Dr Jun Sasaki parks his car and unlocks the trunk. It’s Aug 26, 35 degrees in Tokyo. Dr Sasaki is making a house call. The contraption in the trunk looks like a large air purifier. In fact it’s an oxygen enricher, portable but weighing some 20 kg.
There’s no elevator in the apartment he’s visiting. Sasaki must wrestle the thing up six flights of stairs. He arrives at the patient’s door sweating and out of breath. It’s been a long day and it’s far from over.
Medical journalist Mamoru Ichikawa reports the story for Shukan Josei (Sept 28 – Oct 5). As of early September there were in Tokyo about 17,000 people stricken with COVID-19 but unable to get into a hospital. Doctors like Sasaki save many lives and ease much suffering, but they can’t cover everyone in need. Nationwide, 250 reportedly died at home of the virus in August, deprived of sufficient medical care.
Sasaki finds his patient in grim shape – a man in his 50s, lying on a bed in his one-room apartment, coughing painfully and breathing with difficulty. His complexion is white, his lips blue. With a pulse oxymeter, Sasaki measures the man’s oxygen saturation rate. It’s 90. Anything below 95 means trouble.
A tube attached to the oxygen enricher goes up the man’s nose, and Sasaki activates the machine. Slowly color returns to the patient’s face. Ninety-two, 93, 95. The worst is over. A crisis has been averted.
Ichikawa hears the man’s story. Transferred by his office to Tokyo, he was living apart from his family when one morning about 10 days earlier he awoke feeling unwell. He was feverish and gasping for breath. At a local health center he was given a PCR COVID-19 exam and tested positive. He was given an antibiotic cocktail and sent home. “Take care of yourself,” they said.
But the fever didn’t go down and the coughing got worse. The health center sent Dr Sasaki. After Sasaki’s visit, the man was finally admitted to a hospital and is now receiving the care he needs. But it was close.
There is a great difference, Ichikawa explains in Shukan Josei, between hospitalization and the home care regime instituted for lack of a better solution to the intense hospital congestion caused by the summer wave of COVID-19 infections. Hospitalized, the patient is assured three meals a day and whatever care is required. Symptoms are monitored, and changes addressed immediately. At home you’re basically on your own. Local health authorities lend what support they can – instant meal deliveries, medical advice and so on – but this can only go so far. From Sasaki’s patient we know what this can mean when the patient is alone. In the midst of one’s family, comfort and help may be close at hand, but there’s another danger – that of the entire family being infected.
Back in the car en route to his next patient, Sasaki sighs. This is beyond emergency medicine, he says: “This is disaster medicine.”© Japan Today