2.THE+SEA+AND+POISON



__**The Sea and Poison**__ by Endo Shusaku


 * [|Endo Shusaku's]//The Sea and Poison// examines medical ethics concerns from a cross-cultural perspective. The events covered in this short book are based on [|real experiments performed in Fukuoka on American prisoners of war]during the summer of 1945 just before the atomic bombing of Hiroshima and Nagasaki. At its core is the ethical problem of performing vivisections -- experimental medical procedures on live human subjects. In addition, Endo examines the intersection of careerism and individual pique with medical decisions. Also, the author draws our attention to motivations and culpability of various medical professionals involved. Keep these medical issues in mind as you read the novella. However, the description of Japanese medicine in the 1940s and the comparison of a Japanese hospital with your own should also be interesting, particularly when you think about the roles of patients and doctors, different standards of hygiene and cleanliness, and the types of diseases and ailments that are most commonly described in the story. However, foremost in Endo's mind is what the Japanese call "senso-han" -- war guilt. Japan soldiers and civilians committed many war crimes -- mostly against the Chinese -- killing over 20 million civilians during the war. However, because many of these crimes were not prosecuted, nor the guilty punished, there remains an unresolved unease among Japanese regarding their role in these atrocities. In this book, Endo makes a strong statement about responsiblity and culpability. For Endo, the main responsibility lies not with those who actively committed the crimes whether through feckless ambition or amorality, but those, who know better, who witness these actions and do nothing. **

[|Online Discussion of the Book]


 * READING NOTES **


 * pg. 12-3. Consider the description of Dr. Suguro's surgery. Would you trust a doctor who maintained their practice like this?


 * pg. 20-21. "'Mmm. . . but still . . . the way he put the needle in. You don't find that in a country doctor, you see. I wonder what he's doing living in a place like this.'" Suguro is described as cold but superemly competent. Which quality is more important as a medical professional? Why is the author setting up this contrast early in this book? Why would Suguro choose this remote locale to set up his practice?

pg. 23. The narrator comments on Suguro's accent. Suguro comes from Fukuoka, a large city on the southern island of Kyushu in Japan. Kyushu is the Japanese equivalent of Texas and people from there speak with a distinct drawl. Also, Kyushu is known for its samurai tradition and so it has its own "cowboy culture." Endo is making the point that this doctor with a Texas accent seems out of place in a location equivalent to upstate New York.


 * pg. 23. "'I'll bet the wife's run out on him,' the gas station owner was speculating in the bathhouse. 'Anyway, they say he's got himself another nurse.' 'A funny sort of fellow.' 'Yes, he's funny, but that's all right with me. My kid got sick last year. He examined him and he hasn't asked for his fee yet."

Suguro seems to be absent-minded, taciturn, and living in a dream-state focusing on past events.

pg. 27. Here we have our first introduction into the past events that haunt Suguro. All the information in this paragraph is factual except for the names involved.

pg. 29. Here we have our first contrast between the "sea" and "poison" that gives the book its title. Endo frequently compares the view of ocean (Fukuoka is a port city) and the clean sea breeze with the stultifying air and odor of the First Surgical Department inside the hospital. Endo is reversing the idea of a clean hospital and dirty outdoors so that the hospital seems to be tainted from the inside out.


 * pg. 30. "'...Because nothing could be done. At that time nothign could be done. From now on, I'm not sure at all. If I were caught in the same way, I might, I might just do the same thing again. The same thing . . . ."


 * pg. 32-33. "'Today everybody's on the way out . . . the poor bastard who doesn't die in the hospital gets his chance every night to die in an air raid. What's the point, then, of pitying one old lady. You'd be doing better to thin of a new way of curing TB."

At the beginning of this section we are introduced to the characters of Suguro and Toda in 1945. Suguro comes across as a bleeding-heart sentimental person while Toda is the voce of cold, dispassionate reason. In addition, we find Toda's rationalization for not caring. . . in the long run, we are all dead, so why care about a single patient. In addition, we are introduced to the plot device the drives the first part of the novella: the battle between the first and second surgery to become the Dean of the Medical School. How can this careerism be reconciled with the desire to heal people?

The old lady, Suguro's first patient, will become the precursor to the vivisection on American POWs. She is expendable and will be used as a guinea pig for the good of medicine. Suguro's attitude toward her is a key mirror to the story Endo is telling. She is a "welfare patient" equivalent to a modern day Medicaid patient in the US. In the past, those who could not afford medical care sold their bodies to medicine or submitted to becoming test subjects to receive any care. Since they are not "paying patients," the medical professionals take a different stance toward them.


 * pg. 36 "'I'm not going to be a great man. That's for Dr. Asai or Toda. They'll stay here at the University,' he thougth. 'I'll go to a sanatorium in the mountains somewhere and work as a TB doctor. That'll be good enough. I'll be drafted soon, so I'll be leaving here." This observations is telling about Suguro's personality. Today, there is a shortage of primary care physicians and a surfeit of specialists. Is it a matter of personality? Or is Suguro rationalizing his timidity?

pg. 36-42. The afternoon rounds described in these pages lays out the social hierarchy and relationships of the hospital and the First Surgery in particular. The relationship between doctor and patient in these pages is fascinating to me where patients are literally scared of their doctor and try to get better to please the doctor who they have disappointed. Also, the description of the ward has many details about health and hygiene here. You can watch the dramatization of this scene below in the first section (top left) of the movie below between 8:37 and 13:00.


 * pg. 38 "The odour which permeated the ward was an uncommon one. Recently many of the patients had been doing their own cooking and so now the smell of firewood mingled with that of the dirty bedding and the urine jars stored beneath the beds to form an amlgamated stink which floated out into the corridor." Imagine a hospital where patients cooked their own food in small firepits near their hospital beds, where, due to the lack of a bathroom, urine was kept in pickle jars under your bed and linens were only changed infrequently!!!

pg. 38-39. Notice the game being played between patients and Doctors here. There is a relationship of dependence between patients and doctors, but the patients are trying to manipulate the doctors for medicine. Do you think that individuals use their extra medication for sale today? Also, notice the contrast of medicine with food here. Hunger is worse than pain.

pg. 39. The difference in how the patients react to Suguro and the "Old Man" Hashimoto is striking. While they cling to Suguro, they flee from Hashimoto.


 * " . . . the patients make themselves inconspicuous as possible . . . the patient . . . would cring before the great ones as though awaiting a sentence of condemnation. They would try desperately to conceal it if their fever had gone up or their coughs grown more severe. They would sit . . . hoping to escape the scrutiny of these awesome doctors as quickly as possible."

It is also interesting to compare Hashimoto's cool demeanor with the interventionist and ebullient behavior of his German wife, Hilda. Compare also the patients' reactions to these different caregivers.

pg. 41-42. The discussion of the old lady's case shows how they are not concerned about her recovery, simply as an interesting case for experiment. This conversation would have all occurred within earshot of the old lady. At best a 50-50 chance for survival, but more likely, given here condition, a 95% chance of dying during the experimental operation.

pg. 43-5. Endo pans out and now gives us the context of the experiment: the constant air raids over Japan in 1945. Suguro notes that Fukuoka seems to have been spared. The main reason for this was that Fukuoka was one of the alternative sites for the Nagasaki bomb and therefore was being spared for the moment so that the Americans could gauge the full impact of the atomic weapon. Nearby Kita-Kyushu was the actual target for the bomb dropped on Nagasaki and was spared when cloud cover diverted the pilots to Nagasaki. There is an implicit parallel here between how the Americans are using Fukuoka as a "guinea pig" for their weapon and how the doctors are using their patients for their own scientific advancement.

pg. 46. Once again, foreshadowing. Suguro //knows// that the operation will likely not help the old lady, but he continues to participate in the charade. This will parallel Suguro's role in the vivisection on the American POWs and reinforces Endo's critique of those who know and do nothing. Suguro and Asai seem more interested in the details of a new medical procedure than the care of their patient.

pg. 48-50. Back to hospital politics with the introduction of Mrs. Tabe. She is the niece of the former Dean and the First Surgery thinks it will be a coup for them if they cure her. Mrs. Tabe is young, literate, and beautiful, a stark contrast to Suguro's patient the old lady who is old, illiterate, and decrepit. On page 48, the different treatment of rich and poor patients is described, "It was, all in all, a world quite different from that of the ward patients."

pg. 49. They rush her procedure from Autumn to February. . . of course, this does not end well.


 * "'I have an idea that this operation has something to do with the Old Man's getting the dean's chair."

The election is in April, making an Autumn date too late to help him rise to the Dean's post.


 * pg. 50. "'Sweetness and sentimentality are forbidden luxuries for a doctor . . . doctors aren't saints. They want to be successful. They want to become full professors. And when they want to try out new techniques, they don't limit their experiments to monkeys and dogs. Suguro, this is the world, and you ought to take a closer look at it.'"

Quite a jaded and cynical view. Do you think it is accurate? How should medical professionals reconcile their career aspirations with ethical behavior?

pg 50-51. Toda and Suguro have their form of the "trolley car" debate. Save one or the many? Sins of omission and sins of comission.


 * pg. 52. "'There's no figuring it out,' he muttered to himself, 'It doesn't pay to think about it.' . . . The effort it cost even to think about such thinkgs weighed oppressively upon him."

pg. 53-4. The prayer by Mitsu Abe is a Buddhist version of the Catholic Rosary. The parable here is the Buddhist equivalent of the Golden Rule or the Beatitudes ("Blessed are the poor . . ."). The moral is twofold. Your suffering is the result of your failure to care for others in their moment of need. Two, reconciliation and forgiveness will ease your suffering. We learn more about the poor old lady. Her son is a soldier from whom she has not heard, but even in her few possessions, she keeps the "Rising Sun" flag as a memento. Signing the flag is like signing a cast in America. This is probably a common behavior among old patients who may feel alone and scared by their illness. However, notice the soothing words do not come from the medical professionals, but a fellow patient. Is there a lesson to be learned here?

pg. 55-58. The doctors of the First Surgery are exuding a lot of confidence bordering on hubris, and pride comes before the fall. However, what do you think about how dismissive the doctors are of the mother's concerns? Should patients/family always defer to the professional authority of doctors?

pg. 57. The conflicted feelings of jealousy that Suguro has in the second to last paragraph here are interesting. Why is he jealous or resentful of the treatment of Ms. Tabe? How would you feel?

pg. 59-62. The operation goes bad. ..

pg.63-66. The reaction of the various members of the surgical team. Hashimoto: stunned. Asai: taking charge. Suguro: disconnected. This is telling about their character, but no one questions the decision to cover up the surgical death.


 * "'And do everything else besides, just as you would after any operation. The patient is not dead. She will die tomorrow morning."

Perhaps most telling is the lack of dissent. All the members know what role to play whether it is Asai in lying, Oba putting herself between the gurney and the family, etc. Nurse Oba is described as wearing a "Noh" mask. Noh is a type of Japanese drama, similar to ancient Greek dramas, where the actors wear masks to appear expressionless or with fixed expressions. It is the Japanese equivalent of saying someone has ice water in their veins. A typical Noh Mask is shown to the left.

It is also telling that when things go bad, the most authoritative person is the Chief Nurse, Oba, and not the doctors. Hmmm.

pg. 65-6. It is chillingly cynical that the reaction of the younger doctors is that Mrs. Tabe's death is understood mostly as a sign that their chief is slipping (and therefore opening slots for advancement for them).


 * Toda: "'Our little comedy's moving along nicely . . . A comedy all right. A ready comedy . . . if she had died during the oeperation, it would ahve been the Old Man's responsibility completely. but if she died afterwards, maybe it's not the fault of the man with the knife. There's an element of doubt. you can make our a case for the Old Man at election time. Asai has it all figured out."

pg. 66-7: Of course, no secret can be kept from the people in the hospital. It is interesting to think of this episode from the perspective of HIPAA regulations about guarding patient privacy. Once again, the old lady is used as a pawn. Her treatment is postponed to save face for the doctors of the First Surgery.

pg. 68-9. Suguro's reaction to the old lady here is interesting. First, dextrose = sugar. During the war, this would have been strictly rationed and certainly not given to welfare patients. Suguro gets angry at the old lady because she does not show proper gratitude by dropping the dextrose cube. His desire to laugh at the Tabe incident stands in stark contrast to his behavior here. One way for him to deal with his conflicted feelings about the delay of the old lady's treatment is the "blame the victim" and therefore be able to dispose of one's guilty feelings.
 * "'Like a spoiled child! She depends on me, then she doesn't even take what I give her.' he knew that the old lady could use the dextrose as a valuable barter item in getting food from the other patients, and he felt unaccountably angry." While his reaction might seem incongruous, anger is a common reaction to grief and death. However, Suguro's slapping the old lady support's Endo's overarching theme of those who blamed the victims of wartime atrocities for making bystanders fell guilty. How dare they make us feel guilty!

pg. 69-70. Toda's cynicism once again comes to the fore to contrast with Suguro's sentimentality and emotions.

pg. 70-2. After the events of Mrs. Tabe's death, the quiet death of the old lady is an anti-climax and Endo's transitions to the next act as the first act's foci disappear and the American POWs enter almost without remark.


 * pg. 72. ""'Don't ask me,' Toda spoke from him. 'So with that, your illusion passes. Every attachment is an illusion.'" Many medical observers discuss the psychological process of attachment of medical professionals with their patients. Suguro sums up his feelings: "'She was the one thing in the midst of Toda's pessimistic 'everybody's on the way out' that I was going to make sure didn't die. She was my first patient." Medicine has the power to heal, but not control over life and death, Suguro concludes.

pg. 73-75. To make up for this mistake in the Tabe surgery, First Surgery decides to cultivate warm ties with the military to outflank Second surgery. As the description on this page notes, the military seems to be doing pretty well despite the rationing for everyone else.


 * "'both of you know, I suppose, that ever since //that// operation, the Old Man feels that Second Surgery and Doctor Kando have gained the upper hand. Now this time, we feel that getting on good terms ourselves with the Western Command medical people, with whom Second is so cosy, wouldn't be a bad idea at all. Therefore we feel there's no need to ill-temperedly refuse their friendly proposal and hurt their feelings . . ." What the military wants is medical experiments, and the POWs are "willing" subjects.
 * pg. 76. "'the bastards, what did they do but bomb indiscriminately? They've already been sentenced to be shot by the Western Command. Where ever they're executed it's the same. Why, here they'll get ether and die in their sleep!'"

The Japanese regarded American pilots as terrorists because they bombed civilian areas indiscriminately for the purposes of inflicting terror on non-combatants. Many Americans have justified torture of terror suspects for the same reasons. Do you agree?

pg. 77-8. The list of the three experiments that were performed on the American POWs and the medical rationale for the experiments.

pg. 79. God & Morality. ..


 * THOSE WHO ARE TO BE JUDGED . . .**

The second part of the book looks at the backstories of two individuals who participated in these experiments. In the movie dramatization, these sections are shown as testimony given to the American prosecutors during the Tokyo wartime trials, but as Endo presents them, they can be seen as the rationalizations these individuals give to themselves -- an internal monologue -- for their participation in the vivisection.


 * I. THE NURSE**

Nurse Ueda is one of the assistants to the vivisection. As young nurse she had worked at the Fukuoka University Hospital, but married a patient who works for the Manchurian Railroad. At the time, Japan had occupied Manchuria and many poor and upwardly mobile Japanese moved there to take advantage of cheap land and employment opportunities. Ueda seems to get married for the wrong reasons, she writes. ..


 * pg. 83 ". . . it suddenly flashed through my mind that twenty-five was starting to get on a bit as far as marriage was concerned, and then, too, his job . . .wasn't a bad position . . .but at that time I really wanted very much to have a baby. Not just anybody's baby, of course; but having a baby by somebody like Ueda would be all right I thought."

She goes to Manchuria isolated from her family and friends. It becomes clear that her new husband is kind of a jerk, cheapskate, and a bit a womanizer. They take on a Manchurian servant and the husband advises beating them to put them in their place. This cameo is important because it foreshadows the treatment of Americans, another group of foreigners, during the vivisection.


 * pg. 86-7 "I realized how right Ueda was when he said that the first thing for a Japanese to learn here was the proper way of acting towards the Manchurians. For example, next door to us lived the Zoga family, and they had two Manchurians . . . from across teh garden I could hear Mrs. Zoga and her husband yelling at them and hitting them. At first all this racket scared me, but gradually I got used to it. Ueda told me that it was the way these Manchurians were. You had to knock them around; otherwise they wouldn't do anything. Then it happened that in place of a maid I started having a girl come in three times a week. And, sure enough, I soon got into the habit of hitting her, for no reason at all."

She becomes pregnant, but her husband cheats on her with a prostitute. Her husband places her in a hospital (free to company employees) so that he can take his new woman into their house. The baby is a stillbirth, and this event has a major impact on Nurse Ueda.


 * pg. 88 "Even today to write about the birth is painful., seeing that I have to bring it allup again. when you read this account, maybe you'll see that it's because it turned out that I was never to have a child, that there is someting missing in my heat and in my life. For some reason or other, the baby died inside me . . . finally in order to save my life, it was necessary to cut out my womb altogether . . .When they took away my womanhood, I had a feeling as if a pit had broken open at my feet -- and that empty feeling just swallowed me up. If I had been turned into stone, it would have come to the same thing. Some women have an operation to help them. But my womanhood was torn from me, and there was nothing else for it but to go through life a crippled woman."

There is a lot going on there. First, the connection of her womanhood with her ability to bear children. Second, the emotional emptiness that characterizes her through the rest of the novel. Third, even though she sees herself as a victim, a "crippled woman," she does not seem to have the ability to empathize with the plight of others. Fourth, a cultural aside, is the Japanese attitude toward abortion and contraception as shown in the attitude's of Nurse Ueda and her husband. Abortion has long been legal in Japan, while contraception (the pill) only became legal relatively recently. This seems odd from a Western perspective. However, abortion as a form of family planning favors the husband because it allows him to decide whether there will be offspring to support, while contraception is liberating for the mother because it allows them to time childbirth, allowing them to pursue a career. Country singer Loretta Lynn's song "The Pill" (below) captures the changes that contraception had on the life of most women.

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Nurse Ueda concludes that


 * pg. 89 "Not being able to have a child seemed to have stopped me wanting sex. Even so for two years I kept on living with him on account of my own weakness and because of what people would say. I just didn't want to become on of those poor women -- there were so many of them -- who were kicked out by their husbands and had to go back home."

She returns to the main islands and clearly she does not get along with her family. She takes a single apartment, takes a job again at the Hospital, but much has changed during her absence. Everyone has moved on with their life while hers has been stuck in neutral. Nurses who had been her junior now looked down on her. She buys a dog and names it after her son.

Nurse Ueda makes an interesting observation about the status of doctors and nurses


 * pg. 90 " . . . all during this time, the Chief Surgeon, Dr. Hashimoto, meant nothing to me insofar as he was the man in charge of the work I did. I was just a nurse, and to me professors and assistant professors were not just on the great master level but were people who right form the day they were born lived in a different world. The position we nurses have is just a little above scrub women."

The next three vignettes involving Dr. Hashimoto's German wife, Hilda, illustrate the cultural differences in health and healthcare. First, there are clear differences about appropriate gender roles and the Japanese nurses equate Hilda's bold and gregarious style to a man, not a woman. However, her "work of mercy" by handing out rationed biscuits (cookies) and cleaning the patients undergarments is not taken as she intended.


 * pg. 90-1 "Then one said, 'She's really something isn't she? Passing out biscuits and washing underwear -- that's her specialty.' Afterwards I realized tathat they were being catty about her visit to the ward patients every time she came ot the hospital . . . The fact is that we nurses didn't appreciat eher goodness very much. I think it was a lot of trouble to the ward patients too. The ward was filled with old men and women who had lost everyone they could depend on in the raids, but to have a Western woman like this talk to them would cause them to freeze up. On top of it, when Mrs. Hilda would pull out of their old cloth packs and wicker baskets their dirty underwear, they would get all upset and come crawlingout of their beds. 'No, no, Ma'am. No, please! It's all right,' they'd plead. The funny thing is that the patients' embarrassment didn't worry her a bit. Like a big boy, she'd take these great strides through the hospital, passing out her biscuits and rushing the patients to give up their dirty things so she could put them in her basket and move on to the next one."

The second vignette occurs when Nurse Ueda meets Dr. Hashimoto's son and realizes that he is the same age as her child would have been. This leads to understandable jealousy and competition between Hilda and Nurse Ueda. When Nurse Ueda reaches to touch the child, Hilda commands


 * pg. 94 "'Please don't touch him . . . as you know, children can get tuberculosis easily. When I leave the hospital, I always wash my hands with antiseptic."

Desperate for emotional and physical connection, Hilda denies that to Nurse Ueda. The antiseptic barrier is also and emotional one. Nurse Ueda reacts by taking out her frustration and anger on her pet dog


 * pg. 94-5 " . . . I felt my loneliness more than ever. When I was feeding the dog . . .suddenly I got mad and lifted my hand, and, even though she crouched in a frightened way and looked pitifully at me with her eyes, I hit her over the head again and again. While I was hitting her, for some reason or other I didn't cry."

The beating of the dog parallels Suguro's hitting the old lady in the first section and prefigures the vivisection that is still to come. Anger is projected onto individuals who are not responsible. Bad things happened to me, so others do not matter. Nurse Ueda seem unconnected to events and people around her and focused on her own pain and suffering.

The third vignette begins with a description of the TB ward -- the least desirable assignment in the hospital because of the constant coughing and wheezing of the patients and the inability to cure many of the patients. This third vignette occurs during the operation on Ms. Tabe described in the first section of the novel. A patient on the TB ward has a spontaneous pneumothorax attack (an air pocket in the lung that compromises the ability to breathe). She calls Dr. Asai, who clearly is preoccupied with the failed operation on Tabe, and he basically tells her to give a fatal dose of a narcotic because the patient cannot be saved and he cannot be troubled to attend to her. One could relieve the airpocket with a hypodermic syringe, but instead, she is instructed to relieve her suffering by administering the narcotic. Hilda will have none of it and slaps away the narcotic, embarrassing Nurse Ueda. Afterward, she questions Nurse Ueda


 * pg. 98. "'Why were you about to give her an injection? . . . She was dying anyway, I suppose? Was that it?' 'But . . .' I looked down at the floor. 'Whatever I did, she was going to die. Can't you help a person by letting tem die easier?' ' Even though a person is going to die, no one has the right ot murder him. You're not afraid of God? You don't believe in the punishment of God?'

This interchange parallels Toda's conversation with Suguro where he observes that everyone is going to die so it doesn't matter if it is in the hospital or in an air raid shelter. Moral distinctions do not matter. This passage also illustrates the different views of Asians and Westerners about euthanasia. It is easy for the Japanese to contemplate a "life not worth living" and helping someone die is not seen as an affront to medical ethics. No Hippocratic Oath, etc.

The last pages of this section point to the physiological differences between ethnic and racial groups. Do we dehumanize those of other races? In the American context, this is usally whites relegating blacks and browns to lower status and historically, poor blacks were used for medical experiments in the USA (Tuskeegee Experiments). Endo turns the tables from the perspective of an Asian looking at a European.


 * pg. 99 "I had no idea that the skin of white people got so dirty. The back of the hand was covered with little blond hairs. It all seemed so funny at first . . ."

Later Dr. Asai and Nurse Ueda speculate about interracial sex during their drunken tryst. (pg. 100)


 * pg. 103. After being invited to be part of the team to carry out the vivisections, Ueda speculates about, " . . . a Western woman's skin with downy hair growing on it. I thought: soon a scalpel is going to cut into white skin just like that. 'Is a white person's skin hard to cut, I wonder?' 'What? Don't be silly. Foreigner, Japanese -- it's just the same,'"

Finally, Nurse Ueda gives her reasons for participating in the vivisection. First, her dog disappears, he only emotional connection. She voices her resentment to Hilda, who is trying to get her fired for the pneumothorax incident. She thinks


 * pg. 101. "I didn't care what happened from then on. I didn't care about Dr. Asai. I was thinking about Hilda, who calledup wanting them to fire me. I hated her. Just so she could play the saint all by herself, she didn't care at all howmuch trouble she gave the patients and the nurses. for he, a saint and a mother, somebody like me, who had everything that made her a woman taken out of her . . . would be something dirty, I suppose."

Dr. Asai tries to persuade her by appealing to nationalism ("do it for your country") and professional commitments ("to advance medical research"), but Ueda dismisses both of these reasons.

She concludes
 * pg. 102. "'Will you do it?' 'Doing it for my country doesn't mean a thing to me. Neither does doing it for your medical research.' I didn't care whether Japan won the war or lost it. And I didn't care whether medical science advanced or not. It was all the same to me."


 * pg. 103. "If my baby hadn't died in Dairen, if I hadn't broken up with Ueda, my life wouldn't have been like this, I kept thinking."

**II. THE INTERN**

pg. 103. NOTE: Long hair was considered a mark of high class in Japan. Samurai children put their hair in a top-knot, while this hairstyle for farmer children was impractical and they shaved their head. Toda grew up in a small rural town, but his family (his father was a physician) was higher status than their peers. As a result, he is referred to by his surname, and not familiarly with his first name as the other students are.


 * pg. 104. "The pupils made the same distinction as the teachers, and it wasn't considered a bit strange. This was due to my being the only one who wasn't a farmer's son. My father was a doctor, and he had opened a surgery not far from the school. And these teachers, withtheir tight-collared jackets, wer no doubt in awe of a great personage like a doctor and of the plate with M.D. on it . . . I got nothing but A's on my reported card, and I was the only boy in the school who was going to continue my education."

Toda's cynicism comes from the privileged position he holds as the child of a professional and deceiving those in power (adults) is also a core part of his personality.


 * pg. 104 "I made a practice of pulling the wool over the eyes of adults. These included not just my tight-collared teachers but also my mother and father. I didn't have any trouble reading their unsubtle eyes and facial expressions in order to estimate how best to make them happy or to extract praise from them, sometimes playing the innocent role, sometimes that of the bright child. I perceived by a sort of instinct exactly what adults wanted to see in me: a blend of naivete and wisdom. Overplaying naivete wouldn't do nor, on the other hand, would seeming too wise. However, if one doled out these commodities to adults in just the right measure, they would inevitably respond with praise . . . All bright children have more or less the same kind of slyness to them. And then it sometimes happens that they foster in themselves the congenial illusion that they are good children precdisely because of this capacity."

Toda is not only cynical and manipulative, but embraces his chamelon-like nature. Contempt downward toward his less sophisticated classmates, obsequiousness upward toward those in authority. His rationale: everyone is doing it, and you would too, if you had the ability, don't blame me because I do. In addition, he frames his actions as if he is in control. His cynicism allows him to believe that he is better than, in on the joke so to say, on those who formerly have more power than he. This contrasts with his stated attitude that "everyone is on their way out."

pg. 105. The arrival of a new boy, Minoru Wakabayashi, who shares his social status and sophistication presents a challenge to the young Toda. He is no longer special and unique.

pg. 106. Basically, what Toda is describing is plagiarism. This is not looked on as a problem in Asian schools as it is in American Schools. Emulation is a compliment, not a crime. What matters more is that Toda's emotions and behavior is not sincere, it purpose is to elicit a reaction. Even the virtues displayed by his gift to Kimura are hollow and designed for an effect. Toda reflects


 * pg. 107: "It was true taht I had brougth a butterly collection to a boy named Maseru Kimura, but is wasn't for the purpose of consoling him in sickness. It was true too that I had walked through the onion fields filled with chirping grasshoppers, but I had never thought of regretting giving the collection to Kimura. Why? Because all I had to do was to ask my father and he would buy me three more just like it. Kimura wasn't especially delighted, and what I thougth at the time was how dirty farmers let their houses get, and what I felt was a sense of superiority."

The stark contrast between Toda's internal moral life and his public reception of his actions feeds his cynicism. The path to success is paved with vice, not conventional virtue. In effect, virtue is for suckers.


 * pg. 107. "'When he was walking through the onion fields, he felt sorry about giving the butterflies, and that's just the way he wrote it down. All of you sometimes put lies into your compositions. But Master Toda here has frankly written exactly how he felt. That's beign conscientious.' . . . My conscience wasn't troubled about having lied or having deceived the teacher and my classmates. This was the way I had always acted whether at school or at home. And by so doing, I had become known as a good boy and a first-class student."

The fly in Toda's ointment is that the new boy, Wakabayashi, knows his game and that seems to affect Toda.


 * pg. 108. "'You fooled them all, eh? But I know.' His smille semed to be telling me just that . . . From then on my self-confidence began, bit by bit, to crumble. As long as that boy . . . was near me . . . I felt as though some intangible humiliation were hanging over me . . . the expression in his eyes . . . were by no means the eyes of an accusing judge; nor were they they tye eyes of conscience threatening punishment. It was no more than a matter of two boys sharing the same secret . . .each of whom perceived in the other the image of himself."

Wakabayashi is bullied by his other classmates and Toda does not intervene and instead, passively, wishes them to hit them harder. This parallels Suguro hitting the old lady, Ueda beating her dog: we get angry at those who call us to account for our moral failings, not ourselves or those who put us into the situation.

When the teacher arrives on the scene, Toda is once again being observed and he changes his behavior to give the appearance of virtue and once again receives praise from those in authority. When Toda does do an virtuous act by giving a fancy pen to Kimura (pg. 112-3), he pledges Kimura to absolute secrecy. How the point is that Toda sees nothing abnormal about his actions or behavior and turns to the reader and states
 * pg. 109. "He struggled with them, but then he was hti and knocked down and lay face up in the sand. When he tried to get up, they knocked himdown again. As I watched this scene, it never occurred to me to try to stop them. I didn't pity him at all. Rather I wishing that [they] would hit him harder and pull his hair more."


 * pg. 113. "I am not the only one who had such thoguths in his boyhood. You, too, were probably much the same, however different the form your thoughtss took. but to keep on thinking in this way, to have thought like those which follow -- perhaps this is something peculiar to me. Or is it that you, too, also have expereinces like these hidden within your heart?"

Toda continues on, but his explanation of his choice of medicine as a field of study is telling


 * pg. 114. "My father was a doctor. So I, too, decided to become a doctor. I wasn't motivated by enthusiasm or idealism . . .I had the conviction that as far as the surest way of always having enough to eat was concerend, the best course was to become a doctor. then, too, as my father had told me . . . classification as a medical student would be beneficial."

Toda's interest in insects compares with the examination of the American POWs. In addition, his theft of his teacher's butterfly specimen and the blame put on one of the less apt students (pg. 114-118), Yamaguchi, reinforces the theme that it isn't wrong if you don't get caught. It is observation that makes something right or wrong is the core of Toda's ethics. Yamaguchi's desire to take the blame for things he did not do parallels and contrasts with Toda's desire to get praise for things he did not do. Yamaguchi becomes the hero by being cruel and demonstrating his capacity for cruelty. Toda is jealous because the praise he wants (and deserves) is being taken by Yamaguchi. However, Toda can only get praise by owning up to his actions.

Justice, Truth is negotiable as Toda concludes


 * pg. 117-8. "No matter how you choose to record such experiences, you can never attain objectivity. You'll always blend in some shade o fdifference. Sorting through experiences like these of my childhood . . .one could ine them up any number of ways. All I've done, in fact, is to select one or two incidents . . ."

He reiterates the view that morality and ethics is more ephemeral and contingent in assessing his own conscience -- if everyone else is doing it, why can't I. The only difference is that I am skillful enough to pull it off where others are not. What Toda is doing illustrates the difference between "sin" and "shame" that characterize Western and Eastern societies respectively. The notion of sin is that no matter you do, God is watching and will settle accounts. The notion of shame is that being observed is the worst thing, what others think of you is what matters most. :


 * pg. 188: "I didn't think of myself as a person whose conscience had long been paralyzed. for me the pangs of conscience, as I've said before, were from childhood equivalent to the fear of disapproval in the eyes of others -- fear of the punishment which society could bring to bear. Of course, I didn't think I was a sant, but I felt every friend Ihad was just like me under the skin. Perhaps it was no more than a stroke of luck or an unbroken series of them, but it so happened that nothign I ever did seemed to merit punishment; that is, my actios never brought down upon me the censure of society."

He provides his participation in adultery to illustrate his point
 * pg. 118: "I didn't appear to myself as a heartless betrayer. There was some regret, some uneasiness, some self-contempt; but as soon as I was sure that no one had ferreted out my secret, all this soon went away. My pangs of conscience, no matter how well I nurtured them, never lasted more than a month at most."

The next few pages (pg. 118-121) depict the details of his adultery with his cousin. Basically he takes advantage of a loveless marriage and a vulnerable housewife. The key he concludes is that everyone kept the adultery secret, to the benefit of all involved.


 * pg. 121: "I knew my cousin would never speak of what had happened the night before. As long as she held here hsuband in contempt she was never going to make any confessions of wrongdoing to him. I was at ease, then, knowing my secret was never going to come to light . .. she hasn't said a word about it . .. so he still knows nothing about it and thanks to hsi ignorance, she holds her place today in society as a wife and mother, as I hold mine as a simple intern."

Today feels contempt for the husband because he is too dumb or gullible to know. He concludes by extending these ethics to his medical practice. This section (pg. 121-23) is key to unlocking his character and his motivations for participation.


 * pg. 121-2: "My callousness extends to another area . . . I am able to remain quite undistrubed in the face of someone else's terrible suffering and death. My life as a medical student has for some years brougthme into the midst of suffering on a large scale. if they turned their faces to me it did them no good . . . Patients would groan unremittingly .. . I was able to shake my head. 'No, any more anaesthetic would be extremely dangerous,' I would say; but what i was actually thinking was how troublesome and incosdierate these patients and their families could be."


 * pg. 122. "A patient would die . . . but once out in the corridor, the spectacle would pass out of my mind. It seems as though being in a hospital . . . any sympathy or pity that I might have felt towards these people was worn down to the point where it vanished."

He next relates the tale of knocking-up his domestic and performing an abortion on her when he was a medical student. This scene parallels Ueda's stillbirth and Toda's reaction is similar to Ueda's husband. He states a casual concern that the procedure might have lead to peritonitis. His real concern. ..


 * pg. 123: "The intention foremost in my mind was never to let anyone know about this unhappy miscalculation, not to have my whole life ruined because of a girl like this. The spectacle of Mitsu suffering . . . touched me hardly at all."

Having spared himself from discovery, he sends his domestic Mitsu away, just like Ueda's husband. It is hard to understand what Toda is getting at on pages 123-4 without understanding the shades of difference of the Japanese vocabulary. The point is that he is conscience-stricken, but curious that he feels anything at all and becaue he asserts that everyone is like this and he poses several rhetorical questions to the audience.

He concludes the section of watching an American B-29 air raid from a distance only to hear the collective groan of the dying. One might think that Toda justifies his decision just as the American pilots who killed tens of thousands did without losing a night's sleep. Is he any different than they because he played an active role in the vivisections of just a few POWs?

III. THREE O'CLOCK IN THE AFTERNOON

Three O'Clock in the afternoon alludes to the traditional time of Jesus' death by crucifixion -- a sacrifice of innocents. The authors, Endo Shusaku, was a devout Catholic and this parallel is probably intentional. We open with Suguro in his morning routine on the day of the vivisection. We are presented with the possibility that Suguro could still choose not to participate


 * pg. 127: "'If you're thinking of refusing, then there is still time to do it.' Rigth now, if he were jsut ot turn and walk back to this boarding house . . . He looked behind him. That would be the the thing to do, he thought. But the path stretched before hsi eyes, shining dull silver with frost. if he followed it, it would take him right ot the main gate of the hospital."

Here Endo is setting atmosphere: everything is somber and officious, suggesting an execution, but who is being tried? The mood changes with the introduction of the Army medical officers who will participate and have handed over the POWs to Dr. Hashimoto. The tone becomes more celebratory. They talk of "taking pictures" like it was a picnic or graduation. One mentions the eating of one of the POW's liver (p 129). This is a not subtle allusion to the well-known war crimes in China where soldiers would cut out liver and hearts of their fallen enemies and prisoners for food.


 * "'No joke. I heard in my outfit there was a bunch who opened up a chink and tried his liver.' 'They say it goes down surprisingly well,' said the officer . . . his face aglow with knowing complacency. 'Well, what do you say? Let's give it a try at dinner today!'"

The conversation turns to how to deceive the POWs into believing that this is just a normal check-up and how to administer the anaesthetic, but the word "prisoner" rouses Suguro to the reality of the procedure. "We are about to kill a man." (pg. 131). The next few pages are just narration, until the point where Suguro refuses to apply the anaesthetic mask and Toda volunteers in his place. When Toda asks Suguro to help a second time, he remonstrates Suguro saying


 * pg. 135: "'Come over here. . . You won't come and help?' 'It's no use, no use at all. I can't,' Suguro muttered. 'I. . .I should have refused before.' 'You're a fool. And what do you have to say for yourself? ' Toda turned, glaring at Suguro. 'If it were a matter of refusing, yesterday or even this morning wuold have been time enough. But now, having come this far, you're already more than half way.' 'Half way? What do you mean, half way?' 'You're alrady tarred with the same brush as the rest of us . . . From now on, there's no way out, none at all.'"

The section concludes with a pan out to the ward and Mitsu Abe reading the same Buddhist story that she had read before to the old lady. This story parallels the Christian parable of the sheep and the goats. There is a new patient in the old lady's bed, but we are given the sense of a recurring cycle that does not end.

BEFORE DAWN BREAKS

This last section is mostly anti-climax. We are made aware that there are other parallel experiments in the other surgeries. We are also given the sense that the procedure is like any regular medical operation except with the intent of killing the patient. Toda is aware that his actions will be recorded, will that spark a conscience in the cynical Toda? Suguro is clearly in shock denial of the events transpiring in front of him. A comparison is made between the vivisection and the operation on Ms. Tabe. In both cases the medical staff is conspiratorily lying about what really happened.


 * pg. 150: "'I didn't do anything at all.' Suguro made an effort to shut out his voice. 'I didn't do anything at all.' 'That's it! You've hit it there! You didn't do anything at all. The time the old lady died, this time too -- you didn't do anything at all. You're always there. You're always there -- not doing anything at all!'"

QUESTIONS FOR THOUGHT AND DISCUSSION