Frances H. Kakugawa

Hawai‘i Herald Columnist

Omoiyari . . . Think of others first and good karma will return to you. — Frances H. Kakugawa

Dear Readers,

I received the following letter from Dr. Christian Serdahl, a physician in Sacramento. He was responding to my Feb. 5 column in The Hawai‘i Herald titled “Support Group Angels.” In it, I questioned the lack of good medical care for our elders. His letter arrived a day after he read my column.

Dr. Serdahl is the first physician to ask me, “What exactly do you say to caregivers to bring compassion into their care?” He sat in his examination room and listened to every word I said. I felt like I had preempted his busy schedule, which I actually had done. Dr. Serdahl has no computers in his examination rooms, choosing, instead, to communicate directly with his patients. “My computers are in another room,” he said. His letter explained why.

Dear Frances,

Thanks for the opportunity to give my three cheers to your Support Group Angels. It never ceases to amaze me when I come across a patient who I had assumed would be dead, but is still living because someone loves and cares for them.

As a physician, I have come to understand that even in this age of technology, with new, expensive medicines and surgical techniques, that there is still a finite limit to what we can do for our patients. I could do the best surgery, or make the exact diagnosis and prescribe the perfect medicine, but if that patient has no support group to nurture them, all my efforts are likely in vain. The act of caring for others is transformative, not only for the sick, but also for the caregiver.

When I teach medical students and medical residents, I always remind these uber-intelligent individuals that when we come into an exam room with our white coats on, patients already think we are smart. We don’t need to prove this by speaking in complicated medical jargon or displaying our numerous diplomas. What patients want to know is that we care. Once this is understood, the physician joins the support group, and healing begins.

Sounds simple, right? Not necessarily . . . how many times have you been to a doctor’s office or a hospital and wondered if the doctors and staff really cared about what was going on with you? It happens not infrequently and first impressions do count. When I come into a room with a patient, the first thing I do is introduce myself and reach out to touch them with a handshake. Human touch is one of the most important ways to both communicate and heal.

My college daughter was confronted with the death of a friend recently after a ski accident and asked me what she might do for the mother. A card, flowers, a phone call? My mind jumped back a decade or two and I heard my father’s voice saying that the greatest gift was to spend time with those who are dying or those who are grieving. Time is the most precious thing we can share and so my thanks goes out again to your Angels, who spend their time with the sick and dying. Simply spending time with others, going through life’s rodeo, is another of the most important ways to show that we care.

Spending time with the sick and dying also presents the opportunity to be a patient advocate, something that is absolutely necessary if one is admitted to the hospital. An advocate looks out for the best interest of the patient and makes sure that the proper medicines are given at 3 a.m. in the morning and that appropriate consents are obtained before invasive procedures. Hospitals are complex entities, and with the downward pressure on medical costs, odd things can happen during shift changes or at late hours. If any of my loved ones were admitted to the hospital, I would arrange for someone to be with them 24/7 until they were released to advocate for their well-being. Perhaps your Support Group of Angels is doing this critical type of work already.

Many thanks for the copies of your books that I share with my family and patients. Honoring those with memory issues is no different than caring for those with cancer or other physical illnesses. It begins with respect, letting them know we care, reaching out to touch them and spending our precious time with them.


Christian Serdahl, M.D.

Sacramento, Calif.

Readers . . . When I spoke at the University of Virginia medical school, I was asked, “Can we who live with the sciences humanize our practice through poetry, as you do with caregivers?” “Yes!” I answered emphatically.

Harvard Medical School appointed Dr. Rafael Campo as its poet-in-residence to help “humanize” its medical students. And the University of Wisconsin’s medical school bases its curriculum on the humanities. I dream of the day when every medical school will have a poet-in-residence so that patients will be seen not just for their illness, but as human beings at all stages of life.

Dr. Serdahl is a rarity these days in the medical profession. But there are some doctors like him. My internist, for example, always makes time to “talk books” with me.  And the first time I met with my neurologist, he asked, “Where do you find time to write all your books?” “How do you know I write books?” I asked. “I Googled you before coming in.” It showed me that he cared enough to learn something about me. I would not be just an illness on his chart. It resulted in immediate trust.

As patients, we need to insist on good care. When I went in for minor surgery, I told the surgeon, “Don’t let me die. I hate anesthesia; just make sure I’m given the right amount.”

On the day of the surgery, he told the anesthesiologist to wait until he arrived before administering any anesthesia. When I came out of the anesthesia, he was holding my hand and said everything was fine. Once, before a major surgery, I dramatically left the following poem at my bedside with the message that should I die, it would be OK. At the final moment, bravery had replaced fear.


An unfriendly morn

Awaits my awakening.

Whatever his face

I’ll greet him with mine.

If his breath

Should suck mine dry,

I’ll take his hand

Into mine,

And gently leave

By morning’s light.

— From “The Path of Butterflies”

The surgeon saw the poem as a message from a frightened patient and took attentive care before and after the surgery. Before I was transported to the operating room, he sent each person who would be in the operating room out to meet me. As Dr. Serdahl suggests, we need to become our own advocates. I had returned to a child’s level with “Don’t let me die,” which is a tall order for any physician.

The following are poems written from another surgery that was treated by a physician who was nothing like Dr. Serdahl.


“We need a biopsy,”

He tells me matter-of-factly

Looking at me straight in the eyes.

“It may be cancer.”

Cancer? How dare you say


Why not something

Vague and unclear like

“Unforeseen cell growth” or

Why not even,

“There’s probably nothing wrong with you

But we’ll take tests, anyway.”

Damn you! How dare you say


And look at me

Straight in the eyes.

Lie to me, you bastard!

Suddenly, I realize

He is waiting for me to speak.

I say nothing.

I only look at him straight

In the eyes.


The doctor actually told me to go home and enjoy Christmas because my time was short since Japanese people have a high rate of stomach cancer.


As the white knights

Gather around me

I think with sadness:

If I should die

No one in this immaculate room

Would shed half a tear

For me.

For my heart and lungs

And my uterus

Are as anonymous

As a faceless stranger

In a crowd.

They cannot hear

My rage against

This anonymity.

Ah, Dylan Thomas,

I did rage

Against the black


— From “The Path of Butterflies”


“There’s no malignancy.”

He looks at me straight

In the eyes.

I say nothing.

I look at him

Straight in his eyes

And I smile and smile

And smile.

Frances Kakugawa was her mother’s primary caregiver during her five-year journey with Alzheimer’s disease. A native of Kapoho on Hawai‘i island, she now lives in Sacramento. Frances has melded her professional training as a writer and educator and her personal caregiving experiences to write several books on caring for people with memory-related illnesses.


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