Training Future Doctors

Excerpt #13 - Teaching Future Doctors

M. Bakri Musa (www.bakrimusa.com)

One consequence to our lively rounds, seminars and conferences, as well as my own informality, was that my trainees acquired a reputation of being outspoken to the point of being biadab(disrespectful), or so I was told.

            One day we had a new lecturer fresh with his London University PhD. I suggested that he give a presentation in our usual format:  20 minutes of didactic session followed by Q&A around a couple of our difficult cases. On the appointed morning and after my brief introduction, I left the room to let him take charge.

            Later I asked my trainees how their session went. Not good! This young lecturer did not take kindly to their asking questions. He later dropped by my office to complain that my trainees were rude and impudent!

            Besides young doctors, I also had medical students from the Universiti Kebangsaan Malaysia (UKM) as well as the University of Malaya (UM). The latter were fine except that they expected certitudes and believed that the answer to every clinical question could be found at the back of their textbook, just like their math problems in high school. Once we were involved in an extended discussion on a patient with a complicated acute abdomen. We ended up with a series of differential diagnoses and I concluded by saying, “We’ll soon find out!” meaning, after the surgery.

            As I was accompanying the patient to the operating room, one of the students breathlessly caught up with me. “Sir! What’s the actual diagnosis?” I repeated that we would soon find out, as we had discussed earlier. He was disappointed; he thought I had the answer and that the earlier discussions were but an academic exercise!

            In 1976 the first batch of UKM medical students entered their clinical year. They presented a very different set of challenges for me. First, coming from the Malay stream, their English was not quite polished. Second, they were mostly Malays. The university was set up in response to the bloody 1969 race riots. The faculty, administration, and most of all the students were nationalistically-inclined. Third, they were entering a profession hitherto the traditional preserve of non-Malays.

            The discomfort and barely disguised envy if not resentment among the non-Malay staff to this new order was there but muted. They had yet to accept this new reality but acknowledged its inevitability. It reminded me of the early days of the Quiet Revolution in Quebec to the increasing presence of French-Canadians at such venerable and hitherto exclusively Anglo-Saxon institutions like McGill University and Royal Victoria Hospital.

            Much to my delight and contrary to all my expectations, the English fluency issue was the least problematic. As clinical notes and operative reports were all still in English (the King had exempted those as well as other professional communications from the strictures of the national language statutes), I made those students present their cases in English. I spun it in a positive way, to save them time and effort in translating.

            It was very trying for the first few weeks with the pace slowed to an intolerable crawl. However, by the end of their rotations, I could not tell them apart from the English-stream UM students. I was surprised and much gratified.

            Looking back, I should not have been surprised. They had English classes throughout their school years. It was just that they were not encouraged to use it. English-fluency was seen as being anti-Malay, or worse, a Mat Salleh (Anglo-Saxon) wannabe.

            Once I saw a group of students examining a Chinese patient. They were all wearing gloves and hesitant in touching my patient. Something else about their collective behaviors bothered me. Sensing that I was now on to something novel and potentially sensitive, I asked Mahmud what was going on. He told me of the rise of Islamic fundamentalism among the students. The faculty was very much aware of that. In fact they had scheduled a special senate meeting to address the very issue.

            That did it for me. I gathered the students, and with Sr. Fong beside me, told them that I wanted all my patients be treated the same whether they were in the Third-Class ward or the First-Class suites, from the estate in Ulu Pilah or the exclusive enclave of Bukit Tunku, illiterate or a graduate, and male or female. I skipped the race and religion part on purpose, but they did not miss my point. If they were uncomfortable with that, then they should ask their professors to post them elsewhere. No discussion!

            From then on there were no more problems on that issue. I was amazed at the ease with which I had solved a potentially explosive issue. While the university senate continued to grapple with the matter to no end, I nipped the noxious weed of religious extremism in its bud. That was not the case with the rest of the country. That poisonous weed today engulfs and blights Malaysia.

            God gives us the wisdom to solve a problem with ease to test us. Soon I became overconfident. One day we were making rounds on a challenging patient and I persisted in badgering the bewildered students on what we should do next. After yet another long quizzical silence on their part, I suggested in a thinly-disguised mocking tone, “Recite Surah Yaseen?” referring to the Koranic verse often read at funerals and on visiting the sick.

            The discomfit among my students was immediate and electric. Big blunder! I was ridiculing the holy text; the repercussions would be severe.

            Without missing a beat, I went on. If the family had wanted that, they would not be asking you or me, I told the students. The family would invite an imam or hafizwhose voice and tajweedwould be far more exquisite. The sick came to the hospital because we could offer them something else. Leave the Koran reading to those more pious, qualified, and with a soothing voice!

            With that, the relief on everyone was palpable, more so on my part. I felt like a member of the bomb squad who had successfully snipped the tripwire of his own making that would have caused a massive explosion.

            My other unpleasant encounter with religion, or at least its representative concerned a patient with cancer whom I had done a successful surgery. Her prognosis was excellent. To most, and not just village folks, cancer is a death sentence regardless how favorable the prognosis. She was a recent migrant to the city. Let loose from her comforting village anchor, she was lost. This was manifested in her endless somatic symptoms despite her successful surgery.

            I was about to embark on yet another series of tests when I decided to listen to her with extra diligence. She was obsessed not with death rather the associated funeral rites like ablution and praying for her soul. I assured her that we had an Imam in-house to take care of such matters.

            I contacted him about pastoral counselling and spiritual guidance for her. His reaction stupefied me.

            “When they have weddings, they don’t think of us. Near death, they call us!”

            This imam was paidby the government! I decided to spare my patient this charlatan. We found another imam, not government-issued. She was much relieved after the spiritual counselling.

            Like other faiths, Islam is not spared of pretenders, some very well compensated.

Next:  Excerpt #14 – Looking For A House

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