I, Kazutomu Kurihara, work at Honjo Hospital in Matsumoto City, Nagano Prefecture
which advocates 24-hour, 365-day support.
I'm a gastroenterologist in my sixth year.
Please take me to Kikumoto at Shiraito.
We have been supporting the community medical system
which has been on the verge of collapse
and despite all our wounds, we gathered up what little time we had and held a party.
My friend Shindo Tatsuya, who moved here from Tokyo
has been working at Honjo Hospital for a few months.
together with our newly appointed gastroenterologist, Dr. Nami Obata.
I wish to extend an enthusiastic and warm welcome to the both of them
By the way, please excuse my
somewhat old-fashioned way of speaking.
This is due to the influence of Dr. Soseki Natsume, whom I have admired since my school days.
Good evening, Kurihara. Are you finished with work?
Of course not.
What's the guest of honor doing in the corner? I just got here myself.
And I'm not the guest of honor, I'm an add-on to the guest of honor.
That goes without saying. Where's the monster?
Apparently, he's in surgery for a colon perforation.
Jiro's been assigned as the primary surgeon these days.
That's proof of Dr. Amari's trust in him.
Nice to meet you, Dr. Obata.
Oh please, call me Obata-kun. Dr. Amari
Attention, everyone!
Now that we've got most of our lineup.
I'd like to introduce the new ace of our department.
Dr. Obata Nami. I'm looking forward to working with you.
Obata is a gem that I, Itagaki,
nurtured with all my heart at Shinano University Hospital.
After that, she moved to Sapporo Inaho Hospital,
*Endoscopic retrograde cholangiopancreatography, is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscope—a long, flexible, lighted tube. Endoscopic retrograde cholangiopancreatography, or ERCP, is a procedure to diagnose and treat problems in the liver, gallbladder, bile ducts, and pancreas. It combines X-ray and the use of an endoscope.
one of the top ERCP* hospitals in Japan, where she refined her knowledge and skills
working 12 years in gastroenterology.
She is a very talented physician in her own right.
She is one of the foremost experts in Japan
who can train doctors in ultrasound endoscopy,
and since Obata is coming to our office,
our Administrative Director Kanayama-san is very excited.
He purchased an ultrasonic endoscope.
Please take care of Nami Obata.
EUS? Even Teito University Hospital has only a few of these high-end units.
That's quite a feat. I've never even touched one...
Dr. Kurihara, I am Obata.
GASTROENTEROLOGIST OBATA NAMI
It's nice to meet another fellow student of the same Shinshu experts
I'm Kurihara. Nice to meet you.
No, thank you. Ok maybe a little
I'm not a drinker. - Oh, then...
Excuse me. (vibrating)
Yes, this is Kurihara.
We have an urgent case of hematemesis. Emergency endoscopy, please. *vomitting of blood
I thought it'd be easy tonight since Kurihara's not on duty.
I gotta go. Good luck.
That EUS is an ultrasound endoscope. Is it that expensive?
About a million yen? It's more than your annual salary at least.
That makes me tense
Doctor, are you okay? What do you mean, Tozai?
No, it's just a rumor that Administrative Director Kanayama is giving you a hard time.
Maybe they're planning to make Dr. Kurihara quit and use the money to pay for EUS.
Oh no~ What am I supposed to do if that happens?
What am I supposed to do?
Unfortunately, even with my income, I still can't afford the EUS.
Besides, I have a wife, Tozai.
Yes, yes. The best coffee in the world.
I remember you have a wife who could make the best coffee in the world.
I'll always be number two anyway.
Needless to say. Chief Tozai. - Hmm?
The patient with hematemesis who was rushed to the emergency room last night.
He's coming up to the internal medicine ward over here now.
Ah~ the 36-year-old with Mallory Weiss? Yes.
*Mallory-Weiss syndrome refers to a tear or laceration of the mucous membrane, most commonly at the point where the esophagus and the stomach meet
I heard from Tonomura-senpai. Okay, I'm moving you now
How are you doing, Mr. Sakakibara?
I've settled down a lot. Thanks to Dr. Kurihara.
You seem to have a pre-existing condition of asthma.
I'll keep an eye on you for a while, including Mallory Weiss' progress.
Yes, please take care of her...
Naomi?
Shin?
MALLORY-WEISS SYNDROME PATIENT Sakakibara SHINICHI
Naomi? Shin-chan?
(phone vibrating)
Yes, this is Kurihara. Ah, Dr. Obata
Of course. I'll be right there.
I'm moving you now
Drama Special Kamisama no Karute Night Three
Ah.
What, are you that surprised to see my face?
I wasn't surprised by the face. I was surprised by the how close you were
I was wondering if you were awake
Were you thinking about a woman?
Here, eat this if you like. My family has an apple farm
Dr. Obata, I admit there was some confusion. Please continue.
If you're going to ask me to teach you, you should do some preparations
I'm sorry. I'll be sure to prepare next time.
Can you teach me again? Whenever you're up to it
I'm as busy as you are, Kurihara-kun.
What? Oh, nothing.
Chief, are you okay?
What's wrong?
Oh, no. About Shin-chan?
It's nothing. He's just an old.... boyfriend
You look surprised.
Mallory Weiss' bleeding has stopped completely.
Almost no signs of asthma attack.
But your liver function is poor and you have jaundice...
Sorry, why jaundice?
There was no abnormality in the CT scan. It could be the effect of the medication.
Medication...
I'm ashamed to say that I've been drinking a little more lately.
Maybe that's why.
If it's right after drinking, it's normal.
Jaundice usually disappears after a few days in the hospital.
I'll change the medicine.
Thank you very much, Dr. Kurihara.
Anything else? I'm a lover of the classics.
Is that Jean-Christophe by Romain Rolland?
Ah, yes.
I've let go of many things in my life
but this book is like a charm that I keep close to my body.
"Jean-Christophe" is a masterpiece of French literature that depicts the life of a musician.
It is said to be based on Beethoven, but I am not sure.
The binding is superb.
It's not an exaggeration to say it's a work of art.
Please hold it, if you like
Oh, I'm so embarrassed that I asked for it.
What a fragrance.
The scent of accumulated time and fine paper and ink.
The shine of gold.
This is the second volume. Where's the first volume?
I've lost the first volume somewhere.
Lost? What a shame.
I'm sorry, I got too excited.
I wanted to be a composer like Jean-Christophe.
But that dream is long gone now.
"An artist is a compass
that always points north in every storm."
It's a line from "Jean-Christophe".
Doctor...
Even if it's stormy now.
Let's aim north together, Mr. Sakakibara.
Yes, I'm feeling energized.
Dr. Kurihara, room 317, Mr. Uchimura is VF.
VF? Excuse me. Let's go
Thanks for your help, Kurihara.
It's not you I helped. It's your patient.
Where's Natsuna? If it's the middle of the night, my mom can take care of her.
If anything happens to Natsuna, Kurihara will take care of her next time and bring her home.
That's fine.
I'll take care of the rest. You should go home now.
I'd go home, but Haru's not home right now, she's in Tokyo.
In Tokyo? She has a meeting with the publisher.
They're finalizing plans for her next mountain photo book.
This hospital really does get patients one after the other.
Are you on duty? Good work. Good work
I can't make any progress on my paper at all.
I've got two revisions to do this month. Here, have one
That's amazing. You were posted last week, too.
No it's not
The latest medical treatments keep advancing. If you slack off on your studies
your knowledge quickly becomes obsolete. As a clinician
there's no excuse to write papers just because you're busy
I'm sorry.
Dr. Obata, there's a case I'd like to discuss.
Shinichi Sakakibara-san who has Mallory-Weiss syndrome, is suffering from unexplained jaundice.
There were no abnormalities in the CT scan
I'd like you to perform an EUS on Sakakibara-san just to be safe.
You don't have to. Why?
(vibrating sound)
Yes, sir. Understood
I'm going back to the emergency room.
What a busy hospital.
That was merciless. She hit me right where it hurts.
Good night, Chief Nurse Tonomura.
You're going home at this hour?
Good night.
How's it going with Tozai? Is she doing okay?
Shin-chan and Naomi, huh?
Well, they don't seem to have changed much.
He's in serious condition? Eh?
Well, it's that guy, so I'm sure he'll recover.
Why don't you have a drink with her once in a while, Doctor?
Why me?
You know Doctor...
You've read a lot of books, but you don't understand the heart of a woman at all.
Well, I'm going back to work
Well, whatever.
I need to change rooms? Right now, immediately.
Please give me some time. I have to pack my things.
We'll move all your stuff here.
I don't want to bother you with...
What's bothering me is the fact that you're still doing this!
Ah, no, this is...
The worsening of liver function and jaundice...
They weren't side effects of the medication.
It's because you were secretly buying and drinking alcohol
even after you were hospitalized.
You should be moved to a private room first.
I'd like to talk to you about transferring to a psychiatric hospital that offers alcholism treatment.
or discuss whether to continue treatment here...
Tozai?
What are you doing? Shin-chan. Naomi.
Living like this all the time?
What about your dream of writing the world's greatest symphony?
Answer me, Shin-chan.
Who's going to listen to my symphony after I got fired from school like that?
Who's going to listen, Naomi?
I lost everything.
All I have left is my asthma and Mallory Weiss syndrome
It was unbearable
I drank until I bled
After ten years like that, anyone would...
No, that's not it
This is the life I chose.
You don't have to feel responsible for me, Naomi.
Of course I don't feel responsible.
But you know, an artist...
never loses sight of the north in the midst of any storm.
It's your compass!
I haven't lost sight of the north in 10 years.
Do you know why?
This is a hospital, Mr. Sakakibara.
It's a place where many people are fighting illness.
If you don't want to be cured, please leave.
Pulling out the IV isn't the appropriate thing to do.
I want to cry, but I can't even cry.
Even though I want to die.
I wanted to die, but I was in so much pain that I had to call an ambulance.
I can pull out the IV myself anytime I want.
But I can't even do that
I'm a useless person.
He's too self-deprecating. Illness makes us feel weak.
I'll give you another line from Jean-Christophe.
"As long as your faithful friends cry with you,
life is worth suffering for."
Tozai was crying for you.
It's raining. I know.
Take it with you. I don't want it. The Doctor will get wet.
There's two of us and only one umbrella.
If it's about pulling out an alcoholic's IV,
don't worry about it.
I would've pulled it out myself.
Doctor.
Come have one drink with me.
10 years ago.
He was my music teacher in high school.
He was weak, had asthma, and was good-looking.
He was very talented.
He wanted to be a composer while he was teaching.
He made beautiful music. I liked him.
I knew you were in love.
Boo-hoo! One-sided unrequited love.
You see, I'm the aggressive one, but Shin-chan is shy and sensible.
Besides... You were a student and he was the teacher.
Ten years ago, the symphony he completed after three years of hard work.
won the Best New Artist Award.
So I came over to his house with a bouquet of flowers to congratulate him.
Shin-chan was unusually excited.
He took me to his favorite restaurant.
I was so happy.
It was like I was on a date with the idol of my dreams.
It was like I was in a dream.
There were people my high school at the restaurant.
"What was going on with the teacher and the student?"
It was a big problem.
Shin-chan was blamed by the principal, his colleagues, and his parents.
Shin-chan resigned from the school
Sorry, Shin-chan, I'm sorry.
It's my fault he disappeared from town.
After that, I kept buying classical magazines.
I was sure that Shin-chan would become a composer somewhere.
I was sure he would write beautiful music again.
All I could do was believe.
(shouting)
The reason I wanted to become a nurse was
because Shin-chan was suffering from asthma.
I saw him composing music while screaming from a seizure.
I really thought that I wanted to support people like him
who risk their lives to pursue their dreams.
That became my dream...
Ten years.
For the past 10 years nothing happened
It's not like I've only been thinking about him.
There are people I've been in relationships with, and I feel fulfilled in my work.
But you know...
When I'm down, when I want to cry.
When I'm about to despair.
My compass was Shin-chan, the one who talked so much.
He was the one who wrote beautiful songs while screaming.
That person...
Doctor... I'm so frustrated.
Eh...
Are you that not interested?
Ouch!
Here you go.
Ladies and Gentlemen, it would be foolish to try
and figure out where I've been sleeping.
Master, please keep this a secret from Haru.
Dr. Kurihara, this is Izakaya Kyubei.
Ladies and Gentlemen, I too was a fool.
A few days later, Mr. Sakakibara was transferred to a new hospital.
He volunteered to go to a psychiatric hospital
where he could receive alcoholism treatment.
How is Naomi...no, Tozai-san doing?
I happen to be off today.
Here.
It's the first volume of "Jean-Christophe.
Doctor...how did you get your hands on...
Not from me but from Tozai.
She borrowed it from a music teacher she admired
when she was in high school. I lent it to Naomi?
Oh... that's right.
She said she hadn't read it yet.
Because of that, she had been putting off returning it.
As long as she has this, she'll always have an excuse to go see him.
He's a troubled guy.
There's no trace of her having read it.
It was too difficult for her, so she gave up early.
That's how Tozai is. Don't worry.
She's always been like that.
She's as bright as the sun.
She made me laugh until I was hurting at the sides
Making you laugh is inappropriate therapy.
Naomi kept this for me, didn't she? The first volume.
Yes, for ten years, despite her impure motives.
Your ride is here. Yes.
Doctor, I...
"Oh, my friend.
You mean to tell me that a tree needs a jug of water
more than it needs rain to grow!
You mean to tell me that it needs a pot more than it needs soil?"
"Open your eyes and see the vastness of the earth!"
What's that?
It's a passage from "Jean-Christophe".
Dr. Kurihara.
It wasn't long after that, that Dr. Obata left a patient
in the emergency department overnight
without examining him.
It wasn't long after that, that Dr. Obata left a patient
in the emergency department overnight
without examining him.
Where's Yokota-san? Sorry, Doctor
I'm a little worried. Of course. Yokota-san? Yokota-san?
Nurse Tonomura, how long has she been like this?
Six hours.
Yokota-san! Oh, thank God, you're conscious.
ALCOHOLIC LIVER CIRRHOSIS PATIENT KEN YOKOTA
I can't drink anymore, Mama
It's Nurse Tonomura, not Mama. Damn it, Dr. Kurihara.
I'm sorry you had to be called out again.
I'll run some tests. Blood test for ammonia. Understood
Test results show that Mr. Yokota has
a recurrence of severe hepatic encephalopathy
I'm sorry for the trouble.
Why didn't you check him out? You left him out overnight.
His chart said he had recurrent hepatic encephalopathy due to alcohol consumption.
That's why I thought IV fluids would be enough.
If I'd known the doctor in charge was Kurihara-kun.
I would've been a little more careful. I don't think that's the problem.
You're right.
Doctor.
There's one more patient I'd like you to take a look at.
Is that okay? Sure.
Six days ago, an old man came to the emergency room with abdominal pain.
Dr. Obata was on duty that night too.
What did Dr. Obata do?
Determined it was acute gastroenteritis without taking blood.
He gave him an antibiotic and sent him on his way.
The old man had a mild case of jaundice.
Jaundice....
I'd like to ask Sakakibara-san to do an EUS just in case.
I don't have to. I can't drink anymore, Mom.
Was the old man drinking at that time?
Yes, he was.
His face was all red from drinking, and his grandson was with him.
I told Dr. Obata he was quite the drinker.
The old man came in again earlier.
He said he's been vomiting since last night.
I don't think it was acute gastroenteritis.
Do you drink a lot, Shimauchi-san?
SHIMAUCHI KOUZOU
Yes, though it's much less than it used to be.
GRANDSON SHIMAUCHI KENJI
Grandpa... you should definitely be hospitalized.
I think you should be hospitalized and have a checkup.
Don't be so dramatic, Kenji.
Let me see your back. Ah, yes, yes.
Ah... my grandpa used to work in that kind of business.
He was in charge of a group, or something.
The group? Speaking of groups, in this case, there's only that group.
Ah! But it's different now. He's in a totally respectable occupation
When my parents died in an accident.
He turned over a new leaf. Kenji!
Doctor! Please go ahead
Excuse me.
Is there any effect here?
Doctor! How is he?
My grandpa is my only family.
I will do a CT scan
Let's do as your grandson says and stay in the hospital for a while for tests.
Oh, there's something I'm worried about
(Endoscopic) basket please. Yes.
Target 30 mm away.
Proceeding.
Target caught.
You're indeed Itagaki Sensei's disciple. Your fluoroscopy was spot on.
Dr. Obata, do you remember a patient who came to the emergency room about a week ago?
Do you remember him? Shimauchi Kouzou. 82 years old, male.
What's that? Ah! Yes, yes... this.
It came from my parents' house again. Take it to the doctor's office later.
A gift from me.
I took Shimanouchi-san's CT scan yesterday.
The jaundice wasn't caused by acute gastroenteritis.
There's a strong suspicion it's obstructive jaundice caused by pancreatic cancer.
Mass in the pancreatic head. Blood test showed elevated tumor markers.
Bilirubin level was 4.
It's pancreatic cancer, huh?
Kurihara-kun followed up on me, didn't you? Thank you.
I'm not asking for a thank you.
I'm demanding an explanation.
Why is Dr. Obata refusing to treat patients
you suspect are alcoholics?
Because it's a waste of time.
What do you mean, "waste of time"?
They can't abstain from alcohol.
No matter how many times they're treated, they end up drinking again and relapsing.
I don't have time to deal with that.
Are you serious? Yoo-hoo!
Did you finish the ERCP on the 28-year-old (patient)?
No~! ERCP on a young woman carries a heck of a risk of pancreatitis.
I wouldn't want to expose her if I could help it.
Ah! Obata. I've been requested to give a lecture by the Japanese Society of Hepato-Biliary-Pancreatic Surgery
The material is in the Director's office. Read it later.
I'll look at it now.
Obata's an old-fashioned samurai.
Cut her some slack for her clumsiness, Kuri-chan.
She is not clumsy.
In fact, her ERCP skills are quite remarkable.
But her philosophy is quite eye-opening
Oh, my... what's wrong?
Kuri-chan, talk to me. I'll listen. Let me hear it.
Tell me anything!
Director, are you trying to play the Raccoon?
Who's a raccoon!
Hahahahaha! You know...
I'm always apologizing, Doctor
I'll buy you your favorite drink to celebrate my discharge
Forget it. Cut back on the booze, Yokota-san.
How many times have you been brought in?
It's really life threatening.
I'm sorry! I won't drink anymore!
I won't drink again!
Great Doctor Kurihara.
The next few days passed quietly.
But...
(vibrating sound)
What's wrong? Monster.
What? Yokota-san again?
He was brought in earlier. There was blood in his vomit...
Oh, that's right. Dr. Obata's on endoscopy duty.
She's back from the conference, so I asked her to do the endoscopy.
But as soon as she saw Yokota-san's chart, she said to give him a blood transfusion.
He threw up blood! He coughed up blood.
His blood pressure hasn't risen from 90 when we brought him in.
Okay, I'll be right there.
His blood pressure's rising. Doctor, it's 95 now.
Please continue with Sollact until it maintains 100.
Dr. Kurihara, what about the blood transfusion?
Continue with 2 more units until morning. Secure 2 more units.
Sorry, Doctor...
Thanks for everything.
It's too early to thank me, Yokota-san.
Even if we stop the bleeding, it may tear again and you may bleed to death.
Don't scare me, Mama
It's not Mama, it's Chief Nurse Tonomura.
We stopped the bleeding with the endoscope, but
you have to promise to maintain absolute rest for the next few days and not drink alcohol
Promise me.
Yes, yes.
Yokota-san!
What? This... is quite a mess.
You're looking good. Tozai.
Everyone was worried about the chief having bad luck with men.
I've always been fine, Tonomura-senpai.
Besides, it's not bad luck with men, just the strange men in this world.
Let's talk about that later and get Yokota-san to the ward.
And report to the Monster back at the outpatient line.
Got it. I thought there was some commotion...
Were you doing an emergency endoscopy? Oh, yes...
Dr. Obata... Yokota-san had a ruptured esophageal varicose vein.
He would've died if we hadn't checked on him with just a blood transfusion.
Hey...
What have you been doing all this time?
Wrapping up today's conference? Or another paper?
Your way of doing things is ridiculous!
A nurse shouldn't interfere in a doctor's decision.
Dr. Obata! Please retract what you just said.
It's an insult to all nurses, not just Tonomura-senpai
Tozai.
Dr. Obata, we need to talk.
Do you want to talk over here?
I can't do this.
Stop this childish behavior
where you say you don't bother with drunkards.
Kurihara-kun, Sunayama-kun, and Shindo-kun.
I'm sure Sunayama-kun and Shindo-kun are putting their patients before the academic conference.
Of course.
Instead of researching the literature on intractable diseases and publishing papers,
you take care of patients who're addicted to alcohol or drugs?
Of course I do.
I think you're underestimating the job of a doctor.
Medicine nowadays evolves month by month.
If you don't study hard, you won't be able to provide the best medical care.
I can't provide the best medical care if I don't study hard.
I can't believe I'm wasting my precious energy and time.
If you ask me, you are self-satisfied hypocrites.
That was an extremely unreserved argument
I don't pretend to be the best at what I do, but...
I have no intention of skimping on my learning.
What is the annual cancer rate of IPMN?
Let's see...
What's the difference between hepatic right lobectomy and extended right lobectomy?
In patients with chronic pancreatitis.
How many times higher is the incidence of cancer caused by smoking in patients with chronic pancreatitis?
Huh...
So how can you do ERCP?
There's a lot of second- and third-rate people in the medical world.
You're not the only one.
But you know what? Ignorance on the part of doctors is bad.
A doctor without knowledge can easily become a murderer.
That's what I'm prepared to do as a doctor.
You think a top-notch doctor has the right to choose his patients?
It's not a qualification. Rather, an obligation?
Are you saying you'll continue to abandon patients who can't manage themselves?
I wonder if it's worth your existence to see such patients.
As for Yokota-san, you were a big help.
You have my gratitude. Thank you, Kurihara-kun.
I must confess that
what swirled around in my heart was regret
and even more intense bitterness.
I couldn't answer even one of Obata's medical questions.
On the pretext of being too busy, I had forgotten
the harsh responsibility of being a doctor.
Speaking of which, I heard that Jiro was being sent back to Shinano University Hospital.
The monster at a university hospital? Yeah.
It's still just a rumor, but I'm in favor of it.
Jiro's good at what he does.
If he can advance his career, more patients will be saved.
Am I behind the times?
Did something happen with Dr. Obata by any chance?
It's not a glass ceiling, but women have a lot of difficulties
just because they're women.
That's why they're so tough, strong, and determined.
To be honest, men can't compete with them.
Just between you and me.
Tatsu
Kurihara, your face is pale. Aah
I used to have that kind of conversation with Dr. Old Fox
as a way of saying hello.
That brings back memories. Ah.
If Dr. Old Fox was still alive.
I wonder how he would've responded to Dr. Obata's philosophy.
The doctor who paid the price for sacrificing his body and soul 24 hours a day, 365 days a year
How...
Do you want to play a game? What?
It's already late. Go home, Tatsu. Natsuna's waiting for you.
I'll put my best friend before my pretty daughter once in a while.
If you insist, I'll play
When you're in a tight spot, it's very important
not to be alone
Haru!
Welcome back, Ichi-san.
And I have returned
You're finally back from Tokyo!
We've been waiting for you, Haru!
I've been practicing my star photography.
My publisher has asked me if I'd like to take my next mountain photo.
Why don't we make the starry skies of the 100 most famous mountains our next theme?
My wife is a well known mountain photographer in that world.
She is not just satisfied with mountains, but also interested in stars.
I, on the other hand...
What's wrong, Ichi-san?
Well...
Normal temperature. It's a good luck charm
May I be able to shoulder at least half of your worries.
Don't worry, I'll be there for you, Ichi-san.
Haru...
Don't be in a hurry.
It's just important to push forward like a cow.
Cow? A cow.
Natsume Soseki wrote in a letter to his students.
"The cow pushes forward in a supreme manner.
If you ask me what I push, I will tell you.
I pushes human beings.
I am not pushing a literary man."
If I were to translate that to myself now
It's not about pushing doctors.
It's about pushing people.
You don't push the mountaineer.
You push the human.
(dog barking)
Oh, Danshaku. Hmm?
Aah, Doctor, you're back late as usual.
Are you shopping this late at night?
No, I'm just here for Princess Haruna after she returned from Tokyo.
I thought I'd treat her to something warm.
Here's a steamed bun. Danshaku-sama.
Thank you very much.
You're busy preparing for your solo exhibition.
Princess Haruna, I've decided to cancel it.
As an aristocrat, it's a waste of time to draw so improperly
Besides, I'm a little bored.
It's been a long time since we had a drink. Whoa.
Haru, get ready.
It was the day after this that Chief Nurse Tonomura
came down with the flu and took a day off.
Oh, you scared me
So is the overly righteous Kurihara-kun going to scold me again?
No, it's true that the atmosphere in the Emergency Department became unsettled.
I have a case I'd like to discuss with you.
It's an 82-year-old Kozo Shimauchi with suspected pancreatic cancer.
The patient who underwent EUS and ERCP the other day, right?
The results of the cytological diagnosis came back.
I couldn't confirm any cancer cells.
You can't rely on cytodiagnosis
There are tons of cases of cancer that came back negative.
Even though there was a mass of that size.
I'm a little concerned that both the pancreatic juice and bile duct are negative from the cytodiagnosis.
What's your diagnosis, Kurihara-kun?
Pancreatic cancer.
Any metastasis or vascular invasion? None.
What's the patient's general condition? He's in good condition.
Wouldn't it be a crime if you didn't operate on him?
That's true. Once we sort through the information, we have no choice.
From here on out, at the advanced age of 82, it's a matter of patient
and family's feelings whether to have the surgery or not.
That's what Kurihara-kun is good at, more than technology.
This is where doctors who can relate to the patient's feelings come in.
I'm at a loss for words
I'll certainly do my best to give informed consent.
Don't you have something to say about Chief Nurse Tonomura?
I'm with Tonomura from the start.
No matter how good a doctor he is, he'll overlook a ruptured esophageal varicose vein because of a patient's inability to manage himself.
because of a patient's inability to manage himself.
I'll be a doctor who stands by my patients even if I'm called second-rate or third-rate.
For once in your life...
Maybe Nurse Tonomura's right.
You don't seem to be sleeping. Your face is pale.
Is that what you say to women?
You're right. I haven't been getting enough sleep or eating lately.
I'm getting close to my dissertation.
but the ward is so busy.
They don't seem to take it too well even when I bully the junior staff to relax.
Kurihara's a real weirdo.
If I may offer a word of advice, it's to make the emergency department work more efficiently.
Nurse Manager Tonomura's return is the best thing for us.
It's the logical conclusion for Dr. Obata
to have more time to write her paper.
Please make it easier for me.
Apologize to the Emergency Department.
The nap room is on the 5th floor.
Sounds good...
The jaundice level from the blood test...
That afternoon, I met with the old man and his grandson, Kenji,
to give informed consent.
The diagnosis was pancreatic cancer, and the surgery was PD.
PD = Pancreaticoduodenectomy
Not only the pancreas, but also half of the stomach, duodenum, bile duct and gallbladder
would be extensively removed and reconstructed.
This is a Pancreaticoduodenectomy.
That's all.
Do you have any questions, Shimauchi-san?
If I don't have the surgery, I will have 6 months to live.
Surgery is surgery, and it's pretty big.
That's a difficult question, Dr. Kurihara.
Yes, it's one of the biggest surgeries in gastrointestinal surgery.
However, I've decided that you can endure it under your current condition.
Isn't there anything you can do with medicine?
Grandpa's 82 years old.
You can't just cut out this and that.
Let me think about it for a while.
Grandpa.
Shimauchi-san
Oh, thank you
Thank you for working until this hour, Doctor.
Can't you sleep?
No, I just thought the moon was beautiful.
There were a few times when I made up my mind
that this guy was going to die.
That's a terrible thing to say.
I've caused a lot of trouble for my family and people around me.
So, at least for the last time.
I figured there must be a way to put my body away
without causing trouble to anyone.
But it worked out.
The idea that I should take care of myself was
just a myth of my youth.
When you die, someone else has to take care of things
You'll cause trouble.
Especially Kenji.
His parents are my daughter and her husband.
They died quickly in an accident.
It's my fault for spoiling him.
He'll never be able to get rid of his old man.
I can't believe I'm letting Kenji clean up after me.
I'm depressed, doctor.
Were you more worried about Kenji-san than yourself?
He's a kind grandson.
Then, for the sake of your grandson.
Why don't you stretch yourself to live?
Stretch?
Doctor, are you gambling?
Medicine isn't gambling.
But rather than doing nothing at this point.
Surgery has a better chance of winning.
I see.
Is there a chance?
There is. At least.
there's no discrimination in medicine whether you have a dragon on your back or not.
I'm sorry. I got carried away.
Hahahahaha... hahahahaha!
I've decided. Let's stick with the one who's going to perform the surgery.
This is going to work.
(laughing voice)
What did you just say, Jiro.
I said I'd be the one to perform Shimauchi-san's surgery.
Actually, Ichito
I'm going back to Shinano University Hospital next month.
I know all about that. More importantly...
You knew? Why didn't you say anything? It wasn't funny
I know, but let me ask you first.
PD is a major surgery. Shouldn't Surgical Director Amari do it instead?
Dr. Amari also said so. I have to show him what I've accomplished here.
Don't give me that look. PD is the gateway to success in surgery.
I can't believe they're letting me do it so soon.
I'm... filled with anxiety too.
Turn it down.
Why?
I see. I guess you're sad to say goodbye to me after all.
All right, I'll pour you some of my best Sunayama blend.
Today's Shimauchi-san's surgery, right?
Yes, Chief.
I heard the primary surgeon is Jiro-san... oh, Dr. Sunayama.
You're worried.
No, I believe in Dr. Sunayama
He'll be fine.
Nicotine is said to be effective in relieving tension.
A man who with a cigarette in his hand is precious picture
Nurse Tonomura, don't you have the flu?
Don't ask me nonsense.
Shimauchi-san's PD is about to start.
I hear the primary surgeon is Dr. Sunayama, a close friend of Dr. Kurihara's.
It's not my intention to be called his best friend, but
But I have a faint attachment and a great deal of anxiety.
So, what's with the cigarette?
Doctor, surgery is on the right foot, internal medicine is on the left.
Huh?
Nurse Tonomura, doesn't smoking put a strain on the respiratory system?
I'm going back to the Emergency Department, after I finish this one
Has your anger subsided?
Dr. Obata seems to have endured it for now
She won't say a word of remorse.
But I'm sure she really wants to apologize to Nurse Tonomura.
I was mad at myself for that.
I can't believe I got so angry at Dr. Obata's outburst.
I'm still immature.
Do you want to eat? Eh?
Nurse Tonomura, could the source of this, came from...
I don't know.
The PD for the old man started at noon
and is still going on.
I'm on my way to the operating room.
Watching Jiro perform surgery for the first time, I understood.
Surgery is on the right foot, internal medicine is on the left.
When the right foot moves forward, the left foot stays to support the body.
It's Jiro who's moving forward now.
My duty is to trust Jiro and stay put.
It was the chart of a 28-year-old female patient
whom I assisted and Dr. Obata performed ERCP on the other day.
The day after ERCP was performed, acute pancreatitis developed.
Currently in ICU?
What's this? A young woman with post-ERCP pancreatitis...
No matter how skillful the incision is, it's bound to happen.
The pancreatitis itself has settled down quite a bit.
Obata apparently went over the edge.
She cried out for help for one night.
ICU management is to monitor and treat patients 24 hours a day
who are at high risk of death if there is a sudden change.
ICU management is both mentally and physically demanding.
and is normal for ICU management to be done by a team.
Dr. Obata did it all by herself.
Even when Yokota-san was rushed to the emergency room for the second time.
Dr. Obata, in addition to giving lectures at conferences,
was also involved in medical treatment, wards, emergencies, papers, and ICU management.
Hmm? Kuri-chan, don't tell me you haven't seen this.
Didn't Obata tell you about this?
No.
One person managing an ICU for nearly two weeks? You idiot...
Dr. Obata's overwork is my responsibility.
Because I'm not up to the level of a trustworthy doctor.
That's not true. She just doesn't trust others.
She's especially harsh with her peers.
That's how she pushes herself to reach new heights.
That can be said to be her only weakness.
Weakness? Obata...
She's an outdated samurai, Kuri-chan.
That's what Dr. Raccoon used to be... Raccoon?
Oh... at Shinano University Hospital,
Obata joined the hospital when I was the head of the biliary tract surgery team
She was married as a student. She had a husband 10 years older than her.
When her husband's condition worsened.
Obata brought him to the university hospital.
His doctor diagnosed a pancreatic cyst with an echo and gastroscopy.
He gave him some medicine and decided to check again in three months.
Her husband deteriorated rapidly.
Another CT scan revealed that he had advanced stage pancreatic cancer.
We started anti-cancer treatment immediately, but he didn't last a month and died.
She said, "Doctors who don't know what they're doing can easily kill people.
"Doctor's ignorance means he is a murderer.
Doctor's ignorance is evil."
A doctor without knowledge can easily become a murderer.
I want to study more. Shinano University Hospital
is short-staffed, and I understand that.
But let me go to Sapporo Inaho Hospital,
one of the top hospitals in the bile and pancreas field.
I agreed. I'll fill your hole with my own nose snot.
It's been 12 years since then. All I can do is
apply the brakes every now and then so that she doesn't rush into life.
Dr. Raccoon, I...
Raccoon?
Well, well. Am I interrupting something?
This is unusual. Chief Engineer Matsumae.
Is there something wrong at the medical station?
I was wondering if Sunayama-kun's major surgery was still in progress.
Oh, the cardiologist too. What's wrong?
Isn't Dr. Sunayama's PD still going on?
Yes, it seems it's taking longer than planned.
Really? A cardiologist is worried about a young surgeon?
To say that Dr. Sunayama is a friend who spent 4 years with me, it's not a problem
When he gets over this major surgery.
I'd like to add a word of congratulations, no problem.
What is it? You're all together.
Dr. Shindo, are you sure your daughter's okay at this hour? Yes.
Yes, when I explained it's a big day for my dad's friend.
I told her it was a big day for my dad's friend, and she gave me permission to support her.
Kurihara, are you here because you're worried?
I just came to eat an apple.
PD is completed successfully without problems
You took so long, everyone was worried.
Well... the organ adhesion was pretty bad.
I had to proceed with the procedure, so it took a while.
It was a difficult surgery, to be sure.
Sunayama didn't lose focus even once.
That's quite a feat. Dr. Amari...
Thank you very much.
Then let's have a toast to our fellow patient's great success!
Thank you very much! Pass this around!
Yo, yo.
You did it, Jiro. Congratulations.
Tatsu... thank you.
What is it?
Hehe~!
Then let the big raccoon from Internal Medicine propose a toast.
I said so myself.
I'd like to congratulate Dr. Jiro Sunayama on his great success with PD and
Cheers to his future life as a surgeon!
Cheers!
It was a very happy and warm night in the medical department.
I secretly offered a toast
to Dr. Obata who wasn't here.
Old Man Shimauchi's post-op period was going well.
(clap)
Jiro left for Shinano University Hospital.
the female pancreatitis patient at ICU was safely transferred to the general ward
Jiro left for Shinano University Hospital, and I enjoyed my first holiday in a long time with my wife, Haru.
Every day is a good day.
It's always quiet here, isn't it?
Speaking of which, that photo book of the starry sky you were talking about the other day,
when are you going to start shooting?
Yes, I was thinking of postponing it a bit.
Postpone? Why?
(vibrating)
I'm sorry. (vibrating)
It's me. You've left for Shinano University Hospital,
what do you think you're doing taking up my precious time? Monster
Hmm? Shimauchi-san's pathology results?
That's right. The pathological results of the resected mass on the pancreatic head.
The pathology results for the duodenum, stomach, and bile duct just came in.
Okay, calm down, Ichito.
There was neither pancreatic cancer nor bile duct cancer in the resected specimens.
None? What do you mean there isn't?
Jiro...
That's right. Shimauchi-san didn't have cancer, Ichito?
Shimauchi Kouzou-san had mass-forming pancreatitis.
Among other things.
It was concluded that he had AIP, autoimmune pancreatitis.
AIP is an extremely unique disease.
There are many variations in diagnosis itself.
There are no clear criteria. Director Honjo.
Dr. Amari, how's Shimauchi-san's condition?
He's doing well, Administrative Director.
POST-CASE REVIEW MEETING
He's started taking meals.
We're going to start rehabilitation such as gait training.
Dr. Kurihara: Yes.
Prior to the surgery, the surgeon also performed tests.
We preoperatively diagnosed pancreatic cancer.
It's not just the internal medicine department's responsibility.
Director.
The reason for concluding that Shimauchi-san had AIP was because of
Shinano University's research on AIP
has produced outstanding research results nationwide.
I'm sure other general hospitals are still in turmoil.
That's true, isn't it?
AIP is a case we don't get to see very often.
Besides, pancreatic head-localized type...
I'd like to see internal medicine and surgery stop covering for each other.
Kurihara-kun, what's the treatment for AIP?
It hasn't been established. But...
But there have been reports of dramatic improvement with steroids.
In other words, due to your misdiagnosis.
You opened up the abdomen
of a patient who should've been cured with medication.
Pancreas, stomach, duodenum, etc.?
Therefore, Administrative Director! Misdiagnosis is not the same thing in this case.
It's too rare a case with no diagnostic criteria...
Shimauchi Kouzou-san's grandson has a complaint.
He's upset that we performed an unnecessary major surgery on an old man.
(Knock)
Dr. Obata. I didn't call you here.
I was briefly involved in Shimauchi-san's case.
I felt it was my duty to be present.
Ah
What I want to know is...
not whether this surgery was a success or a failure,
but whether it was the right thing to do.
Depending on the case, there may be a trial.
Let's hear Dr. Kurihara's opinion.
Yes.
I think...
If it's the right or wrong of the surgery, there's no room for debate.
In this case.
I can assure you that surgery was the safest and most reliable option in this case.
I can assure you, Director Honjo.
What's your rationale? Dr. Obata.
Pre-surgery diagnostic cytology positivity rate is about 60 percent.
In other words, even if it's cancer, 40 percent will be overlooked.
Therefore, over-reliance on cytological diagnosis is outdated.
On the other hand, CT scan showed a clear mass.
Tumor markers are elevated.
Also, IgG4*, which should be elevated in AIP, was within normal range. *Immunogolobulin G4 related disease
In other words, there was no basis for preoperative diagnosis of AIP.
It was only natural to diagnose pancreatic cancer.
As a result, it was concluded that Shimauchi-san
was an even more unusual case among extremely rare AIP cases.
Is IgG4 in the normal range?
If it's a misdiagnosis, no one will be able
to make a diagnosis because they'll be too scared.
But before choosing surgery,
wasn't there an option to try steroid treatment
and to see how it goes?
There's a mountain of reports on pancreatic cancer
where the patient was put on steroids and it was too late, Director Kanayama.
However, Shimauchi-san is 82 years old.
Before taking the plunge into major surgery.
I'd like to do something a little more...
Like do a smaller surgery?
We'll set the possibility of AIP at 20%.
and limit the resection to 80%? Obata.
If you still don't want to be blamed for cutting too much.
I'll set the AIP at 40%.
20 percent steroids and keep the resection to 40 percent?
Even though the test data shows pancreatic cancer.
I wouldn't want to go to a hospital that did that.
But...but as a result...
You guys performed surgery that wasn't necessary...
Treatment isn't like a mutual fund, Director Kanayama.
Do you think you can save lives with low-risk, low-return treatment?
That is not what I'm saying!
That is what you are saying.
If a doctor is afraid of the risk and dispenses treatment in small doses.
It's the patient who dies.
A doctor's job is 0 or 100.
If even one percent of a life-threatening disease is suspected.
Doctors put 100% of their energy into it.
And they take full responsibility for that.
Well... just to be sure, let me add this...
Dr. Obata, what if a similar patient comes in the future?
If 100 people come in, 100 of them will have surgery, Director.
That's right.
There's no supplemental material. Director.
Surgery Department thinks the same way. Director.
Very well.
In this case.
I believe we have shared information on this case at Honjo Hospital.
Is that all right with you? Administrative Director Kanayama.
Yes, Director.
But Director, doctors and patients are in different positions.
Are you sure the patient and his family
will be satisfied with the explanation you just gave?
Dr. Kurihara.
To Mr. Shimauchi and his grandson.
You'll have to explain to Shimauchi-san and his grandson in detail why you diagnosed them with pancreatic cancer.
Can you handle it?
Yes, I can.
I'll do it.
The reason my voice trembled slightly at this point is...
So there are no clear diagnostic criteria
for pancreatic head-localized AIP. In this case...
I did a lot of research on the Internet.
Pancreaticoduodenectomy.
It's not an uncommon surgery, is it?
Aren't you forcing us to accept the surgery
to improve Honjo Hospital's track record, Sensei?
Kenji. That's not true.
I'm sure the surgery department gave you an explanation before the surgery...
It's a matter of how much we can trust that explanation.
The primary surgeon, Sunayama, said he was your classmate and best friend.
He did my grandpa's surgery.
He got transferred to a university hospital with that as a souvenir, didn't he?
What the heck is that? That's a misunderstanding.
What the hell kind of misunderstanding is that!
You used him as a training ground just because she's over 80 years old, didn't you!
I'll never forgive you guys!
Will you stop it, kid?
I'm the one with the cut stomach, not you.
Shimauchi-san. I'm sorry, Doctor.
My grandson was too cute and I spoiled him too much.
He shouldn't have been so rude.
Because it's family, it's natural to be angry
The dragon on this back won't change this treatment.
The doctor who said that pale blue line in all seriousness,
I was captivated by him
I put up with you back then.
No more pain. No more nausea.
No more fear that I might have cancer.
I survived.
I won!
We won, Dr. Kurihara!
Shimauchi-san.
That's right. The patient saved your life, didn't he, Kurihara-kun?
I'm sorry for worrying you.
I'm not worried about you.
Something else?
Or are you telling me off again?
I had no idea about the possibility of AIP in Shimauchi-san.
I recommended surgery without differential diagnosis of IgG4.
But Dr. Obata raised IgG4 as a differential.
Also, IgG4, which should be elevated in AIP, was within normal range.
There is a difference between choosing surgery while considering the possibility of AIP
and choosing surgery without considering it at all.
This is the difference between Dr. Obata and me.
For doctors, it's a stark difference.
My diagnosis... was a misdiagnosis.
Is that repentance?
You want to raise the white flag and get some peace?
Don't settle for a mistake. You'll have to carry it for the rest of your life.
That's what Dr. Itagaki said to me when I was a resident...
That's what Dr. Raccoon said to me.
When my husband died of pancreatic cancer.
I never forgave his doctor
at that time, not now, not ever.
Yes.
I was my husband's attending physician at that time.
Once upon a time, It is said that humans
were expelled from paradise because they ate the forbidden fruit.
God forbid, it was an apple
I couldn't sleep today, so I came out.
It's wonderful to meet you by chance.
Ichi-san?
Are you crying?
I'm glad I came out.
It's a bad habit of yours.
No matter what time it is.
Don't forget that I'm here.
You shouldn't cry alone.
Haru...
Haru, thanks for being here...
It's all right.
Actually, I'd like to discuss something with you.
What is it? Ichi-san.
＜Haru agreed with me.
The day I watched the old man Shimanouchi leave the hospital.
I told Dr. Raccoon that I wanted to quit Honjo Hospital
I offered to quit Honjo Hospital and go to Shinano University Hospital to study.
Kuri-chan must be crazy if he wants to go to a university hospital now.
I'll get in touch with them.
I was a little perplexed
when he agreed so readily
Oh, thank you very much.
So, you've been assigned to Shinano University Hospital next month.
Thank you for your guidance during our short time together.
At EUS?
You haven't even gotten to the point where can start teaching.
Also, just because you go to university and write a few papers...
You'll never be able to catch up with me.
Merciless, as usual
Don't worry about the internal medicine department
I'll fill in the holes you made with my own nose snot.
I'd be honored. Ah.
But I'm the kind of person who doesn't dig snot. What should I do?
That's a lie, all humans do it
I can't get it out, really.
Really?
Can't you just keep doing what you're doing? Kurihara.
I have to move forward
I'm not very good at galloping like a horse.
But as Soseki-sensei said.
I think I can do it if I have to push like a cow
I think now is the time.
Huh. From my experience.
University hospitals are pandemonium
But I'm sure you'll be fine.
I'm rooting for you, Kurihara.
Tatsu.
KASAMAKURA
It's from the Tozai.
I can't make tonight's farewell party
because I'm working the night shirt.
I heard your copy of "Kusamakura" is in tatters.
Not a single word to send...
She couldn't write it down, could she?
Drink yourself to death tonight.
If you drink too much and get carried away.
I'll put a urethral balloon in you. Nurse Tonomura, that's sexual harassment.
No, you're kidding. You're as serious as ever.
The farewell party was a lavish affair.
A diligent and honest young man like me was just
too frightened to say anything nice and just accepted the drinks
Dr. Raccoon asked me to join him for one more drink.
I don't even know what time it was that I left the party...
Thank you for six years of hard work.
Let's go~, Kuri-chan.
Okay.
After drinking all kinds of alcohol...
When I get old, I go back to my old drinks.
In the end, the sake I drank when I didn't have money
tasted the best.
Get on your knees and drink.
Excuse me.
I wondered who else was coming?
Kuri-chan can make it anywhere.
I don't know how much you packed.
I hope you didn't pack too much.
Dr. Raccoon...
No, Dr. Itagaki, I'm indebted to you
I'm going to study at the university hospital, Raccoon...
No, Dr. Itagaki... Bwahahahaha.
Just call Raccoon, hahahaha.
I'm going to study at the university hospital and become an internal medicine doctor who
won't be embarrassed to appear in front of Dr. Raccoon and go back to Honjo Hospital.
That makes me happy.
So, Kuri-chan,
the most important thing for a doctor,
what is it?
That's a sobering question.
We don't have enough doctors.
especially those who watch over the elderly endlessly in hospitals.
Those who are exhausted from continuous duty, sudden changes, and calls...
They either become part-time workers or open their own businesses.
They stay away from the field.
That's why there aren't enough doctors in hospitals no matter how long this goes on.
Hey, Kuri-chan
The most important thing for a doctor is to keep going.
It doesn't matter if you work at a local hospital or a university hospital.
It doesn't matter where you work.
Keep on being a doctor!
That's the most important thing.
Yes, sir.
Excuse me!
Oh, here, here, here
Okay, Kuri-chan.
I'm a little drunk and embarrassed.
Let's have another toast. Ah, I'll do it.
It's okay, it's okay. Yes
I'd like to thank you for your work over the past six years, Kuri-chan.
And for your continued good luck in the future.
Cheers. Cheers.
There was someone at that table from the beginning.
Naito Kamoichi, Deputy Chief of Internal Medicine at Honjo Hospital.
Dr. Old Fox's seat...
Study hard and come back.
Yes, sir.
Hmmm...
This is...
I submitted my resignation to Honjo Hospital,
until I go to work at Shinano University Hospital,
I was able to take five days off.
I've been spending my days reading without doing anything.
Doctor, when you
start working at the university hospital,
I don't suppose you're planning to leave Utaki Manor,
the bottom of the social ladder.
Of course not, the rent here is cheap beyond compare
If I work at the university hospital, I'll be a graduate student.
A student. What?
Don't tell me you'll be an unpaid doctor again?
That's right, that's right...
Is that really enough to support Princess Haruna?
Not by any means.
I'm going to do part-time work while off duty.
This drama is a work of fiction and the names of the characters and organizations are fictitious.