Hiroshima

by John Hersey

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  JAPAN was booming. Things were still rather tight for the Nakamuras, and Toshio had to work very long hours, but the old days of bitter struggle began to seem remote. In 1975, one of the laws providing support to the hibakusha was revised, and Nakamura-san began to receive a so-called health-protection allowance of six thousand yen, then about twenty dollars, a month; this would gradually be increased to more than twice that amount. She also received a pension, toward which she had contributed at Suyama, of twenty thousand yen, or about sixty-five dollars, a month; and for several years she had been receiving a war widow’s pension of another twenty thousand yen a month. With the economic upswing, prices had, of course, risen steeply (in a few years Tokyo would become the most expensive city in the world), but Toshio managed to buy a small Mitsubishi car, and occasionally he got up before dawn and rode a train for two hours to play golf with business associates. Yaeko’s husband ran a shop for sales and service of air conditioners and heaters, and Myeko’s husband ran a newsstand and candy shop near the railroad station.

  In May each year, around the time of the Emperor’s birthday, when the trees along broad Peace Boulevard were at their feathery best and banked azaleas were everywhere in bloom, Hiroshima celebrated a flower festival. Entertainment booths lined the boulevard, and there were long parades, with floats and bands and thousands of marchers. In the fortieth year after the bombing, Nakamura-san danced with the women of the folk-dance association, six dancers in each of sixty rows. They danced to Oiwai-Ondo, a song of happiness, lifting their arms in gestures of joy and clapping in rhythms of threes:

  Green pine trees, cranes and turtles…

  You must tell a story of your hard times

  And laugh twice.

  The bombing had been four decades ago. How far away it seemed!

  The sun blazed that day. The measured steps and the constant lifting of the arms for hours at a time were tiring. In midafternoon, Nakamura-san suddenly felt woozy. The next thing she knew, she was being lifted, to her great embarrassment and in spite of begging to be let alone, into an ambulance. At the hospital, she said she was fine; all she wanted was to go home. She was allowed to leave.

  DR. TERUFUMI SASAKI

  DR. TERUFUMI SASAKI was still racked by memories of the appalling days and nights right after the explosion—memories it would be his lifework to distance himself from. Besides his duties as a junior surgeon at the Red Cross Hospital, he now had to spend every Thursday across the city at the University of Hiroshima, to chip away at his doctoral dissertation on appendicial tuberculosis. As was the custom in Japan, he had been permitted to start his practice as soon as he was graduated from medical school. It took most young internes five years of additional study to get their actual doctoral degree; in Dr. Sasaki’s case, it was, for various reasons, to take ten.

  He had been commuting during that year from the small town of Mukaihara, where his mother lived, about an hour by train from the city. His family had money—and, indeed, over the years it turned out (as it did for a great many Japanese doctors) that that most efficacious medicine for whatever ailed him would be cash or credit, the larger the dosage the better. His grandfather had been a landlord and had accumulated wide mountain tracts of valuable woodland. His late father, a doctor, had earned good money in a private clinic. During the turbulent time of hunger and crime after the bombing, thieves had broken into two fortlike storage repositories next to his mother’s house and taken many valued heirlooms, including a lacquer box given to the doctor’s grandfather by the Emperor, an ancient case for writing brushes and ink blocks, and a classic painting of a tiger, alone worth ten million yen, or more than twenty-five thousand dollars.

  His marriage was working out well. He had been able to pick and choose. There had not been many such eligible young men as he in Mukaihara, and numerous marriage brokers had sounded him out. He had followed up some of these feelers. One father of an offered bride had received his agent and turned him down. Perhaps this was because Dr. Sasaki had a reputation of having been a very bad boy, a “tomcat,” some said, when he was young; and the father may have known about his illegal treatment of patients in Mukaihara in the evenings after his work at the Red Cross Hospital. But perhaps it was also because the father was overcautious. It was said of him that he not only followed the Japanese saying, “Check an old iron bridge well before crossing,” he would not cross even after checking. Dr. Sasaki, never in his life having experienced such a rebuff, had decided that this was the girl for him, and with the help of two persistent go-betweens he had eventually won the wary parent over. Now, married only a few months, he was quickly learning that his wife was wiser and more sensible than he.

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  MUCH of Dr. Sasaki’s work as a surgeon at the Red Cross Hospital in the next five years was in the removal of keloid scars—hideously ugly, thick, itchy, rubbery, copper-red crablike growths that often formed over bad burns that hibakusha had suffered, and particularly those victims who had been exposed to the great heat of the bomb within two kilometres of the hypocenter. In dealing with the keloids, Dr. Sasaki and his colleagues were groping in the dark, because they had no reliable literature to guide them. They found that after the bulbous scars had been removed they often recurred. Some, if they were left unattended, became infected, and others caused underlying muscles to tense up. He and his colleagues eventually came to the reluctant conclusion that they should not have operated on many of the keloids. The scars tended in time to shrink spontaneously, and could then be more easily excised, or be left alone.

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  IN 1951, Dr. Sasaki decided to quit working for the hospital, with its awful memories, and to set himself up, as his father had done, in a private clinic in Mukaihara. He was ambitious. He had had an older brother, who, according to the custom of Japanese medical families, had been expected to succeed to the father’s practice; the second son would have to make his own way, and in 1939, urged by the propaganda of the time to seek a fortune in the vast undeveloped reaches of China, Terufumi Sasaki had gone there and had studied at the Japanese Eastern Medical University, in Tsingtao. He had graduated and returned to Hiroshima shortly before the bombing. His brother had been killed in the war, so the way was clear for him—not only to start a practice in his father’s town but also to withdraw from Hiroshima and, in effect, from being a hibakusha. For the next four decades, he also never spoke to anyone about the hours and days after the bombing.

  His grandfather having deposited large sums in the Bank of Hiroshima, Dr. Sasaki went to it confidently expecting a big loan to help him get started. But the bank said that a clinic in such a small town could easily fail, and it put a cap on his credit of three hundred thousand yen, then less than a thousand dollars. So Dr. Sasaki started treating patients in his wife’s parents’ house. He performed simple surgery—on appendixes, gastric ulcers, compound fractures—but he also rather daringly practiced every other sort of medicine, too, except gynecology and obstetrics. He did surprisingly well. Before long, he was getting nearly a hundred patients a day. Some came to him from considerable distances. The bank noticed, and his limit of credit rose to a million yen.

  In 1954, he put up a proper clinic building within the compound of his wife’s family; it was a two-story structure with nineteen beds for in-patients and a total floor space of two hundred and eighty mats. He financed the building with a loan of three hundred thousand yen from the bank and by selling timber from the lands he had inherited from his grandfather. In the new clinic, with a staff of five nurses and three on-the-job trainees, and working himself without pause six days a week from eighty-thirty in the morning till six in the evening, he continued to prosper.

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  LONG before this, doctors in Hiroshima had begun to find that there were much more serious consequences of exposure to the bomb than the traumatic wounds and keloid scars that had b
een so dramatically visible in the early days. The violent symptoms of primary radiation sickness wore off in time in most patients, but it soon became clear that hibakusha were liable to deeper and far more dangerous sequels from the enormous doses of radiation dealt them by the bomb. Above all, it was evident by 1950 that the incidence of leukemia in hibakusha was much higher than normal; among those who had been exposed within one kilometre of the hypocenter, the incidence was reported to be between ten and fifty times above the norm. Over the years, the appearance of “purple spots,” tiny surface hemorrhages symptomatic of leukemia, came to be dreaded by hibakusha. And, later on, other forms of cancer besides leukemia, with longer periods of latency, were showing up at higher than normal rates: carcinomas of the thyroid, the lungs, the breast, the salivary glands, the stomach, the liver, the urinary tract, and the male and female reproductive organs. Some survivors—even children—were developing what were called A-bomb cataracts. Some exposed children were growing up stunted, and one of the most shocking findings was that some children who had been in their mothers’ womb at the time of the bombing were born with heads smaller than normal. Because it was known that radiation affected the genes of laboratory animals, a fear spread among many hibakusha that future descendants of the survivors might be subject to mutations. (It was the late sixties before analyses indeed showed some chromosome aberrations in Hiroshima and Nagasaki survivors, and it would, of course, take much longer to tell what, if any, effects there would be on their progeny.) There were several ailments, less life-threatening than the cancers, that were thought by many doctors—and by most of the people who were subject to them—to have resulted from exposure to the bomb: several sorts of anemia, liver dysfunction, sexual problems, endocrine disorders, accelerated aging, and the not-quite-really-sick yet undeniable debilitation of which so many complained.

  Dr. Sasaki, who had himself suffered nothing but this last, paid little or no attention to any of these revelations. He did not follow them closely in the medical journals. In his town in the hills, he treated few hibakusha. He lived enclosed in the present tense.

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  IN 1963, wanting to get caught up on the latest developments in anaesthesia, Dr. Sasaki went to the Yokohama Red Cross Hospital to learn about them from its director general, Dr. Tatsutaro Hattori. As chief of surgery at the Hiroshima hospital, Dr. Hattori had been Dr. Sasaki’s boss there; he had come down with radiation sickness after the bombing and had moved to Yokohama. Dr. Hattori suggested that Dr. Sasaki might as well have a thorough physical examination, taking advantage of the hospital’s up-to-the-minute equipment, while he was there, and Dr. Sasaki agreed. A tomographic scan of his chest showed up a shadow in the left lung. Dr. Sasaki smoked. Without going into what had been learned about the incidence of lung cancer in hibakusha, perhaps supposing that Dr. Sasaki would know all about such things, Dr. Hattori recommended a biopsy. It was done, and when Dr. Sasaki came out of the anaesthetic he found that his entire left lung had been removed.

  A few hours after the operation, a ligature of one of the blood vessels into the lung cavity gave way, and Dr. Sasaki suffered severe hemorrhaging for nearly a week. One day toward the end of that time, as he continued to cough up blood and grew worrisomely feeble, there gathered around him what he construed as a death-watch: his wife, Dr. Hattori, the hospital matron, several nurses. He thanked them, said goodbye to his wife, and died.

  Or, rather, he thought he died. Some time later, he regained consciousness and found himself on the mend.

  * * *

  —

  IN later years, Dr. Sasaki came to think of that experience as the most important of his life—more important than the bombing. Haunted by the loneliness he had felt when he thought he was dying, he now did his best to move closer to his wife and his children—two sons and two daughters. An aunt startled him one day by saying, “You are lucky, Terufumi. After all, i wa jinjutsu—medicine is the art of compassion.” He had never thought about the meaning of this saying, which is held up before all young Japanese training to be doctors. He determined thenceforth to be calm and composed, and not to leave undone anything he could do for a patient. He would try to be kind to people he detested. He would give up hunting and mah-jongg. His wife said, “You’ve reached maturity in your forties. I grew up when I was in my twenties.”

  He did not give up cigarettes.

  * * *

  —

  IN 1972, Dr. Sasaki’s wife died of breast cancer—the third crisis of his life. He achieved now another sort of loneliness connected with death, this one nontransient and intense. He threw himself more tirelessly than ever into his work.

  His wife’s death and his own near-death, together with his realization that he was no longer young, started him thinking about the elderly, and he decided to build a much larger new clinic, where he would practice geriatric medicine. This branch of the compassionate art was attracting some of the ablest Japanese doctors, and it also happened to be growing extremely lucrative. As he put it to friends, who laughed at what they considered his overreaching, everyone after sixty had aches and pains, everyone as old as that needed massage, heat therapy, acupuncture, moxa, and comfort from a friendly physician—they would come in flocks.

  By 1977, Dr. Sasaki’s credit with the Bank of Hiroshima had soared, and it granted him a loan of nineteen million yen, or about eighty thousand dollars. With this money he put up, on land on the edge of town, an imposing four-story concrete building, with nineteen beds for in-patients and with extensive facilities for rehabilitation, and also with a splendid apartment for himself. He took on a staff of three acupuncturists, three therapists, eight nurses, and fifteen paramedics and maintenance people. His two sons, Yoshihisa and Ryuji, by now both doctors, came to help out in specially busy periods.

  He was right about the flocks. Again he worked from eight-thirty to six, six days a week, and he saw an average of two hundred and fifty patients a day. Some came to him from cities as far away as Kure, Ondo, and Akitsu, on the coast, and others from villages all over the prefecture. Taking advantage of huge tax deductions that Japanese doctors could claim, he saved large sums, and as he returned money on his bank loans the bank kept raising his line of credit. He got the idea of building an old-people’s home, which would cost two hundred million yen. It would be necessary to get approval for this project from the Takata County Medical Association. He submitted plans. He was turned down. Soon afterward, a leading member of the association built in the city of Yoshida just such a home as Dr. Sasaki had proposed.

  Undaunted, Dr. Sasaki, aware that the three foremost pleasures of his elderly patients were family visits, good food, and a relaxed bath time, used the bank’s loans to build, on the site of his former clinic, a luxurious bathhouse. This was ostensibly for patients, but he opened it to the townspeople as well, charging more for admission than the usual public bathhouse did; its tubs, after all, were of marble. He spent half a million (deductible) yen a month on its upkeep.

  Every morning, Dr. Sasaki met with the entire staff of the clinic. He had a favorite lecture: Do not work primarily for money; do your duty to patients first and let the money follow; our life is short, we don’t live twice; the whirlwind will pick up the leaves and spin them, but then it will drop them and they will form a pile.

  Dr. Sasaki’s own pile grew and grew. His life was insured for a hundred million yen; he was insured against malpractice for three hundred million yen. He drove a white BMW. Rare vases stood on chests in his living room. In spite of the enormous tax deductions allowed Japanese doctors, he had come to be the payer of the highest income tax in Takata County (population thirty-seven thousand), and his tax was among the ten highest in all of Hiroshima Prefecture (twelve cities and sixty-eight towns in fifteen counties; population two million seven hundred thousand).

  He had a new idea. He would drill down next to the clinic for subterranean hot water, to fill hot-springs bat
hs. He hired the Tokyo Geological Engineering Company to do a survey, and it assured him that if he drilled down eight hundred metres he would get from sixty to a hundred litres of water a minute, at between 79 and 86 degrees Fahrenheit. He had visions of a hot-springs spa; he calculated that he could supply water for hot baths in three hotels. He started in June 1985.

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  DR. SASAKI began to be considered a bit strange by Hiroshima doctors. He was not attracted, as they were, to the exclusive high society of the medical associations. Instead, he went in for such things as sponsoring a Mukaihara contest in gateball, a primitive variant of croquet; he often wore a necktie—which cost him five thousand yen, or twenty dollars—with Gate Ball embroidered across it in English script. His principal pleasure, apart from his work, was to take an occasional trip to Hiroshima to eat Chinese food in the basement of the Grand Hotel, lighting up, at the end of the meal, a cigarette of the brand Mild Seven, which had printed on its packet, besides its name in English, this courteous Japanese admonition: “Let’s be careful not to smoke too much, for the sake of our health.”

  He could face Hiroshima now, because a gaudy phoenix had risen from the ruinous desert of 1945: a remarkably beautiful city of more than a million inhabitants—only one in ten of whom was a hibakusha—with tall modern buildings on broad, tree-lined avenues crowded with Japanese cars, all of which had English lettering on them and appeared to be brand-new; a city of strivers and sybarites, with seven hundred and fifty-three book-stores and two thousand three hundred and fifty-six bars. If past memories did stir up in him, Dr. Sasaki had come to be able to live with his one bitter regret: that in the shambles of the Red Cross Hospital in those first days after the bombing it had not been possible, beyond a certain point, to keep track of the identities of those whose corpses were dragged out to the mass cremations, with the result that nameless souls might still, all these years later, be hovering there, unattended and dissatisfied.