Last day of the trial, a follow-up blood and urine screening, plus ECG. I was a bit nervous because I was informed that if the blood screening was no good then I would need to fly back down in a few days, but I’ve already booked a flight to Spain for tomorrow, to join my girlfriend on holiday.

Thankfully though, my screening was fine. My roommate has to fly back down in a few days though. He went for a bike ride yesterday.

We all got paid in big fat wads of cash. Japan, despite being one of the most advanced countries in the world, is still very much a cash society. There are a lot of cash machines and few stores and fewer restaurants accept credit cards. The dutch guy laid his cash out on the bed in grid formations, just like his poker chips, and took a photograph.

So thats it. Done. Three weeks of my life, 6 independant drug administrations, 18 pills swallowed in total. About 10 or 12 electrocardiograms, maybe 20 or so blood pressure measurements. I must have filled at least 5 one litre bottles of urine. My blood was taken about 40-45 times I think, slightly less than half via catheter. Each time I gave enough blood to fill 3 vials. Done and done.

On the whole I think it was very positive experience. For one thing, I got over my needle phobia. Sure I didn’t enjoy the first few days very much because of the needles, but in hindsight it wasn’t really a problem, and I’m glad I did it. The trial was run professionally and even without being able communicate fully with the nurses it was fine.

Plus, I made some money. Also made some friends. And I saw a lot of onsens.

Also I’m happy I participated in something for the good of science, that might help out patients in the future. I’m aware of the huge amounts of money drug companies make though, and the money I earned, so this is not a pat on the back by any means.

There is one other thing I should mention that affects my perception of the trial. I was just told this by the trial co-ordinator, after we had been paid and just before I jumped in a taxi to go to the airport.

I was given the placebo.

Back in Tokyo we were required to measure our own blood pressure every second day, and abstain from exercise and drinking. To be honest, I went to the gym and got drunk twice. But I left a few days as a buffer for my body to cleanse itself before flying back down to the clinic. I’m here now. I flew down early in the hope of getting some sun at the beach, but a typhoon is forming out in the Pacific and the weather is miserable.

The last morning of examinations, until the follow up screening. Before all the lab rats left the clinic though, the trial co-ordinator assembled us in a meeting room with newly printed consent forms. There had been another adverse reaction to the drug reported in the United States and we needed to re-sign a modified consent form. I was curious as to what the reaction was, and told it was merely a case of soft stool, or diarrhea. I asked around the table and discovered that one member of our group had diarrhea during the drug administration also.

Usually consent forms are not modified for such minor incidents, but the sponsor is being exceptionally diligent for this trial. Is the fallout from the the TGN1412 trial in London?

I searched the laundry basket again for my underwear. A pair of really nice boxer shorts I brought from UniQlo have been missing for 3 days. I’m pretty sure one of the other lab rats took them. I think he should be found out and punished, but wearing my underwear is probably punishment enough.

We were given portable blood pressure monitors and sent to the airport. We are required to measure own blood pressure each day until the follow up examination in next week.

I arrived at Haneda airport to discover I had an urgent freelance job to finish before I could sleep. I woke up at 6am this morning, and finally crashed out at 4am, back home in Tokyo, exhausted.

Shut up in my hotel room, with decent internet access for the first time, I spent the day reading about the disastrous Parexel TGN1412 clinical trial I briefly mentioned on Day 0. Its the first time I read the full details and I found it chilling.

The drug TGN1412 was a newly developed strain of antibody directly effecting the genes of the immunne system. It was genetically engineered using hamster DNA. Its first usage in humans took place in London in early March. Six subjects were hospitalized with extreme adverse reactions relating to a cytokine burst. Essentialy their immune system’s white t-cells starting attacking their internal organs. Within minutes of being injected they began puking and shaking. Their heads and neck and swelled up like watermelons and a few were reported screaming stuff like “My brain is on fire….” ! The most recent report I could find was from early May. At that point in time one participant was still hospitalised and facing amputation of his fingers, toes and, possibly, he feared, his hands and feet. All of them may face lifelong complications and unfortunately under British law their compensation money may be limited to 30 or 40 thousand pounds. I hope they have some good lawyers representing them. My heart goes out to them.

For anyone reading my diary interested in doing a clinical trial themselves, I urge you to read the following articles:
http://www.iht.com/articles/2006/04/07/news/drug.php
http://www.bloomberg.com/apps/news?pid=specialreport_index2&sid=aG3sg1rIkL4U&refer=news

at least so you know the worst case scenario. Yet consider that such an incident is extremely rare, and by itself does not invalidate clinical trials, rather points to the ongoing development of safeguards and informed consent.

It occurs to me that my diary until now has maybe the wrong focus. At least in terms of what most people are interested in. I’ve hardly conveyed any information about the actual drug being studied in my trial, and instead concentrated on my personal feelings about needles and catheters, and the social dynamic in the group of participants. Its not that I don’t find the pharmacology stuff interesting, but the drug is not as experimental as TGN1412 and so perhaps doesn’t warrant as much attention.

I’m going to go back and re-read the trial guide and my consent form though, because I wonder if I would have so easily volunteered if I knew what I know now about the TGN1412 trial. Of course, any doubts I have my be redundant if it turns out I received the placebo.

Lost ¥5000 last night playing poker, mainly to the Dutch guy, who never bluffed and lined up his poker chips, as he won them, into gridded army formations.

The last morning here. It was the typical wakeup farce that drives my roommate crazy. First the nurses come into an hour before the morning medical check. Today that was 8am for a blood sampling at 9am, but sometimes its 4.30am for the catheter insertion at 5.30am. They turn on the lights, open the window curtains and private curtains we have circling our beds. Ohaiogozaiimas, Wakeup! Then my roomate asks them when we actually have to wakeup, and they say in 1 hour. So my roomate then gets up and closes the curtains, turns off the lights, shuts the door and tries to go back to sleep. Which wouldn’t be so bad except that other nurses repeat the procedure two or three times in the next hour, every 20 minutes or so, and each time my roommate gets out of bed and closes the curtains, deals with the light and kicks the door closed and by now he’s seething, “Why the FUCK do they keep waking us UP!” So this morning when we realised it was the last morning of this crap, we had a private cheer.

But we’re not over yet. The next two more morning are reserved for screenings, which we travel to from a hotel, and then I fly back to Tokyo for half a week. Then fly back for another follow up screening. Then we get paid.

After checking into the hotel we went to yet another onsen, this time up in the mountain. We walked though the forest and found a natural spring flowing into a cold running stream. It was amazing really. You could feel the water change from very hot to quite cold as you moved around in the water. There were little hot waterfalls to place you head under. Three of us jumped in naked and it was very peaceful. After we visited a proper onsen attached to a hotel. It was magically designed, and a thunder storm sprang forth while we soaked outside. I jumped from the sauna into the cold bath and practised pranayama breathing. Within a minute I was high as a kite. This was like the fourth onsen we’ve visited so far, so I guess you could say as well as being a clinical drug trial, a boy’s club and a computer camp, its also a mini tour of the best onsens of southern Japan.

I’m being to realise something about myself, something that is not neccesarily bad, but maybe rooted in insecurity and pride. We spoke today about skydiving, somehow it came out. I described to the guys how I did four jumps several years ago. It was shit scary, and I did it because it was. I wanted to confront my fear. The french guy said, “Yes, and afterwards you felt like a king, right?”. An he was right. Its the same with the clinical drug trial, I feared needles, and wanted to confront that fear. Now, after two weeks and dozens of blood samples, they don’t scare me at all. And I feel pretty good about that. It works like this for other things in my life too; spearfishing and freediving for one; the fear of the deep, the fear of not being able to breath.

Catheter went in painlessly this morning, but otherwise today was a bit of a muck up from the nurses point of view. First of all, I went to the toilet as soon as I got up, forgetting about urine sampling. When I had to give a sample prior to drug administration at 9am, I couldn’t and the nurses got pissy with me.

Then we had an ECG check, which consists of the nurses placing these sticky little metallic strips on our chest, wrists and ankles, then hooking them up via clamps and wires to a computer. The metal stickers usually come off straight away and initially the nurses did this for us and were quite dilligent about it. Last week we had two ECG screenings in one day and the nurses asked us to leave them on for the second reading. Then we had to remove them ourselves. The sticky material on the back of the strips had gone gooey from several hours of body heat and it was real nightmare, especially for my roommate who is quite hairy. He spent ages wiping and re-wiping his chest and ankles with an alcohol soaked tissue to remove the goo.

I have actually shaved a square inch patch on my ankles to avoid this problem, but the nurses always choose to ignore it and place the stickers elsewhere. Today I asked a nurse if I could remove the pads straight away, when they come off more easily, and she said that was fine. Later in the day another nurse was doing blood sampling and the ECG and was in a real hurry about it; the clinic is running three trials concurrently and is quite busy. When got around to hooking up the ECG and she saw I didn’t have my stickers on she flew into a real huff. At about the same time my roommate had his catheter removed early and had an adverse effect, possibly related to the needle striking his vascular nerve. He lay down and looked pretty grim for about an hour. Several nurses attended to him and it all added up to and atmosphere of a busy hospital where things aren’t going quite right.

We usually follow ECG and blood sampling with a doctor’s examination. It takes literally about 10 seconds. The doctor checks your heart is still beating, asks how you are, and then you’re excused.

Today was the last drug adminstration. I wasn’t allowed to take a photo of that, but I did take a photo at the end of breakfast when the doctors were setting up the drug administration which takes place in the same dining area.

Tonight we are playing poker. ¥5000 yen in chips each. There seems to be an sense of finality in the air. Its just as well, I’m kind of over the whole thing. I’m looking forward to seeing my girlfriend again and flying off to Spain together, to spend some of the money I’m making.

Another day out in the town, to relax and do whatever. Its kinda silly really, I feel like I’m on some demented holiday, where I pay for the hotel room each night in blood.

Today we visited the driving range where I whacked 100 golf balls into the sky, but didn’t wear gloves and tore two huge blisters into my hand. I knew they were coming after 60 or so balls, but kept on hitting the remaining 40. I chose not to care. Later in the day visited another onsen, a stinking yellow Chinese style bath built in the 60’s, and I had to hold my blistered hands out of the hot water because of the pain.

Cycled around a local island with the French guy and took some interesting photos with his camera.

A bunch of us lab rats followed the Dutch guy to a Japanese street wear store. He explained that a new line was being released and he needed us to help him purchase clothes to sell on Ebay. The store is obsessively exclusive; they only sell within their own stores and there are only 3 outside Japan. No wholesale accounts for anyone. The Dutch guy buys retails, but still makes a profit selling to wannabe gangsta rappers in America, who thrive on the exclusivity. The Dutch guy needed us today because the store only sells one item per person on days they release new lines. He told us what to buy and in what size.

Spent the rest of the day on the internet. The best place to get unsecured wireless has changed to the third floor ward, upstairs above the balcony. The ward is filled with some guys starting a new trial – a real bunch of gooby gaijins. One of them buys his clothes exclusively in Bangkok (its shows) and wears wrap around sunglasses with blue lenses. Another wears reptile skin pants and a matching mobile phone holder and talks constantly about fucking Japanese girls. I can’t help but wonder if these guys have time warped from the mid- nineties or if they accurately reflect the state of our culture, which is a bit scary. The British guy likes to hang with them quite a lot, enjoying his status as an anime seer-stone and listening vicariously to picking-up stories.

Catheter goes back in tomorrow, for the third and last time.

I had disturbing dreams last night. A friend of mine had asked me to help cut off her own head. She thought it would look cool, for a party. But she started dying and the paramedics came and sealed up the neck wound on top of her body, but left the head unattached in a clear plastic box. Later in the week I was chatting to her. Her body was functional and controlled by her head, still in the box. She had broken the medical record for having her head cut of and remaining alive for over 4 days. She described it as very painful and said it felt like the her head was still connected to her body by a giant etheral worm. She regretted her actions, and was unsure if the doctors could re-attached the two parts.

My roommate also had a bad dream – he dreamed about two girls fucking, one had a dick. A clear plastic tube was connected between the girl on top’s anus and the other girls mouth. Faeces were moving though the tube and the girl on the bottom was chewing on it. Later at breakfast, the worst breakfast we’ve had so far, he threw down his plate and growled, “Its disgusting!”.

I’ve been drawing in my sketchbook. I’m a graphic designer but don’t really sketch that often. On my first trip down to the clinic though I drew a freakish demon character. I had no idea what I was creating as I drew, it just flowed out of me, bulging veins and all. Yesterday on the way to the island I drew another freakish demon, with a teardrop tattoos and mournful expression. I’m think they are self-portraits.

Today started with a drug administration, followed by 4 or 5 blood samples. I tried to record one on my camera phone, but the nurse stopped me. She said it made her nervous.

Ouch. I just had to two dodgy blood samples.

Last night the male nurse couldn’t get any blood out of one of my veins and had to try again on my other arm. He showed me the discarded tube from the failed attempt, it was lightly striped with tiny clots of blood, stuck in the tube from lack of pressure. Apart from this though, I’m warming to the male nurse. On the second attempt he was telling me “Don’t cry!” and laughing, which I found pretty funny, although I suppose he could have been taking the piss, the language barrier makes the precise intent difficult to fathom.

This morning a couple of nurses had a jolly time wiggling a needle around in my arm for half a minute trying to find a vein. My persistent ouching was pretty loud and prompted my roommate to pull out his camera phone and grab some video, but thankfully by then the nurses had found the vein and I was spared the embarrassment of acting like sissy on video.

I wonder how much these experiences reflect on the state of my veins. In bad light they certainly look like they’ve been having a dirty weekend in Bangkok without me.

One of the nurses saw me on TV last night. To support myself in Tokyo and supplement my income I do what a lot of gooby gaijins do – part time modeling and acting. Last month I was paid to be interviewed in Harujuku about these two celebrity sisters, Mika-chan and Kyoko-chan. They asked me who I thought was better looking. Both of them have enourmous boobs, wear too much makeup and are in denial about being middle-aged. I said that both of them have had too much plastic surgery for my taste, but if pushed I would choose the one who wore less makeup. I’m not sure how much of that made it through the translator though. Anyway, the nurse seemed to think it was pretty great, but who knows if thats because my TV charisma was great or, more likely, that it was just great to be on TV, and really I looked and sounded like an idiot.

Released for the day again, and shared a taxi into town with the French and British guy. The British guy kept talking over the top off me, which was pretty annoying. At a sushi bar a couple of young wannabe yakuza guys spoke to us half in japanese, half in broken english. One of them seemed drunk and I think they had been up all night. They made me pretty nervous, especially when I thought one of them was wanted to take me to a brothel, but the French guy, whose Japanese is better than mine, told me later the guy was actually talking about the sushi, that it was good for having sex or something.

Went to a local island by myself, had a swim, walked around in the sun with my shirt off. The British guy called my mobile a few times, but I didn’t pick up.

Back at the clinic I overheard some dudes on another trial complaining about how others are let out regularly, that is, the others and I on my trial. Their trial, a blood thinner, lasts for 11 days and they are in the clinic the whole time. Ours is 15 days or so, plus a followup a week later, but we are let out almost every second day. There is no hard medical reason for the difference; the trials are planned by the sponsoring drug company and its just comes down to operational preference.

Later, in the middle of the night, when we had turned off the light, but had to yet to fall asleep, someone opened our door, looked in and then went away. My roommate become agitated and got up to have a see who it was, but there was nobody there.

I asked the catheter to be taken out early. Not because it was bothering me…. well it was, but just because it was itchy and I wanted to type and play videogames. So I will just give a regular blood sample at 1am tonight, no big deal. In fact, I am adjusting to the blood and needle thing quite well. I’m up to that stage that I can look at the blood as it zips out of my body through the little plastic tube, but I still don’t like seeing it empty into the vials. Watching the injection of the saline solution the nurses use to clear the catheter tube, however, was strangely fascinating. Years ago when I frequented underground dance parties, I knew a few girls who had blood and needle fetishes, and I’m beginning to understand why. I used my mobile phone to video the ritual from my first person perspective.

Blood giving via catheter – long movie – 4.7mbs

Blood giving via catheter – short movie – 800kbs

I believe now that my adverse reactions earlier were completely psychological. I’m not even sure this whole thing about the vascular nerve causing a blood pressure drop is actually that likely. For one thing, I can feel the catheter needle moving around inside my vein and bumping the inside wall. Its not exactly pleasant, but its not really painful either, and easy to ignore if you put your mind to it. But with all the movement, why does it only sometimes trigger the nerve? Pschyosomia for sure.

A new bunch of guys arrived today, they’re sleeping in the dorm on the third floor. I was happy to see a few guys I knew from Tokyo – I had referred them here. By Japanese law the clinic is not allowed to advertise, which means they are solely reliant on word of mouth and referrals to locate participants. This means they sometimes come up short for trials, especially if the screening variables are tight. From what I’ve heard, this is pretty bad because the credibility of the results can be impacted. So they like former participants to refer as many people as possible.

Of course, its not the kind of thing everyone is into. I’ve mentioned it to people at parties that view it immediately with disapproval, distaste or even fear.The botched trial in London in March is still on some peoples minds and I suppose it does have a bit of a stigma. I’ve had a few interesting conversations about it. Putting money to one side (and I never deny the financial incentive) I can justify the trials from a social perspective; participating in a clinical drug trial means being part of a medical/legal process that ensures the safety and development of socially beneficial medicines. Its not like feeding starving kids in Africa, but its not totally without altruistic merit either. Of course, this argument is often countered with all that stuff about how drug companies make so much money, overprice their products and hinder cross-developement with patent restrictions. All true too, to a certain extent, but such a conversation invariably oscillates to a discussion of the value and form of capitalism itself, and for me, life’s to short to worry about all that!

Back at the clinic, hospitalization. Catheter, which makes typing hard. I managed to calm myself very succesfully before the catheter insertion by practicing pranayama yogic breathing. I read about it in a freediving book my spearfishing mate left here for me to read.

Drug administration. Cumulative urine collection. I found out I don’t have a Japanese counterpart, he failed to make the drug administration on the first day. I could believe he had an adverse reaction to the catheter…….maybe. He also could have also gotten drunk 3 or 4 days before, or been too physically active prior to the screening. Alcohol and exercise cause changes in the body’s natural chemistry that can distort the blood test results. We are also told to stay clear of grapefruit juice, caffeine, nicotine and St. John’s Wart. They say they test for narcotics too.

It feels like everything I around me is abstractly related to the clinical trial. Yesterday when I went to the aquarium, I saw dolphins performing tricks in exchange for fish. Singing, jumping, diving……these tricks also included a gynacological examination courtesy of an obliging dolphin rolling over to present itself to an waterproof camera on a pole. With high-pitched squeaks the dolphin thrust its snake like penis towards the lens, and we in the audience were treated to a closeup 10 feet wide, high up on a bank of video screens. The dolphin trainer proceeded to discuss dolphin urine and faeces, and I was of course reminded of our own urine collection.

Much like dolphins tricking for fish we gather our urine into large plastic jars, which we then place into a special fridge in the bathroom. This fridge is alarmed – if the door is left open an alarm sounds in the nurses station. We have two types of urine collection: single and cumulative. The single is given at a specific time prior to drug administration, into a slightly smaller container the size of a chu-shoki beer glass about 375ml. The cumulative urine goes into a big duberu-dai-shoki container, about one and a half litres, which we fill up repeatedly over the course of the day after drug administration. Its hard to hold this container with one hand, especially when the other hand holding your penis has a catheter in it. We’re recommended to use a paper cup instead and then empty it into the container, but that takes longer and requires you to pause and change cups mid-stream. Once I couldn’t be bothered and pissed straight into the big container. Towards the end it got really heavy and I dropped it, splashing my pants with urine. Which was a hassle, but thankfully laundry here is done constantly.

Dolphins weren’t the only reminder of the clinic on my day off. The drug we are taking is a medicine designed to boost haemoglobin in anaemia sufferers. Walking through the deep sea section of the aquarium I cam across an exhibit about deep sea worms that live around oceanic thermal vents. Buried in the exhibit text I was reminded,

“Haemoglobin is the red substance in blood, and functions to bind oxygen and carry it through the animal’s body.”

Deep sea worms and gaijin lab rats. Nothing, but animals.

Well I wrote this post, slagging off one of the guys on the trial who has been getting on my tits, but I’m not going to post it now. Maybe later, when the trial is over and done with, I’ll slot it in. We’re still in confined quarters, and really its just me letting the stress get to me.

I was just told there are some Japanese dudes on the floor above us, doing the same trial. Its a comparative study, comparing doses in different physiology, caucasian and Japanese, to ascertain the value of the existing FDA approval which was based on the results of studies on caucasians only. Apparently, each of us is matched in number to a Japanese guy, who gives blood, eats, and takes the drug at exactly the same time. This is interesting because the Swedish students have been talking about their counterparts, and one had conversations with his. They met during drug administration, the Japanese guy stood across the table from him and they swallowed the pills together. My roomate has confirmed he has a countepart also. But where’s mine? I have never seen him. He’s certainly not opposite me during drug administration. Maybe I don’t have one, maybe not enough Japanese passed the screening and the trial is one short. Except the two Swedish students are at the ends of the numbering range and they both counterparts, so shouldn’t I?

Of course the other explanation is that he is my mythical doppelganger, my supernatural double. In which case its probably just as well he is invisible to me, as according to Wikipedia an encounter with your doppelganger is an omen of doom.

A couple more blood samples this morning and then we were released again. This time for two days, so they put us in a hotel. We went and hired a car and drove to the beach. It was mostly pretty good. It got a little weird at one point; my roomate was driving the car and he clipped the passanger side rearview mirror when driving down one of those tiny little streets you get here in Japan. Actually that was kind of ok because it was the one spot the car already had some damage, and it was marked on the rental form. Yet later he wanted to drive again, and the French guy, who signed the car rental documents, wouldn’t let him. They had a tense, but softly spoken argument about it. My roommate, relegated to the backseat, stayed quietly pissed off until we got back to the hotel.

We went out for dinner and snuck in a few beers on the sly; alcohol is strictly prohibited during the trial. Everyone loosened up and we had some good talks about Japan, women, sex and immigration visas, the usual gaijin coversations. We watched the second half of the Japan vs Croatia World Cup match, the result was nil-nil. The locals seemed a little glum, but not as much as last week when they lost 3-1 to Australia. I’ve been telling people I’m from New Zealand when they ask recently.

So far, no effects from the dug testing.

Part 1

An early start today, and I was up late playing Quake on my laptop. Gotta stop doing that, but using my notebook in the dark disturbs my roommate less than if I keep the light on to read or draw. Unfortunately using my laptop keeps me awake, compared to reading a book which sends me straight to sleep.

The blood samples are getting easier I think. At least it feels that way when I’m really tired. I hardly feel them. Also, the nurse this morning is the very chirpy and slightly good looking one. She has very Japanese features, especially those eyes that look like upside down crescent moons, like this ^_^. She’s very gentle with the needle. I remember her from the smoking trial when I fainted a few months ago, and apparently, according to the trial co-ordinator, she has recognized me as well. So she could easily pull me off this trial if she wanted, but she seems pretty cool about it. Its hard to tell with the language barrier though.

Part 2

I hardly remember writing the above. I was pretty tired. Actually today was the first day I was actually felt a bit bored. I think everybody was, the result being we socialised a little more than normal. I spent some time in the French guy’s room watching a movie, then he and the English guy came into mine to swap movies on our portable hard drives.

My roommate spent most of the day trying to crack the wireless networks we can pick up in our room, something he’s been doing since the first day we arrived. I showed him this program I have on my laptop that detects wireless networks, our room is filled with them, and explained that although these networks are protected, its possible to crack the encryption on them. I’ve never done it, but I told him about how its done in theory. He totally went for the idea, and has spent dozens of hours learning about packet sniffing, weak frames, SSID’s and WEP encryption, all this really technical stuff. Its quite impressive. He’s right into it. He wants to get a connection in our room instead of having to duck off to the balcony to surf the net. Especially since yesterday when we were prohibited from using this balcony, the only place you can connect to an unsecured network, because the clinic is running another smoking trial. The lab rats go there to smoke and the nurses don’t want us to breathe in their smoke or otherwise mingle with them or something. So with the passion of of a 5 year old on Chanukka my Hebrew friend has been up at the window at all hours of the night in his hospital issue pyjama shorts, holding his laptop out the window, trying to find better reception and desperately reading more and more about how to crack networks.

Actually the clinic feels a lot like a computer camp half the time; boys with their toys and all that. We spend a lot of time playing around with our laptops and comparing specs. Last time I was here there were 5 Mac users so we set up a server to play deathmatch Quake, a computer game where you run around madly trying to kill each other over and over. I remember dudes playing it even with their catheters in their wrists, right near their trigger finger. One dude even kept a game going while giving blood, crouching up high on a virtual tower and sniping at the other players with his free hand while the nurse crouched down with her head near the keyboard. Her movements were so practised and automatic she barely looked at the vials she was filling. Instead she watched the action onscreen, offering encouragement when her patient shot someone.

Unfortunately I’m the only Mac user on this trial, so no deathmatch. Also, I have a hard time copying files off my portable hard drive because none of the windoze laptops have Firewire. Its so unnnghh.

Hey my roommate just got all excited; he’s managed to connect to a hidden network. Its not the same as cracking a secured network he thinks, but he can surf a little from his bed so he’s happy for now.

I feel a little isolated from the other lab rats. Last week there was another bunch here, testing a blood thinner drug (we’re doing something do to with haemoglobin levels). That collection of guys included quite a few Americans and Aussies, fun people to hang with, but my group has a majority of northern Europeans – Dutch, Swedish, French. Which is fine, and they are a fine bunch, except our senses of humour aren’t quite meshing yet. My jokes don’t make it through the first time round and I have to do some explaining. It’s just a language thing. Its also partially true for my roommate, an Israeli musician who makes polyphonic mobile phone ring tones. I placed some chocolates on his pillow today. It was meant to be a gag based on a joke we shared earlier this morning about how bad the service is in this “hotel”. Like, there’s no room service or ensuite bathroom, and the staff are constantly ignoring the “no interruptions” sign hanging on the door. The chocolates looked really good because the staff here had actually and unexpectedly changed our bedding whilst we were in town. I folded down one corner to complete the illusion of maid service. Anyway, my roommate came back from his shower and brushed them off his pillow without noticing.

Today was another rest day and they let us out for the afternoon. I visited a local museum for Kamikaze pilots. The Kamikaze were fighter pilots during World War 2 that committed suicide by crashing into enemy ships in order to sink them. I always thought the suicide thing was a kind of last minute decision based on whether they had successfully bombed anything, or had enough fuel to return to base. Or something like that, but no, it turns out their missions were planned in intent. They drank a final farewell cup of shochu, a Japanese liquor, said good bye to their wives, girlfriends and mothers and climbed into the cockpits of their planes that were packed with explosives, wearing a special headband with the phrase “Perfect Win” written on it in kanji.

The exhibit mainly consisted of a restored fighter plane, dredged up from the ocean floor in the Philippines, surrounded by photographs of individually named pilots. There were hundreds. Most of them were very young, and some had drawn adolescent portraits of themselves. It was very sad.

The plane they dragged out of the ocean was riddled with rust and pock marks from ordinance. It prompted me to look down at my own needle-marked arm. There were also a number of military nurse uniforms on display at the museum. Our nurses don’t dress up as much, though.

I’m having fantastic little waking nightmares. The blood sampling today was done sans catheter, so we’ve been subjected to regular needles about 7 or 8 times. When I close my eyes I’ve been seeing a kind of needle ball machine, a tightly wadded apparatus bristling with flesh peircing needles. It moves towards me from a black void, a freakish mental abstraction that manifests just before blood sampling, as the nurse is preparing the equipment. It’s a hard thing not to think about.

A big topic of conversation today was veins. We stood around like junkies comparing track marks and stories…” this needle hurt a lot here, but I didn’t feel this one at all. “

One thing I noticed is that its quite nice the nurses don’t speak much English. The know enough to give me basic instructions in English when I don’t understand their basic instructions in Japanese. Its a nice counterpoint. Thinking back on my experiences with doctors and nurses in Australia, I don’t think I could handle the attitude or forced friendliness from a fluent English speaker charged with taking my blood 8 times a day. It would wear out and become awkward. As it is, I am only able to exchange vague pleasantries and the occasional laugh with my nurses. I especially like the ones that giggle over nothing, their very Japanese girlishness puts me at ease.

I spent most of the day on the internet. There is no fixed connection here, but there is an open wireless network we can pick up on the balcony. Its a bit hit and miss, and unfortunately the best place to recieve the signal is on top of the concrete ledge running around the balcony. Its a bit precarious and I worry someone will bump me and my laptop will spill over and smash to the ground two floors below.

There is a yellow foam rubber cushion glued around the edges of this ledge, that wasn’t here when I was down for the smoking trial. As this was where I departed from consciousness on that trial, I’m assuming I had something to do with its installation.

Thank christ the catheter came out last night, at one in the morning. It wasn’t as much of an immediate relief as I thought, though. My arm was sore, itchy and very sensitive. I wanted to give it a massage, but it felt too delicate. Instead I laid it gently by my side and fell into troubled sleep. I woke up to find my wrist patchy with yellow bruising.

At one stage today, while rubbing my bruised arm, I felt very violated. And doubtful.

Yet although the catheter wasn’t pleasant, but it made blood sampling a lot easier. The needle prick and the dull pressure pinning your arm down during a regular blood donation is replaced by a almost painless manipulation of plugs and tubing. The mental stimulation remains though. I envisioned the nurses as sly little vampires, sneaking off with my blood into cupboards and drinking from tiny vials while giggling. Blood on their lips, lust in their eyes.

We were let out after breakfast, and as a group headed into town for lunch. I’m trying to be social, it will help the time go faster. Most of the lab rats are pretty young – 20 and 21 year olds. They bicker about inane stuff, like whether its better to buy a Playstation DS (whatever that is) or spend the same amount of money on a Louis Vuitten wallet, which is a pretty funny argument to listen to. These guys have interesting ways of making money to enable them to stay in Japan. One of them buys new release video games in Akhihabara and sells them back home on Ebay. Another does the same with a Japanese street wear label. Clothing seems to play a pretty important part in their lives. The Scandinavian wallet guy was pretty much straight up wth his reasons for wanting the wallet. Prestige. He wants people to notice it. He has a strong interest in fashion and design and wants to move into that industry. On the other hand, the British video game dude doesn’t want to do anything. He personally expressed his desire to do nothing with his life except the minimum needed to sustain his addiction to Japanese videogames.

These young guys seem to want to hang out in fast food places all day, so I took off and visited a beautiful onsen, a Japanese hot spring, by the beach. It was mixed sex, so instead of being naked you wear a yukata, a kind of light robe, into the water. Despite the signs saying not to, I stepped into the surf, very carefully as the rocks were both slippery and sharp with barnacles, and floated on my back in the pacific ocean. The yukata billowing out around me. I reflected on the way the catheter made me feel, then imagined the cool sea water around me washing it away. It was peaceful. Two japanese men observed me from the beach, I think impressed. But I cut up my feet and hands coming in. The waves umbalanced me and pushed me onto the barnacles. I looked up as I fell hard onto one knee; the Japanese men were walking off.

I’m hoping the nurses don’t notice my injuries, we’re not supposed to do stuff like that during the trial.

Part 1

I was determined not to faint this morning, the morning of the catheter insertion. The main reason being the rather offensively large amount of money they give for completing the trial. The other reason being that I felt some kind of responsibility to my friend who works here, for given me the another crack at it. But he’s based in Tokyo and not actually hanging around, which takes the pressure off somewhat.

The English trial co-ordinator however, the only employee here who knows about the my previous fainting experience, is acting kind of nervous. He keeps ducking his head round the door when they are taking blood samples, checking my color and asking if I’m alright. He’s also made a number of group announcements to the other guinea pigs about the action of the vascular nerve that can cause people to pass out when giving blood. When the nerve is stimulated it sends a messages to the brain, the brain thinks the vein is damaged and the body is bleeding to death, so the brain lowers the blood pressure to prevent this, thereby causing unconsciousness. He’s telling us its rare, but normal and I think he’s using it to try and make me feel confortable. Really its just reminding me of what happened before. And I’m pretty sure the fainting can’t be explained entirely biologically. My own psychosomia and childhood phobia of needles must have a lot to do with too.

One guy listens to these little stories closely though. He’s been nominated the reserve, meaning unless something odd hapens before the drug administration, he goes home early and doesn’t get the big bucks. From our conversations at the screening I gather his financial situation isn’t very good. He’s a ex-english teacher trying to exist as a gaijin TV celebrity “full time’ , so what do you expect. He keeps looking around the table, no doubt trying to figure which lab rat is most likely to faint. I haven’t mentioned my earlier incident, but the trial co-ordinator keeps giving me knowing and concerned looks and I think the reserve guy is cottoning on.

I didn’t have any real game plan for the catheter insertion. I didn’t try to visualize a tropical beach, or metally recite self-affirminative phrases. I guess I thought that dwelling on it too much would increase my tension, so I just went in blind, tried to relax and used my previous experience as a guide. And yeah, I decided to stay in bed for at least an hour afterwards, so even if I did faint, maybe no one would notice.

You can feel the needle as it slides up the vein. I think thats the worst part. I’m not particulary keen on the rubber hose they tie around your arm to make the veins pop out either. I went pale, but thought about the money and regained a little color. It helped that the clear siphoning tube was closed of properly this time. I didn’t have to deal with a slowly advancing column of blood snaking around my wrist.

So the first hurdle today has been jumped. Next up is the drug administraion.

Part 2

The drug adminstration is kind of fun actually. Its done in the kitchen by a pharmacist, and observed by 4 or 5 other doctors. You are told to stand up, given a certain amount of pills based o your body weight, which you down one after the other, drink a specific amount of water and then open your mouth to show the pharmacist you’ve swalled them. Its a bit like a scene out of One Flew Over the Cuckoos Nest. The whole thing is timed precisely, and every doctor present monitors it with their own personal stoptwatch. They are fanatical about time here. Many of our meals are timed – you must eat everything in exactly 15 minutes – and all the blood sampling is done on the minute too. I was up in the television room today watching Family Guy at one point, when I should have been in bed and one of the vampiric little nurses had to run around the clinic to find me (the most vampiric one; she has a gold capped canine tooth and a face like an ogre). She raced into the TV room with her stopwatch out. There was no time to go back to my room so she took my blood then and there, while the other guys in the room looked on amused.

My roommate has been in trouble already; he is constantly net-surfing out on the balcony when he should be waiting in his room for blood sampling. The nurses have complained to the trial co-ordinator, who’s not happy about it. After drug administration we shuffle back to our rooms and the tv lounge and eye each other warily. We ask each other “Hey man, do you feel anything yet?”. Its only natural I guess. Some of the guy’s talk about the moment of truth “I guess this is when I find out if my balls drop off.” My roommate has been complaining about hot and cold flushes, but really the amount of drug we are given is usually lower than an effective dose. I don’t feel anything at all, but maybe I was given the placebo, another hot topic of conversation. Some of the lab rats are even making small bets on it.

Betting is something to talk about. A whole bunch of guys stuck together for a few weeks, unable to go outside and with only so many movies to watch; the cards come out. The prospect of an approaching substantial cash payout adds fuel to the fire. I know of a few guys that have bet parts of their compensation money in poker during their stays at the ‘Country Club’ as they call it. We’re talking a couple of hundred dollars at the most though. But this being Japan, the locals know how to go all the way. Before I came to this clinic I underwent a screening at another clinic in Tokyo, and on one of the handouts was the instruction “Mahjong are (sic) prohibited”; two young Japanese had been gambling, and one lost his entire compensation money (several thousand dollars) to the other. Come pay day he refused to hand it over, and they had a fist fight in front of the nurse’s station.

The reserve just popped his head around the door to say goobye. He’s on a flight back to Tokyo, now that it looks like everyone has taken to the catheter ok. He looked really disappointed and kinda pissed off about it.

I am participating in a clinical drug trial in Japan. Its a phase 1 trial for a drug that boosts haemoglobin levels in order to treat anaemia. The experiment is designed to determine ethnographic differences in the drug effects between Japanese nationals and caucasion or black subjects. So they need a whole bunch of gaijins. ‘Gaijin’ is the Japanese term for foriegner. Its pretty commonly used, so much so that us gaijins living in Japan refer to ourselves by that name, even though some say its a mildly offensive term.

The clinic needs gaijins who have flexible schedules, don’t mind being stuck with needles and have a reasonably strong or perhaps desperate need for cash. I fulfill all those criteria, except for the bit about not minding needles. In fact I hate them, but I went and ahead a volunteered anyway.

It wasn’t something I did without thinking. Phase 1 trials can be dangerous because they are the first time the drug is tested on humans; the next step after animal testing. The drug is given to healthy volunteers in small but increasing doses and the main area of study is how the drug is metabolised in the blood and excreted in urine. They are serious business and accidents do happen. In March of this year, 2006, in a clinic in London, 6 out of 8 subjects had major reactions during a Phase 1 drug trial. The drug was an anti-inflammatory, developed to treat leukemia patients. Within a few minutes of dosing all 6 feel ill, suffered organ failure and 2 fell into coma’s due to brain injury. As far as I know, these two guys are still in critical condition. The remaining 2 from the total 8 were given a placebo and suffered no reactions.

So particpating in a drug trial is not something to take lightly, but several factors convinced me. Firstly, the compensation money is very generous. Its not like I couldn’t do without it, but it will come in very useful, particulary as having recently moved to Japan my financial situation is unstable. Secondly, drug trials in Japan are more strictly controlled than in other countries. Like many other Japanese administrative bodies, the drug administration is beaurocratic and conservative. For example, while many Japanese drugs trials are technically Phase 1, they have often been passed into Phase 3 in the United States and many already have FDA approval. In order for it to be approved for sale in Japan, it must be proven that there are no adverse effects peculiar to Japanese physiology. So gaijins are used for comparison, as a scientific control.

I first heard about the clinic from an old friend, who told me about it when I enquired how he managed to live in Tokyo for so long with only semi-constant work. Not less than a week later, another friend told me about the same clinic, via a gooby guy he met in a night club in Roppongi. Roppongi is a notorious district in Tokyo famous for nightlife catering to westerners. Its probably the one place in Tokyo thats feels dodgy. You either love it or you hate it. I hate it.

A week after that, I hooked up with a guy I met on the internet to go spearfishing in Chiba and anyway it turned out he works at the clinic as an administrator/recruiter. It was enough synchronicity to convince me. I don’t like needles much but I’m not a pussy either so I volunteered and here I am.

But actually, my story doesn’t begin here and now. Its a bit more interesting than that, and starts several months ago when I first volunteered.

That was about 3 months ago. I volunteered for another trial, an anti-smoking drug. The clinic needed test subjects who smoked at least 10 cigarettes a day, but were otherwise healthy ^o^/-” ‘! I don’t smoke that much, but was happy to boost my addiction for a couple of weeks in exchange for about a little (or a lot of) cash. A whole bunch of interesting gaijins joined me, some gooby, some not, and we stood around chainsmoking on the balcony, telliing jokes and and rating the girls from the local catholic school as they walked past, as the doctors screened our blood and the nurses monitored our heartbeats with portable ECG packs. We wore these in a pouch looped around our shoulders, attached to electrodes on our chests, under hospital issue pajamas. The next step was the catheter insertion, which is the reason why I prematurely left that trial and why I’m back here now on another trial, thankfully for even more money.

A catheter is a long slender needle that is inserted in and up your vein on your wrist. It attaches to a collection of valves that allow blood to be taken regurlary without futher needle puncturing. Most of these clinical trials require the drugs activity to be monitored in the blood, to determine its half-life, its effectiveness, how soon its washed out of the system etc. So the nurse take blood every couple of hours, sometimes every hour. The catheter helps simplify the process.

When I had my catheter put in, it was about 5 in the morning. I had fasted since 7pm the night before, and I had been up all night playing Quake on my laptop. The catheter was inserted and I immediately noticed that the tube running out of my wrist was leaking blood, not freely, but up the tube towards the two way valve. Others had a little blood in their tubes also, but mine exceeded theirs and was increasing, maybe a a few millimeteres every minute. This is really nothing to worry about and quite normal until the pressure inside the tube stabalizes, but it was rattling me a little, so much so I started joking about it, which is never a good sign – forced hunour to alleviate fear. I joined some guys out on the balcony to have ciggie. I inhaled deeply on my clove ciggerate and, as the nicotine hit, my arms resting on the rough concrete ledge suddenly felt very frail. My vision began clouding into a deep green and I knew I was going to pass out. I’ve never passed out before, but I didn’t panic. I asked a friend, standing next to me and on the same trial, to hold my cigerette. I told him quietly I was going to faint, and sat down on a chair so I wouldn’t fall. I vague remember thinking that if I was spearfishing it would be a good time to release my weightbelt, but that might be have been after the fact.

I was told later that as soon as I passed out my head tilted back and I started snoring. But, later still, my friend said, in hindsight, that he didn’t think it was snoring, rather it was the sound of me choking on my own tongue. I choose not to believe him.

I woke up with a couple of nurses in front of me….

“Daijobudeska?“

“er….Hai…..daijobudes……I was just sleeping….no sorry, I mean I fainted…. thats weird….. I thought I was sleeping….”

I was fine, but they insisted I move into a wheelchair, the sudden movement causing me to throw up. Some puke went over my leg, some got on the wheel chair. They laid me down in bed and removed my catheter, and I thought ‘Fuck! I guess that means I’m off the trial!’ But anyway I was paid the reserve fee, which is pretty reasonable, but not the big bickies I was there for. But being mates with a dude here gave me another in – I just had to wait 3 months or so for the nurses to forget my face. Not hard, a dozen new gaijins pass through here every week, and besides we all look the same to them >_0

So anyway now I’m back, I’ve passed the screenings and so far the none of the nurses have recognised me. I’ve been poked, prodded, weighed, blood-pressured and my height has been measured. I’m lying in bed typing his and tomorrow at 5pm they put the catheter in again, so I better get some sleep.