Michael Shannon Hara (6th grade)

That was the first thing I saw when I landed at Seattle-Tacoma Airport, written in big, bright letters. Under the picture of a child with sparkling eyes and full of hope, it also said Seattle Children's Hospital, and I was so excited to think, "Yes, I came here to do my internship here." I chose to do my internship at Washington University, Seattle Children's Hospital during my off-campus clinical internship in my fifth year. While most medical students start preparing for their matching and gradually start studying for the national medical examination at the end of their fifth year, it was a little difficult to decide to spend a very valuable month in February of my fifth year studying abroad in the United States. However, in my fourth year, I had the opportunity to interact with Professor George, who came to Japan for Professor Morimoto's clinical statistics class, and in my fifth year, not only my seniors and classmates at Hyogo Medical University of Medicine, but also classmates I met at other universities studied abroad in the United States. This made me very interested in medical care and life abroad, and I thought that if I spent the rest of my life suppressing this emotion, I would end up regretting it greatly, so I made this decision.

This time, I stayed in Seattle, Washington, and stayed with Dr. Stephen King, who had been a great help to me during my bioethics training at the University of Washington. I often played board games, watched movies, and played basketball in the yard with my eldest daughter, Carys, and twins, Genesis and Gabriel. Mr. and Mrs. King were always kind to me and treated me like their son. All three children learned Irish dance, the eldest daughter and second son learned the clarinet, and the twin sister learned the harp at school, so every day was active and fulfilling. I myself have been playing the clarinet since junior high school, and sometimes practiced with my second son.

One weekend I went on a solo trip to Canada. I could get there by sightseeing bus from Seattle, and the round trip cost only $60. I cycled through Vancouver's famous Stanley Park, walked around Gastown at night, and visited the Vancouver Aquarium the next day, and had a fulfilling time. On weekdays, if my internship finished early, I went to Downtown Seattle, ate at Pike Place Market, and went to the Space Needle and the Museum of Flight. I want to emphasize here that the food in America is always plentiful and delicious.

I studied Radiology at the University of Washington Hospital for the first week, and pediatrics at Seattle Children's Hospital for the remaining three weeks. In the mornings, I practiced reading images and did case studies under doctors who actually work in the radiology department. This was my first clinical training abroad, and I was always struggling to use medical English, which I was not familiar with. When reading images, sometimes the Japanese name of the disease came to mind, but the English name did not come to mind, and I ended up saying a completely different disease name, which was very embarrassing.

From the second week, my internship at Seattle Children's Hospital finally started, and I was assigned to a team that looked after inpatients in the general medicine department. I got up at 5am every morning, got on the bus while it was still dark and cold outside, and my internship started at 7:30am. By the way, I never wore my white coat from my alma mater that I had brought with me (I didn't see anyone wearing a white coat in the hospital). The hospital buildings are nicknamed Ocean, River, Mountain, and Forest, and the interior is colorful and child-friendly. Around 8am, the resident fellows have finished grasping the condition of the patients they are in charge of, and are preparing for the handover from the on-call shift and the meeting before the rounds. After that, I have a short meeting before the rounds with the supervising physician, and head to the ward rounds.

The difference between rounds in Japan is that the order and time of visits to each patient is decided in advance. By deciding the order and time, it is possible to gather the staff in charge and, in some cases, medical interpreters at that time. Furthermore, rounds are not done by doctors alone, but by nurses, pharmacists, and nutritionists working together. When discussing in front of the patient's room, parents also participate, and the whole team listens to the parents' wishes. This type of team structure is not limited to the department where I was, but is done throughout the hospital, and I got the impression that it is something that can only be done in the United States, where there are so many staff members.

Another thing that surprised me when I came to Seattle Children's was that almost every day, some kind of case study meeting, conference, or simulation was held somewhere in the hospital. The daytime case study meetings were led by residents, fellows, and relatively young doctors. The content was diverse, covering not only pediatrics but also related medical departments, medical safety, medical ethics, and more. The motivation of both the doctors who came to listen and the teachers was very high, creating a good cycle. Every Wednesday, special lectures called Grand Rounds were held in a large lecture hall, where world-famous researchers and clinicians give very interesting lectures. The speakers were all really impressive, including the president of the American Department of Pediatrics and the content was really stimulating.

During my training, the thing I had the most trouble with was how to pronounce the names of medicines and diseases. Even if I had the English name of a disease or the katakana in my head, I couldn't understand it at all even if I accented it with the Kansai dialect intonation that I always use casually. In my case, I was able to converse naturally in English, but the moment we started speaking medical English, the conversation froze. I honestly told my supervisor, "I'm sorry, I don't know how to pronounce this properly," and our discussion resumed from there.

Polyclinic students in the United States are simply amazing. When a student is assigned a patient for their training, they take the patient's medical history, examine the patient, record the patient's chart, prescribe the medicine, obtain informed consent for the patient's condition, and even consult with the pharmacy. They research papers and guidelines, come up with a treatment plan, and then discuss it with the supervising physician and make a final decision together. They all calmly and reliably performed the tasks that in Japan are generally performed by interns. At least, I had never done this much. In addition, America is a multicultural country, and not everyone can speak English. What left the biggest impression on me was when a fourth-year student went on rounds to see a Mexican patient. He carefully explained the child's current condition and future treatment plan to the parents in fluent Spanish, answered their questions sincerely, and the parents perfectly understood the situation and at the end sent him the utmost gratitude.

I was so moved that I was speechless. Everything was perfect. "It's incredible... No one can do that normally..." I felt frustrated at my own incompetence, but at the same time, I felt an immense desire to improve myself.

Towards the end of my internship, I had a fateful encounter. As I was doing my internship as usual, my supervisor suddenly asked me, "By the way, Michael, there is one Japanese person in this hospital. Would you like to meet him?" The person was Dr. Ogimi, who works in the Infectious Diseases Department of our hospital. Dr. Ogimi graduated from a Japanese School of Medicine, passed the USMLE with flying colors, and practiced in the United States. I never thought I would meet someone like him here. I sent him an email timidly, and he invited me to dinner at his home that weekend. We talked in Japanese while eating Japanese food for the first time in a while, and it was a truly meaningful evening. It was a valuable and irreplaceable experience for me to be able to hear directly from a Japanese person who had passed the USMLE.

Although it is sad, I would like to write about it here. Mental health has become a problem in the United States recently. Children today have various anxieties and suffer daily from the pressure of academics and human relationships caused by the spread of social media such as SNS. As a result, some children lose hope of living tomorrow and attempt ingestion (suicide by overdosing on drugs, etc.). Although it was very painful, one new patient was admitted to the hospital every day. When I talked to them the morning after their admission, they were all bright, energetic, obedient and kind teenagers, so why...I had never experienced anything like this in my university training, and it was very painful to see such innocent children.

Through this training, my vague desire to become a pediatrician turned into an unshakable conviction. I returned to Japan with the thought that I wanted to become a pediatrician and help innocent children all over the world. I may not be able to speak Spanish as fluently as those students did, but at least I can speak English. I cannot let myself lose. I have my sights set on the Japanese National Medical Licensing Examination and the USMLE, and vowed to become a clinical doctor not only in Japan but also in the United States. It starts with YES, I want to keep that spirit in mind and save children in the future.

America, the land of the free. “The land of the free and the home of the brave” (from the national anthem, the Star-Spangled Banner). Juniors, you may be nervous about participating alone in an environment where only English is spoken for a month, but because you are alone you will have to think for yourself, sometimes reexamine yourself, and then act, so there are many things you can learn and the possibilities are endless. Furthermore, the encounters and experiences you will have there will be irreplaceable. I hope that students with dreams will participate in this program next year and the year after. Opportunities like this don't come around often. It starts with YES, I want you to have irreplaceable thoughts that begin with these words.

Lastly, I would like to express my sincere gratitude to President Noguchi, Professor Tsujimura, Professor Furuse, Professor King and his wife who allowed me to stay with their host family despite their busy schedules, my eldest daughter Carys, twins Gabriel and Genesis, Dr. Ogimi Chikara of Seattle Children's, Dr. Sarah Connell, Dr. Sarah Mahoney, Dr. Sarah Zaman, Dr. Lynda Ken, Dr. Michelle Gern, and Dr. Jason Rubin who guided me, Brandon Comish, a student who spoke to me in Japanese in a friendly manner at the orientation, and Yuka, a Japanese student who I met and became friends with at Space Needle. I would like to take this opportunity to express my deepest gratitude to all of you who helped me.