Book Review: Say Hello to Blackjack (Black Jack ni Yoroshiku)

coverWhat if a hospital admitted only patients with certain kinds of injuries or illnesses because they generated the most income?

What if medical care for the aged or gravely ill was routinely withheld on the basis of a cost-benefit analysis?

What if doctors were encouraged to lie about a patient’s prognosis to avoid lawsuits and adverse impact to a hospital’s reputation?

No, this isn’t an opinion piece on the state of the U.S. health-care industry, or an apocalyptic diatribe on the Obama Administration’s proposed health-care reforms. This is the world of Japanese socialized medicine portrayed in Shuho Sato’s award-winning manga, Say Hello to Blackjack (Black Jack ni Yoroshiku).

The title is a reference and homage to Osamu Tezuka’s classic manga and anime, Blackjack, about a mysterious, brilliant surgeon-for-hire who operates according to his own rules, outside a medical system he sees as corrupt and criminally incompetent.

Seito Eijirou is a new intern–intelligent, idealistic, and determined to be the best doctor he possibly can. He wants to save lives, but he’s driven to the point of mental and physical exhaustion working a night job at an emergency hospital to supplement the poverty wages he’s paid as an intern. Seito confronts the reality of medical practice in a system that puts the welfare of hospitals and professional medical associations above the well-being of their patients, and he’s quickly forced to compromise his most cherished values. He dreams of operating as a free agent like Doctor Blackjack, his childhood hero, curing illness and making the world, as far as he’s able, a better place.

This is not kid stuff. The visuals are gritty and unblinking in their portrayal of medical procedures, trauma, and the indignity and agony of treatment provided by a medical community that, at least in this telling, has lost its ethical and empathic compass. The art ranges from hyper-realism all the way to comical “super-deformed” caricature, and despite the very serious subject matter, there are some lighthearted moments along the way.

Seito fights a lonely, quixotic battle against overwhelming odds, and loses most of his fights. The big question is whether he can avoid being assimilated by the system and keep his soul intact. By the end of Chapter 16 (the most current translated chapter I’ve read), it’s still not clear what the outcome will be, but there’s definitely hope.

The modern graphic novel is a direct descendant of Japanese manga, and in Say Hello to Blackjack, the family resemblance is clear and compelling. This is a comic book for grownups–it wrestles with profound issues of morality and conscience and brings the reader into stories that are intense, human, and frighteningly plausible. Anyone having second thoughts about the consequences of government-run health care will find ample nightmare food here. Seito’s summation is simple and chilling: “Don’t fall ill in Japan at night time.”

Whether you agree or disagree with the way the Japanese medical bureaucracy is depicted, the struggle of an idealistic young doctor against the ingrained policies and conscience-numbing practicalities of modern medical practice is a classic story that never seems to lose its impact.

I’d rate this at an R for graphic depictions of trauma and medical procedures, a little medically-related nudity, and some strong language. Actually not any more intense than your average television episode of CSI or House M.D., but like those shows, definitely not for children.

There are a variety of places to order a hardcopy or access existing compilations of this manga online (google the title), and the artist is also releasing chapters of the ongoing series on a fee-per-download basis as they’re produced (if you happen to read Japanese–unfortunately, I don’t). I’ve been going to, for translated scans of decent quality.

UPDATE: 5 Aug 10: Due to the recent industry crackdown on fan-translated manga scans, OneManga,com and other similar aggregators have pretty much shut down. Until such time as the publisher sees fit to produce and distribute an English language translation of Say Hello to Blackjack, if you don’t read Japanese, you’re out of luck. Too bad. Traditional publishers once again fail to leverage modern technology, preferring to persecute the people who know how to use it rather than use that talent to bring their product into the 21st Century. The only winners here are the lawyers.

Whether you read Japanese or not, do visit Shuho Sato’s official website, if only to see the very cool animated sketchbook, and click around for more samples of his work.

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