One concern some have about the hospitalist model has been that it may contribute to depersonalization in healthcare. And yet, the way the Japanese people responded to the 2011 earthquake and tsunami illustrates how healthcare workers without existing patient relationships can still care deeply for patients and earn their trust.
On March 11, 2011, an earthquake of 9.0 magnitude hit northeast Japan. It was followed by a tsunami more than 45 feet tall. The world was horrified by the images of waves swallowing the coast of Japan, throwing boats and cars about like toys. As of March 2012:
- 15,854 deaths had been attributed to the earthquake;
- 3,155 people were still missing;
- More than 2.5 million houses were destroyed and
- 344,290 evacuees were still homeless.
A meltdown of nuclear reactors at the Fukushima Daiichi Nuclear Power Plant is now under way, and the country still struggles to minimize the impact of radiation contamination.
As government officials and representatives of Tokyo Electric Power Company (TEPCO), operator of the Fukushima nuclear facility, lamented they were “prepared for a tsunami 20 feet tall, but not 45 feet,” I could not help but recall a similar conversation I had years ago with one of my patients.
Working at my primary-care clinic, I was taking care of a woman who was in her fifties who had hypertension, diabetes, and hyperlipidemia. She was adherent to all of her medications and diet; she had just started swimming at the YWCA; she was a model patient whose numbers were all pristine. We did everything we could and all indications were that she was going to do very well. Yet, one day, she suffered a major stroke. “This is so unexpected,” I lamented when I saw her in the hospital.
U.S. Navy Petty Officer Kyle Wilkinson helps move debris during cleanup efforts in Misawa, Japan, following the March 2011 earthquake and tsunami.
Adversity can bring out both the best and the worst of human nature. The world witnessed diligence, solidarity, and fortitude by the Japanese following the 2011 disaster. Viewers around the world were surprised by media coverage of the affected areas, as reports showed hardly any evidence of violence or looting. Hundreds of evacuees living in a school gymnasium were engaging in morning stretches together. At mealtime, the evacuees lined up quietly, waiting for rations of food and water. They politely took turns using portable toilets and showers. Some women were taking care of the elderly while their husbands searched for missing neighbors. There was a strong sense of “we are all in this together.”
Japanese victims were able to remain resilient because they trusted in each other and in the help that ultimately arrived. For example, many people were touched by the dedication of healthcare workers who volunteered in rescue missions. According to a widely read blog posted by a nurse who participated in a mission to Rikuzen Takata, one of the most devastated areas, her team leader had warned her not to expect to eat, drink, sleep, or even use the bathroom. She had also been cautioned not to cry: “The victims are asking for our help, not sympathy.”
Smoke billows as humanitarian aid is rushed to coastal villages.
The nurse took care of several hundred evacuees on her first day, literally without eating, drinking, or using the bathroom. Amid her incredibly hectic day, she found comfort in making a new friend, a cute 9-year-old girl who followed her everywhere. They talked about boys and laughed together. When the nurse later discovered that the girl was following her because she had just lost her mother and her home, she could no longer endure. She cried in secret. Masking her own distress, she remained dedicated and selfless until the end, bolstering the victims with her smiles instead of tears. (Read more of the blog in English at jkts-english.blogspot.com, or read in Japanese at blog.goo.ne.jp/flower-wing.)