福島孝徳先生を偲ぶ：再会を期待して！
福島孝徳先生を偲ぶ：再会を期待して！
森田明夫
（ちょっと専門的な記載があるので、あまり一般向けではありません）
恩師である福島孝徳先生が亡くなった。ご本人の意思で亡くなった詳細はわからないが、一昨年くらいから腎臓の不全などの体調の不良や検査データをお聞きして心配し、また昨年9月にバルセロナのヨーロッパ脳神経外科学会で先生を称えるセッションがあった際、いつもの迫力のなさを見てものすごく心配していた最中である。私は凡庸な脳神経外科医であるが、福島先生に刺激されて洗脳されて、今まで頑張ってきたように思う。以前先生と師とする喜びを書いたことがあるが（前部長のブログ：福島先生のこと：洗脳と師とする喜び）、その時は先生はご健在だったので、ご容赦いただけると思い、ちょっとふざけた（事実ではあるが）内容が多かった。
福島先生の偉大な業績については、多々提示されているので別に譲る。ここでは私が個人的に接してきた福島先生についてMemorialとしたい。
先生と密にご一緒したのは、1984 年から86年の3年間弱、私の脳神経外科専修医としてトレーニングの最も重要な時期を先生と過ごしたことになる。毎日のように「超一流を目指せ！」と専修医には言い、そういうご自分も、日々新しい手術、他とは違う医療のレベルを目指しておられた。先生の夢は「福島手術！」というジャンルを作ることだったと思う。当時先生は40歳くらいで、その若さで三井記念病院という都内の一流の病院の部長を任せられていたわけなので、東大の教授たちの信頼を一身に受けていらした。私はまだ専門医をとっていなかったので、全てをわかっていたわけではないが、印象に残っている最大の教訓は、「出血を徹底的に抑えること。中途半端な止血で次のステップに行かないこと。」先生がおっしゃっていらしたのは、「最初は時間がかかるかもしれないけど、ステップステップをしっかりやってゆくことで、自然とスピードもついてくる。手術は早くやろうとするな、ステップをしっかり踏むことで、自ずと無駄がなくなりスピードもついてくるというものだ。」外来の脇にあった医局ではその日にあった手術を当時4~5名ほどいた医局員で話あった。あの手技はなんだ？どうしてあのような針を使うのか？なんであんなに早くできるのか？驚いたのは90歳の三叉神経痛の患者さんの脳神経血管減圧術(以下MVD)を計画された時、皆が「ブロックで治療の方が良い」と思ったのだが、福島先生は手術を実施され、なんと手術時間はSkin to Skinで15分以下だった。もちろん福島先生はそれまで高齢者のMVDで慢性硬膜下血腫ができたことがあり、特に高齢者では頭頂部を少し下げて、空気がテント上（大脳のある頭蓋）に行かないように努力していた。患者さんは何の合併症もなく一週間で若い患者さんと同じように退院された。それと当時課題だったのが、人工硬膜（ヤコブ病で有名になってしまった人死体硬膜）を用いて硬膜を閉鎖した後に起こる無菌性髄膜炎症状であった。ステロイドの髄注など様々な対応をしたが、あまり良くなることはなかった。ある日突然、先生が、手術の最中に筋膜の一部を採取して、それを硬膜閉鎖の時にパッチとして使うようになった。その途端に、それまで医局の最大の診療課題が完全に解消された。手術のone-stepで全てが変わる。というのを間近でみて、些細なことでも手術ではすべてのステップがそれぞれが極めて重要な要素であることを知った。
福島先生の手術が最初から、ものすごかったわけではない。もちろん福島先生の東京での名声は広まり症例は毎手術日に6~7件の手術を行い、中には非常に難しい（今の私が見ても）手術も含まれていた。時にはうまくゆかないこともあった。ものすごく落ち込んで、周りが手もつけられない程に萎れてしまった福島先生を何度も見させてもらった。ただ必ず翌日にはものすごく元気になっており、不元気を絶対ひきづらない。そして同じような困難な手術が次回にある時にはどこから聞いて教えてもらってきたのか？自分で考えたのか？全く異なる手術技術を用いて、難なく合併症をきたさずに手術をされた。要は絶対に同じ過ちは繰り返さない。徹底的に悩み、打ちひしがれ、回避する方法を塾考して実施する能力を発揮されていた。以前書いた切ってはならない神経を切ってしまって、手術室の壁を半分くらい登ったのは事実である。そのような今となっては本当におかしな所作は数限りない。
また先生は子供のような無邪気さを兼ね備えていた。自分のことを「僕はね、、僕はね、、」とおっしゃるのが口癖で、自分の気持ちを素直に話される。息子さんを含めてスキー旅行に医局で行ったこと。眩しそうな顔で息子さんを見ていた顔。明治神宮の脇にあったご実家に伺った際に、お母様が「この子はやんちゃでね〜〜。皆さんにご迷惑をかけているのではないか心配ですよ。」と先生の頭をゴシャゴシャとしていた。その時の先生の子供に戻ったような恥ずかしそうな顔を覚えている。
当時も最近も文字通り福島先生は言動に困ったところもある人で、あまりよく知らない人には「変人の一人」と思われていたかもしれないが、よく知る医局や知人には本当に敬愛されていた。
私が先生の元を離れてから、情熱大陸での放送をきっかけに先生の人生は大きく変わってしまい、他の病院からの出張手術も爆発的に増え、そして活躍の舞台を海外へ展開することになる。もちろん、先生の手術に対する思いやコンセプトが世界の多くの脳神経外科医に広まったことは本当に喜ばしいことなのは確かだ。ただ、技術的なシャープさばかりが評判となり、みな手先の器用さを賞賛することが主で、先生のその技術を支える一例一例への執念のような考察と術中術後の管理の徹底を重視する姿があまり理解されていないように感じている。そしていつも誰も治療し得ない患者に対する新しい手術や手技を求める一生続いたQUEST(追及の強い意志)を皆さんにわかって欲しいと思っている。
脳神経外科領域は1980年代はまだ黎明期で、わからないことも多く、画像技術も不十分（MRIなど日本に数台しかなく、画像もひどいものだった）、そしてマイクロ手術も、本当の意味で使いこなせていたのは日本でも数名であったように思う。福島先生はそのようなな中で日本の脳神経外科、世界の脳神経外科のレベルを数百段ステップアップしてくださったと思う。あれから40年経って、脳外科や医療は大きく様変わりしたと思う。画像など当時信じられないような神経繊維の走行や機能まで見ることができるようになった。でもまだまだ困難な疾患は多くあり、我々が超えて行かなければいけない山はまだまだ先に高く聳えている。
福島先生が教えてくださった。
１） 慌てないで、ステップをしっかり一つ一つしてから、次にゆくこと。
２） 同じ過ちを決してしないこと。
３） 患者の状態や検査を徹底的に調査し、最適な治療法、なければ新しい治療法を考えて最善を尽くすこと。（不可能への挑戦ビデオ）
を守って進んでゆくことで、我々にも今後の医療を進歩させることができると信じる。
福島先生から教えていただいた根性（一週間月・月・火・水・木・金・金・土・日 休んでいる暇なんて無い！働くべき１週は7日だけじゃない：今の働き方改革など論外と思われていたと思う）、最先端への導き（毎日のように、念仏のようにアメリカに行け！英語を勉強しろ！と言われ続け、米国に9年間行くことになった）、常に新しいことを、患者の最良の結果を導く方法を考案しろ！という洗脳・教えは私にとってはかけがえのない道標である。
そんな道標を自分に授けてくださったこと、そして厳しくも温かい40年以上にわたるご指導に深く感謝したい。
よく欧米ではRIP: May his soul rest in peace!という言葉を使うが、予想するに福島先生の魂は、さていつ生まれ変わって宇宙旅行時代の宇宙の医療をどうしてやろうか？と考えている頃かと思う。もし私も生まれ変わることができるのであれば、ぜひにまたお会いしたいと思う。
またお会いする日まで！「本当にありがとうございました。」
三井記念病院にて
米国にて
MVD2020学会でランチョン講演をしていただきました。
MVD2020で配布された手書きの手記（情熱たっぷり）
森田の日本医科大学教授退職記念会にて
EANS2023 Fukushima Symposiumを終えて集合写真（最後にご一緒した写真）
ENGLISH VERSION:
In Memory of Prof. Takanori Fukushima: Hoping for a Reunion!
Akio Morita
(The contents is not really for the general public as there is a bit of technical description)
My mentor, Prof. Takanori Fukushima passed away. I do not know the details of his death since he did not wish to disclose any info. But I was worried when I heard about his health problems such as kidney failure and test data from the year before last, and I was also extremely concerned when I saw the lack of his usual energy during the symposium honoring him at the European Congress of Neurosurgery in Barcelona in September of last year. I am an ordinary neurosurgeon, but I think I have been inspired and brainwashed by Dr. Fukushima and have been force to work hard until now. I once wrote about the joy of having Dr. Fukushima as a mentor (former director's blog: Fukushima Sensei: Brainwashing and the Joy of Being a Mentor), but since he was still alive at that time, I thought he would forgive me and many of the contents were a bit jokey (although true).
I will leave the great achievements of prof. Fukushima for another time, as they have been presented in many articles. Here, I would like to write a memorial about my personal contact with Dr. Fukushima.
I worked closely with Dr. Fukushima for a little less than three years from 1984 to 1986, which was the most important period of my training as a neurosurgeon. Every day, he would say to his residents, "Aim for the very best, to be a super neurosurgeon!" and he himself was always striving for new surgeries and a different level of medical care every day. I think his dream was to create a genre called "Fukushima Surgery!” He was about 40 years old at the time, and at such a young age he was entrusted as the head of the department of Mitsui Memorial Hospital, a leading hospital in Tokyo, so he had the full trust of the professors at the University of Tokyo and others. I had not yet become a board certified neurosurgeon at that time, so I did not understand all his medical talents, but the biggest lesson that left an impression on me was, "Thoroughly control bleeding. Don't go to the next step with a half-hearted attempt to stop the bleeding." He said, "It may take time at first, but if you do it step by step, the speed will naturally increase. Don't try to hurry during surgery. If you follow the steps carefully, you will naturally become leaner and faster. In the doctor's office next to the outpatient clinic, about four to five members of the neurosurgical team of Mitsui Memorial Hospital discussed the day's surgeries. What was that technique? Why does he use that kind of needle? How could they do it so quickly? What surprised us was that when he planned to perform cerebral neurovascular decompression (MVD) on a 90-year-old trigeminal neuralgia patient, everyone thought it would be better to use a block, but Dr. Fukushima performed the surgery, and to our surprise, the surgery took less than 15 minutes; skin to skin. It was the fastest surgery I ever seen ad microsurgery. Of course, Dr. Fukushima had previously had chronic subdural hematoma in elderly patients with MVD, and he made an effort to lower the parietal vertex a little to prevent air from going over the tent (cranium where the cerebrum is located), especially in elderly patients. She was discharged within a week without any complications, just like the younger patients. The another challenge at the time among in our department was the aseptic meningitis symptoms that occurred after the dura mater was closed using an artificial dura mater (the human cadaver dura mater that became famous for Jacob's disease). Various measures were taken, including intrathecal injection of steroids, but the scenario did not get much better. Suddenly one day, Dr. Fukushima started taking a piece of fascia during surgery and using it as a patch during dural closure. As soon as that minimal change, the biggest medical issue in the department until then was completely eliminated. One-step in surgery changes everything. And I learned that every step in surgery, even the smallest one, is each an extremely important element.
It is not that Fukushima Sensei's surgeries were amazing from the beginning. Of course, Fukushima Sensei's fame in Tokyo spread, and he performed 6~7 surgeries on every surgery day, including some very difficult (even by my current standards) surgeries. Sometimes things didn't go well. I saw many times, Fukushima Sensei got so depressed and became so weak at the corner of department that those around him could not do anything about it. However, the next day, he was always extremely energetic and never let his depression get the better of him. And the next time he had to perform a similarly difficult surgery, where did he get the information from? Did you think of it yourself? He performed the surgery without any complications, using a completely different surgical technique. In short, he will never repeat the same mistake. He was thoroughly distressed and devastated, and demonstrated the ability to think of ways to avoid them and implement them. It is true that he cut a nerve that should not, which I wrote about earlier, and climbed halfway up the wall of the operating room. Such truly strange gestures are now countless.
Prof.Fukushima also had the innocence of a child. He was fond of saying, "I am, I am, I am," and would speak frankly about his feelings. We went on a ski trip together with his medical office team, including his son. The look on his face as he looked at his son with a dazzled expression. When we visited his parents' home by the Meiji Shrine, his mother said, "He's so naughty.... I'm afraid he's bothering you all." and she was gesticulating at the teacher's head. I remember the look of embarrassment on his face, as if he were a child again.
Both then and recently, Dr. Fukushima was literally a person who had some trouble with his words and actions. Those who did not know him well might have thought he was "one of those weirdos," but he was truly respected and loved by the medical staff and acquaintances who knew him well.
After I left him, his life changed drastically following the broadcast of "Jounetsu Tairiku" (Continent of Passion), which led to an explosive increase in the number of surgeries performed at other hospitals, and the expansion of his activities to overseas. Of course, I am very happy that his thoughts and concepts about surgery have spread to many neurosurgeons around the world. However, I feel that the public has not really understood his obsessive consideration of each case and his emphasis on thorough intraoperative and postoperative management that support his techniques, since his reputation has been built only on his technical sharpness and everyone praises his manual dexterity. I also hope that everyone understands the lifelong QUEST (strong will to pursue) to seek new surgeries and procedures for patients that no one else has been able to treat.
In the 1980s, the field of neurosurgery was still in its infancy, and there were many things that were still unknown, imaging technology was inadequate (there were only a few MRI machines in Japan, and the images were terrible), and micro-surgery was something that only a few people in Japan were truly able to master. Under such circumstances, Dr. Fukushima has raised the level of neurosurgery in Japan and the world by several hundred steps. Forty years have passed since then, and neurosurgery and medical care have changed dramatically. It is now possible to see the running and function of nerve fibers in a way that was unbelievable at the time, such as with imaging. However, there are still many difficult diseases, and the mountain we must overcome still rises high ahead of us.
Dr. Fukushima taught us the followings:
(1) Don't panic, take one step at a time and then move on to the next.
(2) Never make the same mistake again.
(3) Thoroughly investigate the patient's condition and tests, and do your best to find the best treatment, or if not available, devise a new treatment. ( Challenging the Impossible Video)
By following his LESSONS, I believe that we can make progress in the future of medicine.
The guts that Dr. Fukushima taught me (“a week is Mon, Mon, Tue, Wed, Thu, Fri, Fri, Sat, Sun. There is no time for rest! There are not only 7 days in a week to work”: I think he thought that the current work style reforms were out of the question), aim to reach the cutting edge (Told me “Go to the US” every day, like a reminder! “Study English!” I ended up going to the U.S. and stayed there for 9 years), and to always do something new and invent methods that lead to the best possible outcome for the patient! This brainwashing and teaching has been an irreplaceable guidepost for me.
I would like to express my deepest gratitude to him for giving me such a guidepost and for his strict but warm guidance over more than 40 years.
In the West, we often use the phrase RIP: May his soul rest in peace! But, I guess his soul is wondering when he will be reborn and what he will do for space medicine in the era of space travel. If I also can be reborn, I would love to meet him again.
Until we meet again! Thank you very much.
Translated with Deep L.com (free version)
