Thursday, May 19, 2011

I'm against radiation. Unless it's free...

All this month, employees at our institute can go in for their annual health checkup. I went last Tuesday with my coworker Mikang.

We met bright and early at Gwanghwamun Station and walked to the offices of the Korea Medical Institute. Both of us had fasted since the night before and brought along our completed information forms, which we handed to the pretty receptionist who was dressed much like a Korean Air flight attendant. The receptionist showed us the list and had us to choose which exams to take. Mikang wanted one extra test that wasn't on the list, so she had to pay a small amount, but everything else was covered by our institute. According to the information I received, the total cost of all the procedures was 578,990 won per person, of which our institute paid 200,000 won, and insurance covered the rest. (US$1 = 1100 won)

Then we were given numbered keys on wrist bracelets and directed to the women's changing room. The setup was similar to a public bathhouse. The numbered keys led us to our lockers, where we found slippers and loose-fitting orange jumpsuits with blue trim and velcro fasteners. I was relieved that the pants on my jumpsuit were not too "Korean-sized" to cause a problem for me.

When we were suited up we proceeded to exam rooms. There was a large waiting area filled with comfy couches on which examinees sat waiting, with numbered doors leading to each of the small exam stations. The fancy medical equipment and matching orange-and-blue jumpsuits on everyone gave the place a vaguely Star Trek-like feel. There were more flight attendant ladies guiding patients from station to station.

This photo taken from KMI's website shows the exam waiting area.

When we stepped into the waiting area one of the flight attendant ladies had our charts set up and ready, and led us first to the bathrooms to prepare the urine sample. We had to pee in a paper cup, then filter a small amount from the cup into a test tube.

You know how, when it's really important not to spill something, you find it almost impossible not to spill it? My hands were shaking pretty badly from not having breakfast, and the paper cup-to-test tube transfer was a somewhat delicate operation, so I decided it would be a good idea to do it over the toilet bowl in case I spilled. But somehow, crouching in front of the toilet with my pants still down and trying to juggle the test tube, the cork stopper and the paper cup full of pee was too much for me and I overbalanced. Luckily, I was able to save enough of the precious fluid to fill the test tube, but I made a bit of a mess.

After that we proceeded from station to station all around the waiting room. The numbers on the doors were not in order but after each exam one of the flight attendant ladies would tell us which number to go to next. The exams took most of the morning, but there weren't many people and we went through each exam station very efficiently. The only time I had to wait more than 30 seconds was outside the ultrasound exam room. The whole deal took a little under an hour. Mikang said that in previous years, when it was more crowded, it had taken all morning.

Each station was manned by a different technician. Thus each exam began with a little routine;  glance at my chart, glance up at me, sharp intake of breath, anxious query if I understood Korean, relieved laugh when I said yes. Around about the 8th time this happened, I said "yes" before the technician even asked the question, and then we both shared a good hearty laugh.

They tested my blood pressure, vision, hearing, body mass index, extracted some blood, did an EKG, a chest X-ray, an arteriosclerosis test, a CT scan (choice of head, lumbar vertebrae, cervical vertebrae, or abdomen), and an ultrasound (abdomen and choice of thyroid, uterus, or carotid). There was also the option of doing a pap smear, mammogram, and choice of UGI X-ray or endoscopic exam, which I opted out of.

In retrospect I probably should have opted out of the CT scan as well, but at the time I wasn't aware of how much radiation was involved. Everyone else seemed to be doing it, and considering how much people here freaked out over the tiny trace amount of radiation from Japan detected in rainfall we had a few weeks ago, I figured that this couldn't be that bad or more people would be objecting. Plus it was free. Honestly, it's a wonder I haven't joined a cult yet.

The strange thing is that one of the nurse/flight attendant ladies went to great lengths to talk me out of the mammogram, on the grounds that at my age it wasn't worth the risk involved in exposing my breasts to that much radiation. Then, literally in the next sentence, she directed me to the CT scan room.

Another promotional photo from the KMI website. In real life, the technician totally does not stand reassuringly by your side as you undergo the scan. He hustles his butt behind the lead door and stays there.
I opted for the head scan, because in the last year I've heard several horror stories of seemingly healthy people keeling over from some sort of brain aneurism or stroke, so I thought it would help ease my mind. Also I was kind of curious to see what my brain might look like after I've spent so many years stuffing it full of Kanji and vocabulary words. While they were doing the scan, just for fun, I tried thinking about geometry problems. Anyway, I don't know if they'll give me a copy of the scan or not, but if they do I promise to post an image.

After our exams were finished we changed back into our street clothes and headed downstairs for the dental exam. This involved filling out a questionaire cleverly designed to passive-aggressively make everyone feel really guilty about their dental hygiene practices ("How many times do you floss each day? Do you think that's an adequate amount?"). Then I stood in front of a video monitor while a lady stuck a wand in my mouth and showed me an extremely magnified high-resolution view of the state of my teeth.

Luckily she didn't spot any cavities, but I hadn't had a proper cleaning in over 4 years and she expressed much consternation over the amount of plaque buildup I had. She asked when was the last time I had something called "scaling." I didn't know what this word meant, so I said "Um, never?" Now very displeased, the lady sternly advised me to schedule an appointment with my dentist to get this done ASAP. As her lecture wound down, I timidly inquired if I couldn't just get the "scaling" done there. Why, certainly, she said, and it would only cost 40,000 won, probably half as much as a regular dentist would charge.

At this point I started feeling like I was caught in an elaborate sales pitch, which was entirely unnecessary since she pretty much had me at "hello." Dental work is one of the few things that is significantly pricier in Korea than in Japan, and I believed her when she said 40,000 won was a good deal.

"Scaling" turned out to be your basic scrape, grind and polish. It took about 10 minutes, and then we were free to go.

The next day at work, I asked Mikang if she wasn't concerned about the radiation in the CT scan. She said she wasn't sure how bad it was but, like me, she figured it must be okay if everyone else did it. Then she did a quick Google search and promptly started freaking out. "Oh my God, I've been getting one of those every year!" she exclaimed. I noticed on the KMI website that their scanner is marketed as "a low-radiation CT scanner," in which "the amount of radiation can be minimized to 1/6 of conventional CT," so there's that. I figure one time wouldn't kill me, but next year I think I'll skip it.

I had physicals several times while I was living in Japan, but nothing as extensive as this. The first was when I was working at a private company in Sendai. I don't remember much about that one, except that it was done at a local hospital and there was some trepidation among my coworkers because the Japanese government had just instituted a tough campaign to fight obesity, and supposedly if they deemed your BMI too high they could put you on a diet regimen and make you come back to monitor your progress.

Then when I entered grad school in Kyoto I remember having a physical at the school medical clinic, which was fairly basic. Later on when I was teaching at a different university in Kyoto, I took advantage of the annual physical available to all teaching staff. This happened on a designated date, before which we received a notice in the mail along with a labeled test tube. We were instructed to collect our own urine samples at home in the morning and then bring them to the physical. On that day a whole university building was occupied with exam stations set up in various classrooms, and little arrows guiding us from station to station. It was kind of fun; like a haunted house, only with doctors. The chest X-ray was done in a special van parked just outside.

The physicals I had in Japan were all somewhat less extensive than the KMI physical - they certainly didn't offer any CT scans or endoscopic exams. But one thing they offered me in Japan that they didn't in Korea was the chance to sit down with a doctor to assess the state of my health and address any questions or concerns. The Korean physical was very thorough about mechanically running through every imaginable kind of test, but there was no face-to-face encounter with a medical professional.

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