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M. Bakri Musa

Seeing Malaysia My Way

My Photo
Name:
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, May 31, 2020

Excerpt #63: Contemplating Private Practice In JB

Excerpt # 63: Contemplating Private Practice In JB
M. Bakri Musa (www.bakrimusa.com)


            Karen and I spent the next few weeks imagining what life would be in the private sector in JB. To start with, money would no longer be a factor. As for social and modern amenities, Singapore was only across the causeway, and from there we could go anywhere in the world. We were already members of the Johor Royal Golf Club, the club in town. It had many reciprocal arrangements with the prestigious clubs in Singapore. We would also no longer be worried about our children’s education; we could send them across the causeway.

            Karen had also formed close ties with the local community. We were close to one couple in particular, Pam and Bakhtiar Tamin. She was an Australian with two sons of comparable ages to our kids. Bakthiar was a chartered accountant in a local private firm. He was also, like me, from Negri Sembilan; thus the ready bonding. Once Pam related to us how his family back home was always complaining and pestering him as to why they had not yet owned a mansion on the hill or he made a “Datuk.” Like us, she and Bakthiar scoffed at the silly feudal value system!

            As for me, it helped also that my maternal grandmother’s youngest brother had settled in a village near JB. In short, we were not strangers; we felt we had already local roots.

            We liked JB, less crowded and less hot, what with a cooling coastal breeze in the afternoon. Away from KL and in the private sector, I would be beyond the reach of officialdom. Even renewing my passport and Karen’s visa could be done locally. Life in JB was positively and definitely for us. It would have clinched it had we been able to buy that house perched on the hill backing up to the palace ground!

            Despite the clear blue skies and cool afternoon breezes, the memory of my colleague’s banishment with only 24-hour notice kept intruding into the scene. What if one of my royal patients or VIPs skipped on his bills, a not uncommon occurrence? Would I dare send him to the collection agency? What if I did not bring the usual tributes to the palace, as my parents failed to do so when they were young? Would I be protected? Just being in the private sector would not be adequate insulation, at least for a Malay.

            There is something universal about bad thoughts. Once one intruded, hosts of others would rush in, as with the chief minister entering the hospital with scissors in hand. Of course, he could not enter a private facility quite as easily. Then what about those who were stopped on the streets and were punched by the crown prince for not wearing the proper mourning attire following the Sultanah’s death?

            After pondering the potential harm that could befall on me should I get snagged by the many tripwires laid on my path, I began questioning how much good or change I could effect. I could not even influence the authorities to let my intern pursue that UN scholarship, or have the young aspiring surgeon in Batu Pahat join my unit.

            When you are in turmoil, nothing could be more comforting than to hear again from long dear friends even if they knew nothing about your travails. It is like a lifeline being thrown when you are caught in swirling waters.

            At about this time we received two letters from our Malaysian friends from my medical school days in Edmonton. Shah Jaya and Thaddeus Demong were a few years my junior in medical school. Our common bonds went beyond having attended the same college and med school. Our wives knew each other before we were married. Unlike me who stayed behind, Shah and Thad returned to Sarawak after their internship. Three years later they both quit to return to Canada, Shah to start his private practice in Calgary, and Thad to pursue his ophthalmology residency in Edmonton.

            Shah was planning to relocate to the United States and would be taking three weeks off to explore opportunities there. Would I be interested to do a locum for him? At the same time, Thad would be doing a short fellowship at Stanford for the summer and would have their house vacant for a few months. They both probably thought that we were ready for a summer vacation back in Edmonton. Or that knowing both Malaysia and us well, we would last at most only two or three years, just like they did. Up to this day I still do not know how they knew we were at a crossroad in our lives. Perhaps they didn’t; just one of those moments of serendipity.

            Both letters opened up thoughts of private practice in Canada. I had been in private practice in Edmonton before, and had maintained my license there. Finding a slot in Canada should pose no problem.

            Once that floodgate of thought opened up, there was no looking back. The challenge would now be to convince my parents. That would be no easy task.

            That thought was not the only one that inundated us that November. The end of the year was the monsoon season, with afternoon torrential rainstorms the norm. One day in late November we had a massive thunderstorm that flooded our house and the neighborhood. The water rose fast; we were frantic, trying to move toys, furniture, and rugs up to the second floor. We had to abandon our lower floor and wait out the flood. When it receded, our whole yard and first floor were covered with thick slimy mud. We had to flush all that out with water from our tap right away. A few hours of sunshine and the whole area would be baked like cement.

            My fear during the flood was not water coming in as we could escape to the second floor, rather of rats and snakes crawling in with the flood waters.

            For the next few days after work I would be occupied cleaning up our first floor, the yard, as well as the silted drains. Those sweat-inducing activities made us wonder whether some mysterious power was trying to flush us out of our home and country.

Next Excerpt #64:  A Hectic Christmas And New Year

From the writer’s second memoir, The Son Has Not Returned. A Surgeon in His Native Malaysia, 2018.

Tuesday, May 26, 2020

Excerpt #62: Planning Our Future



Excerpt #62:  Planning Our Future
M. Bakri Musa

I related to Karen what had happened with my meeting with the State Medical Director, and apprised her on the implications of my “non-promotion” on our home budget. Despite our reduced house rent in JB, no car payments (we were using my brother-in-law Nik’s car), and overall frugal lifestyle, we were still slowly but surely depleting our savings. Come January our daughter Mindy would be in preschool, a major looming expense. We had been counting on my promised promotion to at least halt if not reverse our financial flow.
            Karen however was less concerned with our bank balance, more with my mental health. She had noticed that all I did recently on coming home was complain about the country’s politics, the obstinacy of the bureaucracy, and now concerns about my personal safety should I run afoul of the royal family and other assorted big shots. The horror of my colleague’s 24-hour banishment only a few months earlier remained fresh in our minds. Not too long before that the Chief Minister, one Othman Saad, had made an unannounced visit to the hospital with a pair of scissors in hand looking for young male doctors with long hair!
            The Chief Minister was aping Singapore’s Lee Kuan Yew, a leader known to be intolerant of the “hippie” hairdo and had been known to station barbers at immigration check points to his island, ready to clip long unruly locks. I wished Othman Saad would have emulated instead Lee’s brilliance, efficiency, and intolerance of corruption.
            At least when I was in KL, Karen reminded me, I would talk of the interesting cases I had done, the papers I was submitting for publication, and the compliments I had showered on my trainees for their excellent performances. We were also looking forward to building our dream house in PJ. Now all I did was bitch about everything. She was worried that was eating into me. The only respite from my constant carping was when we were at the club house. Somehow seeing the kids in the pool, and my doing laps were therapeutic and relaxing. We were now spending more time at the clubhouse than at home. Not a healthy sign.
            My old friend and former high school classmate in KL, Ramli, was right; he knew more about the “General Orders” than all those bureaucrats. He had warned me earlier not to expect any promotion until I had served at least five years. Seeing that his words now rang true, it was time to do some serious thinking about our future.
            My dream was still an academic career. However, more than six months after I had submitted my application to the University of Malaya, I still had not received even an acknowledgment. A job there would be perfect. I could continue with my teaching and resume my clinical research. I could even indulge in basic research with the excellent laboratory facilities they have there. With our dream home right across the street from the campus, I could even walk to work. I could yet achieve my dream of being a Professor of Surgery before forty.
            I made some discrete enquiries about my application and was surprised to learn that there was no vacancy after all. That senior academic who was contemplating going into private practice had changed his mind.
            Well, at least I received an explanation for the non-acknowledgment of my earlier application.
            The only option left was private practice. In less than a year I would have put in my mandatory three-year government service and could then secure my private practice license. That was a more endurable wait than the five to be promoted to “superscale” in government service.
            Private practice, in particular private surgical practice, was then viable only in Penang and KL. I had no desire to go to Penang as I had no connections there, family or otherwise. As for KL, it was still a “closed shop.” Opportunities in JB or elsewhere were nonexistent unless I would be satisfied with office practice doing minor surgery under local anesthesia, as with circumcisions. Every Muslim boy has to have that done, a huge and lucrative but not professionally challenging market.
            Soon after my arrival in JB, a colleague who had just retired but was called back into service approached me. He and a few other local colleagues were planning to build a private hospital in JB. Would I be interested?
            He could not give me much details as it was still in the delicate and sensitive negotiating and planning phases. He did intimate that the group was headed by another recently retired physician, a distinguished clinician and well connected, having served as a personal physician to the sultan and had received multiple royal titles. That should ease the application through the bureaucratic swamp.
            I was impressed with the clinical side. However, setting up a hospital was more a business decision. I would be more impressed with an MBA than an MD. Those clinicians, distinguished though they may be in their specialties, were all former civil servants. They had spent their entire adult careers in the civil service receiving regular checks. Giving out paychecks was a completely different and far more challenging proposition. I was not confident that they could make the transition. I also could not get much information on the crucial financial and management aspects.
            I had also been approached earlier by another group from KL who was also planning a private hospital in JB. I did not know whether they were part of the same endeavor, and I could not very well reveal one group to the other. If they were to be separate, that would complicate matters; two competing entries into a new untested market.
            I was attracted more to this second group. It included two of my former colleagues at GHKL, one a surgeon who happened to be my senior at Malay College but qualified as a surgeon after I did, Dr. Ismail Nur. He had joined me in KL through UKM shortly before I left. He had completed a fellowship in Japan on the new and innovative technique of removing retained gallstones endoscopically, that is, without resorting to open surgery (ERCP-Endoscopic Retrograde Cholangio-Pancreatography). He showed me slides of the cases he had done. I was impressed. He presented his series at the College of Surgeons meeting that year, the first in the country to have successfully performed ERCP, therapeutic and otherwise.
            The other was a pediatrician, Dr. Malik. I had the highest regards for him both as a clinician (he was a gold medalist at his medical school abroad) as well as a person. He was with UKM, and once told me not to bother with the university. He was just biding his time before entering private practice.
            I was attracted to this second group for another reason. Both Drs. Malik and Ismail were young; they had not yet been acculturated into the destructive civil service mentality. Beings Malays I thought they would have a better chance because the government was encouraging us to enter the private sector. They would also be more dynamic and entrepreneurial.

Next:  Excerpt # 63: Contemplating Private Practice In JB

From the writer’s second memoir, The Son Has Not Returned. A Surgeon in His Native Malaysia, 2018.

Sunday, May 17, 2020

Excerpt #61: Not Unexpected Bad News


Excerpt #61:  Not Unexpected Bad News
M.  Bakri  Musa (www.bakrimusa.com)

            Sometime in late January 1978, the State Medical Director, another Dr. Lim, dropped by my office at GHJB; a very unusual gesture. The practice, and strictly adhered to in tradition-bound feudal Malaysia, would be for the junior officer to be summoned to the superior’s office. A genial gentleman, he was a “Strait’s Chinese,” meaning his ancestors came to Malaysia centuries ago unlike the vast majority of Malaysian Chinese. Those Straits Chinese spoke fluent Malay and had adopted many of the trappings of Malay culture, including and especially our soft mannerisms. In Malay culture, you do not confront someone with a direct “No!” That would be rude. Rather you respond with a smile and a gentle, “It’s not a propitious time to say yes!”

            Sitting across from my desk, he looked less like an alpha dog, my superior, more a poodle waiting for some treats from its master. He had just returned from KL, he said, to plead for my case with the Public Service Commission. It had denied his recommendation of my promised promotion. I had not been in the service for five years, the minimum period to be considered for entry into the permanent establishment. He even lobbied the new Minister of Health, Chong Hon Nyan, whom he knew well. The minister replied that as a political appointee he had no power to intervene or influence the permanent establishment.

            I had no reaction. Being new to the service I did not know and was not eager to learn the implications, monetary and otherwise, of those bureaucratic terms. He was surprised by my lack of disappointment, or at least a show of it.

            In truth, I was lost. I could follow quantum mechanics and the multiple steps and side branches of the Kreb’s cycle in my undergraduate years, but this convoluted rule of the Malaysian civil service code confounded me; hence my lack of reaction. He too was befuddled by my lack of reaction.

            Then, he blurted, “Will you be leaving us?”

            I replied, more as a reflex and remembering never to be direct, “I don’t know!”

            He acknowledged that since I was not yet in the permanent establishment I needed to give only 24 hours’ notice. However, he would need a much longer time either officially or unofficially so he could have ample time to find a replacement for me. The sultan would not be happy if JB were to have only one surgeon.

So that was his reason for wanting to know my response right away; his personal survival or well-being. He reminded me that was how he managed to get me to JB so quickly earlier the previous year by using the sultan’s threat to bulldoze his way with the civil servants in KL.

Quickly? That surprised me for I had waited for months for that transfer.

            I wanted to remind him about my colleagues 24-hour banishment only a few months earlier. He was in the permanent establishment but that did not protect him. Caution prevented me from uttering my thoughts.

Then I wondered. What if I were to simply abscond on a day’s notice? That would not be fair to my colleagues, trainees, and patients. If I were to leave I would let them know first.

            As he was leaving, Dr. Lim put his arms around me in a fatherly manner and again pleaded with me to let him know well ahead of time should I decide to leave. “Otherwise, the sultan would … ,” he finished his sentence by gesturing with his hand slicing across his neck.

            At least he was honest in expressing his personal concerns. I felt sorry for the man. He had really internalized the values of feudal Malay culture.

Next:  Excerpt #62:  Planning Our Future

Excerpt # 60: Envy, A Dangerous Sentiment


Excerpt #60:  Envy, A Dangerous Sentiment
M. Bakri Musa (www.bakrimusa.com)

            The next morning the surgeon I was subbing for, Dr. Rahman, a contract surgeon from Bangladesh, called me. He apologized for taking me away from my family during Hari Raya. He thought that he would be replaced by my predecessor, a non-Muslim Indian surgeon.

            Dr. Rahman invited me to his house. I was not ready for what I saw. He lived in a mansion, at least as compared to my duplex in JB, with spacious grounds, lush green lawns and shady trees. The lot was so spacious that there was little need for fences as the neighbors were far away. Again, I noted the noticeable absence of any fruit trees. The lawns were well manicured; the leaves raked. The roses and hibiscus were well trimmed and in full bloom. He apologized for the few unpicked leaves as the JKR workers had been lackadaisical because of Hari Raya holidays! The nerve of him to complain!

            On finding out that I had been trained in Canada, he said that he had a distant cousin who was a doctor in America. He asked why I did not stay there. I had no answer other than the old standby about family ties. I learned a lot from him about the perks enjoyed by a contract surgeon, apart from the spacious bungalow with gardeners provided. He also earned a heck of a lot more than me, with regular paid trips home for him and his family! I envied him, and envy is a dangerous sentiment to harbor.

            That afternoon at rounds, I was joined by a young Malay medical officer. He was a graduate of an Australian university and was interested in pursuing surgery as a career. However, despite having expressed his career preference, the bureaucrats saw fit to place him not on the surgical unit but the medical ward! He had heard about me from the other intern and decided to cut short his holidays to join me. We made rounds and I had him scrub with me on a couple of cases.

            Now, that was the kind of young doctors I would like to have on my service if only I had the clout to transfer him to my unit in GHJB. I did my part. Upon returning to JB, I went to see the State Medical Director to plead for this young aspiring surgeon’s case. No such luck. Those bureaucrats in KL had assigned him to Batu Pahat, and that was where he would be for his mandatory three years of government service. What a waste!

            I wish I could say that was my only disappointment with trying to “fast-track” promising young talent I met along the way. A few months earlier I had encouraged one of my interns to apply for a UN scholarship to do Public Health at UCLA, one of the top schools for that discipline. I wrote a very strong letter of recommendation for him. It also happened that one of the UCLA’s faculty members was in KL giving a seminar advocating breast feeding. I was at the meeting and pleaded my intern’s application directly to him.

            To cut short the story, he was accepted. To cut the story even shorter, no, the Ministry of Health or to be specific, the Public Service Commission would not release him as he had not yet fulfilled his mandatory three years of service. That was a blow for me, but my intern accepted it with equanimity. It was not his turn! I on the other hand was livid. That however, too soon turned to equanimity; one more crucial factor to making my big final decision, I calmed myself.

            One afternoon while I was in Batu Pahat and during a lull in my schedule, I drove by the river near the makeshift dock. There was a bustling boat traffic to the village across the river. I wanted to visit that village but just to be sure that I would not be stranded, I asked the sampans’ operators what time would be the last boat from there. The moment I uttered those words, I knew I had made a social if not security boo-boo. What do you mean by at what time would be the last boat? The last boat would stop when there would be no more riders! Duh!

            The boatman gave me a suspicious stare. I must be a stranger. Who else would ask what time the next boat be but a stranger? Before I could get into more trouble, I retreated to my car and back to the safety of the hospital.

            Batu Pahat was a notorious entry point for insurgents coming from Indonesia across the Strait of Malacca during the height of konfrontasi in the 1960s. The area was also a favorite entry point for illegal immigrants from there. He must have thought that I was a leftover intruder or an illegal alien masquerading as a tourist.

            Late Saturday evening, the end of my weekend relief for that surgeon, I returned to JB. I was glad to be back. It dawned on us that that was the first time we had been separated in Malaysia. The kids kept asking where daddy was; that was the hardest part for Karen. For my part, I was so busy in Batu Pahat that I felt like I was back at my residency days when I would not see Karen for days.

            For me, there was yet another not-so-pleasant emotion when I returned to my modest duplex in JB. Images of Dr. Rahman’s spacious bungalow kept intruding in my mind to disturb my emotions and equilibrium, reminding me of my village wisdom, Kera di hutan disusukan, anak di pangkuan mati kebuluran. (breastfeeding the infant monkey you found in the jungle while your own dies of starvation). Again, the dangerous sentiment of envy!

Next:  Excerpt #61:  A Not Unexpected Bad News

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

Sunday, May 10, 2020

Excerpt #60: Envy, A Dangerous Sentiment

Excerpt #60:  Envy, A Dangerous Sentiment
M. Bakri Musa (www.bakrimusa.com)

            The next morning the surgeon I was subbing for, Dr. Rahman, a contract surgeon from Bangladesh, called me. He apologized for taking me away from my family during Hari Raya. He thought that he would be replaced by my predecessor, a non-Muslim Indian surgeon.

            Dr. Rahman invited me to his house. I was not ready for what I saw. He lived in a mansion, at least as compared to my duplex in JB, with spacious grounds, lush green lawns and shady trees. The lot was so spacious that there was little need for fences as the neighbors were far away. Again, I noted the noticeable absence of any fruit trees. The lawns were well manicured; the leaves raked. The roses and hibiscus were well trimmed and in full bloom. He apologized for the few unpicked leaves as the JKR workers had been lackadaisical because of Hari Raya holidays! The nerve of him to complain!

            On finding out that I had been trained in Canada, he said that he had a distant cousin who was a doctor in America. He asked why I did not stay there. I had no answer other than the old standby about family ties. I learned a lot from him about the perks enjoyed by a contract surgeon, apart from the spacious bungalow with gardeners provided. He also earned a heck of a lot more than me, with regular paid trips home for him and his family! I envied him, and envy is a dangerous sentiment to harbor.

            That afternoon at rounds, I was joined by a young Malay medical officer. He was a graduate of an Australian university and was interested in pursuing surgery as a career. However, despite having expressed his career preference, the bureaucrats saw fit to place him not on the surgical unit but the medical ward! He had heard about me from the other intern and decided to cut short his holidays to join me. We made rounds and I had him scrub with me on a couple of cases.

            Now, that was the kind of young doctors I would like to have on my service if only I had the clout to transfer him to my unit in GHJB. I did my part. Upon returning to JB, I went to see the State Medical Director to plead for this young aspiring surgeon’s case. No such luck. Those bureaucrats in KL had assigned him to Batu Pahat, and that was where he would be for his mandatory three years of government service. What a waste!

            I wish I could say that was my only disappointment with trying to “fast-track” promising young talent I met along the way. A few months earlier I had encouraged one of my interns to apply for a UN scholarship to do Public Health at UCLA, one of the top schools for that discipline. I wrote a very strong letter of recommendation for him. It also happened that one of the UCLA’s faculty members was in KL giving a seminar advocating breast feeding. I was at the meeting and pleaded my intern’s application directly to him.

            To cut short the story, he was accepted. To cut the story even shorter, no, the Ministry of Health or to be specific, the Public Service Commission would not release him as he had not yet fulfilled his mandatory three years of service. That was a blow for me, but my intern accepted it with equanimity. It was not his turn! I on the other hand was livid. That however, too soon turned to equanimity; one more crucial factor to making my big final decision, I calmed myself.

            One afternoon while I was in Batu Pahat and during a lull in my schedule, I drove by the river near the makeshift dock. There was a bustling boat traffic to the village across the river. I wanted to visit that village but just to be sure that I would not be stranded, I asked the sampans’ operators what time would be the last boat from there. The moment I uttered those words, I knew I had made a social if not security boo-boo. What do you mean by at what time would be the last boat? The last boat would stop when there would be no more riders! Duh!

            The boatman gave me a suspicious stare. I must be a stranger. Who else would ask what time the next boat be but a stranger? Before I could get into more trouble, I retreated to my car and back to the safety of the hospital.

            Batu Pahat was a notorious entry point for insurgents coming from Indonesia across the Strait of Malacca during the height of konfrontasi in the 1960s. The area was also a favorite entry point for illegal immigrants from there. He must have thought that I was a leftover intruder or an illegal alien masquerading as a tourist.

            Late Saturday evening, the end of my weekend relief for that surgeon, I returned to JB. I was glad to be back. It dawned on us that that was the first time we had been separated in Malaysia. The kids kept asking where daddy was; that was the hardest part for Karen. For my part, I was so busy in Batu Pahat that I felt like I was back at my residency days when I would not see Karen for days.

            For me, there was yet another not-so-pleasant emotion when I returned to my modest duplex in JB. Images of Dr. Rahman’s spacious bungalow kept intruding in my mind to disturb my emotions and equilibrium, reminding me of my village wisdom, Kera di hutan disusukan, anak di pangkuan mati kebuluran. (breastfeeding the infant monkey you found in the jungle while your own dies of starvation). Again, the dangerous sentiment of envy!

Next:  Excerpt #61:  A Not Unexpected Bad News

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

Sunday, May 03, 2020

Excerpt #60: Operating In A Small District Hospital

Operating In A Small District Hospital
M. Bakri Musa (www.bakrimusa.com)

A few weeks before the airline disaster, it was Hari Raya Haji. I was looking forward to taking the family back to Seremban, and the beach at Port Dickson. My parents too were looking forward to our visit. My last break was at Hari Raya Puasa, just before the Sultanah’s death. I needed a holiday, even a brief one, badly.

            I was to leave that Thursday and have an extended weekend, returning the following Tuesday, the day after the celebration. Late on the eve of our departure, I had a phone call from the State Medical Director. He informed that I had to substitute for the surgeon in Batu Pahat, some sixty miles north. I was not aware of any other Malay or Muslim surgeon in the state. Surely a non-Muslim surgeon would not be so inconsiderate as to take the Muslim holidays off and have a Muslim colleague cover for him!

            Karen and the kids were disappointed; they had been looking forward to that trip. I left after making my rounds, and gave a ride to one of my young patients and his mother who needed a ride home. As they were from a village on the way up there and well aware of how erratic village bus services were, I offered to drive them home. She did not hesitate accepting my offer, with no put-on hesitancy or false modesty of waiting for the second or third offer, in the usual Malay courtesy.

            Again, reflecting on what Malaysia and Malay society have turned into, I wonder what would have been the repercussions today had the moral squad stopped me and found a young woman in my car who was not my wife?

            The road to the village had more potholes than an adolescent’s face pitted with acne scars. It was straight enough along the rice fields but with the ubiquitous pot holes we had to crawl along, with her and her boy in the back being tossed around as I swerved to avoid yet another deep pothole or braked upon another unexpected dip.

            An oft-quoted hadith had it that Allah admitted a man to heaven because he once removed a thorn from a path. If that was the reward for removing a thorn on the road, imagine the special place in heaven for those who build roads. However, that applies only if the road is safe. An incompetent engineer building unsafe roads is laying but a dangerous death trap. Or as American tort lawyers would put it, an attractive nuisance.

            No sooner had I signed in at the Rest House at Batu Pahat, I was called in to the Emergency Room and was met by a Malay intern. He was surprised to see me. He thought I, being a Malay, should be off for the holidays. He was working because being at the bottom of the totem pole, he had no choice. I however, being a surgeon, was at the top of the heap and thus should have had my way. Smart intern!

            The patient was a pedestrian hit by a lorry. It did not take me long to diagnose internal bleeding from a possible ruptured spleen. I explained to the patient and his family the need for immediate surgery to control the bleeding, detailing the risks of waiting. He and his family agreed right away. The intern was surprised, not at the patient’s quick decision rather that I had explained the procedure in some comprehensible manner, and the need for it, to the family members. Judging by the intern’s reaction, I presumed that was not a local practice.

            I did the surgery with only the surgical technician, also a Malay who happened to be, like me and the intern, unlucky enough to be on call during Hari Raya. The case went smoothly. Surgery on Malaysians was rarely a technical challenge. Unlike in the West, they were not obese.

            When I announced that I was closing up, the anesthesiologist was startled as he had just given the patient a booster dose of muscle relaxant, anticipating a long procedure. Seeing that I now had plenty of time, I went into teaching mode, going over with the technician what I had done, showing him the clot that had temporarily stopped the bleeding, acting as a tamponade. It would be easy to imagine that if the clot were to dissolve or get dislodged a few days down the line and the patient could bleed to death; hence the need for the immediate surgery.

            I demonstrated the different techniques of removing the spleen, as with medical splenectomy when the organ is enlarged (hypersplenism), or when it is so large as in malaria that it could be easily injured and ruptured during the removal. There, we would first tie the artery and then inject adrenalin into the organ so the blood would be squeezed out into the veins and be preserved. It would also make the organ smaller and easier to remove, lessening the risk of tearing and uncontrolled bleeding. Indeed, he related an incident when such a tragic mishap did happen.

            Despite my impromptu extended exposition on splenectomy, we still had plenty of time to spare. To fill it up, I asked whether he would like to close the incision. He was more than eager; and was slick with his hands. I demonstrated the various suturing techniques, and when and how to use retention sutures as well as cosmetic skin closures. He was thrilled, and was a fast learner.

            When we finished he told me how much he appreciated what I had shown to him. He never had such an operating room experience since the British surgeons left way back in the late 1950s. Local surgeons were not interested in teaching him or any of his fellow technicians. Those local surgeons treated him and his colleagues not as fellow professionals but as inferiors. He was thrilled to have a young surgeon who behaved like the old colonial ones. He meant to compliment me, but I was saddened by his remarks.

            I had a few more cases that weekend, with that Malay surgical tech eagerly coming in to scrub. He wanted to learn as much as possible from me as he would not have another chance! Wow, he sure knew how to flatter me!

Excerpt # 60:  Envy, A Dangerous Sentiment
Excerpted from the author’s second memoir, The Son Has Not Returned. A Surgeon In His Native Malaysia, 2018.