==JAPAN: KM== [Death]

Today, in Japan, about 800 thousand old people who have various handicaps are not in hospitals but are living at home. Many of them are bedridden, which is called "netakiri-rojin" in Japanese, and they need various kinds of home care. The families that have a "netakiri-rojin" on their hands are known to face a lot of problems with such care. For example, it costs a great deal to look after one bedridden person, weighing heavily on a family budget, and as a result, a forced suicide sometimes occurs. How to care for aged invalids has indeed become a very serious question. In fact, in the last few years, my family had to struggle with this problem.
My grandmother had a bad stroke four years ago and the right side of her body was paralyzed. She was also senile, but through rehabilitation training in the hospital, she made a little recovery temporarily. One Sunday afternoon, last November, I was told by my mother by phone that grandma had had another graver stroke and was now bedfast. She said, "I think we should care for her at home."
During this winter vacation, I went back to my hometown to help my mother. My grandmother was lying in bed with a blank face and muttering something. She couldn't eat solids, so we fed her liquid foods like rice porridge or yogurt, but after she ate a little, she wasn't able to swallow any more and looked at us painfully. Though she could hardly eat, she had heavy diarrhea, and we had to change her diaper hastily every two or three hours. To tell the truth, I felt bad because of the terrible smell at first, but I was soon acclimated to it. The hardest job was to give her a bath! It took three people to carry her to the bath and wash her body, hair and face. She was afraid of the hot water at first, after not being in it for a long time, but soon she was soaking in the bath with her eyes closed comfortably. Seeing that, I felt a little bit better. While she was taking a bath, the other family members had to make the bed in a hurry, heat the sickroom and prepare new underwear and night clothes.
This time I also saw the actualities of medical treatment at home. I was surprised that diverse medical workers had something to do with my grandmother and all of them were very kind. The doctor visited her immediately when we called, and the nurse always spoke to her gently, treating her as a conscious person. The pharmacist living in the neighborhood showed concern for my granny and was a reliable adviser to my mother. But for their warm support, we could not have taken care of her for even a single day.
My experience was very trivial, but I know that there are so many difficult propositions we must learn how to handle when we actually tend old sufferers. Though it was only three weeks that I practically saw to my grandmother, I was extremely tired. How heavy was the burden for my mother, who was constantly at grandmother's side? Although my family is usually cheerful, the sound of laughter broke off in my house and everyone became nervous. If the aged pa- tient gets worse unexpectedly, what should we do? I worried continually about it because we had no knowledge of first aid.
Another problem is about the system of home care itself. It is remarkably important and indispensable, yet it is still in the first stages and sometimes insuf- ficient. The jobs of care staff are so hard, but they often seem to have salaries which are not commensurate with their work. I think only a few people under- stand the importance of home care.
At midnight on February 10th, when I had written half of this essay, my grandmother died suddenly, but calmly in the hospital. Now, I'm left with one question: Can we say the last days of my grandmother were "life"? What is "life"? She certainly breathed, but she could no longer eat or discharge wastes by herself and couldn't even understand her own children's or grandchildren's faces. Which would have been better for her, to keep on "living" even though in such a painful situation, or to---? I, who will be engaged in medical care in the future, don't know what to answer to this question now.

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COMMENT

Problems as stated in this essay can also occur to my family, so I have sympathy with it. The Old will be weak. Young people must help them, but some of the young people today dislike them. The author seems to have loved her grandmother, which must have delighted her.
The treatment of old people is a difficult problem. We must think about it as medical school students. We must not make old people's life meaningless. We must treat old people as persons with experience. We were given a lot of things from old people, so we mustn't forget gratitude for them.

Yuko Minami