Exceprt #8: A Much-Needed Reorganization

Excerpt #8:  A Much Needed Reorganization

I have always admired my friend Ramli Ujang. He was smart both book-wise but of more relevance, street-wise. He was also an astute judge of character. He could sniff out a lie or fakery even before you could even think of expressing it. Elsewhere that would be a useful trait; in Malaysia, that would not enhance your career. During our high school he was the first to suspect that one of our teacher’s “helpfulness” to some of our female classmates was more than just to help them pass their tests.

            Ramli filled me in on the local politics, the hospital’s as well as the university’s. Then as I accompanied Ramli out of my office, I was stunned to be greeted by a mob. “You have a busy clinic today!” he observed.

My office was in the surgical out-patient clinic. The scene resembled more a pasar minggu(weekly flea market) than a hospital clinic. The clinic hours were from 2 to 4 but everyone came in at 1:30 or even earlier. The staff on the other hand staggered in at quarter after the hour, at the earliest; hence the impatient mob.

            I stood there fascinated by the crowd and wondering of the variety of maladies they would present to challenge my staff and me. Someone must have noticed my surveying the field for soon I saw the staff scurrying to man the counters, like rats disturbed out of the comfort of their nests by the presence of a cat. More than a few were still rubbing their eyes, their siesta having been interrupted.

            I used to moonlight as an Emergency Room physician during my residency days. I enjoyed the challenge, and the pay was great! It was so good that the faculty considered prohibiting the practice because we residents ended up earning more than our professors! It was my practice during a busy shift to scout the waiting room every so often to pick out the sickest patients, my informal but very effective personal triage system.

            I did that on this, my first day of clinic at GHKL, and soon everyone was clamoring for my attention and I had a crowd control problem. Nonetheless I stuck to my unscientific triage method. It did not take long for everyone to realize that they were more likely to be picked up by me if they were to remain quiet. Everyone was now quiet pretending to be very sick. No more drama queens!

            There was nothing magical about my trick. Animal trainers know this; you reward the behaviors you want, and ignore or punish those that you do not desire.

            At the clinic I focused on one house officer and one new patient at a time. Part of that was selfish professional reasons; I was eager to learn about Malaysian patients and their maladies. The other was that it would be the best way for me to know my junior doctors individually. That was the system at my old residency program.

            It did not take long for those junior doctors to be comfortable with me. Only that morning my presence was cramping their style. By that afternoon we were colleagues, though that might not be the correct term.

            At the next morning’s ward rounds, I was no longer the silent observer. I intruded often with questions. “Out of curiosity on local practice!” I assured them over and over. When we finished, I gathered everyone including the nurses and reminded them that I would remain only as an observer for the rest of the week, as I had earlier promised. They were to continue with their usual routine.

            Earlier that morning Dr. Mahmud Nur came to make his rounds. That was his usual time. He was head of UKM’s Department of Surgery. A graduate of the University of Malaya, he trained and stayed there until his UKM assignment. I introduced myself but he recognized and remembered me from our Malay College days. He was four years my junior there. When I told him about my new position, he congratulated me and expressed how pleased he was to have someone take over the clinical load as he was overwhelmed with his university duties. Underneath the pleasantries however, I could detect his embarrassment. He knew nothing about my appointment, at least not until that morning. It did not help that Sister Fong was now directing her queries and questions towards me instead of at Mahmud.

            He and I had much to talk about, so we excused ourselves and retreated to my office downstairs. Before departing I told Sr. Fong where and how to get hold of me. Mahmud was taken aback by my gesture.

            Back in my office, the first thing we did was, as expected, reminisce about our Malay College days. Mahmud remembered a lot about me but I had no memory of him. During my last year there I was a prefect at prep school, the dorm for first-year students coming in at Form One (Year Seven). Prep school was located in a secluded corner, far away and thus protected from the main dormitory, derisively referred to as the uluof the campus. Mahmud reminded me that I had done many evening prep-supervision hours of his class. We talked about our favorite teachers as well as the standout characters in the dorms. I was able to carry on the conversation as if I had known him all along.

            Mahmud was confused and curious about my status. He was still with the government, only seconded to UKM, he emphasized to me. When he was seconded, he was promoted to Superscale F, whatever that meant. He asked what my civil service classification was and I didn’t have a clue.

            Then we talked about hospital matters. He too was lost there, not knowing where he stood in the hierarchy of things. I was sure that my appointment to Unit III without his knowledge did not help. Meanwhile the university had pressured him to give up his civil service appointment and be on the fulltime faculty but he treasured his Superscale F status, what with the luxury bungalow in a secluded part of town as a perk. He would have to give all that up if he were to join the university.

            Then I remembered the reminder and almost stern warning from Tan Sri Ismail only a few days earlier. My job was to take care of the clinical load so those university boys would have no excuse about being distracted from their academic duties.

            By the end of that week I’ve had it with the ward routine, what with the mob in our out-patient clinic, the indecisiveness during rounds, blurred lines of authority, and the house officers blaming each other when tests or dressings were not done in time. Sister Fong and the nurses too were now pestering me. Months if not years of problems and issues left unattended, and now somebody coming in to take charge, or presuming to.

            The more overwhelming the problems, the more they seemed familiar. It was an eerie déjà vu to me after hearing of yet another unresolved issue brought to me by the nurses, house officers, or even Mahmud. I had been through this before.

            I remembered towards the end of my residency training in Edmonton, there was a massive change in the program. Dr. Robert Macbeth, Professor and Chief of Surgery, with heavy prodding from the Royal College of Surgeons of Canada, expanded the training experience of university residents to include substantial rotations in community hospitals. It was a controversial move, both among the trainees and faculty. We trainees felt we would be wasting our time to be with those less-than-brilliant “town” surgeons; the faculty, obsessed with maintaining “standards.”

            As luck would have it, I was the first guinea pig in this new learning venture. I remembered how dejected I was. My fellow residents consoled me, more out of relief that they were not selected. Dr. Macbeth assured me that I was the best candidate for this new experiment. I was flexible, he complimented me. Dr. Yakimets, a new faculty member, comforted me by saying that since I would be going back to Malaysia it would be good to be exposed to other than university medicine, to see how “real Canadians” received their healthcare. He related what a wonderful experience he had when he took a detour in his training and went to New Zealand.

            Royal Alexandra Hospital, “The Alex” to locals, was a major fixture in downtown Edmonton. It was much bigger by bed numbers than the University of Alberta Hospital, and with its own equally distinguished history. It also had its own surgical residency program. To make it worse, I was assigned to a unit notorious for its fractious surgeons and their dysfunctional relationships with each other. Unlike the other units which were staffed by surgeons from the same clinic or group practice, the surgeons in Unit D were all independent practitioners, and very proud of that fact.

            Unit D lived up to my worse expectations on the very first day. I remembered how chaotic and exhausted I was, with surgeons yelling about cases being delayed and my house staff paralyzed with calls from the floor, emergency room, and operating suites. As chief resident, I was in the middle of the chaos trying to settle things down.

            Even the longest day must end. It did on my first day there. The next day I decided that on subsequent weekdays we would start at 6 AM so as to give us time to see all the patients and be ready for their attending surgeons when they straggled in during the morning. There were grumbling protests from my junior colleagues, of course. “What if we had been up all night?” one protested. Then continue on as if you were still on the night shift!

            To my great surprise the new routine worked well. It helped that being early meant we had no difficulty finding parking spots. We had 90 minutes for our rounds, coffee in hand, and thus could engage in some robust clinical discussions. The best part was that when the attending surgeons arrived, we were ready for them.

            The chaos of Unit III of GHKL reminded me of my old Unit D at The Alex, except that now I was the surgeon in charge, not the chief resident. I could now call my own shots!

Next:  Exceprt #9: A Leaner, Flatter Organization

From the author’s second memoir, The Son has Not Returned.  A Surgeon In His Native Malaysia(2018).