I don't operate.
I'm slightly intrigued.
By Tachibana-sensei.
He would've died if he'd gone on that way.
I want to know the reason.
She's a famous neurosurgeon,
so why is she in A&D?
She started at Hakushukai West Tōkyō General Hospital 18 months ago,
and before that she worked at a hospital overseas.
But no one knows where the overseas hospital was.
Is there a reason she's hiding it?
So I've met you at last.
I'm home.
Our hospital was proud of Tachibana-sensei's reputation.
We didn't want to lose her, but she was determined.
Is there a reason why she left?
I don't know...
She seemed the same as ever.
Even just before resigning,
she successfully completed a difficult operation.
She used to operate?
She's a bona fide genius.
We never have and never will
have a neurosurgeon better than her.
I heard she worked abroad before coming here.
Do you know which hospital?
I don't.
Why don't you ask Kitabatake-sensei?
Our director?
He's the one who introduced Tachibana-sensei to us.
He knows her the best.
Director Kitabatake is involved somehow.
Apparently they were teacher and student.
He's also the one who brought her to A&D.
He may know all about her.
I understand a little how you feel.
There are too many mysteries surrounding her.
It's very interesting.
Look at that face.
This takes me back.
Do you remember?
Children grow so quickly.
It seems like only yesterday you were a baby.
Right, Mao?
Takasugi-sensei...
Why...?
No matter how much you miss the past,
you can't go back there.
Mao...
Mao?
Mao!
You make everyone around you unhappy.
What's he doing?
Ah, careful!
The patient was admitted yesterday.
Okuyama Kentarō-san, age 28, male.
He apparently attempted suicide
by jumping off the observatory at Wangan City.
He has whole body bruising and a fractured left heel.
He was lucky.
By chance he fell onto bushes.
Why are we being given a patient who attempted suicide?
That's right.
He should go to Psychiatry.
He insists it wasn't a suicide attempt.
An accident?
Multiple witnesses have said he jumped.
That many people saw?
Wangan City's observatory is a date spot.
I've been there myself sometimes.
If the patient is telling the truth,
he behaved against his own will.
Yes, we need to find out if there's a medical reason.
So that's why he was sent to us.
A disease that moves a person against their will?
That could be caused by drugs like cocaine.
They create hallucinations and elevated mood.
But he hasn't mentioned that,
so maybe he's hiding it.
He's already been tested for drugs.
He was clear.
Sleep apnoea syndrome?
Or narcolepsy?
It's possible he entered a sleep state and fell.
In some cases there are no subjective symptoms.
In that case it should've shown up in his life before.
He'd be aware of it.
How about transient ischemic attack?
He fell due to sudden paralysis.
He'd have been aware of the paralysis.
None of them seem likely.
Perhaps it's a psychological issue after all.
You mean a mental illness?
Suicide is the leading cause of death among those in their 20s.
Patients may feel suicidal,
but they don't want their families to know
so they lie.
He's likely to try again.
We'll treat him in conjunction with the Department of Psychiatry.
Yes.
Do you agree it was caused by mental illness?
Could be. There were witnesses.
Then Iwakura-sensei was right,
Okuyama-san is lying.
There's one problem though.
What?
Would someone suicidal choose a crowded place to die?
You're right, that's odd.
It's odd.
Where are you going?
I just went to look at the view.
Then when I approached the fence,
I suddenly fell.
You weren't trying to jump?
I've never even considered dying.
This is my wife.
I'm Yumiko.
Thanks for helping my husband.
I'm his doctor, Tachibana.
A baby?
Yes, due next month.
Really? Congratulations!
Thank you very much.
Boy or girl?
- A girl. - Ah, I have a girl, too.
Although she's 10 now.
Okuyama-san, you're an architect, aren't you?
Yes, I work for an architectural design office.
I normally just do the drawings,
but yesterday I visited a site for the first time in ages.
It happened to be near the observatory.
Aren't you hungry?
The hospital doesn't give enough food.
Medical Team
Lady da Vinci's Diagnosis
Subtitles by Candylemon
He doesn't seem like he wants to die.
They'll have a baby next month.
So why did he jump or whatever?
I'm not good with heights.
Did you know? People with a fear of heights
are often very imaginative.
Eh~? Really?
I suppose they imagine falling.
I don't consciously do that.
But I can't handle roller coasters or Ferris wheels.
How about you? Can you ride them?
At amusement parks?
They have scream machines.
Dropping down from a terrific height.
I love them!
I'll queue up however long the line.
I see, you're willing to queue.
You must be fine with heights, then.
That's great.
Huh?
I feel like I shouldn't have said that...
Kuroki-sensei said that?
Yes, he said you were the one who introduced Tachibana-sensei
to Hakushukai West Tōkyō General Hospital.
That's certainly true.
I don't deny it.
I've heard that prior to that, Tachibana-sensei was abroad.
Sit down.
You're as interested as ever in Tachibana-sensei.
Please, sit.
Not one person
knows what overseas hospital she was at.
Why is that?
Why doesn't anyone know?
That's not normal.
It's true that Tachibana-sensei was at an overseas hospital.
Then why the big secret?
Is there some reason to hide it?
Some reason connected to why a famous neurosurgeon
came to this hospital, to A&D,
and says she won't operate.
Nothing of the sort.
While she was abroad,
she doesn't seem to have been registered at a specific hospital.
She did an inspection tour.
Ah...
Could it be you want to go to an overseas hospital?
No no, you're needed in A&D,
even if you want to leave.
But if you're really set on going,
I'll introduce you to my friend at Beacon Hill Teaching Hospital in Boston.
They're the world authority on neurosurgery,
so Tachibana-sensei has been there too.
Did she really go overseas?
Of course.
Would I have any reason to lie?
Tachibana-sensei.
Thanks for last time.
Is something wrong?
No, nothing.
I heard from Nitta-sensei.
About your successes.
- From Nitta-sensei? - Yes.
I've been close to her since she was in Cardiology.
I see.
I'd like to have a leisurely chat sometime.
- With me? - Yes.
I'm interested.
In your diagnosis.
It's all couples.
Inviting me to a place like this...
Could it be...
We met at the hospital and you followed me here.
You said Tachibana-sensei had sent you on another errand,
so I couldn't just leave you.
I happened to say the wrong thing.
She said, "You're good with heights, take some photos!"
Would you like someone to take one?
A photo of us.
No need.
Ah, this is where Okuyama-san fell.
It's under construction.
Oh?
That's the only spot with no fence.
There's a sign saying it's off limits,
and I can't imagine it escaping his notice.
It's easy to see it's under construction,
and with no fence you'd usually stay away.
He must be absent-minded.
He's not like you.
Eh? What's that?
Where is this sign?
The location?
Is it on the left? In the left corner?
Yes.
Eh?! How did you know?
I see...
So that's it.
What do you see?
You've had a hard time, haven't you?
Tell us honestly.
I told you, there's nothing like that.
There's no need to feel ashamed.
Everyone has weaknesses.
Here you go.
What's this?
My book.
"108 tips for survival in a stressful society."
Try reading it.
It's a masterpiece.
Tachibana-sensei, what's wrong?
Okuyama-san wasn't lying.
He had no intention of suicide.
Why do you say that?
Something to draw on...
Ah, hey...
Can you draw a picture on here?
- Tamaru-sensei, the photo. - Ah, yes.
Try to copy this photo.
It should be easy.
- The observatory? - Yes.
What are you doing? That book...
Fine.
It's done.
This is proof Okuyama-san wasn't lying,
and didn't plan to commit suicide.
- Murakami-sensei. - Yes?
Prepare for MRI.
Will do.
These are MRI images of Okuyama-san's brain.
Look here.
There is a small infarct.
A small infarct on the right parietal lobe.
Because of this, Okuyama-san
took an action misunderstood as a suicide attempt.
Cerebral infarction...
Okuyama-san fell from a place
under construction and with no safety fence.
A sign there declared it off limits.
- Tamaru-sensei, the photo. - Yes.
Thanks.
This is where Okuyama-san fell.
Ah, Iwakura-sensei's "Illness from the Mind".
I've got it, too.
Ah, wait...
I asked Okuyama-san to draw a picture of the area.
Here it is.
Eh? That's...
It's only the right half.
Here is the problem.
The construction site was on the left,
so Okuyama-san didn't draw the place he fell from.
Why might that be?
Yes, Iwakura-sensei.
He didn't see it, so he didn't draw it.
Ping-pong, that's right.
I'd expect nothing less.
What do you mean?
He didn't notice the caution sign.
He didn't see it.
That's right.
More accurately, he didn't recognise it as existing.
Okuyama-san's brain can't register things visible on the left.
It's unilateral spatial neglect.
Unilateral spatial neglect?
He was looking at the view,
and walked along by the fence.
But the construction site was on the left
and he didn't recognise the warning sign.
He carried on, and fell.
He didn't jump in a suicide attempt.
Right.
This is why it was mistaken for suicide.
If we remove the infarct,
it'll cure the unilateral spatial neglect.
The symptoms first appeared yesterday evening.
It's been less than 24 hours.
We'll start cerebroprotective medication immediately.
Aspirin, too.
Yes.
We'll begin now.
Okay.
It's good that we've found the cause.
That's right.
Did you know from the start?
That he had unilateral spatial neglect.
I wasn't sure.
That's why I sent you to the observatory.
To confirm where the construction work was.
The first time I met Okuyama-san
he was hungry but had left half his food.
The hospital doesn't give enough food.
There was a clear left-right division.
It's still less than 24 hours since onset,
and the lesion is small
so he should make a full recovery.
Yukino.
What did you say to Tachibana-sensei?
Eh?
I saw you talking to her.
Ah, just an idle chat.
It looked like you were having fun.
Are you hiding something from me?
Like what?
Sorry, but I'm due in surgery.
See you.
Tamaru-sensei, let's go for a meal today.
I'm busy today, so I can't.
You always say that!
When will you be free?
I don't know.
I won't keep chasing you forever.
Someone else is interested in me.
Please go to that person.
- Ah. - They say I can be discharged soon.
Oh, that's a relief.
I'll be out in time for the birth.
Ah.
Shall I inflate that for you?
Yeah!
Give it here.
Wow~ Awesome!
There you go.
Thank you!
- Bye-bye. - Bye-bye.
We'll have a child of our own soon.
I can't wait.
I look forward to seeing you!
They look so happy.
What a wonderful couple.
I can feel the love even from here.
A girl? That's great.
Have you decided on a name?
Not yet.
She'll be born soon,
but he's determined to choose her name himself.
I want to give her a special name.
He keeps on talking like that.
If he's like this before she's born, the future looks tough.
When she gets married, and so on.
I won't let her get married.
You're so silly.
There, please don't leave any.
- Thank you very much. - You're welcome.
What are you doing?!
Darling?
What are you doing, Okuyama-san?!
Ow!
What's wrong?
Okuyama-san suddenly turned violent!
It's not me!
Okuyama-san, calm down.
I am calm!
It's not me.
- Yumiko... - Okuyama-san!
- Yumiko! - Calm down, Okuyama-san!
I'll prepare a sedative.
Please calm down!
Are you alright?
I feel a bit shaken.
Has he ever been like this before?
No, never.
If anything, he's rather quiet.
He was saying it wasn't him.
Has he behaved strangely at all lately?
Behaved strangely?
Try to remember even trivial things.
Ah, that reminds me,
he forgot how to use his smartphone.
- Smartphone? - Yes.
What's wrong?
How does this work?
Hm?
I want to phone the manager,
but how do I call with this?
What? Are you joking
I don't get it.
But a while later,
he used it like nothing had been wrong.
He was temporarily unaware of how to use it.
Also, at work
he told me he'd suddenly forgotten how to write his own name.
That went away quickly, too.
Do we really need another MRI?
We found the infarction yesterday.
There's something else wrong.
There can't be, we examined it properly.
Stop! Back by one.
Okay.
Look at the corpus callosum.
Eh? A new infarct?
Is that why Okuyama-san suddenly turned violent?
Yes.
The location of the infarction gave his body a life of it's own.
A life of its own?
It's alien hand syndrome.
One hand moves arbitrarily, without the person intending it.
He had no control over his own hand.
That's why what he said didn't match what he did.
According to Yumiko-san,
he recently forgot temporarily how to use his smartphone
and how to write his own name.
That was also due to infarction.
Before it was unilateral spatial neglect,
now it's alien hand syndrome.
If more infarcts keep appearing,
what will happen?
There was no brain cell death where the new infarct was found.
Why not?
On the contrary, compared to the previous MRI
the focus of the unilateral spatial neglect has gone.
It's likely that up to now there's been a cycle
of new infarctions occurring and healing naturally.
But why would they keep on happening?
It's not normal.
It could be due to atrial fibrillation in the heart.
Atrial fibrillation creates a thrombus,
which travels to the brain and causes cerebral infarction.
We've done an echocardiogram and chest CT.
We've also done a Holter ECG,
but we haven't yet confirmed thrombosis or atrial fibrillation.
It's not atrial fibrillation?
Hello, Analysis and Diagnosis.
Ah, Satomi-sensei.
Eh? Okay!
We'll be right there.
Okuyama-san's condition has sudden changed.
It's alright, we'll treat you soon.
It hurts...
Darling, are you alright?
- How's it going? - Myocardial infarction.
He coughed and then complained of severe chest pain.
Tamaru-sensei, sublingual nitroglycerin,
then prepare for echocardiogram.
Yumiko-san, it's alright, come over here.
Okuyama-san, I'm putting medicine in your mouth.
- Prepare defibrillator. - Okay.
Yumiko-san?
Are you okay? What's wrong?
- The baby... - I'll feel.
It's slightly expanded.
There's a risk of preterm delivery.
- Uematsu-sensei. - Yes?
Fetch a stretcher.
Murakami-sensei, sorry but can you fetch blankets?
Alright, easy does it...
I'll perform PCI.
- Prepare it, Tamaru-sensei. - On my way.
Deep breaths.
And breathe...
That's the way.
Yumiko-san, hang in there.
You can do it.
Save my daughter, please!
I don't care what happens to me, but please, save my daughter!
Mao...
Tachibana-sensei?!
It's no good, please calm down.
Save Mao!
MAO!
Spider.
The stent is in.
Add the contrast medium.
Injecting the contrast medium.
How is she?
For now, we've avoided preterm delivery.
She's stable.
How's Okuyama-san?
He's fine,
we only found myocardial infarction.
So nothing linked to the cerebral infarctions?
For now.
I see.
Where's Tachibana-sensei?
She suddenly collapsed while we were transporting Yumiko-san.
Collapsed?
She was calling her daughter's name.
Tachibana-sensei has a daughter?
Yes, she has a 10-year-old daughter.
Tachibana-sensei is a single mother.
What's wrong?
Mao...
Did something happen at the hospital?
I remembered the past.
How's the patient?
Not too good.
You left him and came home?
You shouldn't.
I'm sorry.
I was thinking of you.
Even one person can save many patients, right?
Want to try talking about it like usual?
Let's see...
There are frequent cerebral infarctions,
which aren't caused by atrial fibrillation in the heart.
But we don't know another cause.
So it's not the heart?
The echocardiogram and CT didn't show anything wrong.
Are you being fooled by an illusion?
Hm?
Like with insects and fish.
They camouflage their bodies to match their surroundings
so they can't be seen.
A butterfly can look like a dead leaf.
Is it something like that?
It looks good, but it's actually bad...
There's been a cycle of new infarctions occurring and healing naturally.
But why would they keep on happening?
Myocardial infarction.
A life of its own?
It's alien hand syndrome.
It's unilateral spatial neglect.
Yesterday I visited a site for the first time in ages.
It happened to be near the observatory.
So that's it.
Tachibana-sensei, are you feeling better?
I'm fine now. How's Yumiko-san?
It didn't reach critical point.
Although she's not out of danger.
I have something to ask her about Okuyama-san.
Yumiko-san, how are you feeling?
I'm okay, thanks to all of you.
I'm glad.
Thank you.
By the way, about your husband...
Just before he developed alien hand syndrome,
did anything unusual happen?
Something unusual?
Yes, did he do anything different?
Suddenly get angry, or tense?
Nothing like that.
He was his usual self.
- His usual self? - Yes.
We went to the courtyard
and met a little boy there.
Did something happen with him?
The boy had a balloon he couldn't inflate,
so my husband inflated it for him.
After that, we went back to his room.
He blew up a balloon?
Yes.
I knew it...
A microbubble test?
Pouring ultrafine bubbles into the blood
to test the blood flow?
Why do that?
Okuyama-san's cerebral infarctions originate in the heart.
But the echocardiogram and CT scan didn't show anything.
What else could cause frequent cerebral infarctions?
It's not that there were no abnormalities.
It just looked like there were no abnormalities.
We've been fooled by an illusion.
Illusion...
We're going to see that now.
Microbubbles will travel through the bloodstream to the heart.
Echocardiography and CT can't show
whether the cardiac blood flow is abnormal.
They can only show a few things.
They're going in.
The microbubbles have reached the right atrium.
Okuyama-san, please hold your breath for a moment.
Breathe now.
Ah!
Microbubbles flowed from the right atrium into the left .
This is...
Patent foramen ovale.
Patent foramen ovale is a hole in the wall
between the heart's left and right atria.
Everyone has one before birth,
while they're in the womb and don't use their lungs for breathing,
but it normally closes shortly after birth.
When the hole doesn't close,
it's called a patent foramen ovale.
This part of the atrial wall
usually sticks together and becomes a valve.
It appears normal at first glance.
It can't be seen on an echocardiogram or CT scan.
This is the situation in Okuyama-san's heart.
It's the illusion that fooled us.
That's why we didn't notice it.
But when abdominal pressure is applied...
The pressure in the right atrium temporarily rises
and the valve opens
causing slight blood flow between atria.
This is how a small thrombus
passed into the left atrium
and travelled to the brain to cause cerebral infarction.
This is why various types of cerebral infarction developed.
Before the alien hand syndrome developed,
Yumiko-san said you inflated a balloon for a child.
That caused your abdominal pressure to rise.
Myocardial infarction without any risk of arteriosclerosis...
It developed after the coughing.
Myocardial infarction.
He coughed and then complained of severe chest pains.
A thrombus travelled to the coronary artery.
If it's patent foramen ovale,
we can use a catheter to close the hole with an amplatzer plug
and the symptoms will improve.
I'll be cured?
Yes.
Without the cerebral infarctions,
you won't have any more of these symptoms.
Done!
Success.
Just what I'd expect from a cardiovascular surgeon.
You're skilled.
I spoke to Okuyama-san.
The day before he fell from the Wangan observatory,
he'd carried a heavy load at the site nearby.
That increased his abdominal pressure.
When he forgot how to write at work,
he'd just been badly scolded by his boss.
He was angry and tense.
Everything had the same cause.
Cerebral infarction caused symptoms of a variety of rare diseases,
so we were slow to notice it was a heart problem.
But you did well to notice it.
If things had gone on that way,
who knows what might have happened.
I was talking to my daughter and suddenly thought of it.
Does your daughter want to become a doctor?
I don't know.
Sounds good, parent and child doctors.
You should bring her to A&D.
She's too young.
Hello, Analysis and Diagnosis?
Eh? Really?
Understood.
I'll tell everyone.
Has Okuyama-san's condition changed?
No, it's not that.
Yumiko-san has had the baby!
What was that for?
It's a little before the due date,
but it shouldn't be a problem.
Okuyama-san's mysterious condition was resolved
and the baby has been born.
For now at least, they'll be fine.
That's right.
So cute~
You're adorable.
Tachibana-sensei, Tamaru-sensei, thank you so much.
You've cured my husband, and helped me too.
We didn't do anything much.
You two have both worked hard.
- Darling. - Ah...
I discussed it with Yumiko, and we've chosen a name.
What is it? I want to hear.
We've decided on Shiho.
- Shiho. - Eh? Eh? Why?
- That's lovely. - It's not!
- Shiho-chan. - Stop that...
Okuyama Shiho-chan.
Well, hello, Shiho...
I just can't...
- Really? - Yes.
She'll have a stubborn personality.
Yes?
Come in.
We keep meeting like this.
Use the stairs.
The director's office is on the top floor.
It's impractically tucked away at the end of a corridor.
By the way, how's Tachibana-sensei?
Is she getting on well with everyone?
What?
Are you worried about her?
Not really.
How about Nitta-sensei?
What's this about?
Nothing at all.
I just want the doctors of A&D to work comfortably together.
I'm the head of department, so you shouldn't worry.
That's true.
Ah, Iwakura-sensei,
would you like to go golfing with me?
Huh?
We both need more exercise.
Mind your own business.
I forgot to press the button.
I'll get out here. Bye.
You're kidding...
Nitta-sensei... What's wrong?
I have a favour to ask of you.
What is it?
I'm rather busy.
Could you tell me Tachibana-sensei's address?
- Tachibana-sensei's? - Yes.
There's been a lot of fuss about privacy lately.
Even if she's a colleague, I can't tell you so easily.
You want Iwakura-sensei to be the next director, don't you?
Hm? What of it?
If Tachibana-sensei has a secret or blemish in her past,
what would that mean?
What?
The one who head-hunted Tachibana-sensei
was Director Kitabatake.
Tachibana-sensei's flaws
can be blamed on him.
Dismissal due to irresponsible behaviour.
Can you find a way?
Oh, is it that time already?
I have a meeting, so I'll have to go.
The doctor rosters are here.
Although as I said, I can't show you.
However, while I'm not here,
I can't possibly know what you do.
I'll be back in an hour.
She doesn't have a daughter.
She has a 10-year-old daughter.
Tachibana-sensei is a single mother.
I was talking to my daughter and suddenly thought of it.
Why?
Have they really named the baby Shiho?
Seems so.
Will she grow up right?
What does that mean?
I've grown up to be pretty good.
How rude.
What do you want for dinner?
Curry? Good idea.
Eh~? Extra hot?
Can you eat that?
I'll make it really hot.
Mao?
Are you saying it was my mistake?
The operation was perfect!
What's a failure doing here?
It's all your fault!
Don't you want to help the patient?
I have my own way of doing things.
Don't interfere.
Saving the patient.
Nothing is more important than that.
Everyone has them, right?
A few things in their past they don't want to touch.