Good morning.
She doesn't have a daughter.
Why?
It's like there's someone beside her.
Now that's just wrong.
A beauty like you looking so gloomy.
Director Kitabatake.
May I sit here?
I didn't say you could.
I can't?
Afraid it'll look like we're dating?
- Did you want something? - Not at all.
I just happened to see you.
Are you still investigating Tachibana-sensei?
Does it matter to you if I am?
You're right, it does.
Why are you so obsessed?
I'm not obsessed.
Oh? Leaving already?
I don't want anyone to think I'm dating you.
You don't like older men?
Goodbye.
Why don't you leave things alone?
Everyone has them, right?
A few things in their past they don't want to touch.
I do,
and so do you.
Are you saying it was my mistake?
The operation was perfect!
You saw it, didn't you?
Her condition has got even worse!
1 year ago
Yet you insist it was perfect?
Results are everything.
Nitta-sensei, I'm disappointed in you.
Hello, Nitta here.
Eh?
- Lifting her down. - What's her condition?
Chief Secretary Sasaki!
Takasugi-sensei, we've got big trouble.
They're here!
Go and prepare.
Changes during transportation?
We gave 10 litres of oxygen
and switched to a reservoir mask.
Hurry!
Mum!
You can't go in.
They'll be starting treatment.
I'm Chief Secretary Sasaki. Family should stay out here.
1, 2, 3!
I'm attaching a chest monitor.
Secure the line.
Prepare 12 induction.
Check blood gas!
Monitor attached.
Line secured.
I'll take blood pressure.
Inserting balloon.
Disinfect.
Inspection.
Continuing with 10 litres.
- Prepare back valve. - Okay here.
Intravenous injection of furosemide!
- Blood pressure dropping. - I can't feel a pulse.
Lower her head.
Beginning heart massage!
Norad to 0.3 gamma.
Prepare dobutamine for 5 gamma administration!
- Then prepare DC! - On it.
Takasugi-sensei!
Nitta-sensei!
- What's her condition? - Acute heart failure.
No blood pressure.
We're out of time!
Why is this happening?
This can't be happening!
I know! But it is!
We can't let her die this way.
We have to save her.
Get ready!
Hurry and call CE!
Don't worry, they'll save your mother.
A-are you okay, Anna-san?!
Help! Someone help!
- Tachibana-sensei. - What's wrong?
- Can you hear me? - Yes.
Try to grip my hand.
- Is that okay? - Yes.
Looks like mild cerebral anaemia.
We'll move her to that bench.
Okay.
We'll lift you now.
Anna!
Councillor Kitamura!
Dad...
How's my wife? How's Shiori?
She's being treated now.
Chief Secretary Sasaki, what's going on?
It's not even a year since her last surgery!
I was told she would be fine now!
Well...
Was it another medical error?
No...
Ah, how is she?
It didn't look good,
but she's stable now and sleeping.
Great, that's a...
Why are you two here?
What's a failure doing here?
I don't believe I failed.
If you hadn't, she wouldn't have needed more surgery!
Please calm down.
Why did your second surgery fail?!
We still don't know the cause.
- We'll determine that now. - I already know the cause.
It's just like back then!
Councillor Kitamura, please calm down.
Don't touch me!
Do you two understand?
My wife has been suffering ever since then.
She keeps collapsing, keeps having surgery.
Ever since the first operation failed!
Without that...
If that had been successful...
If your first operation hadn't failed,
this would never have happened!
It's all your fault!
Medical Team
Lady da Vinci's Diagnosis
Subtitles by Candylemon
The patient is Kitamura Shiori-san, age 44.
She was brought in with heart failure due to dilated cardiomyopathy.
This is Kitamura-san's heart.
Dilated cardiomyopathy.
Myocardial cells degenerate for some reason,
the wall of the left ventricle becomes thinly stretched
and the space in the heart grows larger.
The heart's ability to contract deteriorates
so it can't pump blood through the body.
It can be fatal.
In severe cases the only cure is a heart transplant.
Kitamura-san's heart was in bad condition before
and a heart transplant seemed necessary.
As a countermeasure until a donor could be found,
she had lifesaving surgery twice at this hospital a year ago.
- Twice? - Yes.
The first was done by Nitta-sensei,
the second was by Takasugi-sensei.
I've never heard of it being done twice before.
The surgery involves
sewing a patch into the expanded left ventricle
to reduce the internal space.
It shouldn't get this big after surgery.
Right, it shouldn't happen but it has.
That's why the patient was sent to A&D.
Is it really alright to do that?
Don't Cardiovascular Surgery mind?
Chief Secretary Sasaki arranged it.
The patient is the wife
of local councillor Kitamura Eiichirō.
He has great influence in the government.
If there's even a tiny chance, we can't ignore it.
What's the patient's current condition?
She's stable for now,
but she may only have a week or so.
A week?!
There's not much time.
Please do it somehow.
Councillor Kitamura believes this was caused
by an error in the surgery a year ago.
If he tells the media it was medical malpractice,
the hospital's financial troubles will...
Yes, hello?
Eh?! Councillor Kitamura has?!
I'll be right there.
The future of Tōkō University Hospital depends on you!
Please do this!
So we need to find a disease other than dilated cardiomyopathy??
If there was one, it would have been found.
She's had surgery twice.
That's true.
The surgery must have been bad.
Nitta-sensei, what's your view?
Cardiovascular Surgery
judged that it was malpractice.
Speaking of which,
Nitta-sensei is said to be a surgical genius
but Tamaru-sensei said she's nothing special.
- What?! - What?!
You did say that!
Nitta-sensei's surgery must have failed.
W-what are you talking about?
You said to me...
The operation was perfect.
I made no mistakes.
You see, Tamaru-sensei?
She says it was perfect.
You shouldn't have said it.
Apologise.
You're the one who said it!
Just apologise, quickly.
I'm sorry.
Right!
You all heard that, right?
There were no problems with the surgery.
That's Nitta-sensei's view.
That's true.
Nitta-sensei and Takasugi-sensei
are both highly skilled surgeons.
It's unthinkable that they would make mistakes.
Isn't that right, Murakami-sensei?
Iwakura-sensei is correct.
I was simply repeating the general opinion.
Now, let's think again about diseases other than dilated cardiomyopathy.
What could cause the heart to expand
in spite of the lifesaving surgery?
I wonder...
How about...
Sarcoidosis, or the Aspergillus fungus.
Wet beriberi, alcoholic cardiomyopathy.
Amyloidosis, Chagas disease,
or mitochondrial disease.
There are many possibilities.
It'll be hard to narrow down.
Haemochromatosis.
Haemochromatosis...
That's a disease caused by iron metabolism abnormality?
The body can't control the amount of iron absorbed,
so it's deposited in the liver, heart, joints and so on.
It causes cell damage and organ dysfunction.
Kitamura-san previously complained of pain in her limbs.
Plus she has elevated ferritin.
But I heard there were no pathological abnormalities found.
It's sometimes overlooked.
You don't trust Pathology?
Not 100%.
Are you insulting Pathology?
Uematsu-sensei, calm down.
I think we should treat it as suspected haemochromatosis.
It certainly could be that, but...
Where are you going?
We're short of time, we need to start treatment.
Wait, we need to discuss it more...
I'll leave that to all of you.
I'm going to start treatment.
She's unbelievable.
What an attitude.
Iwakura-sensei, can you allow that selfishness?
We don't have any alternatives.
We're short of time,
Nitta-sensei can try her treatment
while we explore other possibilities.
Yes.
Her heart failed,
so we can't take much blood for testing.
I'll administer an iron chelating agent,
so keep an eye on her urine colour.
Okay.
I see.
Nitta-sensei is administering treatment alone.
She's not listening to anyone else.
Well, it's understandable.
She has a history with that patient.
The operation a year ago?
There was a fuss about it being medical malpractice.
That's right.
Nitta-sensei led the operation.
Re-operation was necessary due to poor prognosis.
The patient's husband is a government heavyweight.
If she needs further surgery,
we need to be clear about the cause.
Nitta-sensei insisted there was nothing wrong with the operation,
but from the patient's viewpoint it has to be considered a failure.
Nitta-sensei was forced to take responsibility
and driven out of Cardiovascular Surgery.
That's...
She has real ability.
She knows that herself.
She moved from Neurosurgery to Cardiovascular Surgery
to increase her surgical abilities.
Just watching her makes me nervous.
She's too focused on surgical skill alone.
Obviously that's important,
but it's not everything.
So that's it.
The reason she came to A&D.
She wants to go back to Cardiovascular Surgery.
Don't let it get to you.
Everyone recognises your surgical skill.
1 year ago
Even if you leave Cardiovascular Surgery,
it's just for appearances.
You're bound to come back soon.
You think it was malpractice, too.
I'll get back through my own power.
Nitta-sensei.
Tachibana-sensei.
How's Kitamura-san?
The excess iron in her body
will be removed in her urine.
I'm using iron chelation therapy.
Iron chelation therapy...
That takes a long time.
We have to remove the iron.
I think it's the right decision.
If it's haemochromatosis.
Although she might die before it's complete.
We need to think of other methods.
- Such as... - Don't bother.
I'll do this alone.
Don't you want to hear my idea?
I think it's a pretty good one.
Don't you want to save the patient?
Or could it be
you're trying to clear the stigma from a year ago?
- Is that why... - So what if I am?
I have my own way of doing things.
Don't interfere.
They suspect a surgical error.
Just like a year ago.
Rather than you returning to Cardiovascular Surgery,
I might be fired.
I don't think the patient has dilated cardiomyopathy.
What?
I think it's haemochromatosis.
It's a different disease?
If it's not dilated cardiomyopathy,
and I can show it's another disease,
it'll prove our surgery was fine.
How will you prove that now?
It'll only show the lifesaving surgery wasn't needed.
This is important to me.
I just need to know
the operation I led had no mistakes.
If there was nothing wrong with my surgery,
I'll be able to return to Cardiovascular Surgery.
Yukino...
It must be hard being a politician's wife.
I couldn't sacrifice myself to support a husband.
Ah, I'm divorced by the way.
I just try to do all I can.
You support Councillor Kitamura, don't you?
Tachibana-sensei, what are you doing?
Did you know?
Being a politician's wife is hard.
Attending local events on your husband's behalf,
and showing your face at gatherings.
Giving out business cards and shaking hands.
- Even though you're not him. - Please don't interfere.
I told you I would treat her.
Yeah...
- Tachibana-sensei. - Hm?
I've had so much fun chatting with you
my throat is a little dry.
Ah, shall I fetch some cold water?
- I'd like something warm. - Hot water?
The nurse brought some earlier.
Here it is.
- Here you go. - Thank you.
Ah! I'm sorry!
- It didn't scald you? - I'm so sorry...
Don't do anything unnecessary.
You can't work by yourself if I'm here?
You really want to go back to Cardiovascular Surgery, don't you?
What's wrong with that?
I want to do operations.
First class doctors save patients with surgery.
Diagnosticians are second class, with no surgical skill.
I'm not like that.
I shouldn't be in A&D.
I wonder...
I don't think surgery is everything.
What's up with you?
Eh? Me?
You're a famous neurosurgeon
yet you came all the way to A&D,
and with the condition you won't do surgery.
You've helped lots of patients with surgery, haven't you?
So why?
I don't understand you at all.
As a doctor,
I want to be at the forefront of medical care.
So please don't get in my way.
Nitta-sensei has begun iron chelate therapy.
She really intends to treat Kitamura-san alone.
She was told the surgery she trusted had failed,
and driven out of Cardiovascular Surgery.
She's determined to get past this.
I can understand that,
but it's selfish.
She's a fool, isn't she?
Are you still angry about what she said about Pathology?
I'm not angry.
- You are! - I'm not.
It's hard when your pride is injured.
Is your father eating properly?
He's a busy man,
so look after him for me.
This isn't the time to worry about Dad.
I'll be fine.
The doctors are looking after me.
Nitta-sensei, the blood test results.
The iron has gone down slightly.
The iron chelation therapy is working.
Is Mum getting better?
Her condition is improving.
Sensei!
Kitamura-san, what's wrong?
- M-my breathing... - Mum!
Head down!
- What happened? - Acute respiratory failure.
Tamaru-sensei, prepare for intubation.
Fujimoto-kun, ventilator.
Mum! Mum, hang in there!
Mum! Mum...
Looks like she's recovered from it.
She's stable for now.
Don't you blame me?
Why?
"Why?"...
I told you to leave me alone
and let me do it myself.
Here's the result.
Shouldn't you blame me?
I don't particularly.
We didn't think of
any likely candidates besides haemochromatosis.
Treatment for that led to this.
It's nobody's fault.
But...
Our circumstances don't matter to the patient.
Our job as doctors
is to save the patient in front of us.
We consider the best way to do that.
Saving the patient.
Nothing is more important than that.
Side effects of the chelating agent
caused acute respiratory failure?
There was a considerable burden on the heart.
Her condition is deteriorating.
Murakami-sensei and Tamaru-sensei are with her now.
This is punishment for making light of Pathology.
What about the family?
They haven't been told the details yet.
The daughter was there, so she's passed the basics on.
Wait, please!
They're holding a conference.
Councillor Kitamura.
What's going on?
Are you trying to kill my wife?
- Kill her? - My daughter saw it!
She was told her mother's condition was improving,
then she had acute respiratory failure!
Is this your work again?
Why don't you say something?
Why is a failed doctor being allowed to diagnose patients?!
What's this hospital thinking?!
Councillor Kitamura, please calm down.
"Calm down"?
While you're doing this,
my wife is suffering!
Do you have a grudge against Shiori?
This is the same as murder!
Councillor Kitamura.
I understand how you feel.
Your wife's repeated hospitalisation and surgery
must place a burden on your family.
When treatment doesn't have the expected results
it's difficult for us too,
and we feel responsible.
We accept your criticism.
But please believe one thing.
All the doctors here
are working tirelessly trying to save your wife.
Especially Nitta-sensei, who led your wife's surgery.
She's more determined than anyone to save her.
That's why however harshly you rebuke her,
she continues to treat her.
Do you still blame that Nitta-sensei?
In that case, do something!
Save my wife!
Damn it.
Wait, Councillor Kitamura!
The patient and her family are fighting.
We have to save her.
That's right.
What will our treatment policy be?
From now on,
I'm removing Nitta-sensei.
Your independent actions led to this situation.
I can't allow any more.
Wait, Iwakura-sensei.
I'm opposed to removing Nitta-sensei.
It's true her diagnosis and treatment were wrong.
But when she acted,
we had no candidates other than haemochromatosis.
The patient's condition deteriorating
and Nitta-sensei bearing full responsibility.
Isn't that what happened in Cardiovascular Surgery a year ago?
Along with Nitta-sensei,
let's try to re-diagnose Kitamura-san.
She's taking the brunt of the blame.
Just like with the surgery.
We can't risk something else going wrong.
Please let me do it.
Nitta-sensei...
Even as support or transporting specimens,
I'm willing to do anything.
In order to save the patient,
I'll do anything.
Please let me.
I'm asking too, please let her.
Fine.
Thank you very much.
- Check these, please. - Yes.
- It's all set. - Thank you.
Has the SIMV setting been changed?
That's true, raise the PEEP slightly, please.
Will do.
These are the surgical records from a year ago.
This is the first, led by Nitta-sensei.
This is the second, which I led.
I don't see anything unusual.
No abnormalities in the preoperative examination.
It was diagnosed as dilated cardiomyopathy.
When I re-operated,
I saw the traces of Nitta-sensei's work.
The patch was sewn carefully,
and I noticed no problems.
It's just as Nitta-sensei said.
I've checked the video of Takasugi-sensei's operation
over and over again,
but there was nothing wrong.
It was accurately done.
We didn't find any clues.
There should have been a hint.
Maybe...
...it's hopeless.
Nitta-sensei.
Kitamura-san doesn't have much time left.
By the time we find the real disease...
Do you see that?
The people suffering the most
are the patient and her family.
She'll be alright.
Looking at them,
can you still say what you just did?
He pulse is weak.
Things look bad.
There must be something.
I'm sure of it.
Tachibana-sensei,
we should speak to the family.
Wait a minute.
She has a fever.
And a rash.
Erythema on her arms.
Big trouble.
The blood tests show
her white blood cells, erythrocytes and platelets are all decreasing.
Eosinophils are increasing and she has liver dysfunction.
It's an allergic reaction to medication.
But we haven't started any new medication.
Allergic reactions don't always show immediately.
It could be any medication started in the past 3 months.
Tachibana-sensei,
a clot formed in Kitamura-san's heart a month ago
and caused transient ischemic attack.
She takes antiplatelet drugs and anticoagulants.
That's the cause.
Stop them immediately.
Then prepare a steroid.
Take a new line.
- Here. - Thanks.
The steroid.
Attach the drip.
When examined, Kitamura-san
was found to have abnormally high HHV-6 activity.
HHV-6...
Human herpesvirus 6?
Perhaps Shiori-san doesn't have dilated cardiomyopathy,
it's myocarditis due to persistent HHV-6?
Myocarditis...
When the muscles that move the heart become inflamed?
HHV-6 is famous for causing sudden rashes in children.
In adults, it can be a rare cause of heart failure.
The onset period also varies,
so it's often overlooked.
So that means...
It wasn't caused by a surgical error.
Then, it can be treated with antiviral drugs.
Unfortunately there's no miracle cure for HHV-6.
The only option is symptomatic treatment of her heart failure
No...
At the rate it's deteriorating,
she'll need a heart transplant.
If possible,
she should wear an artificial heart while waiting for a donor.
But her heart couldn't cope as it is now.
We finally found the cause...
You're tired, aren't you?
A bit.
What happened with the patient?
We've found what's wrong with her.
But?
It's too late to do anything.
You're giving up?
I'm not giving up.
But I can't think of anything.
There must be something.
Try to remember.
She had 2 operations for dilated cardiomyopathy,
but developed heart failure.
She had abnormal iron metabolism
so we incorrectly suspected haemochromatosis,
but now it seems it was myocarditis due to HHV-6.
Aren't there any other possibilities?
Something no one has noticed yet.
A small side street somewhere
leading to the real goal.
A small side street...
You'll think better with coffee.
Thanks.
Ah, hot!
It's not.
When you heard "coffee", you assumed it would be hot.
Ah.
- It didn't scald you? - I'm so sorry...
The hot water had cooled to lukewarm.
So why did she drop it?
People tend to prejudge.
So that's it.
I may have found the true goal.
- Ah, there she is. - Tamaru-sensei!
Let's go for a meal together soon.
I've found a delicious Spanish restaurant with flamenco.
I'm busy today. Another time.
- You always say that! - Hey hey hey...
Ah, Tachibana-sensei.
Summer or winter, which do you prefer?
Pardon?
Summer or winter, which?
- Summer. - Me too, summer.
You'd like Hawaii?
- I want to go. - Me too!
You want to go?
Are you going to take us?
Waikiki Beach is a place for lovers.
- Where are we going? - Just come with me.
We're going to track down Kitamura-san's true illness.
I thought it was myocarditis due to HHV-6?
That's not the true goal.
Huh?
It's so hot.
Tamaru-sensei, you've done well.
It's as hot as Waikiki Beach.
Give me a break.
Huh? Where's Miyabe-kun?
He's collapsed over there.
Waikiki... Waikiki...
Going to Hawaii with Tamaru-sensei.
He's so innocent.
You should go for a meal with him sometime.
Tamaru-sensei.
What's all this for?
Hawaii, the land of everlasting summer.
What will you do if anything happens?!
That would be bad.
"Bad" is an understatement.
Even so, we had to come to Hawaii.
It really is hot.
It quickly makes you sweat.
We have to get her back to the treatment room.
Don't be so impatient.
We can see the main point now.
Excuse me.
What are you doing?
- Well? - What?
Try touching.
She's not sweating.
Even in this heat?
This proves Kitamura-san's true illness.
I see.
I'll do a myocardial biopsy.
I'll begin.
- Ready. - Ready.
Look at this.
Ah...
This confirms it.
Thank you very much.
You're welcome.
The results of the myocardial biopsy
show Kitamura-san has neither dilated cardiomyopathy nor myocarditis.
In fact she has Fabry disease.
Fabry disease.
It's a congenital metabolic disorder
where the enzyme alpha-galactosidase
is produced in too low a quantity in the cells.
The substances it should decompose accumulate in the body.
Fabry disease is known to cause myocardial damage,
but it occurs almost exclusively in men.
And it normally resembles hypertrophic cardiomyopathy.
It's rare for it to resemble dilated cardiomyopathy.
It's a pitfall missed even by doctors.
Precisely.
The patient this time is female,
and it's a rare case where the heart muscle is thinned instead of thickened.
The blood tests a year ago should have shown
the alpha-galactosidase value was decreasing,
but it was probably within the normal range.
The pathologist likely overlooked it.
Fabry disease was overlooked due to human error.
That's right.
What made you realise it was Fabry disease?
The heart dilating for unknown reasons,
and lukewarm water.
Lukewarm water?
Right, lukewarm water.
The heat of even lukewarm water made Kitamura-san drop a cup.
She had unbearable pain in her fingers.
Warm contact gave her electric shock pain.
And her body couldn't sweat normally.
These are symptoms of Fabry disease.
The increase in ferritin
was due to inflamation.
It's definitely Fabry disease.
Yes.
It's good we have a confirmed diagnosis,
but Fabry disease is incurable, isn't it?
How should we treat it?
An enzyme preparation has recently been developed to treat Fabry disease.
Nitta-sensei,
let's start treatment immediately.
Yes.
We've administered an enzyme preparation,
and once symptoms improve
you can go home.
Mum can come home?
Yes.
Up until now,
I've been extremely rude to you.
Please forgive me.
I'm so sorry.
Please raise your head.
It's not me who did this.
It's thanks to everyone in A&D.
All I thought about
was clearing myself of the malpractice stigma.
Rather than finding the true illness,
I just wanted to prove
there'd been no error in my surgery.
Rather than to save your wife,
I treated her for my own pride.
My selfish behaviour
caused trouble for everyone.
Even if there was no error in my surgery,
because of that
I'm disqualified as a doctor.
That's not true.
I could sense it.
You did your utmost to save me.
Over and over
you came to watch me.
Even though you were inflexible
and always quarrelling with Tachibana-sensei.
Always...
...you were facing me.
For the past year
you've had a hard time, too.
Nitta-sensei,
thank you...for saving me.
Thanks to all of you,
Councillor Kitamura's wife has been saved.
You've also proved Nitta-sensei's innocence
after she was accused of malpractice
and left Cardiovascular Surgery.
In response to Nitta-sensei's wishes,
I've decided you can return to Cardiovascular Surgery.
That's great.
Congratulations.
You can operate all you like now.
The surgical genius is back.
I'll view your operations.
Be sure to listen to Pathology.
You can return whenever you wish.
Kitō-sensei has also approved it.
I'm...
...not going back to Cardiovascular Surgery.
Pardon?
I'm staying in Analysis and Diagnosis.
Are you sure?
You were so desperate to go back.
Yes.
I'll stay here a while longer.
Being a doctor isn't only about surgery.
I know that now.
I see.
Understood.
Well then, for now,
Nitta-sensei will stay in A&D.
I see.
You're staying in A&D.
Yes.
I wanted you to come back.
I will someday.
I know what I need for myself now.
Seems like now
you've gone back to the way you were when we met.
What does that mean?
Ah, I forgot.
Remember my kōhai who was investigating Tachibana-sensei?
From West Tōkyō General Hospital?
Yeah.
He's investigated more since then.
And found this.
Tachibana Family Tomb
Mao Died aged 10
You told me, didn't you.
Mao Died aged 10
Tachibana-sensei says she has a daughter.
The truth is, she died 2 years ago.
That's...
Then that was...
Tachibana-sensei's daughter...
Mao Died aged 10
Mao
I had fun, chatting with you.
Could it be you like him?
Blood in the cerebrospinal fluid?
There's still no sign of improvement.
It could be fatal.
What shall we do?
I won't let that happen!
Don't worry, she's stronger than that.