A pean? Is this...?
Hanabusa.
Mr Igarashi's report was on my desk.
Sorry for wasting your time. - It's fine.
You can go back now. - Oh, yes.
The successful completion of 2 simultaneous SNIPE operations at Tojo...
Done. - Done.
...caused some big changes.
Finally, at Dr Takashina's request,
Tojo University will be bringing in 20 more SNIPE devices.
They cost 300 million each!
Everyone will eventually be allowed to operate by SNIPE,
so make sure to arrange for individual training.
Dr Saeki gave permission
for Tojo University to move forward with the SNIPE,
as a sudden change in policy.
It's reached the mitral valve.
Done.
It's much faster than the Saeki method.
And it's so simple.
We really might be entering an era when skilled doctors aren't needed.
Dr Takashina added more cases
and his SNIPE paper was almost complete.
But there was still one big problem.
The key points for a paper are the author's name in the heading,
and the name written at the end of the paper.
The last name represents the person with final responsibility for the research,
and the paper's impact factor goes to the author and that final person.
In other words, the person named at the end of the SNIPE paper
would receive a big impact factor
and win the Society chair selection.
If the previous editor, Mr Kusunoki, is backing him
then I can't interfere.
I will definitely repay your kindness.
If you don't do something,
we won't be able to publish that paper in your name, Dr Nishizaki.
Don't worry about that.
I've already taken steps.
The battle for the SNIPE paper
was reaching its final stage.
That included an emergency conference about a certain patient's surgery.
Shimano Koharu, age 7. A transfer from Teika University.
She has mitral valve insufficiency.
The biggest problem is with Koharu's blood.
She has extremely low platelet and coagulation factor counts,
so it is very difficult for her blood to clot.
She also has allergic reactions to blood transfusion
and has unusual antibodies,
making it difficult to transfuse.
Surgery by thoracotomy would mean a lot of blood loss and would certainly kill her.
That means the Saeki method is not possible.
Why did Dr Saeki accept this patient?
I wanted to talk to you about something important.
I was in charge of this patient at Teika University before.
Her heart is failing again,
Patient Name: Shimano Koharu
and she has about a month to live.
Would you allow her to have mitral surgery here at Tojo?
I'll think about it,
but your main job is to finish that paper.
I supported you
so you could bring in more SNIPE devices and increase the number of cases.
This is a copy of another medical record.
Patient Name: Kusunoki Chie
Mr Kusunoki's wife.
Test results showed that she has a malignant tumour in her liver.
Through Dr Nishizaki,
she's being treated for liver cancer at Teika University.
It's cutting-edge chemotherapy that no other Japanese hospital can provide.
Although Mr Kusunoki owes you a favour,
he owes Dr Nishizaki, too.
That means, whichever name I write at the end of my paper, it will be published.
You understand what that means, don't you?
But will Dr Nishizaki help you?
Unfortunately,
I can't take that risk at the moment. - I can't take that risk at the moment.
Didn't he say something like that?
Surgery to save a child's future.
How wonderful.
Fine, let's have her here at Tojo.
Thank you.
However--
Well, you know.
About the paper...
I'll make that promise.
Based on various test results,
I'm thinking of performing SNIPE surgery this time.
Let's have Tokai as the lead surgeon.
Dr Tokai again?
Obviously he'd pick someone skilled.
Shh! - Okay, Tokai?
I refuse.
You refuse?
This surgery isn't possible with a SNIPE.
Well, if you still insist that I have to do it,
I'll do it by the Saeki method.
Your opinions don't matter here!
He said that the Saeki method would be too difficult,
so we've decided to use the SNIPE. Those are your orders!
Oh?
Ah, so this isn't the Saeki Surgery,
it's the Takashina Surgery, after all.
In the Saeki Surgery where I worked,
all mitral surgery was done by the Saeki method.
No one changed their methods
just because some new toy appeared.
Toy? - Changed?
You're all so impressive.
Even though you were so against it in the beginning,
now you're all SNIPE this, SNIPE that,
studying it with a passion.
Watch your mouth, Tokai! - Dr Tokai...
You've taken on every difficult operation so far and succeeded in them all.
Isn't that the Saeki method by Saeki Seigo?
Saying that the Saeki method won't work
but you can do it by the SNIPE method...
You've lost. - Tokai!
If you can't use it anymore, give it to me.
The black pean.
Tokai.
I see.
Looking down on me and the black pean this much
must mean you're prepared for this, right?
I don't need you anymore.
You don't have to operate ever again.
You're not qualified to be here.
Get out.
Dr Tokai.
If those are your orders.
Then I guess you'll have to be lead surgeon.
Okay?
Yes, sir.
And the punishment Dr Tokai received...
Excuse me!
Dr Tokai, Chief Moriya says you have a month to make preparations and leave.
I was told to take your belongings to the medical office.
What should I start with?
Do what you want.
I can't just do what I want.
Why did you say those things?
So heavy...
Hey, what are you doing?
Take my stuff too, while you're at it.
Huh? Wait! What do you mean, Nekota?
That Tokai guy is our Saeki's right-hand man, though.
If Tokai is out, that means the Saeki Surgery is about to collapse.
Dr Saeki is really cutting his own throat, isn't he?
So there's no way you'll lose the Society chair selection.
And when that happens...
I'll leave one of our affiliate hospitals to you, Chief Moriya.
Thank you, I'm very grateful.
Hanabusa! - Yes?
Give this to Dr Tokai.
Me?
Thanks.
Excuse me.
Um, Dr Tokai?
Want some?
No, I'm fine.
It's delicious!
Right?
Isn't rice delicious?
Apparently, Japanese bodies are made from rice.
A pean?
Dr Takashina ran lots of simulations to work out how to deal with Koharu's poor blood clotting.
To limit the bleeding, the incision in the heart must be as small as possible.
It's usually 20 mm.
We'll do 12 mm.
12 mm.
The same as the diameter of the SNIPE.
That's the limit.
If the grip is even slightly off-target,
it will easily tear the muscle and cause bleeding.
But it's theoretically possible.
The operation is scheduled one week from now.
Please run more detailed blood coagulation tests.
Yes, sir.
Honestly,
the probability of success is less than 5%.
5%?
Before I can finish the paper,
I just have to save this child,
no matter what.
Your soy-sauce ramen. - Ah, here it is!
And your soy-sauce char siu ramen. - Thank you. - Thank you.
So no matter how the surgery goes,
your name will be on the paper, Dr Saeki?
Yes, that was my condition for accepting the surgery.
It's really funny,
seeing such great first-class people do all this for a single paper.
What I really want isn't the paper,
it's the impact factor.
Of course, the impact factor is like a Michelin star for doctors.
The instant this ramen restaurant got a star,
it became world famous.
And for us, those stars even decide the next Society chair.
So I'll do whatever I have to do to get it.
I don't care how ugly it looks to an outsider.
Whoever gets it will win.
Even that ugliness is wonderful.
Tojo University - Dr Tokai
Excuse me for a moment. - Sure.
There's something I want you to do for me.
Isn't it impossible with 12 mm?
The blood vessels around the device will be damaged.
It's theoretically possible.
There's no other choice.
With only a few days before Koharu's surgery,
Dr Takashina's impatience started to show.
Koharu,
I'll definitely cure you.
I promise.
It's a promise.
Yes.
Isn't Dr Takashina amazing?
He spends the day doing scans, tests and simulations
and at night he writes the paper and does more tests by himself.
I wonder when he sleeps.
Honestly, I respect him.
I thought he was just some egghead at first,
but on the inside he's tougher than we are.
Yes. - He's nothing like Dr Tokai, just sleeping all the time.
You know that's supposed to be our nap room, right?
That's right.
Which room is it? - This way.
What happened? - Doctor!
It's acute heart failure. Bring oxygen and diuretics. - Yes, sir.
It's okay. - Hurry up with that oxygen.
Acute MR?
MR = mitral regurgitation
He needs emergency surgery.
We'll do a SNIPE operation. - Yes, sir.
Bring him to operating room 1.
I contacted the head nurse, too.
Here's the SNIPE.
Set up a TOE to show the valve.
TOE: transoesophageal echocardiogram
Yes, sir. There it is.
I'm preparing to insert the SNIPE.
Wait. There's a vegetation on the mitral valve.
Vegetation = mass of bacteria
If we put a prosthetic valve in there
the bacterial infection will spread.
We can't use a SNIPE. - Then what should we do?
The aorta is calcified, so we can't stop the heart either.
The Saeki method is the only way.
Don't be ridiculous. Dr Saeki isn't here.
Um, this is Dr Tokai's patient.
Let's call him. Dr Tokai is the only option.
Please go! - Yes, sir.
Let's switch to a midline incision. Set up the heart-lung machine.
Yes, sir. - Miyamoto, bring this down.
Excuse me.
Dr Tokai, they're doing emergency mitral surgery in operating room 1.
Will you come?
I refuse.
What?
He's not coming?
No. Because Dr Saeki banned him from operating.
Please give Dr Tokai the phone.
Okay. Um...
I'll put it on speaker.
Dr Tokai, can you hear me? Dr Tokai!
Don't shout, it's late.
It's Mr Murakami from room 314.
He's your patient, Dr Tokai.
He needs mitral surgery right away, but we can't use the SNIPE.
It has to be the Saeki method. Won't you come?
Like I said, Dr Saeki ordered me not to operate.
But you're the only one who can help us now.
Blood pressure is 50. - He's in septic shock.
Noradrenaline. Add more volume.
Dr Tokai, please come here. Dr Tokai. Dr Tokai!
Saline, quickly! - Yes, sir.
His temperature is up to 39.
The vegetation could break off at any moment.
If we don't perform the Saeki method soon,
that bacteria will spread through his entire body.
We're out of time.
Dr Saeki...
Head nurse... - Miyamoto, gown!
Dr Saeki just got back from his lecture event,
so he rushed over. Switch places.
Report.
It's acute MR due to infective endocarditis.
Plus a vegetation on the mitral valve.
So we can't use the SNIPE. - Yes, exactly.
Then let's remove the infected part and repair the valve.
Excuse me.
Scalpel.
We need suction to clear the field. - Yes, excuse me. Right away.
I don't need it. These fingers will tell me.
It's the Saeki method.
Scissors.
Black pean. - Yes, sir.
He's amazing.
He's really a god.
Compared to him,
that person is...
Sir!
Thank you so much.
I'm sorry for the trouble.
Dr Tokai is here too, but...
I told Tokai not to do any surgery.
There's no problem.
Well, this was an unexpected situation.
It can't be helped that we took a while to respond.
Takashina,
medical treatment doesn't always match the simulations.
If he's going to follow Dr Saeki's orders to that extent,
he should have agreed to do Koharu's operation in the first place.
Dr Tokai said he's never killed a single person during surgery.
That's why I thought Koharu's operation
would be okay if he did it, too.
I wonder why he refused that order.
Isn't that why?
Huh?
Isn't that why Dr Tokai refused?
Mother
What do you want?
Don't be like that. You sound sleepy.
Are you eating the rice?
I'm eating it every day.
Japanese bodies are made from rice, you know.
You always say that. Why are you calling?
I sent you some rice to give to Dr Saeki.
What? - Since he helped both you and your father.
Make sure he gets it, okay?
Okay, bye! - Wait, hey--
That kid is good.
Right? Maybe Koharu will be able to play too.
Koharu, good morning. - Good morning.
Do you like football? - Yes.
They said I'll be able to play soon.
Dr Takashina promised to help me get better.
Really? Then once you're feeling better after the operation,
let's play football with Dr Takashina. - Yeah!
So we'll receive the paper as soon as that girl's surgery is done?
Yes, please look forward to it.
But isn't it a dangerous operation?
Dr Takashina is the operating surgeon,
so he might have to take responsibility if it's a failure.
Well, the paper is almost done.
He's finished playing his part.
If Takashina fails,
I'll just take his name off the paper.
Why do you have so much rice?
Ah--
Don't touch that.
Sorry.
Koharu will bleed to death 24 hours after the surgery.
I'll definitely cure you.
I promise.
It's a promise.
Dr Tokai.
Isn't your paper almost done?
In that case, this operation is meaningless.
It's true that the professors don't care if this operation succeeds or fails.
They're only interested in my paper.
I know that.
But this operation...
Koharu has had mitral disease since she was born.
I've watched her suffering this whole time,
and although I tried desperately to help her, there was nothing I could do.
That was what first led me to the SNIPE.
I wanted to save Koharu.
The SNIPE is here because she is here.
I bowed and scraped to Dr Nishizaki
and managed to bring the SNIPE to Japan.
Then I betrayed him and swore loyalty to his enemy.
Now I finally have the chance to do this operation.
If I don't save her now,
I can't call the SNIPE or my paper complete.
I've finally come this far.
I've run 30 simulations so far.
And all 30 times
I've killed her.
Even though it's theoretically possible,
with my current level of skill...
it's impossible!
I thought that if I had the SNIPE,
if I had the latest technology,
I'd definitely be able to save her.
Koharu believes in me.
I promised to save her.
But I can't save her like this.
If I do this...
I'll kill her.
Dr Tokai.
Please use this SNIPE
and save her.
What a long excuse.
Then kill her.
Or rather...
Just die already.
It's not possible with that SNIPE anyway.
Move.
Dr Tokai.
Why isn't it possible with the SNIPE?
Do you mean that even you would fail if you used the SNIPE?
However skilled you are,
you can't operate with a blunt scalpel.
Why do you have the SNIPE blueprints?
The problem is that its body is too big.
That's Koharu's CT scan.
Since we can't damage the blood vessels, we should go through the blood vessels instead.
Through them?
With a catheter?
Oh yes, we could reach her heart by going through the vein in her thigh.
But that route only goes as far as the right atrium.
It's separated from the left ventricle by the septum, and a catheter can't get through that wall.
Right atrium
Left atrium
Mitral valve
That's why the SNIPE was invented, to access the mitral valve directly.
The catheter is an old-fashioned method. - Which is why
we should attach the SNIPE to the catheter.
The SNIPE's prosthetic valve placement system?
She has a small defect in her septum.
We can use that hole to get through.
If we can reach the mitral valve from there,
then we just have to replace the valve.
You can use a catheter like that?
There's no point in using the latest technology just because it's available.
The old methods have their strengths too.
Medicine isn't just progress and nothing else.
But there's one problem.
This kind of difficult surgery...
Only you can do it, Dr Tokai.
Impossible.
I was told not to do surgery.
That's what this is about?
You were planning to be lead surgeon from the beginning, weren't you?
What will you do?
Dr Saeki, I need to talk to you again.
I'd like to ask Dr Tokai to be the operating surgeon for Shimano Koharu's SNIPE operation.
Won't you let Dr Tokai come back to work?
You're bowing down for that guy?
Didn't you want to chase Dr Tokai out of here?
Please let Dr Tokai be the operating surgeon.
Sure, that's fine.
I mean, I ordered Tokai to do the SNIPE operation to start with.
And you want Tokai as lead surgeon. So there's no problem.
You need tools to treat people,
but you need skill, too.
Support Tokai as his assistant.
I was planning to, of course.
We'll definitely succeed.
And so, the fateful day arrived.
Has it started? - It's about to.
Let's perform off-pump mitral surgery with the new SNIPE model.
Ultrasound. - Here.
Bring it here. - Yes, sir.
Tokai is really the lead surgeon...
Guide wire. - Here.
Ready to insert the SNIPE.
New SNIPE. - Here.
Okay, I'm inserting it.
It's in. Take this.
Catheter. - Here.
They've stuck the SNIPE's prosthetic valve placement system on the end of a catheter?
That would limit the bleeding.
Tokai asked you for the SNIPE blueprints, didn't he?
I helped him so that this operation would succeed.
It's almost at the right atrium.
Right atrium.
The right atrium already?!
He's not just first-rate with a scalpel, but with a catheter too?
We've reached the right atrium.
It's there!
The difficult part starts here.
The septum leads to the left atrium and then the mitral valve.
Septum
Left atrium
Mitral valve
They have to break through that wall.
Tokai plans to use the small defect in this patient's septum to get through,
but if he misses even slightly, he'll damage the conducting pathway
and injure the heart.
In this patient's case, she'd die immediately.
Is such a precise technique really possible?
Dr Tokai.
I'll tell you when to push it through.
When the hole in the septum is at its widest,
I'll give the signal.
Not yet.
Now!
It's through the septum.
It's in the left atrium.
Oh! - They got through!
They have both Dr Tokai's skill and the brains of Dr Takashina,
who knows Koharu's condition better than anyone.
The strongest possible team.
Okay, now they just have to place the prosthetic valve.
It's at the mitral valve.
Dr Tokai.
Prosthetic valve placement complete.
The prosthetic valve is moving correctly.
Yes! - Wow!
They did it.
Leave the rest to me.
Dr Tokai.
Thank you.
Let's close up the hole in the septum.
Take my place. - Yes, sir.
Did you really mean what you said to me before?
If you can't use it anymore, give it to me.
The black pean.
Tojo University is going to become even greater.
While things are changing,
don't worry about things that don't concern you.
You should just support me.
Trust me.
Thank you very much for this.
Do you understand now?
Teika is only focused on research,
but here at Tojo you were able to actually use the SNIPE and expand its possibilities.
If we work together,
your ideal world where everyone receives equal treatment can really exist.
I'll definitely make it real.
Trust me.
I'm looking forward to your paper.
Dr Tokai.
Why do you obey Dr Saeki's orders so faithfully?
Do you trust him that much?
Well, that's fine.
What are your demands this time?
I'll pay as much as you want.
You can owe me for this one. - What?
Anyway,
it's not money I want from you.
Don't trust him.
Saeki Seigo...
Don't trust him.
When that man thinks he's in danger,
he'll happily throw anyone to the wolves.
Even if they've been his best friend for years.
And another fateful day arrived.
I'm sorry, but please understand.
I'll accept whatever punishment you give me.
Excuse me.
So it all went according to the original plan?
Just as I expected.
Unfortunately, I can't take that risk at the moment.
But Dr Saeki would probably accept it.
Please pretend to accept whatever conditions he proposes.
Let's use him as much as we can.
If the operation succeeds, we'll have another important case study.
That will finish off the paper.
This means Dr Nishizaki and I get the impact factor.
So now,
we don't need Tojo anymore.