Biomedicalization and the Practice of Culture: Globalization and Type 2 Diabetes in the United States and Japan

By Mari Armstrong-Hough | Go to book overview

CHAPTER FIVE
Our Diabetes
Diabetes in the Japanese Exam Room

It was 8:40 A.M.; Dr. Saito and Nurse Kurokawa were ahead of schedule. Outpatient hours did not begin for another twenty minutes and we had already reviewed the schedule for the day and checked the electronic medical records for the first appointment of the morning. For Dr. Saito, the petite internist in charge of the hospital’s new type 2 diabetes clinic, this was a rare opportunity to relax during her workday, usually packed with morning outpatient hours, afternoon inpatient service rounds, and a new diabetes education program—not to mention the endless series of meetings that are part of the reality of Japanese clinical practice.

Dr. Saito was not interested in relaxing. She checked her watch and looked at her nurse, an experienced woman at least fifteen years her senior. “I wonder if there’s time to visit the dialysis center?” she asked. She had been worried about a particular hemodialysis patient all week, ever since Nurse Kurokawa told her that she had heard from the nurses staffing the dialysis center that he had been having difficulties with “self-management” (jiko kanri).

The three of us left the outpatient clinic. As we walked to the elevator bank, Dr. Saito explained the situation. There was some question as to whether or not the patient, Ichiro, should be admitted as an inpatient. He was undergoing dialysis three times a week and had a home nurse every morning to help him administer insulin injections. Even with these aids, however, Ichiro was not controlling his blood sugar and was thought to be a nonadherent patient. Nurses reported that he was known to eat lunch in the hospital dining hall after each dialysis treatment, where he would fill his coffee mug three-quarters of the way with coffee, then pour in creamer and sugar to the top. Further, because he lived alone, there was no way to enlist the help of a wife or daughter to manage his eating, drinking, and insulin. The best thing, Dr. Saito explained, might be to admit him so that he could spend more time at the hospital learning how to “manage” himself.

Arriving at the dialysis center, we met Ichiro. I had expected someone old or infirm, but Ichiro was middle-aged, perfectly lucid, and did not appear physically infirm beyond the usual way that dialysis patients’ bodies seem

-92-

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