Toyoda Yoshiya moved to the United States to improve his skills in cardiac surgery, and has saved many lives as a talented cardiac surgeon. Today, he is the first Japanese person to serve as division chief of cardiovascular surgery at an American university hospital. Motoya Toshio spoke with Toyoda about topics including what inspired him to become a physician, what motivates him to work in the U.S., memorable surgeries, methods for maintaining health, and hopes for the youth of Japan.

 

(M) Thank you for joining me on Big Talk today. I understand that you live in the United States.

(T) Thank you for inviting me. Yes, I live in Philadelphia, which is located between New York and Washington, D.C. It’s the sixth-largest city in the U.S., with a population of about 1.6 million. I’m back in Japan for just one week.

(M) Could you start by telling our readers about yourself?

(T) Of course. I was born in Hyogo Prefecture in 1965. I attended Koyo Academy High School in Nishinomiya City, then went to Kobe University’s School of Medicine and graduated in 1990. I spent three years as a medical intern before going to graduate school and earning my PhD in 1997. After working for 1.5 years as a cardiac surgeon at Kobe Children’s Hospital, I studied for three years at Harvard University in Boston. I came back to Japan and spent 1.5 years doing cardiac surgery at Kobe City Medical Center General Hospital, then returned to the U.S. as a clinician at Massachusetts General Hospital, which is affiliated with Harvard University. I’ve worked as a cardiac surgeon in America ever since.

(M) What inspired you to become a cardiac surgeon?

(T) After my grandmother died of heart disease when I was a junior high student, I decided to go to medical school and become a cardiologist.

(M) I see. You can work in that field here, so how did you end up in the U.S.?

(T) After completing my undergraduate studies at Kobe University, I was doing a medical internship at a university hospital when one of the staff members had just returned from a children’s hospital in Toronto, Canada. He told me that cardiac surgery training is offered in the U.S. To become a skilled cardiac surgeon, you have to do lots of procedures. There are fewer cases of these surgeries performed in Japan. The job is shared between several residents, and it takes time to really master these skills. The number-one cause of death in America is heart disease, so many more cardiac patients are seen at each facility. For example, Japan is a better place to receive training for stomach cancer, which is more common here. Because so many Americans experience heart disease, even young physicians are in charge of hundreds of patients per year, with many opportunities to perform surgeries. That’s why I decided to move to the U.S. to improve my skills. Of course you have to pass a national exam to do work in clinical medicine there, so I earned my certification before going abroad as a research fellow.

(M) You’ve worked in the U.S. ever since, and you’ve saved many lives as a truly talented doctor. What is your current position?

(T) I am chief of Cardiovascular Surgery and executive director of the Temple Heart and Vascular Institute at Temple University Hospital in Philadelphia. I’m apparently the first Japan-trained doctor to become chief professor at an American university hospital, and I help train many doctors from the U.S. and around the world.

(M) That difficult position shows you are highly valued.

(T) Perhaps, but I’m also very lucky.

(M) What was the most memorable surgery you’ve done so far?

(T) About 10 years ago, I saw a young man with pneumonia who had just gotten engaged. An X-ray showed that both of his lungs were totally white. We kept him alive by using extracorporeal membrane oxygenation (ECMO) to draw out three to five liters of blood per minute, oxygenate it, and return it to his body, then I performed the surgery to transplant both of his lungs at once. I do lung transplants as well as heart surgery. The patient would certainly have died without that surgery. He got married in the intensive care unit right before the procedure. He’s recovered, and now he has two children and is enjoying a healthy life.

(M) It takes a great deal of skill to do such a difficult operation, and I’m sure you’ve saved many lives.

(T) I think so.

(M) You must seem like a godlike figure to your patients. Many people die quickly from heart attacks, strokes, and other diseases that affect the heart and brain, which are extremely important organs.

(T) Yes, heart disease in particular can lead to a fast death. With brain-related diseases, donor organs can be taken from a brain-dead patient whose heart is still functioning. All organs play crucial roles, including lungs.

 

(M) What are you planning to do in Japan?

(T) My main goal is to visit my mother. When I was in Japan last time, my family and I went with my parents to Arima Hot Springs in Hyogo. My mother collapsed in the women-only bath one morning, so I couldn’t immediately help her. I waited for her outside, and when she came out of the bath her blood pressure was 70. I called a cardiovascular surgery colleague at Kobe University Hospital, my alma mater, and rode with her in the ambulance as her blood pressure fell. Paramedics aren’t allowed to administer IVs, so I did so inside of the ambulance. Cardiology and cardiac surgery doctors were waiting on standby at the hospital. They started in the emergency department with an ultrasound scan, which showed that blood had built up around her heart. It appeared to be acute aortic dissection, not myocardial infarction, so they did a CT scan to make sure and performed an emergency surgery that saved her life. “Acute aortic dissection” refers to a tear in the inner layer of the artery. Ishihara Yujiro had the same condition.

(M) It’s lucky that you were together.

(T) That’s true, but she was saved by the wonderful physicians and their team at Kobe University Hospital. It was also good that she collapsed in the early morning, when they could immediately reserve the cardiac catheterization and operating rooms to perform emergency surgery.

(M) Your mother was very fortunate, and I’m glad it happened so close to Kobe University. Lately I’ve been thinking about the importance of living somewhere that’s close to a hospital where you can get immediate care. If you are too far away, there might not be enough time. I get peace of mind knowing that my home is near a hospital.

(T) Time is of the essence.

(M) Some say that humans can live longer if they don’t get sick. It’s true that average lifespans are increasing in Japan, which I think is partially due to systems that provide prompt care, including AED defibrillators installed in many locations.

(T) I agree. We’ve also made progress with cancer treatments and anticancer drugs.

(M) Medicine has made particularly great strides. Are you going to keep working in the U.S., or do you plan to move back to Japan?

(T) As a cardiac surgeon, I wouldn’t mind living outside of the U.S. – I’ll work anywhere I can help patients. However, one reason I stay in America is because the large number of cases makes it a good place to train the next generation of cardiac surgeons. Temple Hospital draws international students from Japan and many other countries.

(M) They must come to the U.S. because there are lots of heart disease patients.

(T) Americans suffer many heart attacks, while Japanese people have more aorta-related diseases. I think there is so much heart disease in the U.S. due to diet, illegal drugs, and other lifestyle factors, along with obesity. Japan has fewer overweight people, but lately heart attack deaths are decreasing in the U.S. because more people are paying attention to their weight and watching what they eat.

(M) Is that because Americans eat a lot of meat?

(T) The biggest problem is that they eat lots of unhealthy food, like juice and other foods and beverages with a great deal of sugar. Of course, balance is essential.

(M) A balanced diet is important. I had a friend who loved meat and boasted about eating it three meals a day. He ended up dying from a brain hemorrhage. I think the healthiest people eat meat, fish, vegetables, and lots of different foods. I feel like the way a person is raised affects their diet as an adult. Picky children turn into picky adults, which is why I think nutrition education is so important.

(T) That’s right. There are major economic disparities in the U.S. Wealthy, educated people pay attention to their health and eat balanced diets. Some people don’t even know who their parents are, and they haven’t been educated about nutrition. These households tend to eat and drink more unhealthy things, such as hamburgers and soda.

(M) Are carbonated drinks bad for you?

(T) It’s not good to drink them in excess, since they contain so much sugar.

(M) I like cola, but I don’t think I consume too much. My favorite is Japanese green tea.

(T) Water and tea are great choices. I usually eat Japanese food, although it’s easier to obtain meat and other American ingredients.

(M) Japanese cuisine is the healthiest.

 

(M) People also talk about the importance of exercise. In Japan, I often see American and European people running in the morning. I wonder if Westerners who come to Japan tend to be wealthier and pay more attention to their health.

(T) I think so.

(M) Although moderate physical activity is good, excessive exercise can harm the body. It seems possible that athletes can hurt themselves while testing the limits of human abilities. You can build muscle, but it’s not so easy to make your brain and heart healthier.

(T) It’s true that most of my friends who like marathons end up with knee or heart problems.

(M) If you run for dozens of kilometers in one day, it strains your body significantly. I think some people look healthy on the outside, but they become sick because their internal organs are not healthy.

(T) My lung transplant teacher passed away in his 70s in the middle of a triathlon. I think that young people can usually withstand some excessive exercise. I did a lot of strenuous activity when I was a child, until I graduated from medical school.

(M) I think broad-minded people who live a long time are the true winners at life. Even if you accomplish great things, it means little if you die early. I’m constantly thinking about how to live longer. Perhaps I should exercise a bit more, but I don’t want to harm myself, either.

(T) I have an over-serious friend who exercises even when he is tired, saying that he can handle it because he’s so active. Exercise might be dangerous for your health if you force yourself past your limits and end up collapsing. I think it’s okay to take a day off when you’re exhausted. People who are dedicated to exercise might be at the greatest risk of overdoing it.

(M) I agree. It’s also important to get tested if you think something is wrong. When I had an office job, one of the younger employees collapsed at work. After a minute, he stood up and said he was fine. Luckily he seemed to be okay, but he collapsed again several months later and ended up dying. I think he avoided thinking deeply about it because he recovered quickly the first time, and he ended up passing away since he was a robust man and assumed everything was fine.

(T) He might have had some type of heart disease. Cardiomyopathy, valvular heat disease, and hereditary disorders can cause fainting, and other diseases can lead to sudden death.

 

(M) My American friend once told me I should always have friends who are physicians and lawyers. Doctors can advise you about how to maintain your health, and lawyers are good to know if you get into some kind of trouble. The U.S. is a very litigious society. You can be sued if someone slips and injures themselves in front of your house – they can seek restitution by claiming it was your fault for not cleaning up the water.

(T) America is that type of place. People have sued for damages because they fell and hit their head in front of a house where the owner didn’t shovel.

(M) Japanese people assume that the person who fell is responsible, but it seems like Americans want to blame someone else.

(T) They sue for huge amounts of damage, totaling hundreds of millions of yen.

(M) I think that’s a classic American technique. They start out big and make a deal midway through.

(T) I live in a residence that’s part of the Ritz-Carlton hotel chain, so I don’t have to shovel snow or mow grass.

(M) I used to own a home in Huntington Harbor, an upscale neighborhood on the outskirts of Los Angeles. I bought a house so I didn’t have to stay at a hotel during my frequent trips to America. The homeowner association had to approve property sales, and I was the first person of color allowed to buy a house in that white neighborhood. I didn’t take sufficient care of the lawn because I wasn’t there very often, and my neighbors complained and threatened to bring a lawsuit. The whole thing was too troublesome, so I ended up selling. American houses have open front yards without fences or gates. Neighbors keep a strict eye on the grass and other parts of these lawns. Different areas have different customs. As they say, when in Rome, do as the Romans do. I should have hired a property manager to prevent issues.

(T) I used to live in a single-family home in Pittsburgh when my children were young. We had to mow the lawn, rake leaves, and shovel snow. It was a white neighborhood, but everyone was very nice. Now it’s easier for my wife and I to live in a condominium, since our children have left the nest. I sometimes receive sales pitches about buying a second home, but as you say, they are a pain to take care of. I prefer to stay in nice hotels or traditional inns when I travel.

(M) Owning a home does involve more work. The houses in Huntington Harbor all had mooring facilities for cruisers. Boats cost a lot to maintain, and I’ve heard some say they were happier when they sold the boat than on the day they bought it. I also had a car in the U.S., but I rarely used it because I rented one at the airport. Of course, that cost money to maintain as well.

(T) Lately I’ve been taking an Uber or taxi to and from the airport, rather than driving myself.

(M) Simple ride-sharing services have launched in Japan, but they aren’t yet widespread. There are certainly difficulties involved with owning an asset in a distant location. At the end of the interview, I always ask for a “word for the youth.”

(T) It’s important to work hard on the tasks in front of you. It’s even better if you like these tasks, or if you find something else you become fond of. You feel more enjoyment doing something that you like, which provides meaning and motivation and makes your life more fun. I went to the U.S. by myself and had a good time devoting myself to my work. My efforts were noticed, and I ended up in higher positions. I feel like Japanese people make good leaders in places such as the U.S., where lots of different races work together. We don’t focus on religious differences. Many other people are overly concerned with whether someone is Christian, Jewish, or Muslim.

(M) The traditional Japanese religion worships nature and believes in “eight million gods.”

(T) I work with many people of color, some of whom regard Japan as a country that helped them gain independence from colonial rule, or as a nation that worked to banish racial discrimination from an early stage. Most top figures in American universities and medical schools are white people, and some expect great things of me in those environments because I am Japanese. That’s another reason why I think Japanese people can be excellent leaders.

(M) I heard you visit Yasukuni Shrine each time you come to Tokyo. Why is that?

(T) Yes, I went there this morning. I didn’t learn much history as a child, but I’ve come to understand Japanese history through my studies in the U.S. I feel great respect and gratitude for our forefathers who suffered and died in the Greater East Asia War. They fought hard and gave their lives for their families, their country, and nations under colonial rule. That’s why I always visit Yasukuni Shrine, and I give thanks every day at my household altar before going to work. It has amulets, sake cups, folding fans, and writings by fallen heroes, including items from Yasukuni, Izanagi Shrine, Ikuta Shrine, and Hieizan Enryakuji temple. Most of my classmates in medical school – and other people with advanced educations – devoted themselves to studying for entrance exams since childhood, and they learned history based on a masochistic viewpoint. That’s why so few of them have ever visited Yasukuni Shrine. I hope young people will go there and experience the Yushukan Museum.

(M) You have a patriotic spirit and correct views of history and the nation. From your standpoint in the U.S., what do you see as the positive aspects of Japan?

(T) Japan is a great country with traditions, history, and a solid national structure. The people are considerate and kind. Japan is a lot safer than the U.S., with much lower crime rates and fewer illegal drugs, although it does seem there are more drugs in Japan lately. There’s almost no gun crime, either. Japan is clean with many delicious foods.

(M) I hope you will keep working hard as a cardiac surgeon to make Japan into an even better country. Thank you for joining me today.

(T) Thank you.

 

BIOGRAPHY
Toyoda Yoshiya, MD, PhD

Born in 1965 in Itami City, Hyogo Prefecture. Graduated from Karatachi Kindergarten and Sanda Municipal Shidehara Elementary School, then attended two years at Sanda Municipal Uenodai Junior High School. His childhood was spent in a natural environment, where he enjoyed baseball, sumo, tennis, track and field, and catching stag and rhinoceros beetles. To prepare for his entrance exams, in his third year of junior high he transferred to Shinkitano Junior High School (Yodogawa Ward, Osaka City). At Koyo Academy High School, he played for three years on the Regulation Baseball Team. After graduating, he entered Kobe University’s School of Medicine and was part of the Judo Team for six years. He became captain of the School of Medicine’s Judo Team and earned his 2nd Dan rank. After graduating in 1990, he entered the 2nd Division of Surgery. Was trained as a surgeon at the Kobe University Hospital, Kobe Children’s Hospital (cardiac surgery), Takasago Municipal Hospital (surgery), National Sasayama Hospital (surgery), and Kobe Rosai Hospital (cardiovascular surgery). Spent four years in Kobe University’s graduate program from 1993 to 1997, and earned his PhD in surgical treatment for chronic heart failure. Worked in cardiac surgery at Kobe Children’s Hospital, then spent almost three years as a research fellow at Beth Israel Deaconess Medical Center (Harvard University). He returned to Japan and worked at Kobe City Medical Center General Hospital (cardiac surgery), followed by a job in cardiac surgery at Massachusetts General Hospital (Harvard University), where he received cardiac surgery training as a senior fellow and chief fellow. Did a fellowship in cardiopulmonary transplant and assist device at the University of Pittsburgh Medical Center. Became an assistant professor in 2006 and an associate professor in 2007, then chief of the cardiopulmonary transplant and assist device division in 2008. Helped the University of Pittsburgh’s Medical Center win the number-one ranking for cardiopulmonary transplants in the U.S. Transferred to Temple University as a professor in 2011, and became chief of cardiovascular surgery in 2015. Has trained many cardiac surgeons from the U.S., Japan, and other countries.