Relearning the meaning of “gambaru”

Last week, I went out to Tokyo for a few days.

On Thursday, I stayed with a friend from high school who lives in Yoyogi. She moved to Tokyo in January, and works at a company in the online art business. Her apartment was very cozy, her work hours were long, and (it being Tokyo) her cost of living was significant. Yet she was living her dream–to be with her partner in Japan, working for a community that she cares about. She treated me to a delicious izakaya-style dinner despite her modest budget, and let me stay the night.

On Friday, I went sight-seeing in Tokyo with a friend from my JET Program days. After JET, he started doing research in the linguistics field at a university in Tokyo, then passed the university’s graduate school entrance exam, so he will start grad school in April. He was working 4 part time jobs to save up for grad school as it is difficult for foreigners to get loans.

Pressing my typically vague itinerary (“Let’s hang out in Tokyo!”) upon him, he took me out on the town to visit the Sky Tree, watch the sakura (hanami) in full bloom and visit Kaminarimon at Asakusa, and stay the night at his place in Urayasu. Along the way, we briefly got a little lost, found soba flavored ice cream (for which he had to sacrifice another flavor to absorb a maccha [green tea flavored] ice cream cone), and had a delicious sushi dinner with the whole restaurant to ourselves. In other words, I impinged and relied on him for the whole day. Although I had a ton of fun, I hope he did too–in between having to watch out for and clean up my messes. He even saw me off the next morning.

On Saturday, I went to Ikebukuro to meet up with a long-time friend from high school who is living there now. We hadn’t seen each other for over a decade. In that time, he had worked for Microsoft, gotten married, and obtained his master’s in computer science. We had a delicious lunch at a standing sushi bar, then went back to his place. I finally met his wife, who is a delightful lady, thoughtful as well as talented in many arts and crafts. It was a joy to see them happily married, and we chatted away the whole afternoon. In the evening, we had ramen before I went back to Kawagoe.

On Sunday I toured Kawagoe with Y, who is married to my rotation sponsor, and their 3 year old son. Or to be more accurate, she took me on a tour of the city, visiting historic parts of town, seeing the sakura blossoms, and exploring museums. I was treated to lunch (washoku!!!) and all sorts of goodies. I had a great time, and learned all about the history of Kawagoe and Japan. She is expecting a child in 3 months, and taking care of an energetic 3 year old already.

I speak of my friends partly to record the details of my trip, but mostly to illustrate how they are all working hard, in their own way, to keep their lives meaningful. And, although they are already working so hard, they welcomed me as a friend in ways that I could not have imagined. I wished only for good conversations and a corner to lie down for the night; not only did they open their homes to me, but also went out of their way for me, a silly traveler, already so lucky to just be here, with unending generosity. I learned again the meaning of “gambaru,” renewing my desire to pay forward the kindness that has been shown to me in so many ways.

// j.

Health + Care, in another system, at a glance

A week and a half have flown by on my Neurosurgery rotation in Japan. Of course I am not qualified to analyze the differences of the healthcare systems of two countries after such little experience in either. But, as doctors often size up a situation in 15  minutes or less, I thought I would give my first impressions. It’s not possible to talk about healthcare without mentioning costs: the cost of medical education, physician salaries, healthcare expenses, and how the system is financed. I would like to explore this in more detail sometime, but suffice it to say that money drives many things in medicine, of course. At a glance, I will only mention costs related to medical training and physician reimbursement. I’m told that in Japan, there is much less discrepancy in earnings between specialties, and between residents and staff/attending physicians. This system seems to be rather opposite of our American Way, where training salaries are modest, and staff salaries take a jump into the six-figure “big leagues.”

It is still hard for me to imagine what the distribution of generalists/specialists would be like in the US if our specialists didn’t earn significantly more money. No doubt we’d have fewer of them, but by how much? Something like the Japanese system, where I’ve heard that there is a shortage of specialists, as doctors earn more by running private primary care clinics? I do not deny that the students going into “ROADE” (radiology, ophthalmology, anesthesia, dermatology, emergency medicine) love their specialty, but I do think fewer of them would choose that field if the pay were worse, hours were longer, and the balance between work and life blurred more.

Perhaps the personalities of people going into various specialties would be different also. I don’t like to stereotype, but stereotypes are born somewhere, and it’s no coincidence that surgeons in the US are not considered the most touchy-feely doctors in the world. Our highly competitive system feeds a super-star mentality that may develop in the people who “won” that competition. This is an exaggeration, but it does come from somewhere (h/t: PY).

Also of interest, public medical schools are the most competitive schools to enter in Japan, because tuition costs are subsidized by the government. Although state medical schools are highly competitive–especially for in-state residents–reputation appears to outweigh cost considerations for many incoming medical students in the US, since it’s so difficult to avoid enormous debt by the time you graduate, regardless of private/public school type. The residents here were surprised to learn that I’ll graduate with ~$150k of debt, and this is pretty average for students now.

Last but not least, I wanted to say a few words about patient care. From what I’ve seen, the Neurosurgery service here takes care of many patients who are being observed, who may or may not undergo surgery. On my surgical rotations in third year, patients on the service either were planned to undergo surgery or were post-op. Furthermore, once it was decided that they did not have surgical issues anymore, they were “turfed” to Medical teams. At  one point on Neurology, we even had a consult from Neurosurgery to basically perform a neurologic exam. On the one hand, that meant the surgeons could focus on operating and perioperative management. On the other hand, they wouldn’t have the breadth of knowledge or experience to manage medical issues. “Medically optimize,” translated from surgical speak, meant something like: “let Medicine get the patient in shape for surgery.” One way or another, surgeons here are probably forced to be more holistic, since they do so much in addition to operating. I’ve seen the neurosurgery residents here perform tracheostomies, carotid endarterectomies, neurovascular angiography–all procedures that “belong” to other specialists at my home institution.

There are pros and cons to every system. Again, as I’ve seen so little of healthcare systems (only 6 years in the US, and 10 days here in Japan), I can’t say what is better. But, I do think there is something nice about working with colleagues in a specialty where you know that lifestyle and monetary motivations were less likely to influence their choice, hence they genuinely love their field. The neurosurgeons I’ve met here are certainly like that. And that has always been, and ought to be, the greatest reward of going into medicine.

// j.

Chasing to the cut…or vice versa

Here in Japan, I had to bring a ticket up to the cash register just to get a box cutter. They keep the sharp objects behind the counter. In contrast, you can walk into a gun store in the US and pick up a deadly weapon right off the rack. I exaggerate–there is usually a waiting period for purchasing a gun.

I didn’t want to ignite another frenetic, hot-blooded yelling match about gun rights vs gun control. I just wanted to point out that we as Americans have certain values and sometimes, when you think about them logically, they aren’t all that logical. Numerous people  have already pointed out how exposing children to nudity on TV causes more of an uproar in the States than exposing them to graphic violence. I just wonder about our problem with violence, and how we might best solve or at least mitigate the problem.

We require people to have licenses in order to drive, set an age limit, and have vehicle registration, because we recognize that driving is a serious responsibility. Improper use of a car can cause a lot of harm to oneself or to others. Yet we do not require gun owners to even have a license to purchase a gun. Cars can cause a lot of damage, but guns even more so. Surely, since we are so ingenious, we could come up with more effective ways to ensure that Americans own guns responsibly?

I guess I’m not smart enough to figure out how to do that. There are also a lot of guns being obtained illegally, and I don’t know how to shut down those  operations. Putting in more hoops to jump through in order to obtain guns will deny good citizens access to those guns, while doing nothing to deter criminal elements from arming themselves illegally.

Instead of proposing legislation, I’m going to use my box cutter to simulate wounds (in banana skins and the like) and work on my suturing technique. It’s getting close to “gun season” now–Emergency Medicine’s cynical colloquialism for the large increase in gun-related wounds seen in the ED  in the summer months, due to increased gang activity. Thanks to this American tradition, trauma surgeons will get better business. I guess that’s supposed to be the silver lining to our gun violence problem.

// j.

Recovered. Next up: the next 3 years!

I am the luckiest girl in the world. I walked home with that feeling today, after having met and discussed my rank list with many mentors who have guided me along the way. Truly, no future is built alone. Just during my medical education, I have gotten to where I am with the help, often unsolicited, of so many talented and kind people. And before that, getting to medical school was a mixture of work and luck and the help of dozens if not scores of other well-intentioned people.

I also realized that I have recovered from a certain amount of burnout, as I am able to think positively and mobilize my energy again to get on with the next steps: matching into residency and graduating. I hope I will be able to help out others someday, passing along the altruism that was shown to me.

I wish every fourth year medical student (and while we’re at it, residency programs–it’s a two way street) the best on the Match. I hope everyone will be happy with the next step of their medical training.

// j.

Over.

After all that’s said and done, I’m not sure what to do with myself right now. What should I be doing, if I am not thinking, worrying, and dreaming constantly about sick and dying children in the ICU? On my last post-call day, I went home and slept. Now that I’m awake (9 hours later), I feel a pit in the bottom of my stomach and an emptiness in my chest. Maybe it’s because I am suddenly relieved of the responsibility. All that I have been living for the past 4 weeks, I no longer have to. What will replace the intensity of that experience? Not the thank-you letters I still need to write, the hotels that I need to book, the tuition that I need to pay. Maybe all I need is a little more sleep and a good long run.

// j.

Harvard and Happy?

How many times have you heard about the successful professional who is rich, accomplished, and terribly unhappy? The moral of the story usually goes something like this: “All those great things in the world can’t buy you happiness.” We nod to ourselves, satisfied that there is justice and balance, as we continue our own much less accomplished, but supposedly happier lives.

I wonder if these accomplished people are truly less happy than the rest of us. If you find happiness in accomplishment, then wouldn’t you be happier the more that you accomplish? Perhaps you will not have time for your family, or have a life outside of work, but if work is your joy, then aren’t you in your element? Why should accomplishment preclude the ability to enjoy life the way the rest of us do?

Or do we just yearn for the things we didn’t do, at least a little, and justify that feeling with a pithy adage? The most often mentioned regret of older people is that they wished they had had more education when they were young. The often mentioned regret of accomplished people is that they wished they had spent more time with their family.  Even so, I don’t believe they are unhappy at what they accomplished. Perhaps we are also ignoring another possibility, that the world is just unfair, and some people are happy, beautiful, and successful while others don’t have as much in all, or in any, of those categories.

Personally, I am greedy. If given the opportunity, I would have the best of both worlds. I intend to accomplish certain things in my lifetime. I would like to enjoy life outside of work. But to be perfectly honest, I’d rather not expect anything other than work, because you can count on your own ability, but you can never really count on someone else, soulmate or what have you, to be there for you when you need it most. At this point in my life, I am happy to choose career and achievement above all else. If I should find someone I can be happy with, then that’s all well and good. Otherwise, I will be content to be accomplished and unhappy, because I’ll know that I’ve earned it.

// j.

Residency application season, officially open.

I know, I submitted my application two days late. ERAS opened up on 9/15 but I need to almost pathologically double- and triple-check my application before it’s spot-perfect and I am satisfied to release it to the world.

Now I did it.

So excited and anxious tonight that I won’t be able to sleep. Hello, tachycardia.

// j.