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428departments consisted only of neurosurgery, ortho-pedic surgery, and general surgery at that time. The annual number of operations managed by the anesthesiology department was less than 1,000, and the operating rooms were closed on Wednesday. As I expected, there were many cases of emer-gency surgery, such as traffic injuries and subarach-noid hemorrhage, which accounted for one-third of the cases. An emergency call could come at any time even when I was not expecting it and I was expected to be on-call for 3-5 days a week. After two years, I felt that the hospital was not a good fit for me in the long-term. Although the number of medical staff had not increased, the number of operations had gradually increased, and the number of patients managed by the anesthesiology depart-ment exceeded 3,000 in 2000.Izunagaoka Hospital gradually expanded its scale, and ophthalmology, otolaryngology, and cardiovascular surgery began to be performed; however, the five operating rooms were insuffi-cient. A new building was constructed in 1998, and the number of operating rooms increased to eight. With the new establishment of the obstetrics and gynecology department and the urology depart-ment, eight operating rooms soon became fully operational, and the total number of operations increased from about 1,200 in 1986 to more than 5,000 in 2005 (Figure 1). In the same year, Izun-agaoka Hospital was renamed Juntendo University Shizuoka Hospital, and I thought that this was the opportunity for it to finally evolve from a municipal hospital into a university hospital. Recently, the number of total operations has been about 8,500, and the number of operations managed by anesthe-siologists has been about 4,500, which is about a half of that in the main hospital. As an emergency core hospital, it has one of the largest number of operations in the eastern area of Shizuoka prefec-ture (Figure 1).I have worked in a pain clinic as a sub-specialty of my anesthesiology work. I entered this depart-ment when I was a student. I became interested in the pain clinic when I saw a patient’s pain stopped by a nerve block performed by Professor Emeritus Toyo Miyazaki. I was told that the pain clinic would not be able to teach me anything if I would not enter the anesthesiology department. This was one reason why entered the department. In the 3rd and 4th years after joining the department, I could learn pain medicine at the pain clinic one day a week. This experience still is a happy memory for me. After that, Dr. Miyazaki took the trouble to visit Izunagaoka Hospital and taught me treatment of pain using nerve blocks, such as nerve root block, lumbar sympathetic nerve block and celiac plexus block, in the operating room. In 1990, the anesthesi-ology outpatient department (a pain clinic) was established with the support of the deputy director, Professor Yozo Watanabe. Within three years of its establishment, the total number of outpatients reached about 2,000 a year, and as a result of active ：emergency operationsFigure 1　Annual Cases of Operations performed in the operation rooms：elective operations