Nomura didn’t call James right away. He waited a few days. They worked together as usual. Cases. Questions. Occasional disagreement. Nothing unusual on the surface. But James noticed the pauses. Nomura watching a little longer before moving on. Letting silence sit where he usually would have filled it. Then he asked him to come back.

James entered and closed the door behind him.

“You wished to see me?”

“Yes.”

Nomura remained standing a moment longer than usual before sitting.

“I’ve written to Los Angeles.”

James felt it immediately. Not surprise. Something tighter than that.

“The fellowship director is Alex Kim.”

James nodded. “I’ve read some of his papers.”

“He trained under me.”

That changed the tone of the room.

“He was my resident,” Nomura said. “Disciplined. Exact. He later completed clinical dermatology training.”

James looked up. “I didn’t know that.”

“It wasn’t required,” Nomura said. “He chose it.”

Nomura folded his hands. “Dermatopathology isn’t just pattern recognition. It sits between two fields. Neither fully trusts the other.”

He leaned back slightly. “When I began, dermatologists saw pathologists as technicians.”

James held that.

“So you went back,” he said.

“Yes.”

The answer was simple. “I returned to residency after already practicing.”

James tried to picture it. Starting over. In a room where no one cared what you had already done.

“Did it change anything?” he asked.

“Yes.”

Nomura didn’t elaborate. “They stopped questioning whether I understood them.”

The room quieted. Nomura looked at him.

“You already think clinically,” he said.

James didn’t respond.

“History. Tempo. Morphology. You use all of it.”

Nomura smiled. “You won’t struggle with dermatology.”

James felt that land in a place he hadn’t expected.

“I appreciate that,” he said.

“You should,” Nomura replied. “It’s not given.”

“You need to understand something,” Nomura said.

James leaned forward slightly.

“This field rewards patience. It does not reward forcing a conclusion.”

James nodded.

“You let the tissue tell you what it is,” Nomura said. “Not what you want it to be.”

That felt familiar. More than he liked. The room went quiet again. Then Nomura shifted. Not in posture. In tone.

“There was a judge,” he said. “When my mother and I left Wyoming, after the camps, we had nothing.” Nomura looked at his bookshelf.  “A Jewish judge and his wife helped us. Paid for school. Made sure I had a place to stand.”

James stayed still.

“They told me to pay it forward.”

Nomura’s hands rested on the desk.

“For a long time, I thought that meant choosing students who looked like me.”

He looked up. “It didn’t.”

James held his gaze.

“It meant recognizing something else.”

Nomura studied him.

“You remind me of someone.”

James didn’t move.

“Myself.”

The word didn’t feel like praise. It felt heavier than that. James wasn’t sure what to do with it.

“You’re not the same,” Nomura added. “You’re less rigid.”

A faint shift—almost humor.

“That will help you.”

James let out a small breath.

“You understand what it is to be measured before you’re known,” Nomura said.

James nodded. “Yes.”

“I will write to Dr. Kim,” Nomura said. “And to two dermatology faculty.”

“That’s not necessary,” James said.

“I know.”

A slight edge entered Nomura’s voice. “That’s not the point.”

James didn’t respond.

“When you go,” Nomura said, “don’t think of it as leaving.”

James felt Carter’s voice in that, unexpectedly.

“It’s continuation.”

Nomura’s gaze stayed on him. “You carry what you’ve learned.”

“I will,” James said.

Nomura stood. Slower than usual. He moved toward the window.

“You also need to recognize when your thinking changes,” he said.

James turned slightly. “I’m not sure what you mean.”

Nomura didn’t face him yet. “Fatigue doesn’t always feel like fatigue.”

Nomura turned and faced him. “It can feel like certainty.”

James frowned slightly. He didn’t fully understand. But he didn’t dismiss it either.

Nomura turned back. “That’s all.”

James nodded. He left quietly.

When the door closed, Nomura remained standing. He flexed his right hand. Steady. But earlier that morning, he had reread a note he had written. Twice. Not because it was unclear. Because it hadn’t made sense the first time. He didn’t react. He recognized it.

Gaman.

He returned to his desk. Sat down. Pulled a blank sheet of paper forward.

Dr. Alex Kim
Director, Dermatopathology Fellowship
Los Angeles Memorial Hospital

He paused before writing. Not searching for words. Choosing them.

Then he began.

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