"In this world,"
"the brain is the only unexplored region remaining."
lt was you.
You ruined my life...
A dream...
"Neuroanatomical Clinical Cases and Diagnosis"
lt was you.
"Incoming call: Stupid Boss"
l said ifyou call on the day l'm not on call,
l'd kill you, didn't l?
Oh, l'm sorry.
You see,
a new doctor willjoin us today, right?
How can you say that shamelessly?
Tell me,
who has been supporting
our hospital's Neurosurgery Department?
It's you, Dr Miyama, ofcourse.
Who put three doctors there without asking me?
Well, it was me.
And you want me to put them together?
I'm busy enough already.
I know you're busy.
I'm not convinced.
Your blood pressure will rise ifyou're angry.
That's not the point.
Well, you know,
change is necessary for the brain,
just like our Neurosurgery Department.
All right?
But it doesn't mean you can put all the good and bad--
Yeah.
Hello?
That sly old fox.
The good...
and the bad.
Change, huh?
I graduated top ofthe class
from Kaitei University's medical school.
After that, head of Neurosurgery Department, Dr lmadegawa,
strongly wished that l'd join you, so here l am.
My reason for choosing neurosurgery?
It's the most difficult clinical department.
My reason for choosing neurosurgery?
It's the most difficult clinical department.
Medicine has advanced, but the brain is still a black box.
That's why it's worth taking on the challenge.
Challenge.
It is my belief.
I've always been trying to get the best results as a student,
and now l've been recruited as a neurosurgeon,
the acme ofJapan.
It must be the fate ofthe able.
But it's my heart's desire.
I want to polish my skills here as my starting point.
I look forward to working with you.
It doesn't sound right. Maybe it's too modest?
I'll polish my skills here. Iooking forward.
That's it.
I've got it right.
What?
Oh, you're the new doctor of NS Department?
Yes?
Yes.
- Come. - Yes.
Explosion at a factory.
A 42-year-old male is being sent here.
No other details.
A female nearby was blown off her motorcycle, slightly injured.
The air ambulance will arrive in three minutes.
Where are the other doctors?
The doctor on duty is busy working at the lCU.
I heard the Top Knife is coming.
Top Knife?
Well, l suppose you can say so.
Consultation on my first day?
Nobody mentioned it.
Who's she?
A doctor from Neurosurgery. She'll do the consultation.
Mr Masashi Kihara, 42 years old. He was working at the factory...
Doctor, please take this. lt's his right arm.
Another person will be sent here later.
Okay.
Mr Kihara, can you hear me? Mr Kihara!
- He hit his head pretty hard. - Yes.
- His family? - They're coming now.
- We'll move him. - One, two, three...
l'll take it off.
Insert another lV!
- Get a fluid warmer! - Yes.
- Take them away. - Taking them off.
- Connect monitor. - He's bleeding a lot.
I'll cut open the top.
Put his arm down!
He has anisocoria. What should we do?
Well...
His right pupil is dilating.
- Intracranial pressure is rising! - Measure BP.
What should we do?
His heartbeat is dropping rapidly to 55.
Anyway, do a cranial CT scan.
He'll die while you're scanning.
In that case, give him mannitol...
Heartbeat, 40.
What should we do?
FAST exam negative.
- Call NS! Call someone else here. - Okay.
He hit his head?
He was blown off by a blast. Right arm severed...
Can you hear me?
Head injured, FAST shows no chest injury,
heartbeat below 40.
Get the A-line ready.
Brain herniation? We'll open his head.
It's ready.
The haematoma on the right is getting bigger.
We have to operate here.
What? Here?
- Trepanation kit. - l'll get it.
Get 10 units of RBC, he'll bleed a lot.
Yes, ma'am.
- It's around here. Scalpel, please. - Here.
- Book Operating Room 3, please. - Yes.
Brachioplasty for his arm and treatment for his head
are needed.
Okay.
Hello, ER here.
Dr Miyama will perform craniotomy to remove a haematoma,
and brachioplasty needs to be done.
Please get Operating Room 3 ready.
Hold his head still.
Yes?
- Now. He'll die in two minutes. - Yes, ma'am.
Don't move it! Or it'll pierce his brain!
Yes, ma'am!
Okay.
- Scalpel, please. - Here.
- Suction. - Here.
- Okay. Cotton. - Yes.
He would've died if he was treated 10 seconds later.
Transfer him to the OR. l'll go after l finish.
Yes. We'll begin the brachioplasty first.
- Okay. - What should l do?
Disappear.
I see.
Darn. Stupid Dr lmadegawa.
I'll kill him.
I really will kill him.
"Top Knife"
- Took it. - Let's see.
It's time.
Hurry up or you'll be late for school.
But...
Don't worry.
The world famous Dr Kuroiwa will operate on me.
I'll be totally fine.
That's right.
Even you too? l'll be fine.
Let's go.
See you!
I'll go too,
to the operation room.
He'll have the surgery?
It's fine. Don't worry, and go to school.
He'll be the way he was again after the surgery, right?
Yes, l travel around the globe to operate on patients.
In Japan,
l do surgeries here at Tohto General Hospital
for three months.
I recruited him.
Dr Kuroiwa, your surgical skill is said to be the world's best,
and you were chosen as Top Knife, the model neurosurgeon.
The first in Japan, by the way. This is the award.
You do check-ups without sparing time for sleep.
What's the source ofyour passion?
I do this to protect the lives of my patients. What else can it be?
What's the matter?
Now, let's go to the room and take your time...
Did you see that on his neck? Maybe it's a hickey.
Do you know the rumour about the world's Kuroiwa?
His surgical skill is the very best, but he's the scumbag ofscumbags.
If his surgical skill is the best, isn't it fine then?
Well, you're right.
Which patient has a giant skull base tumour?
Oh, it's 401's Mr Tokura.
Oh, this man?
Who will operate on him?
It hasn't been decided.
Is that so?
Will they let me do it?
May l just ask the head ofdepartment,
Dr lmadegawa?
Probably.
He's a "Top Knife" too?
Seems so. He does both surgeries and catheterisation.
He loves doing surgery more than anything.
Everyone Dr lmadegawa recruited is troublesome.
I'm sure that they'll have a fight.
With our "Empress"?
Turn round the corner.
Be careful.
I am tired.
You did nothing.
But l was watching!
I'm exhausted now.
What's the matter? Morning. What's the matter?
What the heck?
What is that?
A new doctor.
You didn't tell me that she was so bad.
I can't accept your having recruited the other two either.
Do we need them? Does NS need them now?
Yeah, we have to change too.
But...
We shouldn't be afraid ofchanges.
The brain always needs new stimulations.
You need the three ofthem too.
Okay?
I need them?
Why did he wink?
- Excuse me... - Yes?
We do surgeries on Tuesday, Wednesday, and Friday.
Attend to the patient and talk to the family,
and record the surgery before you leave.
So...
Prepare for academic meetings and write papers in between.
That's all.
Ifyou understand, go check on Ms Ueno,
who was sent here by ambulance.
- So... - Just so you know.
There are only two types ofdoctors at the NS Department.
Two types?
Like young and old?
Don't point your finger at me. l'll break it.
Yes, ma'am.
There are only two types ofdoctors at NS.
Those who should be neurosurgeons
and...
those who should never become one.
I see.
Ordinary surgery is teamwork,
but in neurosurgery, the surgeon's skill is everything.
Ifthe brain is damaged, it can't be undone.
Surgeons walk on a 10-centimetre wide board on the floor.
Neurosurgeons walk on a board across high-rise buildings.
Ifyou're prepared to do so, work at our department.
Yes, ma'am.
- High-rise. - That isn't the point.
Sorry.
- Hey. - Yes?
That surgeon must be single.
We don't talk about our private lives, so l don't know.
Let's go and take the CT scan image.
She can't possibly be married.
Impossible. No way at all.
Why do you not want us to operate on him?
This is Mr Takuma's tumour.
As l've explained,
it spreads from the tip of his temporal lobe to the inside
and presses on his frontal lobe.
It's right next to his brain stem.
Its position puts his life at great risk.
Yes.
After Mr Takuma travelled to Vietnam,
he was hospitalised for three weeks for his head's external wound.
The tumour is close to the important blood vessels and nerves,
so we evaluated it carefully.
We made the decision because Dr Kuroiwa would operate here.
Why do you want to cancel the surgery right before it?
She doesn't like Dr Kuroiwa?
- She really said that? - Yes.
Why did she say that?
Well, she wants a surgeon who cares more about the patient to do it.
But she knew how he was when she asked him to do the surgery.
Yes, but...
But nobody except Dr Kuroiwa can remove the tumour.
Right?
"Hiroshi Takuma"
l'll do it.
Indeed, Kuroiwa only does the surgery.
That's what the contract says.
But l can understand why it makes you worried.
Yeah...
ln that case, l'll operate on him.
As you know, l've been observing the progress of Mr Takuma's disease.
My surgical plan is thorough too.
Anyway, it should be removed as soon as possible.
His condition is such that anything can happen at any time.
The other leg.
Thank you.
"Blown offthe motorcycle by the blast when driving,
sent here by an ambulance."
l think there's nothing wrong with you.
I, a neurosurgeon, will give you permission to go home.
It's okay.
Dr Nishigoori said you were fine too. Really.
I see.
Don't say something you shouldn't.
Dr Miyama, you'll do it?
That's the only way.
I don't mind that,
but the surgery is pretty difficult.
I'll approach by right frontotemporal craniotomy
and remove the external and apical part ofthe temporal lobe
for the surgical field.
I'll remove the tumour and the hippocampus.
Have you done the simulation?
I always stand by for all the surgeries ofthe patients here.
By all means, ifyou can get him to sign the consent form.
Are you sure, Dr Kuroiwa?
"Hiroshi Takuma"
lt seems my work is done, so l'll call it a day.
I'll put a blanket on you. Excuse me.
I'll be fine.
See you later.
It'll rock a little. Please keep your arms to your sides.
We'll go now.
Hang on.
We had met on academic meetings many times.
I've read your papers too. l'm honoured to be your colleague.
Well, thanks.
Mr Takuma is your patient, right? Are you fine with this?
I only get one fewer from the 700 surgeries l do a year.
You aren't worthy ofthe title ofthe Model Neurosurgeon.
Oh, now that we're colleagues, l'll give you some advice.
Something that l have and you don't.
You think too much about the patients.
Will you be more polite?
It's natural for a doctor to care about their patient.
No. lt's over ifthe brain is damaged.
It can't be undone.
But even so, sometimes, you need to take a bold step.
- You don't have such courage. - l doubt it.
You know...
you're too weak.
I'll go and do the approach. lt's an unusual surgery after all.
I'll do the preparation perfectly.
Why do you talk like my friend? l'm your supervisor.
Oh, l don't worry about that.
Yes, it will begin soon.
I refused to let Dr Kuroiwa operate on him,
then Dr Miyama said she would do the surgery.
She said he'd die if he didn't have the surgery, so she'd do it.
Are you okay with that?
Are you really okay with that?
Anyway, come with Miku when it's over.
"Hiroshi Takuma"
- Mr Takuma has been anaesthetised. - Your work here is done.
- Do rounds at the lCU. - l won't do the surgery?
We don't need someone useless.
Oh, no.
I'll kill you ifyou say that again.
Yes, ma'am.
Anyway, the Takuma family is close.
- I'll kill you for chitchatting. - But don't you find it strange?
Why are all the photos in his ward taken after he was hospitalised?
People usually put ones taken when they were healthy.
I am sorry.
What's the matter? This--
Will you not do the surgery?
Okay.
We'll do the temporal lobectomy before Dr Miyama comes.
- Okay. - Okay.
Scalpel.
- Bipolar forceps. - Here.
- Scalp clip. - Here.
- Skin marking pen. - Here.
- Drill, please. - Here.
- Water, please. - Okay.
"Hiroshi Takuma"
Here we go.
- Too much. - Yes.
- Too little. - Yes. l'm sorry.
- Change it. - Yes.
- Dura mater elevator. - Here.
- Okay, let's cut it open. - Yes.
- Drill. - Here.
- Elevator. - Here.
What is going on?
It actually isn't because you don't like Dr Kuroiwa.
You refused to let us operate on him because you were scared?
Indeed, l am scared.
Ifthe surgery is successful...
my husband will be the way he used to be,
and l'm scared.
Ms Ueno? What's the matter?
My hands... They are numb.
Can you clench your fists?
Maybejust one?
Ifsomeone has a brain tumour,
will their personality change completely?
Yes, it happens.
The brain decides a person's personality.
It changes when something foreign is formed.
Why do you ask?
Don't you find it strange?
Why are all the photos in his ward taken after he was hospitalised?
- So... - lt was since he was hospitalised.
After he has a tumour in his brain, his personality changed completely.
He became gentle.
He was terrible until then.
Cheers!
Eight years ago,
he quit his officejob and started an investment business.
It went well.
After he started earning a lot of money,
his personality changed.
Alcohol, women, gambling... He fooled around as he liked.
Welcome home.
Jerk!
What the heck?
Then he started to abuse me physically.
Domestic violence?
Please stop. Please...
Shut up!
He's always had a habit ofshaking people's hands randomly.
So, before long,
he'd only have to move his hand,
and l'd think he was going to beat me,
and my body would react.
For the past eight years...
l thought about getting a divorce every day.
He travelled to Vietnam with a woman too.
When my son found out,
he got angry and punched my husband for the first time.
You jerk!
Don't do this!
Stop!
Your son injured his head,
so he went to the hospital and discovered the brain tumour?
His personality changed completely?
Why did it happen?
One's personality and how one sees and feels things
are all decided
by the limbic system and the frontal association cortex.
Ifthese regions are affected,
a gentle person can become aggressive, or vice versa.
The brain is a group of 100 billion neurons.
It's the most complicated creation in the universe.
As ofyet, we know nothing about it.
The only thing we know is it's more fragile than we imagine.
Ifthe tumour is removed in a surgery,
maybe he will be his old selfagain.
What will you do then?
He'll die at this rate.
Whether he'll be his old self again or not...
none of us can tell.
However, there is another possibility.
The reason that Mr Takuma became violent
might be because ofthe brain tumour.
Judging by the tumour's size,
l wouldn't be surprised
ifthe tumour formed eight years ago and grew bigger gradually.
It is possible that the tumour is the cause of his violent propensity.
But...
The position and size ofa tumour can cause a change in personality.
Originally, Mr Takuma was gentle, like he is now.
He was a kind person, wasn't he?
For our baby,
for our family, l'll work very hard!
I'm looking forward to it.
Afraid ofchange...
Even she is too.
I will bring Mr Takuma back.
I'll move them a bit.
Please keep them here.
Can you move your fingers?
I can't move them.
Any one ofthem. How about you little finger?
I can't.
My legs feel weird now too.
I see.
The tumour turned Dad into a bad person?
So he'll be the same man in the past after it is removed.
Okay.
Excuse me.
Temporal lobectomy done.
Inferior horn of lateral ventricle just revealed.
It'll take a long time today.
- Micro dissector. - Here.
"Mari Ueno"
lt obviously looks normal.
You mean, it's psychogenetic?
The image shows that.
- See you, pretty girls. - Wait, Dr Kuroiwa!
- Please come here. - Excuse me...
The amygdala is here.
We'll move on to remove the hippocampus.
Bipolar forceps.
Here.
- I'll touch your legs. - Okay.
Try to keep them here.
I can't move any part of my body.
Is it spinal disc herniation or a clot?
Anyway, we'll do another CT scan? l'll arrange it.
Get a surgery consent form. l'll let her sign it now.
Surgery?
It's getting worse.
It isn't simply psychogenic or spinal disc herniation.
She probably has an epidural haematoma at C3 and C4,
and it's expanding.
You mean, she developed an epidural haematoma
at the cervical vertebrae?
Book an operating room and an anaesthetist. Hurry.
- Without doing a check-up? - We have no time.
It's my hunch.
She'll stop breathing. We won't make it in time.
Yes, sir.
- Dissector. - Here.
We're finally there.
So quick.
Impressive skills.
It's this one. l knew it would be big.
- Bipolar forceps. - Here.
I've been thinking about it.
About what?
The tumour is so big,
but the symptoms only showed just a month ago,
after he returned from his trip to Vietnam.
Is that possible?
In the end, nobody knows what goes on in the brain.
It's written on page 1 ofany NS textbook.
- Do the suction properly! - Yes, sir.
We're racing against time. Hurry up.
Yes, sir.
- Curette. - Here.
Do the suction there.
Yes. l'm sorry.
- Tumour forceps. - Here.
Okay. Removed.
What is this?
Not a tumour. They're eggs.
Drilling on vertebral arch done.
- Intervertebral disc rongeurs. - Here.
Found it.
- Here. - Here.
This is it.
Her neck was twisted at a great angle,
and the ventricle was cut somewhere.
- Bipolar forceps. - Here.
- This side. Water. - Yes, sir.
- Water. Here. - Yes, sir.
Good. Stop the bleeding.
Thank goodness.
- We'll close it. - Yes.
4-0 nylon suture.
It was cestodes.
It's called neurocysticercosis.
Cestodes on pork entered his central nervous system
when he ate it.
He probably was infected during his trip to Vietnam.
Parasites in the central nervous system
are extremely unusual.
We couldn't tell from the image.
It wasn't a brain tumour?
That means...
his personality didn't change because he had a tumour?
Well...
However...
after having a dangerous surgery,
some people's view of life changes completely.
The only thing l can say is
the surgery went well.
An epidural haematoma on her spinal cord?
Yeah, l've never heard ofthat before either.
It'd be too late ifa check-up was done first.
Only Dr Kuroiwa could make that decision.
Hejudged the situation in an instant,
bore the risk, and made the decision.
Impressive, isn't it?
He might be confused. Please wait for a moment.
Dad will be back to normal, right?
About that...
Actually...
He'll surely be.
He'll be the dad we knew in the past.
Because the tumour caused it.
He'll be back.
Dad?
Hiroshi.
I am back.
Finally.
I'm finally back.
Welcome back, Dad.
"Bar Casablanca"
Today was your first day? Really?
So, how do you find NS, Sacchi?
"Sacchi"?
I did surprisingly well. lt gave me confidence.
Really?
You are gifted!
Welcome to my bar. Enjoy yourself.
Here we go!
What's the matter?
He-- My hand...
Careful, he does that to everyone. He loves kissing people.
Everyone?
Don't shout.
How did you know
it was an epidural haematoma on the spinal cord?
Usually, nobody can figure it out.
I am impressed.
- Has there been any past case? - l've read about it.
It was the data and my hunch, l guess.
Dr Kuroiwa.
Good evening.
I heard it was neurocysticercosis?
I hope you didn't let me do the surgery because you knew.
Well, l thought it wasn't just a brain tumour though.
So you didn't gain the title of Model Neurosurgeon
just for show?
- Any drinks for you? - My usual.
I'll tell you one thing.
Nobody can copy my skills, that's why l'm the model.
I'll tell you something too.
A doctor like you, who doesn't care about his patients, shouldn't exist.
I am going to be the next Top Knife.
I'll go where the ladies are. Have a good evening.
That old guy is interesting.
I have to get up early tomorrow. See you.
Already?
Cells in the body never stop changing.
People too.
Miyama, cheers to ajob well done.
Tonight is a welcome party for them.
They've left, but let's have a drink.
It's supposed to be my hideaway. Will you not use it without asking?
Don't get so serious about it.
How was it?
Did you enjoy the change?
What?
Everyone is afraid ofchanges,
but the brain grows because there are changes.
Just kidding.
Your drink. Here we go!
Okay, Tohto staff, come here.
- Gather here! - Okay.
Only a few are here, but welcome!
- Cheers! - Looking forward.
Look forward to working with you.
It's hard to change when one gets older,
but people have to keep changing.
Stubborn, eccentric doctors like us too.
- Let's dance. - Let's dance...
You can dance?
Oh?
Even her dancing is bad.
Well, doctor, please show her an example.
Dr Miyama.
Yes.
Just watch, kids!
Let's go, Queen!
- Jumped offa building? - The third in two months
who tried to kill themselves.
She kept complaining about the pain.
I'm not here to fix the head ofa suicider.
You broke the rules.
That person is stalking me.
A surgeon ofour Neurosurgery Department?
Who is it?
Prince!
What's the matter?
Everyone comes here to take offtheir armour.
Maybe they have their own troubles too.
My life is ruined because of you-know-who!