When the Timing Breaks, It’s Hard to Recover

 Recording a lecture should be simple—at least in theory. But once the rhythm breaks, getting it back can be surprisingly difficult.

I was asked to give a lecture for the upcoming spring meeting of the Japanese Pathology Society.
This year, however, it will be delivered as an on-demand presentation.

That means the lecture has to be recorded in advance and submitted before the deadline, which is next weekend.

Since I have another research meeting that weekend, I decided to finish the recording today.

Recording directly in PowerPoint is convenient enough, but it feels quite different from speaking live in front of an audience.
I recorded it in a quiet room, but when I listened afterward, the sound echoed slightly and was harder to hear than I expected.

More than that, I simply am not used to speaking while recording.

The script appears at the top of the screen, so all I have to do is read it.
Each segment is only about a minute long.

Even so, reading it smoothly from beginning to end turns out to be harder than it sounds.

Once I stumble over a word, it is surprisingly difficult to recover.

It reminded me of a moment during the recent Winter Olympics.
A skier lost balance midway through the run and could never quite regain the rhythm afterward.
It felt very much the same.

And thinking about that only made me stumble again.

In the end, it took three hours to record a thirty-minute lecture.

Broadcast announcers really are impressive, I thought again.

 

 

The Final Diagnosis Often Arrives Just Before the Presentation

 Spring has arrived—slugs at the door, pollen in the air, and the season of conferences beginning. But for diagnostic case discussions, one requirement still bothers me: submitting the presentation materials too early.

 

When I returned home last night, I noticed a slug at the entrance.
It felt warmer than usual, and I later realized that the day was Keichitsu, the traditional Japanese calendar day when insects are said to emerge from the ground.

The pollen has been terrible—almost enough to make me “close my nose” rather than just complain—but it is unmistakably the feeling of spring.

Next week I will give two presentations at a research meeting.

These are not lectures in the usual sense. They are pathological explanations of cases in which clinicians struggled with diagnosis and treatment.
Using biopsy specimens from the patients, I will discuss how we approach the diagnosis and what kind of disease mechanisms we consider.

As expected for difficult cases, both of them are extremely challenging.
In truth, achieving a perfectly definitive diagnosis in such cases is rarely possible—but once I have accepted the task, there is no turning back.

The meeting will be held in a hybrid format, both onsite and online, and the organizers require that presentation materials be submitted in advance.

I have never been very good at that.

For a standard lecture, where the content is already fixed, early submission is not a problem.
But case discussions are different. Preparation time is limited, and I want to keep thinking about the case for as long as possible.

If everything must be prepared early, new findings may appear just before the presentation.
Sometimes I have had to leave out an important observation simply because time ran out, only to have the session chair point it out during the discussion.

The truth is that, in diagnostic case presentations, the final insight often arrives suddenly—almost as if it falls from the sky—and it tends to happen right before the talk.

The same is true for shaping the story: deciding how to explain the reasoning process in a way that will actually help the audience understand how the diagnosis was reached.

But when advance submission is required, that moment of insight must be captured twice—once for the submission, and once again for the actual presentation.

After reaching that first peak, the tension naturally fades.
Before the real talk, I must somehow build it back up again.

I suspect this system was designed mainly for the convenience of companies running online streaming platforms, rather than for the realities of how presenters actually work.

Still, I accepted the invitation.

So this weekend, I will simply have to concentrate and do my best.

 

 

Switching into Spring Mode

 A thin yellow film on the car hood announces the arrival of pollen season in Japan. As spring approaches, everyday scenes—from cheerful groups of high-school travelers to crowded train platforms—offer small reminders that the season is changing, even as work and responsibilities keep piling up.

The hood of my car is covered with a faint yellow film.

For the next several weeks, pollen will be at its peak.

Headaches, coughing, runny nose—every year I struggle with hay fever.

On trains and in station concourses, groups of young girls have begun to stand out.

Some are carrying large shopping bags from the theme park in Urayasu.

They are probably high school students who have come to Tokyo on graduation trips.
They laugh loudly and excitedly, clearly enjoying themselves.

I hope that each of their lives will be filled with hope and happiness.

But as if to cast a shadow over such cheerful trips, a train accident involving a person on the tracks occurred last night. Both the Yokosuka Line and the Tokaido Line were suspended for hours.

At the terminal station, the platforms were overflowing with people. Many stood staring at their smartphone screens, probably searching for alternative routes, looking somewhat lost.

I had a web meeting scheduled at 8 p.m. and had planned to join by chat, but I could not even board a train. In the end, I participated from a bench on the station platform that I barely managed to secure.

I thought I might at least be able to speak, but the station announcements were constant. In the end, I could not say a word during the meeting.

The bench on the platform at night was cold.

Even after the meeting ended, the trains were slow to resume, and it took me another hour longer than usual to get home.

Because the trains were so crowded, I used the Green Car on the way back.

I managed to get an aisle seat, but across from me a woman had placed her luggage on the empty seat next to her, effectively occupying two seats.
Her seatback was fully reclined, leaving the person behind her looking rather uncomfortable.

When someone is sitting behind you, it seems considerate to recline only halfway. Yet many people do not think that way.
It is often discussed on airplanes as well, so perhaps it is a universal issue.

Still, even a small number of such people can cause a surprising amount of stress.

Eventually someone asked for the seat, and she reluctantly moved her luggage, dropping it with a loud and rather careless motion.
Why are there people like that?

It is hard to claim that Japanese manners are always exemplary.

In any case, it is already March 5.

Looking at the calendar, I see that next week alone I have four deadlines and lectures.
On top of that, I should probably start preparing for a research meeting scheduled for next January.

After many years in the field, one becomes involved in many different activities, and there are responsibilities that one ends up accepting almost by circumstance.

But it is no longer easy to push through everything with sheer stamina as I once did.

Perhaps I should stop aiming for perfection, but that is easier said than done.

It seems time to raise my energy and switch fully into spring mode.

The Direction of America’s Raised Fist

 Nearly four years after Russia’s invasion of Ukraine, reports have emerged of U.S. military action against Iran under President Donald Trump.
The circumstances are different, yet one uncomfortable similarity remains: a powerful nation striking a weaker one. The world once spoke loudly against Russia’s invasion. But how will it respond this time?

 

 

It has been almost four years since Russian President Vladimir Putin launched the invasion of Ukraine. Now, reports say that the United States, under President Donald Trump, has carried out an attack against Iran.

The situations are different in many ways. Yet they share one striking feature: a major power using force against a smaller nation.

When Russia invaded Ukraine, many countries around the world issued strong statements of opposition. But what about Iran?

Iran has carried out missile attacks against several Arab states and is often described as being in a situation close to diplomatic isolation. Perhaps for that reason, few voices have openly defended it.

Or perhaps some countries remain silent simply because speaking against the United States carries its own risks.

Some reports suggest that an exit strategy is not yet clear. The fist has already been raised and brought down, but what exactly was the objective?

This time, the action appears to carry the strong character of unilateral American decision-making. That may make international cooperation difficult to secure.

Since the end of the Second World War, the overwhelming military power of the United States has shaped the global order. Japan itself was defeated in the Pacific War, and American military bases have remained throughout the country ever since.

Many nations still find it difficult to speak openly against the United States, and that situation may continue for some time.

The stated objective of the recent attack is to prevent Iran from acquiring nuclear weapons. From that perspective alone, it is not easy to oppose the action outright.

Would a Democratic administration have been able to prevent such a situation? It is impossible to know.

At the same time, the question remains whether one nation has the right to force political change upon another. Nuclear development and regime stability are deeply intertwined issues, and the judgment is far from simple.

Where, then, is the eventual landing point — the political “place to settle” this raised fist?

Even the United States itself seems to be searching for that answer.

For now, the world watches the unfolding situation in tense silence.

When Emotion Multiplies and Flattens: A Quiet Thought on Modern Entertainment

 This year’s Hinamatsuri arrives with rain.
Winter-like cold lingers, and though it is already March, I put on a down jacket once more.

 

It has been a week since the Winter Olympics ended.
In Japan, attention now turns to the WBC—baseball’s turn in the spotlight.
Soon there will be grand sumo, then Major League Baseball, and before long, the FIFA World Cup.

Beyond sports, countless events unfold.
Last year there was the World Expo.

Stepping back, I cannot help but marvel at how much there is.
At times it feels as though we are gently led—if not carried—by an endless current of entertainment.
How much stimulation does a human being truly need?

I would not call myself particularly devoted to such events.
And yet I have visited Urayasu more than once, I enjoy traveling, I cheer and sigh over sports, and I watch films.
When something happens, I take interest; when I go or see it, my heart is moved.
Whether all of this can be reduced to a single word—“entertainment”—I am not entirely sure.

In the age of streaming, even experiences themselves are delivered to us.
They serve as show windows to possible emotions, inviting us to sample what once required presence.

But as when walking through a vast department store, there are moments of quiet fatigue before the abundance.
And at the same time, many experiences begin to appear curiously level—
as though their emotional heights have been carefully standardized.

Human ingenuity has diversified the forms of inspiration.
Yet if these emotions could somehow be measured, would their differences truly be so great?

Even if one were to travel into space and float in zero gravity, perhaps the difference would lie only in the gap between imagination and reality.
It might not alter anything essential within oneself.

What weighs more heavily is not the absence of wonder, but the excess of information.
In such moments, I feel I can faintly understand the mind of a hermit sage—
one who withdraws not out of disdain, but to preserve clarity.

If I could become such a person, perhaps life would feel a little lighter.
It is only a passing thought.

 

Living With Peace Enforced by Force

 Is this, too, a symbol of MAGA?
America remains overwhelming in its power—and the world is being reshaped under that weight.

 

Reports say the United States launched attacks on Iran and killed figures close to the core of the regime.
If strikes are carried out without any formal declaration of war, legal arguments will follow. But I’m no longer sure how much those arguments matter in a world that increasingly moves by sheer momentum and capability.

This is an operation justified by America’s own logic. How other countries truly interpret it is still hard to read. An emergency UN Security Council session is expected to bring some clarity, but I doubt it will change the course of events.

For Japan, the most immediate anxiety is the safety of the Strait of Hormuz. If energy transport becomes unstable, fuel prices may rise. That, in turn, could revive the argument that Japan has no choice but to lean on nuclear power—casting the slow pace of reactor restarts in a harsher light.

I can’t help thinking of the last war, when Japan was thoroughly crushed by America. Whether it was necessary to fight on through Okinawa and even the atomic bombings—no one can truly know now. History offers no “what if.” And yet, sometimes I imagine that even if Japan had never started the Pacific War, we might eventually have been forced into submission somewhere, somehow, by a greater power.

America is vast, wealthy, and formidable. It attracts talent, builds rational systems, and protects freedom—while also carrying division and dissatisfaction at home. Still, Americans chose Trump as president. And under him, higher tariffs and hardline interventions—toward Venezuela, toward Iran—signal that the global order is shifting in real time.

Trump seems to embody a certain lesson: this is how power is used. During the campaign he survived an assassination attempt by a narrow margin; at times I wonder what the world would look like if that shot had landed. But terrorism must never be justified. I’m glad his life was spared.

And yet, I cannot easily say whether it is right to subdue other nations by force. If someone answers, “Talks never worked—this was the only way,” it becomes strangely difficult to argue back.

Peace is not preserved simply by staying silent.
Sometimes peace is maintained—perhaps even “won”—through force.

But whose peace is it?
And what is “peace,” really?

The Return of the Weight Rebound

After shedding a few pounds during a freezing but active stay in New York, I have found myself drifting back toward old habits. Commuting, long hours, and small indulgences have quietly undone my progress.

Recently, my weight has started creeping up again.

During the New Year holidays in New York, despite the bitter cold, I walked everywhere. Perhaps that constant movement helped, because I actually lost a little weight.

But after returning to Japan, weekdays have become what they usually are: long hours on the train commuting, and only occasional walks with my dog, Anne. The reason is obvious.

Lack of exercise. What to do.

I leave home at 7 a.m. and return after 8 p.m. It is difficult to insert exercise into either end of that schedule. People say, “You make time for what matters,” but it is not quite so simple.

My wife suggests doing squats while brushing my teeth. As someone who once belonged to the athletic crowd, I cannot help feeling that both activities would suffer if combined.

And so, with such excuses, inactivity accelerates. I have reached 78 kilograms. The 75 kilograms I once considered my benchmark now feels like a distant memory.

Although I try to reduce carbohydrates, yesterday I had yakiniku at a restaurant called Nikuno Mansei for the first time. When my wife said her rice portion was too much and passed some to me, I added it to mine without hesitation.

I sometimes wonder whether even occasional indulgences make the body rejoice and immediately shift into storage mode.

Recently, I have also been casually drinking a bottle of sake I bought in Motomachi. I usually choose red wine to be mindful of sugar intake, but even that becomes another story when it is every day.

So this evening, I walked a little longer than usual—about an hour and a half.

Tomorrow morning, at my usual weigh-in time, we shall see what the scale says.

 

Rediscovering Akihabara After Years Away

Although I travel to Tokyo every day for work, I rarely step off at any station other than the one nearest my hospital. Tokyo Station, Shinjuku, and occasionally Shibuya — that is about it.

Recently, however, I found myself returning to Akihabara with my wife, and what I saw felt like stepping into a different era.

When heavy snow fell earlier this winter, I attended a conference near Ochanomizu. That neighborhood seemed comfortingly unchanged.

But Akihabara was another story.

The last time I truly walked its streets was several years ago, when I attended a pathology workshop. Since then, I had only briefly passed through to transfer to the Tsukuba Express. In other words, I had not properly visited since before the pandemic.

The transformation was striking.

From the Chuo Line train I had already noticed that the iconic Meat Mansei building was gone. What I did not realize was that Yamagiwa — once a landmark electronics store — had actually closed fifteen years ago. My wife and I felt like characters from an old Japanese folktale, like Urashima Taro returning to find the world transformed.

While searching for that “phantom” Yamagiwa, I encountered another surprise: rows of young women dressed as maids, calling out to passersby to promote maid cafés.

The sight was impressive in scale, yet also strangely unsettling. Akihabara, once known primarily as “Electric Town,” has clearly evolved into something else — a global center of anime, gaming, and pop subculture.

Still, tucked between the colorful storefronts, a few small electronic parts shops remain. Stepping inside them felt like discovering fragments of an earlier Akihabara, preserved in quiet corners.

As expected, there were many international visitors. What caught my attention, though, was a group of foreigners gathered around a coin-operated parking lot, displaying customized cars.

Perhaps it was a meeting of enthusiasts, a celebration of Japanese car culture.

Standing there, I wondered what exactly they were sharing — and how this district, once devoted to circuits and solder, had become a stage for so many different worlds.

 

Can We Think in Proportion to What We Have?

 As February—precisely four weeks long—comes to an end, new demographic data quietly marks another turning point. Japan’s annual birth count has fallen to a historic low. Rather than asking how to reverse the trend, perhaps it is time to ask a different question: how should we design a society that is no longer expanding?

 

February, neat and exact at four weeks, ends today.

Last year’s number of births reportedly fell to just over 700,000—the lowest on record.

The decline in birthrate may no longer be something we can simply halt.
Its opposite—an era of many children—is not something that can be summoned at will.

It is undeniably lonely to imagine a society with fewer children.
Yet if the population is shrinking, might there not be ways of thinking and living that correspond to that reality?

Japan cannot be compared with countries whose populations exceed a billion.
But even as our numbers decline, we remain comparable to nations such as Germany, the United Kingdom, and France—countries that continue to sustain stable and mature societies.

Advances in AI make further labor-saving increasingly possible.
Both intellectual and physical work may not be entirely replaced, but supported and streamlined through greater efficiency.

There still appear to be many unnecessary tasks in the world—duties that continue more out of habit than necessity.
Reducing such work is not an act of coldness. It may instead mean redirecting limited time and human effort toward what truly matters.

With more margin in daily life, people may become gentler.
Marriage and child-rearing might be considered not as burdens but as choices.

When I see young physicians struggling to rearrange schedules in order to raise children, I cannot help feeling that our institutions are still designed on the assumption of constant growth.

To stop expanding does not mean to decline.
To shrink can also mean to increase density—to refine and concentrate what is essential.

If we are fewer, then perhaps we can imagine a quieter, sustainable society—one without excess, yet without deprivation.

Rather than lamenting demographic decline,
perhaps we should accept it and consider what to discard and what to preserve.

That may be closer to our responsibility as those living in the present moment.

The other day, while examining a routine hematoxylin and eosin (H&E) slide—the most common stain used in pathological diagnosis—I felt a subtle sense of discomfort. Something did not quite fit.

That small “unease” eventually led to a diagnosis that would completely change the patient’s treatment plan.

 

Looking at the H&E section, I had the impression that the case did not follow the usual pattern. Rather than staying on the expected diagnostic track, I began to suspect a different disease altogether. To explore that possibility, I performed immunohistochemistry—a method used to identify specific proteins within tissue.

The result confirmed that my sense of discomfort had been correct. The diagnosis was established. Fortunately, it was a condition in which the treatment strategy would change 180 degrees depending on whether it was present or not.

But what struck me most happened afterward.

Once the diagnosis was confirmed by immunohistochemistry, I returned to the original H&E slide. This time, the disease was unmistakable. The abnormal cells expressing that protein seemed to leap into view.

“Were you all here the whole time?” I almost wanted to say.

It reminded me of those online puzzles in which you move a single matchstick to make an incorrect arithmetic equation correct. Before you know the answer, it feels nearly impossible. Once you see it, however, it becomes obvious.

Why does everything suddenly become clear once you know the answer?

Of course, if you do not know the disease at all, there is no starting point. That would be like attempting the arithmetic puzzle without knowing how addition or subtraction works. But beyond that basic knowledge, something interesting happens in the diagnostic process.

As I once discussed with AI, pathological diagnosis begins in a state of exploration. We look at tissue without knowing what disease is present and search for patterns. When a diagnosis is established, it means the disease has been recognized. And once recognized, a pattern forms.

That is why common diseases—such as gastric cancer, colorectal cancer, or breast cancer—can be diagnosed almost instantly. We have encountered them countless times.

Rare diseases are different. By definition, they are rare. Over ten years, one might diagnose 10,000 cases of common cancers, while encountering only two or three cases like the one I saw the other day. It is difficult to build stable patterns from such infrequent exposure.

Still, the diagnostic process itself is fascinating. Under the microscope, all the information initially appears fragmented and unstructured. Yet once various techniques are applied and a diagnosis is secured, the scattered pieces suddenly organize themselves into a coherent structure. A pathway to the diagnosis becomes visible.

In theory, once that pathway is learned, the next case should be easier. In reality, if you encounter such a case only once every two or three years, memory fades.

Excellent pathologists, however, seem to retain a vast number of such patterns. They have many “drawers” to pull from. My own drawers are not particularly numerous, although having seen many rare diseases, I know this field reasonably well. Even after more than thirty years in pathology, I still feel that my training is incomplete. The depth of medicine is profound.

People often say that AI will eventually replace pathologists. It is true that AI excels at pattern recognition. If trained on an enormous number of images, it can achieve high accuracy in diagnosing common diseases.

However, pathology is not merely image classification.

It requires the ability to sense subtle “unease,” to question whether a case is diverging from the expected path, and to reconstruct the diagnosis into a meaningful narrative once it is established. That is where the human role still lies.

AI reorganizes existing knowledge. It does not yet originate hypotheses from a vague sense of discomfort.

That said, with sufficient training data, AI can recognize patterns of common diseases, and such systems are already being implemented. A portion of the pathologist’s workload may indeed be delegated.

In a time of pathologist shortages, that may be, in some ways, welcome news.

Choosing Progress Over Sighs

 As the seasons shift and the weather turns uncertain, it is easy to feel unsettled—not only by the climate, but by the state of the nation. Yet even in times of economic strain and geopolitical pressure, the question remains: will we continue to sigh over decline, or consider how to move forward?

 

The change of seasons always brings unsettled weather.

This week the skies have been gray, the temperature has refused to rise, and it feels as though winter has returned.

For the first time in a while, I stepped outside carrying a long umbrella.

Perhaps the fact that I rarely use one anymore is, in part, a quiet sign of climate change.

President Trump of the United States has announced new tariff measures, and Japan will likely feel their impact once again.

China’s stance toward Japan has also grown more severe, with new measures introduced just yesterday.

It is now undeniably a major power.

Meanwhile, Japan seems to be losing its former affluence. Even maintaining infrastructure is no longer easy.

We must rely on foreign labor, yet the framework for accepting and integrating workers is still far from fully organized.

Japan’s decline is often traced back to the collapse of the bubble economy.

But there is little point in endlessly lamenting the so-called “lost thirty years.”

In the recent general election, Prime Minister Sanae Takaichi’s message was clear: Japan can still do it. The future begins now.

Rather than dwelling on the long rule of the Liberal Democratic Party with regret, she spoke of hope for what lies ahead. That left an impression on me.

There is no reason to expect a rosy future awaiting this country.

Still, with the mandate gained under the name of Sanae Takaichi, I hope that over the next four years Japan can move forward, even if only a little.

Reflection is, of course, necessary.

But sighing alone will lead nowhere.

No matter how small the action may be, we must ask what can be done to help this country move ahead.

Each of us has a part to consider.