She almost forces Black Jack to shove a scalpel into his throat during the operation until Black Jack attempts to bargain with her by saying that he will promise to keep her alive once she is removed from her twin sister's body.
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She is barely able to babble in her new body, and is technically nameless at the time. Since then, Pinoko started to develop as a tumour on her twin sister's abdomen and "lived" there for eighteen years.
Blackjack Ep 1-2
The surgery constantly had to be cancelled due to this problem and the doctors had no choice but to seek Black Jack's help in order to remove the tumour. He did this because he was envious of Tom's stories of living on a ranch and helping out with all of the chores there.
Chako, having heard about Black Jack, begs her brother to have him take her case. The aliens eventually convince Black Jack to start the operation by using telepathy to show him a picture of his mother. Kuro asks him why he laughs so much and his classmate says it is because he likes being happy and bringing joy to other people.
After a second operation, both the carbuncle and personality are gone. But wait, someone is wrecking them!
She also has a pair of brown eyes and a light complexion. Before the doctors consulted Black Jack to proceed with the removal of the tumour, previous surgeons found it hard to operate on the twin sister due to a sort of curse cast on them when attempting to operate. Rescue teams cannot get to them in the snow, so the captain leads them all to a barn km away.
When a man is injured by fireworks, Black Jack's fee is too much for the hospital, and the underestimated Dr. Black Jack follows the boy, to his annoyance.
Black Jack is called in to perform the operation at the behest of a seemingly inhuman mother who was forcing the boy to get up and walk every night, further injuring him. On a night some years ago, a group of doctors came to Black Jack with a masked woman who had a Teratoma --a cystic tumor caused when one twin does not develop fully but continues to grow inside the other.
Black Jack is extremely impressed by the friendliness and respect Dr. Pinoko studies hard and gets to the exam, but collapses with severe stomach pain. After they leave, Black Jack immediatly begins with another surgery on the remaining parts, assembling and arranging the scrambled body parts into a complete body.