Mikoto Itoshiki, third child of the Itoshiki family and older brother to Nozomu Itoshiki, serves as a physician at the family’s sparsely frequented private clinic. The clinic’s quiet halls clash darkly with the lethal wordplay hidden in his name—its kanji rearranged horizontally spell “Zetsumei” (絶命, “death”)—a morbid irony against his life-preserving profession. This linguistic contradiction threads through the series as a recurring motif.

His appearance mirrors Nozomu’s nearly identically, a familial likeness frequently remarked upon. The Itoshiki name itself twists into “zekke” (絶家, “extinct family”), anchoring the clan’s penchant for grimly humorous puns. Each member’s name reflects their quirks, with Mikoto’s embodying the tension between life and death central to his role.

When Nozomu vanishes temporarily, Mikoto discloses his brother’s retreat to their family estate for an arranged marriage meeting—a ritual binding participants through eye contact. Nozomu’s skill in avoiding direct gazes thwarts these obligations, while Mikoto’s exposition spotlights the family’s absurd, tradition-steeped dynamics.

Gender ambiguity plagues the Itoshiki men: Mikoto, like his father, faces mistaken identity due to his androgynous features. Once, clad in women’s attire, he flees after being misgendered, echoing a past incident involving their patriarch. These comedic misunderstandings underscore the family’s perpetual clash with societal norms.

Mikoto’s documented role remains confined to these interactions, with no elaboration on his personal history, motivations, or expanded presence in spin-offs, films, or OVAs. His narrative function centers on illustrating familial eccentricities rather than individual growth.