Saijô no Meii
Ties of Obligation
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Saijou no Meii – chapter 27
By phichan, to be used exclusively by Trinity Bakuma
Chapter 27 – Ties of Obligation
Sena: That’s a nice looking clinic.
Sena: Is this postcard from Dr. Haga?
Mikoto: He wanted us to know that he opened up a place in his hometown.
Sena: Cool. Can I read it?
Sena: Let’s see…Dear Saijou Mikoto,
Postcard: I found a great looking place to start a clinic, so I went ahead and rented it.
Postcard: I was able to hire a wonderful nurse, and we are frantically preparing for our grand opening.
Haga: Isn’t she pretty? Though she doesn’t stand up to Toujou Meiko-chan.
Postcard: PS: Opening my own place means there are no ties of obligation, and it feels pretty nice.
Miyabi: I’m glad he’s happy about how it all turned out.
Ayame: In the end, he was tied to his University like everyone else. This is for the best.
Mikoto: Hey Ayame.
Mikoto: I don’t really get what he means by “ties of obligation”.
Ayame: They don’t have that system in America do they.
Ayame: It refers to the system in Japan where a medical department becomes a human resources organization, headed by a single professor.
Ayame: For example, let’s say there’s a Prof. A at Tokyo University.
Ayame: Prof. A not only is able to dispatch doctors to affiliated hospitals, but he actually also has the authority to send them to other various hospitals.
Ayame: He was talking about being stuck in that system.
Mikoto: How are they able to do that?
Mikoto: The other hospitals are other hospitals right?
Ayame: True, but…
Ayame: Since all doctors are unique in their skill and experience, if left to their own devices, they would all want to work in the city. The rural areas wouldn’t have enough doctors.
Ayame: So the professors from various universities got together and decided that it was better for everyone if they evaluated their employees and dispersed them accordingly, to some extent forcefully.
Mikoto: So, Dr. Shindou dispatches his workers too?
Ayame: This system has a glaring flaw.
Mikoto: A flaw?
Ayame: If this were a perfect world, the professors would all be unbiased in their decisions, but in the end they’re only human.
Ayame: The bad ones will abuse their power and send anyone they don’t like to waste away in the middle of nowhere.
Ayame: Academic harassment, power harassment, sexual harassment…you name it and there’s probably a professor doing it.
Academic Harassment – Things like taking your employees papers for your own
Bad Doctor: This paper is mine, right?
Power Harassment – Verbally and emotionally abusing your workers.
Bad doctor: You’re the worst piece of trash I’ve ever seen!
Sexual Harassment – Using your authority to extort sexual favors.
Bad doctor: You and me, tonight?
Mikoto: I wonder which one Dr. Shindou is.
Shindou: I wouldn’t do any of those things!
Mikoto: So everyone is competing to get that kind of power?
Ayame: Of course they are.
Ayame: And if it was only that, then it’d just be like any other company, employees looking to climb up the ladder.
Ayame: But for doctors, it isn’t just vertical they climb, but also horizontal. Even the departments compete with each other within a hospital.
Ayame: This is one reason why everyone hates you here.
Ayame: Let’s pretend this Heisei Central Hospital is a private hospital of equal scale called Alpha University Hospital.
Ayame: In Alpha hospital, the gynecology, pediatric surgery and orthopedic surgery departments are made up mostly of doctors from KO University.
Orthopedics Pediatric surgery Gynecology
Ayame: And the gastrointestinal surgery, neurology and cardiovascular surgery departments are made up mostly of doctors from TO university.
Cardiovascular surgery Neurology Gastrointestinal surgery
Ayame: The plastic surgery department was mostly KO University, but due to a certain incident the torch was passed from KO to HO, then from HO to TO university. At which point, doctors are brought in from different hospitals.
Ayame: And that’s how, even within a hospital, the balance of power can affect from which hospitals doctors are brought in from. As a result, there are constant struggles for power that are constantly changing the balance.
Ayame: It’d be like if you took workers from Toyota, Nissan and Honda and put them to work in the same factory. They would be constantly competing with each other.
Ayame: That’s why faction forming is very common.
Ayame: Every department in every hospital wants to increase the number of posts they can dispatch to, so there isn’t much socializing between different university doctors.
Mikoto: I see.
Mikoto: But what does that have to do with me being hated?
Ayame: Everyone is scared of you.
Ayame: The primary powers of this hospital are Teiou University, lead by my brother, and Saihama University, lead by the Director. The departments from those hospitals are constantly fighting for hegemony.
Ayame: You came here by the recommendation of Prof. Shindou of Saihama right?
Ayame: Everyone from Teiou sees you as Saihama’s secret weapon, no matter your actual intentions.
Mikoto: That’s not my intention at all…
Ayame: It’s not your fault.
Ayame: A normal hospital has enough competition as it is, but this hospital also has the “best doctor” privilege.
Ayame: If someone from Saihama or Teiou were to come out on top
Ayame: It’s thought that not just he would hold all the power, but also the university he comes from.
Ayame: It’s no surprise that someone as skilled and famous as you would be feared and hated.
Mikoto: *sigh* This just got a lot more complicated.
Miyabi: This is only the beginning.
Miyabi: I’ve worked at several other hospitals.
Miyabi: I’ve seen a university’s entire surgery team get swapped out at a chairman’s single word.
Miyabi: It’s not uncommon that surgery teams from different schools use different procedures and techniques.
Miyabi: Suddenly changing the attending physician only hurts the patient.
Mikoto: This is starting to anger me.
Miyabi: Channel that anger into reforming our hospital.
Miyabi: Even if you won’t admit it, everyone else is starting to see you as the “best doctor”.
Miyabi: It seems you were only intent on fixing the lack of pediatric surgeons.
Miyabi: But for your sake,
Miyabi: The patients’ sakes,
Miyabi: And for the sake of all the doctors trapped in this god forsaken system
Miyabi: I think it’s time you stepped up and became a leader.
Mikoto: A leader…
Miyabi: But that’s just me.
Sign: The next day
Sign: Examination room 32
Mikoto: Your son had a surgery to repair a herniated diaphragm?
Mom: Because he was born without half his diaphragm, they immediately inserted a Gore-Tex prosthesis.
A healthy person’s diaphragm
This patient’s diaphragm
Mom: It’s just, according to him, his stomach has felt taut.
Mikoto: I see…
Mikoto: Where was that first surgery done?
Mom: At a Teiou affiliated hospital.
Mom: But that attending physician got sent out to the countryside.
Mom: And I happened to hear that some amazing doctor has come to this hospital…
Mikoto: Is that so?
Mikoto: We’ll take a closer look his stomach. If you could take him to the ultrasound examination room.
Sena: Um…Dr. Saijou. If his stomach feels taut, does that mean…
5 years old 0 years old
The body grows, but the Gore-Tex doesn’t. As a result, it becomes taut.
Mikoto: Since Gore-Tex doesn’t grow, it’s become too small for his body.
Mikoto: It doesn’t look too serious yet, but there might be a tear already. We’ll probably have to operate after the tests are done.
Sena: I see…
Mikoto: What’s wrong?
Sena: Oh, nothing! It’s no big deal, but…
Sena: I’ve heard that Teiou and Saihama use different procedures for this surgery.
Sena: At Teiou, they just put in another, bigger piece of Gore-Tex.
Instert a larger piece of Gore-Tex
Sena: At Saihama, they peel off muscle from behind the ribs and use it as a surrogate diaphragm.
Peel muscle from the flank
Turn the muscle into a surrogate diaphragm.
Sena: Both procedures have their pros and cons and are in constant debate.
Teiou’s method: Replacing the Gore-Tex
- Pro: The surgery is easy.
- Con: Will need more surgeries as the body continues to grow.
Saihama’s method: Peel off the flank muscle and use as a surrogate diaphragm.
- Pro: As it is muscle, it will grow along with the body. Only one surgery needed.
- Con: Since the flank muscle is thinner, when the abdominal pressure increases due to breathing, only the flank muscle expands.
Sena: Oh, but,
Sena: Don’t get me wrong.
Sena: Although I’m from Saihama University, I’m still a resident and not yet interested in departmental competition. I’m okay with either procedure.
Sena: It’s just…no matter which you choose, some people will come to hate you more.
Mikoto: I know.
Mikoto: You’re just worried about me.
Sena: But, there’s still not one more beneficial than the other, even for the patient. Guess he’ll end up alienating one faction or the other…
Mikoto: But you know what?
Mikoto: I won’t do either procedure.
Mikoto: First, we’ll go through the old incision and make our way around the rib cage to the back.
Enter through the old incision.
Enter the back.
Mikoto: Then, we’ll peel off the back muscle, pull it through the rib cage, and turn it into the diaphragm.
Peel the back muscle.
Pull the back muscle through the rib cage.
Turn the back muscle into a surrogate diaphragm.
Mikoto: Unlike the flank muscles, the back has bones for support so it won’t expand. There shouldn’t be any ill-effects.
Sena: He’s right!
Sena: But, if you do that…
Mikoto: I don’t care who I make an enemy.
Mikoto: I’ve made up my mind.
Mikoto: To make others believe that I’m right,
Mikoto: I’m going to make myself the standard!