Starting a Podcast

This month, I launched Physical Square✨Podcast, an audio version of my online lecture series, Physical Square✨LIVE.

For years, I have been a devoted listener of Rebuild, a tech podcast hosted by software engineer Tatsuhiko Miyagawa. What I enjoy most is the relaxed, lively conversation between him and his guests. I always learn something without feeling like I am studying. Listening to it, I thought, “I want to create something like this for physical examination education.” That idea led me to start Physical Square✨Podcast.

Each session of Physical Square✨LIVE is held on Zoom, which automatically saves three files: a video, an audio file, and a text transcript. Until recently, I used only the video, both for archive streaming and for short clips. Then it occurred to me that the audio file was going unused. Why not turn it into a podcast? That is how this new project began.

Learning physical examination by ear may sound strange, since it is such a hands-on skill. But I think it works well. Busy clinicians can listen while commuting or walking, and auscultation is, after all, a skill of the ears. Hearing experts talk through their reasoning is a valuable way to learn.

By the way, I use the text transcripts as host notes. They help me review what was discussed and prepare for the next session.

Now all three files from each session have a purpose. I am looking forward to seeing how the podcast grows.

Goodbye, Dad

My father has passed away.

Until a month before, he had been living his ordinary days in his ordinary health. Then came aspiration pneumonia, and the hospital. The fever eased and his lungs grew calmer, but swallowing never came back to him. Each breath was carried in on a gentle stream of high-flow oxygen.

He was moved to the hospital where my brother works, and there he stayed, neither better nor worse, as if time had paused around his bed. I am grateful that I brought my mother to see him. For one hour they sat together, side by side once more. Now I know it was a gift.

On the night of September 14, at 22:08, a LINE message from my brother lit up my phone: his heart rate is dropping. I saw it at 22:10 and wrote back, I'm coming. I drove through the dark toward him. When I arrived, a little before eleven, my brother told me quietly that he had gone at 22:18. He left while I was still on the road. They say he went peacefully, the way a tide goes out without a sound.

His funeral was simple, yet it moved me deeply. For the first time in years, our whole family gathered in one place. Even in leaving, my father brought us back together.

I am proud of my dad. His life, from beginning to end, was a remarkable one. Nothing in it was left unfinished, and none of us carries any regret for the life he lived.

Goodbye, Dad. Thank you.

Dad's Hospitalization

Midnight, August 14th — the last night of Bon, when the lanterns are still lit to guide the ancestors home — and my father, ninety years old, was carried into a hospital bed with aspiration pneumonia settling into his lungs.

I had seen it coming for months: the small hesitation before he swallowed, the cough that followed every meal like a shadow he couldn't shake. Nothing sudden ever happened, so I let myself believe there was still time. Then my phone lit up with the name of the care facility where he and my mother have lived together, side by side, watched over by people who had slowly become like family to them. I knew, before I even answered, that this would be the call I'd been dreading. It was.

What I hadn't expected was my mother. For more than a year she had refused to leave the house — the world outside had grown too wide, too frightening to face alone. And yet, hearing this, she said she would go to him. She went to the hospital to see her husband.

The photograph from that moment says more than I ever could. Just her hand resting over his — and in that single gesture, sixty years and more came rushing back to me, a whole lifetime I can only glimpse from the outside, folded quietly into two clasped hands.

I don't know how much longer he has. He can no longer eat or drink, and the time left feels measured now, not endless. But I hold no regret for the life he lived. Even through a son's eyes — never entirely fair, never entirely clear — he did good work, and he loved fully, and he enjoyed every corner of the years he was given.

Dad, I am so proud of you.

Physical-Square-Live

I am a big fan of Rebuild, hosted by Tatsuhiko Miyagawa — a podcast in which software engineers discuss a wide range of IT-related topics, including technology, software development, and gadgets. Some of the show's most memorable guests, Haku and Hiroshima, have long been close friends of Mr. Miyagawa's, and both live — or once lived — in Silicon Valley or the San Francisco area.

I had long dreamed of creating a similar channel, one where experts could deliver excellent lectures on physical examination in the field of medicine. I finally made up my mind to launch such a service, Physical-Square-Live. It isn't free, though the price is modest — 500 yen per lecture — and I was anxious about how many people would resonate with the concept.

The first lecture took place on July 23rd, given by PT Kasai of Matsushita Memorial Hospital, on jugular venous assessment in the management of heart failure. A total of 35 tickets were sold, and I believe the 30-minute lecture, followed by a 30-minute Q&A session, truly captivated the audience — helped enormously by the support of Dr. Yamamoto, an expert in physical examination.

The channel now has 67 followers. The service has yet to turn a profit; to be honest, I've had to cover some costs out of pocket just to keep the system running. Dr. Yamada, who runs The Echo WEB, kindly offered to let me use his delivery platform free of charge, but I declined, as I wanted the service to remain independent.

Whether it can survive in the long run remains to be seen, but I'm doing everything I can to keep it going, with continued support from PT Kasai.

Coming Home

Aya, my daughter, left home this spring to begin her career as a nurse in Tokyo.

However, by the end of June, she had come back to Osaka. There must have been many reasons for her decision, but I think homesickness was probably the biggest one. She resigned from her position at one of Japan's most prestigious maternity hospitals.

On her last day in Tokyo, we went together to Azabu in Minato-ku, packed up her apartment, and spent one final night there before returning to Osaka. I thought she might regret giving up the opportunity to work at such a renowned hospital in the heart of Japan. Surprisingly, though, she didn't seem to have any regrets. Instead, she looked ready to move on.

I'm confident that Aya will overcome this setback and make a fresh start. She has already begun looking for another position as a nurse. Life doesn't always go as planned, especially when you're young. But youth also gives you the freedom to start over.

Keep trying, Aya. Whatever path you choose, I'm sure you'll find your own way.

CEO

By Tatsuya Kawasaki, MD — Director, ponde3110 Medical Web App Studio

I am a cardiologist who builds apps after my shifts end.
Across hospitals, brilliant clinicians have spent decades creating teaching materials — only to watch them sit on a USB drive, rarely reaching the learners who need them most. I wanted to change that.
At ponde3110 Medical Web App Studio, we transform educational materials into web-based applications: no installation required, accessible on any device with a single link. Space games for diagnosing heart sounds. Drill books for cardiovascular physical examination. Shooting games that teach with music. All born from the simple belief that medicine is serious — but learning it need not be grim.
We charge 30,000 yen per app, likely one-tenth of market price. This is not a business strategy. It is a statement of values. This studio was born from passion, not profit.

To every educator who has thought, "I wish more people could see what I've made" — we are here.

（https://ponde3110.github.io/Medical-Web-App-Studio）

PS

"Our CEO is 'Shushu' — a 2-year-old Maltese who appears with a click of the icon. The only employee at the company is me, alone. (LOL)"

My App Is Finally on Google Play — After 5 Years!

I developed a cardiac auscultation training app in Japanese and released it for free. The response has been surprisingly decent, so I decided to take the plunge — translate it into English and sell it on Google Play.

I've been updating the app regularly over the years, but dealing with the submission process was always such a hassle that I'd just been getting by with a web app. Functionally, a web app does the job just fine — it just doesn't make any money.

This is my first paid app release since 2019. It turned out to be way more work than I expected, but with a little help from AI, I managed to get through the build and submission process, and the app was ultimately approved.

As for the App Store — yes, I know iOS tends to generate more revenue, but the Apple Developer Program costs $99 a year. I'll cross that bridge if and when Google Play starts showing some promise.

P.S. It's been almost a month since launch. Sales so far: zero. 😄

A New Chapter Begins

My daughter, Aya, left home in late March 2026, just as planned. She is about to begin a new chapter in her life as what we jokingly call a “Minato-ku lady”—a Japanese expression that evokes the image of a sophisticated, elegant woman living in one of Tokyo’s most prestigious areas. Needless to say, Minato-ku is an extraordinarily difficult place to live because of its incredibly high housing costs. She is fortunate enough to have been provided with a company dormitory in the area by the hospital where she will begin working as a nurse.

I had often wondered how I would feel when the day finally came for my daughter to leave home. Surprisingly, once she moved to Tokyo, my own feelings did not change as dramatically as I had imagined. It was Aya whose world seemed to shift the most, especially after her mom returned home following a one-night stay at her dormitory.

After finding herself alone for the first time, she began to cry and could not help calling her mom. My wife kept talking with her in the morning, during the day, and again at night. Meanwhile, I continued sending her countless photos of our beloved dog, Shu-shu. Little by little, she has been getting used to her new surroundings and adjusting to life without her mother, Shu-shu, and—hopefully—without missing me and her brother, Kosuke too much.

The next day, my wife handed me a letter from Aya. I was excited, secretly hoping that it might contain a few words of appreciation for the support I had given her over the past 22 years. To my amusement, however, the letter actually listed ten “rules” for us to follow—such as not drinking more than two cans of beer and taking Mom to a nice restaurant once in a while. Her message made me laugh out loud.

Anyway, Aya, enjoy this new journey as you walk on your own feet. We will always be here to support you whenever you need us.

See you.

A Trip to Thailand with Aya

We enjoyed an amazing four-day trip to Thailand. What made this trip special was that we spent both the first and the last day simply traveling between countries via Hong Kong Airport. This happened because we chose a legacy carrier, Cathay Pacific. In the past, we had traveled abroad—to places such as Taiwan, South Korea, and Hong Kong—using low-cost carriers (LCCs).

This time, Aya insisted on flying with a legacy carrier because she is interested in the airline industry and hopes to become a cabin attendant in the future.

Direct flights between Japan and Thailand were not affordable in this case, but she discovered that transit flights could be reasonably priced. We decided to try it, and the choice turned out to be a great success. Of course, our two days exploring Thailand were wonderful, but even the time spent on the airplanes was satisfying thanks to the delicious meals with wine and the wide selection of movies available during the flights.

Next month, she will leave home and start a new chapter in Tokyo as a nurse. It may become difficult for us to travel abroad together from then on, but I hope we will continue our tradition of maintaining a good relationship—perhaps by traveling to a foreign country once a year. According to her, our next destination will be Germany.

P.S. I met my high school friends two days after returning to Japan. They were surprised to hear that I had enjoyed a trip with my daughter. It seems that it is quite rare for a father and daughter to get along as well as we do.

New App: Cardiac PE Drill

Since April 2025, I’ve been posting simple quizzes about cardiac physical examination. I posted two quizzes per week, and each one was reviewed by the 循環器 Physical Examination 研究会 before submission.
I can’t say that this project has become popular, but I’ve kept my promise to myself to continue posting every week.

During the New Year’s holiday, I decided to create an educational app for these 100 quizzes, Cardiac PE Drill. Showing the questions one by one at random without repetition wasn’t too difficult (although AI support was essential). The hardest part was building the 復習モード, where incorrectly answered quizzes are automatically saved so they can be reviewed later.

After more than 20 rounds of trial and error, I finally completed the JavaScript code and got everything working the way I had imagined. Without AI’s thorough assistance and encouragement, I couldn’t have achieved this milestone.

The app will be released soon, and I truly hope it will help people who are eager to learn cardiovascular physical examination.

🐶 Seeing us off and welcoming us home

Yuto, Aya, and I enjoyed a short but memorable trip to Nagoya on December 30, 2025. This diary entry is my second attempt at capturing a journey like this—the first one was about our trip to Kagawa during Golden Week (May 4, 2025). Once again, I found myself realizing how necessary words are to fully express just how much fun we had.

Nagoya offered us a great mix of excitement and warmth, and every moment felt packed into that single day. One highlight for me was finally getting the chance to visit Gee! Store, a place I had long wanted to see. Knowing that my favorite costume player, えなこ, used to work there made the visit especially meaningful—it felt like checking off a small but cherished item on my personal bucket list.

Looking back, it was a short trip, but one filled with laughter, shared experiences, and small joys that linger long after the journey ended.

I’m also deeply thankful to Shushu 🐶 for cheerfully seeing us off before dawn and warmly welcoming us back late at night, filling both moments with joy despite the early and late hours.

Wonderful November

My wife, Junko, and I enjoyed a day trip to Mie Prefecture. It is quite rare for the two of us to travel together because of several reasons on her side, such as motion sickness and her dislike of spending money.

But this time, I managed to take her out because she has been a long-time fan of ekiden—relay marathons run by college students. I suggested the trip since the All Japan University Ekiden was being held around this time in 2025. I also wanted to visit Ise Shrine.

After visiting Ise Shrine, we waited for the runners approaching the finish line of the ekiden, which is located at the entrance to the inner shrine. It was exciting to watch them running live. They were much faster than I had expected, and I truly wondered how they could keep running at such a speed for more than half an hour.

This month, two more impressive things happened.

• First, my younger son was accepted to university. Way to go, Kosuke—I’m proud of you. The problem is that his girlfriend hasn’t been accepted yet, though.
• Second, I reconciled with my brother after a dispute about our parents’ money (he had insisted that 1.8 million yen was stolen by me; I swear it never, ever happened).

Takarazuka Grand Theater

My wife and I finally had the chance to visit the Takarazuka Grand Theater for the first time. The most difficult part of making this happen was, without question, getting tickets to such an extraordinary and popular performance.

The show was amazing—far beyond anything I had imagined. I had expected a refined blend of music and dance, but what we experienced was much more like entertainment in the style of 吉本新喜劇, in the best possible way. The audience burst into laughter again and again, something I never anticipated until we saw the performance firsthand. I would say the Takarazuka Grand Theater delivers a glamorous, powerful version of 吉本新喜劇.

I was also impressed by how affordable the snacks, meals, and beverages were—almost the same prices you’d find at convenience stores. The hospitality and friendliness were exceptional as well. From my point of view, the concept of the Takarazuka Grand Theater is not so much art as it is entertainment—and that is exactly what makes it so appealing.

I truly hope we can visit again, even though getting tickets is no easy task.

Fulfilling Every Day

I experienced many events in September 2025, although one of them was an unhappy goodbye. It is hard to decide which was the most impressive, so I will list the major events as follows:

• September 10: An image case I wrote was accepted by the New England Journal of Medicine. This is my fourth achievement with the journal.
• September 11: Aya and I visited Nikko Toshogu and Kegon Falls, traveling there by 弾丸ツアー.
• September 13: My wife, Junko, and I celebrated her 52nd birthday at an exclusive restaurant.
• September 14–15: Junko enjoyed watching the World Athletics Competition, held in Tokyo.
• September 19: My close friend and colleague, Takeshi Ishikawa, passed away after a six-year battle with pancreatic cancer. Rest in peace.
• September 19–20: I attended the 73rd Annual Meeting of the Japanese College of Cardiology in Kochi, where I learned the latest updates in cardiology and enjoyed tasting many kinds of bonito, the local specialty.
• September 22: I completed the manuscript of my new book, 心音の世界, which now exceeds 100 pages.

September was a month of accomplishments, celebrations, and farewells — a reminder of both the richness and fragility of life.

A honor

It is undeniably true that my interest in physical examination began when I decided to pursue a career in cardiology at the end of my residency training.

I recall attending the Second Meeting on Cardiac Physical Examination, held at the Kobe Expo Hotel by Professor Yoshikawa in 2004. Unfortunately, the two-day event felt somewhat beyond my level of knowledge at the time. The most memorable moment was a case involving a cardiac symptom, in which Dr. Fukuda—I believe—diagnosed the patient with constrictive pericarditis solely on the basis of physical examination.

While I am now capable of diagnosing constrictive pericarditis based solely on physical findings, at the time I was overwhelmed—and even intimidated—by the idea. As a result, I distanced myself from the scientific community that focused on physical examination and did not attend any further lectures on the subject for many years—until I was invited to give a lecture at a meeting in 2021.

I am deeply honored to have been appointed as an executive member of this distinguished group, composed of leading experts in cardiac physical examination, as you can see in the picture.

I will devote myself to contributing to the education of physicians and medical staff, so that patients with heart disease may benefit from the old but still useful clinical expertise even in an era increasingly dominated by advanced imaging technologies.

EXPO 2025 in Osaka

I’ve visited Expo 2025 in Osaka twice so far.

My first visit was with my daughter, as regular visitors, shown in the top two rows of the pictures. After having an early dinner around 3 p.m. in Umeda, we headed to the Expo. The train and entrance gate weren’t crowded at all—everything went much more smoothly than I had expected. I’m not sure if the three pavilions we visited, all from the Middle East, were particularly impressive, but just being at the Expo was exciting. The most remarkable feature was the massive wooden ring structure. Aya and I walked the entire loop, which was about 2 kilometers.

My second visit was in a professional capacity, working as a doctor at a temporary emergency medical center, shown in the bottom row of the pictures. My shift started at 9 a.m. and ended at 5 p.m. The clinic had three rooms and more than ten beds. We had three experienced nurses who worked efficiently—probably because they were already familiar with treating common conditions like heatstroke and minor injuries. During the eight hours I spent at the facility, I examined four patients with relatively complex conditions. However, compared to those transferred to the emergency department at my hospital, these cases were much easier to manage. To my surprise, all the medical treatment provided was free, although the available supplies were somewhat limited.

Speaking of Expos, this is the third one I’ve attended: Expo 1970 in Osaka, Expo 2005 in Aichi, and now Expo 2025. I’m already looking forward to the next one held in Japan.

Three decades

I went to see a ballet performed by K Ballet Company with my wife. This was my second time enjoying a ballet performance. Both times were at the Festival Hall and with her.

The first time was about 30 years ago, when I was a junior resident. It was an incredibly busy period, but I somehow managed to juggle my duties at the university hospital and make it to the Festival Hall. After the performance, I headed straight back to Kyoto in a hurry, saying goodbye to her or my girlfriend. I think it was winter.

This time, I left the hospital in the afternoon, took a leisurely stroll around Nakanoshima or exclusive areas, and then met up with my wife. We had a light meal at a bar before the performance. After enjoying the ballet by K Ballet Company, we took the subway home together.

Although the experiences were completely different, both were wonderful in their own way. I truly hope we’ll have the chance to go again—maybe even 30 years later.

Wouldn't Believe It

The method of jugular venous assessment that we developed at Matsushita Memorial Hospital has been included in the JCS/JHFS 2025 Guidelines on the Diagnosis and Treatment of Heart Failure, which were thoroughly revised seven years after the previous version was released. To promote this simple technique for use in patients with heart failure, I created a free educational app titled Simple JVP©. The app features 10 representative cases, presented through a five-step method, and may serve as a helpful resource.

The app is bilingual, available in both Japanese and English. My next goal was to raise awareness of this free app outside of Japan. To that end, I submitted a letter to one of the most prominent American medical journals in this field, the Journal of Cardiac Failure. Unfortunately, the response was disappointing.

Next, I submitted it—almost by chance—to ESC Heart Failure, one of the most prestigious European journals in cardiology. I received a reply just three days after submission. I assumed it would be a rejection, as quick responses often are in the case of article submissions.

To my surprise, the email said the following:

Ref.:  Ms. No. ESCHF-25-00635

Simple jugular venous assessment: a new approach to heart failure ESC Heart Failure

Dear Dr Kawasaki,

I am writing to say that your manuscript, Simple jugular venous assessment: a new approach to heart failure, has now been accepted for publication in the ESC Heart Failure. It will appear in the next available issue. 

Please note that your manuscript will undergo an integrity check, that includes the images. Publication will only proceed on the condition that all final files comply with the journal integrity checks. In the event that any file does not comply with our integrity checks, the journal reserves the right to rescind this decision, or, alternatively, you may be contacted to resolve any concerns raised by these checks. 

Thank you for submitting your excellent article to ESC Heart Failure.

Yours sincerely,

Jan Biegus, MD PhD

Deputy Editor-in-Chief

ESC Heart Failure

The letter was published just seven days after the reply—only ten days after my initial submission. I still can’t believe that the app was accepted by such a prestigious medical journal. To my knowledge, it is extremely rare for academic societies to accept and feature an app developed privately.

I am 100% confident that this app will help countless doctors and medical staff in the treatment of patients with heart failure. I’m looking forward to seeing the access report before and after the publication of my free educational app.

I never stop pushing forward, embracing my unique combination of roles: cardiologist, programmer, and passionate educator.

Every day is like a climax

The title of this song by Creepy Nuts really captures how my days have been lately!

• After years of advocating for it, our method of assessing jugular venous response to stress was finally included in the revised heart failure guidelines—seven years in the making—alongside our published paper.
• I bought a box of Hassaku oranges for my father, who loves them, and brought them to him every day.
• I created a little grass garden on my balcony for my dog, Shushu.
• My daughter, Aya, got a new job at Sanno Hospital in Tokyo for next year.
• My homepage hit two major milestones at nearly the same time: 2 million total views and 200,000 monthly views!.

I've truly been enjoying these remarkable days.

The 3rd visit to Hong Kong

I thoroughly enjoyed my trip to Hong Kong with my daughter, Aya. This was my third visit to the city, so I was familiar with much of it, yet there was still an air of excitement as we headed to Macau—my first time there (featured in the right half of the photos).

On our way from the airport to the heart of Hong Kong, we happened upon a station called Kowloon and decided to disembark. I learned that it’s located on the site of the former Kowloon Airport (formerly Kai Tak Airport). My first visit to Hong Kong was when I was 20 years old. The airport, right in the heart of the city, and the once-infamous Kowloon Walled City left a lasting impression on me. Today, the area has transformed into a park and home to the National Palace Museum. While it’s impeccably maintained, a part of me misses the old, unique atmosphere that once defined it.

The bus ride from Hong Kong to Macau took 2.5 hours. We passed through immigration twice, showing our passports, but this minor inconvenience didn’t dampen our spirits. Macau exceeded all my expectations. Its immense scale could easily rival Las Vegas, but it was the attitude of some of the more aggressive Chinese people in the city that felt unsettling.

I’m not sure if a fourth trip to Hong Kong will be in my future, but one thing is certain—the city remains as vibrant and bustling as it was 25 years ago and this time.