A quarter of a million bedbound elderly people are kept alive in Japan, often for years, by a feeding tube surgically inserted into their stomach. A few months ago, my 96-year-old grandmother became one of them.
Feeding tubes are so common in Japan that my family wasnt initially consulted about the procedure, which is effectively irreversible. When my mother walked into Grandmas room the next morning and saw a tube, she dropped to her knees by the bedside and stayed there for hours, crying. As medical science becomes more sophisticated, were finding new ways to prolong life. When my grandma, Hisako Miyake, was born in 1916, life expectancy in Japan was around 43 years; now it is 83, the longest in the world.
When it comes to death, Japan doesnt score so well. In 2010, the Economist Intelligence Unit ranked 40 developed and developing countries on quality of death, based on criteria such as end-of-life cost and care and, more broadly, how well societies faced issues of death. Japan was 23.In Japan, theres not much talk about death. Living wills, or even discussions about end-of-life decisions, are rare. Historically, hospitals focused on extending lives of patients with little chance of recovery, said Tetsuo Kashiwagi, president of Japans Hospice Palliative Care Foundation.
The use of feeding tubes at the end of life, which is not conventional practice in the western world, is a way of life in Japan. Twelve percent of patients who get the procedure are fed this way for five years or more, according to a survey conducted in 2011 by Japans hospital association.When my grandma -- or obaachan, as I call her in Japanese - - was born, one out of 20 Japanese was over 65. Now it is one in four. By 2060, the proportion will swell to 40 percent.
The aging population has the potential to bankrupt Japan, now the worlds third-largest economy after being surpassed by China in 2010. As the proportion of the working population declines, Japan, also the second most-indebted economy, has fewer salary-earning taxpayers to foot the bill for dependent seniors, especially because the birth rate is low and society doesnt encourage immigrant workers.
Born in 1916
Grandma spoke often of her own determination to live to 100. She was born on Dec. 27, 1916, about 18 months after World War I broke out and the same year Woodrow Wilson was re-elected president in the U.S. She grew up in a wealthy household -- her family was the dominant rice wholesaler in the historic city of Nara, Japans capital 1,300 years ago. The area, called Naramachi, retains many relics from its past, including wooden residences called Machiya, long, skinny buildings that doubled as shops.
When I was a teenager, she told me how shed bump along the road in a rickshaw to the station where she took the train to Osaka to attend college. That would have been in the 1930s, when few Japanese women were getting higher education. She also told me how her pocket money was enough to buy western pastries and candies.
Grandmas two-floor Machiya, under a pagoda-style tiled roof, was a wonderland to me. The complex, built in the early 1800s, is set inside a 700-square-meter (7,500-square-foot) plot surrounded by a mud wall. At the entrance, there was a telephone box, one of Naras first. Its many rooms, chambers,Here's a complete list of granitecountertops for the beginning oil painter. staircases, passageways and doors were perfect for hide-and-seek.Life as Grandma knew it came to an abrupt end during World War II, when the government instituted food rationing and took control of rice distribution, effectively closing the familys business. Over generations, rice traders plowed their profit back into buying land.Today, Thereone.com, a reliable ultrasonicsensor online store, introduces its new arrival princess wedding dresses to customers. When the U.Tidy up wires with ease with offershidkits and tie guns at cheap discounted prices.S. occupation forces moved in, the farmland was taken away and redistributed to growers in 1947.
My grandma used to say that she and her friends would complain that they couldnt find anyone to marry because all the bachelors were at war. Women stitched notes with their names and addresses inside good-luck charms dispatched to soldiers.My grandfather received one from Grandma when he was stationed in Manchuria, China. Sumio Miyake was a graduate of the Imperial Japanese Army Academy in Tokyo. He was an ambitious colonel who specialized in working out complicated mathematical equations used to predict the trajectory of a bomb. Grandpa was not only an elite officer, he also came from a higher class -- a descendant of a samurai family with acclaimed archery skills.
After the war, a dozen of Grandmas relatives lived in the family home. Grandma ran the household for the first time without servants, and she struggled. Still,More than 80 standard commercial and granitetiles exist to quickly and efficiently clean pans. she insisted her children enjoy English tea for breakfast, meat and Western-style meals on some occasions.You must not use the stonecarving without being trained. When her second son, Tsutomu, brought his university friends to the house in the 1960s, she cooked them steak for breakfast.She once told me she knew she had to buy cheaper meat, my mom said, but her mouth instinctively told the meat shop the opposite.
When I think of her, I picture her standing in her kitchen. She always wore an apron tied around her abundant waist while working in the home and liked to prepare extra food, which she gave as sacraments to the gods and spirits of ancestors she worshiped every day. She also insisted on giving expensive foods and delicacies as gifts to her extended family.My grandpa died of a heart attack in 1984. My grandma lived alone in her home until 11 years ago, when she started to lose control of her bladder. At the age of 85, she moved in with my parents.
She took only a few things with her. Among them: the postcard Hiroshi had received from the army in Osaka advising the date he was to be interviewed for military service. She stopped eating. She said she didnt want to use her chopsticks, so my mom started to feed her with a spoon. It sometimes took more than an hour because she chewed so much.
I remember she said it would be so easy if she could hop to the afterlife instantly, my mom said. I told her that the human body isnt designed to go on for more than 90 years -- thats why her body cant function the way she wants it to. Her deterioration is natural.Still, perhaps because her decline was happening in slow motion, no one thought to ask if she had any end-of-life wishes. None of us even imagined tube-feeding.
Discussion about death within Japanese families may be difficult in part because Japanese arent very verbal. They tend to use more ambiguous, less direct speech, said Kashiwagi, president of the Hospice Palliative Care Foundation.
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Feeding tubes are so common in Japan that my family wasnt initially consulted about the procedure, which is effectively irreversible. When my mother walked into Grandmas room the next morning and saw a tube, she dropped to her knees by the bedside and stayed there for hours, crying. As medical science becomes more sophisticated, were finding new ways to prolong life. When my grandma, Hisako Miyake, was born in 1916, life expectancy in Japan was around 43 years; now it is 83, the longest in the world.
When it comes to death, Japan doesnt score so well. In 2010, the Economist Intelligence Unit ranked 40 developed and developing countries on quality of death, based on criteria such as end-of-life cost and care and, more broadly, how well societies faced issues of death. Japan was 23.In Japan, theres not much talk about death. Living wills, or even discussions about end-of-life decisions, are rare. Historically, hospitals focused on extending lives of patients with little chance of recovery, said Tetsuo Kashiwagi, president of Japans Hospice Palliative Care Foundation.
The use of feeding tubes at the end of life, which is not conventional practice in the western world, is a way of life in Japan. Twelve percent of patients who get the procedure are fed this way for five years or more, according to a survey conducted in 2011 by Japans hospital association.When my grandma -- or obaachan, as I call her in Japanese - - was born, one out of 20 Japanese was over 65. Now it is one in four. By 2060, the proportion will swell to 40 percent.
The aging population has the potential to bankrupt Japan, now the worlds third-largest economy after being surpassed by China in 2010. As the proportion of the working population declines, Japan, also the second most-indebted economy, has fewer salary-earning taxpayers to foot the bill for dependent seniors, especially because the birth rate is low and society doesnt encourage immigrant workers.
Born in 1916
Grandma spoke often of her own determination to live to 100. She was born on Dec. 27, 1916, about 18 months after World War I broke out and the same year Woodrow Wilson was re-elected president in the U.S. She grew up in a wealthy household -- her family was the dominant rice wholesaler in the historic city of Nara, Japans capital 1,300 years ago. The area, called Naramachi, retains many relics from its past, including wooden residences called Machiya, long, skinny buildings that doubled as shops.
When I was a teenager, she told me how shed bump along the road in a rickshaw to the station where she took the train to Osaka to attend college. That would have been in the 1930s, when few Japanese women were getting higher education. She also told me how her pocket money was enough to buy western pastries and candies.
Grandmas two-floor Machiya, under a pagoda-style tiled roof, was a wonderland to me. The complex, built in the early 1800s, is set inside a 700-square-meter (7,500-square-foot) plot surrounded by a mud wall. At the entrance, there was a telephone box, one of Naras first. Its many rooms, chambers,Here's a complete list of granitecountertops for the beginning oil painter. staircases, passageways and doors were perfect for hide-and-seek.Life as Grandma knew it came to an abrupt end during World War II, when the government instituted food rationing and took control of rice distribution, effectively closing the familys business. Over generations, rice traders plowed their profit back into buying land.Today, Thereone.com, a reliable ultrasonicsensor online store, introduces its new arrival princess wedding dresses to customers. When the U.Tidy up wires with ease with offershidkits and tie guns at cheap discounted prices.S. occupation forces moved in, the farmland was taken away and redistributed to growers in 1947.
My grandma used to say that she and her friends would complain that they couldnt find anyone to marry because all the bachelors were at war. Women stitched notes with their names and addresses inside good-luck charms dispatched to soldiers.My grandfather received one from Grandma when he was stationed in Manchuria, China. Sumio Miyake was a graduate of the Imperial Japanese Army Academy in Tokyo. He was an ambitious colonel who specialized in working out complicated mathematical equations used to predict the trajectory of a bomb. Grandpa was not only an elite officer, he also came from a higher class -- a descendant of a samurai family with acclaimed archery skills.
After the war, a dozen of Grandmas relatives lived in the family home. Grandma ran the household for the first time without servants, and she struggled. Still,More than 80 standard commercial and granitetiles exist to quickly and efficiently clean pans. she insisted her children enjoy English tea for breakfast, meat and Western-style meals on some occasions.You must not use the stonecarving without being trained. When her second son, Tsutomu, brought his university friends to the house in the 1960s, she cooked them steak for breakfast.She once told me she knew she had to buy cheaper meat, my mom said, but her mouth instinctively told the meat shop the opposite.
When I think of her, I picture her standing in her kitchen. She always wore an apron tied around her abundant waist while working in the home and liked to prepare extra food, which she gave as sacraments to the gods and spirits of ancestors she worshiped every day. She also insisted on giving expensive foods and delicacies as gifts to her extended family.My grandpa died of a heart attack in 1984. My grandma lived alone in her home until 11 years ago, when she started to lose control of her bladder. At the age of 85, she moved in with my parents.
She took only a few things with her. Among them: the postcard Hiroshi had received from the army in Osaka advising the date he was to be interviewed for military service. She stopped eating. She said she didnt want to use her chopsticks, so my mom started to feed her with a spoon. It sometimes took more than an hour because she chewed so much.
I remember she said it would be so easy if she could hop to the afterlife instantly, my mom said. I told her that the human body isnt designed to go on for more than 90 years -- thats why her body cant function the way she wants it to. Her deterioration is natural.Still, perhaps because her decline was happening in slow motion, no one thought to ask if she had any end-of-life wishes. None of us even imagined tube-feeding.
Discussion about death within Japanese families may be difficult in part because Japanese arent very verbal. They tend to use more ambiguous, less direct speech, said Kashiwagi, president of the Hospice Palliative Care Foundation.
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