair. I counted off ten seconds, pulled it back out again, and watched her, wondering what might happen next.
From my perspective, not much happened. Once past the initial shock, she actually might have calmed down a little because she at least knew that her allergic reaction was probably not going to run away with her and her life, at least not for the 20 or so minutes that the epinephrine was going to be effective. Perhaps for my amusement, she tried to explain that it felt somewhat like being filled with pure energy. She also mentioned that it does interesting things to her hearing, including pitch-shifting and spatialization effects. I made a mental note to name a preset “Epi-Pen” the next time Audio Damage builds a pitch-shifting or delay effect.
Apparently some part of these events did attract someone’s attention, because shortly thereafter a nice woman (another visitor, not a staff member) directed us to a chair at the end of the counter, where a staff member took her vital signs. Her pulse rate was impressive. Somehow they still didn’t really appreciate our sense of urgency, so Tracie dropped the used Epi-Pen on the counter. The staff member apparently read English well enough to understand what it was, because after reading a bit of the label her eyes got about as large as Tracie’s had when I stuck her with it.
The pace picked up a bit at that point.
We were ushered into the ER. They got Tracie onto a bed and started talking to her about what was going on. It became evident that the doctor’s English was somewhat limited. He did understand that we weren’t there just for the fun of it, but the stilted nature of the exchange of information led to some maddening circularities. Tracie’s situation was not a simple one, but it was frustrating to be asked to dwell on seemingly tangential points such as why she used the Epi-Pen or why she even had it in the first place.

It might be useful to mention some background points. While in Japan, Tracie and I always strive to be as polite and respectful of local conventions as we can. We remember that we are guests in this country and consider our needs and whims to be secondary to those of the residents. However, this was an unusual and life-threatening situation. Tracie knows as much about medicine as any nurse and most doctors, is the most self-assured person I’ve ever met, had just received a whopping dose of epinephrine, and very much wanted to not die. Hence there was possibly a bit of cross-cultural trampling of the toes of decorum. While I shared at least some of Tracie’s desire to keep her alive, I lack her knowledge of medical care. I mostly kept quiet and tried to smooth rough edges of translation when the opportunity arose.

It didn’t help any that the ER was pretty busy than evening. One visitor was groaning and shouting at regular intervals. At some point a screaming baby arrived in the bed next to ours. (The ER was one big room, with the beds separated by moveable curtains, most of which were left open.) Eventually a couple of other doctors, including a neurologist, joined in the conversation, and eventually–at our behest–someone spoke to Dr. Gunshin by phone. I think it wasn’t until then that they completely understood what was going on.
Tracie’s veins were still a mess from recent travails, so they ended up putting the first IV line into the back of her hand. I decided that it wouldn’t help matters at all if I fainted, so I opted to not watch that part of the proceedings. I did eventually take this picture, later on in the evening after someone forgot to remove the needle:

They drew some blood samples; in retrospect I’m not sure what they did with them, if anything. Eventually it was decided that they’d put more steroids into her–same stuff that she’d been given the night before, same stuff that she’d been given in Boulder a couple of weeks ago. This was all fine, but it entailed a good deal of back and forth conversation in limited English. (When Tracie asked how much they were going to give her, they first thought that she was asking how much it would cost. No, folks, money is not the object here…) They decided to put her in ICU overnight, a decision which Tracie wasn’t wild about at first, but we all agreed that it was prudent to keep her around for awhile to make sure that everything was going to stay settled down after the epinephrine wore off, the steroids took effect, etc.

I think it was close to midnight by the time we were transferred to a section of the ICU. I tried to not stare at the other residents, most of whom were elderly, with various numbers of tubes attached to them in various locations.
At this point, food became something of a concern. We hadn’t eaten anything since that afternoon. I can eat more or less anything, but Tracie has all sorts of food allergies and other dietary restrictions. We established that there was a convenience store in the lobby of the hospital, so we made our way to that, Tracie holding on to her mobile IV stand while I pushed her along in her wheelchair. Yes, it was kind of surreal, really.
We were hoping that the convenience store might have some plain rice, one of the few things that Tracie can both eat and readily find in Japan. Sadly, this was not the case. We ended up with some cans of coffee, a bottle or two of tea, a carton of orange juice, a container of plain yogurt (which went uneaten) and one onigiri (rice ball wrapped in seaweed) for me. I must say that the proprietor of the store was one of the most polite and warmly cheerful people I’ve encountered in such a role. The guy deserves an award of recognition or something for being such a happy presence in an unhappy setting.

I had no appetite whatsoever, but I was dead tired. Someone had found a cot for me but Tracie wanted me closer at hand. She propped herself up at the head of the bed–the IV line in her arm and the various wires connecting her to the monitor basically precluded lying down, given her limited mobility–and I lay on my side next to her. I fell asleep as soon as I was horizontal.

—
That’s as far as I got with this narrative while we were on the shinkansen from Kobe to Tokyo. I’ll try to cover the rest day after tomorrow, when we’ll be on a shinkansen to Kyoto for a few hours. To avoid keeping you in suspense, the short summary is this: Tracie is okay, we have an actual explanation for the reactions, and we’re spending the remainder of our time here in Tokyo so that we have ready access to Dr. Gunshin.

Yeah, the vacation hasn’t gone quite as planned. Still, it’s hard to complain about being stuck in Tokyo. We’re going back to Kamakura tomorrow to say hello to the Great Buddha again. Maybe some of his serenity will rub off on us.

Local cuisine is, of course, an ongoing discovery. I was curious about a particular kind of yakitori in a case, so I grabbed a quick photo of it so that I could translate the name later, out of the bustle of the crowds.

In the foreground it’s been cooked with tare, which is basically what we call teriyaki in the US (a term that’s almost never used in Japan, although I saw it on a menu for a Subway sandwich shop once); in the background it’s plain, cooked with just some salt. Looks pretty good, eh? It turns out that the name is nankotsu (なんこつ) which means cartilage.

We were enjoying a cup of coffee and cocoa (respectively–I had the coffee) in the Doutor at the main intersection in Ginza when we struck up a conversation with three young Asian women. One of them was from Singapore, one was from China, and one was from Hong Kong; they were also in Tokyo on vacation. Among other things, we talked about languages. Their English was quite good; I asked how they happened to be so proficient, and they said that most Chinese start learning English in the fourth grade. Moreover, proficiency in English is one of three major requirements for college entrance; the other two are Chinese and mathematics. Imagine if every engineering major in the US had to be proficient in a second language, or every liberal arts freshman had to be skilled with math.

The conversation got rolling in large part when I couldn’t help but comment on this package, which one of them pulled out of a shopping bag from a nearby department store:

It contained a cheesecake, or something sort of like cheesecake and sort of like ice cream. This particular one was a special version for the sakura season and had a layer of cherry-flavored goo on top. (At their insistence I tried a bite.) As we explained to them, the bizarre part was that Tracie and I lived in and met in Oregon, and here we were in Japan, sitting next to someone from China who had just purchased something which referenced Oregon.

Yay! I found half a dozen new origami books, including three by my favorite designer, Tomoko Fuse.