And sometimes the most complicated consent form in the hospital was the one nobody truly wanted to sign.… At 8:30 p.m., the emergency department doors opened with a metallic bang. A paramedic pushed a stretcher through the entrance. “Eight-year-old male. Pedestrian versus vehicle. Blunt chest trauma. Hypotensive en route. Possible splenic and thoracic injury.” Behind him came another paramedic, still wearing the expression of someone who had spent too long arguing with telephone operators. “We called two hospitals before this one,” he said. “Both declined. One said they didn’t have an operating room available. The other said they couldn’t guarantee pediatric surgical coverage.” Dr. Kenta Arai looked down at the boy. His name was Sota. There was dried blood around his mouth, but the external wounds were surprisingly small. The ultrasound showed fluid accumulating in the abdomen. His blood pressure continued to fall. The CT scan confirmed what Arai had feare...