Amla Analysis

Chapter-2
Physicochemical analysis of different varieties of Amla and comparative analysis of functional and nutritive values of Amla fruit, seed and seed coat powder.

Physicochemical analysis of different varieties of Amla and comparative analysis of functional and 
nutritive values of Amla fruit, seed and seed coat powder

2.1. Introduction
Amla (Emblica officinalis L.) as a Euphorbiaceous plant is widely distributed in subtropical and tropical areas of China, India, Indonesia and Malaysia.
 The fruit is used as a major constituent in several Ayurvedic preparations for promotion of health and longevity. It is known that Amla is a good source of polyphenols, flavones, tannins and other bioactive compounds. These substances being strong antioxidants might contribute to the health effects of Amla. Several active compounds like gallic acid, ellagic acid, 1-O-galloyl-D glucose, chebulininc acid, quercetin, chebulagic acid, kaempferol, mucic acid 1,4-lactone 3-O-gallate, isocorilagin, chebulanin, mallotusinin
and acylated apigenin glucoside compounds have been isolated from the aqueous extract of Amla. These bioactive components have anticancer, hypolipidemic, expectorant, purgative, spasmolytic, antibacterial, hypoglycaemic hepatoprotective,
hypolipidemic activities and also can attenuate dyslipdaemia. Though the functional properties of Amla have been reported, the seed and seed coat of Amla have never been investigated for their functional properties as well as compositional analysis. In this
chapter the physicochemical properties of different varieties of Amla are presented.
Further, Amla seed and seed coat of Chakaiya variety (major processing waste of Amla based industries) were separately analyzed for their proximate composition, antioxidant
properties, total phenolic contents, major/micronutrients and fatty acid profile.

2.2. Materials and methods
2.2.1. Raw material
Amla of Chakaiya, Francis, Kanchan, Nnarendra-7 and Krishna variety were procured from local market of Allahabad, India. The Amla fruits were cleaned thoroughly under tap water to remove adhering dust and wiped with muslin cloth. Fresh fruits of different varieties were evaluated for their physical, chemical and functional
properties. The fleshy part of Chakaiya variety of Amla was grated and seed was separated manually from adhering Amla. Grated Amla shreds were dried in tray drier at 40℃. The dried Amla shreds were ground in laboratory grinder and passed through 0.5
mm screen sieve. Whole Amla seeds were dried in tray drier at 40℃. As the whole seeds dried they broke along the ridges with a crackling sound. The seed coat was separated from the brown seed from each of the broken units. Seed coat and seed were separated manually and both were converted into powder separately as done for Amla shreds. The powder of fruit, seed and seed coat were stored at refrigerated temperature (4℃) for further analysis. Fig 2.1 shows the image of whole seed, seed coat and seed of Chakaiya variety. 



Fig. 2.1 Images of (a) Amla fruit of Chakaiya variety; whole seed; grated Amla;seed coat; and seed.

2.2.2. Methods

2.2.2.1. Analysis of physical properties of Amla.
Different varieties of Amla were measured for their height and width with varnier callipers with least square of 0.02 cm. Number of fragments and shape were analyzed visually. Ten readings were taken for each physical property.

2.2.2.2. Proximate analysis of Amla.
The moisture, crude fat, protein, crude fiber content of the samples were determined by the method of Ranganna, 198612. Available carbohydrate was calculated by balance method.

2.2.2.3. Vitamin C estimation.
Sample solution equivalent to 0.2 mg ascorbic acid mL was prepared in water containing 3% w/v metaphosphoric acid added to increase the stability of ascorbic acid.
It was titrated against standard 2, 6 dichlorophenol indophenol (2,6 DCIP) solution of concentration 0.5 mg mL until the pink color developed completely. The operation was repeated with a blank solution omitting the sample being examined. From the
difference the ascorbic acid in each mg of sample was calculated from the ascorbic acid equivalent to DCIP.

2.2.2.4. Determination of hydration properties.
The water retention property (WRC) and swelling capacity (SWC) of Amla seed and seed coat were analyzed by the methods given by Robertson et al. (2000) with slight modification. For WRC, 1 g of sample was hydrated at room temperature in 30 mL of distilled water and centrifuged at 5000 rpm for 15 min and after 18 h of
equilibration the supernatant was removed. The residue was dried at 105℃. The weight of residue was recorded both prior to drying (fresh weight) at 105℃ and after drying until constant weight was obtained. WRC was calculated as the amount of water
retained by the sample (g/g of dry weight).

WRC = Fresh weight of residue(g) - Dry weight of residue (g) ÷ 
 Dry weight of residue (g).

For SWC determination, 0.1 g of sample was hydrated with 10 mL of distilled water in a calibrated cylinder (15 cm diameter) at 30℃ temperature. After equilibration for 18 h, the bed volume was recorded and expressed as volume/g of original sample dry weight.

SWC = Volume occupied by sample (mL) ÷
 Original sample dry weight (g)

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Healing Cancer Coaching Program (Continue) [My Protocol]

My Daily Anticancer Routine: Now I'm going to walk you through my daily anticancer routine.

1. First thing in the morning I drink 16 to 24 ounces of filtered water. I had a distiller back then, now I am using Berkey water filter. So first thing I do, is drink 16 to 24 ounces of water. Why? Because it hydrates you and it gets your bowels moving.  I like to add things like amla  and moringa, green powder, lemon juice, and I often steep a bag of tea in the water overnight like Jason Winters tea, green tea, or hibiscus tea.

2. Next would be 10 to 20 minutes of morning exercise. Walk, jog, ride your bicycle, jump on a rebounder/trampoline , do some breathing exercise, some push-ups, do a workout DVD, whatever. Just get your blood pumping and your lymphatic system moving. And get a little sweat going. Perspire daily.

3. After that, I would take a shower , and then spend 30 minutes or more of devotional time reading the Bible, journaling, affirmations, and prayer.

4. The next step was to make my juice for the day. I made 64 fluid-ounces of juice. That's 8 x eight-ounce servings to drink throughout the day stored in airtight mason jars. Most days I would skip breakfast and drink juice through the morning.

5. Mid-morning I might have a piece of tart fruit like a green apple or a grapefruit.  But any fruit is wonderful. Don't be afraid of fruit because it's sweet.  Fruit is awesome. So, any fruit you enjoy eat it ; pineapple, cantaloupe, watermelon, oranges, kiwi, any fruit you want to eat.  You didn't get cancer from eating too much fruit. If you need more calories go with organic oatmeal for breakfast.

6. Lunch is the giant salad.  And the fruit smoothie is also a great afternoon snack, but it could be breakfast or lunch. But if you have cancer, I think it's important to make sure you get two giant salads in your body every day.  If you're hungry between meals that means you need to eat more. Eat bigger meals. But you can also snack on almonds or walnuts or snack on fruits. Eat an apple, eat a banana, have a few oranges, eat some dates, or figs. Like I said, don't be afraid of this sugar in fruit. Fruit is good.

7. 10 to 15 minutes before lunch and dinner, squeeze in some light exercise, like bouncing on the rebounding/trampoline, a quick walk, whole body stretching exercise, jog , anything. That's an easy way to remember to do it, just get it into your routine.

Obviously, you don't want to get sweaty, 3 times a day, necessarily because then, you are going to feel the need to bathe 3 times a day. So rebounding, or brisk walking is great, because you are moving your body and moving your lymph without breaking a sweat and getting body odour, BO.

8. Taking a walk after dinner is a great thing to do with the family.  We love to do that when the weather is nice. So again, movement before or after dinner or both, and dinner would be another giant cancer-fighting salad.

MY PROTOCOL
The first 90 days of my protocol was 100% raw fruits and vegetables ; juicing, giant salads , and full smoothies, all raw.  And I think that's a great place for the majority of cancer patients to start.

Now this diet is meant to ne tweaked based on your metabolic needs.  if you're overweight, the raw diet will be perfect for you because you can eat as much as you want and you're going to lose weight.  but if you are thin with a high metabolism and you're struggling to maintain your body weight, then you need to eat more cooked food.

After 90 days on raw food, I added some cooked vegetables back to my diet. I lost a lot of body weight with cancer, I lost more weight when I went raw and after doing water fasts and juice fasts.  And at my lowest I was 130 pounds and I 'm 6 feet 2 inches in height, so I was definitely underweight.  I looked like 'Jack from The Nightmare Before Christmas,' and I just needed more calories that I was getting from a 100% raw diet.

So 100% raw diet is not necessary, but 100% plant-based is. Like I said, if you're overweight, 100 % raw diet would be great for you because you can stuff yourself with fruits and vegetables and you will still lose weight. Just keep the oils to a minimum, because oils are the most concentrated source of calories you can eat.

If you are overweight, it's because you have a very efficient metabolism. Your body is really good at maintaining muscle mass and storing food as energy. You need less food intake than the average person which means you actually have a survival advantage. But because we've been conditioned to eat 3 times a day (breakfast, lunch, dinner) by the food industry, you've been putting more calories into your body than it needs and it's stored those extra calories as fat.

The raw diet is naturally lower in calories than the Western diet so your body will start burning any excess fat and you'll eventually get back down to your ideal body weight.

But I had the reverse problem and I needed more calories.  It's a simple problem with a simple solution. So I added some cooked food back to my diet.  I started  by adding some cooked vegetables with dinner like sweet potato, brown rice, quino, or lentils. Since then I've discovered black rice and red rice, which have higher antioxidant levels than brown rice, and they're delicious.

BLACK RICE


RED RICE


BROWN RICE


QUINOA



All types of beans and peas are wonderful : Black beans, garbanzo beans, black-eyed peas, green beans, split peas, chick peas, lentils.  Any cooked vegetables you like is allowed.  Just don't cook them in oil or grease and  no fried food.  Boiling or steaming is best, baking is okay.

Now, let's talk about meat. Along with some cooked veggies, my nutritionist also recommended adding a few servings of clean meat to my diet.  I start with a serving of wild caught Alaskan Salmon or organic lamb meat a few times a week. At that point I'd been on a raw vegan diet for 90 days, and I just assumed I would probably never eat meat again and I  was fine with it.  I didn't change my diet because of an animal reason, I changed it for a health reason.  I was trying to save my life, so I was willing to eat anything if I  thought it could help me. As long as they could help heal my body of cancer, so I didn't have  any kind of resistance to eating meat again except that I wasn't sure if it was healthy or not.  I was willing to do whatever it took to get well, and I was definitely underweight and I was ready to put some of animal protein back to my diet,

Since then, I've learned that the healthiest populations around the world do eat a little bit of animal meat, but not much. The healthiest, longest living people in Africa, Asia, South America, the Mediterranean, and the Middle East and even in the U.S. eat diets that are about 95% plant-based on average and only about 5% animal meat, What we don't know is whether or not this small amount of animal meat is actually health-promoting or if it's just not enough to hurt you. In hindsight it may not have been necessary but I added a couple of serving a week of either wild-caught salmon or lamb meat along with cooked vegetables like sweet potatoes, brown rice, quinoa, and lentils with dinner.
*[Lamb, hogget, and mutton are the meat of domestic sheep at different ages. A sheep in its first year is called a lamb, and its meat is also called lamb. The meat of a juvenile sheep older than one year is hogget; outside North America this is also a term for the living animal. The meat of an adult sheep is mutton, a term only used for the meat, not the living animals.]
And those extra calories helped me get back to my normal weight. Again, if you're trying to lose weight, juice throughout the morning, eat two giants salads for lunch and dinner and fruit, or fruit smoothie as a snack.

If you are trying to gain weight, definitely eat oatmeal for breakfast, the giant salads for lunch, fruit smoothie as an afternoon snack, and then another giant salad with cooked veggie for dinner ; like rice, beans, peas, lentils, and sweet potatoes.  This is a simple strategy.  We don't need to reinvent the wheel here.  We just want to get the most potent anti-cancer foods into your body every single day.  And consistency matters.

If you do this for a few weeks and then go back to your old routine it's not going to make any difference. But when you're popunding in 15 to 20 servings of fruits and vegetables every day there is s snowball effect that happens in your body.  You will gain momentum and accelerate the regeneration and restoration of your body.  This of course is assuming you're not in such a late stage that your body cannot recover.

Occasionally that is the case of some cancer patients if they've been through all the treatments possible and the doctor says there's nothing more we can do.

Sometimes it is too late.  but look, you never know unless you try. So if that sounds like you, it's still worth going for it.  Pull out all the stops, because I've seen miracles happen when people make a radical diet and lifestyle change like this.

I've met many stage four cancer patients who have healed after they were sent home to die.  just keep it simple and follow this formula and enjoy your life, and the process.

Now I want to talk a little bit more about animal products. But first, I want to make sure we're all on the same page.  When I use the word meat, I'm not just talking about beef or red meat. I'm talking about all parts of all animals : the muscles, organs, and tissues of all animals. The term dairy is anything that comes from the mammary gland of any animal ; milk, cheese, butter, yogurt.  yes, that includes ice cream, gelato, and frozen yogurt. The term animal products include all of the above, anything that came from an animal: meat, dairy, eggs, bone broth, et cetera.

As I discussed in the anticancer diet part one, knowing what I know now about how hormones IGF-I, methionine, and heme iron in animal products can fuel cancer growth, I think what I did was a bit risky. And I think the safest approach for cancer patients is to stay off all animal products for the first phase of your healing journey, at least 90 days, maybe even a few years.  But for those of you who've been well for a few years, or if you're doing this for prevention and you're eating some animal protein, hopefully no more than a few times a week, here's something you need to know about the safest healthiest types of animal meat, and the best ways to prepare it. In 2004, right around the time my nutritionist recommended I add a little animal protein back to my diet, I came across some one who made the case that we should follow the same dietary principles as the Israelites in the Old Testament. Now God gave the Israelites very specific dietary rules. They were allowed to eat all seed bearing plant food, but they were given specific rules as to which animals they were allowed to eat. Some animals were deemed unclean and were forbidden to be eaten by the Israelites.  The first time I read those dietary law I was much younger and I thought they were completely arbitrary and I was told that they didn't apply today.  But what I believe is true now is that these guidelines are still valuables and if we follow them, we will have better health.  the reason that God gave these dietary guidelines to the Israelites, to His chosen people , were not arbitrary at all , it was because He wanted them to be strong and healthy and free from disease.

 

Chapter One , The Rude Awakening

"Our painful experiences become the passages that open our hearts to empathy."

The Rude Awakening

"Please help me die, Dr Ohno!  Please help me die! I know you can help me, Dr. Ohno.  Please show mercy and help me ! Stop this pain I am going through ! I beg of you, Dr.Ohno, be merciful and help me die. send me to heaven and relieve me of my pain ! "

She stunned me with her outburst. I responded.  "I know you are in a state of intense pain and you are not able to think straight!  Please understand that what you ask of me is unthinkable and I cannot help you die. I am a doctor! "

She took deep and deliberate breaths.  It was obvious that she was in a tremendous amount of pain because of the anticancer medication in her body system.  I wondered if it was the pain that had taken over her senses, affecting her sanity. But her eyes told me that she was not insane, quite the opposite. In fact, she was quite rational, and her intention was very clear. 

"Dr. Ohno, please understand, I am asking you to do this out of mercy for me!  I am asking the 'unthinkable' because you are my doctor , and I trust that you will help me.  If you were not my doctor, and if I felt you did not care for me, I would never think of requesting such a thing.
"I have been waiting for the right time to approach you.  I have been praying to God to give me the chance to talk to you. It is at this moment that I am telling you that I have decided to die. I have hesitated because I knew, of course, how you would react to my request to die.  Your reaction is not a surprise to me. I would not have requested you to react in any other way !"

She looked at me carefully and calmly.  She as almost too calm. She had surrendered herself totally to this decision to die. There was no fear in her voice or in her eyes.  She got up out of her bed and closed the door quietly,  wanting privacy in the room so no one else would hear our conversation. 

"Dr. Ohno, I have asked you before to stop giving me the anticancer drug ! The side effects are to strong and I know you don't want to watch me suffer 1 Every time you inject me with this drug, I know you, too , are suffering as you watch me suffer.
"I have lost over 25 pounds since I have been here. Iweighed 100 pounds when I was first admitted here and now I weigh only 75 pounds. Look at me !  I look like a living skeleton! Nobody recognizes me anymore, because I am only a shadow of the person I used to be! 
"Putting food into my mouth is a nightmare because I know I will vomit up everything I eat .  When there is no food in my stomach, then I experience the dry heaves.  Right now I am also suffering from bleeding of my gums. It looks like I never clean or brush my teeth."

Her eyes were filling with tears again.  She suddenly held her hand out from underneath her bed sheet and said, "Look! Look at my finger!" When she showed me her finger, I noticed that the fingernail had fallen off and the skin under the nail had turned black. 

"Look at my finger.  it looks like a dead person's!" She waved her finger in front of me to see. Sobbing, she lifted off her wig . "My hair has completely fallen out! I am completely bald!  I can tolerate my hair loss, but I have no energy left to stand the continuous nausea and vomiting and chills !  The chills that take over my body after you inject me with the anticancer drug are terrible. It doesn't matter how many blankets I use to cover myself with, the chills are so intense that nothing makes me warm ! 
"After the chills subside, I have another severe attack of abdominal pain. The pain is so strong that I have to take another drug to ease the pain. After the abdominal cramps, I can't move my arms or legs.  When I go to pick up something , I have no feeling. Even if I prick myself with a needle, I am numb and feel nothing. After the paralysis, I have nausea again with more vomiting. 
"Dr. Ohno, even though I am a strong and patient person, I cannot tolerate these strong side effects.  I am reaching the end of my limit ! Dr. Ohno, I beg you, please stop giving me the anticancer drug! I have experience strong side effects before from anticancer drugs, but this new anticancer drugs, but this new anticancer drug has worse side effects.  They are unbearable for me to tolerate.  I know I do not have the strength to handle the pain anymore!"

Her words lingered in the room, hovering over me like a thick, dark cloud. It was very clear that she was nearing the end of her pain tolerance.  She was getting weaker every time I saw her. Her voice was very strained now. Simple conversation was very difficult for her.  But she found energy to make an appeal to me. 

I sat there in the room with her, struggling for something to say.  At that moment, there was nothing I could tell her, no words I could find to say to her , to give her any comfort. Although I felt compassion for her, a part of me wanted to get up and leave the room. I wanted to process what was happening, not only to her, but to me as well.  Just as  I thought of leaving the room, she instinctively reached over and grabbed my hand.  I remember how the strength in her frail and lifeless hand amazed me.  I felt the inner strength of her soul at that moment.  As I hesitated, searching for a way to bring comfort to her, she continued . . .

"Dr. Ohno . . . from the first time I met you, and looked into your caring eyes, I knew you were a person who would understand.  I sensed that you were completely different from the other doctors who had treated me before. I felt this way because I watched how truly sincere and empathic you were with your patients. 
"The other doctors have always ignored me while I have struggled with the agony of my pain. But your eyes have always shown me your genuine concern.  I have never found another doctor who has demonstrated compassion the way you do. 
"I am aware that you do not agree with the hospital professor and you want to stop giving me the anticancer drug. I know that you suffer from being embarrassed about this situation and that you are deeply troubled because of your disagreement with the professor on how I should be treated.  I know that if it were up to you, you would be taking care of me in a completely different way."

Again, het statement caught me totally by surprise , I responded, "What?" I suddenly raised my voice to her. "How do you know such things? Who has spoken to you about this?"

She reached over and gently patted my hand.  It seemed so strange to watch her comfort me while I was searching for a way to bring comfort to her. Then she said, " No one has had to tell me anything.  I know of your personal struggle because your face is always pale and drawn.  I have been watching you and I have recognized your personal battle.  Your work is depressing and you are aging and looking older and tired from the struggle."

She was talking to me with concern in her voice as though I were her son.  Her insights were amazingly accurate.  She stopped and took a sip of tea.  During the silence,  I started thinking about what she had just said.

It was true that I was struggling and my physical state was showing the fatigue from my internal battle.  I was not sleeping well. I would not go to bed until after 1:00 in the morning every night/early morning. As tired as I was, I would lie in my bed unable to sleep. Since I could not sleep,  I would usually get up and sit at my desk.  I would think about her and if there were possibly different ways of helping her.  I often thought to myself , "Why did I become a doctor?"

When I first became a doctor, I thought that I would find ways to help my patients. But instead of a healer, I felt more like a murderer. i was aware that the struggle would continue for me if I didn't find a better way to help my patients.  I realized that I must decide whether I could continue being a doctor.  I knew I would not remain the kind of doctor who could not effectively care for his patients.  Nearly every night I would lose sleep over  my preoccupation with this concern.  During the day, my eyes were red and weary from lack of proper sleep, and I was being emotionally drained. 

She finished her tea and continued, "Since I have been here, I have become very fond of you because you remind me of my son.  I always think to myself that if I die, Dr. Ohno will be with me at my deathbed.  This thought gives me a feeling of comfort. 

"I have tried my best to be a good patient. I have never complained or refused your help because I have believed in you with all of my being.  I have trusted you with my life.  However,  I cannot tolerate taking this new anticancer drug anymore, because the side effects are too strong for me to handle ."

She held my hands and looked directly into my eyes. then she continued to speak . . . . .
"I have talked to my family about my decision to ask you to help me die.  I have made them promise me that they will not see you or bother you after my death.  I am trying to make this easy for you to do. All I want you to do is to put another drug in the tube.  That is all you have to do and then walk away.  or, you can  just leave the drug on the table and I will pick it up and swallow it. You can leave the room and leave me to die in peace and my  pain will be over.  If you are a humanitarian doctor, you will obey your patient's last wish.  You are the only doctor who can help me!  My family will not blame you ; they will be appreciative because they know of my wish to die. 

"Please sent me to heaven right now! "Please, Dr. Ohno, please send me to heaven!"

She was convulsing and weeping.  her frail and lifeless body shook with her sobs.  I immediately answered, "I cannot help you die! I am a doctor, not a murderer! I have taken an oath to help keep people alive.  I know you are in a tremendous amount  of pain, but I cannot help you die!

"Please don't ask me again! I cannot help you. Not in that way!"

A part of me died that day, watching this woman collapsing in sobs and begging me to release her from her misery.  This incident I just described happened shortly after I graduated from medical school and was interning in Orthopedics at the University of Osaka, in Osaka, Japan. When I first met her, she was a 62-year-old breast cancer patient, being treated in the outpatient clinic.  I saw her husband first and I thought he was my patient because he looked as though he had no energy, and he was so thin.

The nurse accompanied the couple into the examination room. When they entered the room I realized that I had misunderstood who the real patient was.  I asked her to give me a brief description of her medical history and she began, 

"I was found to have breast cancer five years ago.  I was operated on at a different hospital and at first, it seemed that the operation had been successful and that all the cancer had been removed. However, one year after the  operation, the cancer reappeared again, so I was put on the anticancer drug.  The anticancer drug worked for awhile, but then the cancer reappeared.

"The last doctor I had did not care about terminally ill cancer patients.  The doctor and his staff encouraged me to be discharged from the hospital and they suggested that I go to a hospice.  I o not want to go hospice because I have not lost my will to live.  I have decided to fight the cancer and fight for my life!

"This is why I have come to your hospital."

As she talked about the details of her breast cancer, her X-rays were delivered to the examination room.  As I reviewed her x-rays, I was shocked to see that the cancer had metastasized to her pelvis and to her brain.  I thought to myself, it is impossible to help her at this stage of the cancer. Al she can do now is try to be as comfortable as possible and wait for her inevitable death. 

Then I spoke to her as honestly as I could. "Your cancer has already metastasized to your pelvis bone.  And it has als metastasized to your brain.
"Unfortunately, i am also recommending that you go to the hospice because we can do nothing for you now.  It is too late to try alternative measures because your cancer has already spread to the extent that there is no therapy that can help you at the stage of your cancer. The damage is irreversible.
"I realize this sounds cruel to you, but the more chemotherapy you are given, the sooner you will die.  You see,the anticancer drug kills not only cancer cells in your body , but destroys even healthy cells. It cannot distinguish between a cancerous cell and a healthy cell.  As a result healthy cells are destroyed.  Your body loses its immune ability and death results soon afterward.

"The anticancer drug is generally successful when only a small part of the body has been affected by cancer.  But your case isa completely different situation because the cancer has spread throughout your body.
"I don't recommend chemotherapy because it is too hard on patients. The side effects are too strong and counteract what the chemotherapy is designed to do.  I suggest that you should consider an alternative measure."

Objecting to my recommendations, she said, "It doesn't matter to me what the painful side effects are from the anticancer drug, because I have to get well so that I can take care of my husband! That is why I will keep trying to fight the cancer !

"Please admit me right now so that you can begin to help me!  If I go to the hospice, then I am surrendering myself to death.  I refuse to surrender my life until I know within my heart that I have no choice!"

"I know how difficult this must be for you and I do understand how you must feel, but right now our hospital is full. Even if there was something we could do for you, we don't have a bed for you at this time.  Please understand that although I wish I could , there is nothing that I can do to help you.  I am suggesting that you go home."

"No! I can't go home ! My husband is not healthy. He is very weak and I need to look after him.  If something were to happen to me, he would surely die very soon because he is not able to care for himself.
"Please, Dr. Ohno, admit me into the hospital now ! Please find a way, any way, to cure my cancer!"

The scene in the clinic was a heartbreaking one. This sweet and loving couple had obviously been together and devoted to one another for many years.  Although she was literally dying from the cancer that had taken over her body, she was more concerned in her husband and her responsibility to take care of him. I so desperately wanted to be able to give them both some kind of hope.  But the facts were on the X-rays, and there wasn't anything I could do at this point in time to help her.

"As I have already told you, the hospital is full. If you decide you want to come back, you will need to wait until we have the room to admit you."

"You don't understand, Dr. Ohno ! I don't have time ! I only have now and I need a miracle ! Please reconsider and admit me ! Can't you make a special provision for me, because I am an end-stage cancer patient?"

At that moment, the hospital medical professor, who was my superior, stepped into the examination room and interrupted the conversation, "Dr. Ohno, I will take care of this patient.  I will be able to help her. You should take care of another patient."

He continue, " I am sorry to interrupt your conversation. let me introduce myself, I am the main professor of the hospital. My name is Doctor 'A'. 
"I have had the opportunity to look at your X-rays. Because  your cancer has metastasized to you pelvic bone and to your brain, I agree with Dr. Ohno that it is not going to be easy at tis stage of your cancer.  The cure rate is only five percent for end-stage cancer, and unfortunately in you case, I don't see any hope."

He watched her face intently.  The colour in her face turned completely pale.  He waited for the impact of the news for her chances of survival to set in.  Once he saw the couple's reaction and how discourage she and her husband were, he then continued, " I think I can save you with a new drug I have developed.
"This new drug only destroys the cancer cells and it has no side effects, based upon animal testing.  It is true that this drug is in the experimental stages, but the data from the testing has  shown that there is a definite decline in the cancer, as well as showing not to have any side effects. I can offer you this opportunity for a possible cure for your cancer!
"This new anticancer drug had never been used in another hospital. If more cancer patients knew about this special drug, the response would be tremendous!  You are very fortunate that you have come to our hospital and met me."

The professor's words were totally unexpected by her.  her expression changed from one of despair to an expression of hope. She and her husband began to cry with tears of joy and relief. 

She grasped the professor's hand and said, "Oh, thank you so very much! I never expected a miracle like this from your hospital! You have given me hope again!"

The couple held each other and cried from the good news. The scene touched everyone in the room.  The professor was very pleased with himself.  As I watched this dramatic scene, it seemed as though I were watching a scene out of a movie.  However, despite the deep emotion of the event that had just taken place, I felt completely separated from the joy that everyone else was experiencing. I knew that the anticancer drug the professor was talking about absolutely had very strong side effects. 

I wondered why the professor insisted on using the anticancer drug on this woman.  I internally questioned his decision and I felt very uncomfortable for this patient because I suspected that his recommendation was not in the patient's best interest.

This was the first of what was to prove to be many rude awakenings for me. After years of medical school, of learning how to help people, I was now coming face to face with the grim reality of obeying a hospital staff professor, who was testing patients as though they were experimental animals.  There was no empathy for people who were terminally ill.  I wanted desperately to disagree with the professor, but I was only an intern in this hospital.

The Japanese medical system is very conservative.  The professors on staff are upheld as though they were royalty , and the interns are looked upon as nothing more than slaves.  I knew if I said anything to question him I would probably be fired on the spot. 

The professor ordered the breast cancer patient to be admitted into our hospital.  Immediately after being admitted, she received the 'new' anticancer drug twice a week.  Then a course of agony began for this patient.  The new anticancer drug had devastating side effects.  It took hold of its victim with a force so intense that the agony of the pain was unbearable.

"Please stop giving me this drug, Dr. Ohno, I beg of you! Please help to take the pain in my stomach away! The professor told me that there would be no side effects from this drug and I am in agony !"

"Please stop this pain! Please stop it!"

The tragedy of this scene would repeat itself over and over , becoming my ongoing personal nightmare.  The anticancer drug was given to the patient, and after each injection her life energy to withstand the trauma declined.  Even though I knew I was not responsible for causing her pain,  I was in fact the doctor who administered the injection.  I watched as other interns around me were able to go about their daily routine.  I noticed that they were able to set themselves apart from the pain their patients were experiencing.  However, this was impossible for me to do.

I felt so much empathy for my patients that it was very difficult for me to stand by and do nothing, especially when I knew in my heart that some of these patients were not receiving the right kind of care.  But again, I kept reminding myself that I was only an intern and perhaps this was something I needed to work through so that I could eventually become the kind of doctor I knew I could be.  I was determined to become a doctor who healed people and a doctor who was able to make a positive change in people's lives. 

Dr. Yoshitaka Ohno,
Intern.