The temperature drops about 10 degrees when you walk into Senen General Hospital, which hasn't had gas, electricity or running water for a week and a half.
The old concrete buildings, in a part of town between a river and the coast, were flooded on the first floor when a giant tsunami swamped the neighborhood. In these cold, dark halls, the staff _ some of whom have lost their homes and are now living in shelters _ work 24-hour shifts to keep its remaining patients alive.
"The worst thing is the cold," says nurse Takako Suzuki.
The hospital has one or two deaths a day, all older and fragile patients most vulnerable to the frigid conditions _ they've lost 11 since the disaster struck. More subfreezing temperatures and rain are due this week.
Fish from the river swim in the flooded basement, which houses the boiler, the electrical room and other key machinery. Two small generators pump water out of the 7-meter (23-foot) rooms underground _ at about a centimeter (less than a half-inch) per hour.
With its first-floor medicine stockrooms and kitchen ruined, the staff has had to improvise. They pour hot water into plastic juice bottles and tuck them around patients, carefully rinse and mix soiled medicines, and try to clean off adult diapers with newspapers to make them last longer.
"The staff has been amazing. Some are living in shelters and others ride their bicycles three hours to report in," says Dr. Satsuki Ishigaki.
She says patients are weakening without standard supplies like oxygen and antibiotics.
"Those that have died so far have been elderly, but we could have lengthened their lives if we had what we needed," she said.
The six-story hospital lost one wing and its ground floor to the earthquake and flooding, so eight patients have at times been squeezed into rooms, with sick women and men side by side. In one room, elderly patients stared ahead, buried under mounds of blankets against the cold, as nurses hand fed them cold meals in the dim light from a window on a cloudy day.
Suzuki said she rides her bicycle several miles through the cold to work her shifts, catching naps on mattresses in the staff room. Her car was swept out of the hospital parking lot and smashed, but even if it had survived, there is no time to wait hours for gas.
Supplies have begun to trickle in.
The hospital can now light the halls for two hours at night with a large generator from the government, run by gas that from Self Defense Forces. Patients are wiped down with towels donated by neighbors, and one hot meal a day is cooked with a gas stove from a local utility. There are two portable toilets for staff, instead of the newspapers they had been using.
"We take anything we can get, from anybody," says Takahiro Suzuki, the hospital's chief administrator. "I understand that the government is overwhelmed, but it is moving too slowly."
The hospital had about 200 patients when the earthquake hit, and those that can go to shelters have left. Functional hospitals in the region are packed, but several have agreed to take the more serious cases, and occasionally an ambulance pulls up outside for a transfer.
On Sunday, 52 patients were left. Some have no living relatives and are too sick to care for themselves. Others have family, but their homes were ruined in the disaster.
Power is due to come back on in the neighborhood later this week, but with the hospital's facilities in ruins, it will stay dark.
"I'm not sure this hospital will ever recover," says maintenance chief Masakazu Niinuma, standing outside and watching fish dart around in the oily water covering the stairs to the basement. "The tsunami destroyed its heart."