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McCandless was never withdrawn, and he actually left some lasting memories in the hearts of many people he met in his last years, but obviously had some problems building intimate human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.
  Reality.
  Independence.
  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.

limited time

It's been a long time since I wrote last.  I actually glanced through my last couple of entries, and to tell the truth, I feel a bit embarrassed.  If anyone is still reading this blog, I really appreciate it that you took time to read even my whiny posts.

I passed a test in February and am now training in the hospital as a student doctor.  So far, I have trained at the radiology department, the urology department, and am now in the gastrointestinal department.  There are probably a lot of important things I should be writing about, but in short, I'm learning every day that the human body is a miracle.  And every medical knowledge that humans have accumulated over time to maintain the miracle when anything goes wrong, is a miracle.  I am amazed by the smallest invention, the smallest discovery that supports the medical services we can provide to patients.  And before I forget, it's another miracle that you can sit down.  After hours of standing still in surgeries, every chair you see looks like its shining at you.  Seriously.

The reason I wanted to write today was because I was greatly moved by a story I heard yesterday about a shogi (Japanese chess) player who died at the age of 29: Satoshi Murayama.  He suffered from nephrosis from a very young age, and it was while he was hospitalized that his father introduced him to the world of shogi.  He soon got absorbed in it and started studying it by himself.  By the time he became thirteen years old, he had won all local tournaments and was willing to study under a shogi master in Osaka to become a professional player.  His parents worried about his health and opposed to the idea of their son having to live away from them, but in the end, decided to respect his decision because he insisted he didn't have time.

Murayama's talent bloomed, and he became a professional shogi player in less than three years.  He won tournament after tournament, but at the same time, his illness worsened, and he would call his mother to take care of him after every game when he would suffer from high fever.  He didn't like the thought of having to depend upon his mother, and would occasionally treat her coldly, but his mother never said anything about it because she had always thought it was her fault that her son had become sick, and she thought there was nothing she could do to make amends to him.  She never watched her son's game because she believed shogi was worsening his illness, and she secretly wished he would stop playing.

By age 25, Murayama had become one of the top ten shogi players, but soon found out he had bladder cancer.  He refused to go through surgery because it meant he would lose his sexual function, and he was afraid he would not be able to have his own family.  In the end though, he was persuaded to have a bladderectomy, and devoted the rest of his life to his only dream that was left now, which was becoming a "meijin" (master of shogi).  He returned to the tournaments a month after his surgery, and soon regained his previous rank as one of the top ten players.

However, a couple days before the final match (against Habu -- the most famous shogi player to date) he was told that his cancer had relapsed.  He silently watched his mother burst into tears, and after a while, suggested they go out to eat udon (Japanese noodles).  On the way, he said he wondered if he could win the game.  He told his mother that he really wanted to win, and she was surprised that the match still mattered to him when he was dying.  She realized that his focus was only on the present, and she thought that if he was living for today, she should do the same -- that she should stop running away.  And finally, when she decided to support her son from the bottom of her heart, her sense of guilt melted away.

The final match started out with Murayama taking control, and he was dominant until he was only a couple of moves away from becoming a meijin, when he suddenly made a poor move.  The countdown had started, and he moved a random piece in a rush.  It was the kind of mistake he had never made before.  The piece he moved lay crooked on the board, and it was fatal.  Murayama lost all too soon.  But during the interview after the match, he appeared with a radiant face.  He had done everything he could.  It was five months later that he passed away.

Life doesn't always give us what we want.  We all have regrets, and we all worry about the future.   But maybe that's only because we're not living in the present.  Murayama always knew he didn't have enough time.  It reminded me of what Yuzuru Hanyu had said when he was asked why he didn't take some time off after he was injured during a rehearsal.  After all, he was already a world champion.  He said he wanted to keep on skating because he was aware that his time as an athlete was limited.  Some day, his quadruple jumps won't be perfect anymore, and one day, the crowd won't remember his name.

But of course, nothing lasts forever.  No matter how many miracles occur, and how much medicine advances, we're all going to grow old; our legs will stop working like they used to, our sweetest memories will fade, and one day, we will die.  Our time is limited.  So until then, I hope to live like Murayama -- free from past regrets, free from future fears, only focusing on the present and every moment I'm allowed to have.

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.