Dr Saeki must be annoyed.
After all, he helped to increase my impact factor.
Dr Takashina used Dr Saeki to achieve success with the SNIPE operation
and published his paper under Dr Nishizaki's name.
Current impact factor
As a result, Dr Nishizaki's impact factor surpassed Dr Saeki's,
New Society chair
and it seemed certain that he would become the next Society chair.
This makes you the most successful of our graduating class. - Matsuoka.
Teika University Surgeon Matsuoka Jin
I couldn't do what you're doing.
Going out to some rural university like Tojo
and kissing up to the doctors there, just to get more cases...
Don't misunderstand.
All I did was treat patients.
Research won't come to anything without treatment.
You must have a fantastic post lined up at Teika, right?
Sadly,
I'll be leaving as soon as Shimano Koharu is discharged.
Patient Name: Shimano Koharu
Football? - Yeah.
She made a promise with Dr Sera and the others
to play football when she gets better.
That's okay, right? - Koharu, the doctors are very busy.
Okay.
Let's play football next time.
It's a promise. - Yes!
Then I'll do my best. - Okay.
Ah! Hang on, Koharu!
Is Dr Takashina leaving Tojo?
Well, after what happened...
But the surgery was a success,
and Koharu seemed really happy.
Hm... Dr Takashina is a good doctor for his patients, at least.
Isn't that enough?
Honestly, I don't really understand about research and papers,
but whatever his motives are,
Koharu recovered from such a dangerous condition.
I mean... I think that might be enough.
Dr Takashina. - Yes?
Um...
Why didn't you write Dr Saeki's name?
I'm looking forward to your paper.
Saeki Seigo... don't trust him.
To Dr Saeki, the SNIPE is just a tool for winning the Society chair selection.
In order for the SNIPE to save even one more person,
I chose Dr Nishizaki. That's all.
And...
Empty words alone can't save a single life.
And so, the battle of the SNIPE came to an end.
But then...
So please run a detailed blood test.
Patient Name: Shimano Koharu
Body temperature record
I see.
Are you serious?
Yes. As one of the co-authors,
Japan Surgical Journal: Editing Department
I'm requesting retraction of the SNIPE paper published in the Japan Surgical Journal.
Dr Saeki, retracting this paper
will cause a lot of damage to your own career, too.
I'm aware of that.
As a doctor, I can't let an incomplete paper go out to the world.
But the final case with the 7-year-old girl
is a valuable one that couldn't have happened without the SNIPE.
The success of that operation alone
makes it worth publishing, in my opinion.
Unfortunately, that patient is still at our hospital
and needs detailed blood tests.
Blood tests? - Well,
just in case.
In that case, can we decide after we see the test results? - Fine.
Editor Ikenaga.
You seem to like this paper a lot.
I think it's a fantastic piece of research.
Because it's your good friend Dr Nishizaki's paper?
Well then, until next time.
Retract the paper?!
Saeki went to the Japan Surgical Journal in person to discuss it.
He wants to do blood tests on that SNIPE patient from the other day.
That's... He's just being a bad loser.
But we can't ignore Saeki's complaints.
Finish those tests and discharge the patient as soon as possible, okay?
Yes, sir.
I see. Dr Saeki must have been surprised.
He doesn't plan to hand over that impact factor so easily.
Don't you think? - You're really enjoying this.
Isn't it thrilling to see two first-class people fight?
There's no problem, after all.
We'll discharge her.
What?
The results show that her septum is infected. We need to treat her right away.
Wait. If it's a septal infection,
Normal Abnormal
it wouldn't be unusual to overlook that in testing.
What? - Pretend you didn't notice.
Discharge her for now.
If people find out that the SNIPE caused a septal infection,
it will give them a good excuse to retract the paper.
If she's been discharged, the cause could be anything.
But... - That's an order!
If you want to succeed as a researcher, focus on the future,
Takashina.
Good evening, Dr Takashina.
Good evening. - Hello.
Koharu will be discharged soon, won't she?
She'll be playing football any day now.
Oh... that's right.
What is it?
Discharge permit
Submit this and leave with that kid already.
That way, the SNIPE will spread throughout the country,
and more lives will be saved. But...
At least you did some good research.
Dr Takashina, what was that about?
Koharu can be discharged safely, can't she?
Dr Takashina?
Dr Takashina promised to help me get better.
I'll definitely cure you. I promise.
Let's play football next time.
Yes! Then I'll do my best.
It's a promise.
Pretend you didn't notice. Discharge her for now.
I've been so stupid.
I am a doctor!
What do you want? - About Shimano Koharu---
Is this about Shimano Koharu's septal infection?
So you knew about it.
Won't you hold an emergency conference?
Wouldn't that be convenient?
I thought you didn't need Tojo University anymore.
How did she get this infection?
In the last operation,
Septum
Mitral valve
we plugged the hole in her septum using the SNIPE.
We think the plug came loose after that
and let infection set in. - I see.
If that kind of thing can happen,
we'll have to completely restrict the use of the SNIPE at Tojo from now on.
Wait! The SNIPE isn't the direct cause.
You can tell me the details of this patient at the conference.
So the SNIPE operation has been accepted as the cause?
No, there were no problems with the operation itself.
I don't care about how the operation went.
If I can't get that impact factor, it's a failure!
There's no place for you to come back to.
I never want to see your face again.
Was that Dr Takashina?
Huh?
Takashi... Who's that?
Matsuoka.
I have high hopes for you.
Yes, sir.
And so, the SNIPE paper suddenly turned back into blank sheets.
New Society chair
Current impact factor
Dr Nishizaki's added impact factor was cancelled,
and once again, Dr Saeki was ahead.
New Society chair
We've confirmed that Shimano Koharu has an infected septum.
If the bacteria spread,
her heart could fail at any time.
We need to operate and remove the focus of infection as soon as possible.
This patient has extreme difficulties with blood clotting,
so didn't we decide that thoracic surgery was too dangerous for her?
What do you think, Tokai?
Operating is impossible.
You should treat her with drugs instead.
Then for now, use pharmacological treatment and observe her condition.
The conference is over.
Please wait.
There is one way to save Koharu.
What are you talking about now?
Darwin.
Darwin...?
The Darwin is a robotic surgical assistant developed in America.
Using a high-resolution camera and three arms,
it can perform very precise operations.
Unlike with normal thoracic surgery,
Normal thoracic surgery
it only requires small incisions,
so there's almost no bleeding.
Even Koharu's surgery would be possible with the Darwin.
That's true, it might be possible to operate with the Darwin.
But there's no Darwin at Tojo.
Not at Tojo, but there is one at Teika.
Let's transfer the patient to Teika and operate on her with the Darwin.
You want to transfer a Tojo patient to Teika?
How can we do something so humiliating?
It's the only way to save her.
Even so, do you think Dr Nishizaki will agree to it?
Well...
From today, I'm removing Dr Takashina as her attending doctor.
Shimano Koharu's new attending doctor is...
Dr Tokai.
The conference is over.
Dr Takashina had lost his position, both at Teika and at Tojo.
Meanwhile, as Koharu's new attending doctor,
Dr Tokai brought in a new blood-forming drug from a clinical trial: Nespa.
Her haemoglobin count is 12. - Okay, put in 20 of Nespa.
Yes, sir.
Where's Dr Takashina?
Isn't he coming today?
Well, Koharu,
Dr Tokai will be treating you instead of Dr Takashina from now on.
Koharu,
Dr Takashina lost his job.
Lost?
Um... - Don't worry about it.
Please stop.
Anyway, you can rest for a bit now.
Okay...
Koharu is still a child.
You shouldn't say "lost his job", you should...
Isn't there a better way to put it?
Dr Tokai.
These are Koharu's handover documents.
How long do you plan to continue this drug treatment?
I don't know.
The Nespa will increase her blood volume,
but it won't cure the underlying problem. - Wait a minute.
Does that mean she'll keep getting worse?
If Koharu dies, it will be blamed on the SNIPE.
Dr Nishizaki was the one promoting the SNIPE, so he'll have to take responsibility.
You're following Dr Saeki's orders, aren't you?
What if I am?
You do it, then.
You do it.
Is the experimental drug working well?
I don't know. I've only just started using it.
I'm surprised you chose to use pharmacological treatment.
Even I can work with drugs.
Well, since you're testing something for me, I don't mind either way.
Koharu, it's almost time for your medicine.
He said Dr Takashina lost his job...
It's okay.
Dr Takashina will definitely come back.
Really?
He promised, didn't he?
So don't worry, Koharu. Just do your best to get better.
Okay.
Okay, time to take your medicine.
Dr Takashina. These are Koharu's repeat test results.
Here you go. - Thanks.
Thanks to the pharmacological treatment, she's stable.
But if we don't do something,
Koharu will die, won't she?
Can't we do something?
Koharu still believes in you, Dr Takashina.
You're the only one she can rely on.
And yet...
Please don't give up so easily.
Didn't you say "we can change the rules if we need to"?
We have to carry on with Koharu's surgery, even if it means changing the rules.
Dr Takashina!
Ms Makino in room 302 suddenly got worse.
Ms Makino, are you okay? - Take deep breaths!
It's a pulmonary embolism. - Who's on duty today?
Dr Sekikawa and Dr Tokai.
I brought Dr Tokai.
Dr Tokai, look at this.
Ah, that's a problem.
Both pulmonary arteries are completely blocked.
Thrombus (blood clot)
Pulmonary artery
She also had heart surgery as a child
Childhood history of surgery for tetralogy of Fallot
so there are too many adhesions for a midline incision.
We can't operate, can we?
There is one method.
We remove both clots through a left thoracotomy.
Doing both sides through a left thoracotomy? Is that possible?
It's never been done in Japan.
What does that mean?
I assisted with this operation when I was in America.
But you can't do it. You were just the assistant.
Move.
No, I'll do it.
Dr Tokai, please be my assistant.
We can change the rules if we need to.
I'll take responsibility.
Oh?
Dr Tokai, please be my assistant.
We can change the rules if we need to.
I'll take responsibility.
Let's start thrombus removal from both pulmonary arteries by left thoracotomy.
Coopers.
Dr Sekikawa, please set up the heart-lung machine and bring it down to 18 degrees.
Yes, sir.
Scalpel. - Here.
Please stop her circulation. - Yes, sir.
Let's remove the thrombi. Magill forceps.
Here. Miwa, bring some 4-0. - Right away.
Amazing. What precise work...
This is Dr Takashina's true strength.
Scissors. - Here.
Done.
Her vitals are all fine.
You look like you're about to die.
Dr Takashina.
I'm sorry about earlier.
It's weird for me to say this myself,
but how can I take responsibility, the way I am now?
Thanks to this, I finally realised something.
I have nothing left to lose.
But...
That's why there's something I can do.
Tell Koharu I'll come back soon.
Yes, sir.
Hey! What are you doing?
Dr Nishizaki. Dr Saeki is planning to let Shimano Koharu die.
If the patient dies now,
it will become your responsibility as lead SNIPE researcher.
Are you threatening me?
Will you let me use the Darwin?
What?
I was wondering what you would say.
The Darwin is the jewel in the crown of Teika's techniques.
I can't let you transfer such a high-risk patient here and fail.
I'm not transferring her.
I want to borrow the Darwin.
Borrow it? - Yes.
I won't cause any problems for Teika.
If anything does go wrong,
then Takashina of the Saeki Surgery department will be responsible.
Please.
Okay.
But I have no intention of letting you operate.
Matsuoka, the Darwin is your specialty.
This is a good opportunity to collect another case study.
Show Tojo just how powerful Teika really is.
Leave it to me.
I'll definitely succeed for you, Dr Nishizaki.
Matsuoka will operate the Darwin? - Yes, that's their condition.
You're acting very confident too. Don't you care how you look?
I have nothing left to lose.
Fine.
Thank you.
I'll start preparing immediately.
And so the Darwin was brought to Tojo University.
It's on a completely different scale to the SNIPE.
It has 4 arms. It's a real robot!
Amazing. He can write on such a small grain.
Rice is for eating.
What?
I'd heard about it, but it really can write on a grain of rice.
Teika University
You're like commoners seeing the Black Ships for the first time.
*Western ships that arrived in Japan in the 19th century
Real country bumpkins.
Country bumpkins?!
He really said that?
Kind of disgusting, isn't it?
Come to think of it, I wonder how long we'll keep giving her this drug.
Dr Tokai said to keep using it until the day before surgery.
Right until the last minute?
Is there a reason for it?
It's a study drug, so there'll be a payment for helping with the clinical trial, won't there?
So it's just for money?
Mr Tomizawa, I'm very grateful
for the Ministry of Health's kind support for this Darwin surgery.
I want to change Japan's stagnant medical industry.
Ministry of Health Chief Medical Officer Tomizawa Masayuki
That's why I want to proactively bring in the latest medical techniques
and eliminate the skill gap between surgeons.
I agree with you.
However, certain people are against it.
The ones saying skill with a scalpel is the most important,
who get their authority from that position.
In that sense, performing Darwin surgery at Tojo University
is really very significant, isn't it?
We ran a simulation of Koharu's Darwin surgery.
Scissors on the left arm. - Yes, sir.
Okay, no problem.
This surgery will definitely succeed.
Good work.
Matsuoka, isn't this your first Darwin surgery on a child?
Will you really be okay?
Hey, how many Darwin surgeries do you think I've done so far?
Everyone at Tojo's such a worrier.
Dr Tokai, take these.
They're documents on the Darwin. - Don't need them.
I have nothing to gain from this surgery.
All I want is for Koharu's life to be saved.
I'll do anything I can for that to happen.
People really do change.
It's because I've lost everything.
But I realised something because of that.
At a university hospital, people who don't care about success are the strongest.
Like you, Dr Tokai.
Excuse me. Dr Tokai?
Dr Tokai...?
This is...
And so, the fateful day arrived.
They're here!
Thank you for inviting me, Dr Saeki.
It's been a very long time.
Thank you for coming. I'm glad to see you're well, Dr Nishizaki.
Not at all. I haven't been sleeping well since the SNIPE paper was withdrawn.
At least we were able to withdraw the paper before something serious happened.
Your reputation would have been damaged, Dr Nishizaki.
I hear today's surgery will decide whether the paper succeeds or fails.
I'll be watching closely as well.
Please do.
Dr Nishizaki, please sit here.
Connect the monitor.
Okay, please begin. - Yes, sir.
At last. So this is Tojo University's first robot-assisted surgery.
Koharu...
Keep going. Keep going. Stop.
The cart is in position.
Then let's start removing the focus of infection using the Darwin.
Docking. - Yes, sir.
I heard a rumour that your department was planning to let this patient die, Dr Saeki.
I'm just glad we could help.
We're truly grateful to be borrowing the Darwin.
Not to mention that excellent doctor.
It doesn't seem like there's any way this can go wrong.
Of course not.
I'm inserting the clamps.
Can it work through such a small hole?
She's barely bleeding at all.
Maybe the time is coming when surgical skill won't be needed.
No way. Are you going to let some robot beat you?
But seeing this...
Okay, it's showtime!
Pericardium
The tip of the clamp is at the pericardium.
Set the electrocautery knife at 25. - Yes, sir.
Starting the pericardial incision.
With the Darwin, operations that even a great surgeon couldn't do are now possible.
I've opened the right atrium. Visual scope. - Yes, sir.
Focus of infection
Right atrium
You're almost at the focus of infection.
Next is the difficult part.
Difficult part?
There's no such thing.
Next I'll remove the focus of infection.
What detailed work. - Is this the power of Darwin?
Now he just has to cut it out...
It looks like a success, doesn't it?
This is the last step. What an easy job!
Okay, I'm removing the focus of infection. - Yes, sir.
What's this? - What's wrong?
What's happening? The clamp won't move.
The clamp won't move?
What happened?
She's starting to bleed more.
The arms are hitting each other!
This is bad.
With a child's small body, each arm has a limited range of motion.
Damn. - Didn't I tell you?
If you force it to move, her heart will tear!
What's happening? Should we move the arms?
H- Hold on. - What are you doing, Matsuoka?!
Get ready for a conversion. - Koharu...
Hey, isn't this bad?
Shouldn't someone go and help them?
But who at Tojo knows about the Darwin?
This is...
Dr Tokai...
Excuse me. - Miwa?
The bleeding is getting worse!
Matsuoka, you have to withdraw it for now.
I'm the lead surgeon here.
We'll continue the removal like this.
Know your place, Takashina!
I don't have a place to begin with.
I'll be right back. - Yes, sir.
Dr Takashina? - Forget him, let's continue the removal!
Dr Tokai!
Let's move the arms. - We can't! She won't stop bleeding!
Then transfuse-- - This patient can't be transfused!
We told you that! - We're losing visuals!
S- Suction! Use suction! - Yes, sir.
Dr Tokai!
Please help me.
Let's go.
It's at maximum suction! She can't lose any more blood!
Damn it. It's over.
Dr Tokai!
Tokai?!
Takashina, don't just bring in whoever you want.
You're the one at fault for not adjusting the arms to this child's small body.
Even though you're a "Darwin professional".
Write your resignation letter. - What?
I'll save you in return for your severance payment of 10 million yen.
D- Don't be stupid! 10 million yen?!
So you're going to let the kid die like this, in front of the great Dr Nishizaki?
Matsuoka, get away from there.
What?
Move!
Move.
Takashina, number 3. - 2 cm to the right.
Number 1. - 3 cm to the left.
Okay, it should move now.
The clamp is moving. - Okay, let's remove this machine.
We'll go in through the chest.
She can't be transfused, so we can't open the chest.
We can if we use her own blood, can't we?
Her own blood?
That's why you were using blood-forming Nespa?
To stock up on Koharu's own blood?
Neko, how much is there?
Enough for 30 minutes. - Okay.
30 minutes from now? There's no way you can do it.
I can do it.
Tojo University can do it.
Pull the cart back. - Yes, sir.
Get ready! - Yes, sir.
I'll use the holes that are here already.
Scalpel. - Here.
Electrocautery knife. - Here.
Let's open it up. Come on, think about the next steps.
We're opening the chest, right? So open it!
Right. Rib retractor! - Here.
I'm opening the chest. - Get more blood into the heart-lung machine!
You, I need suction! - Neko, muscle hook. - Here.
Take this. - Placing clamp forceps.
Okay, it's in place. Suction.
Amazing. He's as accurate as the Darwin was earlier.
No, even better.
He's really amazing.
Dr Tokai... - Maximum suction. - Yes, sir!
It seems it was difficult, after all.
To operate on such a small child,
he should have prepared more thoroughly.
Matsuoka, was it?
He doesn't understand what surgery's really about.
I'm taking it out.
Got it. I'll stitch her up now. 4-0. - Here.
I said suction! - Yes, sir.
Scissors. - Here.
Suturing complete. - Here vitals are stable. Everything's fine!
Then you do the rest.
Dr Tokai.
Thank you.
I just did what's expected.
After all, I'm a doctor.
It seems the surgery was a success.
Thanks to you, I've learned a lot,
Dr Nishizaki.
Nothing could make me happier.
Well then, I'm leaving.
Mr Ikenaga, I'll contact you later.
Dr Nishizaki!
Takashina, thanks for patching things up.
Ah... - I'd like to talk to you about our next step.
Come and see me later.
Yes, sir.
There's no place for you to come back to.
Wait! Please wait! Dr Nishizaki, please!
After that, Koharu steadily recovered
and it was almost time to discharge her.
Wow! Maybe you'll be able to play football soon.
Yay!
Where's Dr Takashina?
I think Dr Takashina is training as well.
Dr Takashina, that was terrible.
Should I teach you? - Please.
Okay.
It seems like I'll be staying at Tojo a bit longer.
Huh?
A Japanese Darwin? At Tojo? - That's right.
The Japanese Darwin is a major joint project between Daiichi Juuko and Teika University.
I want you to run its first trial operation.
But... - Collect cases before the Society chair selection,
and write up a paper for me.
I can add even more to my impact factor.
Understood.
I'm relying on you.
The Japanese Darwin project is being supported by the Ministry of Health.
The Ministry of Health?
So this project definitely has to succeed.
This is our last chance.
In the end, I can't escape my position...
I'll try again. - Try to do it twice this time! Let's go!
Twice! - Let's go!
1... Ah! 2! 2!
Excuse me. A letter for you, Dr Saeki.
Okay. - I'll be leaving, then.