Author : Dr Michelle Muscat
Writer: Yoru Sumino
Original Publisher: Futabasha
Publication Date: June 2015
Producer: Akira Kobe
Director: Sho Tsukikawa
Original Release Date: July 2017
Producer: Keiji Mita
Writer: Shinichirou Ushijima
Original Release Date: September 2018
The protagonist Sakura Yamauchi has a terminal pancreatic condition yet retains a positive outlook towards life with a bubbly personality. Sakura keeps a daily diary called ‘Living with Dying’ about her coexistence with the disease. The male, initially unnamed protagonist, Haruki Shiga, on the other hand is her polar opposite, he is reserved and has little interest in others. Sakura has come to terms with her incurable disease and shares this secret only with her family and only this one classmate, Haruki, who accidently picks up her diary ‘Living with Dying’ when they happened to meet in hospital. Later on she joins the library team with Haruki which is from where they start getting along with one another, albeit with very different modes of expression. Sakura is as cheerful as Haruki is oblivious. Their words and gestures vary greatly, but in the end they established an important bond that is the focal point of the story.
Through their excursions and everyday life there are small grim reminders of the truth of Sakura’s condition. When they go for a trip he catches a glimpse in Sakura’s bag of a sheer multitude of medications, she is also suddenly hospitalized later in the story. Her cruel reality surfaces from time to time, when the mood changes as she asks Haruki what he would do if she were to tell him that she really does not want to die, a question to which at the time he had no answer.
Sakura shows no signs of denial of her condition although at one point Haruki asks her if she is really going to die. Although it is established from the very beginning that Sakura is indeed going to die, it is made clear throughout the tale that we all are. The poignant conclusion lies in how the story unfolds to her actual cause of death and the messages she leaves behind to those she cherished in life. The climax of the story is reached when at the end they read the words ‘Kimi no Suizou wo Tabetai’ which literally means ‘I Want to Eat Your Pancreas’. This metaphorical implication stems from an old superstition told by Sakura to Haruki earlier in the story which narrates that if a person has a diseased organ then one should eat that organ. At that point Haruki had changed, cradled a desire for her to get better, take a leaf out of her book and see her soul live on. The plot twist is that paradoxically her pancreatic disease was not what indeed kills her in the end.
The story is both a coming of age tale for Haruki who learns to see the world from different perspectives to his own and a tear jerking story of a girl living fully cognizant that her life expectancy is significantly reduced.
This tragic romantic drama obtained various awards and is acclaimed by many. It also spanned various adaptations having the original novel, a manga, live action movie and animated movie to its name. It recognizes that life is fleeting and one has to cherish and make the most of the small moments since sooner than you think and for reasons you may not have expected, it may be too late.
Sakura’s cheerful nature and enmeshed coping mechanisms, priorities, outlook, suffering and hope provide the reader or viewer with fresh perspectives.
Although this movie is not tackled from a purely medical perspective, a lot has been written in the medical field on hope and alleviation of suffering in terminal illness.1-6 Sakura’s free-spirited character shows that in the end, illness can sometimes be, in some ways, what you make of it.
- Schuyler D. How to live with a terminal illness. The primary care companion for CNS disorders. Prim Care Companion CNS Disord 2014;16(1).
- Drews MF. The evolution of hope in patients with terminal illness. Nursing 2017;47(1):13-4.
- Rousseau P. The Cost of Hope in Terminal Illness. J S C Med Assoc 2015;111(4):134-6.
4. Villacieros M, Bermejo JC, Hassoun H. Validation of the Scale of Hope in Terminal Illness for relatives brief version (SHTI-b). Validity and reliability analysis. An Sist Sanit Navar 2017;40(3):391-400.
- Bell C, Nielsen MK, Neergaard MA, et al. Remaining Lifetime After Recognition of Terminal Illness Depends on Diagnosis: A Nationwide Population-Based Cohort Study. Journal of pain and symptom management. J Pain Symptom Manage 2017;53(1):116-23.
- Bates AT, Kearney JA. Understanding death with limited experience in life: dying children's and adolescents' understanding of their own terminal illness and death. Curr Opin Support Palliat Care 2015;9(1):40-5.