Excerpt #51: Twin Tragedies

Excerpt # 51:  Twin Tragedies

That August, a few months after my arrival in JB and only a few weeks after I had my phone installed in the house, 

Mr. Bhattal phoned me from the hospital. It was a Thursday afternoon, a half day and I was at home. He called from the royal suite asking me to “give him a hand.” A solid experienced surgeon, he was not one easily rattled. He did not intimate what he wanted me for.

         I arrived to a chaotic scene, with officials running around and policemen and police cars all over the place. I knew something terrible had happened. As the hospital elevators were packed, I navigated my way up the stairs to the royal suite on the top floor, identifying myself to the ubiquitous policemen along the way as “one of the doctors” so they would let me through. Even the stairs were filled with officials and policemen. Bhattal spotted me as I entered the floor and took me aside to apprise me of the situation.

         There had been an earlier head-on collision between the Sultan’s car and a timber lorry. The Sultan suffered only minor bruises and a deep gash across his forehead; his consort was unconscious from head injuries and was already intubated. Occupied with the two, he did not have time to evaluate the Sultan’s ADC who had been in the front passenger seat. There was no mention of the drivers, the Sultan’s or the lorry’s. Bhattal asked whether I could take care of the ADC, Othman.

         Othman and I recognized each other right away from my earlier visit with Karen to the palace. My job was to make sure that he did not sustain any immediate life-threatening chest or abdominal injuries. He did not. Bhattal had warned me that being a military men and stoic, Othman would minimize his symptoms; hence to be cautious. Later that evening I checked on him again; he was fine. Instead he was concerned with my checking on him so often. Was there anything I was worried about, he had asked. I assured him that it was just my practice to check on my patients twice daily.

         The Sultanah on the other hand was deteriorating. She was started on steroids to reduce her brain swelling. She would need immediate neurosurgical intervention. The country had only two neurosurgeons then and both were in KL. The earliest one could be flown in was the next day.

         Dr. Arumugasamy was my former colleague at GHKL. He did his training in Minnesota, a top notch program. In GHKL we bonded right away based on our common training system. As he was new to GHJB, I oriented him and assisted at the subsequent surgery on the Sultanah.

         By this time the hospital was swarming with VVIPs. I did not realize that a small country like Malaysia could have so many very important people. I recognized a few of the sultans, and there was Prime Minister Hussein Onn and the state’s Chief Minister Othman Saad. I remembered the Chief Minister from his earlier crusade and visit to the hospital to crop the scalp of young men, including or especially doctors with long hair. I was lucky to be the operating room all day and thus was spared of his scissor-hands. No wonder the roads and affairs of the state were neglected as its chief executive was obsessed with his tonsorial hang-ups.

         Those VVIPS in turn had their retinue of hangers-on. The hospital staff was strained to the limits to cater for these important people and those who considered themselves so. Special foods had to be ordered from the nearby fancy restaurants. I later discovered that the hospital’s funds were exhausted to pay for the caterings alone.

         The hallways and stairs were clogged with assorted princes and princesses, all making a pest of themselves and blocking the traffic. A few of the young princes took the opportunity to hassle my nurses with wolf calls as they reported to the operating suite. That made me angry; those princes were interfering with our preparation for the emergency surgery. I told them to get out of the way. To my utter surprise, they all cowed down. No one defied me. One of those pesky princes whom I had told off is today one of the Sultans.

         There was much ceremony and ritual in transporting the Sultanah to the operating room. Those all came in the way of getting her to the operating suite fast and safe. The anesthesiologist struggled to ventilate the patient underneath the yellow umbrella and in between the embroidered songket cover. I did not know why he didn’t just toss off those obstructing cloths so he could maintain visual assessment of his patient at all times. Then there was a huge retinue trailing her stretcher right into the operating suite. The royal mob had taken over; the professionals had kowtowed to them.

         Things threatened to get out of control with each visitor wanting to kiss the Sultanah’s hand and offer prayers. I was concerned with breaches of sterility. I too believe in the power of prayers, but please do not break our sterile precautions.

Next:  Excerpt #52:  Operating Room Faux Pas

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

Excerpt #50: Issue With Trainees

Excerpt #50:  Issues With Trainees

         I had minimal problems with my trainees in JB. Minimal did not mean none. One of my interns, a product of an Indian medical school, took time off right after graduation and deferred her internship to have a baby, an unusual practice at the time and perhaps even now. Women, still a minority then and often not welcomed at medical schools, were expected to defer their pregnancies till after their internship.  She was also much older than her colleagues and thus had minimal rapport or social connection with them.

         She had difficulty keeping up with the fast pace. Despite my frequent encouragement and reminders, she was still behind in her work. One day I called her to my office for some pep talk. I was still in the encouraging and supportive mode.

         She had prepared herself well, fresh lipstick, well perfumed, and her jet-black hair well coiffured in a tight shiny bun. I told her right away that her performance was sub-par. She had her ready excuses and rattled them off; her husband seeing other women, problems with her maids, and demanding in-laws. She pleaded for me to be forgiving and that she was doing her very best. She did not raise any issues with the ward. I was expecting her to blame her colleagues for not being supportive and the nurses, unsympathetic. None of those. It was all about domestic issues for which I could do nothing for her.

         I was trying hard to regain control of the conversation as she was now hogging it. I had to interrupt her to warn her that if she did not improve I would have to make her repeat the rotation.

         That jerked her into reality. “No!” she pleaded, “The whole world will know I have failed!” She started to cry, which made me even madder. Then in between sobs, her eyes looking straight to meet mine, like a whining poodle waiting for a treat, “Please, Mr. Bakri, please! I’ll do anything, I mean anything, for you not to do that!”

         Perhaps I was mistaking the twinkle in her eyes; it was to rub away the tears and not what I thought she meant. I was furious that she considered me a lecher and not her teacher. To her I was just another male to entice into her trap. That thought made me even angrier.

         I pretended not to read her signals and went ahead dispassionately instructing what specific areas she needed to improve. The history and physical examination must be more complete, her differential diagnoses more thorough, diagnostic work-up more appropriate. Most of all she must be on time.

         My listing the criteria snapped her out of her coquettishness, and I repeated them for emphasis. As I was opening the door for her to leave, she burst into crying such that I had to shut the door quickly lest my secretary would hear her.

         I could not make her stop. Now it was my turn to panic. She was so helpless and I felt sorry for her. It was not so much pity as fear. I feared that she would go home that evening and kill herself. I wondered whether her lackluster performance was but a manifestation of her postpartum depression.

         My God, what if she were to commit suicide and in her note she blamed me and the pressure of work? I recovered myself. “Let’s begin with your coming to work on time,” I assured her. “We can work on the rest later!”

         The next day, and on subsequent days, she was punctual. As for the quality of her work, I would give her an A for effort, but C for results.

         The other problem I had was with a medical officer who was a graduate of an Indonesian medical school, a fellow Minangkabau to boot. We were about the same age. “We have lots in common, brother!” he assured me at our first encounter with his exuberant, fraternal long-lost brother hug. He said he had heard many good things about me and my program, and would like to join it. He too wanted to be a surgeon. I asked him to tag us along for a few days or so to be sure of what he was getting into. After one session, he could not contain his enthusiasm. On the next scheduled rotation change, he was in my unit.

         Medical officers ran the out-patient clinic and supervised the interns, under my direction of course. At the first clinic he was scheduled, I had a call from the nurse that he was missing, and the crowd was getting restless.

         Over thirty minutes later came this medical officer huffing and puffing, making a big fuss of hurrying up the nurses and interns. I ignored him and continued on supervising the interns. When he came in to check on the interns, I quizzed him too, treating him like one of them. Later he apologized for being late as he was “at the palace.” When the clinic was over I asked him to come to my office. He had missed or misread my body language, or if he did read it right, he figured he could sweet talk his way out for on the way he was making small talk but I ignored him.

         By the time we got to my office he realized that he was being taken to the woodshed. Before he could apologize again, I told him never to be late again, not for the out-patient clinic, not for rounds, and certainly not for surgery. When he again attempted to use the palace as an excuse, I cut him off. I could not care less whether he was with the sultan, he (my trainee) had to be punctual.

         He was startled by my dismissing the sultan. To him that was downright un-Malay and biadab(uncouth). After he assured me that he had understood me, I let him go. The next day he came to see me, wanting to be released. I did; he joined the medical unit. Its head, who was also a regular visitor to the palace, welcomed him.

         The medical unit was two floors above and GHJB was not a huge hospital. Nonetheless we never set face on each other again.

Next: Excerpt # 51:  Twin Tragedies

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

Malaysia's (and Malays') Darkest Moment

Malaysia’s (And Malays’) Darkest Moment

M. Bakri Musa

[News Item:  On January 8, 2020, Latheefa Koya, Chief of the Malaysian Anti-Corruption Agency (MACC), released wiretaps on then-Prime Minister Najib Razak’s phone. The world heard, among other things, a late midnight call by Dzulkifli Ahmad, then a public prosecutor, tipping off Najib on impending criminal charges against him, as well as his (Najib’s) groveling to the Crown Prince of UAE pleading to him to backdate a loan agreement to protect Reza Aziz, Najib’s stepson and one of the principals named in the DOJ’s Asset Forfeiture Lawsuit of July 2016. Hearing His Highness repeatedly giving Najib a not-so-subtle royal shove-off and Najib not getting the message was painful.]

I had to take breaks more than a few times while watching MACC Chief Lateefa Koya’s press conference of January 8, 2020. I had to, my revulsion could not be restrained otherwise. Persevere I did, only to be cursed with the darkest of moods at the end.

This is what Malaysia has turned into, her leader with utter impunity and unbridled arrogance betraying the sacred trust citizens have placed upon him. Not just him but also his coterie of top officials.

I was gripped me with an even deeper melancholy, accompanied by utter shame and barely controlled rage, on realizing that those officials were all Malays. Many were later honored as Datuks, Datuk Seris, and Tan Sris.

Is this what Malay leaders meant when a few months ago they held a much ballyhooed gathering addressed by no less than current Prime Minister Mahathir under the banner of Maruah Melayu (Malay Dignity)? Is this what the culture that I have been brought up in my old kampung only a couple of generations ago has degenerated into?

Then amidst my gloom, a spark of hope, as in Dostoyesky’s The House of the Dead where in the depth and sea of unimaginable inhumanity of a Soviet Siberian prison, a glint of humanity–a young man crying over the death of a stranger-to-him inmate. He replied to the narrator, “He, also, had a mother.”

After hearing those MACC tapes, I also was desperate to find any sliver of honesty, integrity, and dignity amidst Najib’s Malay crowd.

Then, there it was! We Malays also had one with integrity and honesty. He (or she) was there all along, hovering over but unnoticed. This hero or heroine loomed large though unseen and unheard. I hope that that would remain so for I fear the consequences otherwise.

This brave soul saw evil being perpetrated. He (or she) was guided by our hadith that says (approximately rendered) when you see evil being perpetrated, use your hand to stop it. Failing that or if it would be too risky, then use your tongue, meaning, voice your disapproval. And if that too is dangerous, then at least disapprove of it in your heart, though that is the path least favored by Allah.

This brave soul used his (or her) hand to install the tapping device, and in so doing trapped the tongue of those evil doers.

I am assuming (or pinning my hopes) that the upright individual is a Malay. I desperately want him (or her) to be one. God help Malaysia and that soul if he or she were to be a non-Malay. Yet another sneaky pendatang trying to shame and “do in” an honest, upright Malay leader. Malays, in particular Najib, already have difficulty digesting the role of that other chubby Chinaman.

Malays like me are in desperate need of that righteous figure now, even an anonymous one, upon whom we could share some sense of reflected dignity and integrity.

Confirming the authenticity of those MACC tapes is an elementary forensic exercise. Meaning, those tapes are genuine. Further, no one has denied them or claimed that they were concocted by slick actors and actresses, or rather actress. There was not even a sly “Sounds like me but not me” or “taken out of context” denial.

What surprised me was not the tapes’ content. That present Malay leaders are corrupt to the core and top civil servants (again mostly Malays and UMNO partisans) lack an iota of integrity are not news. You do not need those tapes to validate that. That is the saddest and most painful part for me as a merantau (expatriate) Malay to acknowledge.

More revealing were the responses of the participants, or lack thereof. Most remained silent. Rosmah managed, “I have nothing to say!”

Then there was the rubbish from Najib claiming that those tapes vindicated him! Note, he did not deny the contents. There is a term to describe those who have difficulty discerning fantasy from reality. The good news there is that the malady is treatable.

I always knew that Najib was not terribly bright. However, I did not realize he was that stupid as to use an unsecured land line to speak to a foreign head of state on a very sensitive matter. The man also lacks dignity; his shameless groveling to the Arab Crown Prince was despicable.

I wonder how many other heads of state who had communicated with Najib over the phone and discussed 1MDB would feel now? Rest assured that those tapes were only the tip of the proverbial iceberg.

To those who claim the tapes’ release was sub judice, violated due process, or an invasion of privacy, it is significant that so far no one has filed a court motion or police report.

The reason is obvious–the behaviors of those whose voices were recorded were so egregious and beyond the pale. I am surprised and saddened that those who complained about the propriety of the tapes’ release have not seen fit to condemn the participants in the tapes.

Focus on what those tapes reveal. Does anyone approve of what they did?

Meanwhile Inspector-General of the Police (IGP) Hamid Bador was waiting passively to receive those tapes. He should have responded:  “This is serious! I am on my way to see Latheefa right away to secure those tapes.”

Those who argue that the tapes should have been handed to the police first and dispense with the public release, consider the police “investigation” of the other infamous so-called semburit videotape of two consenting men frolicking in a Sandakan hotel. That dragged on and at the end, “No Further Action!”

Those individuals in the MACC tapes thought they were doing the patriotic thing to protect their leader, the Hang Tuah excuse. It is this perversion of our noble values that is so destructive.

That prosecutor who tipped Najib was later promoted to be MACC Chief and given a Tan Sri. There’s more. He was caught soon after holidaying abroad, probably celebrating his reward, I mean promotion, with a female other than his wife. Worse, this slimy character had the audacity to give a Friday sermon on–yup, you guessed it!–the evils of corruption!

Next JAKIM would invite him to give a sermon on marital fidelity. That’s the degradation of Islam in Malaysia, but that’s another and very long chapter.

Save unconditional denials, the Keeper of the Rulers’ Seal should ask the Agung and his brother rulers to rescind the titles awarded to those knaves. Syed Danial should not be like IGP Hamid, menunggu arahan. I am proud that the Ruler of my state of Negri Sembilan had already rescinded 15 months ago Najib’s and Rosmah’s honorifics.

There was another shocker on the Council of Rulers. Latheefa’s predecessor Shukri had apprised them twice on 1MDB and the need for immediate action. The Rulers refused.

Shukri called Duzlkifli a pengkhianat (traitor). From what we know today, that term could apply to many more.

In the pantheon of infamy, those MACC tapes would be with Nixon’s Watergate’s. With Nixon, it was the missing part that undid him; with Najib and his ilk, the contents.

To MACC Chief Latheefa Koya, continue the good work. Give ’em hell! You already struck fear among the corrupt. Let them have more sleepless nights believing that their past conversations could also have been tapped.

To that brave righteous soul who tapped Najib’s phone, my heartfelt gratitude. You are my North Star; you personify “Duty, honor, country!”

Unsolicited Advice For The Next Minister of Education – Tackle The Basics First

M. Bakri Musa

[The News Item:  On January 2, 2020, the first day of school, following a private meeting with Prime Minister Mahathir, Education Minister Maszlee submitted his surprised resignation to be effective the very next day. He did so on the advice of “Ayahanda” (father-figure) Mahathir. In his nearly 20 minutes press conference, surrounded by his top officials, Maszlee blamed the media for focusing on controversial issues like pupils’ shoe color and the introduction of jawi while ignoring what he thought were his spectacular successes, as repairing dilapidated schools and providing free breakfasts in rural schools. Foremost he highlighted his Ministry’ Annual Report, the first Ministry to do so. And his was released even before the year ended! It was clear, at least to him, that he had done a super job. Being magnanimous, he is returning the “gift” of being Minister of Education back to his father figure. Early in his tenure Maszlee took time off for Hajj, presumably to thank Allah for that gift.]

The challenges facing Malaysian schools and universities are as monumental as they are obvious. The new Minister of Education should not try to be a hero in attempting to tackle all at once. It would be wiser as well as more prudent, and more likely to succeed, if he or she were to focus on the more fundamental and pressing issues. Defer the peripheral and distracting ones like students’ shoe color. Likewise, assessment of UEC (Chinese School Certificate), holistic or otherwise, should not be your top priority, nor the introduction of jawi.

                The Ministry of Education (MOE) is the biggest and most expensive. Beyond that, its policies and pronouncements impact the nation far more than any other portfolio, and for generations to come. Malaysia today still reels from educational policies instituted way back in the 1970s. MOE is also the most prestigious, as reflected by the fact that all Malaysian Prime Ministers had once been Ministers of Education. No wonder Maszlee thought that he had been granted a special “gift” bestowed upon a rising political star.

The first challenge relates to the very management of the Ministry. The other pertains to its policies. Both are interrelated. Failure to address the first would doom your second. Both would exhaust your time, talent, and energy. There would be little time to undertake a Hajj or umrah during your tenure, more so very early on. Besides, you should think first about the salvation of young Malaysians, not yours.

If you lack executive experience or management talent, entice someone to assist you on that crucial front. Be humble. Don’t consider yourself innately multitalented or a hitherto hidden gem.

Management problem is not unique to MOE. The entire civil service is blighted with this onerous burden of intractable bloat. It’s more than a burden. The massive bureaucracy impedes effective policy execution, and at times works against it – the self-interested entrenched “deep state.”

Delegate power and authority to the periphery, and you would not need a huge bureaucracy at head office. Grant the universities their autonomy. Then all you would need would be a clerk to prepare the checks for you to sign every month or quarter for those campuses. That one initiative would rid MOE of its Director-General for Higher Education, his deputies, and their assorted highly paid support staff. Let the universities choose their own Vice-Chancellors, Deans, and Professors, or what color of drapes for their faculty lounge. The Minister’s control and influence should only be through such macro levers as the funding mechanism and his appointees to the governing boards.

Peruse MOE’s organizational chart, replete with such bureaus as the Islamic Education Unit, Institute of Translation, and Institute of Language and Culture. Get rid of them. Private publishers do a far superior job of publishing and translating, and at no cost to the government.

The new Minister’s focused vision and MOE’s sole aspiration should be to prepare young Malaysians to be competitive for the new global realities so they could contribute. And only that. Heed the wisdom schoolteachers Pak Harfan and Bu Mus drummed into the handful of precious young minds entrusted to their care, in Andrea Hirata’s bestselling novel Laskar Pelangi (The Rainbow Troops):  “. . . [B]ahwa hiduplah mu untuk memberi sebanyak-banyaknya, bukan untuk menerima sebanyak-banyaknya.”

To paraphrase, be a proud contributor to society, not its dependent. That is the best and most succinct encapsulation of the purpose of education.

Help young Malaysians achieve that goal by ensuring that they are fluent in Malay and English, as well as be science literate and competent in mathematics. Teach those four subjects daily, at all levels, and in all schools, including religious ones. Fictional Pak Harfan and Bu Mus taught their pupils English, STEM subjects, and music in their very modest Muhammadiyah pondok school.

Malaysia is in desperate need of competent teachers of English. Yet not a single public university has a Department of English, and there are no English-medium Teachers’ Colleges. This jarring anomaly, obvious to all, is missed by those in MOE, as well as the personnel they select to run the universities.

Leverage the funding mechanism to make every public university have a dedicated Department of English. Make a pass in MUET (Malaysian University English Test) mandatory. Quadruple the number of scholarships for those pursuing English and STEM. That would be a good start. Discontinue scholarships for Malay Studies as well as Islamic Studies. The country already has a glut of those graduates.

Make MUET mandatory for all teachers and MOE personnel. Their promotions and continued employment should depend on it. That one initiative would be far more effective and consequential than all the endless exhortations of leaders and educators on the importance of English.

With mathematics, if Malaysians were to have some elementary competency in it, they would not dismiss Vietnam’s impressive six percent economic growth rate versus Malaysia’s meager four as “that country growing at only two percent faster.” Vietnam is growing 50 percent faster! If Malaysia’s rate were to drop to three, then Vietnam is growing at 100 percent more, or twice as fast.

Make 13 years of schooling the new standard. Modify the last two years (Sixth Form) for those not academically inclined to focus on vocational subjects. By reinstituting Sixth Form, the Ministry could dispense with its massive matrikulasi division. You would also be spared its quota controversy. The universities too could then dispense with their resource-wasting “foundation” and matrikulasi courses. Universities should focus on doing what other institutions could not, that is, education at the undergraduate, graduate, and professional levels, as well as undertaking research. Again, use the funding lever as well as your appointees to the universities’ governing boards to achieve those ends without having MOE micromanage those campuses.

Teach the young critical thinking. Dispense with regurgitation. Pak Harfan asked his students to pen essays describing Heaven as they envision it. That demands both critical as well as creative thinking.

In a plural society like Malaysia, education should go beyond. It must be a major if not the instrument to integrate her young. When young Malaysians learn and play together at school, the nation would be that much better. Diversity in the classrooms also enhances the learning process.

Today, Malaysian schools are dangerously segregated along racial and religious lines. Getting rid of religion from national schools would go a long way in making those schools attractive to non-Malays.

Most of all, the one attribute the new Education Minister must have and instill in his officers, is the mindset that he and his Ministry does not have the exclusive wisdom and insight on what’s best for Malaysian education. The Ministry should be a resource center, not a command and control one.

The writer is the author of An Education System Worthy Of Malaysia (2003). The issues he raised then are even more relevant today.

Excerpts from my memoir The Son Has Not Returned, will resume next week.

Excerpt #49: The Gratitude Of Plastic Surgery Patients

Excerpt # 49:  The Gratitude Of Plastic Surgery Patients

         We had plastic surgery clinic every few months, with the plastic surgeons from GHKL coming down to JB to do the cases. We had this young boy with a simple cleft palate. It should have been a routine case. The patient being a child, I suggested to the consultant anesthesiologist that maybe he, instead of the medical officer, should do the case. He assured me that he had full confidence in his medical officer and that she had many years of experience under her belt with young patients. The plastic surgeon expressed no preference so I did not push the issue.

         The surgery was flawless. As we proceeded to our second case, there was a commotion in the recovery room. To shorten the story, the patient had an apneic (cessation of breathing) episode that was not recognized early as he was not being monitored closely enough. He suffered brain injury. Totally preventable. Today all surgical patients are fitted with oxygen monitors during and immediately after surgery.

         That tragic fate of that young boy reminded me of the earlier catastrophic abortion case. Despite the decades that have gone by, my sorrow in recalling both tragedies has not been dulled.

         I was in awe of my plastic surgeon colleagues, Drs. Lal Kumar and Yusof Said, who came down from KL to help us. Both could have done very well money-wise in private practice but chose instead to be in government service, and with all the constraints. The unbounded gratitude of their patients and their families was reward enough for them.

         I did not realize the depth of this emotion until I saw a young woman with severe cleft palate and lip. It was obvious that she would need at least two and possibly three stages of repair. As the slots for the upcoming session were already full, I booked her for the next, three months hence. They were simple village folks; they accepted my pronouncement with no question. Her parents did not even attempt to convince me to squeeze her in. It was their fate to wait and that was it. Besides they were pleased that somebody had agreed to do it, never mind when. In the village, time had no meaning.

         Something about their quiet and graceful acceptance tugged at me. I asked the father if there was any special reason to do her sooner. Again, three months’ wait would be fine, he replied. Remembering my old village courtesies where you had to ask at least three times before accepting a “No!” I repeated my query.

         “There is something … ,” the father hesitated. He had difficulty uttering it. After many promptings from the nurse and me, he finally let out that her wedding would be next month. He thought it would be nice if the gaps in her lips could be closed when she would be on the pelamin! (wedding dais).

         Yes, every parent would like their daughter to be beautiful on her wedding day. I re-booked her for the first slot the very next day. Later when it was time to remove the sutures, I took her to a private room with a nurse, a female intern, and her parents only. She already felt the vast improvement right after surgery with the gap in her lips gone. When I was done removing her sutures, I handed her a hand mirror and stepped back while she stared at herself in the mirror. No words were spoken; none were needed. She wiped away her tears and soon everyone in the room too were teary-eyed, including her father and me. He shook my hand with both his palms and repeatedly offering prayers of gratitude, “Alhamdulillah! Allah hu Akhbar!” (Praise be to Allah! God is Great!)

         The girl did not say anything; she didn’t have to. Her expressions said it better than words could.

         Non-Muslim readers may wonder why the father did not thank me and the plastic surgeon. When Muslims wish to express their gratitude or appreciation, they would utter the phrase, Alhamdulillah, Allahu Akhbar! It is a short-hand version of “Thank you Great Lord for giving the surgeon such a talent that he could help my daughter!” It is an indirect compliment. Likewise, when you hear a beautiful rendition of the Koran. Thank you, Lord for giving her that voice and talent that she could share with us! To me that is a humbler and more heartfelt way of expressing your gratitude, a recognition that your talent is ultimately the gift from Almighty Allah, and for you to share it with your fellow beings.

Excerpt #50:  Issues With Trainees

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

Excerpt#48: VIPs - Very Important Patients

Excerpt # 48:  VIPs - Very Important Patients

I was asked by Mr. Bhattal to consult on a VIP patient in the Intensive Care Unit. He did not need to be there except for the fact that he was a VIP, a senior appellate judge. Except for the royal suites, the ICU is the only place where you have private rooms for patients. I saw him poring over his legal papers, and on seeing me he quickly gathered them all up and turned them over. Later I discovered that he was preparing his judgment on a major corruption case involving a high-profile national figure in the ruling party.

         This judge had a toe infection. That is usually a minor affliction, more a nuisance, except in diabetics and others with compromised immune system. He was about to show me his recalcitrant ‘minor’ wound when I stopped him to ask a few questions, focusing my query on the status of his circulation not only to his legs but also elsewhere, as well as for symptoms of nerve damage from his diabetes. Even though I tried to be as clinical and detached as possible, he was discomfited by my queries. He was a busy judge and had an important decision to write, and this young surgeon was enquiring about his sex life! I had to explain more than once why the answers to my questions were important. As it turned out he had severe circulatory impairment, and not just to his toes.

         He thought he had a minor toe infection and all that was needed was to clean and dress it up, plus some antibiotics. What was the big fuss? He reminded me of a severely anemic society lady I saw in GHKL who wondered why I could not diagnose her malady right away, like all her previous doctors, and had to do all those tests. Give her the iron pills and vitamins that she sought and be done with it. I had to explain to her the multitude of causes, from simple worm infestations to more serious stomach and colon cancers. She felt insulted by my reference to worm infestations, implying that she was from the rubber estate walking barefooted every day. Only with my mentioning cancer did she begin to take me seriously. She turned out to have the rare pernicious anemia, a major risk factor for stomach cancer.

         Up till recently most patients were afflicted only with acute illnesses. Modern medicine has been truly miraculous in treating those to the point where physicians are viewed now simply as human mechanics, highly skillful to be sure but mechanics nonetheless. Check me over, order a CAT scan or MRI, remove or fix the defective part, and let me carry on with my life.

         Today most diseases are chronic, like diabetes, where there are no cures, simple or otherwise. We have to instead learn to manage or at least keep it under control for as long as possible and with minimal interference to our daily lives. The physician’s role is less a healer, more a teacher. Indeed, its Latin origin, docere, means just that. At that moment with the judge I was not a surgeon but the true original physician, a teacher. I was trying to educate this judge on his chronic condition.

         One way to gain patients’ rapport and also to gain their confidence, as well as to reassure, is to tell them that you have seen worse, or that their condition could be worse. I told the wise judge that diabetes affected all organ systems.

As a student, my professor used to tell me to know syphilis “cold” (thoroughly), as it affected all systems. Whenever I was asked during orals about the differential diagnosis of any sign or symptom, I was reminded to always include syphilis, and utter it with some noticeable hesitation. Then when you were queried further, as your examiner had been lured into interpreting your hesitation as a sign of uncertainty, you could then show off your mastery and impress him! Syphilis is today readily curable and no longer a menace. Instead we have lupus and diabetes. Lupus is rare; diabetes, not so. Know both and you know medicine, my professor advised me. Or at least be well versed for the orals!

         I expounded to this learned judge the systemic nature of his disease and that the toe was only one manifestation. He was lucky that it was the circulation to his toes that was affected and delayed the healing. Had it been to his heart, he would have a heart attack; to his brain, a stroke; eyes, blindness; and kidneys, kidney failure and be on dialysis.

         That grabbed his attention. Because of the nature of diabetes, his legs and indeed his whole body was high maintenance. Meaning, watch his diet, discontinue smoking, regular exercise, and faithfully take his medications. As for his legs and feet, he had to examine them every day, wear thick socks and well fitted shoes. He could no longer rely on his physical sensations as his nerves were now damaged.

         That judge was not expecting a lecture from me; he expected me to change his dressings or do only some minor cutting and trimming while he deliberated on his important written judgement.

         I learned my lesson on dealing with important patients early in medical school. Our dean, Dr. Walter C Mackenzie, had an inherited condition of his bowel that required regular surveillance. He was admitted once to our hospital and I was the medical student assigned. Prior to that my chief resident John Irwin warned me that the dean was very particular that every step be taken and there be no shortcuts or he would let you know in no uncertain terms. I had to insert a tube into his stomach through the nose, a routine procedure that today would be done by nurses. To an unsure medical student however, that was a monumental task, especially when the patient is somebody important like your dean. I was tempted to call my senior, either the intern or resident to do it but would risk getting de-meriting remarks. Remembering my chief resident’s advice, I did it myself, treating him like any of my other patients. I had no difficulty as he was the most cooperative.

         It was this temptation to breach routine and take short cuts in the misguided notion to “spare” patients some discomfort or embarrassment in dealing with “special” or important patients that could lead physicians and surgeons astray, as demonstrated by the near tragedy of the circumcision of that VVIP’s son in GHKL a year earlier.

         Likewise, concerns with niceties or professional etiquette would get in the way of good patient care. I was making rounds in the ICU one day when I saw a patient’s x-ray on the viewing box. Something ominous about the image made me call the patient’s physician, an Ob-Gyn man, and I told him of my suspicion and the need to operate on the patient right away. He replied that he was consulting with his senior colleague on that case. I left it at that. It was a case of a botched backstreet abortion, with all the radiologic signs towards a catastrophic outcome.

         The next morning, I was again making rounds and noticed the bed empty. She had died. The surgery was unnecessarily delayed and with a fatal outcome. I should have been more forceful to my colleague. I would not know whether that would have altered the outcome, but at least my conscience would have been clear.

Next:  The Gratitude Of Plastic Surgery Patients

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

Excerpt #47: Tolerating VIP Visitors

Excerpt # 47:  Tolerating VIP Visitors

As a junior consultant surgeon, Dr. Bhattal being the senior one, I did not get many VIP patients except those who came through the Casualty Room. I was thus spared many potential faux pas as I did not know the local top honchos and the associated social status symbols or protocols.

One weekend I admitted a woman who had been through a non-fatal car accident. She had soft tissue mild whiplash injury to her neck. The next day her brother came and demanded to see the “doctor in charge,” me, right away. Yes, demanded! I overheard his conversation with the nurse as I was making rounds at that time. Earlier I was aware of his presence by the loud steps of his leather shoes announcing his arrival.

The nurse, sufficiently intimidated by the man’s expensive three-piece suit and attitude, brought him to me right away. I introduced myself and reaffirmed that I was his sister’s doctor. He however, did not reciprocate by introducing himself. One of the things I learned early in Malaysia was that VIPs (even self-professed ones) did not introduce themselves. You ought to know them; they had no need to introduce themselves, a non-verbal expression of social dominance and hierarchy. You however, had to, if nothing else for courtesy sake, which I did. I always introduce myself to my patients, young and old, rich and poor.

         I apprised him of his sister’s condition; soft tissue injury with no fractures or nerve involvement. She should expect only some mild neck stiffness. Instead of being pleased with my excellent prognosis, he wanted her transferred to GHKL right away.

         That was music to my ears. I had wanted to discharge her earlier but she refused, insisting that she needed a longer stay. Now with this request, I instructed the nurse to go ahead with the transfer arrangements. She came back telling me that no ambulance would be available for a couple of days. The VIP brother would not accept that.

         I enquired what car he was driving. He felt offended by my query and replied in a huff, “Mercedes SEL 450!” Top of the line, provided by a generous government. I should have known!

         I then told him that a ride in his Mercedes would be much more comfortable than with the government’s cargo-model ambulance. Yes, the sister would be safe to be transported without a nurse. He warned me that I would be held responsible should anything untoward were to happen to his sister on the trip. I assured him that she would be fine … as long he was careful with his driving!

         I knew of that VIP but had never met him. I recognized Tan Sri Arshad Ayob from his many pictures in the papers. He was a prominent educator and one of the first few Malays to have a science degree back in the early 1950s, after an initial setback when he failed his first year in Singapore. To his credit, he did not take that as a measure of his self-worth. Undeterred, he transferred to the Agricultural College in Serdang for a diploma course, and from there to a British university.

         We had more than our share of VIP visitors in JB. It was a popular destination for federal bureaucrats. One of my first was the new Director-General, Dr. Raja Ahmad Nordin, the top professional in the ministry. A public health expert (MPH Berkeley), he had just taken over from the legendary Tan Sri Majid Ismail, an accomplished orthopedic surgeon turned policymaker. At that time GHJB had a rash of negative publicities, and he was out to prove his mettle as an executive as well as to “show the flag.” Being new, I was nervous about this scrutiny from the very top. I was expecting some tough questioning. My more seasoned colleagues however, were not at all perturbed.

         Whenever we had or even only anticipated important visitors, the whole hospital would be mobilized–and paralyzed–to welcome him (always a him when I was there). The whole day would be a washout, a major disruption to our busy schedules.

         As usual, this top honcho came in late, very late. As the chauffeured black limousine finally drove up to the hospital’s entrance porch, the medical director rushed out to open the car’s rear door. Out came a short, balding man in his dark (always dark) ill-fitting locally-tailored suit, smiling like a comedian trying to be serious. Or was it a serious character trying to be funny? We were lined up to greet and be introduced one by one to him, as was the custom. What with the obligatory fawning welcoming remarks by locals who considered themselves equally important, by the time we finished it was already close to lunch time. After a perfunctory walk in the wards, we retreated to the nearby golf club for a sumptuous lunch, and again the speeches. Not a bad bargain for a free generous lunch.

         The only problem was that after such a big lunch you were predisposed to siesta. Fortunately, Thursday was a half-day in Johore, so your workweek was done. Then I realized why Thursday was the favorite for federal officials to visit JB. They would then be free to jaunt over the causeway to Singapore for their early weekend shopping.

         Later in the year we had another VIP visit, this time from the minister himself, Mr. Chong Hon Nyan. A former top civil servant in the Finance Ministry, considered the most prestigious among the mandarins, he was enticed into politics by Tun Razak. Chong’s visit was even briefer. He made no pretense of doing any business. He stopped by just to satisfy the “General Orders” that he was indeed on government business and then he was off to a local branch meeting of his party. There was to be a general election in a few months.

         There would be many other and even more important as well as consequential (at least to us, the hosts) visitors later on, but those titillating details will have to wait.