big dreams

Last night, we had a welcome party for new students, and their big dreams reminded me of my own dream I'd had when I entered med school.

If you've read my past entries, you probably know I tend to dream big.  As well as wanting to be a writer, saving the lives of people in developing countries has been my dream since high school.  I realize there's no difference between staying in my country and treating people here, and going abroad to treat people there.  If there's some kind of a philosophy behind it, it's just that I think I was lucky to have been born in Japan and as my parents' child, and I feel I should at least help people who weren't as "lucky" as I happened to be.  But in the end, it's probably just another way to feed my huge ego.  And I realized it clearly last night, as I conversed with a new student who had just come back from Uganda where he had worked as a veterinarian.

He said his dream was to work as a member of Doctors without Borders and eventually get a job in the WHO.  I think it's a great dream, and regarding the fact that he has already worked in Uganda, I'm pretty sure he has the guts to make his dreams come true.  The only problem I had with him (apart from the fact that he kept spitting at me and into my plate with every other word he spoke) was that he didn't seem to see what was right in front of him because he was too busy looking at Africa.  He wasn't a bad person at all; I actually even liked him a bit, but I thought I didn't want to be like him.  I don't want to forget the things lying in front of me.  I guess I've realized lately that it's really the small things that matter to me.

A couple of weeks ago, our emergency medicine professor told us about how he had saved a three month year old baby and he was outraged that some stupid doctor had criticized him for saving such a child -- hardly a human being -- who would have to live the rest of his life with serious disabilities.  I was amazed that the professor seemed to have no doubt whatsoever that what he had done was perfectly "right".  I realize that when you practice medicine, you sometimes end up forcing upon patients (and their families) the sense of value that being alive means everything.  Even if you can't walk or talk or go to the toilet on your own, it's great just being alive.  I want to believe it's true.  We need to make a society that makes this true.  But in reality, I'm not quite sure.  Doctors save lives and feel happy.  But what do they know about what happens to those lives they save?  After all, who feeds the kid for the rest of his life?  Who can guarantee that those lives in developing countries saved by foreign doctors who return home to their warm beds and meals, find the same warm shelter and enough food?  What if the country can't support that many people?

I don't want to forget that it's harder to save lives than we usually think it is.  I want to remember that we can be wrong.  I don't know if I still want to work abroad, but regardless of where I work, I want to live with humility.

leaving a mark

I was folding a paper crane today and suddenly wondered who it was that had first created it.  I don't know how many times I've folded a paper crane; maybe a hundred times or nearly two hundred times, and the question never occurred to me until today.

Since I read The Fault in Our Stars two weeks ago, I've been thinking about the meaning of life for the hundredth time.  The book is about two teenagers with cancer who fall in love.  It's one of the most romantic love stories I've ever known, but what struck me most was the boy's strong desire to leave a mark on the world.  Most of my close friends do not seem to have this kind of desire, and I always thought it was just me.  I guess the desire is pretty evident in the obsession towards fame we occasionally see in our societies, but still, most of my friends are like the boy's girlfriend who he admires because of her uniqueness of not having that arrogant desire.  And I've wondered why.

The boy writes a eulogy for her before he dies, and it shows how he lets go of his own desires -- he comes to the conclusion that most of us can't leave any mark, and even when we do, it's not always a good one; we can cause harm too.  So what's important is not what we can do to the universe, but what we can observe from it.  We're here to listen to what the universe has to say, and accept it as it is.

I almost hated the book because I loved it.  It's kind of embarrassing to admit it, but since I've already mentioned it here in this blog -- I always wanted to be a writer and the dream is not yet dead completely.  When I really like a book, it inevitably reminds me of what I will never be.  It's really embarrassing that I even need to be "reminded"; it's an obvious fact.  So why do I still want to be a writer?  Apart from the fact that I like writing, I think it boils down to that desire of leaving a mark on the world.  If I didn't care about marks, why is it not enough to write a story and keep it private?  Why am I even making this writing public?

I actually found it somewhat contradictory and ironic that a million seller book -- a book that leaves a mark -- insists that leaving a mark is not important.   But what does it even mean to "leave a mark"?

I don't think anyone desires to leave a physical mark.  No one would want a statue of themselves made if there was no one who looked at it and remembered them.  Leaving a mark obviously means leaving a mark in people's minds -- securing a place for yourself in the minds of future people.  A good story touches people's hearts over and over, gives the same experience to countless people even after the author's death.

Having said that, it's only an experiece -- one of the many we all go through in our lifetime.  A story may touch my heart, but there are also so many other things that touch my heart.  Among those many experiences, the story is only a dot in my life.  Of course there are big dots and small dots, dots I will remember for a long time, and those that disappear right away.  But everything, in the end, is a dot that makes up my life.  The nameless person who created the paper crane for the first time in human history, and all the great writers and scientists, and all my ancestors who did or didn't make history -- they are all important to my life in the same way.

A couple of days ago, my French uncle went back to France to visit his ill mother (I met her fifteen years ago when we used to live in France).  I wrote her a letter in French (she only speaks French), and it took four hours.  Maybe I could've done something more productive, something that would've led to leaving a mark on this world or whatever, but today, I received an email from my aunt telling me that her mother (in law) had read the letter aloud and had dropped tears.  She had read it again and again.  Considering the fact that she ususally has no family around her, I knew how much the letter meant to her.  And I thought -- well, even if I can't write a great story like I once dreamed, I can still create a dot in someone else's life.  I may not be able to create millions of dots in millions of lives, but still, there are dots for me to create by living my own life with a bit of compassion.

A movie I just finished watching, Quelques Heurs de Printemps, reminded me of my uncle and his mother.  I was greatly moved by the scenery the protagonist's mother saw as she traveled to the place where her euthanasia was to be conducted.  It was just trees and the blue sky you see every spring, and yet, when I saw it through her eyes, when I thought this was the last sky I was going to see, I felt like I really had to see it properly.  To remember it clearly.  But when you know your memory is only going to last for another few hours, that it's going to disappear with you altogether, what value does it have?  It's always only that moment that counts -- memento mori, carpe diem.

So rather than worrying about how many dots I can create to "leave a mark", I might as well go to bed now so I can enjoy tomorrow -- a new day that will never come back.

three minutes

All I've been writing about lately has been my shadowing experiences but here's another one.  If anyone has felt angry or even hurt by a doctor's insensitive attitude, I want to apologize on behalf and promise I will try my best not to be the same (when I finally become a doctor).

The other day, I shadowed a physician specializing in liver (and the surrounding organs).  One of the outpatients came to get the results of her test and it turned out she had some hepatitic virus in her blood and that her liver had some kind of inflamation.  The doctor wanted to do a biopsy and he needed the patient's consent.  But the patient's daughter asked most of the questions and the doctor's answers were blunt.  The patient just sat there with a worried face, not knowing what to do.  Amidst an awkward silence, the doctor started glancing through a chart of another patient while the patient in front of him thought about the options provided.  I totally understood how busy the doctor was -- he had so many patients waiting; the list went on forever.  His behavior may have been unavoidable for the greatest happiness of the greatest number.  But I could tell he was also in a bad mood (partly because his computer kept bringing up the wrong kanji).  And this is where things started going worse.

He leaned back in his chair, glanced at the patient, and told her that he himself had never caused hemorrhage that required transfusion but that he had seen a horrible case in the past when he had been a resident.  He laughed a bit, and the patient just nodded.  It's of course important to inform the patient of the risks but it's useless to stir up her anxiety with an accident that occurred thirty years ago.  Some doctors bring up so much statistics and even talk about cases of other patients under different conditions.  If the patient wants all that information, she will ask for it, or she could even look it up herself.  What's good about getting informed by a doctor, in my opinion, is that the doctor is not a computer; he becomes a human filter that picks up necessary information for the patient and provides it with consideration towards her feelings.  All she needs is a clear explanation of what the biopsy is for and how it will be done, and what the risks are in her case.  Not the next patient.  When I become a doctor, my duty will be to treat as many patients, but I still don't want to forget to focus on the patient I am seeing at that moment.

The same day, I happened to listen to an interview with Ed Sheeran, and he described how a brief exchange with another singer had changed his life.  It had only been three minutes for that other singer and it might've meant nothing, but it meant his life to Ed Sheeran.  That's why he thinks it's important that he always leaves his personal emotions backstage or in the car.  His fans are going to meet him only once for less than three minutes, and if he acts like a jerk, he might pluck a bud that otherwise would've bloomed as a great musician like himself.  Doctors don't change lives like that.  A liver biopsy being postponed for a week may not change a patient's prognosis.  But I think it's the same three minutes.  "Another three minutes" for a doctor means more than that to a patient.

0~1 year olds

A quick note of nursery shadowing round 2:

1. Kids can tell if you're a stranger from when they're around a couple months old.

2. Kids aren't interested in one another until they're around two years old.

3. They're fine with tasteless foods until they taste all the yummy stuff out in the world.

4. They're more interested in picking at pieces of Velcros on toys rather than toys themselves.

5. Some kids bite their peers when they fight for toys.  (Reminded me of a certain soccer player.)

6. The yellow lines on their diapers change blue when they've peed.

7. You can feel the gelatin in their diapers when they've peed.

8. When they're crying, it's because they need a warm hug or a bottle of milk or they've peed.

9. The reason the nursery staffs don't throw away used diapers and give them back to parents is NOT because the parents check the contents when they get home.  They have to take the diaper to the doctor when the kid is sick but usually, no one checks.  They just stink.  So the nursery has decided to stop giving back wet diapers from next month.

10. Some parents prefer cloth diapers because kids can feel the uncomfortable wetness when they've peed and they learn to use the bathroom earlier than kids with expensive paper diapers.

11. Most kids are messy and have runny nose.  They drool over your shirt and then look back at you with innocent eyes.

12. And they're so adorable it's heartbreaking when you leave them and they start crying.

two year olds

I still remember about the day I stopped crying at nursery school.  Until then, I think I stayed by the glass door and cried as I watched my mother disappear into the distance, but that morning, I went into the playroom and decided that I wasn't going to cry.  The sliding door closed, and I held back my tears as I picked up a wooden block to force myself to focus on playing with it.  I was three years old.

When we moved to New Zealand and I started going to kindergarten, the whole process started all over again.  I cried like mad every time my mother tried to leave me.  I don't really remember when it was that I finally stopped crying.  Maybe it was when Kate came up to play with me.

Today, I went to visit a nursery school as it was part of our shadowing program.  I was put into the rabbit class with 17 cute two year olds.  The hardest part was making them finish their lunch.  They do all kinds of stuff to avoid eating what they don't like: they drop spoons on purpose, drop the food on purpose, walk around the room, stick their hands under your apron to touch your breasts, make faces, and cry.  It's amazing how they change their attitude according to who's helping them eat.  A girl who would keep shaking her head to me would open her mouth when a strict teacher comes to force the food into her mouth.  They can't control their pee, and yet they know how to manipulate college students with huge drops of tears and vague complaints.

One episode that might be worth noting -- a girl I was feeding (Erika) said she was finished and left her seat to pick up her toothbrush, and then the girl sitting next to her started crying, apparently because she thought it was unfair that Erika got to leave her veggies while she still had to eat hers.  It reminded me of a monkey experiment that proved that even monkeys didn't accept unfairness (you can watch it here).

Later when Erika had to get changed for her nap, she came up to me with her bag packed with diapers but instead of giving me a diaper, she handed me a pair of pink undies and insisted she was going to be totally fine with that while she made me take off her wet diaper.  Well, at least she didn't spit lettuce on me!

On a side note, after nap time was over, they were served a cup of milk with their snacks, and I winced as the teacher gave me my cup.  I don't like milk (my mom could hardly breast-feed me).  When I took a sip, it was tepid and it just tasted really bad.  Having to drink it with messy kids made it harder, but what could I say after telling them they shouldn't be so picky?  In New Zealand, I didn't have school lunch, so when I came back to Japan, I told the teacher I couldn't drink milk because I didn't like it.  She told me I couldn't say that.  I didn't quite understand her, but eventually, I learned to accept the only choice.  School lunch does make kids grow up -- physically and mentally.

just the way we are

In today's result-oriented system, almost everything is conditional.  To be worthy, we have to be good at something.  With nothing to be proud of, we're called losers.  With no contribution to the society, we're worthless.  In Japan, we have to be married and have children to be a woman.

About a week ago, a 35 year old female member of the Tokyo assembly was subjected to sexist abuse while she tried to debate support for childrearing (the details are here).  It took more than five days for one of the male culprits to come out and admit the inappropriateness of his remark ("You're the one who should get married").  He did not admit his underlying disrespect to single women with no children.  We still don't know who did the rest of the heckling ("Are you even able to have children?" etc.)

Many Japanese showed anger towards this incident.  But I think the male councillors precisely represent the general Japanese who do think that women should get married and rear children rather than stay single.  These kind of people think of marriage and childrearing as what makes women a full human being, and also what gives them "true happiness".

The declining birthrate is a serious problem.  Personally, I don't understand the feelings of people who avoid marriage because they don't want to "grow up", or because they might "get tired of their partner".  But lack of responsibility is not the only reason why someone is single.  It might not even be their choice.  If it is their choice, it must be a very important choice to them -- a conclusion they came to after overcoming many difficulties in their lives.  Happiness is different to everyone, and we have to respect every shape of happiness as well as every lifestyle.

Apparently, many young people are doing the Shikoku Pilgrimage lately.  During the pilgrimage, they are given free meals along the way from local people.  It's a tradition from hundreds of years ago when pilgrims were called 稀人(rare person).  The local people have welcomed them unconditionally to this day: every pilgrim is welcomed the same way, and as a result, by the time they finish their pilgrimage, they realize that they are worthy just the way they are.

We all want to be accepted unconditionally -- married or unmarried, with or without children.

if i die tomorrow

Another old draft (I've been sorting out my drafts lately):

I daydream daily.  And I sometimes imagine myself being a mother of a small child with only a month left to live.  Of course it's not a very nice scenario, and I have no plan or possibility of becoming a mother in the near future, but I've daydreamed about this situation a couple of times.  I think it's because it gives me a rather new perspective.  It makes me think about what is really important to me when I think about what kind of message I would want to leave my child.  This is the list for now, but I actually think it would be a good idea to update it occasionally.

1.  Always keep in mind what is truly important to you.

Your time is limited.  If you choose to do one thing, you lose the opportunity to do another.  Choosing means dumping.  So in order to live a good life, you need the courage to dump, and for that, you need to know what is important and what is less important to you.
Knowing what is important also helps you control your emotions because you wouldn't be influenced by small things that may go wrong.  If you're depressed, always ask yourself if it's something really important to you.  If you're hit by failure, think about why that matters.  What's your ultimate goal in life?  When you feel like everything's over, try to imagine the bigger picture.
Know what is truly important to you, and it will lead you to the best decision.

2.  Accept yourself for who you are.  Mistakes and all.

Life is a constant process of making decisions.  You are made by the decisions you've made.  But you can't always make the best decision.  There will be some decisions that you regret later, or those that you regret even while making them.  Sometimes you know you will regret it later and still make that decision.  It's difficult to always do your best.  But that's okay.  Even if you made a stupid decision, that was the best you could do.  And the current you is the best you could've been.  Don't think about the could've's and might've's.

3.  Try to do your best but accept your limitations.

Doing your best can be somewhat frightful.  What if your efforts don't pay off?  What if you only end up proving yourself (and others) that you're no good?  What if everything turns out to be a waste?  All these questions are normal, but you just have try, because that's the only way you're going to know what you're good at.  You can't win without fighting.  And if you keep fighting, you might win in the end.  But if you face your limitations, be brave enough to give up and accept that limitation.
If that's what you really like though (maybe to the extent that you do it because there's no other choice), stick to it, no matter what.  Because one day, everything is going to disappear -- this whole universe and all -- and when that happens, all that matters is how much you cherished every moment.

4.  Nothing has to be perfect.

1. to 3. might be summed up to this.  If you realize that you're looking for perfection, let it go.  Always remember to look at the big picture -- what is truly important to you and why.  You can't get everything.  In the end, nothing is permanent anyway, and keeping that in mind also may help you be tolerant towards yourself and others.  Appreciate what you have now.  Don't take "ordinary" things for granted.  Love yourself for who you are now; not for what you hope to be in the future.

5.  Learn a foreign language.  And be fluent if possible.

Your thoughts are made of words.  Language shapes your thoughts.  Learning a foreign language gives you another world to live in, another perspective that would save you, and countless discoveries you would never have experienced with your mother tongue, because by learning a foreign language, you can experience another culture from the inside.  If you become fluent, it's almost like getting another brain.
Fluency comes from reading and writing.  Write, write, write.  Get used to thinking in that language.

6.  Read books.

If you have a question, someone else probably has the same question.  And that someone could even be from another country, another age.  Some people keep records of their thoughts and some of them get published.  Almost every question is answered somewhere by someone in the way that would convince you.  Search for it.  Keep searching until you either find the answer in a book or inside yourself.  Writings that is seemingly unrelated to your current question will help you anyway in the future so don't worry if you think it's a waste of time.

7.  Learn an instrument.

Living in the moment may be easily said than done.  Music can almost give you a blank state of mind and a very emotional experience all at the same time.  It helps you develop concentration -- the power to concentrate on this moment now.  Maybe it's a form of meditation; when you focus all your nerves to your fingers and the sounds they make, there's no space for random thoughts that distract you during other activities.  And last but not least, music is borderless.

8.  Eat well and excercise regularly.

A sane mind comes from a sane body.  Our bodies are made of what we eat and how we use it.  The brain is influenced by glucose level, hormones, and other chemical substance.  Good meals are essential.  Better if combined with good conversation.  And since body muscles are as important as brain muscles, make excercise a habit.  Playing sports also has the same effect as learning an instrument. 

9.  If all the above does not work, and one day, you feel like death is the only choice, get something to eat and get some sleep.  No alcohol.

The reason is simple: no decision made under hunger, lack of sleep, or intoxication is good enough.

10.  If you wake up in the morning, and your feeling hasn't changed, stop focusing on yourself.

Finding your own happiness is not the only goal in your life.  Live to make others happy.  There is always someone in need of good company -- someone who needs another person who really understands his hardships.  If you're thrown down to the point of wanting to die, you will know what you can do for him.
Dying is never too late.  So leave that option for later.  Don't dwell on things you can't do anything about.  Even amidst regret, jealousy and despair, there is something you can do.  It may seem trifle; it might be something anyone can do.  But live until you find it.  Because eventually, you will find it, and it will mean something to someone else.

reunion

This was an entry dated July 8, 2013, around the time I went on hiatus.  Found it in my drafts:

Without the time I spent in New Zealand, I probably would have been a very different person.  It was where I first learned English.  It was where I learned that I was "Japanese".  It was where I learned it was only mongoloid kids that had blue butts.  And it was where I first went to school and made friends and "fell in love" with a Michael who lived nextdoor.

The past weekend, I met up with a friend from New Zealand whom I hadn't met in eighteen years.

The very first time I met her was at a uniform store.  We were both with our parents, buying shirts and skirts and gym clothes, and had the same problem with the size: When you're growing, you don't want to buy anything that's too big but you want something that would still fit you after a year or two.  As a result, you end up trying on T shirts that are too big.  I pulled at the extra piece of cloth that hung under my arms.

In another fitting room, another girl was trying on the same shirt, pulling at the cloth that drooped over her thin arm.  That was her.  According to my mother (who remembers the incident more clearly), the little girl followed her around and asked where we were from.  She was so intrigued to see these Asian people who looked different and spoke differently.

The next time we met was on the first day of school.  Her seat happened to be across from mine.  She was so ecstatic to see me that it almost scared me.  I never thought she would be my best friend for the next two years.

When I think about her now, it's still the little girl with big ears and freckles wearing a sleevless check dress under the cloudy winter sky.  We hadn't been in contact in years when we found each other on Facebook.  Her father had died but she still had the portrait of the five-year-old me my dad had painted, which had ended up at her place for some reason.

When I saw her at the hotel lobby last weekend, I recognized her right away.  She hadn't changed at all -- even the size of her head!  Well, she'd gotten taller and she'd developed some really nice breasts but that was about it. She probably thought the same about me (except the breast part). I was more worried about what kind of person she'd grown up to be, but she hadn't really changed inside either.  Maybe she had; maybe we just couldn't catch up enough to realize the change; maybe there were some moments we felt distant, but she laughed the same way.  And she remembered what I remembered.  In a world where almost everything keeps changing, it's nice to find that certain things stay the same.

formula of life

Yesterday, I had a role playing class in which I had to play the role of a doctor who had to persuade his unconfident patient to work on losing weight (because the physical checkup showed that she had borderline DMII and metabolic syndrome).

To be honest, I was a bit shocked when I saw the demonstration weeks ago.  We were first told to praise the patient for writing his own self-monitoring sheet and to show appreciation for his every effort.  Doctors should never deny what the patient says (we just accept it and nod with an understanding attitude) and we patiently suggest what might be a good method for the unmotivated patient to lose weight while he complains why he is unable to do such and such.  This all seemed too much to me.  I mean, we're talking about the patient's own health!  Why does the doctor have to show appreciation?  It's first and foremost the patient's responsiblity.  I'm really interested if this is a very "Japanese" class or if doctors abroad are also expected to treat their patients like "clients".

That said, I am prepared to do whatever it takes for a patient's health.  So in yesterday's class, I did exactly what I was told to do, and the supervising doctor pretty much loved my act but commented that he would not want to get in an argument with someone who talked like me.  One of my peers told me he wouldn't want to see me next time if he had been the patient and had failed meeting the set goal (which was simply not to lay out snacks in the basket where she could see them).  He said he would seriously consider changing hospitals in the case of failure.  According to the doctor, I was straightforward, eager, to the point, and was really good at casually cornering the patient into a situation where she could no longer say no.  In short, I was talking more like a lawyer than a doctor.  I have yet to see my "legal background" come into good use...

So do I consider my previous education a waste?  This is not a question I've ever really asked myself because it's nonsense.  I am aware that going the long way was partly necessary for a human being like me, and I just happened to pick up a law degree along the way.  But of course, if there had been a way to avoid all the twists and turns, I would like to know.  I actually asked this question to another blogger who seemed like an efficiency-prioritizing father very much devoted to his son's education:

...But many student do change their mind after entering college. In some cases, they gradually realize what they really want is different from what they had thought they had wanted. So my question is, do you think there is a way to avoid this kind of "mistake" and to know your calling at age 14 or even younger? In other words, is there some kind of formula we can use to lead an "efficient life" without having to go the long way?

He gave me a response that made me realize (again) how lucky I am to have had parents who provided me with good education so I could choose whatever I wanted to do when the time came, but my own question led me to another train of thoughts.

As a child, I never liked memorizing formulas -- I would pretty much obsess over how they came to be and get kind of upset when I didn't understand.  But my mother told me I would realize some day that those stuff were not really important in living my life (unless I was some kind of genius who planned to live in academia).  If I could pass my exams required to do what I ultimately wanted to do, then it didn't really matter if I fully understood everything.  She repeatedly told me my life wouldn't end just because I didn't understand!  In fact, life goes on no matter what.  Formulas were created by smart people -- boneheads can leave the difficult part to them and just use their legacy without furthur thoughts.

Although our lives can't be determined by a simple math formula, it seems to me like some people are good at living their lives according to a kind of formula.  They are flexible and some of them use it in a creative way to lead an efficient and happy life.  On the other hand, I'm still not really good at "accepting" an existing formula right away and using it.  I have to experience trial and error to confirm that the formula is "right", or maybe it's like I'm trying to create my own formula.  Either way, it's not that different from how I used to write down all the thinking process that would lead me to a formula I had learned.  It's luxury; it was only possible because I could find the time one way or another -- the time to probe into matters and take them hard.  My mother still has to tell me that's not the only way to live a life.  "Self cornering is not the only philosophy," she says.  "You don't have to be special.  Being mediocre is enough.  You ask too much from yourself."  I totally agree.  If I ask less from myself, I would ask less from my patients, and then they wouldn't have to change hospitals just because they can't stick to a small goal.

A formula I should keep in mind: no one is perfect = everyone needs an escape

ocd & perfectionism

If anyone remembers the post about my perfectionism, I am still suffering the same "symptoms" though they have become better gradually.  I'm doing psychiatry right now at school and have come to the conclusion that I am a borderline OCD-related perfectionist.  When I realized my "symptoms" were OCD-ish the other day, I looked up "OCD and perfectionism" right away, and the articles that came up made me feel like I had finally found someone who understood me.  Whenever I looked up perfectionism, the descriptions never felt quite "right", nor did the descriptions of OCD.  I don't know why I never linked the two together until now.

Here are some abstracts from the articles:

OCD & Perfectionism

OCD leads you to think too much and this leads you to compulsions. Set a timer and when the alarm goes off, be impulsive and stop what you are doing. Go do something else. Plan ahead so that you know what is next on your schedule. You can say something like: “This will need to be good enough right now. Tomorrow I’ll pick up from here.”
→ I have been trying something similar over and over for the past year!

 “Part of who I am is my perfectionism. I’ll lose my identity. I want to continue to achieve, be organized, be detail-oriented, and be determined. I don’t what to change who I am.”
→ I have said this before more than once!

Refocusing on what matters in your life can be helpful.  Life is meant to be enjoyed despite mistakes and problems.  At the end of the day, what do you really care about? If it is happiness through perfection, you may wish to refocus and resolve that happiness is a state of being and mind. It’s an attitude.  You can choose to obsess, redo, and worry. Or you can chose to spend your time on what really matters.
→ This is exactly what I have been saying to myself for the past year!

Perfectionism: Are you sure it pays off?

Perfectionists report that they usually are identified by others as being detail oriented
→ I don't know how many times my parents have told me not to focus on the details!

Everything is Equally Important: Because perfectionists want to do everything well, they have a difficult time prioritizing tasks.  All tasks seem equally important, and the same level of detail, effort and energy is brought to all tasks.  If you asked a perfectionist to identify some tasks to complete at 100%, some at 80%, and some at 50% they have a difficult time moving tasks out of the 100% category.
→ This is exactly my problem!

if you projected yourself into the future and look back, what would you like for your life to have stood for?  What do you want to be remembered for?  Based on this then, one begins to form their A list (tasks to be completed at or near 100%), a B list (tasks completed at 80%), a C List (tasks completed at 50%), and an F List (what to let go).
→ Again, I have been trying to do this for the past couple of months!

Repetition Until it Feels/Looks/Sounds “Right”:  Because tasks have to be without mistakes and feel/look/sound “right”, perfectionists tend to over edit, review, and repeat compulsively.  This behavior is also intermittently reinforced as a teacher or boss will say that it was the best paper/report in the class/office.  It is unacceptable for a perfectionist to let others see “rough drafts” or “works in progress”.
→ This is another problem of mine!

OCD and Perfectionism

Finally, unhealthy OCD perfectionism may help to perpetuate obsessions. For instance, like many people with OCD you might believe that you must have complete control over your thoughts. As such, when a bizarre or distressing thought pops intrusively into your mind, you label these thoughts as dangerous because they are out of your control. This causes you to monitor the thought even more closely, which can help to create an obsession.
→ I could never decribe this symptom better!

Practice Giving up Control: As part of cognitive-behavior therapy and/or exposure and response prevention therapy, you may be asked to participate in exercises designed to build your capacity to tolerate a loss of control. This can involve being prevented from checking something or adjusting something until it is "just right." Although this can initially be extremely distressing, over time you will gain more confidence in your ability to tolerate a loss of control.
Adopt a Mindful Stance: Mindfulness emphasizes being less “invested” in our thoughts. Accepting that we have less control than we think over our thoughts can be very helpful in reducing the distress that often accompanies intrusive thoughts. Mindfulness meditation exercises can help to promote a more objective awareness of our day-to-day thoughts and emotions.
→ This is exactly what I need!

Anyway, if anyone reading this feels like they're reading about themselves, here is a list of signs that show you may have OCD-related perfectionism.  In my case, sign#3 (rereading passages multiple times in order to make sure I’ve understood them properly) began to surface when I started studying for university entrance exams and instead of avoiding to read (like it says in sign#4), I read and read and read, trying to overcome the symptom and actually, it kind of worked, though I'm still super slow with calculations -- I was by far the slowest in class when we had to do a speed calculation test for our pharmacology experiment.  Also, when I understand something too quickly (especially when others seem to have difficulty) I tend to doubt that I really understand it; I keep asking myself if I really thought it over and understood it "fully" and it's really tiring because I never know what the "full comprehension" is or what it feels like, and even if there is such a thing, I know it is often times not required to be able to "function".  The passage below almost gives me a sense of relief!

Even though your mind seems to tell you there is such thing as “achieving perfection,” don’t believe it! Your OCD is lying. Sometimes clients say, “There are times I feel like I’ll turn over the leaf of uncertainty once and for all.” Unfortunately, it doesn’t happen.

The reason I say I have "borderline" OCD (when it definitely has caused some pretty strong anxieties) is that I usually don't care that much about what others think of me and thus I don't have a morbid fear of making mistakes, nor have I missed a deadline due to procrastination or the all-or-nothing spirit described repeatedly in the articles.  In short, my OCD has not quite bothered me to the extent of getting in the way of my necessary work.

I must say, however, that I am very glad to have reached a "perfect diagnosis".

falling in love at 85

Today, I was sorting out my mailbox and some old messages I sent to my crush (during fights) came up.  I was terrified.  Some messages were awful and just really terrifying that I actually started laughing.  (I'm glad he's still my good friend.)  Later that evening, I heard a rather heartbreaking (but at the same time funny) story from my mother:

My grandmother takes 気功 lessons (it's a kind of Chinese exercise) and she fell in love with the instructor.  The problem was, he didn't like her back.  Well, at least not in that kind of way.  And to make things worse, it got a bit complicated because my grandma ended up confessing due to jealousy.  Two weeks ago, she and the instructor and this other woman (we'll call her Satoko) had lunch together, and the instructor ate Satoko's pickles.  My grandma told the instructor not to (it made her jealous for some reason), and he asked her why.  Later that day, he called my grandma to tell her he thought she was being a bit mean to Satoko.  And that really hurt my grandma.  (She also didn't like the fact that the instructor seemed to pay extra attention to Satoko which is probably because she has some mild aftereffects of a stroke.)  So she decided to write this looong letter saying how much of a great person she was -- she had never ever been mean to anyone -- and she wrote down all her life time accomplishments, how she had raised three great daughters, how great their husbands were and so on, ending the letter with a list of people she had recruited to the 気功 club and insisting how much she had contributed to the growth of it.  She also asked the instructor to "treat all students fairly", confessed her feelings for him (that was the main part actually), and faxed it.

The instructor wrote her back, but he didn't really know how to use the fax machine, and this is where things went out of control.  His letter didn't reach my grandma, and so she got really upset and mad and sent more letters and started saying bad things about him behind his back.  She was awfully depressed and couldn't do anything by herself.  She was thrown into multiple panic attacks -- she would suddenly forget how to stop the fire while she was making tea -- and was getting extremely forgetful in general.  So my mom ended up calling the instructor to talk to him and asked him to send the fax again.  His response was a bit cold anyway ("I like your bright smile, BUT I am only your instructor; every student is equally important to me"), and my grandma is now so embarrassed that the whole family knows the story (though I don't think she expects it to have reached all the way down to me!) and she just wants a hole to hide in.

When I heard all this from my mother, the first thought that came to my mind was -- wow, maybe I inherited that terrifying-letter-writing gene.  But the next thought was, I wonder if I would still fall in love when I'm 85.  I have a hard time falling in love even now.  I mean, I guess I was kind of obsessive with my crush, but he was really an exception; I'm actually almost sure that I will never be that way with anyone else.

continuing and gaining trust

（大切なのは）当たり前のことを当たり前でないくらいやり続けること
(The important thing is) to continue doing ordinary things for an extraordinary period of time.

- Shinya Miyamoto （宮本慎也）

This habit trains you to have a stronger will.  Motivation apparently doesn't last -- your will is the power to continue when you don't have the motivation.  Many athletes (such as Ichiro Suzuki and the baseball player above) have achieved their goals not by motivation but by this strong will.

I think continuing certain things under any circumstances also gives you confidence.  It's like keeping a promise to yourself.  When you keep breaking it, you eventually lose trust in yourself, but if you can keep it every single day, it proves yourself that you're worth trusting -- which means you have confidence.

I've had a vague impression that this kind of confidence has a lot to do with "the power to endure" I had written about in my last post.  To endure the current unsatisfying state, you have to believe in your future self -- that she will be better and thus the future will be better.  To trust in your future self, you obviously have to trust your current self, and the above habit of continuing seems to be the key.

I've actually been trying to live a disciplined life lately (if that doesn't sound too funny), sticking to several things and making them a habit.  I'll report about the results after a couple of months!

patience and tolerance

An old draft -- posting because it reminds me of important stuff:

I've noticed lately that it gets harder and harder to stay friends with some people from high school.  After all, you're not in the same school anymore.  You start going different ways and your perspective changes.

My current best friend O from high school was not my "best friend" when we were in school.  We became closer after graduation because our life stages and our basic attitude towards life and work happened to match.  We once agreed that other people's happy rosey stories could sometimes be hurtful when your life was not going well, and O has opened up to me even more ever since. 

I have a bitter memory from a couple of years ago (which I think I've written about before): I met up with another friend from high school and she made me feel like the ugliest living being on earth.  She was happy with a bright career, a caring talented boyfriend, and talked about her future daughter who she hoped would model for her painter husband -- while I, on the other hand, had nothing but a new dream.  I wanted to be happy for her; I wanted to stop comparing and just be happy for this happy friend but I couldn't do anything about my ugly feelings.

Obviously, there are ups and downs in life.  I'm not going to break a friendship every time I feel left behind.  I've noticed that avoiding certain people during certain times is one way to keep peace.  But apparently, the reason we compare ourselves with others in the first place is because we're arrogant and we forget to appreciate what we have.  I didn't think I exactly lacked appreciation when my heart turned ugly, but I definitely wasn't happy with my own life, which might mean I did lack appreciation.

So why wasn't I happy?  The question reminds me of what my professor in grad school said to us in our first Chinese politics class:

勉強の肝は「わからない状態に耐える力」である。今までは何でもすぐに理解できたかもしれないが、勉強が高度になればなるほどわからないことがたくさん出てくる。その時に、性急に答えを求めずに耐えることを覚えなければならない。
What you have to take to heart is "the power to endure when you don't understand".  The more complicated your studies become, the more you will encounter things you don't understand.  Do not hurry to the answer when that happens; endure the situation.

I guess the important part was that he was talking to students who had always been able to get to answers fairly easily and thus lacked patience.  He was warning us that that was not always going to work from now on.

I actually still tend to hurry to get to answers; it's almost like I fear the state of not being able to understand.  And maybe that is reflected in my whole attitude towards what I aim in life -- if I want something, I want it now (which ironically shows how lucky I've been).  But if I could grow this "power to endure", I will probably appreciate everything I already understand, everything I already have, and be happy even when I can't have what I want.

sense of worthiness

Tonight, I listened to this talk by Brene Brown, recommended by a friend.  I've mentioned her book a couple of posts ago, and what I didn't like in the book, I didn't like in her talk.  Frankly speaking, I think she tends to dramatize her so-called breakdown.  But maybe that's just because I'm Japanese and sometimes every sentence spoken by an American can sound exaggerated (no offense; it's just a cultural difference).  Either way, that's not what I want to write about.  Below is breifly what she says (for people like me who aren't really interested in her personal stories but still want to know the essence of her talk in five minutes):

We all live for connection, but there's an obstacle called shame.

Shame = fear of disconnection.
"Is there something about me that if people know or see it they would think I'm not worthy of connection?"  The feeling of "I'm not smart/thin/pretty/promoted enough."

But in order to let connection happen, we have to allow ourselves to be seen.

People who have a strong sense of love and belonging have a strong sense of worthiness -- they think they are worthy of connection.  These people have
1. courage = the ability to tell the story of who they are with all their heart; the courage to be imperfect
2. compassion = the ability to be kind to themseves because we can't practice compassion with others if you can't treat yourself kindly
3. authenticity = the willingness to let go of who they think they should be in order to be who they are

Connection is the result of the above three.  Those people with a sense of worthiness embrace vulnerability and believe that what make them vulnerable make them beautiful.  They know the necessity of the willingness to do something where there are no guarantees.

The world we live in is a vulnerable world.  So we numb vulnerability with addiction and whatnot.  But we can't selectively numb feelings without numbing other emotions so we end up numbing joy, gratitude, happiness, everything.  We struggle to make the uncertain certain, to perfect ourselves and our children (when in fact, they are wired for struggle when they get here and our role is to tell them they are worthy of love and belonging despite their imperfection), and to pretend that what we do doesn't affect others.

Instead, what we should do is to let ourselves be deeply and vulnerably seen, which means
1. to love with our whole hearts even if there's no guarantee
2. to practice gratitude and lean into joy in those moments when we're wondering: Can I love you this much?  Can I believe in this so passionately?  Can I be this firece about this? -- just to be able to stop and instead of catastrophizing what might happen, to say I'm just so grateful, because to feel so vulnerable means I'm alive.
3. to believe that we're enough.  Not when we're perfect, but just the way we are. 

...So how do we believe that we're enough?  I get it that if we feel worthy, we can allow ourselves to be vulnerable and hence find connection.  But how do we believe we're worthy?  This was the question I was left with.

The word worthiness hit me strong because the moment I heard it, I knew it was exactly what I lacked when I did what I most regret in my life: sleeping with someone I didn't even like.  It was just once, but the regret has haunted me for years.  I knew a guy was drooling over me, thought I could use him to make myself feel worthy, and ended up feeling used, probably because I let it happen when deep down my mind was actually saying no.  It's the most foolish thing I've ever done, and one of the saddest stories I've ever known --  I was not brought up by parents who loved me only when I was perfect.  They always, always loved me, no matter what, and still, I took their love for granted and thought I was not worthy of anyone else's love.

I don't think about it anymore, but when I do the pain is excruciating -- my imperfection regarding this mistake is almost unacceptable, though at some point I realized there was no other choice but to accept it and move on.

As a result, I no longer suffer to find the reason of my worthiness, but I still think it's impossible to love myself unconditionally.  I mean, you can't just sleep all day, do whatever you like, and say, well, that's me, I love who I am!  I know all I can do is to do what I can, keep doing what I must do to accomplish my dreams, however small or big they may be, and just do my best every day, because that's the only way for me to feel worthy.  At least, that was how I lived my life when I was still very young and never knew what it was like to hate myself.

no need to give up

Where there's a will, there's a way

When I was around twenty, I was invited over to my friend's place where she homestayed for just over a year.  The hostparents were a young couple with two little kids.  They -- especially the father -- didn't hide his strong interest in me when we met.  Knowing where I went to school and hearing my English (my friend was American), he seemed to see me as an ideal daughter he wished his own daughter to grow up to be like.  When I said I wanted to become a fiction writer, he said it was もったいない meaning "You would be wasting your talents."  It gave me a brief shock, because at that time, I was almost willing to give up everything else if I could support myself as a professional writer.  It never occured to me that I would be wasting something -- losing other opportunities -- to spend my life (not necessarily my whole life but even part of it) on writing.  During the following years, I thought I started seeing what he meant.

While studying to become a doctor can be sometimes tedious, I never feel like I'm wasting my time.  If I only help one patient after I become a doctor, that probably wouldn't matter.  I studied all this time, just for him.  Writing and other artistic jobs, on the other hand, can be more difficult to measure their value.  I still sometimes wonder if I'm just wasting my time when I practice my guitar for more than two hours.  There's a limit to what you can do in a lifetime.  Since you never know if you're going to be good enough, you might as well give up on art altogether unless that's all you can do, just like the father implied.  Really?

I came across an inspiring interview today with Ryu Goto, a classical violinist who was known as a prodigy.  Does he still play the violin because that's his only choice?  No.  He holds a Harvard degree as well as a black belt in karate.  He tells us all that it's okay to be (overly) ambitious.  You don't have to choose one thing and stick only to that (you can listen to the interview here though it's unfortunately in Japanese):

今の時代の我々は、夢を一つもギブアップしなくていい。ちゃんとプランニングをすると、後回しにしないといけないこともあるけれど、ギブアップはしなくていいんだと思う。夢はいろいろあって、どれ一つとしてあきらめたくなかったので、一つ一つこなしていくことにした。０．０１％でも前進していればいつかは夢にたどり着く。死ぬまでに夢を成し遂げることができるのかと疑問に思うこともあったけれど、今のテクノロジーの進歩を考えたら、まぁいいやと思った。夢は僕にとっては夢ではない。夢はいつか起きること。ただ起きるだけ。100％起きる。夢を信じきっているので、何があってもそれはすべて夢への過程。全体像を見ると、すべては肥やしになっている。何があっても前に進んでいる。＜中略＞意志さえあれば方法はあると考えて、時間はかかってもあきらめなくてもいいわけだから、とにかくいつかはそれが完成するので、それまで毎日ただ少しずつ頑張るだけ。

"A dream, to me, is not a dream.  It's something that happens.  No matter how long it takes -- some things you might have to put on the back burner for a long time -- but as long as you take one step at a time, it's eventually going to happen.  You don't have to give up."

iron will

"That's not your duty.  That's your ambition."

Tonight, I watched The Iron Lady, the movie about Margaret Thatcher.  I thought its main focus would be on what she accomplished as a prime minister but it was more about her as also a mother and a wife -- a normal fragile human being with regrets and fears and pain.

The film surely tells us that her priority had always been public service.  She always knew what the nation needed, and she had strong faith in what she was doing.  No critisizm wavered her courage.  She was always correct and brave and just perfect.  Regret and fear seemed like the last thing she would feel.  But as she suffers dementia and has conversations with her dead husband in her hallucinations, she feels the weight of the sacrifices she had made in order to pursue her career, and also remembers the pain she had to go through when resigning.

Earlier this evening, I had a call from a friend and during the conversation she told me what she felt about med students in general -- they had too much pride and were too cold and superficial.  She had a problem with a certain guy in particular who tried to look good in front of everyone.  I don't know him in person, but from what I heard from her, it seemed like he didn't have his own mind.  He lacked confidence.  He reminded me that not knowing what is truly important to you really makes your life complicated and painful.

Thatcher never lacked confidence.  She knew what was important to her, to her nation and the people.  She acted faithfully to her own principles and still, she faced (at least in the movie) the pain caused by her own choices.  After all, being a prime minister was not her duty; it was her ambition.  And as satisfied as she was while being in the position, she wonders what all the painful decision-making had been for when she nears the end of her life.  All her past accomplishments seemed to fade away before her current regret towards her family (or husband in particular).

The Iron Lady reminded me of another movie about another female political leader -- The Lady (about Aung San Suu Kyi), and I think both women share the same kind of regrets resulting from their iron will.  Correct decisions so often seem almost like a mistake in hindsight.

So life is painful either way -- with or without confidence and convictions.  If one is destined to regret, probably anyone would rather regret a decision made according to his own principles.  But if that means sacrificing the people he loves, perhaps not everyone can be as strong as the two women.

the aesthetics of life

...It was a work of art and it was beautiful because he alone knew of its existence and with his death it would at once cease to be.

- W. Somerset Maugham


April's half way gone and this is my first post of the month.  The reason I haven't been writing is simply because I didn't have anything I wanted to write about -- probably because I was busy not only studying neurology but also practicing the guitar.

Surprisingly, this may be the first time I mention my guitar in this blog.  Music, for the most part, has always been a big element in my life.  The piano was the first thing I said I wanted to take lessons for.  I was four years old then, and took lessons till seventeen.  I never had any questions about it.  It wasn't always fun but I did it because I liked it.  I started the guitar a few years before I stopped taking piano lessons.  I couldn't bring my piano with me when I moved away from home for university, so I mainly practiced the guitar from then on.

But I was never passionate about it as much as the piano.  Maybe because I wasn't so passionate about music itself anymore by the time I graduated high school.  Now that I think about it, the reason is pretty clear: I started playing the guitar under the influence of a friend whose music abilities kept reminding me of my own limitations.  I just knew I could never be like her.  It was not a matter of effort.  I didn't have her ears.  After ten years, I can now tell the chords if I hear a song, but I can never learn a whole guitar piece by ear.  Nor do I have any creativity.

When I realized that, a question that had never bugged me started to raise its head: What's the whole point?  If I can play Chopin's Ballad No.1, that's great, but a bunch of other people can play it.  They would play it much better than me.  So why go through the trouble of learning twenty pages of music?  What do I gain?  What do I create?  What is there to be left if I die tomorrow?

I never put my question into words, but this feeling was probably what drove me away from music and pulled me towards writing instead.  When I was writing, I was sometimes intoxicated with my words -- no matter how useless they were, I was creating something and they would still be there if I died tomorrow.  I was looking for a meaning in life, meaning of my own existence, meaning for everything.  I was almost breathing to explain why I was breathing.

Tonight, as I went through the music sheets with frustration, the same question popped in mind.  More clearly than ever.  Why do I have to play this when so many other people can do it better?  Isn't it just another waste of time?  And of course, this question leads me to the ultimate question: why am I living my life?  So many people can do so many things better than me.  What's the point in me doing it?  Can I leave anything behind when I die?

I still have no answer.  But right now I don't think it's important anyway.  One day, the sun is going to burst and everything will disappear.  Or at least, everything will cease to be the way it is today.  Nothing is permanent.  So what does it matter if I leave nothing behind?  The obvious fact is that all we have is this moment.  Who cares if a billion other people can play the guitar better than me?  I pluck the strings because I want to.  It fills my heart with joy and lets me appreciate the moment for what it is.  No past, no future.  No greed or anxiety.  Isn't that enough?

Now I think the aesthetic nature of music also lies in that when the last note turns to silence, the whole piece disappears, leaving nothing solid behind, just like every moment of my life will cease to be with my last breath.

mistakes done

"What do you really want?"

After two days of sewing blood vessels together under the microscope, I didn't feel like doing anything today so I watched a movie: The Words.  My father had told me I would like it, and he was right.

The story is like looking at someone in the mirror looking at someone in the mirror looking at someone in the mirror; it's about a writer (Clay) delivering a story about a writer (Rory) who stole a story from another writer (the old man).

When he is still young, the old man loses his daughter to illness, and the relationship between him and his wife starts to fall apart.  He endures the lifetime pain by writing about it.  He gives the writing to his wife to read but she ends up losing it.  The old man loved the words he had written so much he had to end the relationship with his wife, the very person who had inspired him to write in the first place.  He sees her once again years later with another man and their child and that's the end of his story until many more years later when he finds his words published under the name of another young man.

Rory, when he finds the story in an antique briefcase he had bought in Paris, is suddenly terrified that he will never become what he wants to be.  The story hits him with such great power that he is forced to accept his limitations.  After he meets the old man (the old man had followed him to tell him "the truth"), he wants to take his name off the book and "put everything right", but is told to live with the choice he has made.  He stole a part of the old man's life; now he has to live with the pain, even if that destroys his most precious things.  "We all make our choices.  The hard part is living with them."

The ending suggests that Clay is Rory, but we never know.  The movie ends almost abruptly with a female student (who Clay has invited over to his place) asking Clay what he really wants (when he tells her to leave soon after they start making out).  I don't think it was only me who felt like being thrown into a deep well.

The theme is sort of the same as Crime and Punishment, but I could relate so much more to this story.  Mistakes sometimes sting so badly.  But you can't always make the right decision.  Life comes with life changing mistakes you can't undo.  Maybe the only thing that can make us feel better is that we're not alone.  We all live with a bit of dark shadow in our hearts.

wholehearted living

Dance like no one is watching.  Sing like no one is listening.  Love like you've never been hurt and live like it's heaven on Earth.

- Mark Twain


Today I read The Gifts of Imperfection (by Brene Brown).  I know a lot of people like this book and say it changed their lives; that's exactly why I decided to read it.  Halfway through the book though, I wondered if it was worth finishing.  I'm going to be honest about it because the book talks so much about how important it is to be true to yourself rather than to seek approval of others and fitting in.

To me, the book was abstract (despite the fact that it had a fair amount of examples drawn from the author's experience; unfortunately I couldn't really relate to them), there were too many definitions (though I understood the importance of them), and it just didn't speak to my heart.  Maybe I've read too many self-help materials that I've become numb.  Maybe my expectaion was too much.  Maybe people like me don't read self-help books in the first place.  At any rate, I wouldn't have bothered to leave a note about it if it hadn't been for the last chapter where she talks about dancing:

...there is no form of self-expression that makes us feel more vulnerable than dancing.  It's literally full-body vulnerability. ...(but) you can see this desire to move in children.  Until we teach our children that they need to be concerned with how they look and what other people think, they dance.  They even dance naked.  Not always gracefully or with the beat, but always with joy and pleasure.

As a kid, I loved dancing.  I took ballet lessons and I remember being comfortable enough to dance in front of my classmates at least up till seven.  Now I never dance.  One reason is that dancing is not prevalent in the Japanese culture.  Schools never have dancing parties.  The Japanese in general are not used to expressing themselves through dancing and I am no exception.  But there was a time in my life when I was not embarrassed at all.  So I must have changed, no matter how much I claim that I usually don't care too much about what people think about me.  And if that -- measuring my worth on the scale of others -- is getting in the way of leading a wholehearted life, I will probably go back to the book again someday when I really realize that.  Right now, I have a vague feeling that my problem (if there is any) lies somewhere else.

As I was talking to my mother about the book though (I thought about the problems she was facing while reading the book), I came up with a single idea that seemed very convincing.  I've been struggling to find some comforting words the past couple of months, resulting in some pretty nasty fights every time my mother dwelled upon the fact that her life seemed so meaningless.  I thought: well, that's what life is; it's meaningless and it's painful and empty but you live it because that's life.  But today, as I was talking to her, I said something I might want to say to my future self when I hit my own mid life crisis:

Now that you look at how your picture has turned out to look like, you might be depressed to find out that it doesn't look at all like the picture you had in mind or the ideal picture you've suddenly created in your head, but when you were painting the picture, you probably always chose the best color and the best brush every time you added a stroke.  It was always the best stroke.  Even if it seems like a mistake now, it doesn't change the fact that it was the best in that moment, no matter the reason.  There was a meaning back then, and if you can't find it now, it doesn't matter.  Love your picture as it is because it's the best picture you could've painted.  It may not be perfect but there is no such thing as perfect -- if your "perfect picture" had been the reality you would've found that imperfect anyway.  All we can do is live in the moment.  You can't really control the ultimate outcome (in many cases it will not fit your ideal image) but it's still something worth loving because it's the result of those moments you lived that you could not have lived better, no matter what you think of them now or what you thought of them then.

In short, maybe it's almost like the mere fact that you made a certain choice makes that choice good enough -- if that makes any sense.

of human bondage

It might be that to surrender to happiness was to accept defeat, but it was a defeat better than many victories.

A quick note since I just finished the book:  Life has no meaning; it's just like a pattern of a Persian rug woven for no end but the pleasure of the weaver's aesthetic sense.  Anticipation of an ideal pattern, untamed passion beyond reason, sense of shame, severe poverty all become bondages -- obstacles that prevent you from weaving your own "perfect rug".

The protagonist's morbid obsession towards his unrequited love seems to emphasize the human nature of having to live under lack of satisfaction.  Current unhappiness is always unconsciously ignored because the future by definition is bright -- there is a perfect pattern somewhere, waiting to be woven.  The empty cup is always waiting to be filled.  Anticipation builds.  Except that that future never comes.

It's always now or never.  What you should do to weave and complete your ideal pattern (which in fact may be designed by thoughts instilled in you by other people) is not important.  What matters is what your own heart desires now.  Now is the only time you can liberate yourself from all bondage and be free.  And if you can find happiness there and then, if you can allow yourself to do that, the rug you're weaving is better than any other rug you pictured with your lofty ideals.

I think it was one of the best books I've ever read.  I had so many parts I could relate to that it was almost like reading my own thoughts and following the path I've been walking for the past decade.  I'm glad I read it now and not sooner or later in my life.

 

On a side note, I realize the title was taken from Spinoza's Ethics but I'm wondering why the Japanese title means human bond instead of human bondage.  I'd appreciate it if anyone could give me some insight.

aging

Spending a lot of time with my mother and grandmother during spring break, I have realized little by little what aging means: my mother is facing her mid life crisis and my grandmother is almost on the verge of becoming senile -- both my future self if I live long enough.

This morning during breakfast, my mom talked about a conversation between a woman who lives in the same apartment building.  My mom and her are both housewives, but when my mom used to work as a language teacher, the woman used to ask her why she worked so hard.  She asked how much she made with one lesson, and saw no value in keeping oneself busy for so little money.  "We can't do anything much.  We shouldn't expect too much from ourselves"  she used to say.  Every time, my mother thought: I'm different.

But now, she is having difficulties accepting the reality, that she was no different in the end.  She was just one of the many housewives and the realization kills her with regret, shame and bitter feelings.  I can say very little to her that makes her feel better.

On the other hand, my grandma had a very fulfilling life career-wise.  But since she is not used to doing the housework (my mother always helped her with that since she was a child) she finds it difficult to do it now.  She has also become increasingly forgetful.  She still enjoys dressing up and cares a great deal about how she looks, and she also notices small stuff like the small pimple on my forehead (which she insisted was growing: "Are you just going to let it get fatter?") and whatnot, but spending time with her really teaches me what it means to get close to death.  I guess it's a process of losing -- losing memories and skills/abilities and precious people you could share your memories with.

I felt slightly emotional as I watched her practice putting on her pearl necklace she had to wear for a funeral.  Although we discovered that she could do it when she brought the clasp in front of her, she insisted she could do it with the clasp at the back and kept trying.

Looking at it from the other side though, it's the process of learning again, which rewards her (and those around her) with the joy of reaching a small goal every time she finds a way to overcome her new difficulties.

Life is maybe an endless learning process until the very moment death picks you up.

on death and dying

Death is just a moment when dying ends

-Montaigne

Finished reading On Death and Dying by Dr. Elisabeth Kubler-Ross.  It's a study on death and dying -- how each individual patient copes with his last yet greatest ordeal in life.  It contains many dialogues between the interviewers (the author with the hospital chaplain) and the patient who found  the interviews as a chance to let out their suppressed concerns and emotions as well as to teach the medical professionals and pass something on.

Several things I want to remember (mostly from the last two chapters):

1. Terminally ill patients are aware of the seriousness of their illness whether they are told or not.  Those who are not told explicitly know it anyway from the implicit messages or altered behavior of relatives and staff.  Those who are told explicitly appreciate it unless they are told coldly and without preparation or follow-up, or in a manner that leaves no hope.

2. Leave hope when telling the truth.  No matter the stage of illness or coping mechanisms used, all patients maintain some form of hope until the last moment.

3. We have to take a good hard look at our own attitude towards death and dying before we can sit quietly and without anxiety next to a terminally ill patient.  The most important thing is to let him know that we are ready and willing to share some of his concerns.

4. For the patient death itself is not the problem, but dying is feared because of the accompanying sense of hopelessness, helplessness, and isolation.

5. Dying patients has the need ro leave something behind.  They want something that will continue to live perhaps after their death and become immortal in a little way.

On a side note, the Japanese translation of the title is 死ぬ瞬間 which literally means "the moment of death".  I haven't read the translation so I'm not sure what the translator meant but this book is not about the moment of death; it's about the suffering and eventual acceptance that comes before that moment in life; it's more about dying - the last process of living - than about death itself.  But then again, I think there's no such word as "dying" in Japanese.  Interesting.

understanding pain

Today I went to a mental hospital to listen to a public lecture on dementia only to doze off until the lecture was over and people started asking questions.  My mother had come too, and curiously, we ended up having very different impressions on the director who gave the lecture -- she thought he was overbearing and that he looked down on patients' families; I thought he was humorous and had a deep understanding towards patients (or maybe accepted the fact that he did not understand them fully).

An old man (probably around 80) asked a question about his wife who was taken care of at the hospital but was about to be discharged.  He was concerned about her roaming habits and asked if it was a good idea to hang a cell phone around her neck and put a name tag on her shirt, to which the director answered that in the first place, we all had to remember that no one roamed because they liked it.  Patients roam around because they are anxious; they don't know where they are, they don't know who they are, and so they roam around.  He added that maybe the patient didn't want to have a cell phone hanging around her neck; maybe she didn't want to have a name tag on her shirt; and maybe she didn't want to walk around shouting at the whole world that she had Alzheimer's.  Maybe she still wants dignity.

My mother pointed out that the director had an overbearing attitude towards the old man who was desperate.  He was clearly worried about how to take care of his wife.  It wasn't like he didn't think of her as a human being anymore; he was just... worried.  He didn't need a lecture on how to let her live with dignity.

A care worker also asked what she should do when patients asked if they could go home.  They asked every day, over and over, and she didn't know what to do.  The director said that was normal.  They were after all "abducted" and thrown into a hospital.  We all had to acknowledge that it is practically impossible to convince the patients that they were better off "here" than back at home.  We should never pretend "here" was "home".  If we let go and just listened to them and accepted their anger and grief, then the patient would eventually find his own way to convince himself about his own situation.

Again, my mother thought the director was looking down on the care worker who probably already knew all that and was still asking the director for his insight.  I could see that my mother had felt exactly the same as how I had felt towards the brain surgeon who talked about brain death and organ transplantation last month.

Maybe the director did look down on families.  After all, he was a pro at taking care of patients with mental problems while families were always amateurs struggling to accept the unacceptable -- the process of losing someone they love -- and trying to take care of them while dealing with other problems in life; of course they were not going to be perfect, they were going to be inconsiderate towards the patient at times.  But as my mother said, that doesn't mean the doctor can just sit back and give them a lecture like he knows everything.

When I said I didn't really think the director was that high-handed and added that it might have been because I was the same kind of human, I didn't really mean it, but my mother said maybe I was right.  "You're too good at everything."

I don't know what she really meant, but I hope I can become a doctor who can understand the pain of both the patient and his family.

believing in yourself

If you gave up on yourself, if you didn't believe in yourself, who would?


I finished reading Crime and Punishment.  I had bought the first volume a decade ago and had never touched it since (except for when I was packing to move) but finally found the time to read it.  I didn't think it was especially an impressive book.  It wasn't exactly entertaining, nor did I think it would influence the rest of my life; some parts were interesting but I didn't feel like writing an entry about it right after I finished the book.

After a whole day, however, I thought I might as well leave some thoughts here.  It was a surprise that the protagonist never actually suffered the pangs of conscience (or at least never clearly admitted it).  On the surface, what he finally suffered from was the fact that he couldn't help but confess (which I guess means that he actually did feel remorse for having comitted a murder).  He didn't think it was a sin to commit a "crime" in order to achieve a goal that would make a better world.  Some people -- people like Napoleon who could endure his crime by strongly believing in himself and his belief -- had the right to violate the law for the better.  The protagonist's sin was that he couldn't stick to his own belief.  He couldn't believe in himself, and thus had to confess.  He was ashamed of himself for that very reason until love saved him...

Everything was depicted pretty dramatically (it was almost like reading a play script); maybe I thought the second volume was better because I got used to the dramatics and could focus more on the content (and also finally saw that every character - some that seemed unnecessary - had his own role).

Speaking of believing in yourself, I was deeply moved last night by Mao Asada's free skating program, especially after witnessing the failure that hit her the night before in her short program.  I had always looked up on her for her efforts and perseverance.  She always knew that hard work was the only thing that could give you confidence, but often times, it was not enough for her when it came to important games; effort betrayed her over and over, resulting in anger and trauma.  Her desire for the olympic medal deprived her of her confidence yet again in her short program -- another defeat to herself.

But she didn't give up -- finally last night, she nailed a perfect program including a triple axel jump she had waited for so long.  Maybe she had let go of her pride and expectations; she had lost everything, and was back to the state when she had just loved skating and had nothing to lose but her strong will, now evident in every step, every jump.  Asada burst into tears the moment she finished.  When interviewed afterwards, she said rather calmly: "I believed in myself that I could do it.  It was the program I always had in mind and I'm pleased that I did it."  Her words -- her strength -- meant more than a medal.

It was really as if she returned to life under the spell of Rakhmaninov's music, just like the protagonist in the Russian masterpiece found his life once again after his "death".

overcoming yourself

Japan has yet to win a medal in the Olympics.  Speed skating finished just now and we missed another anticipated medal.  The two skaters who had been expected to win the gold medal didn't hide their bitter feelings when interviewed.

It reminded me of what my friend asked me a couple of days ago:  Why do you value hard work?  Why do you have to be the best?  Why can't you be happy with what you already have?

Now, I personally think I've changed over the past year; I have found some happiness, and I don't feel like I need to be the best.  I guess, however, that my competitive nature will never change, and obviously, it still shows.  To me, it sounded like my friend was trying to tell me that it was foolish to seek happiness in hard work and its expected results.  It's ridiculous to compare yourself with others; useless battles just wear you out.

So are all athletes in Sochi fools?

I don't think so.  It's simply amazing that all these athletes have trained every single day for more than four years for a single race that's over in a matter of seconds or hours.  It's impossible to imagine how hard it is to accept a disappointing result.  But at the same time, it's also impossible to imagine how great it is when they win what they want.

I don't think it's just about competing with others.  It's not a "useless battle".  It's a battle against your other self - your weaker self - and overcoming it through competition.  It's about proving something to the world, but more to yourself: that you can do it; that life's worth living.

Finding happiness in small things - fine weather, the smell of a new shampoo, a smile from a stranger - does make your life better.  After all, efforts sometimes never pay off; these small things may be the only things that could make you happy if anything can.  But hard work and overcoming weakness can probably give you what fine weather can never give.  That's for sure.  That's why so many atheletes dedicate their lives to the Olympics.  And that's why their efforts are often moving, giving us courage to believe in ourselves.

recycling

Human recycling.  I think that's what organ transplant is in the end.  The concept of brain death only emerged when human recycling started.  Before that, no one was dead unless their heart stopped beating.  Human recycling is wonderful as it saves many lives, but at the same time, it is not the most natural phenomenon on earth and I totally understand that there are many families who have difficulties accepting the fact that a patient's brain death means their death.  And if that is why Japan has such a low transplant rate, I think we just have to accept it.  But maybe I'm wrong.

Japan is said to have the best skill when it comes to organ transplant and yet we have the worst transplant rate among developed countries.  The US still provides 5% of their transplant organs to foreign patients, and the majority goes to Japanese patients who come with hundreds and millions of dollars.

Today, a brain surgeon came to talk to us about organ transplant.  It was his 123rd time to give the talk, and he said he was here to give us some "correct knowledge".  He seemed to have some very strong feelings towards doctors who didn't present the option of organ transplant to the patients' families, and towards journalists who critisized that families were often unfairly "urged" to consent under some kind of pressure.  These people were being the obstacles in preventing the growth of transplant industry in Japan.

According to him, doctors never "urged" families.  A doctor's job is to tell the family that the patient will soon be dead and ask if they would consent to organ donation.  I think the point the surgeon wanted to make was that we should all accept that it was natural to be asked about organ donation at times of death -- it is out-of-date to regard this type of "request" as insensitive "exploitation".  After all, we're living the age of human recycling.

I do understand at a very logical level, but I was not convinced at all on an emotional level (maybe because he spoke so fast and came on pretty strong).  I personally think many families will more or less feel that they are "urged", as some journalists (and lawyers) point out.  If you dissent, it's literally the same as being asked if you would save someone's life and saying no.  The surgeon said doctors were the same as waiters at Mc Donalds -- they offer cheese burgers and chicken nuggets for customers to choose, while we offer the chance of saving a life or not saving a life, for families to choose.  I don't think it's the same at all.

He also said the Japanese were too emotional when it came to the definition of death.  Being brain dead means being dead in the context of organ transplant, just like red means stop in the context of traffic lights.  I don't think it's the same at all.  It's easy to accept the latter; it's much much harder to accept death.

A doctor's job is to save patients -- not only those who are right in front of them, but also those who they haven't met.  As the surgeon insisted strongly, Japanese doctors do need to learn to bring this subject up in front of families.  However, I think it's also important to realize that some families will, in fact, feel urged or even forced to consent.  We have to know that it's not the same as offering burgers and nuggets.  And we should acknowledge that we are asking families to think about saving someone they don't even know, when all they can think about is the fact that they are about to lose someone they love.  It's obviously important we reassure that families who decide not to consent will not be blamed for "killing" anyone.

dream cells

In exchange for making each of us original, genes are unfair.  Michael Jackson was born black when he wanted to be white.  So technology and plastic surgery helped him get what his genes couldn't.  Once when he was still alive, I heard someone joke that he had a set of noses and ears in his closet and would pick one every morning to wear for the day.  What if we could do something similar with our organs?

Tissue engineering (or regenerative medicine) seems to be a huge trend these days.  In the future, human bodies might be repairable like cars.  If your kidney fails, you get a new one made from your own somatic cell.  If you need a new liver, you will never have to wait for a doner.  If your son is born with a heart disease, you will never have to hope (even for a second) that another child will be brain dead so that he can provide a new heart for your son.  One day, you may never have to watch your loved ones die.  At least, no nation would have to pay billions of money for dialysis, and therefore, the money can be used to enhance our lives in other ways.  It's a technology no one could ever have imagined 100 years ago; it's full of dreams.  It's exciting.

And yet, I wonder if we're really heading the right way.

A young Japanese researcher recently published her discovery of a revolutional way of making stems cells from somatic cells by merely exposing them to low-pH (the link is below**).  When she first submitted her paper, however, the editor told her that she had mocked the long history of cellular biology.  The reason is obvious -- the editor had been soaked in preconception he had formed over many years of editing and researching; he could not believe, or accept that a cell could be reprogrammed with such a simple method.

Steve Jobs said in his famous speech that death was nature's best invention.  I agree.  Altertion of generations is essential to the progress of human society.  The only way the old can give way to the new is to die, or get a new brain with no preconception -- every couple decades, you get a set of new organs along with a new brain for your birthday.  Except then, it's not really you.  It's just a human with the same set of genes as you.  So rather than getting a new brain in a "100 year old" body (with organs of various ages), you might as well be born as a different being with a different set of genes.  Then it's called evolution.

Either way, you don't really want a brand new brain.  The realistic scenario is probably that you get a set of new neurons that would work along with your old ones so that you can still be you.  By the time you reach seventy, you have a brain that still works like when you were twenty (with a lot of unwanted preconception but also with more wisdom) and since you have a twenty year old ovary (and uterus) you have two more babies.  But we would never have enough food to feed that many humans, so we would have to set a law saying no more babies after age fifty.  And maybe no more organ repairment after age eighty.

Of course, I say all this because I am not in fear of death at this moment.  I respect the wishes of people who are dying or suffering from illness.  How could I ever blame humans of their ego in such a situation?  It's indeed unfair that some people get to live a healthy life up till hundred while some die before reaching twenty.  Genes are unfair.  Life is unfair.  And tissue engineering has the possibility to grant all dreams of people who wish to live a long fulfilling life just like everyone else.


*In case anyone's wondering, it is apparently possible to treat genetic diseases by tissue engineering.  As far as I understand, the very basic idea is that you make iPS cells and replace the abnormal genes (that's causing the disease) with normal ones and then transplant them.  You can read more about it in papers like:
Science. 2007 Dec 21;318(5858):1920-3
Treatment of sickle cell anemia mouse model with iPS cells generated from autologous skin.
Hanna J, Wernig M, Markoulaki S, Sun CW, Meissner A, Cassady JP, Beard C, Brambrink T, Wu LC, Townes TM, Jaenisch R.
http://www.ncbi.nlm.nih.gov/pubmed/18063756?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

**Nature 505, 641–647 (30 January 2014) doi:10.1038/nature12968
Received 10 March 2013 Accepted 20 December 2013 Published online 29 January 2014
Stimulus-triggered fate conversion of somatic cells into pluripotency
Haruko Obokata, Teruhiko Wakayama, Yoshiki Sasai, Koji Kojima, Martin P. Vacanti, Hitoshi Niwa, Masayuki Yamato & Charles A. Vacanti
http://www.nature.com/nature/journal/v505/n7485/full/nature12968.html
(update: this paper is now being considered of retraction by some co-authors for various reasons)