Excerpt # 66: Recalling Fond Memories

Excerpt # 66:  Recalling Fond Memories

M. Bakri Musa (www.bakri musa.com)

            There is never a good time or way to drop bad news on a dear friend. That was how I felt when I visited my friend Badri Muhammad. As soon as I was settled on his living room sofa of his home on the UPM campus in Serdang, I told him of my decision. He snapped up straight, slapped his thigh and cried, “No way!” Then shaking his head and with both palms supporting his forehead, added, “Why?” more as a rhetorical question. He knew the answer; we had been comparing notes and commiserating whenever we got together.

            His Karen was calm. “I’m sorry it didn’t work out for you, Bakri!”

            As I went through by now my all-too-familiar laundry list of frustrations, he interjected. Had I received that university appointment, it would be no better, he said. The only thing that kept him going was his students, especially his graduate students. He could not leave them. His mentioning of his students brought forth fond emotions with my own interns and medical officers. Then there was the heartfelt gratitude from that surgical technician in Batu Pahat.

            I also had many fond memories of my grateful patients and their families. One that still remains vivid was the boy whom Mahmud and I did the first Duhamel operation in Malaysia. When I first saw him, he was emaciated and with a distended belly. His parents related how he had been constipated since birth. They knew something was very wrong with their son. Yet they were seen by no fewer than half a dozen doctors and were told that there was nothing wrong.

            I saw a similar patient at the Montreal Children’s Hospital. He had Hirschsprung disease, where a segment of the large bowel is devoid of its nerves and thus paralyzed or functionally blocked. I remember when I did a rectal examination, there was an explosive release of the blockage, with stool and gas shooting across the room. I wanted to replicate that demonstration for my trainees and medical students, with the parents’ permission, of course.

            The parents were so relieved when I told them that there was indeed something wrong with their son and that we would be able to do something about it.

            For the demonstration, I gathered my team of house staff and medical students around and then asked who among them believed that there was nothing wrong with the boy. Everyone agreed that there was something very wrong. Yet I reminded them that six doctors had examined the patient earlier elsewhere, and all had said that he was fine.

            I told my young doctors and medical students that the most important skill a physician could have, and the most difficult to develop, is to be able to tell what is normal and what is not, when someone is sick and when he is not. You may not have the right diagnosis but knowing that something is not right would be a major first step. It would also be wiser to admit that you don’t know or have not yet found the right diagnosis than to say that nothing is wrong with the patient, unless you know for sure that is the case.

            For that dramatic clinical demonstration, I picked the smallest intern, a lady. I thought she would have the smallest finger to do the rectal examination on the boy. Sure enough, as soon as she pulled out her digit, there was an explosive expulsion of gas and stool, much to her embarrassment! I had earlier apprised the parents, so they were not embarrassed but instead joined in the laughter even though it was at their son’s expense. It was a rare and precious teaching moment.

            Like me that many years ago in Montreal, those present on that day would never again forget that dramatic manifestation of Hirchsprung disease.

            That boy did well after surgery, rather two surgeries. Because of his poor nutritional status, I had to do the procedure in two stages. It was gratifying to see a limp bloated boy develop into an active boisterous youngster. His parents were so grateful that every time they came for his follow-up visits, they would bring me the choicest durian from their village.

            The first time they brought the fruit I shared it with my staff as there was no point bringing it home. To Karen, the smell of durian reminded her of an outhouse of a not well-maintained summer campground. Seeing that I did not bring the fruit home but instead shared it with my trainees, on the next occasion, they brought two, with specific request that one was for my wife and kids. Alas, they did not know that my wife had yet to acquire the taste. To her, unlike to the natives, durian was anything but the king of fruits or the fruit for kings, or queens!

            Another memorable patient had a prolapsed tumor out of his rectum. I asked my medical officer to reduce it (put it back in) so we could plan an elective operation and spare him the necessity of a temporary colostomy (artificial opening on the abdominal wall for the stool to come out), not an appealing prospect. Tried as she did, she was unsuccessful. No surprise there; she being a female and inevitable question of modesty on my patient’s part prevented him from relaxing his sphincter.

            I took over. I tried all positions but still was unsuccessful. He was not relaxed enough. In a last-ditch effort, I asked him to prostrate himself as with praying and to take deep breaths as well as recite any prayer to calm himself. He did, reciting some verses of the Koran, and I could feel his abdomen and sphincter become relaxed. After a few attempts I was successful, much to his and my relief. We later went on to do a one-stage surgery without the need for a colostomy. He was grateful. As for the credit, I do not know whether that should go to the power of the Koranic verse, his self-control at relaxing his sphincter, or my digital dexterity!

            On his discharge, he gave me a three-volume translation of the Koran. “For your wife, doctor!” We still have it!

            When Badri related to me how he felt about his students, I understood him. I felt the same about my patients and trainees. I too felt that I was abandoning them, not a pleasant feeling or thought.

            When we left, Badri again expressed his disappointment. He wished things would have worked out differently for me. A true friend, he nonetheless wished me well. For my part I asked him to visit my parents often with his children as those visits meant a lot to my parents. Adam and Su reminded my parents of our Mindy and Zack. They were of comparable ages.

Next: Excerpt #67:  My Family’s Attempt To Dissuade Us

Excerpt From The Autor’s Memoir, The Son Has Not Returned, 2008.