Japanese Surgeon's Daily Life

Inspection of Emergency Generator

     I've not experienced a power failure since I became a doctor. Though I had a rather big earthquake 7, 8 years ago in Matsuyama City, a blackout didn't occur at that time. However, if a blackout occurred, what's going to happen to us?
     Patients on a respirator would be cut off from their air supply. Sputum wouldn't be drawn. If a surgery was going on in the operation room, the patient and the staff would become isolated in the dark room. The operation room has no windows to prevent contamination. Needless to add, a lot of operating gadgets like monitors, anesthesia apparatuses and cautery knives (electric scalpel) wouldn't work. Just at the time the blackout occurred, if we were doing something difficult and fine in a deeper spot in the body, the patient would be put in a serious condition.
     My hospital is equipped with an emergency generator for rainy days. When the commercial electric supply stops, this generator is supposed to start automatically and we can use electricity for a few more hours.
     Today the inspection of this generator was done and it proved to be perfect. It was OK, but after the inspection I couldn't get on the internet with my PC. I wanted to call the mechanical staff and get it fixed, but it was on Saturday evening and I thought they surely were enjoying their day-offs and made up my mind to put up with a no-internet night. I was afraid that I would feel bored because I am addicted to the internet, but I could read a few books that I stopped reading on the way. It was relaxing. It's good to spend such a night for a change.

     The cause of the trouble was the router which was connected with an ordinary electric output. It is now connected to an uninterruptible power outlet.

(Vocabulary)
power failure / blackout  停電
Needless to add,  言うまでもなく
cautery knife / electric(al) scalpel    電気メス
uninterruptible power source   無停電電源
outlet    コンセント　
get on the internet   インターネットに繋がる

Medical Clinic in Whistler

     I came down to the village earlier because my condition was not perfect. I had three days to go. If I got injured today, I would end up throwing away these three days. Besides, I wanted to walk around the village.
     When I left Japan, I bought a general liability and travel insurance that covered obligations to pay reparations to others and injuries and illness of myself. This insurance company advised me to consult a certain clinic in Whistler in the event of accidents because the procedures to get medical service with the insurance was simple and easy.
     I came across this specific clinic and I'm showing you the picture. When I took this picture, a staff member came out of the clinic. I explained my profile showing my name card and she invited me in for some tea. I really wanted to take this invitation, but I had to pick up my daughter at the designated spot and I couldn't accept this invitation. It was a bit regrettable. It was a good opportunity to see inside a private clinic. I've worked in the operation room in some big hospitals like the Mayo Clinic and Pittsburgh University Hospital, but I've never visited a small private clinic.
     At any rate, everything that I saw in the village made me happy.

(Vocabulary)
liability [U] (損失・賠償などに対する法的な) 責任, 義務
reparation [C,U](フォーマル) (損害などに対する) 償い, 補償

A New Data Storage System

     This is my consultation room. After I posted a picture of my office before, two items were added. One is the newest CT scan system, the display of which you can see on the shelf. It's the left-hand side one of the two displays.
     Another is the PC screen on the desk. From the point of resource-saving, the authorities are planning to reduce the amount of X-ray films all over the Japanese medical services. When we check X-ray tests like CT, MRI and take an X-ray of the chest, abdomen and bones,,,etc, if we don't use films and see the results on the computer screen, we are supposed to get more national health insurance points, that is to say my hospital can get more money from insurance agencies.
     The huge storage system has already been installed and the modification from paper-based storage to digital system is going on now.

(Vocabulary)
left-hand　左の, 左側の
national health insurance points 国民健康保険点数

Rubber Stamp

     The Japanese language has three types of characters, which were originally born in ancient China and came to Japan. Japanese characters have subsequently and independently developed in Japan. Each is called Kanji, Hiragana and Katakana. I'll write about Kanji today.
     Kanji is an ideogram. I've no idea how many Kanjis there are, but I can say that the number is at least more than 5000. The average Japanese has to learn 1500 Kanjis in compulsory education. It's not an easy task to memorize these Kanjis, but what Kanjis mean is more perceptible rather than what alphabets and Hangul letters mean because Kanji is an ideogram. Besides, Kanji saves the space to be written on, I mean Kanji can express the same meaning in a smaller space than alphabets and Hangul letters need. This is an advantage of Kanji.
     However, it's frustrating to use Kanji in daily routine work. It takes time to write Kanji, and if I write Kanji in a hurry, the character would be distorted and it would be difficult to make out what it says. When it comes to writing prescriptions of Chinese herbal medicines, Kanji makes me crazy.
     Therefore we often use rubber stamps that are shown in the picture. I wonder if it is only Kanji-using countries like Japan that needs this many stamps in the medical field.

(Vocabulary)
ideogram (漢字などの) 表意文字
make out [句動詞]
1 make sth ↔ out (かろうじて) ＜…＞を見分ける, ＜言葉など＞を聞き取る
He could just make out a shape in the dim light.
ほの暗い明かりの中，彼はかろうじて人影を認めることができた．
I couldn't make out what he was saying.
彼の言っている事が聞き取れなかった．
2 make sb/sth ↔ out(インフォーマル) ＜…＞のことがわかる
I couldn't make him out at all.
彼のことがまったくわからなかった．
I couldn't make out what I'd done to annoy her.
私のした何に彼女が怒っているのかわからなかった．
as far as I can make out (from what I can make out とも)
私にわかる限りでは
[同意] figure out, work out(英)
rubber stamp  ゴム印
Chinese character   漢字
make out what it says  それがなんと書いてあるのか判読する
The letters are distorted.　　字がゆがんでいる

Training Session of an Industrial Physician

     I'm a surgeon and also an industrial physician. Have you heard of industrial medicine? This is a medical science for people who work. There are many kinds of industries in Japan and some people might get injured on their job. Industrial medicine is to keep their working conditions away from anything bad for their health. Enough illumination? Clean air in the office or factory? Any irritating noise? Any work related disorders? Any mental problem? From these points of view, industrial physicans work in companies and give advice to the employers.
     Authorities oblige the companies that hire twenty or more people to have a contract with industrial physicians based on the company size. Consequently, this requires a significant number of industrial specialists and clinical doctors like me come to be in charge. For this reason, I have to attend the training sessions on industrial medicine about twice a year.
     I've had lectures in various places, like an atomic power plant, a fire department, a petrochemical complex, a seafood processing factory and so on. Today's lecture was in Matsuyama Castle administration office, one of the municipal facilities. The picture shows members going up to the top of the castle. An aerial tramway runs between the top and the bottom of the hill and the condition of the employees who get in the gondola daily was one of our topics of today's lecture.

http://www.city.matsuyama.ehime.jp/lang/en/sightseeing/castle.html#HONMARU

(Vocabulary)
lecture class / training session     講習会
industrial field    産業分野
petrochemical complex　石油化学コンビナート
aerial tramway    ロープウェイ

(KW: 松山城)

Today's Operation

     I performed surgery on a patient suffering from cerebral thrombosis. He had thrombosis in his left hand too at the end of last year. Our medical team gave him intensive treatment and everything that we thought was good for him, but we couldn't save his hand. Finally I had to amputate his left hand today.
     I've performed more than ten amputations of the lower leg of patients with arteriosclerosis obliterans, critical infections and malignant tumors. However it was my first case of having to amputate a hand. This surgery was inevitable, but I don't like such kinds of operation in which I surely deprive the patient of his/her ability and those abilities never come back to the patients.
     I refrain from showing you the amputated specimen because some of you would get sick and be troubled with a nightmare.

(Vocabulary)
amputate someone's right hand     （人）の右手を切断する
arteriosclerosis obliterans〔ASO〕  閉塞性動脈硬化症
be troubled with a nightmare       悪夢にうなされる

 

A Friend's Death

     I received the news of the death of one of my best friends today.
     I graduated from Okayama University Medical School which has a special teaching system for students. Students were separated into like ten groups and got practical lectures at the bedside of the wards group by group. He and I were members of the same group. We were at the same place almost all the time in the campus. After graduation he chose anaestheology as his major, and I general surgery.
     When about eight years had passed after our graduation, he was working at the Mayo Clinic in Rochester in Minnesota. I was eager to see and know how surgery was in the Mayo Clinic, which is famous for its high level medical service. I wanted to compare my skill and that of surgeons of the Mayo Clinic. At that time, he did all the procedures for my joining the surgery team in the Mayo Clinic on my behalf, though I didn't have a surgeon's licence in the U.S. It was a really valuable experience and I could gain more confidence.
     I hope that his family will snap out of it as soon as possible. Life goes on and we have to move on.
     The picture was taken at a park in Rochester with his family and my colleague's wife.

(Vocabulary)
snap out of sth
1 snap out of it
(悲しみ・落胆などから) 立ち直る, 元気を出す
2 ＜空想など＞から我に返る

Completely Screwed

     A terrible stomachache started this morning. I had no recollection of having had bad food the previous night and I was afraid I had gotten some malignant disease in the abdomen. While I was wondering if I had some medicine in my house, a severe diarrhea started and at the same time I was relieved to see that it was just because of a gastrointestinal infection, not a malignant disease. Though I felt relieved, my severe stomachache was continuing.
     I had some appointments with patients today and had to make a general round in the wards. I got to my office anyway, but I felt a disabling fatigue from dehydration and I got drip infusion.
     As you know, a drip infusion needs at least a few hours and it means that I had to cancel all of my schedule today. Since I had a stomachache, I was being pressed to think that I had to work today as usual, but I gave them up. I had medication in my office. Peculiarly, there's a kind of freedom in being completely screwed because you know things can't get any worse. I could enjoy a DVD movie titled "FRESHMAN" starring Marlon Brando in the daytime of a weekday. I found the phrase "There's a kind of freedom in being completely screwed because you know things can't get any worse" in this movie, and I thought that it was really true.

(Vocabulary)
have no recollection of  ～した覚えはない
disabling 障害をもたらす, 無力にする
There's a kind of freedom in being completely screwed because you know things can't get any worse.
不幸も限界を超えると開放感がある（映画Freshmanで気に入ったフレーズ）

New Year Calendars

     I've been about to cry uncle with the overwhelming amount of work lately!
     Anyway, the new year is just around the corner. A lot of calendars of the next year started to be delivered to my hospital from various companies related to medical services. I put some of them on the wall of my study and my office. I usually choose the calendars which have pictures of scenery.
     Japan is a small country, but it has many chains of mountains. Climbing is one of my hobbies and I sometimes feel relaxed to see mountains. The picture shows two of those calendars. The right one is from Kissei Pharmaceutical Co., Ltd:
http://www.kissei.co.jp/e_contents/from_ceo.htm This company is located in Nagano prefecture, where the Nagano Winter Olympics were held in 1998. Nagano prefecture is also noted for having the Japanese Alps.
     This company makes calendars with pictures of the mountains and distributes the calendar to their customers as a New Year's gift. I'm looking forward to seeing them every year.
     The left one is from a bar where I sometimes drop in. The owner of this bar loves car rallies and named his bar "Bar WRC". The WRC (World Rally Championship) will be held in Hokkaido in Japan next October and I'm going to join it as an official. I decided to use both in my office this year.

(Vocabulary)
cry uncle  降参したと言う、参ったと言う、敗北を認める
about ready to cry uncle 《be ～》早くもお手上げ状態である
mountain chain  山脈

Field Work

     I'm going to show you a school activity today. The other day a dozen junior high school students visited my hospital to see how it is inside the hospital. Some of them were eager to become a medical doctor, some wanted to be a nurse or a pharmacist. Boys and girls think of their future vaguely when they become a junior high school student and have to choose which way to go next. In order to help them find out the chance is given to them to see or experience a lot of occupations and work places. My hospital was approached as the medical service company.
     When I was exchanging the gastrostomy tube of a patient who had been in a vegetative state for more than 5 years, the head nurse came to me and asked me to explain the condition of the patient and what I was going to do to the students. He had got the consent of the patient's family in advance. The picture shows the scene.
     All the students didn't know what the vegetative state was. It looked like they were shook up to see the patient. They were also showed the operation room, a few X-ray related rooms, the pharmaceutical facilities, rehabilitation department, , , . I thought this day would be strongly imprinted on their minds.

Leathers

     Today was my day! I got the leathers for motorcycle riding from my boss.
     When I went downstairs to OPD this morning, my boss came close to me and said that he had a suit of leathers for riding and he wasn't going to put it on. He wanted me to put it on because it was almost new and too expensive to throw away. I was so surprised! I didn't know that he had ridden a motorcycle long ago. The picture shows it hanging on the wall of my room.

An Unexpected Visitor

     Japanese medical practitioners' law requires that hospitals must preserve the records of treatment of all the patients for at least 5 years. The bigger the hospital is, the more enormous the store space needed. Some big hospitals adopt the microfilm system for the preservation of documents and films so that they can save space. However, my hospital doesn't. Besides, we preserve all the documents for more than 20 years. Some X-ray films stick to each other and some documents are moldy and smeary. It might be of no use to preserve them for such a long time, but anyway my boss didn't throw away the records for more than 20 years.
     A few nurses and an X-ray technician went into one of the store rooms to clean up the room and allow fresh air into the room. The room air smelled stale. At that time they found a bat hunched over on the floor. He or she didn't move a bit. They took the bat back to the nursing station and looked after it. They were afraid that the bat was suffering from dehydration or hypoglycemia and fed the bat with a 10% glucose fluid from a dropper.
     A day later the bat seemed to have recovered and began to fly in the room and was released outside at midnight. The nurses were great!

(Vocabulary)
get moldy  カビが生える
smeary  汚れた, しみの付いた; しみのような
stale  (食べ物などが) 古くなった, (パン，ケーキなどが) 固くなった; (空気などが) よどんだ, (煙・息などが) いやなにおいのする
stale bread  固くなったパン
hunch over  うずくまる
dropper  スポイト (目薬・芳香油などの) 滴びん, 点滴器

When the cat's away, the mice will play.

     I usually spend 4 hours in the afternoon at OPD when I have no operating schedule. Today my boss was on a business trip to Tokyo and absent at my hospital. The staff members are as you can see in the picture. When the stream of patients stopped, I took this picture. You could understand how relaxed we were.
     These 4 nurses and another 2 nurses are my staff members at OPD. All are nice ladies. Did you notice the surgical tape attached to their uniforms just like toilet paper. The cloth that the tape is fixed to is genuinely part of their uniforms but they are using it as you see. It looks funny, but it seems to be convenient for them.
     The badge that they put on is my hospital logo that is made from the shape of the ventricles of the brain. My hospital developed it based on brain surgery. This logo resembles the Motorola logo. When I bought a cellphone from Motorola (M1000), all of us were surprised to see the logo and my boss was saying that he should file a lawsuit against Motorola.

(Vocabulary)
When the cat's away, the mice will play.　　鬼のいぬ間に洗濯

Orthodontics

     My second and youngest daughters have been getting their teeth treated because of crowding of the teeth for two years. My youngest daughter looked happy this morning. She was going to see her dentist and have the appliance removed. I was relieved to see her corrected teeth.
     Talking of teeth, when I was a medical student about 30 years ago, my clinical instructor asked us, "How and who do you choose among some unconscious people who were equally seriously injured and transferred into your hospital at the same time?" The answer was, "You can figure out his or her lifestyle from their teeth. The condition of the teeth highly correlates with their daily life or their social status. The distinction is of course not good, however you would often have to make prompt decisions about many difficult problems." It was a tough question. This might be one of the reasons that I recommended my daughters to get the orthodontics.

(Vocabulary)
orthodontics  歯列矯正(術)
crowded teeth  叢生歯
correlate [自] (事実・考えなどが) 相互関係にある
correlate with something ＜…＞と相互関係にある
correlate strongly/significantly/closely 強く［著しく，密接に］関連する
be correlated 《常に受け身形で》相互に関連する
be correlated with something ＜…＞と相互に関連する

A House Visit

     I go out for some house visits on Friday every two weeks. The patient that I visited today is an 80 year old gentleman. He is being cared for by his wife. It is not easy to believe this story, but he survived two kinds of serious malignant diseases in his 50s. After that, he has been suffering from rare diseases one after another. His wife says that it must be due to the atomic bomb in Hiroshima.
     He was a teenager when the bomb was dropped. Hiroshima is three hours away from our town by ship. He seems to have gone to Hiroshima with his teachers and schoolmates to rescue people the day after the bomb. His role was to recover numerous bodies out of the river and find things to show their ID. If he could find the name of the body, he carried them to some places for the people looking for their relatives, friends and acquaintances. If he couldn't, however, he carried them to the Body Dump Station. The bodies were thrown into the fire. He and his group were working in Hiroshima for a few days. They wanted to work more, but they didn't have enough food to continue their volunteer work.
     People at that time didn't have any knowledge about the radiation. They didn't mind being exposed to residual radiation. Many people got invisibly injured like this. This fact is not widely known to the public.
     Researchers and developers of the atomic bomb seemed to predict that no trees and grasses could grow in Hiroshima for the next 50 years. This prediction was fortunately wrong, but was it necessary to drop such a cruel bomb on Hiroshima? If the U.S.  only wanted to stop the war, they should have dropped the bomb in the Tokyo Bay area. The Japanese authorities, including the Emperor, would directly have seen the mushroom cloud. One more thing, I'd like to ask Mr. Truman the reason why the U.S. chose Hisoshima and Nagasaki as victims of the atomic bomb; a wide city around which they could draw concentric circles in the horizontal area and a city that is closed by mountains on one side and open in the direction of the sea. Both geographic locations must have been attractive for the researchers of radiation.

(Vocabulary)
residual radiation　残留放射線
concentric circle　同心円

Power Harassment?

     Japan is one of the developed countries now, but in terms of smoking it is not keeping up. It is true that the total smoking rates in Japan are decreasing however the number of young female smokers is increasing rapidly, while the rate of adult male smokers is decreasing.
     To my sadness, the incidence of smoking among my staff members surpasses 70%, especially with nurses and care workers. We are working in the field of medical services. I couldn't believe this fugure at first. Smoking apparently harms not only the person who smokes but the people around the smoking person.
     I proposed a total ban on smoking at all times in my hospital at the monthly conference. The members who don't smoke were fully behind my proposal, but the other looked like they were against it. However, such smoking people do know that smoking is harmful. I asked them why they didn't refrain from smoking in the office. I continued that we were working for sick people IN THE HOSPITAL. They couldn't help agreeing to my proposal.
     I don't smoke and I'm one of the ranking members. All doctors, including part time doctors, are non-smokers. I hope smoking members don't think I am grilling them and my proposal is a power harassment.

(Vocabulary)
incidence of smoking among women  女性の喫煙率
behind ～の手助け［応援］をして、～を奨励して
I'm behind you all the way. : いつも応援してるよ。
ranking 最高位の、一流の; 上級の、幹部の
grill  ～を直火で焼く; ～を厳しく尋問する、厳しく追及する

(From comments)
spirits 《複数扱い》 気分, 心持ち
be in good/high/low spirits  機嫌がよい［上機嫌である，しょげている］
He is in good spirits despite his illness. 彼は病気にもかかわらず明るい．
reason with ＜人＞を諭す, 説得する
to no/little avail  まったく［ほとんど］役に立たない, 無駄になって
We searched everywhere for him to no avail. 彼を見つけようとあらゆる所を捜したが無駄だった．
suffocation  窒息, 窒息死; 窒息死させること
infirmity [U] (老人などの) 体調不良, 病弱; [C] 疾病, 病気

Historical Village of Hokkaido 6

     Two structures were moved from Furubira, Shiribeshi district. The main wooden house, designed by Dr. Seikichi Kondo himself, was built in 1919 and was a novel western style building for the district at that time. The attached stone storage house, built in around 1900, was used as his library. These were actually in use until 1958.

     Looking at this building, I had the feeling that I had seen it. I felt nostalgic and felt like seeing inside. I didn't have any time left,but I got into the building.

     It's a medical inhaler and you boil water in the bottle. The patient with some respiratory illnesses could inhale the vapor and this would relieve the dyspnea. This device is very old and not in use in present day Japan. So, you'll wonder why I know how to use it. It's because I had sometimes seen this in use. The hospital director of the hospital that I was working for until 3 years ago had often made the patients inhale a vapor by using this inhaler. Because I knew that there were many other inhalers which were up-dated and are more effective now, I often advised him in vain to use a newer technique for the treatment. He didn't accept my opinion. He was around 85 years old and stubborn. I think he should stop working as a surgeon. He is a person who serves as an example of how not to behave. I got many lessons from him. It's important to know when to pull back. This display reminded me of these things.

     Tables for operation and delivery. I had the feeling that I had seen it in the infographic topping of the textbook of surgery.

     Can you see the bottle hanging from the ceiling? Can you tell what it is for? Yes, it is kind of water supply system. You push the switch under the bottle and water comes out. It was very commonly seen when I was before school age.

     Many kinds of papers needed for the management of the clinic in Meiji, Taisho and the early Showa era were on display. Those were very interesting to me. The transcript of a lecture was written with a writing brush.

(Vocabulary)
novel   斬新な, 目新しい, 画期的な
storage house  貯蔵庫
infographic topping  巻頭写真、巻頭のグラフィックページ
transcript  (会話・口述などの) 筆記録

(KW: 北海道開拓の村)

It's Hot!

     It's getting hot. What I used to do first in my office in the morning was to turn on the PC, but now it is turning on the air conditioner.
     When I get to work by motorcycle, I throw my helmet, gloves and clothes away on the bed. I have to cool my body down for a while. I don't like hot weather but when I survive this hot summer the winter comes. I feel that Whistler is waiting for me. To Canadian friends, I'm planning to visit your home piste next March. Why don't you have a party!

Funny Socks

     I talked to nurses about the product for relaxing that I wrote about before.
     http://kumo.typepad.jp/weblog/2007/07/goods-for-relax.html

     A nurse said to me, "Isn't that for drying pedicured toes? Your daughter is kidding you!" I thought that it could be so. My daughter often enjoys kidding me, but it is true that that intersting product is good for me. I often put it on when I spend time in my living room. It is comfortable to spread the toes far apart.
     When we were talking, another two nurses were coming in and they showed me their socks. Their socks had toes and they told me that those socks are good. It might be the same feeling that I felt. I asked them to take pictures of their feet for this blog. Are there such socks in other countries?

A Wake-up Call

     My old friend came back to Okayama University as a professor this April, where we graduated from a quarter of a century ago. I was happy to hear that and went to Okayama city to see him and say "Congratulations!" We met for the first time in 25 years.
     We invited a teacher who taught us a lot of valuable lessons when we were university students. He is about 80, and has an eye problem. We felt sorry to see him because he was very active and passionate or crazy about many things; skiing, hunting, bowling, water-skiing, baking cakes and teaching young people,,,in those days. I had thought he would never get old.
     However, the story of my old friend was uplifting. He had gone to Indonesia for three years to study malaria just after getting his PhD in postgraduate school. In Indonesia he thought it was not enough to treat people one by one and he was eager to treat a whole area of people. He got to want to handle administration-related tasks. Consequently, he was warmly welcomed to the Japanese Health and Welfare Ministry after his research in Indonesia.
     After a while, he was sent to Geneva as a WHO official. Finally he began to work on the frontiers of world hygiene science. He was going to work there the rest of his life, but Japan didn't permit his desire. He didn't talk about this, but I imagine that Japan needed his ability. AIDS, SARS, Bird Flu,,,. He might be in step with the times.
     We had a common acquaintance. In about 1996, a classy middle-aged lady visited my house. She was a former American diplomat and the wife of the WHO Secretary General. She had a strong interest in the Shikoku 88 temples pilgrimage and she was asking information about the pilgrimage using the CompuServe Bulletin Board Service. Shikoku is my home. I found her comments on the board but I just kept watching because I didn't have any confidence in CompuServe communications and I thought someone would help her. However, no one replied to her comments, so I tried to post my comment with my chin up for the first time. CompuServe was an American-based computer network service and very few Japanese access it, I thought.
     Anyway she actually came to Japan. I didn't know anything about her except her name until I met her. I had only imagined that she was a kind of young backpacker. So, when I met her for the first time, I was very surprised at her Japanese and gentleness. She could speak Japanese very fluently. "Why?" "My husband is Japanese. I was a diplomat and learned some languages." "Wow..!"
     My parents' house is big and Japanese-style and maybe attractive for Americans. I proposed that she stay one night with us if she wanted. She replied that she'd like to, but she had an appointment with Mrs. Hilary Clinton in Beijing the next day and had to leave here that day. I was at a loss for words. "Have a teatime with Mrs. Clinton?! Who is this lady?" That year was the International Women's Year and the international meeting was held in Beijing.
     I talked to my old friend about these stories in more detail. The world might not be so large as we think.
     He showed me the miserable situations of the Third World. I'd like to do something if I can. Now I have three ball-and-chains, I mean daughters! After they are independent, my time will come!
     This meeting was a wake-up call for me. I must be more and more trained.

(Vocabulary)
uplifting  (人を) 幸せな気分にする, 気持ち［精神］が高揚する（ような）
in step with  ～と歩調を合わせて［そろえて］、～とともに、～に一致して、～と調和して
leader who is in step with times  時代が求めるリーダー
walk with one's chin up  顔を上げて（明るく元気に）歩く
ball and chain 《常に単数形で》束縛, 足かせ; (囚人を拘束しておく) 鎖付きの鉄球, 足かせ; (ユーモラス) 夫［妻］, お荷物
trained 〈人が〉 訓練を積んだ
a trained nurse 訓練を積んだ看護師

(Key Words: Martha Nakajima, Shikoku 88 temples pilgrimage)