I totally understand how it feels to be a patient..
Just laying on bed is a boring thing.
Please bear it for another 3 days.
Thoracic aortic aneurysm: a weakened area in the upper part of the aorta. The aorta is the major blood vessel that feeds blood to the body.
How is the examination result? It's a thoracic aortic aneurysm.
Where is the location?
There's 8 cm of aneurysm from the ascending through the arch.
I see. Anything else?
Cerebral aneurysm? Furthermore,
It's on the tip of the basilar artery which is the most difficult operation.
No need to worry.
We will definitely cure you. Yeah, if so then I'm relieved.
Sakurai-sensei's BNP is also going up to 220.
If the blood pressure keep going up like this, and then the cardiac aneurysm explode,
There's a high possibility that the aneurysm in his brain will explode as well.
Before that happen. Which one first?
There's only a way, a simultaneous operation. Who will do the brain?
It's impossible for Asada to do both.
We have to find a brain surgeon who can do this operation as soon as possible.
There's no other way to save Sakurai-sensei.
An aortic arch aneurysm operation is the most difficult one in the field of cardiac surgery.
Basilar tip aneurysm operation is the most difficult one in the field of brain surgery.
In other words, without a brain surgeon who has the equal skills as you,
A simultaneous operations will be impossible to do.
I will find that brain surgeon.
I guess it might be difficult to find him here in Japan.
In America, only a top class doctor who can be a brain surgeon.
There's a possibility if you find him in that country.
Please save Sakurai-sensei by using every possible way.
This is good, isn't it?
There's a story called "The Gift of the Magi", right?
The Gift of the Magi: a short story written by O. Henry
A couple who deeply loves each other even in poor.
Because they have no money to buy Christmas presents,
The husband sold his precious pocket watch
then gave a gift to his wife a comb made from tortoise shell.
The wife sold her prideful beautiful hair then gave her husband a watch chain.
To do such thing as letting go of your precious thing,
and exchange it with an useless gift.
Such a stupid couple, right?
Is that so?
What you will give me isn't a chain that will be put on the watch.
It's the success in India.
The scouting of the team dragon is going well.
So far, right?
But Asada will not be easy to manage.
Yes, I know. Noguchi-sensei has personally proved it to me.
The next target isn't Asada-sensei.
It's Ijyuuin-sensei.
Ijyuuin? Is he there?
I'm thinking that Ijyuuin-sensei is indeed the shortcut.
Please leave it all to me this time.
I went to Meishin today.
And then they said that Ijyuuin-kun has quited.
I'm sorry.
I've been trying to say it to you...
A while ago, I got invited by a doctor whom I respect,
and now I'm working at a place called Sakurai General Hospital.
It's not a big hospital and also no latest facilities there,
But the medical treatment that I wish for is there.
Properly face the patient one by one,
and choose the best treatment method... Why did you quit?
What?
It will be useless if it's not Meishin.
They said that my dad has a lung cancer.
They also said that a surgery is impossible because it's a terminal cancer.
But dad said that he doesn't need any treatment anymore.
Ijyuuin-sensei. A guest for you.
Dad?
I'm sorry about Miyuki.
No.
You're having a hard time since your relationship didn't go well because of me.
There's no such thing. How is your physical condition?
Ah...
Strangely I'm fine after I got a cancer.
She said that you don't want to take any treatment..
Yes.
They said to me, that in Meishin, if you didn't take any treatment there, they wouldn't accept me.
I've been thinking to look for a hospice too.
Then, I'll leave Miyuki to you.
Excuse me..
Could you just come here instead of a hospice?
Let's think together for the things in the future.
Hayakawa-sensei.
I'll be going out for a while, If there's anything happens, I'll leave it all to you.
No. I'm on the middle of my lunch break.
Hayakawa-sensei.
The blood pressure of Aoki-san from room 301 has increased.
Could you please examine her for a minute?
Hayakawa-sensei! Okay... okay.. I'll go now.
I'm sorry, the medical examination has been prolonged..
It's okay.
Apart from that, it would be alright even though the room wasn't this big..
Please feel free to use it.
Please say that you will also take treatment of anti-cancer drugs from Ijyuuin-kun.
Enough for that discussion already. It's not good.
Why are you giving up? I'm this old already.
It's inevitable to have a painful thought for a brief moment, even if I live long.
Certainly some symptoms such as hair loss and nausea will come out with the anti-cancer medicine.
However, now there are molecular target drugs which have fewer side effects.
It's an effective medical treatment even for the last stage of cancer.
Okay, Dad? Let's fight together...
I won't take the medical treatment. Dad...
86 years old woman.
The lung cancer that occurred in the left lower lobe has invaded the diaphragm.
In this operation we'll perform an extended operation including the diaphragm.
The lung cancer has been invading the diaphragm means that it's on the stage III A.
It's on the limit line for the operating application, isn't it?
Yeah.
But, extended operation is daring for the elderly patients.
We have to choose between a radiation therapy and chemotherapy this time.
I guess most of the doctors would say so, right?
However, if it's Asada-sensei... It's okay no matter how good your skill is,
but an forced operation, I wonder how will it be..
It's an ego of a surgeon, isn't it? It's a strong hope of the patient..
What? She has been caring for her bedridden husband.
That's why she said that if there's a possibility to be cured,
she wants the cancer to be removed by undergoing a surgery.
From now, we'll perform a left lower lobe excision for the lung cancer.
Scalpel. Tweezers. Gauze.
Electric scalpel. Ok.
Dissecting the pulmonary ligament.
Scissors.
Sucker. Ok.
Right Angle. Ok.
3-0.
Right Angle. Ok.
3-0.
Scissors. Here.
Here, please. Ok.
Left lower lobe excision is completed. Next, we are moving to the closed-chest.
Scalpel. Ok.
Pean. Here.
The limited excision is perfectly completed, huh?
I'm glad that we did the operation.
Asada-sensei, can we have a minute?
Regarding the lung cancer as the primary focus,
It has spread to the left adrenal gland.
It seems that he has been told by Meishin or other hospitals that it's a terminal cancer.
At first they seem to tell him that the operation can be done..
If you look at the lung cancer only, it's a stage I A of the early-stage of cancer.
But it's a stage IV, because there's a distant metastasis at the adrenal gland which is separated from the lung.
In other words, it's a terminal cancer. it's impossible to do the surgery.
But the patient earlier,
there was an invasion of the diaphragm, right?
But the cancer removal can be done with an operation.
An invasion of the diaphragm is different with a metastasis at the adrenal gland.
But this patient is younger,
if it's Asada-sensei's skill... Ijyuuin...
At this stage, even if you remove the cancer,
you may find the another one in different locations.
The operation will only be a burden to the patient's body.
Are you telling that I should give up?
How are you feeling? Ah..
There's no pain.. But I can't sleep..
Wanna play?
Yes.
Are you alright?
Hey.. you surely don't want to take the anti-cancer medicine, huh?
I'm really grateful to be able to be accepted in here.
Are you making him accompanied you to play Othello again?
Dad is strong. I know.
I'll go change the flower, okay? Okay.
Looks like Miyuki-san still want you to take the anti-cancer drug therapy.
She was in her 3rd year of university when her mom died because of a cancer.
Miyuki was nursing her mother during those 2 years of sickness all the time.
It seems that she reduced meeting her friends, she couldn't think about job hunting either.
She didn't regret anything about her mother.
However if I live 1 day longer,
It means that Miyuki's suffering extends for 1 day.
And then?
For you the doctor might wonder,
why I don't want to take the anti-cancer drug therapy?
But for me, I don't want to burden Miyuki anymore.
Translator: penk_88 | QC-typesetter: ryuulynn @IDWS
If only we found out about the cancer earlier,
The surgery would be possible to do...
I can't save an important person at a crucial time.
Are you giving up just because the operations can't be done?
Thing that a doctor can do for the patients isn't just a surgery.
What?
Sorry. It's time for temperature checking already, isn't it?
It's alright.
How is the pain? None.
I will wipe your body, ok? Don't.
Things like that, let me do it. It's alright.
Ah.. it feels good...
Shall we also wipe your back? Thank you.
I will help. Okay.
What's happened with the wound? Ah..
It might has been more than 20 years... It has been there that long?
A fire spread out from the neighboring house then the fire happened.
I was about to go out while holding Miyuki
then a fragment of a broken pillar stuck me.
What?
But I didn't feel any pain because I was preoccupied.
Well.. I'm glad that there's no injury in Miyuki.
I don't remember it at all..
Yeah..
Come in. Excuse me.
How is Ijyuuin-sensei's situation?
His fiance's father got hospitalized under a palliative care.
Every night after his practice ends, he always goes to check his condition.
Is that so? Yes.
Well.. although it doesn't mean that there's something he can do...
On the other hand, thanks to that my duty has increased.
I also got bossed around by the nurses.
If you examine the patients at the emergency room or on your duty, you can experience various cases.
Moreover, your growth will also be faster because it's an environment where you can't rely on the other people.
Ah, Ijyuuin-sensei also said the same thing.
Ah.. but in L&P, we don't have to do such things, right?
Thank you for the report.
Eh?
Ah, excuse me.
Ijyuuin likes to do useless thing, huh?
Sakurai Hospital is indeed suitable for him, don't you think?
According to his efforts, Ijyuuin-sensei has gained the techniques that Asada-sensei has.
Ordinary person isn't taught by a genius,
but it's possible for a person who has learned the techniques from the genius in person.
Even if we gather those excellent research doctors in L&P,
There's no suitable doctor who is talented as he is.
The one that I want isn't a research doctor.
I want a superstar who can make miracles.
There's no miracle in the work of the doctor.
If you happen to have seen a miracles,
that supposed to be the result of a pile of hard works and experiences which is invisible to others.
I'm not sure about what Okamura-chan saying recently.
Had you promised to leave all about Ijyuuin-sensei to me?
Entlassen.
Entlassen: Taken from German language, in medical term it means "discharge from the hospital; leaving the hospital".
Don't let me say it, ok?
I have an experience for aneurysm of the basilar artery tip.
The difficulty level is high, but it's not impossible.
Can you please help me? Yes.
Thank you very much.
Aortic arch aneurysm? Are you possibly planning to do a simultaneous operations?
The heart operation will be ended by our team in the shortest amount of time.
That's why... It's impossible.
I'm sorry but I can't take this operation.
How are the doctors from the Neurosurgery Department?
How about yours? Now along with the patient's request,
I'm thinking to assist the palliative care.
I see.
What is this? Ah..
Some stuffs which sent by my patients who had been operated by me when I was in MSAP.
What does he hold?
It's a bullet that had entered the patient's body. Eh?
He was involved in a conflict then got shot,
But he seems to be left alone without any decent treatment as well.
If you try to open his chest last year,
A calcified lump like this came out.
The bullet were inside this stone?
The bullet which had entered the body, became one part of the body,
occurring a fibrous hyperplasia of the inflammatory and covered around it.
Fibrous dysplasia: an uncommon bone disorder in which scar-like (fibrous) tissue develops in place of normal bone.
Thanks to that it could stay inside the body for a long time, without injuring the blood vessels nearby.
A variety of foreign body granuloma.
The same mechanism as gazeoma, right? Yeah.
Human body has a marvelous power.
Amazing.
Could it be...
Around 20 years ago, this patient was accidentally stuck by a fragment of a broken pillar on the waist.
If that fragment of the broken pillar were not completely removed and remained there inside.
There's a possibility that it might be wrapped by his own tissue inside of the body.
Like this...
What?
If it's like that, this isn't a cancer but a foreign body granuloma.
In other words, there's no metastasis from the lung cancer.
In that case, the lung cancer isn't in the stage IV,
it become stage I A which initially diagnosed.
Operation is possible because it's the first stage of the cancer, right?
Yes. If the operation is possible, then we can remove the cancer.
It also quite possible that the shadow of the adrenal gland is a cancer.
But if it's a cancer,
It means that it's a progression of the stage I A of the lung cancer.
That means that either of doing the operation or not,
both of them have risks, right?
The patient said that he won't take the anti-cancer drug therapy,
because it will be a burden to his family.
However, if the cancer is cured then he can go back to his usual life,
then undergo the surgery... Patient who will choose it.
What?
Doctor is not a God.
Tell him everything, but more than that, the patient who will decide on what will he choose.
Surgery? You mean that he will be saved?
However, I've tried to examine the tissues, it still be possible to be a cancer.
In that case, surgery will only be a burden to the body.
Eh?
We choose a surgical procedure that with less burden as much as possible,
But there's also a risk of the other organs in some part of the body might be damaged.
No. Quit it. I can't let him to take such a dangerous surgery.
But the position of the shadow of adrenal gland and the position of the scar on the back where the wood was stuck are matched.
I don't think that it isn't a coincidence.
There's a possibility of the cancer to be able to be cured.
But what if it fails?
I can't let you to do such a gamble.
I understood.
It's my first time, huh.. Eh?
to see a doctor who said to me that I might able to live...
Ijyuuin-kun came to my place every night.
And then he found out the possibility that it isn't a cancer.
While the other doctors only talk about the palliative care and anti-cancer agent..
But.. Miyuki..
I want to undergo the surgery.
For the first time, I want to try to trust a doctor named Ijyuuin Noboru,
who has given me a hope.
Foreign body granuloma, huh..
There's such a possibility...
Even when you see it just in a data, you won't notice.
This time, we will cut the adrenal gland first,
If it's a cancer then we'll stop.
If it's a foreign body granuloma, then we'll continue the operation as it is...
then remove the lung cancer.
Rapid pathological diagnosis is needed, isn't it? Yes.
Moreover, because patient's respiratory function is decreasing due to the lung emphysema,
we need to do an operation that use minimally invasive chest laparoscope.
With the facilities in Sakurai Hospital, this operation is impossible.
Is that the reason why you came to L&P?
Yes. Would you let me do the surgery here?
Leave it all to us.
I will let you to do it with the authority of a director.
Thank you very much.
No!
You'll get trouble if you do thing selfishly.
Noguchi.
Doing an operation for a patient with a terminal cancer,
There's no way that such an insane operation will be approved by the outsiders, isn't it?
But...
I wonder how the sound of the crane will be like, huh?
Tsuru no hito koe (one word from the crane): the ?voice of authority?. A decision by someone powerful that settles a difficult debate
You're the director but my "No" is such thing like a word from the crane, isn't it?
I'll give the permission.
What are you saying?
You have left it all to me this time, haven't you?
Huh...
It's great, isn't it? Okamura-chan is your savior.
Translator: penk_88 | QC-typesetter: ryuulynn @IDWS
Glad that we can do the surgery.
Yes.
From now, we'll perform the laparoscopic left adrenalectomy.
Scalpel. Here.
Tweezers, Gauze. Ok.
Tweezers, Electric scalpel. Ok.
Are you worried about Ijyuuin-sensei?
The patient is trusting Ijyuuin.
Separating the myofascial fusion, then dislodging the spleen.
Sonic. Ok.
Do the mist suction. Ok.
Here it is.
I've seen the adrenal gland.
I'll do the blood vessel processing first, okay? Hemodynamics is stable.
Dissecting the ligature of the adrenal vein. Maryland.
Ok.
This Ijyuuin is like my younger brother.
He's still lacking of skill but I guess he's working hard, right?
Skillful as usual...
Isn't he? Please.
Hey, get out of the way!
Scissors. Ok.
Ligation is done. This is the tumor.
The adhesion of the tumor looks big, doesn't it?
Seems to be plenty of bloodstream. Be careful.
Ok. Continue to dissect the surrounding. Sonic.
Was the tumor blood vessels torn?
Blood pressure drop. It's 68. Please put in the camera.
Sucker. Here.
The volume is going up. Increase the abdominal air pressure.
Ok. The bleeding point is here.
Hemo-clip. Here.
Bleeding has stopped. Stop the transfusion.
Ok. Blood pressure has returned to 110.
Moving on to the adrenaloctomy. Sonic. Ok.
The left adrenal gland is located at the deep place which is surrounded by the internal organs.
If they damage the kidney, it will be a single kidney.
And if they damage the pancreas, it will cause a fatal injury.
It looks like a simple thing to do,
But it's a field that can't be reach without a substantial experiences.
Right?
Adrenalectomy.
Try to cut it. Ok.
Scalpel. Ok.
This is..?
It's not only a calcification. There's a solid component in one part.
That means a cancer cells?
Bring it to the pathological diagnosis.
Ok.
If they have it pathologically confirmed that it's not a cancer,
The lung cancer is not at the stage IV, but I A.
Because it becomes an early-stage cancer, excision is possible.
Operation continues.
If they have it confirmed that it's a cancer cells, operation will be stopped.
Yes, operating room.
It's the pathology laboratory.
We've observed the fibrotic changes and inflammatory cells in the sample that was submitted.
We also have identified the tissue piece that appears to be a wood chip at one part.
They weren't identified as cancer cells.
Just like what you've thought.
Okay! Let's resume the operation!
You've done it, Ijyuuin!
Continuing, we'll move to the excision of the lung cancer in the lower lobe.
Scalpel. Here.
Tweezers, gauze. Ok.
A miracle has happened, huh?
It's not a miracle.
It's the result that has been obtained because Ijyuuin faced the patient.
Dad... Dad...!
The surgery is safely completed.
We've pathology diagnosed the tumor in the adrenal gland,
and because it wasn't a cancer, we excised the lung cancer.
Then?
We've taken out the cancer.
An observation might be required but he can returned to his usual activities.
Thank you. Thank you.
I'm glad that Ijyuuin-kun is here for us.
Congratulations, Ijyuuin-sensei.
You have to keep your promise.
To let you do the operation here,
means that we also need Ijyuuin-sensei to be a professor in L&P.
What?
Other than that, there's no other way to help the patient.
Ijyuuin-sensei has joined in L&P.
I'm sorry, Asada-sensei.
Why do you apologize?
The patient was saved.
If they train the medical interns under your guidance,
The numbers of life that can be helped will also increase.
Go.
If there's anything happen, everyone will gather.
We are team no matter where we are.
Yes.
Okamura-chan. Have you planned to beat me,
by taking away the precious Ijyuuin from Asada?
Such a thing...
Those 2 people letting go the important thing unexpectedly,
Obtaining a deeper bond than before. Such an irony, huh?
They said that "The Gift of The Magi" is such a story.
You wanted to lecture me, didn't you?
The mission this time is acquiring Ijyuuin-sensei.
As for you sensei, you will demonstrate your abilities, in the education of the local staff after you go to India.
It will be nice if they will work for me as you think.
Do you understand? The shine is different, isn't it?
It's a gift from whom?
I've bought it by myself.
I have to obtain things that I want by myself without expecting from other people, right?
Sensei.
There's a cerebral aneurysm too, right?
If you didn't tell about it,
means that it considerably in a tough condition, doesn't it?
It's an aneurysm in the basilar tip.
Doing the simultaneous operations with the heart are difficult no matter how good you guys are, right?
Right now, I'm searching a brain surgeon who can do it.
I want to find him. Allow me to do the operation.
Until then don't earnestly force... I understand.
But I'm a doctor before a patient.
Let me be a doctor until the end.
Have you found the brain surgeon?
We've been refused by all brain surgeons that were said as the top class in Japan.
I guess they would...
As soon as they hear about the simultaneous operations with the aortic arch aneurysm,
They gave up.
It's not easy to find a brain surgeon that can do a simultaneous operations with Asada.
Even in America too.
Yes.
But it doesn't mean that he doesn't exist.
Do you happen to know who is he?