==JAPAN: KM== [Medical Themes]

In a hospital in Osaka, the parents of a young girl who had become brain dead were grieving because of her poor prognosis. When the doctor was telling her parents the facts and asked them," May I take the heart lung machine away from her?" The father said, "I want to tell you a story, doctor."
Once upon a time, a young woman who was crying came to see Buddha. She said,"Please help my baby, Buddha." Her baby had died. Over and over again, the woman entreated him to revive her baby. Finally, Buddha felt pity for her and said,"I'll try to bring your baby to life if you bring me a few poppy seeds." "Only a few poppy seeds? Really, will you restore my son's life?" she said, stopping crying. "Yes I will I promise, but I make it on the condition that you should gain them only from a family who has had no one die in it," Buddha said. "I see. I'll be back soon," she said and went to look for poppy seeds with great joy.
In spite of the fact that she looked for them all over the village, she couldn't find them, because in every family someone had died. She was very disappointed and came to see Buddha again. "I can't find even one seed, Buddha," she said, being discouraged. Then Buddha said, "Do you understand? You are not the only person who has been sad about the death of a family member." The Buddha's words woke her up. She stopped crying and went back home with her new understanding.
This is a famous Buddhist tale. The father of this patient told this story because he was a Buddhist monk.
This man's daughter was rushed to the hospital because she had her head hit hard in a car accident. Her mother who had been driving felt much guilt, so she sat up nursing her daughter, but before long her daughter became brain dead.
After the father finished telling the Buddhist tale, he pleaded," Doctor, please don't remove the heart-lung machine from her. My wife feels guilty and her mind is unsteady. Your taking the machine away means that you are giving up on curing my daughter. But she is still warm and her face isn't pale. She isn't completely dead even if she can't become conscious any more. We need more time to accept her death. Doctor, your care will be 'a poppy seed healing' for us. We really need it."
Respecting the patients' feelings, the doctor left the heart-lung machine on the girl. And her mother kept on nursing until her daughter's heart wouldn't work any more. When her heart finally stopped, her mother accepted her death naturally.
I have been thinking about this story since I heard it. Of course, in some people's opinion, his terminal care was a waste of time and money because, in general, such care requires a lot of money. But I think that doctor's care, from brain death to heart death, was indispensable for the mother.
Anyway, the Japanese Diet has been arguing over the organ transplantation bill which ambiguously says that brain death is the death of a human. But I think if they pass the bill, the parents of the girl I talked about would have had to pay all of the fee for the terminal care because their health insurance would not have been available. On the other hand, this bill is good because it allows organ transplantation for patients who suffer from serious disease and when there is no other choice, such surgery is the only help. But I think we shouldn't forget the existence of patients like the girl from Osaka. I have no idea whether organ transplantation is more important than terminal care, but, in general, if they make a kind of rule, somebody always falls victim. I mean, if we look from a larger view, the rule is necessary, but as we face each individual case, the rules sometimes stand in the way.
When we become doctors, we will have to worry about this dilemma. At present, I have no idea except for keeping balance between two aspects, but I want to try not to forget the existence of the weak who are apt to be cut down.

COMMENT This essay reminded me of the fresh spirit I had when I entered Fukui Medical School. In those days, I used to think about brain death profoundly, whether brain death is the death of a human or not. But it was easy to forget thinking about this problem because of my busy school life. Now as I consider this matter again, I think the doctors cannot help keeping balance between the two aspects the author states in this essay. Perhaps we will become doctors facing various medical problems, and we may be able not to find clear answers for them, but we must not forget to think about medical problems without getting away from them.

Yasunari Nobukawa