The patient is a boy with Type I diabetes.
Dr. Hayakawa ran into problems with the patient's mother.
You're a doctor, aren't you?
Why do you have to say it like that?
What's the matter?
You want to say that it's our fault
that our son got sick, don't you?!
That's not true at all.
I only asked if you know any relatives
who also have Type I diabetes.
You told me my son will need shots every day.
How can I do that to a little boy?
It's necessary so that he'll have insulin.
You seem dissatisfied with various aspects of our care.
I'll refer you to a pediatrician at L&P.
Are you trying to get rid of us?
I'll take over from here.
After succeeding in cardiac cell sheet therapy in Japan,
L&P Hospital was authorized by the FDA in America
to perform clinical trials on five patients,
and the trials were all successful.
Dr. Fujiyoshi Keisuke, the principal investigator,
has stated that he'd like to begin treatments in Japan as early as next year...
Dr. Hayakawa, please draw blood and check the patients' vitals.
I've been wanting to say this for a while,
but that isn't something doctors should have to do, is it?
The director and Dr. Asada both do it themselves.
At L&P, nurses collect patient data.
The electronic patient files are continuously updated,
so doctors just have to check them.
We're not L&P.
But why do doctors have to go through the trouble?
Even at other hospitals—
Doctors who take their patients' vitals
are better informed and can respond more quickly if needed.
It's the director's policy.
Please do it.
Ow!
Get it together already.
Isawa-san, your veins are really thin.
Ow!
This is the third time already!
Cut it out!
It'd be a challenge for anyone.
Please be patient.
Dr. Asada, help!
My arm's going to become a pincushion.
It didn't hurt at all.
I wonder what's the difference between you two.
He used an arterial puncture, which isn't typically used for this purpose,
and drew your blood from a peripheral vein.
So you know things,
but you can't actually use them.
Your blood pressure's on the high side.
Let's give you antihypertensive drugs.
Hayakawa.
Oh, I prefer Dr. Asada, if that's not too much trouble.
What?
Me, too.
Hey, Sonny.
Um...
I am a d—
Never mind all that.
Yes?
I have horrible shoulder cramps.
Can you give me a massage?
Huh?
Right here.
I'm at the end of my rope.
Please let me come back to L&P.
I am not a good fit for Sakurai Hospital.
You don't feel it is commensurate to your abilities?
The patients here have zero respect for doctors.
They think they can get away with saying anything because I'm a young resident.
They're all bullies.
Dr. Hayakawa,
you still have things you must do at Sakurai Hospital.
Such as reporting on Dr. Asada?
There is much you can learn at Dr. Asada's side.
But, still...
Thank you for your patience.
You'll be rotating to Anesthesiology tomorrow.
At this rate,
I'll become an all-around "super" doctor.
It's important not only to master your specialization
but also to gain overall competence by rotating through various departments.
Yeah, listen up.
This super doctor right here is your role model.
Thank you, Dr. Ijyuin.
I'll see you tomorrow.
Tomorrow's Anesthesiology.
Sounds fun.
Don't get too full of yourself.
What do you mean?
You're getting full of yourself, aren't you?
Dr. Ijyuin, your new residency program seems to be off to a smooth start.
I'm glad they'll be learning.
Me, too, Ijyuin.
When we first met,
you were a klutzy resident.
But now,
you're in a position to teach many residents.
You haven't changed at all, Dr. Kihara.
What he's trying to say is,
I've always been a full-fledged doctor since day one.
Your hair hasn't changed at all, either.
Right.
The Kihara Hair is my trademark.
It's something I've been thinking for a long time,
but it doesn't suit you.
What? For a long time?
So for more than seven years?
Seriously? What?
Wait, why'd you tell me this now?
Well, then.
Okamura-san,
may I go help out at Sakurai Hospital in the evening?
Of course.
That's our arrangement.
Comprehensive Choice-Based Residency Program
Maybe you can participate when you have the time.
I already have Okamura-san's permission.
When would I find the time?
What?
Now that even you've left for L&P,
my workload's increased.
I'm slaving day and night,
and I don't have that kind of time!
Besides, this residency plan—
is there any point to all this?
If residents have the time to rotate through all the departments,
they should use it to choose and focus on their specialization instead.
It's a smarter career choice.
Why did you become a doctor, Hayakawa-kun?
I didn't have to become one.
What?
I was always smart and at the top of my class.
You don't mince words, huh.
It leads to marketable skills,
vocational training, and social status.
That's why I took the med school entrance exam.
But maybe I'll quit.
It'd probably only take me a year to pass the bar.
Oh, maybe I'll get a license to practice law overseas
and become a management consultant like Okamura-san.
I'm sure you could.
Yeah.
But you'll eventually just hit the same wall if you don't change.
What? What do you mean?
I don't think it's possible to persist in a career
unless you really want it.
I found a neurosurgeon who can help Dr. Sakurai!
Who?
No one in Japan will,
but there's someone in America.
This guy.
Mike Baldwin?
He's the top neurosurgeon in America!
He's been consistently ranked number one in the Best Surgeon in the USA
over the past decade.
He's succeeded in operating on
similarly challenging cases numerous times.
If Dr. Baldwin and Team Dragon can work together...
We can save Dr. Sakurai.
I'll send Dr. Sakurai's patient files over right away
to begin negotiations.
Two months.
Based on Dr. Sakurai's condition,
I'd like to do the operation within the next two months.
We're finally down to the main target.
There is one major hurdle to our efforts to recruiting him.
It's Dr. Sakurai.
Sakurai?
Yes.
If we can't make Dr. Sakurai's operation a success,
we won't win Dr. Asada over.
Why not?
Dr. Asada was entrusted with Sakurai Hospital.
Do you think he'll leave his ailing mentor behind
to go to India?
In addition,
Dr. Sakurai is the real deal.
We need doctors like him.
You puzzle me.
When I'm talking with you,
I feel as though I'm talking with Asada.
Dr. Asada, please see a patient.
Excuse me, but I have another patient who says it's urgent.
Dr. Hayakawa.
What?
Well, we should just have the patient wait.
Please.
I'll be in Examination Room 1.
Call me if you need anything—
Yes, I'll ask you to switch with me
if a bully shows up and starts a fight.
He was our first resident in a long while,
so I had great hopes for him, but...
The director mentored you,
and you mentored Dr. Ijyuin.
So I was hoping
it'd be the same way with Dr. Hayakawa...
but I guess it's not so easy.
Feel free to put your belongings here.
Please have a seat.
I'm Asada.
I saw your medical history.
So you sometimes lose track of time?
Oh, that was only for a few seconds at a time.
Once they went away, I've been fine.
Come in.
Feel free to put your belongings—
It's fine.
I'm Hayakawa—
Oh?
Where's Dr. Asada?
You're quite young.
Oh, you must be the doctor who's not good at drawing blood.
I heard about you from a friend who's hospitalized here.
My goodness, I'm being seen by a underling in training?
If you prefer Dr. Asada,
if you're willing to wait a little longer—
I'm busy.
I'm fine with a trainee.
So your feet are swollen?
Yes.
Let me listen to your neck.
"Neck"?
Excuse me.
Please hold your breath.
Okay.
I'm sure it's nothing serious,
but it's been tough lately
since I'm on my feet all day because of my job.
What do you do?
I'm a fishmonger.
Oh, hey.
Do you eat enough fish?
Kids these days don't eat enough fish.
Please show me where your feet are swollen.
Sure.
Right around here, see?
You have varicose veins.
What?
The valves in your veins aren't working properly,
so the blood is backing up.
Is it serious?
It's common in women,
especially those who have to stay on their feet due to work.
Ow.
If it's not serious, just tell me already!
You seemed to have some difficulty walking when you came in.
Do you also experience any weakness in one arm,
weak vision,
difficulty talking,
or numbness in your mouth?
Anything like that?
Oh, now that you mention it...
I heard carotid bruit.
It's highly likely that you have left carotid stenosis,
which is when the blood vessel in your neck becomes narrowed.
What?
It's a sign that you may be at high risk of having a stroke.
"A stroke"?
Does that mean I'll have to get a major operation?
It's currently possible to treat it with a catheter.
Dr. Ijyuin at L&P Hospital is skilled in catheter procedures.
I'll write you a referral.
You're going to be fine.
Varicose veins in lower limbs
I'll prescribe compression stockings.
Stockings for confession?
It puts pressure on your legs
to prevent blood from pooling—
I have stockings.
They have to be made for medical use.
What? How much are they?
Five thousand yen.
What?!
That's a rip-off!
It's actually very reasonable.
I didn't ask for this.
Goodness, I'm glad you didn't draw my blood on top of everything else.
Dr. Hayakawa,
you seemed to have had trouble with the patient. Did it go okay?
Ugh!
The patients here are low-class!
They don't get a free pass to say whatever they want, just because they are patients.
Hayakawa.
There is no "class" of patients.
None of the patients at L&P ever mouthed off at me.
The patients here have zero respect for doctors.
Maybe you haven't built good relations with your patients.
Dr. Asada always faces the patient in the exam room,
and he looks them in the eye while he talks.
Dr. Hayakawa, you're always looking at the monitor or the patient history.
Are you saying we shouldn't ground our diagnoses in data?
There are symptoms you can detect
only by interacting closely with the patient
after confirming the data.
How can I interact with a patient like her?!
When I prescribed compression stockings because she said her feet were swollen,
she said I was trying to rip her off.
It's unacceptable!
I make accurate diagnoses
and inform patients of their treatment options.
If we can't provide that treatment, I write referrals to L&P.
I am doing my job.
Have you found a surgeon for Dr. Sakurai?
We are negotiating with Dr. Baldwin, a neurosurgeon at
University of Central Pittsburgh Hospital.
He's suitable for the task at hand.
You know of him?
Yes.
I met him when I was helping restructure a hospital in America.
Whether it be aneurysm clipping via a craniotomy,
endovascular coiling,
gelatin sponges,
embolization with NBCA,
or Gamma Knife radiosurgery,
he is the world's best neurosurgeon.
You're very knowledgeable about neurosurgery.
My job involves interacting with many doctors.
Becoming knowledgeable about medicine is par for the course.
Is something wrong?
No.
Why did you become a healthcare consultant?
What I meant by that is,
why specialize in healthcare as a management consultant?
There are some things in medicine
that can be changed only
through the power of economics.
I thought it a worthwhile lifetime goal.
That's...
my motivation.
Well?
Can you land Asada?
It depends on Dr. Sakurai's recovery.
He has a basilar tip aneurysm.
Few neurosurgeons can repair that.
Team Dragon appears to be negotiating with the top neurosurgeon in America.
Mike Baldwin?
There's a man you know very well.
But...
Dr. Baldwin can't save Dr. Sakurai.
You should know that better than anyone.
Hey, is Dr. Asada here?
No.
He's making his rounds right now.
These are tangerines we grow at home.
Ah.
Dr. Asada realized that I'm at risk for stroke yesterday.
If he hadn't, my life would've been in danger.
I owe him my life!
Please tell him how grateful I am.
I will.
There are symptoms you can detect only
by interacting closely with the patient
after confirming the data.
Dr. Hayakawa.
We have a patient in urgent care.
What?
The patient is Naganuma Yoshie-san, whom you saw yesterday.
Patient's name is Naganuma Yoshie-san, age 60.
She collapsed at work after complaining of having difficulty breathing.
Let's lift her up.
Got it.
One, two, lift.
We're going to raise your head.
There.
It's neither pneumothorax nor pneumonia.
It's not heart failure, either.
Naganuma-san, when did it start?
I was tired,
so I'd been sitting.
Then it started right when I stood up.
Right when you stood up...
Come to think of it, yesterday...
Her left thigh is extremely swollen.
Her calf has very pronounced veins.
Sheesh. You didn't wear the stockings?
Dr. Hayakawa, look at her right leg.
Excuse me.
Her right leg is fine.
Even if she has varicose veins in both legs, this means...
It's deep vein thrombosis.
Economy class syndrome?
Given this discrepancy between the two legs...
Doctor, didn't you check both legs during the exam yesterday?
Patients who develop deep vein thrombosis
can have varicose veins as the underlying cause.
Where's Dr. Asada?
We don't need to call him!
We'll do thrombolytic therapy.
We'll use heparin to dissolve the clot.
Get it ready.
G-Got it.
You're going to be okay.
You suck at it, just like people said.
Dr. Hayakawa, let me.
You're going to feel a prick.
Oh, the nurse is better than you.
This should do it.
The clot should dissolve.
Start
O-2 sat's at 80!
It's decreasing!
Should we give her more oxygen?
Increase to five liters.
If heparin won't dissolve the clot,
we'll use t-PA.
But if we use t-PA,
if the patient ends up needing surgery,
she'll bleed out.
She won't need surgery!
Bring t-PA.
Got it.
Naganuma-san?
Naganuma-san!
We need to intubate!
I'll bring the trauma cart.
Naganuma-san!
The clot's traveled to her lungs.
It's a pulmonary embolism.
The clot that formed in a vein in her leg
traveled to her lungs via the bloodstream
and got lodged in a pulmonary artery.
A clogged pulmonary artery
will shut off bloodflow to the lungs,
thereby preventing gas exchange,
and causes a rapid drop in partial oxygen pressure.
It will lead to difficulty breathing,
and in the worse case, suffocation.
Call Dr. Asada.
Got it.
Naganuma-san?
8.0 ET tube.
Got it.
We'll have to operate and remove the clot that got into the lungs.
Get a PCPS on standby.
Got it.
"Operate"?
Get ready for surgery, now.
But we don't have an anesthesiologist today.
Call Arase.
Got it.
The patient's family is here.
They're requesting an explanation.
Hayakawa,
she's your patient.
Go explain.
We will operate
to remove a clot that has become lodged in an artery in her lungs.
"Operate"?
She just had swollen legs.
Why is it about her lungs?
She was seen here yesterday
and was told there was nothing serious going on.
Why is this happening?
She's going to make it, right?
We'll do everything we can.
Please help her.
Please.
That Reverse Mullet is such a troublemaker.
Okay, stand please.
Got it.
1...
2...
3...
4...
5...
6...
7...
Okay, she's under.
We're ready.
That's not where you should be.
What?
Naganuma-san is your patient.
You should be the operating surgeon.
What? But—
A patient's life is at risk because of your previous diagnosis.
You have a responsibility to save the patient.
Thank you for your assistance.
We will now begin
an emergency thrombolectomy for a pulmonary embolism.
Scalpel.
Here.
Forceps.
Here.
Gauze.
Here.
Bovie.
Here.
Set up cardiopulmonary bypass using the ascending aorta
for arterial cannulation and the right atrium for venous cannulation.
Got it. Scalpel.
Here.
Hurry.
Even with 100 percent ventilation, her SpO2 is at 80 percent.
Got it.
Dissect perpendicular to the aorta.
Got it.
Don't push too hard.
G-Got it.
We've got full flow.
Stop the heart.
I'm just a resident.
Dr. Asada, please take over from here—
You're the operating surgeon.
This patient's life...
is in your hands.
Hey.
Get on with it, Reverse Mullet.
Aorta clamp, please.
Here.
Flow down.
Got it.
Cross-clamped.
Give plege.
Giving plege.
Provide backup.
Providing backup.
Dissecting pulmonary artery.
Scalpel.
Here.
Tilt down.
Continue dissecting to the right pulmonary artery.
Metz.
Here.
Found it.
Found the clot.
Be careful when you remove it.
Forceps.
Here.
Basin.
Here.
Dr. Asada?!
Stop the pump.
What?!
Starting circulatory arrest.
Start countdown.
Let's put her head on ice.
Yes, sir.
What's the bladder temperature?
35.2 degrees.
Cooling mat's on.
Suction.
Glycerin.
Here.
Monitor.
Got it.
Get a Fogarty catheter ready.
Got it.
Calm down, Reverse Mullet.
The bleeding's just backflow
from the extremities now that we've removed a clot.
We've set the stage.
You do the rest.
I've removed all the visible clots.
Reinflate the lungs.
Got it.
There are no more clots.
Good, we just need to close the vessel.
Rewarm.
Got it.
Metz.
Here.
Pulmonary artery's closed up.
Declamp.
Flow down.
Got it.
Declamped.
Providing backup.
Spontaneous heartbeat isn't being restored.
What are her calcium levels?
They're fine.
Come back.
Getting a reading on the monitor!
Spontaneous heartbeat...
restored.
It's all...
my fault...
Your surgery...
saved the patient's life.
Naganuma-san's regained consciousness.
Go to her.
I am so sorry.
So if you hadn't made a mistake with the diagnosis,
the operation would not have been necessary?
That's right.
I should have been able to diagnose her
if I had examined her more closely.
I am truly sorry.
That's the boy who was diagnosed with diabetes.
He's so happy.
As you also said, his only course of treatment
is to keep injecting insulin.
But Asada acknowledged the patient's fears head-on,
then explained that he can live with the disease.
That if he continues the shots, he can live a normal life like other children.
That easier treatment options
should become available as they're developed in the future.
Doctors need to be trusted by their patients.
When patients get better, they smile,
and thank us for our help.
That's the best reward.
Is that why you became a doctor?
There are things only doctors can do.
That's why I want to stay a doctor until the very end.
Why's this here?
Fish?
Hey.
Come over here.
Did the fish arrive?
There were so many.
Thank you.
Don't worry about it.
They're all fish no one buys.
But those are the kind that taste the best,
Dr. Hayakawa.
Doctor!
Please give me your arm.
I need to take your blood.
What?!
Oh please, not that.
No, I swear I'll be good at it today.
No way.
I'll be asking the rest of you, too.
Thank you for your time.
Is something wrong?
You suddenly want to hear about the residency program?
I thought about participating when I find the time.
I'd like to learn more about it.
What? What is it?
Are you sure?
It's already past five.
Well,
it's still five.
Please tell me.
Okamura Tadashi is entlassen.
He has fulfilled his purpose.
You haven't been able to recruit Asada yet.
I'd like to leave that to you, Ms. Kito.
"All rivers flow to the sea,
no matter how they may twist and turn."
An Indian proverb.
Okamura and Asada...
I can't shake the feeling that they're headed toward the same sea.
I don't want to wait until the hunter turns into the hunted.
You need Okamura to get Asada.
You still don't know anything about that man.
Good evening.
Did Dr. Baldwin agree to perform the operation?
I sent him Dr. Sakurai's files.
He said he can do it
after reviewing Dr. Sakurai's brain and heart symptoms.
I see.
But...
"But"?
He said he can't do it until two years from now.
He has patients from all over the world asking him for help,
so his schedule is completely full for the next two years.
Not to mention, he's demanding over five million.
America is a land of private medicine.
Patients can choose their own surgeons,
and doctors receive payment that's commensurate to their expertise.
It's an inevitable outcome of such a system.
Asada was...
hoping to operate within two months.
"Two months"...
Any longer and...
Dr. Sakurai's life will be at stake.
A two-year wait.
Damn.
And he was the first surgeon willing to do it.
No one else can do it but him.
Huh?
What?
Oh,
Dr. Baldwin was number two in 2004.
So there's someone better than him?
The top surgeon's information has been removed, though.
It says he retired.
So there's still only Dr. Baldwin.
So we're back to square one.
What should we do, Dr. Asada?
Investigation Report on Okamura Tadashi at L&P
Checkmate.
Next Episode Preview
Top Neurosurgeon in America
I hear you're trying to lure
an American neurosurgeon with an exorbitant sum of money.
Peripartum Cardiomyopathy
We suspect it might be peripartum cardiomyopathy.
An Expecting Mother with Heart Disease
"Peripartum cardiomyopathy"...
There's no debt or favor involved when a doctor saves a patient's life.
He's the son of L&P Leasing's Vice President Wakisaka.
There can be no failure.
Then I guess I don't need to be there.
Right.
I lost someone I knew to peripartum cardiomyopathy.
So that's who he really is.
There are patients who can't be saved
A Patient Who Can't Be Saved
This is a work of fiction.
no matter how many competent doctors there are.