WILLPOWER MELTDOWN SOMETIMES

I cannot live in the past, nor can I live in the future. I can only live in the present. Nothing will remain for me after I die, nor can I leave anything behind. Therefore, I want to live in the present to the fullest for someone else. I will keep this firmly in mind as I live through today.

A woman in her early forties undertook a coil embolization for a ruptured cerebral aneurysm of the right internal carotid artery. I was assigned a secondary operator. The aneurysm was heart-shaped. A primary operator so skillfully shaped a microcatheter tip that it naturally entered the aneurysm while he was retracting the microcatheter. I thought things would proceed smoothly from there and I could go home early, but they did not. He chose too large size of a first coil to place it. He attempted to advance it using a balloon, but the microcatheter tip inevitably backed out from the aneurysm during the final few millimeters. He switched the first coil size smaller and shorter. As of a second coil, the same thing happened. Consequently, the neck area became sparse. Even with a balloon, oversized coils are difficult to place properly. A delta-shaped neck remained, so we added a smaller coil. However, when he was withdrawing the microcatheter, a loop of the coil was snagged and partially emerged into the parent artery. We discussed whether the coil might migrate distally. We concluded it should be fine since the coil was properly entangled within the coil mass, located in the neck rather than the parent artery. Personally, I would have packed it in a piecemeal fashion. While this might result in insufficient coiling, given the acute phase of rupture, I believe a simple, quick, and safe approach is preferable.

He has malignant brain tumor. It is gradually growing in spite of radio chemotherapy. Right hemiplegia due to the tumor made him bedridden, but he could eat and talk with his wife until a week ago.

When they were young, he annoyed her often for reasons she never tells. She has taken care of him since he presented with hemiparesis.

I told her that he would remain unconscious and asked her if resuscitative measures should be attempted when he suffered a cardiopulmonary arrest. She said “I really love him” and signed the DNAR code.

I was surprised because I had never said such a thing to someone I loved. I wondered if I had ever really loved anyone.

Even when I’m troubled, I have no one to talk to, so I try to put my thoughts into words. As in the poem “The Road Not Taken,” two roads diverge in front of me. One road is to work at another hospital, which means I must devote all my time to studying from now on. The other road to stay at this hospital as I am now, which means I don’t require such sacrifice, but have to lose my current expertise and give up on striving. I must choose one. I swear I will choose one and will never come back here again.

To do list

• Routine
• Medicine
• English
• Law

I want to resign from this hospital. You might say that I am paid well and have a good position. But, honestly, it’s too painful. In other words, staying any longer would make me sick. I thought I was strong, but I have to listen to my heart. I must acknowledge my weakness. It’s a message from my heart. I can hear it now. I need a change of pace; I can’t go on like this. Besides, the younger staff are doing well. Maybe my role here is finished.

I told my partner that I find my current job hard and that I want to change jobs. Her response was simply, “No way.” Then, she acted as if she hadn’t heard me and went back to petting the dog. I never empathized with others’ suffering, so my suffering isn’t understood. It’s karma.

Still, my son, who knows nothing, asked me to take care of myself. He is growing up. I don’t want to get in his way. Even if I did get in his way, he would probably push past it and continue to grow. So, what about me? Should I endure this suffering until I reach my limit, knowing that my mind and body can’t take any more? No, I have my own path. No matter how old I get, I should be able to continue walking it.

A man in his 70s was transported by ambulance with mild impaired consciousness and vomiting due to an acute subdural hematoma. Approximately one month prior, he had suffered a cerebral infarction, leaving him with severe left-sided paralysis, for which he had been hospitalized at Hospital A for rehabilitation. He had fallen and sustained a head contusion both two days and one day before transport. After vomiting late at night, a head CT scan had revealed the acute subdural hematoma, leading to his transport to this hospital. It appears he was refused admission at Hospital B, the nearest facility with a neurosurgery department. This was despite the fact that Hospital B had treated his cerebral infarction. Hospital B apparently has only a few neurosurgeons and cannot handle emergencies.

Time is finite. When planning things, time is a crucial factor to consider. That is, considering deadlines. I have a serious flaw: I’m too lenient with deadlines. I should work on fixing that. It’s not that I’m being lazy. I’m doing what needs to be done now. It’s just that the “now” expands incredibly long for me. I’m addressing things immediately. It’s just that “immediately” expands incredibly long for me. Everyone is busy. They can’t spend time for free for others.

In the sweltering heat that could melt a cell phone, middle schoolers are playing a rugby match. I think it’s crazy, but they’re serious. I’m participating as the team doctor. They’re by no means a strong team, but I like their earnest attitude. A skinny little girl caught the pass and started running. “Run!” I shouted in my mind.

I read Haruki Murakami’s Dance Dance Dance. Someone had praised it in a blog as a novel that gave him strength while aiming to pass the bar exam. I wanted that strength too. But it had no such effect on me. The male protagonist believes that as you get older, you naturally come to recognize “who you can sleep with and who you can’t.” I’ve gotten older, but I have never recognized. I don’t even know if it’s fortunate or unfortunate.

I want to make a feasible plan. Until now, I thought that even if the plan was unreasonable, I could make it by working weekends and pulling all-nighters. But in reality, such plans don’t come to fruition, and I get sick. I want to create a sustainable plan.

To clean my room, I need to throw away trash. To keep my heart clean, I need to discard unnecessary memories. It’s true that something I threw away might be needed someday. But that doesn’t mean I should keep everything. I decided to keep throwing things away. I think that’s what I need right now.