(function() { (function(){function b(g){this.t={};this.tick=function(h,m,f){var n=f!=void 0?f:(new Date).getTime();this.t[h]=[n,m];if(f==void 0)try{window.console.timeStamp("CSI/"+h)}catch(q){}};this.getStartTickTime=function(){return this.t.start[0]};this.tick("start",null,g)}var a;if(window.performance)var e=(a=window.performance.timing)&&a.responseStart;var p=e>0?new b(e):new b;window.jstiming={Timer:b,load:p};if(a){var c=a.navigationStart;c>0&&e>=c&&(window.jstiming.srt=e-c)}if(a){var d=window.jstiming.load; c>0&&e>=c&&(d.tick("_wtsrt",void 0,c),d.tick("wtsrt_","_wtsrt",e),d.tick("tbsd_","wtsrt_"))}try{a=null,window.chrome&&window.chrome.csi&&(a=Math.floor(window.chrome.csi().pageT),d&&c>0&&(d.tick("_tbnd",void 0,window.chrome.csi().startE),d.tick("tbnd_","_tbnd",c))),a==null&&window.gtbExternal&&(a=window.gtbExternal.pageT()),a==null&&window.external&&(a=window.external.pageT,d&&c>0&&(d.tick("_tbnd",void 0,window.external.startE),d.tick("tbnd_","_tbnd",c))),a&&(window.jstiming.pt=a)}catch(g){}})();window.tickAboveFold=function(b){var a=0;if(b.offsetParent){do a+=b.offsetTop;while(b=b.offsetParent)}b=a;b<=750&&window.jstiming.load.tick("aft")};var k=!1;function l(){k||(k=!0,window.jstiming.load.tick("firstScrollTime"))}window.addEventListener?window.addEventListener("scroll",l,!1):window.attachEvent("onscroll",l); })();

M. Bakri Musa

Seeing Malaysia My Way

My Photo
Location: Morgan Hill, California, United States

Malaysian-born Bakri Musa writes frequently on issues affecting his native land. His essays have appeared in the Far Eastern Economic Review, Asiaweek, International Herald Tribune, Education Quarterly, SIngapore's Straits Times, and The New Straits Times. His commentary has aired on National Public Radio's Marketplace. His regular column Seeing It My Way appears in Malaysiakini. Bakri is also a regular contributor to th eSun (Malaysia). He has previously written "The Malay Dilemma Revisited: Race Dynamics in Modern Malaysia" as well as "Malaysia in the Era of Globalization," "An Education System Worthy of Malaysia," "Seeing Malaysia My Way," and "With Love, From Malaysia." Bakri's day job (and frequently night time too!) is as a surgeon in private practice in Silicon Valley, California. He and his wife Karen live on a ranch in Morgan Hill. This website is updated twice a week on Sundays and Wednesdays at 5 PM California time.

Sunday, December 29, 2019

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.

Sunday, December 22, 2019

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.

Sunday, December 15, 2019

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.

Sunday, December 08, 2019

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.

Sunday, December 01, 2019

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.