Naoko leaves college and enters a sanatorium

Naoko’s decision to leave college and enter a sanatorium is both a practical retreat from a life she can no longer sustain and a painful redefinition of her bond with Toru Watanabe. In a short letter, she explains that the decision has been forming for a long time, takes responsibility for what has happened to her, and asks him not to blame himself. The separation does not resolve her crisis: it gives her a quiet place to rest, while leaving their hoped-for understanding suspended between distance, correspondence, and the possibility of meeting again.

The decision and Naoko’s letter

Near the end of June, after a long silence, Naoko writes that composing the letter has been painful and that she has begun it at least ten times. Her conclusion is direct: she will take a year away from college. Though officially a leave of absence, she suspects she will never return. The decision is not presented as a sudden response to one incident; she says she had considered it for a long time and had tried, unsuccessfully, to tell Watanabe. Even saying the words had frightened her.

Naoko also tries to keep Watanabe from turning her illness into a charge against himself. Whatever happened between them, she writes, the result would have been the same; she has to take the situation on herself, and she does not want him to blame himself. She describes the year of companionship as something for which she is grateful, insists that he is not the person who hurt her, and identifies herself as the one who caused her own pain. Her words do not make the separation painless, but they define it as an effort to face a condition she cannot hand over to him.

After leaving her flat, Naoko returns to her family home in Kobe and sees a doctor. On his recommendation, she considers a place in the hills outside Kyoto: not quite a hospital, but a sanatorium with a freer style of treatment. She needs rest for her nerves in a quiet place cut off from the world. She promises to explain the arrangements in another letter, but for now she is not ready to see Watanabe. That distinction matters: she says she does not reject seeing him; she is not yet prepared for it. She will write when she feels ready, and the possibility of getting to know each other better remains open rather than fulfilled.

A community organized around convalescence

The sanatorium is described not as an ordinary hospital but as a place for convalescence. Its gate is open, there are no bars on the windows, and residents enter and leave voluntarily. Doctors check on people and monitor their condition, but the institution does not ordinarily administer treatment in the manner of a conventional hospital. Residents must be suited to this kind of recovery; people who need specialized therapy may be transferred to a specialist institution instead.

The scale and setting help explain the distinctive atmosphere. About seventy people live there, alongside just over twenty staff members, including doctors, nurses, and office workers. The grounds are spacious and immersed in nature, and the relatively small population makes the place feel unusually quiet—almost, in Naoko’s account, like the normal world, though she recognizes that it is not. That quiet depends on the particular conditions under which the residents live, rather than representing a life available without qualification to everyone.

Daily life includes shared activity rather than confinement to a ward. Residents and staff play sports together, and on the basketball court Naoko can lose track of who is a patient and who is an employee. People also grow vegetables—among them tomatoes, aubergines, cucumbers, watermelons, strawberries, spring onions, cabbage, and daikon radishes—using greenhouses, books, and advice from experts. The work follows the growth of plants over time and gives the residents a practical, communal routine. The account presents this structured quiet as a form of convalescence, not a cure or a return to ordinary college life.

Acceptance, not correction

Naoko’s explanation of the sanatorium’s outlook turns on a conversation with the doctor responsible for her case. When she tells him that everyone seems equally deformed while playing a game, he agrees that she has grasped something important: the residents are not there simply to have their differences corrected, but to become accustomed to them. People have individual ways of walking, thinking, feeling, and seeing. These patterns cannot necessarily be altered overnight, and forcing change in one place may unsettle something else.

The doctor’s account is deliberately limited: it is a simplified explanation and only one part of the residents’ difficulties. Naoko nevertheless understands its central claim. People come to the sanatorium because the pain caused by their differences can be difficult to accommodate within themselves, and they need distance from situations in which that pain leads them to hurt or be hurt. The institution makes those differences explicit instead of treating them as invisible deviations from a universal standard. Naoko describes the residents as wearing their deformities openly, a shared recognition that allows them to live quietly and avoid harming one another.

This approach shapes the meaning of Naoko’s departure from college. The sanatorium does not promise to make her conform to her former life; it offers a protected environment in which she can rest and live among people who do not have to pretend to be without difficulties. Yet the account also draws a boundary around what that environment can do. Its openness and mutual accommodation are not equivalent to intensive clinical care, and the possibility of referral to a specialist hospital is part of the institution’s design from the beginning.

Watanabe, Reiko, and the limits of the arrangement

When Watanabe visits, Reiko initially appears to him to be Naoko’s doctor, but she corrects him: she is a music teacher who helps with the office, another resident, and someone who has lived there for seven years. The nickname “The Music Doctor” sometimes makes her role hard to distinguish from staff work. She is also Naoko’s roommate, and says that she likes living with her. The overlapping roles of resident, teacher, and helper echo the sanatorium’s broader refusal to divide people neatly into fixed categories of patient and staff.

Reiko becomes an intermediary between Naoko and Watanabe. She tells him that she and Naoko talk about many things, including him, and later writes that Naoko enjoys his letters and that she enjoys them too. This correspondence maintains a connection while Naoko is not ready to meet him directly. It also gives Watanabe news from inside the community, though the letters cannot make him present with Naoko or decide what her future there will be.

That limit becomes clearer when Reiko later reports that Naoko is doing poorly. After Naoko’s mother comes from Kobe, she, Naoko, the doctor, and Reiko discuss what to do. They conclude that Naoko should move to a proper hospital for a period of intensive treatment, with the possibility of returning to the sanatorium depending on the results. Naoko would prefer to remain where she is and recover there, and Reiko expects to miss her and worry about her. But Naoko’s emotions have become increasingly unstable; during intense episodes in which she hears voices, she shuts down and retreats inward, and the staff cannot safely take their attention from her. Reiko agrees that specialist care is then the best available course. The hope she expresses is patient and incremental: to untangle the disorder one thread at a time, even when the situation appears dark.

Separation, grief, and the afterlife of the decision

Naoko’s letter reaches Watanabe after he has spent months trying to put distance between himself and his memories. Her words renew a sadness he cannot set aside or conceal. The leave from college and move to the sanatorium thus begin a prolonged separation: Naoko asks for time and quiet, while Watanabe is left to wait, write, and confront the fact that her recovery is not under his control.

The novel later places this separation beside Watanabe’s continuing struggle with death. He had come to understand death as part of life, a truth first associated with Kizuki’s death. But after Naoko dies, his travels along the coast show that such a philosophy cannot cure grief. He sleeps on beaches, makes fires from driftwood, roasts dried fish, drinks whisky, and finds that memories of Naoko return with an almost physical force. In those memories she can seem present, living with death inside her; then the image recedes and he is left alone with the fact of her absence.

Watanabe eventually recognizes that no truth, sincerity, strength, or kindness can remove the sorrow of losing someone loved. The insight does not cancel the earlier idea that death belongs to life; it corrects any expectation that understanding this can make bereavement manageable. When he returns to Tokyo, he shuts himself in his room and spends his days in the rooms he has kept for Naoko, with their windows shuttered, furniture covered in white, and dusty sills. His memory remains fixed on the dead rather than the living. In retrospect, Naoko’s move to the sanatorium is neither a clean break nor a recovery completed offstage. It is the beginning of an interval of care and separation, whose promise of rest remains real even as the later story reveals how little any place or truth can guarantee against loss.