Excerpt #46: Clinical Challenges in JB

Excerpt #46:  Clinical Challenges In JB

I had two unique clinical challenges in JB. One was the large number of pediatric burn patients; the other, psychiatric patients with acute surgical problems from the nearby mental institution at Tanjung Rambutan.

            The pediatric burn patients touched me. Nothing tugs at your heart more than to see a child in pain staring at you pleading for help with their weary, watery eyes. Their frequent dressing changes were painful and had to be done in the operating room.

            I wanted to collect as much clinical data as possible on those two challenges. For the burns, I assigned Yahya, my most senior trainee. I saw the potential of many papers, and what better way to help launch his career than to have him publish a couple of papers with me. I guided him on effective literature search as well as chart reviews, and to think of future trials on a prospective basis to be conducted to improve their care. I was most interested in the preventive aspects.

            Most were the results of home accidents, in the kitchen from spilled hot fat and boiling water, as well as during Hari Raya and Chinese New Year celebrations from exploding homemade carbide cannons and fire crackers respectively.

            Village families cook on caste iron, round-bottom kualis. In the traditional kitchen with three metal spikes protruding from the ground, those kualis are stable. When placed on the parallel bars of the ‘modern’ stove-top grill, they tip with ease, splashing out their hot contents.

            The psychiatric patients presented a whole different set of problems, one being delayed diagnosis. Their psychotropic medications also interfered with their intestinal motility. We had many complications arising from that, their hard stools rubbing against the inner lining of the intestines forming stercoral ulcers that could perforate, causing life-threatening peritonitis. Managing colostomies (artificial opening of the bowel on their abdominal wall) in such patients proved problematic. I assigned that review to another trainee.

            Meanwhile my formal seminars were going well. We did one on surgical emergencies in the newborn and reviewed the few cases of tracheo-esophageal fistula (TEF) in KL from the adjacent huge maternity hospital. In all cases I was called in late when the patients were in extremis from their lung complications. Despite extensive preoperative chest management, none of the anesthesiologists would touch those patients. I was wasting my time, they counselled me. One accused me of wanting to “experiment.”

            I had scrubbed on a few such cases during my residency days. Being rare and complex cases, they were done by the attending with the residents as first assistant. That was how we learned.

At my seminar, I focused on the need for early diagnosis to avoid the chest complications that doomed these patients. I told the audience that I could not care less who was the one calling me if they suspected a case. Even the student nurse could call me, I emphasized. The essence was early diagnosis and intervention if we ever hoped to salvage these unfortunate babies.

            A few weeks later I had an excited call in the middle of the night from an intern in the maternity ward. She had been through a rotation in my unit and recalled my earlier seminar. She said that they had just delivered a baby who might have TEF. After telling her to also call my medical officer, I came right away. She was right on her clinical diagnosis; I complimented her. I instructed the nurse on elementary pulmonary care.

            I called the anesthesiologist. Like his colleagues in KL, Dr. Poopathy too balked. I was wasting my time and giving the parents false hope, he added. I told him that this baby had the best chance being that he was born just a few minutes ago and had no lung complications as yet. I did not know what it was that triggered him to change his mind. He came right away.

            In the operating room as we were setting up, I reviewed the instruments and went over the procedure with my team. It was less my instructing them, more my mentally rehearsing a thousand times the many steps in my mind.

            As soon as I opened the infant’s chest, I gave a huge sigh of relief! The anatomy was exactly what I had anticipated from the x-rays. I would need minimal dissection to connect the esophagus and close the fistula. The surgery went so smoothly that Dr. Poopathy was taken off guard when I uttered my signature phrase signaling the end of a case, “Let’s get out of here!”

            A few hours after surgery seeing that the infant was doing so well, we decided to extubate. Later in the afternoon I checked on the baby and he continued to do well. The next day I removed the chest tube. Now the only tubing attached to the infant was the intravenous line, a vary tangible and reassuring sign of improvement to the mother and also us.

            Later in the afternoon as I was making my rounds, to my horror the mother was nursing him. Seeing that both were so contented, I did not interfere. The baby was not very good at sucking nonetheless I gave him an A-plus for effort. From then on, the recovery was smooth and fast. The mother’s only concern was the baby’s cry. It was shrill and high pitched. I assured her that this was common with the condition and to give it time.

            I emphasized to her to continue nursing and not rely on formula so the baby could develop his sucking skills and instinct. In Malaysia then, as in most developing countries, bottle feeding was the rage while breastfeeding was associated only with the poor and those unable to afford “modern” formula. With all the negative associations with breastfeeding and the glamor implied with bottle feeding, the results were often catastrophic as those formulas were mixed with less-than-clean water. It did not help that the major formula makers, in particular Nestle, were giving away generous samples of powdered milk free to new mothers, a marketing technique drug dealers would later emulate with devastating effectiveness.

            When we lived in Bungsar, our daughter Melindah had a febrile seizure and was hospitalized at GHKL. Karen brought our son Zach along and would breastfeed him in the open so the other mothers could see that it was something cool and that even “white” women did it! In JB too, Karen would ask the nursing mothers in her group to come to the hospital to demonstrate breastfeeding. It helped that Dr. Tan, the pediatrician, was also enthusiastic about breastfeeding. I reminded my patients that infant formula was but powdered cow’s milk, and cow’s milk is best only for calves.

            On second thought I wondered whether that was a good reminder to this particular patient. She was Indian; to them cows were sacred. I hoped she would not treat powdered milk as being holy or divinely sanctioned and would stick to breastfeeding!

Next:  Excerpt # 47:  Tolerating VIP Visitors

Excerpted from the author’s second memoir, The Son Has Not Returned. A Surgeon In His Native Malaysia, 2018.

Excerpt # 45: A Museum Of Vintage Cars

Excerpt # 45:  A Museum Of Vintage Cars

            After our clinical digression with the elbow lump, the sultan was now onto his favorite topic, cars. He became animated with a glitter in his eyes as he proudly listed his vintage collection. Would I like to see them?

            Before I could answer he was up, sprightly using his cane not as support but as a pointer. He led us onto his huge covered garage a level below, filled with classic vintage cars. I was not sure which shined more, the garage floor or the cars. This one my father drove during King George’s coronation, he enthused, and that one, Queen Elizabeth’s, both gleaming elegant silver Rolls. Then there was a sleek yellow Studebaker, my favorite. He had enough Bentleys and Rolls for each day of the week. If his teenage grandson were to have a Volkswagen bettle, it would be oddly out of place in that garage. No, that was not a garage, more a museum. I hope he had enough insurance for the priceless collection.

            It seemed that every time he or his father went to England they would come home with a Rolls or a Bentley. In those days those cars would be transported by ship. Today it would be by air. I remembered being bumped once from my flight from Los Angeles to KL because the King at the time, that sultan’s son, had bought a Delorean to bring home. To do that he commandeered a Malaysian Airlines 747 cargo combo. Thus was my seat given to one of his many hangers-on.

            From cars to Arabians, the sultan’s other passion. He had only a few at that palace, his main stable was at the other side of town, at Pasir Pelangi, where he had enough for more than a few polo teams. Captain Othman, the sultan’s ADC and who was always beside or behind him, paraded one of the prized ones. A superb rider on a magnificent beast, you could not get a better equestrian display than that morning. The sultan invited me to join Othman on another horse, but I politely declined.

            I had only two previous occasions to be on horses, the first when I had a summer job in Lake Louise, way up in the Rockies. My fellow worker was a farm boy from Ontario and an expert on horses. On our days off we would explore the Rockies, renting our horses from a nearby stable. I had seen the Rockies once before on my arrival in Canada on the flight from Vancouver to Ottawa to meet the Foreign Aid officials. I had read about the mountain range in my geography books in secondary school. The dry prose of my textbooks did not prepare me for or do justice to the spectacular grandeur that I saw from the air. Peaks after rugged peaks still snow-covered in mid-September, and lush green, colorful valleys in between.

            That summer I experienced the Rockies at ground level, the grandeur seen this time at eye level. We would ford streams, gallop across plateaus, trot above the tree line, and scale up the peaks. At the peak, everywhere we turned we would be rewarded with one spectacular panoramic view after another. I also sensed what thin air meant and how ordinary breathing could be an effort at that level!

            With the superb instructions from my friend, I was not at all sore and my horse was very responsive to me. Those outings acquainted me with the subtleties of horses, or at least a little bit of it and enough to be overconfident of my skills.

            A few summers later Karen and I were holidaying with two other couples at Waterton Lakes National Park in southern Alberta. After my Lake Louise experience, I fancied myself an accomplished rider and thus led the posse. I looked back every so often to make sure that everyone was fine and no horse was acting up. We came upon a lush flat spring meadow. That was just what I needed to make the group go faster. I started a slow gallop and looked back, and all the other horses followed suit. No one seemed frightened and we were all whooping it up! Soon as it would be inevitable in such cases, the horses became competitive (or was it their riders?) and someone hollered, “Let’s have a race!” And off we went!

            I looked back and the girls’ blond hairs were flying straight up in the air just like in the movies, as were the horses’ tails. Then I saw someone fast catching up to me. I pressed my heels and my horse went flying. I looked behind to see my friends left behind in my smoke. Then, suddenly, something happened. Karen who was following me best described that something.

            All she saw was my body hurling over my horse’s head and landing way ahead while my horse stood still. The others following included two would-be doctors and two nurses. Both nurses had neurosurgical experiences. Karen said that I went over so smoothly, and gracefully too, that she thought it was a planned maneuver on my part. The others however, imagined a more catastrophic scenario, as with me breaking my neck and being paralyzed. They stopped and were relieved when they saw me getting up and running to my horse ready to mount it and proceed with the race. It was then I realized there was a deep narrow creek ahead that made my horse stopped. I did not see it as I was busy looking behind. I still did not know why my horse stopped as it could have easily jumped over it. There was still a lot I did not know about horses.

            After we realized how lucky I was, we decided to return and not press our luck. Allah had protected me that day, and I did not want to indulge Him further.

            That day when the sultan invited me to go riding with Othman, I demurred. I was unmarried back then but now I had a wife and two young kids. Horses, unlike simple village folks, do not always obey the commands of their master, even if he were a sultan.

            After the visit to the palace Karen dropped me at the hospital. Alone at home and with the excitement subsiding, she wrote her parents in Canada, “… so you can tell your friends that your daughter had a private audience with the sultan here!”

            She then added, “Big deal! Sultans are a dime a dozen here, one for each tiny state.”

            Later in the evening, we pondered on the sultan’s offer to help us find a house. It did not take us long to realize that we were happy to find our house on our own. Had the sultan directed the top civil servant in the state to find us a government bungalow, imagine how high my standing would have soared among the local bureaucrats! I would have been insufferable, and untouchable! But then we would forever be indebted to the man.

Excerpt #46: Clinical Challenges In JB

Excerpted from the author’s second memoir, The Son Has Not Returned. A Surgeon In His Native Malaysia, 2018.

Excerpt # 44: A Royal Command To The Palace

Excerpt  # 44:  A Royal Command To The Palace

Midway through my first week at GHJB an ambulance drove up to the house. As in KL, getting a phone for our home was a monumental endeavor. Meaning, we did not have one at the time. Assuming that it was an emergency call from the hospital, I was ready to leave. The driver gestured for me to settle down as he handed me a note. It was from the Matron (Director of Nursing), Sister Chong.

            The Sultan wanted to see Karen and me the next morning. He had heard that there was a surgeon from Canada and asked Sr. Chong whether he was a Canadian. She, who I later discovered had an extracurricular role as the sultan’s personal nurse, had replied that I was a Malay.

             “Good!” he replied. “Ask him and his missus to see me!” How was that for a welcome?

            If not for Sr. Chong’s note, my mind would have wondered wild, speculating what royal protocol had I breached in my first few days in JB. My only experience with royalty was during my primary school prize-giving ceremony. I did not sembah (genuflect) to the Regent of Negri Sembilan when I was called on stage to receive my book prize from him. I was immediately taken off stage and made to practice the ritual before I could repeat the ceremony.

I had been down with chicken pox and thus could not take part in the rehearsal the previous week. As all the winners who had gone on stage before me had been non-Malays, I had no example to follow. They did not need to sembah, only Malays do.

            Back to the royal invitation, I rushed to the kitchen to tell Karen. She laughed, dismissing it as a bad joke. When I showed her the note, her immediate reaction was, “I have nothing to wear!”

            Later I discretely asked Yahya for some much-needed advice. He was from a long-time aristocratic Johor family and thus would be familiar with such feudal rituals and palace protocol. His immediate advice was, “Be careful!” I did not know what he meant. I wanted to know what attire to wear, traditional or formal business suit. He confessed his ignorance as he had never been to the palace.

            I then asked one of my Malay interns. Dr. Hashim was from Trengganu, a conservative state. He advised me to be traditional. You could not go wrong; otherwise I could appear biadab (uncouth). I asked Sr. Chong. Just be yourself, was her only advice. The sultan was quite modern, she assured me.

            I wore my maroon suit with a matching tie and black songkok. It was then that I realized that I was in a bad need of a haircut. A hippie in a suit! I did not remember what Karen wore. She couldn’t either.

            We were led in through the side door to find His Highness seated alone on his sofa in the parlor He was wearing a subdued Hawaiian shirt. He had both his hands on his walking cane in front of him. He looked cherubic, fair-skinned, his face with generous sprinkles of age spots. He was on the chubby side but his loose Hawaiian shirt camouflaged that.

            As we navigated in between the elaborate parlor furniture, I could not help but notice the absence of anything that would remind me that we were in a Malay house or palace. All the furniture was English-themed, Victorian specifically. It was as if we were in an English country castle except for the abundance of Chinese vases.

            He extended his right hand for a firm handshake.  “You are from Canada!” he greeted me, beaming.

I corrected him and that Karen was the one from there. That shifted the conversation to her.

            The sultan was knowledgeable about Canada, asking Karen about Vancouver, Ottawa (she had lived in both cities) and Toronto (she was born there). The conversations were now in Karen’s direction. He asked us whether we had trouble finding a house. When we replied that we did not, he went on to reassure us that should we encounter problems, to contact him. Wow, that would be quite an endorsement; a royal imprimatur. No one would dare say no to us then!

            He complimented us for what we had done to our yard. He noticed my hard work! He was pleased that we had planted the trees. As the conversation slowed down, he showed me his right elbow. There was a small lump and he wanted my professional opinion.

            There is nothing that would make a nervous young doctor ill at ease in a social situation feel confident than to be asked a medical question. I was now no longer an unsure peasant in front of his sultan but a surgeon being consulted by a patient, albeit a very important one. He kept rubbing the lump as I asked him some clinical questions, as with any pain or recent change in size. He had neither. Thinking that it might be a rheumatoid nodule, I asked him about joint pains and swelling; again, he had neither except for some neck pain and occasional knee stiffness. He spoke impeccable English with no trace of the distinctive Malaysian accent. No “lah” or “mon!”

            The lump was a lipoma, a benign fat tumor, an inch in diameter. To be thorough, I examined his axilla for nodes (I once had a patient with a rare malignant form of the disease), as well as his hands and wrists for any swelling or stiffness. There were none except for some mild degenerative arthritis expected of someone his age.

            I assured him about the lump. He asked about surgery and I replied that would not be necessary unless the lump was causing him symptoms and discomfort, as rubbing against the surface of the desk when writing. He assured me that it did not.

            He inquired about my examination of his hands. I replied that occasionally the lump could be the sign of an underlying rare form of arthritis (rheumatoid) but I again assured him that he did not have that.

            I could not decipher whether his smile expressed satisfaction with my clinical thoroughness or concealed contempt for my physical intrusion upon his body.

Next:  Excerpt # 45:  A Museum Of Vintage Cars

Excerpted from the author’s second memoir, The Son Has Not Returned. A Surgeon In His Native Malaysia, 2018.

Excerpt $3: Dealing With Garbage Everywhere

Excerpt # 43  Dealing With Garbage Everywhere

            Our house in JB abutted Jalan Kolam Ayer with the side of the house facing the street. It was not the main street but busy enough. With the hospital at one end we often heard the ambulances as they sped by. At the other end was Bukit Serene palace. The sultan used to drive by on that road on his way to his other palace at Pasir Pelanggi on the eastern side.

            There was nothing but weeds and tall grasses, plus the ubiquitous strewn garbage between our fence and the street, a width of about twenty feet. People walking or driving by, and that included the sultan, could see right into our living room.

            The first thing I did was to plant some flowering trees. The hospital had plenty of Gliricidia trees they were pruning. I took some of the branches and stuck them into the ground outside our fence. Karen laughed when I told her that the sticks would sprout. Within a few days when she saw the light green shoots at the tip, she was not laughing at me anymore. She was amazed how fast they grew. Within a few months we had enough greenery to ensure our privacy.

            I hired a gardener, an old man with his ubiquitous gas lawnmower on the back carrier of his bicycle, which was how I deduced his vocation. I asked him to mow not only our lawn but also to clear up and maintain the stretch of land outside our fence. He told us that we did not need to do that as it was the responsibility of the Town Council; we would be wasting our money! We told him that the town was not doing its job, as was obvious. Only after we threatened to find another gardener did he agree to our terms. You would have thought that he would have welcomed the extra work and money!

            That was and is Malaysia; you do what you absolutely have to, nothing beyond. That would be someone else’s responsibility, like the Town Council or government, except that it did not, and still does not.

            Soon the area outside our fenced yard resembled a park, what with the trees I had planted now blooming with purplish white flowers, a striking contrast to the areas outside the other houses along the road. That notwithstanding, none of the other neighbors emulated us. They probably thought we were being stupid spending our money to do the Town Council’s job.

            My next major project was our stinking stagnant open drains that surrounded the house and emptied into the canal beyond our property. Those drains and canals were perfect breeding grounds for mosquitoes, their larva squiggling in the green slime. Clearing only the portion of the drain by my house would not do it. I had to clean the entire length, right down to the canal. None of the neighbors helped. It was beneath them to indulge in manual labor. Besides, that was the responsibility of the Town Council! One neighbor complained of the stench as I had disturbed the goo. He told me that the heavy rain would flush everything out. Malaysia has frequent heavy downpours yet its drains are still plugged! At the very least I destroyed the habitat for the zillions of mosquito larva.

            Our backyard abutted a large empty lot along Jalan Kolam Ayer. Any empty land in Malaysia is the neighborhood’s dumping ground. So it was with this empty property. We had rats from there rummaging in our yard. Karen was terrified of the huge critters. I was scared too but for a different reason. Those critters would attract snakes, in particular cobras.

            One hot afternoon I set the heap of rubbish on fire. I wanted to clear just the area near our house. It did not take long for that fire to spread and soon the whole lot was ablaze. There was so much garbage and debris hidden in the underbrush that the fire soon became huge. A few firetrucks came by but the firemen let the fire burn through.

            I was afraid that I would find some charred bodies among the ashes but thankfully, none, only metal and zinc debris. The fire scared us but we were rewarded with a clean lot beside our house. Now I became assertive. Whenever I saw someone bringing garbage I would intervene telling them that it was my land. It worked! I now had a vastly expanded clean area behind and beside the house to enjoy.

            Despite that we still had critters in the house, only this time the much smaller mice rather than the huge menacing wild rats. Their favorite safe retreat when chased was to get into the ground spouts of our gutters. One day I stuffed the outlet with some old newspapers and set it on fire. The smoke suffocated those mice. Those that tried to escape were met with instead beheading by me with a spade. Karen was horrified by my gruesome but quick and surgical method.

            We could now enjoy our yard in the cool of the evening, free from the stench of the stagnant drain and the invasion by swarms of mosquitos that it bred, as well as the prying eyes of the passengers in the cars and buses passing by.

            As for garbage, which at times buried the country, Karen and her expatriate ladies decided to do something about it for the hospital. They bought wastepaper baskets for the wards so the patients could put their garbage into them instead of tossing it out of the windows and hitting those on the ground.

            They as well as the nurses decided to make a big fuss of the occasion, with cakes baked and balloons hung in the ward. The ladies made a ceremony of placing a basket at the end of each bed, as well as at the nurses’ station. Then the cakes were cut and Karen and the ladies make a big show of nicely folding the wrappers and then tossing them into the wastepaper baskets.

            One of the Chinese patients was about to throw his banana peel out of the window when he saw what those white ladies were doing. He caught himself. He leaned over his bed to drop the peel into the wastepaper basket at the end of his bed!

            The message had been delivered, and very effectively too, with no sermonizing lectures on the importance of cleanliness.

            The only folks unhappy were the cleaning crew. They were upset as they now had to empty all those baskets–more work! I pointed out those baskets saved them from having to clean up the pavements down below. That did not matter as those pavements were the responsibilities of the gardeners! The Jamaicans have an apt expression for that. “It’s not my job, mon!”

Next:  Excerpt # 44:  A Royal Command To The Palace

Excerpted from the author’s second memoir, The Son Has Not Returned. A Surgeon In His Native Malaysia, 2018.

Excerpt # 42: Dealing With Garbage Everywhere

Excerpt # 42  Dealing With A Federal Medical Bureaucrat

            Soon we had a medical specialist from headquarters in KL on his annual tour to apprise our equipment and other needs. I put in my request for some basic journals and textbooks, as well as for a gastroscope. Nothing fancy or out of the ordinary. That was not enough, I was told. I had to justify them. So I added in the large comment section, “Desperately needed!” My pair of words looked like an isolated island in the vast ocean.

            He was not satisfied. He wanted me to specify how many people would be using the equipment and how often. For the books and journals, I put in “daily” and the number 50, the number of doctors in the hospital. For the gastroscope, I also put in daily, and 6, the number of medical officers in the two surgical units.

            Worse than a bureaucrat would be a failed clinician turned bureaucrat. That was this character. He called for a grand summation meeting with all the doctors in attendance to go over what we had requested, and also to impress upon us how important he was. Bhattal urged me to attend lest I risk my modest wish list not being fulfilled.

            We were taken away from our busy clinics that day to listen to this self-important doctor-turned-purchasing agent. Our requests would be reviewed and prioritized by a special committee at the ministry, he intoned, and then put out to bid to get the best prices. There would be no shady practices, he declared with great pomposity and put-on emphasis.

            I asked how long the process would take (over a year) and whether with respect to the journals he could get any better price than that advertised. He could not answer me except to revert to the bureaucrats’ old standby, “It’s SOP!” (Standard operating procedure.) As for the gastroscopes, the ministry would purchase from only one manufacturer so as to achieve maximal discounts with bulk purchases. Fair enough.

            He took great pride in disposing my queries with ease. Then I suggested that wouldn’t it be much easier and remove needless hassles if the ministry were to give each hospital a fixed allocation for books, journals and equipment every year and let the local doctors decide what to buy without going through all these hoops. His job would then become redundant and he could return to clinical practice.

            He ignored the snickering among my colleagues. It was to prevent corruption, was his curt reply. He was not amused!

            Sensing that I was now the alpha dog and he, the pariah, I piled on. “Let’s see,” I rebutted, “You trust us with the lives of our citizens but not with a few measly ringgit!?”

            He had no answer to that one and I did not press him. No, we did not get the books and journals we ordered. I had anticipated that and subscribed to the journals through my trainees using their discounted student rates. The ministry could never beat those prices!

            Malaysia would save more money by having that doctor work at its clinics and hospitals instead of wasting his time and talent being a bureaucrat taking purchasing orders.

            Karen and I were pleasantly surprised at how fast and smooth our transition to life in JB was, notwithstanding our (or at least my) initial disappointment in not being able to buy that house on the hill. I was still as busy in my work as when I was in KL but somehow I was not so exhausted at the end of the day. I still had the energy to take Karen and the kids out to the clubhouse once in a while. Those visits rejuvenated me.

            The short commute to the hospital had much to do with my not being so exhausted. Sometimes I would take the bus. That would always elicit stares from the other passengers; a doctor taking the bus instead of driving his own car or even being chauffeur-driven! It also helped that my car was now air-conditioned. My taking the bus freed the car for Karen. That greater mobility liberated her. We were however shocked every time we had to fill the tank, which was often. Despite the short commute, the car consumed more gasoline because of the air-conditioning.

            One day when she was hanging the clothes outside to dry, an Australian lady who was driving by stopped and introduced herself. She was married to a Malaysian. Through her Karen was introduced to the local expatriate community.

            Karen was at first reluctant to join them, remembering her earlier experience with the Canadian Universities Women’s Club in KL. She thought they were a bunch of women with too much money and time on their hands. Karen had neither. She remembered how sorry she felt for them for missing out on the local life and culture. This JB crowd turned out to be very different.

            Our daily routine was set. After work, I would grab some pisang goreng (fried banana) at the hawker stall by the hospital (being hot allayed my reservations of the otherwise atrocious food hygiene) and Karen would be ready with our afternoon tea. Then some days we would drive up to the golf club for our swim. That swim was not only relaxing but also therapeutic for my back. The prolonged standing and stooping over in the operating room are killers to your back and neck. On Friday evenings, we would stay for dinner and take in the movie at the clubhouse. On other days we would have dinner at home. If Karen did not feel like cooking, we would hail the satay man on his motorbike and he would grill right there on our front lawn. Very cheap too, and no cleaning up!

Excerpted from the author’s second memoir, The Son Has Not Returned. A Surgeon In His Native Malaysia, 2018.

Next:  Excerpt # 43  Dealing With Garbage Everywhere

Excerpt # 41: An Easy Transition

Excerpt #41:  An Easy Transition

I had a warm welcome from everyone at GHJB[1], in particular my senior colleague and fellow surgeon, Mr. A R Bhattal. He had a more practical reason for welcoming me; he was tired of covering two busy surgical units!

            He assured me that I should have no problem transiting to the local scene. “Unlike KL, we don’t have big egos here!”

            He added that I was lucky to have an excellent team of interns and medical officers. He mentioned Yahya Awang and Suraya Hussein, medical officer and intern respectively. I knew Yahya’s older brother, Hussein Awang, a urologist at GHKL. He had wanted me to join his kidney transplant team after he had heard about my research experience in Canada. I was tempted to, but considering that I already had so much on my plate, declined it. I could not justify joining his team when we had so many patients with incarcerated hernias, bowel obstructions, and ruptured appendicitis to take care.

            Suraya was Prime Minister Hussein Onn’s daughter. You would not know that from her demeanor on the wards. One morning during our usual robust rounds early during my tenure there, I came down hard on her over what I thought were her shoddy clinical notes. She tried to correct me a couple of times as I read them to the group, but I ignored her. Likewise her fellow interns who tried to rescue her.

At the end after my very pontificating–and condescending–“I don’t want ever again to see that caliber of clinical notes . . .” comment, she responded in a cool, calm voice and a winning smile, “I wanted to tell you that I forgot to remove my page of scribbles. My actual notes are behind that.”

I read her finished notes, taking my time.

“Yes, this is what I want on all my patients!” I did not know whether I succeeded in hiding my utter stupidity and embarrassment. It was a good thing that the ward floor did not have a hole, or I would have crawled into it and stayed there!

            Earlier, Bhattal must have sensed my lack of reaction to his introduction, for he added, “They are nice kids, really, unlike children of other big shots!”

            He alluded to my teaching program in KL and expressed his hope that I would continue with it. He would give me his full cooperation. GHJB used to have a national reputation for its post-graduate medical training program under Dr. Lim Kee Jin, an internist. With his retirement a few years earlier, that program fell apart. Bhattal hoped that I would resurrect it, this time focusing on surgery. I took that to be a compliment; I was comforted by his confidence in me.

            My transition to GHJB indeed went without a hitch. The hospital director was extra effusive in welcoming me. He complimented me on my publications. “Unprecedented in the history of our hospital for a staff member to have papers published! Not even Datuk Lim had any!” he gushed. He expressed his hope that one day while he was still there to read in the medical journals, “From the Department of Surgery, General Hospital Johor Baru.” Well, at least he was different from that medical director at GHKL. Bhattal was right; they did not have big egos at JB.

            My next courtesy visit was to the head of medicine. He had just taken over from the legendary Lim Kee Jin. Lim’s replacement wanted everyone, especially me, to know that he was more than capable of filling in that big shoe, and then some. That visit was pleasant enough but l was fortunate that he did not pick up on my lack of enthusiasm to his frequent name-dropping.

            Bhattal next introduced me to the head of anesthesia, but not before giving me some editorial commentaries. The man was very competent and ran a very tight ship, he told me. If I were not to interfere with his domain, I should be fine. Fair enough; that applies to most individuals.

            I had an instant rapport with this anesthesiologist, Dr. Poopathy. He apologized that he had just retired and was holding the fort until the new chief arrived. Whatever rules he had in place could become inoperative with the new head. Perhaps his retirement and now being called back to work but minus all the administrative and other headaches had mellowed him. He could now focus on his clinical work.

            Dr. Poopathy was more than just any anesthesiologist. He was one of the country’s pioneer formally-trained ones. Prior to him, Malaysian anesthesiologists were the products of “quickie” British training, sporting the Diploma of Anesthesia. Dr. Poopathy was a Fellow of the Faculty of Anesthetists of the Royal College of Surgeons (FFARCS).

            Later I met the radiologist, another Dr. Lim. I went to his department to check on a patient’s films. We introduced ourselves and exchanged pleasantries.

            “I’m embarrassed to show you these shitty films,” as he put them up, his earthy language matching his casual attire. His machines were so ancient, he said, that by the time he could demonstrate the pathology I could have figured it out clinically. He was right about the quality of the films, nonetheless he went over them with me.

Then, focusing on me, “Let’s see, you graduated from Canada, trained there, and have practiced there. Now you’re here!” He leaned back in his chair. “What madness brought you here?” he laughed.

            He said that he had submitted numerous proposals to upgrade the department under the various Malaysia Development Plans but to date nothing had been done. Only promises.

            I was glad if not relieved to discover that I was not the only one bitching about the government. That was reassuring.

            Looking back, I was pleased that Bhattal had taken his time to introduce me all around. That was what I missed in KL. I didn’t blame Datuk Menon, the surgery chief, for he was in the ICU when I reported to work there.

            Bhattal went beyond and apprised me of the local social scene. An avid golfer, he told me about the Tasek Utara Golf Club and its many wonderful non-golf activities such as its Friday-night movies, swimming pool, and fantastic dining. Good for the family, he assured me. As a civil servant I was entitled to a vastly discounted membership, subsidized by the government. He encouraged me to join, and I did. He was right about the facilities. The club was my as well as my family’s savior while in JB.

            I had minimal difficulty duplicating what I did in KL. My trainees in JB were just as smart, diligent, and enthusiastic. Unlike in KL, this time I paced myself in part because we did not have as many young trainee doctors as there. I had only one weekly seminar, alternating the combined basic science and clinical surgery. The pathologist declined to participate in my conferences. He was already swamped with his regular responsibilities, was his excuse. I was fortunate that Yahya would be sitting for his FRACS (Australian surgical board), so he and Hew, another trainee contemplating his FRACS, were the major impetus behind my teaching program.

            We had our seminars on the top floor, the site of the now defunct Post Graduate Medical Institute. It still had a functioning staff, the sole medical librarian. She willingly accepted the new responsibility. With her old mailing list, she helped spread the word around about my surgical seminars. At least I now had some clerical help, unlike in KL.

            GHJB may be a large hospital but it did not have a cafeteria. There were many makeshift hawker stalls of doubtful hygienic standards along the adjacent streets. As the seminar would be at lunch time (to accommodate everyone time-wise), we would have to provide lunch, otherwise we would waste precious time with everyone trying to grab their own meals. How to fund that?

At first I wanted to have the drug companies sponsor the meetings, but that meant I would have to scramble every week to find a sponsor. Besides, it did not seem right. In the end, I decided to have everyone chip in RM10 at a time. When the funds got low we would chip in again. Since we always had an influx of new interns throughout the year, we had a constant inflow of fresh money. There were no free loaders. During the year we all had to chip in no more than two or three times.

            Our JB seminars soon developed a local following. The presence of the other specialists as well as the town’s practitioners enhanced the quality and appeal. My expanding the topics beyond the purely surgical gave it wider appeal.

            One of my medical officers presented a topic on surgical immunology, the same one Zul presented in KL a year earlier. At the end of the seminar one of the consultants, Dr. Ravi, an ENT specialist, came up to compliment me. He had just returned from Britain to take his FRCS examination and had enrolled in its basic science course there. He gushed that my presentation was far superior. I corrected him that it was not mine but my medical officer’s.

            “Come on lah, Bakri,” he teased in disbelief and then went ahead to ask me a question on the presentation. I pretended not to be sure of the answer and turned to my medical officer. He gave an impromptu full dissertation on the topic. That convinced my colleague!

            Excerpted from the author’s second memoir, The Son Has Not Returned. A Surgeon In His Native Malaysia, 2018.

Next:  Excerpt # 42  Dealing With A Federal Medical Bureaucrat

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[1] Now the Sultanah Tun Aminah Hospital

Excerpt #40: Still In The Market For A New Home

Excerpt # 40: Still In The Market For A Dream House

            Even though we had rented a house, we still went out house hunting. Part of that was our commitment to JB and part, my curiosity about the local real estate market. At that time it was heating up fast, with Singaporeans snapping up local properties as they could not afford homes on the island. My rationale for wanting to buy was that even if we were to be transferred back to KL, we could still sell the house and reap a tidy profit, just like we did in Edmonton.

            As luck would have it, we found a beautiful house up on top of the hill overlooking the Strait of Johor onto Singapore. The backyard abutted the palace grounds of Bukit Serene. Being on top of the hill we would not have to worry about the people above us dumping their smelly garbage into the open drain, as with our house in Bungsar. The price too was well within our range. The house was empty and the agent managed to pry open one of the doors and we had a free uninhibited tour inside. There were cobwebs all over, but we overlooked that. The house had been empty for a while; we thought it had not even been occupied before.

            We could imagine ourselves having a leisurely afternoon tea and watching those planes taking off and landing at the distant Paya Lebar Airport in Singapore. That was a reassuring sight. If something bad were to happen in Malaysia, we could escape to Singapore, and from there to anywhere in the world.

            We salivated at our find. As was (still is) our practice, we arranged for a second visit, this time at a more leisurely pace, our eyes wide open, and critical faculties well honed. This second visit only enhanced the house’s appeal. We fell in love with it even more. Then we went around to the back of house to the private entrance to the maid’s quarters. It faced the spacious grounds of the palace. That very private maid’s room would be my “man cave!”

            I opened the bathroom door. There, coiled in the toilet hole in the cement floor, was a cobra, coiled and ready to strike! I jumped back! Karen saw my reaction and came over to find out what had frightened me. She saw the snake and took off to our car, grabbing the kids. Our agent was not perturbed. He had no difficulty catching the serpent and chopping its head off. The critter was about four feet long. The length did not matter. It petrified us regardless. He told us that it was probably from the palace. The sultan was an avid snake collector. Probably one of his collections had escaped.

            That was it. We gave up. I remember as a youth my father found a snake in the house. He had it killed in an instance. He was not worried about the snake itself rather by what it portended. Snakes were considered a terrible curse. So that Thursday evening we had a kenduri in the village to remove the curse. It must have worked for I did not remember any untoward consequences.

            We had to calm ourselves on the verandah where we could see even a worm that would crawl to us on the cement. I kept thinking that things were going swell until we opened that bathroom in the maid’s quarters. It was not a good omen. However, after a few minutes sitting on the verandah sipping Green Spot lemonade that the agent had brought, and with the view of the vast expanse over the Strait of Johore with modern bustling Singapore in the distance, I fell in love again with the house, the cobra notwithstanding. Persuading Karen however, took some time.

            From the modernish décor we were expecting the owner to be a rich Chinese professional. He was now perhaps fed up with Malaysia and ready to emigrate to Australia. Imagine our surprise when our agent took us to a dirty Chinese settlement to meet an elderly man living in a shack. He could hardly speak a word of Malay or English. I was sure that he was one of those hawkers described in McGee’s book who had through sheer frugality and hard work saved a lot and built for himself a beautiful house on the hill. Then when he discovered that his neighbors were doctors and lawyers, felt uncomfortable living there. Indeed, at the bottom of the hill resided the state medical director, my local superior. Across the street was a lawyer turned entrepreneur. He had harnessed the needs of the thousands of Malaysians studying in Britain to come home for vacations every so often into a lucrative airline charter business.

            The whole Chinese neighborhood came out to see what this white woman with an officious looking Malay were doing slumming in the area. It took quite a bit of coaxing by our agent to get the man out of his shack just to talk to us.

            It did not take long for me to decipher from the man’s body language and the abbreviated responses he gave our agent that the deal was not going through. The man looked like a cowed Chihuahua with a prized T-bone steak in his mouth, trying to hide it so no one could see and thus grab his prized possession. Yes, he had changed his mind about selling, the agent told us, and we left. I was devastated; Karen less so. She was in fact relieved. That earlier encounter with the cobra was indeed a premonition that we were not welcomed in that house on top of the hill.

            I related our experience to my brother Sharif and his wife Zainab. Our accepting the full asking price right off the bat was a big mistake, they advised us. A rookie’s eagerness, also a mistake. The owner took that as a sign that it was underpriced, which it probably was. I should have offered a much lower figure and also not have brought Karen along with me. Seeing a white lady only confirmed the owner’s suspicion about the house being modern and desirable to a Mom Salleh (white woman), and therefore underpriced.

            It would have been prudent had I emphasized that the property being adjacent to the palace grounds, to remind the owner that it was vulnerable. The sultan could grab it at any time without any compensation. Malay sultans are fond of doing those kinds of things.

            I should have also brought up the encounter with the cobra and the bad luck that it symbolized, Sharif suggested. However, that could have backfired. To the Chinese, snakes are considered auspicious, a mini dragon guarding the place.

            That was our only house hunting saga in JB. While our experience was radically different from what we had endured in KL, the results were the same. We were unsuccessful. We were destined to reside at No: 2, Jalan Baiduri, off Jalan Kolam Ayer.

Next:  Excerpt # 41:  An Easy Transition

Excerpted from the author’s second memoir, The Son Has Not Returned.  A Surgeon In His Native Malaysia, 2018.