K. Goto
Hiroshima, Japan
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because of its effectiveness in
treating difficult neurovascular
diseases and low invasiveness.
On the other side of the coin
however, occasionally severe
complications may occur that have
vital as well as neurological effects.
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Treatment is usually performed as a
preventive measure on asymptomatic
or minimally symptomatic diseases.
Treatment is less invasive and
performed at the ‘center of excellence’.
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Once grave complications occur, we
have simultaneously to take care of not
only the psychic trauma of patients and
families but also that of our own.
If the treatment is not appropriate, we
might invite malpractice suits or end up
in occupational burn out.
In order to rectify this omission, we
administered a questionnaire survey
to members of the Japanese Society
of Neuro-endovascular Treatment at
the turn of the century.
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51% of 300 respondents stated that they had
been the targets of severe recriminations by
patients and/or families as a result of
complications.
284 respondents had multiple (2.5 on average)
signs and symptoms of psychic trauma.
Also, 23%of respondents were unable to
continue interventional neuroradiology or
resorted to conservative treatments.
I.
II.
III.
Intellectualization and searching for
procedural mistakes not effective when deeply hurt
Emotional measures trying to recall:
a) the image of the physician as a
competent specialist, and
b) the motivation that made the
physician want to become a specialist
Work through grief focusing on new
patients yearning for treatment
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Graduate and postgraduate
educations used to train
physicians to feel shame about
their personal responses to the loss
of a patient and
to view these responses as
unprofessional.
Therefore, many of us repress
our losses and carry our own
pain ungrieved, often for years.
 Resultantly we have become
numb, not because we don’t
care but because we don’t grieve.
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I.
II.
III.
IV.
Shock phase
Illusory denial of the fact
Hyperactive phase
Hostility to culpable physician and the
hospital expressed emotionally
Depressive phase
Numbing of general responses predominates
Facing up to reality phase
Acceptance of handicap/loss
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they tend to bring the responsible
physicians to justice, primarily in
order to effect procedural changes to
ensure the deceased did not die in
vain (phase IV).
For them, the anticipation of the trial
may become something to live for.
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With marked advance and
diffusion of diagnostic imaging,
asymptomatic but potentially
high-risk neurovascular diseases
are being found and subjected to
treatment.
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More and more less experienced
physicians are engaged in this new
subspecialty.
Patients and/or families armed with
medical information abundant on
the web tends to accuse physicians
of undesirable results.
 But
many of my colleagues
experienced communication
breakdown despite apparently
complete informed consent.
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that the higher the risk of the
treatment, the more patients and/or
families fail to appreciate the
magnitude of the risk by
psychologically covering their ears.
We should notice that the patient’s
self determination can only be
achieved after the patient-physician
relationship matures.
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the period allowed the patient to take an
informed decision,
the number of visits,
practitioners consulted before proceeding ,
the systemic provision of information
leaflets
and the notes made on the patient record.
Recommendations by the Assistance Publique des Hopitaux de Paris (Bicétre)
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Most are not, judging from the diagnostic criteria
of PTSD (DSM-IV, 1994).
The most decisive difference is that physicians
feel that they are wrongdoers and at the same
time victims.
Regretting hurt caused to patients entrusted to
them brings about feelings of incompetence and
a sense of guilt.
Also, serious damage caused to physician’s
personal and professional self-esteem was
outstanding.
denial, discounting, and distancing.
 He concluded that the coping
mechanisms are seen as healthy
adaptations under stress.
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While defense mechanisms are
commonly viewed as adaptive
devices gone wrong,
 so that the cognitive field is either
partially blocked out
 or subjected to a major interpretive
distortion.
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focus their attention on a
perceived problem or mistake
instead of their own grief.
 They have become numb, not
because they don’t care but
because they don’t grieve.
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Why our grieving so important?
 It
is an adaptive advantage that
allows
maximum survival characteristics
when
human beings are placed in
situations of extreme stress.
 physicians
often fail to
complete the mourning process
– thus failing to release the
emotion of the situation and
attain catharsis.
 Physicians
who took
defensive attitudes to
complications from treatment
significantly remained
unmoved after tragic
experiences.
who reacted to tragic experience
affirmatively and acceptingly
acquired an ability to empathize
with patients and families.
 They felt able to deal with their
own grief, and were able to
reconcile with patients and
families.
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We need to grieve in order to attain this.
The pain we have not grieved over will
always stand between us and life.
When we don’t grieve, a part of us
becomes caught in the past like Lot’s
wife who, because she looked back, was
turned into a pillar of salt*.
*Genesis 19, Old Testament
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Grieving allows us to heal, to
remember with love rather than pain.
It is a sorting process.
One by one you let go of the things that
are gone and you mourn for them.
One by one you take hold of the things
that have become a part of who you are
and build again.
from My Grandfather’s Blessings by Rachel Naomi Remen
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Grief is the door to male mode of feeling.
Robert Bly, American poet
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Grief is the way that loss heals.
We should have a community of
professional peers who grieve together
and give each other the permission and
the courage to feel again.
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Every interventional neuroradiologist
has one’s own complications related to
the procedure.
Having ground Zero of Nagasaki as an
initial memory of my childhood and
finishing my career as a physician in
Hiroshima, I realized that everyone has
one’s own Nagasaki and Hiroshima.
The scene of Nagasaki when I came back from evacuation at the age of 4.
He did not do well
after going back to
the US due to the
residual radiation
he had received
during his stay in
Nagasaki.
He spent the last
years of his life
traveling around
Japan exhibiting
pictures of ruined
Nagasaki.
I had a privilege of
having a deep
conversation with
him a few years
before his death.
pursue further development of our
specialty,
 and each of us should be keenly
aware of the reality of nuclear
weapons, and pursue peace at the
same time.
 Otherwise, wars begin and human
progress ends.
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by focusing on economy, have
brought about devastation of our
society today.
 or by focusing only on technical
aspects of interventional
neuroradiology , invites conflicts
with patients/families repeatedly.
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We have to stop,
and
think about
what impetuous progression
have brought about.
Infrastructures of the
town were completely
destroyed and covered
with thick ashes.
gas tank
Nagasaki University Hospital
Cathedrals and Shinto shrines were destroyed alike
animals and children
were killed alike

A boy who took his
younger brother to
the cremation site
by Joe O’Donnell
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Nobody knows how
he is doing, because
60% of A Bomb
victims lost all
family members
and relatives.
Most likely, he died
of late effect of
radiation.
We have the heritages of A Bomb disaster:
1. A Bomb Dome in Hiroshima
has been conserved and became a World
Heritage Site.
(Regrettably, ruins of Urakami Cathedral in
Nagasaki was completely removed.)
2. The Article 9 of Japanese
Constitution is an expression of
human being’s will to abandon war.
There has been incessant struggle
between the parties for vs. against
preserving them.
There are many
places on earth
that could be
another Nagasaki.
Areal View of Nagasaki
before
after
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gathered from all over the world, cannot
stand still.
Though Cold War has been ended, the
possibility of a nuclear attack has increased
because of the global proliferation of
nuclear weapons.
It may seem impossible to achieve a world
without nuclear weapons.
But we are here today because founding
members of SNR believed that
neuroradiology today could be possible.
when they saw camphor trees standing 800m from
the hypocenter, once considered dead, survived the
blast, heat and radiation and kept growing
embracing a huge scar.
Thank you
for your
attention!