I'll bring the best team here.
I'll give you full rein.
We need Sakurai Hospital
to serve as bait
to draw them in and have them go to India.
The Delhi Shanti Hospital.
We can use the cardiac cell sheets?
L&P Hospital is the only place in the world
where you can use the cardiac cell sheet to save patients.
Children all around the world with heart disease
are waiting for your magic heart.
I'll get it approved in two years
for the children who can't get transplants.
Dr. Arase, let's create an ideal hospital together
with anesthesiologists at its core.
I'm going to become the director of L&P Hospital.
He is the best choice to attract the best residents to L&P.
Go.
We're a team, no matter where we are.
You're not going to bring Asada over?
I have decided to wait until
Dr. Sakurai's operation is complete
and he can resume his work as a doctor.
Entlassen.
Then we can operate on Dr. Sakurai?
Okamura helped us.
We'll be simultaneously performing extremely challenging
procedures on the heart and the brain.
You won't be able to save Sakurai.
What do you mean?
I won't let you operate on Sakurai
unless you come to L&P.
Do you know why I advise L&P?
L&P needs the government's support
to expand overseas.
That's why I'm the advisor.
My authority is absolute.
If you don't intend to join us,
go hit up some other hospital.
"Some other hospital"?
Oh, right. I forgot.
Dr. Baldwin can operate only in the super medical zone, L&P.
Do you want to do the operation in America?
I guess you're screwed if anything happens to him during the flight.
It's all up to you
whether Sakurai can be saved.
If even Dr. Asada leaves this hospital,
there'd be only Dr. Sakurai and Dr. Hayakawa left.
But Dr. Sakurai's operation can take place only at L&P.
I'll figure something out to send enough doctors over from L&P.
We have to prioritize saving Dr. Sakurai's life right now.
Both have grown to the point that they may rupture at any moment.
Do everything you can to save Dr. Sakurai.
Please let me stay a doctor until the end.
One more time.
Hold your breath.
Sakuma-san.
You're having trouble breathing
because your prosthetic valve is malfunctioning.
Does that mean it's reaching the end of its lifespan?
It would, yes.
It's just like you said.
Hm?
Remember when you operated on my heart?
You gave me your guarantee that I won't need a reoperation
for at least 30 years.
It's been exactly 30 years since then.
Oh, I see.
I'm really grateful.
I thought I could never make sushi again.
But thanks to your operation,
I've been able to keep my restaurant open.
My heart's kept on going long enough.
It's enough.
If you get valve replacement surgery,
you'll be fine for another thirty years.
That'd make me more than a hundred years old.
It's okay.
I don't need to go through another surgery.
I've had—
I'm getting surgery, too.
Huh?
I have problems in my heart and brain.
I thought it was just that my time had come,
but then there are patients who need me.
And there are doctors who're desperate to save my life.
That's why I want to live,
and see patients as a doctor in this hospital.
Let me eat your eel sushi again.
So, thirty more years.
You sure my heart will last that long?
I promise.
I guess I'll just compete with you to see who can live the longest.
Sakuma-san...
can be admitted to L&P.
I've decided to go to L&P.
I will make sure that L&P will send doctors here.
And, I will come here as much as my time will allow.
I see.
You're going to L&P for my sake—
The top neurosurgeon from America
will be coming here to operate.
We'll perform the simultaneous operation
on your heart and brain at L&P within a month from now.
"One month."
We...
will save you.
I believe I said we would acquire Dr. Asada only
after Dr. Sakurai's operation succeeds.
Taking such a long view
will make us fall behind schedule for the opening.
You took too much time recruiting him.
Forcing them to join will not ensure success.
It's only once they each feel personally motivated
here at L&P that we can present India to them.
I had thought of you as a competent businessman,
but in the end,
you are just like a doctor driven by emotion.
If you do not understand how doctors feel,
you cannot manage hospitals.
You'll soon receive a notice from the executive director.
This is farewell,
Mr. Okamura. {time to JP 'subs'}
It's entlassen for you.
Welcome to L&P, superstar.
That was in Hindi.
It's the third-most widely spoken language
after Chinese and English.
We're in the era of globalizing healthcare.
You should study up on it.
I'll have you honor the partnership with Sakurai Hospital.
Okamura made me a promise.
He's no longer with us.
I told him, "Entlassen."
No worries.
We'll continue our partnership with Sakurai Hospital.
We'll continue our partnership with Sakurai Hospital...
although it'll only be for a short while before you...
leave for India.
All done!
Dr. Asada.
I spoke with Noguchi.
I won't let him shut Sakurai Hospital down.
Yeah,
I'm the hospital director.
Don't worry about managing doctor shifts.
And we will do Dr. Sakurai's operation here by the end of this month.
I have word from Dr. Baldwin.
He'd like to confirm the workflow for the operation.
All right.
First, we'll use hypothermic cardiopulmonary bypass.
We'll induce circulatory arrest once
his core body temperature reaches 20 degrees.
The maximum time for circulatory arrest is 30 minutes.
In that time,
we will perform aortic arch repair
for the aortic arch aneurysm,
while Dr. Baldiwin performs clipping
on the basilar tip aneurysm.
If circulatory arrest continues for too long,
there will be brain damage.
His vitals will need to be managed with great care.
That's why I'm on it, right?
There can be no error,
however small, for either procedure.
Be sure to be fully prepared.
Asada.
I know it's important to start off on the right foot.
I'm the Chief of Surgery at L&P.
That means I'm your supervisor.
Keep that well in mind—
Kihara.
Y-Yes?
For Dr. Sakurai's operation,
we'll need a four-branch synthetic graft.
Please have it ready.
O-Of course.
I'll get right on it.
I'd like to use business economics to save not only patients,
but doctor as well.
It's a grand place, just the way people say.
With these facilities and Asada's skills,
you have nothing to fear.
I trust you, Dr. Sakurai.
We will perform Sakuma-san's mitral valve replacement in three days.
I'll show you to your tests.
First, please change out of your clothes.
Okay.
Dr. Sakurai,
we have a date for your operation, as well.
It'll be March 27th.
I see.
By the way,
where is the advisor's office?
What?
Come in.
It's been forty-six years.
Asada and his team will operate on me here,
so I thought I should pay my respects.
Once I am cured,
I intend to resume my work as a doctor.
Noguchi,
please make this hospital
into the ideal hospital you and I dreamed of back then.
I'm counting on you.
The ideal hospital...
changes with the times.
I will create an ideal hospital
suitable for the times to come.
I see.
I am sure you are up to the task.
I will make...
the ideal hospital.
Asada Ryutaro—
you were the final piece of the puzzle.
Now, you can do Dr. Sakurai's operation.
Please save him.
That's why I came to L&P.
You're right.
But...
there's more to that.
What do you mean?
We will make the global announcement on March 20th.
"March 20th"...
That's one week before Dr. Sakurai's operation.
They won't be able to refuse.
Okamura would never stoop to such a move—
I'm not him.
I don't care as long as I get Team Dragon.
Of course.
The only person capable of
leading them is you, Ms. Kito.
Here, thank you.
Drawing blood and measuring vitals? That's not our—
It is our job here.
We're not L&P.
What?
If we do it,
we gain a good understanding of our patients' current condition
and can quickly take appropriate measures.
Jeez.
Dr. Hayakawa, I heard that you can go back to L&P now.
I guess, since I've fulfilled my original purpose here.
Oh, uh.
But you told them that you'll stay here?
What choice do I have?
The director's ill,
and the L&P doctors are all useless.
Thank you.
We need you at this hospital.
Get better already!
I'm having to work too hard!
I'll go take a look around.
Thank you.
Dr. Sakurai performed Sakuma-san's valve replacement
thirty years ago.
We can expect a lot of adhesions
to have formed over that time.
Unlike the first operation,
this reoperation carries the risk of bleeding due to the adhesions.
You're right.
After 30 years, there will be adhesions
where Dr. Sakurai operated.
Even if we carefully work through the adhesions,
it'll be difficult to secure a decent surgical field.
If the Bovie hits the heart,
it will trigger V-Fib.
If there are strong adhesions,
we may damage the right ventricular wall
or the ascending aorta,
which may lead to massive bleeding.
We'll spend far more time working on the adhesions
than the procedure itself.
Because of the patient's age,
the more time we spend, the greater the risks.
Arase.
You can count on me.
I've got the anesthesia covered.
I'll make sure we have the equipment to deal with the adhesions.
All right.
Sakuma Kunio Day of Mitral Valve Replacement Surgery
Stand.
Yes, sir.
Don't worry.
We'll make sure your heart'll keep you going until you reach a hundred.
1...
2...
Listen up.
Make sure you watch every single operation
by Team Dragon, the team I developed.
But it's not the simultaneous heart and brain surgery people talk about—
You idiot!
Any operation they do is worth learning from.
So it's a mitral valve replacement surgery.
Mitral Valve Replacement Surgery
Severe adhesions are expected.
It'll be yet another difficult surgery!
6...
7...
Okay, he's under.
He's ready.
We'll now...
do a valve replacement for a stuck valve.
Scalpel.
Here.
Forceps. Gauze.
Here.
Bovie.
Here.
Ijyuin,
put in a sheath in the left femoral artery in case we need an emergency blood transfusion.
Got it.
Sheath, please.
Here.
Wire twister.
Here.
Wire cutters.
Here.
Tilt down.
They chose to remove the sternal wire
that's normally left untouched in order to safeguard against possible injury to the heart.
They're just gunning for it.
Control rate.
Sagittal saw.
Here.
Claw hook.
Here.
Suction.
Here.
Arase, induce respiratory arrest.
Got it.
Sternotomy complete.
Bovie.
Time to cut through the adhesions.
Weitlaner retractor.
Here.
There are barely...
any adhesions.
What?
I've never seen so few in a reoperation.
Is that even possible?
If the first operation was precise and efficient,
it's possible not to see any adhesions.
But I didn't think there was a surgeon
capable of doing a perfect valve replacement back then.
Dr. Sakurai is amazing.
We'll do this just as well as he did.
Let's finish dealing with the adhesions.
Bovie.
Here.
We'll gain access to the mitral valve with a right-sided left atriotomy.
Scalpel.
Here.
Sponge.
Here.
Increase suction on green.
Got it.
Vent off.
Got it.
Metz.
Here.
Cooley clamp.
Here.
Increase suction on yellow.
Got it.
Vent back on.
Got it.
Well? Can you see what's wrong?
There's pannus wrapped around the leaflet's hinge in the tilting-disk valve.
This is the culprit.
Dr. Sakurai's sutures are faultless, though.
We'll now remove the prosthetic valve.
Scalpel.
Here.
Forceps.
Here.
Get a sizer ready.
Got it.
Urine's fine.
Valve removal, complete.
So this is a tilting-disk valve...
At the time, it was cutting-edge.
It lasted thirty years, huh.
Impressive.
Replacing prosthetic valve.
Sizer.
Here.
They're emulating Dr. Sakurai's approach
to the valve replacement.
Should the patient ever need another reoperation,
adhesions will be minimal.
They're thinking long-term with their approach.
Seeing surgeries like these
is what makes me want them.
What?
Enjoy their operations
while you still can.
While I still can?
Metz.
Mitral valve replacement, complete.
All right,
start the weaning once they close up the left atrium.
Got it.
5-0 thread.
Here.
Sakuma-san,
this is the prosthetic valve that was inside your heart.
Wow, this was in my heart?
Can I have it as a souvenir?
Yes, of course.
So this has been helping me all this time.
We switched it with a top-of-the-line model,
but please continue taking anticoagulants.
I know.
I've been taking them for 30 years.
When you are on anticoagulants,
your blood won't clot very easily, so—
Right, I should be careful when I get injured.
Dr. Sakurai chewed my ear off about it back then, too.
We have word from Dr. Baldwin.
He's on board with the operation plan.
I see.
He says he's looking forward to working with Team Dragon,
and that he'll make it the best operation he's ever done.
Of course.
It'll be the first operation of its kind in the world.
But...
we can make it happen.
We will save Dr. Sakurai.
Pump off.
Got it.
Ijyuin, clamp the femoral arterial cannula.
Got it.
Clamp, please.
Here.
We'll do it together.
Got it.
Circulatory arrest.
Starting countdown.
Scalpel.
Metz.
I'll be using the Harken clamp here.
Got it.
Putting head on ice.
I'll instruct the circulating nurses about the cooling process.
Cooling
30 Minutes Maximum
You're fine.
No problems so far.
March 20th
Sakuma-san,
congratulations on your discharge.
I'm going to see Dr. Sakurai.
I want to show this to him and thank him.
Dr. Sakurai would be happy to see you doing so well.
Maybe I'll take him some of my eel sushi that he likes.
Dr. Sakurai's operation is happening soon, right?
It'll be next week.
Please take good care of him.
We will.
I heard you can move forward with Dr. Sakurai's operation.
Yeah.
Medical Research Laboratory L&P USA
The top neurosurgeon in America will come
and do a simultaneous operation with us.
Dr. Mike Baldwin, right?
I met him at a conference in America.
He said he had a difficult time moving his schedule around,
but he was looking forward to working with your team.
Okamura negotiated on our behalf.
Oh, right, he's—
Asada!
Our L&P Hospital
has been in the spotlight for being the bastion
of the best cutting-edge healthcare Japan has to offer.
The time has come
for us to take this healthcare onto the global stage.
The first location of our International Medical Chain
will be in India!
The hospital will be named
Delhi Shanti Hospital.
Japan's universal healthcare system
is on the verge of collapse.
and will surpass 40 trillion yen in a few years.
There is only one remedy for this crisis:
establish successful Japanese hospitals overseas
to serve as an industry that brings in foreign currency.
This is a joint project between L&P Leasing
and the government.
After India
will come Russia, China, and Vietnam.
We intend to build hospitals
modeled after L&P Hospital around the world.
We have assembled a team
of our best doctors to commemorate our expansion overseas.
First, as the one who will lead the medical team in India...
we have Dr. Kito!
And the clinical team who will provide patient care
is our best team of doctors with top-notch skills.
They are Team Dragon!
Team Dragon
Team Dragon's going to India?
Ryutaro-chan and his team are going to India?!
Team Dragon will cure patients from around the world!
I see.
It's a project on a grand scale.
We will fulfill our objectives in five years.
Please include that in your article.
Certainly.
Bye, then.
Thank you.
What's up with this India business?
This is the first time we're hearing about this—
This is why we recruited you to L&P.
Oh, Okamura-chan didn't tell you?
He left out all the important details.
What a troublemaker.
And I've already told the world about you.
Cut the bullshit.
We weren't told anything.
You'll understand if you read this.
The Japanese healthcare system is wonderful.
Anyone can receive safe care
anywhere and anytime.
But our healthcare costs are spiraling out of control.
What should we do?
The only thing we can do is secure a new funding source.
But where would we find one?
The world.
We'll effectively export Japan's high-quality healthcare
and earn foreign currency.
It'll be reinvested into Japanese healthcare,
thus serving as a secure funding source.
Isn't it a marvelous idea?
See, I...
want to save Sakurai Shuzo.
You need L&P's super medical zone to save him, don't you?
If hospitals like L&P appear all around the world,
don't you think there'll be more cases like Sakurai Shuzo
being saved by Dr. Mike Baldwin?
Do you disagree with anything I've said?
I'm right, aren't I?
Yes.
You're right.
This project...
is the last hope for Japanese healthcare.
Asada Ryutaro,
I need your help.
All right.
Ow.
Sorry!
Are you okay?
Yeah, I'm fine.
Never mind me.
Sorry!
Dr. Sakurai,
Sakuma-san's here to see you.
Hey.
Sakuma-san, what happened?
Oh, I fell.
Anyway, I brought the eel sushi I promised.
They're a bit jumbled up now,
but I can guarantee that they still taste good.
Oh, thank you.
Look what we got.
You shouldn't have.
Thank you.
Oh,
and here.
Hm?
This was keeping my heart going for 30 years.
What a trip down memory lane.
Dr. Asada told me
that your operation was perfect.
He's just like you back then.
Asada's operation
guarantees that you'll be fine for another 30 years.
Now it's your turn to get better
so that we can compete...
Sakuma-san?
Sakuma-san?!
Sakuma-san!
Sakuma-san?!
Sakuma-san?
Sakuma-san!
The impact of the fall
must've caused pericardial effusion.
He's having a cardiac tamponade.
Get a trauma cart and a gurney.
Hurry!
Got it!
He's in cardiorespirataory arrest.
Bring an AED, too!
Got it!
Come back.
Come back!
Director.
We have a pulse.
The gurney's here.
Lowering side rails.
Transferring.
1, 2, lift.
We just need to do a pericardial tap.
I'll do it.
Pierce the pericardial sac with ultrasound guidance,
then use a pigtail catheter to drain the blood
and alleviate the cardiac tamponade.
Right.
Dr. Asada's drilled the procedure into me.
You should rest, Doctor.
He's going to be fine.
Let's go.
It's been a long time.
I need to talk to you.
Yeah.
I need your help.
Final Episode Preview
Ruptured Aneurysms in the Brain and Heart
Dr. Sakurai?!
What's the status?
The aneurysms in his brain and heart have both ruptured.
No Neurosurgeons?!
Dr. Asada's team will do the simultaneous operation now!
Asada Performing Brain Surgery?!
I'll operate on his brain!
It'd mean Dr. Sakurai might die by your own hand!
It's a no-go.
All of our neurosurgeons are saying they can't do the operation.
It'll have to be me.
You can't possibly operate on a basilar tip aneurysm
while you operate on his heart!
I can't just have us stand here wringing our hands while he dies!
You have a call from Dr. Fujiyoshi.
We will now perform aortic arch repair.
There is one neurosurgeon in Japan
A Neurosurgeon Appears?!
This is a work of fiction.
Final Episode Preview
who can save Dr. Sakurai.