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Future of Shrinking Japan: Doctor selflessly provides home care support for elderly

Shigeo Isaka listens as a patient talks to him at their home in the Inage Ward of the city of Chiba, east of Tokyo. (Mainichi/Naoki Watanabe)

CHIBA/TOKYO -- Doctor Shigeo Isaka, dressed in a white coat, visited an elderly woman on the fourth floor of a housing complex in Kaihin New Town in Mihama Ward, Chiba, east of Tokyo, with a nurse in the twilight hours.

"Did you come out to say hello to us? Don't expose yourself to cold winds," Isaka told the woman who was waiting for him at the front door to her apartment.

The 89-year-old woman is living alone. She had regularly visited the hospital to receive treatment for a brain tumor, but she has been visited by Isaka at her home since October.

"The doctor rushed to me when I had a fit while outside," the woman said.

After graduating from Chiba University, Isaka worked as a surgeon specializing in urology. When he was young, he was concentrating on the most advanced medicine while believing, "I'll cure all diseases with my surgeries."

He encountered many patients and saw some of them die. As he has grown older, he has raised questions about the idea that if a patient dies then medicine has been defeated.

"That's not necessarily true. Medical services are necessary for those who have chronic illnesses and who die from incurable diseases," Isaka says.

Isaka himself has lived in an ordinary house in Kaihin New Town for nearly 40 years. The ratio of elderly people aged at least 65 to the population of his neighborhood has reached 50 percent. If the ratio has reached at least 50 percent, a neighborhood is regarded as "marginal" where it is difficult to maintain the community.

Isaka had served as director of a general hospital in Saitama Prefecture for many years, but he switched to the Kurosunadai Clinic in his neighborhood two years ago after his elderly neighbors began to ask him to "be at my bedside when I die."

He visits his patients living around the new town four days a week. When he started visiting patients, he was surprised to see them flash smiles they would never show at hospitals. Since he cannot provide much effective treatment to terminally-ill patients, he instead listens to when they talk about their history as well as their hobbies.

Isaka talked about baseball with a patient who has many photos of legend Shigeo Nagashima in their apartment. The doctor looked after 121 patients over the past two years and was by the side of 44 of them when they passed away at home.

After finishing examining the 89-year-old woman, he moved to the home of a 74-year-old man who lives in the same building. He was a terminal-cancer patient. He gave up on using anticancer drugs and began to receive treatment at home in August.

He was unable to get out of bed, but when a reporter asked him if he preferred to stay home rather than being hospitalized, he nodded saying, "I can tell my wife what I want to say." When the reporter left his home, the man raised his right hand and said, "I'll make a miracle. However, he passed away in the predawn hours of Nov. 28 as his wife and others were by his bedside at their home.

The man's wife recalled on Dec. 8 that he spent peaceful days shortly before his death. They played go, the couple's common hobby, and the wife made his favorite food.

"For his last meal, he enjoyed eating his favorite boiled fish," she said.

She said it was tough that she had to see her husband weakening. When he complained about pain, she was unable to do anything to alleviate his suffering.

The wife said she cannot answer whether it would have been better if he was hospitalized.

Isaka visited the woman suffering from a brain tumor again on Dec. 20. "You can contact me during the year-end and New Year's period," he told the patient. The woman appeared to be relieved to hear that. Isaka will continue visiting his patients at their homes until New Year's Eve.

-- Demand growing for home medical care

The government is trying to reduce the number of beds at hospitals in an effort to reduce snowballing medical expenses. At the same time, the number of elderly people aged at least 65 in the metropolitan area comprising Kanagawa, Chiba and Saitama prefectures as well as Tokyo is estimated to reach 11 million by 2040, 1.5 times the figure in 2010. Numerous elderly people will likely use home medical care services.

Home medical care is drawing attention in the face of a growing number of senior citizens. In such medical services, doctors regularly visit patients, who have difficulties visiting medical institutions, at their homes to provide consultations and manage their health. Such doctors are also by the bedsides of dying patients. This medical care is aimed at supporting the quality of patients' lives unlike medical treatment at hospitals using advanced equipment and technologies.

As of 2016, there were 14,700 registered medical institutions that can provide home medical care services around-the-clock across the country, including the Kurosunadai Clinic where Isaka works, about 1.5 times the figure 10 years earlier. However, the increase has leveled off since then. In 2025, all baby-boomers will be aged at least 75, and there is expected to be more demand for home medical care services.

"There aren't many doctors who want to be providers of home medical care services because of the heavy burden," Isaka said.

(Japanese original by Shin Yasutaka, Jun Kaneko and Hiroshi Endo, City News Department, and Buntaro Saito, Chiba Bureau)

This is Part 2 of a series.

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