I've been away for a long time so I don't know if there is anyone still reading this blog, but in case anyone's wondering, I wanted to let you know that I've graduated med school and have become a doctor.  I've started working at a hospital in Tokyo, and it's been a great experience.

I haven't been writing at all these days; I actually don't feel the urge anymore.  Whether that is a good thing or a bad thing, I don't know...  I still feel like some day I might come back with stories I want to share, but for now, I'm busy living each day, getting used to being a doctor, and finding out what life actually is!  Now that I'm finally working and interacting with people, all the things I read in books and all the thoughts I used to have seem to fade in color.

I think my sense of value has changed a bit.  I used to wonder what it would feel like to actually become a doctor and work day and night.  I used to worry about becoming one of those "disposable" doctors -- that if I quit, someone else would replace me easily.  It's true, especially since I'm still a useless resident.  But it doesn't bother me as much as I thought it would.  In short, I think I've finally accepted the obvious fact that I'm not special.  If I meet a patient though, if I meet someone I can relate to, someone I can help, that encounter IS special, and nothing can replace that one encounter.

When you're really sick, you can't really focus on anything.  When you have a strained back, all you can think of is the pain in your back; if you have a painful hemmoroid, your butt hole becomes the center of your world; you forget about your favorite book, how to appreciate your favorite painting, your favorite piece of music, and you can't focus on all the things that make you you.  But being a (good) doctor would enable me to bring you back to being a human, to being yourself again, and I think that's a huge honor.  I'd always dreamed of writing someone's favorite book, but I feel like it doesn't really matter anymore.  For now, I'm really happy with what I have.


is it so wrong to eat meat?

I haven't written here in a looong time, and so much happened while I was away that I'm not sure why I'm here to write about whether it's right to eat meat, but that's what I'm going to write about anyway.  The subject has been bothering me since a couple of days ago when a good friend of mine sent me a link to a video titled "Best Speech You Will Ever Hear" by Gary something.  I had been in Boston for two months (first time being outside of Japan in fifteen years!) and was surprised to find the vegan version of everything!  I never thought so much about it while I was there; I just felt like consumer autonomy was much stronger in America with so many choices (compared to Japan where I guess would be difficult to lead a completely vegan lifestyle).  But now that I've watched a couple of videos and read a couple of articles made and written by vegans, I couldn't help the urge to write down the stuff I personally found kind of odd, just to get it off my chest.

Firstly, it really bothers me that some vegans make it sound like there is a strong link between how a human treats animals and how he would treat other humans.  Gary makes it sound like animal lovers are peaceful loving beings while meat eaters are baby Nazis (if not full grown Nazis).  If that's true, I'd like to ask why Western countries that consume more meat are generally more concerned about human rights, compared to Asian "vegan" countries.

And I don't think it's totally wrong to say that we eat meat because we're part of the food chain.  Every creature on this planet is part of the chain, right?  Given our intelligence, we found a way to farm animals (which might seem upsetting because no other animal does it), but any species with the same intelligence would have done the same, because it's an easier (if not better) way to survive.  Of course, we should make sure that animals are treated well until they are slaughtered, and I agree that there is no "humane" way to kill an animal, but we have the technology to make sure that the suffering of a cow being killed by a human is at least better than that of a gazelle being killed by a lion.

As for the health aspect, I haven't looked into enough studies to say whether meat increases or decreases human life span, but it's a famous fact that the Japanese average life span increased and became #1 in the world only after WWII when American style cuisine came into Japan and the consumption of meat rose dramatically among the Japanese population.  Also, it's commonly said in Japan that eating meat is the easiest way to make sure you're taking in certain amino acids that you'd otherwise lack if you were to only eat plants.

I realize there are farmers that mistreat animals, and this is a huge problem that needs to be addressed.  As consumers, we should always remember that our lives stand upon the sacrifice of other lives that we do not necessarily see.  But becoming a vegan?  I need to find more data before deciding on that.  It's really a shame that so many vegans put emphasis on the emotional aspect and keep showing videos of animals treated badly.  I wonder what they think about all the animals killed in labs.  I agree humans are not "superior" or "special", but does that mean we're supposed to sit on our hands and watch our fellow sick humans die because we're not superior and we're not supposed to experiment with mice to save human lives?

If animal protein is necessary to pursue better survival, the sacrifice is necessary to some extent.  Or is it human ego to pursue a longer life?  Should we simply accept a shorter life if that saves animals?  It surprises me that so many people found Gary's speech convincing.  If I had been shown the proof that becoming a vegan guaranteed better survival, I would've turned a vegan overnight.  Without solid data though, his speech was just emotionally controlling in my opinion.


every life

Two weeks ago, we visited a hospital far in the mountains where they took care of children who were mentally and physically handicapped severely.  It was sad to read their charts, how some of them ended up there -- some parents didn't want to take care of them anymore because their handicap was too much to handle, while others hadn't wanted them in the first place, abusing them until they had to be hospitalized.

But what also shocked me was when I saw full grown adults who weren't all that different from the children -- just a bit larger in size.  With medicine's advancement, the severely handicapped children can now grow up and live on to become adults.  It must be something to be celebrated.  But to be totally honest, I felt this unfathomable sadness when I saw the adults lying side by side on the futons, hardly able to move, not being able to say one word.  I was embarrassed to feel that way, because who was I to decide that they were unhappy or that they couldn't even tell if they were happy or not?

Back in the university hospital, the doctors were discussing what they should do about a two year old boy with cerebral palsy whose mother had left the hospital without notice.  The boy was so small, soundly asleep in the hospital's large bed, and I thought about the adults I saw in the hospital in the mountains, the future versions of the little boy.  Of course, the doctors had done their best to save him, and were still trying to find the best place for him to live.

Because every life is worth living.  Every life.



-- Sacrifice is the spirit of love

Summer vacation has almost come to an end, and as I traveled back, I finished reading 犠牲(sacrifice) written by Kunio Yanagida (published the same year Into the Wild was).  It's an essay about his son, Yojiro, who committed suicide at the age of 25 after suffering metal illness for more than a decade.  One of his problems being anthropophobia, it was difficult for him to get a job, and thus he despaired that he had nothing he could give to society.

At the same time, he was deeply moved by one of Tarkovsky's films, Sacrifice, which expresses the belief that the reason we can live today in peace is due to "the sacrifice of a nameless person who lives somewhere under the broad blue sky".  When Yanagida finds his son brain dead, he agrees to donate his kidneys as a token of Yojiro's existence, thinking that this kind of 'sacrifice' was what he had always wanted.

One of the things Yojiro feared most was oblivion -- the fact that when one dies, even the fact that he lived and suffered will be forgotten and deleted from history.  A character from a book I read last summer states the exact same thing, to which the protagonist retorts that he should get over the fear, because "there was a time before organisms experienced consciousness, and there will be time after".  Her point is that even if some people remember you after your death, they too are going to die, and in the end, there will be no one remaining to remember you anyway.  This logic applies even to the world's most famous person, because at some point, the human species will extinct, and the planet will collapse.

I guess it's a decent argument, but obviously, the truth that everyone dies doesn't really liberate you from the fear of death.  Logically, I understand that everything is going to disappear one day, that it's nonsense to dwell on whether or not you will survive death for what amounts to less than a fraction of a second in geological time.  But emotionally, I still fear the possibility of dying leaving nothing behind.  I want to give my life some kind of meaning, and I think a lot of people do, including my mother.

To tell the truth, I'm a terrible daughter -- deep down in my heart, I have not always respected her.  I've told her more than once that I will never live a life like hers, and that I was 'different'.  Apart from the years she spent working as a language teacher, she has worked as a full time housewife, and since she started seeing her 60th birthday coming around the corner, she started asking herself (and her family) the meaning of her own life.  She suddenly realized she had no personal accomplishments, and began questioning the value and meaning of her 'self-sacrifice'.

Now I realize that the real reason I sometimes have a hard time respecting my mother is only because she is too busy imagining what she could've become and regretting what she could've done that she sadly fails to see the meaning of the life she has actually lived -- the whole process she calls self-sacrifice.

After reading Sacrifice (and all the other books I've read), and living my life for more than 1/4 of a century, I have come to the conclusion that the meaning of life comes from 'giving' which often requires sacrifice.  When I give, the receiving person will also give to another person, and that person will do the same and pay it forward.  We will all die, but we will all live on as a participant of a 'giving relay' as long as it goes on.

I don't know how much I will be able to give in my lifetime, how many people I will be able to help when I become a doctor, but every patient I help would not have been saved without my mother's 'sacrifice'.  Will my patients think of my mother's existence?  Most likely not; they wouldn't even remember the doctor after a while.  And does that make my mother's life meaningless?  Is she eventually going to disappear forever in cold oblivion?  I'd say yes to the latter.  But does that matter so much when the unmovable truth is that my mother's sacrifice has helped me help the patient (in some way) to live his life and pay it forward (to someone who hopefully will pay it forward)?

Yojiro, at some point, encounters the concept of "indestructibility of human existence" which appears in a passage written by Mircea Eliade, and states as follows:  Every death has contributed to the continuity of life, and my own current life is standing upon the sacrifice of numerous nameless soldiers.

We all fear oblivion because that is our final death.  It's scary to think that the evidence that we ever existed is as fragile as a drawing on sand.  But even if it is a picture on sand, there are new pictures that will not exist without it.  Our life, our sacrifice and love will always be of someone's support, and it's encouraging to think that just because we will never escape oblivion will never change that fact -- something we might call the meaning of life.

I should now call my mom and tell her how much I've appreciated her 'sacrifice'.  Because that is why I also want to live to love and give.


the cards we are dealt

We cannot change the cards we are dealt, just how we play the hand.
-- Randy Pausch

I read the rest of the book (Into the Wild) while I traveled back home, and it reminded me of the fact that many patients who came to visit the psychiatry department had divorced parents and other family issues.  McCandless doesn't seem to have suffered any mental illness, and what brought him to Alaska was his intense character and adventurous spirit combined with his love of nature, but what pushed him to the extreme -- cutting off all contacts with his family for two years, and ultimately all human contact for his "great Alaskan odyssey" -- was apparently his discovery of his father's past bigamy (which had ended a couple of years after his birth).

McCandless was never withdrawn, and he actually left some lasting memories in the hearts of many people he met in his last years, but obviously had some problems building intimate human relationships, and it seemed to stem from his parents' mistakes that made his "entire childhood seem like fiction".  Maybe he needed something to believe in, and nature -- its absolute existence and its merciless honesty -- was what he turned to.  He was apparently criticized of his arrogance for trying to live in the wild without enough preparation, but perhaps it was his naivete -- he'd put too much trust not only in himself but the wilderness as well.

The tragedy was not really the fact that such a young man had died alone in starvation, but that he had to die when he was finally ready to go back to civilization and human community -- his severe experience of developing a bond with the wilderness had somehow helped him move on and it seemed like he had just found a way to forgive his parents' imperfections and his own, but that was when one careless mistake took his life.

Then again, I found a not-so-tragic answer to what I'd been wondering when I wrote my last entry -- how he had felt when he realized he was going to die.  It reminded me of what Viktor Frankl had said in his book, about how we were always -- always -- free to choose how to react to a circumstance (and death too is one of those circumstances).  The author of the book, Krakauer observes that McCandless was unmistakingly at peace in his last picture, "serene as a monk gone to God", and I don't think it was the author's wishful thinking -- the below is what McCandless had written before deciding to walk out of the bush to possibly end his "great Alaskan odyssey".  It was shortly after he had shot a moose and regretted it due to his failure of preserving the meet and wasting it.  He'd always demanded a great deal of himself (and others) but this moose episode seems to have taught him the value of acceptance:

Consciousness of food.  Eat and cook with concentration... Holy food.

I am reborn.  This is my dawn.  Real life has just begun.
Deliberate Living: Conscious attention to the basics of life, and a constant attention to your immediate environment and its concerns, example→ A job, a task, a book; anything requiring efficient concentration (Circumstance has no value.  It is how one relates to a situation that has value.  All true meaning resides in the personal relationship to a phenomenon, what it means to you).
  The Great Holiness of FOOD, the Vital Heat.
  Positivism, the Insurpassable Joy of the Life Aesthetic.
  Finality -- Stability -- Consistency.

On a side note, the plane I took yesterday had a problem landing, and it flew past the airport into the city.  It took the staffs quite a long time to announce what the problem was, and until then, I seriously wondered if the plane had been hijacked or something, and if we were all going to die.  To be honest, I was quite upset by the thought of it, mostly because I thought my life hadn't even started yet, but after a while, I just started wondering what the last thing I had said to my mother had been.  Had I ignored her last call?  Had I been nice to her?  I was actually still holding the book in my hands but the whole McCandless story seemed to have dropped off from the surface of my brain.

After a lot of useless and unnecessary panicking and finally landing on the airport, I went straight to my grandmother's place only to find out she was sick, though it was mostly a mental thing; she is always too busy worrying about dying and feeling sick that it almost looks like she never has enough time to have fun.  When she started feeling better, I was going through a pile of books on her shelf, and she told me the novel I was holding was supposedly really good: "What was it about... yes, yes!  It teaches you how to survive!"  She hadn't read it, and I was pretty sure she never would, so I just told her maybe she could just forget about surviving for a moment, and relax.  Otherwise, I really wanted to ask her what she wanted to survive for so badly.  If she knew, I think she would stop worrying too much, but then again, I will never know how it feels to be 86 for another sixty years.


into the wild

Since I last wrote, I went through training at the neurosurgery and anesthesiology departments, and finally our first term has ended.  As soon as I came back home a couple of hours ago, I started reading Into the Wild.  I've only read 1/3 of it yet, but I'm slowly beginning to understand this Christopher McCandless -- a kid in his early twenties who ended up dying in the wilderness of Alaska in 1992 after hitchhiking for two years.  In one of the letters he wrote to people he met on the road, he talks a great deal about the importance of getting out of your comfort zone.  I've heard a lot of people talk about this, and it's a piece of advice that makes me wonder a bit if I'm nearing the end of my twenties missing out on important experiences I could've had had I chosen different ways.

I say this because I've never really tried to get out of my comfort zone in the sense McCandless did.  Some people tell me it was very brave of me to decide to switch to medicine after majoring in law, probably because I had to endure some sense of insecurity until I got a place in med school, but it wasn't a crazy plan, like ditching all my possessions and travelling to "see the world" and meet random people on the way.  I've always planned my future carefully for a stable job, a stable life, and I value stable human relationships.  And actually, I don't necessarily think it's a way of life to be criticized the way McCandless probably did:

So many people live within unhappy circumstances and yet will not take the initiative to change their situation because they are conditioned to life of security... ...nothing is more damaging to the adventurous spirit within a man than a secure future. ...The joy of life come from our encounters with new experiences, and hence there is no greater joy than to have an endlessly changing horizon, for each day to have a new and different sun.

Personally, I think it's perfectly possible to be happy with a "life of security" with no "adventures" or "new experiences" as long as you have good eyes to notice the little reasons to be happy in your sedentary repetitive existence.  But maybe it's a totally different type of happiness that you find in the wild -- "the great triumphant joy" to be alive -- and I can only imagine because I've never hitchhiked my way to Alaska, and I probably never will; that is not my dream.

Perhaps I will try to "get out of my comfort zone" in some other way at some point in my life once I start working as a doctor and gain financial freedom.  I can almost hear McCandless point out that I have totally missed the point here, but I have no courage to abandon everything and take the risk of dying alone, cold and hungry.  I cannot help but wonder if McCandless still believed in his values and the reckless choices he had made when he realized he was going to die.

Still, any life is transient, a passing phenomenon after all, and the security I value is only a borrowed hut I will have to let go anyway.  In that sense, there may be nothing to lose at any point in life.

Regarding human relationships, I've learned to value ones that don't necessarily last; it's not only those "stable relationships" I mentioned earlier that shape my life and who I am.  Sometimes, a one time encounter can make a mark on someone's life; a single memory can make someone feel glad to be alive.  But I have always valued human relationship, and there is one passage Chris wrote that has kind of opened my eyes, of course not in the same way as his "raw transcendent experiences" had opened his own eyes, but I think it's worth quoting:

You are wrong if you think Joy emanate only or principally from human relationships.  God has placed it all around us.  It is in everything and anything we might experience. ...My point is that you do not need me or anyone else around to bring this new kind of light in your life.


singing in the rain

It's been raining almost every single day where I live, I haven't been able to sleep well for whatever reason, but the training goes on, and I've been training at the neurology department this week.  Today, we visited a hospital where they take care of patients with intractable diseases such as muscular dystrophy and ALS.

One of the first patients we met was a man in is early sixties with ALS who could no longer move his body (including his respiratory muscles -- he was connected to a ventilator) but was still able to move his facial muscles.  I knew they used alphabet boards to communicate at that stage, but it was my first time to actually watch a patient do it.  The person talking to him would read out the alphabets on the board, and he would blink every time the reader came to the right alphabet.  There's an easier way using a computer, but when I watched the man blink with all his strength just to choose a single alphabet in a single word in a single sentence, it felt a bit like having a small carrier pigeon fly back and forth in a small room with one letter at a time, and I couldn't help but realize how lucky we were to be able to communicate so easily.  When we left the room, the patient moved his mouth to wish us good luck, and I think it made us all feel relieved that he looked rather cheerful.

But the next patient we saw was a woman in her forties who had been diagnose in her twenties, and was now unable to move even her facial muscles.  The doctor explained that it was a case of locked-in syndrome, which I think actually leaves the patient with control over her eyeballs and eyelids, but apparently, she couldn't even move her eyes, so there was no way to communicate her feelings.  Her sensory nerves were intact, and she was totally conscious, so she could still hear what others were saying and see what was right in front of her, but no one could tell what she wanted, and she had been that way for the past decade or so.  After training as a student doctor for three months at seven departments, this illness is the one I fear most.

Having said that, I don't mean to say that she must have been unhappy.  Before we left the hospital, the doctor told us a story about a couple with a son who was born with muscular dystrophy (which is a X-linked recessive disease): when the wife conceived their second child, there was a new option they hadn't had with their first child -- prenatal diagnosis.  The wife didn't want to take the test, and was determined to give birth to the baby regardless of his genetic status.  However, her husband's parents insisted they get tested, and as a result, they discovered that their second child also had MD.  The mother ended up having an abortion, but strongly regretted her decision, especially because she thought it meant that she was unconsciously hoping to let go of her first son as well.  She also remembered that many people had told them when he was born that certain babies were born only to parents who could take care of them, and she felt guilty that she had let go of a baby who had "chosen" her.

The patients we met today didn't necessarily look depressed.  We didn't get the chance to actually ask about what they thought about their life, but I personally want to believe that all humans have the power to find happiness under any given circumstances.  I definitely didn't think it was a bluff when the doctor told us what one patient had said to him: that he was unlucky, but not unhappy.  I've thought about the option of prenatal diagnosis a couple of times, but what I thought today was that it was a very arrogant option in a way.  Who was I to decide my child was going to become unhappy just because he had a certain gene (or a set of them)?  Of course there would be hardships, but any kind of life has hardships.  There may be more for him, but he would also have the chance to enjoy happy moments.  Even if it was just once, a brief moment, I think it can still be a moment worth living his whole life for.  But what I think may not even matter -- the point is that the child will have his own thoughts, his own world, and I can't evaluate it with my sense of value.  And at the end of the day, I believe no happiness lasts forever, and when we're feeling happy, it doesn't matter if there are a thousand more moments like that, because right then, we have that, and that's all that matters.