Chapter 14

Chapter 14

Dow Medical College-Civil Hospital Karachi –Early UK
1961-1965

I tried to catch up with my studies, but it was very much an uphill task. I was out of my depth as I had missed too many classes and laboratory work. If it were just a question of cramming lecture notes, or even memorizing whole chapters, it would not be much of a problem. My memory for printed word was very good. I recall that during the pharmacology examination the year before, it seemed as though the textbook was lying in front of me, and I was copying the sentences onto the test booklet. But I could not learn from books the methodology of the experiments we had to conduct, the slides we had to study and the bacteria we had to grow on “culture media” . With out actually conducting experiments in the laboratories and understanding the subject, it took longer to learn by rote as well. Pathology, Jurisprudence and Hygiene were taught over two years. I had attended very few classes in the last twenty months. But I got down to the task and tried to emulate the dedication to books I had shown in 1951-52 while in the tenth grade.
I had to visit home a few weeks later. I had heard that my father was not well. We did not have a phone in our home in Quetta. I called a friend who worked in Quetta telephone exchange office . My father was well, but my mother was very depressed. I desperately wanted to see her. But there was a hurdle. I had to seek permission to leave town. I called on the administrator of the college, Lt Colonel Naqi. I have had occasion to mention him before. He had a sneaking admiration for us. He called the relevant people and saved me from the red tape. I boarded a train the following day.
I had not had time to inform my family that I was on my way. I took a Tonga (a one horse carriage described earlier in the narrative) home from the railway station. My mother who had nerves of steel broke down. I too cried in her arms. She did not say a cross word that I had nearly wrecked all her hopes. She did not need to. We understood each other and hardly had ever to explain our thoughts at length. I must not neglect my sister. She was rather proud of all the attention paid to me and basked in reflected glory.
I decided there and then that the days of my playing “truant” were over. I did not suddenly give up my convictions. It was only that I did not have the stamina for a marathon. My mother had had a very bitter and sad life. Her husband was never able to put her on a pedestal, she in my admittedly biased opinion deserved. We were always hand to mouth. In fact the only physically comfortable time, free of material want, I remember was when we stayed with my Nana. But it was not the same as your own father’s house or your husband’s. She had, moreover, sacrificed what little comfort she could have for me. Her only hope for fulfillment, even meaning in life lay in my future success.
My Dadi had never really liked me. I had resented her blatant attempts to browbeat my mother, and never made a secret of the fact that I did. That was also the reason my relations with father were soured. I did not quite know how would she receive me. I knew she had been often complained to my father that I was not exactly rude to her but consciously kept my distance. Would she tell father that the trouble I had got into was the result of my poor upbringing and would lay the blame on my mother? I had been rendered too willful. On the other hand I was her eldest male grandson. She might relent a bit. But nothing had prepared me for the passion she hugged me with. She cried. She had had a hard life too, and was close with money. Now she opened her purse and sent away for delicacies for me. She even gave some money to a beggar exhorting him to pray for my welfare!
The news spread soon all over town that I was visiting and was treated as a minor celebrity where ever I went. In a small town every one knows every body else. I had been something of a star student in the only college in the province and visited the town during summer vacations. My adventure was particularly exiting . I called on friends and former teachers and reveled in their curiosity and frank admiration. My intellectual friend, now the editor of the local English daily wanted to write a piece about me, but I asked him not to; I did not want the provincial education department to learn about my activities for reasons referred to below. In fact the only unpleasant experience I had was during a visit to the principal of the school my father worked in. Among those present was a retired army major who had helped my father in getting to the Brigadier in charge of our case in Karachi. He was very rude and sarcastic. I was on the point of an angry retort. The principal, an urbane gentleman saved the situation from turning ugly.
I barely escaped another disaster. My Quetta scholarship depended on certification of regular attendance of classes. Every six months I was required to go to the offices of all the departments, and get a note that my attendance of classes and laboratories was satisfactory. In the fourth year though we had instructions in all clinical subjects, the university examination was only in Hygiene and Public Health, Medical Jurisprudence and Pathology/Microbiology. The last one was the most relevant and important, as a good grounding in the subject helped you understand clinical subjects . In the departments of Hygiene and Jurisprudence, office clerks gave me the requisite certificates with out a demur.
It was another story in the Pathology department of Dr Tafazzul Hussein. I asked the clerk to type the requisite note and get it signed by the Professor. I returned a while later, blithely unaware of the fate awaiting me. The clerk expressed regret on his inability to furnish the certificate and added that the Professor would like to see me in his office.
I had a premonition of grave trouble. If I had a way out I would walked away. But I really had no choice. It was either see the Tafazzul Sahib or quit college. I presented myself as directed. The Professor seemingly busy with what he had been doing ignored me completely. After letting me shift my weight uneasily from one leg to another, and sweating for what seemed like hours, he lifted his glance and glared at me. That reduced me to a mass of quivering jelly and that too with out a word of reprimand. Finally he asked me quite gruffly what did I want? It was a far cry from the time he used to ask me, in his very sophisticated Hyderabadi tone , to take a chair.













I started; Sir I need a certificate of attendance for my scholarship to continue. I could not quite bring myself to say satisfactory attendance. But you have not attended so many classes; all in the quietest but the most ominous tones I had heard before (or since). I could not say a word. He asked me what was the state of my attendance in other departments. I said it was all right there. He snapped. For a person who never raised his voice, he nearly screamed, “why did you not arrange for a proxy in my department too”? I thought I would surely lose the scholarship. I would have to take a job and instead of graduating in a little over a year, I would have to wait for two or three before I could qualify as a doctor, if I ever did . The Professor let me squirm for a few minutes more and then pushed the already signed certificate to me; and turned his face away from me. That rejection was greater punishment than any verbal abuse he could subject me to. Always a considerate person, he would not wish that I were forced to leave the college because I could not pay the tuition fee. But he wanted to put the fear of God in me. He never spoke to me again, only nodding his head when I saluted him.
Four years later I went to call on him in his office in the medical college. I was on the point of leaving for England. Asking for his forgiveness was unfinished business. After staring at me for a minute he smiled and told me that it had hurt him to be so harsh with me in our last interview. But, he added with a twinkle in his eyes, that I would not be leaving for England if he had not rebuked me so.
During my visits to Karachi I used to make it a point to call on him. He had a wonderful sense of humor and would often ask me if I was in need of further reprimand. He retired shortly after my last visit to him in mid seventies. I never saw him again and still regret that I did not visit him at his home. I knew that he was still in Karachi. We had, in one of our conversations, discussed his post retirement plans. One of his children lived in Chicago. I had suggested that he should consider living in the USA. Most of his pupils would be there too. He had firmly rejected further immigration. The move from India was bad enough .
On my return to Karachi from the Quetta visit to my family, I told my party friends that I was through with radical adventures. They commiserated with me and asked me to think about it, before taking any irrevocable decisions. I could go on leave of absence from active politics for a while. It was a great cause. They went on that my talents were needed etc. I agreed with them that the goals were no doubt lofty, but I simply could not afford to let my family down. It was not in my nature to lie back, take half measures, and not carry my weight. I would either work openly, diligently, give it my all or not at all. They gave in graciously.
All this had happened a few months before the annual University examination. By the time dust settled down, we had only three weeks or so for preparation; not my usual three months of study time. I worked very hard, even harder than I had in the tenth grade. But I had had six months then. My study group helped. It was the most drab time of my life. My heart was not in the routine of study, eat, sleep and study again. I was so nervous I could not even enjoy reading a magazine. My conscience would gnaw at me. I could not reconcile my self to the idea of failing. I was hoping against hope. I reminded myself that I had passed the BSc honors examination with far less preparation.
Examination was an adventure. I had, some how, managed the theory papers fairly well. After a life time of sitting at examinations one can assess one’s chances with a fair degree of accuracy. I have always had the knack of guessing what would be asked in the theory tests. In essay type examinations if your luck holds, you can get passing marks even though your grasp on the subject is not all that firm. Oral (viva voce- vivas as they are called colloquially)) examination is another story. My reputation had preceded me to the examination halls. Junior teachers who had only a few years on us were sympathetic They would put in a word with the examiners to go easy on me. The examiners, of course, knew of our conflict with the authorities and besides a few who would be in the ranks of neo-cons now, all despised the military regime.
In Jurisprudence the external examiner, a venerable bearded gentleman from East Bengal, asked me what a posthumous child was. I told him. He asked for an example from world history. I told him of the Prophet of Islam. He was a devout Muslim and was pleased to no end. I later learnt that he had asked the same question from the candidate preceding me. He was from a “westernized family”, and his response had been Clarke Gable, the Hollywood actor. The Professor had spluttered, nearly frothed at the mouth and shouted the poor boy out of the room.
In Hygiene the examiners had, as usual, been briefed about me. Mistaking the examinee who had preceded me the external examiner asked him how they had treated him in jail. He was flabbergasted and too nervous to tell the examiner that he was not the one, and that the candidate who was to follow him was the jailbird. The examiner shook his head. You don’t look like a person the government would bother to take in custody. He wet on; standard of student leaders like all else in society was falling etc. The military were too stupid to judge. Luckily for this poor guy a demonstrator (junior most rank on teaching staff) hastened to clarify the situation. When it was my turn every one was enjoying what in their opinion was a good joke. I had a rather interesting conversation about my term as a “state guest” as prisoners of our type were euphemistically called. Apparently the examiner had been quite a radical in his time and was vicariously sharing my experience.
Pathology was no fun and games. In the practical, laboratory assistants and demonstrators could help you a bit. I had more than my share of favors. In the viva section, Professor Tafazzul was presiding over the proceedings. I gave an inane answer to the external examiner. My professor left the room in disgust.
I managed to get passing grades in Hygiene and Jurisprudence and in the theory papers in Pathology. But I failed the Orals in the latter subject. I had never before failed in an annual examination, not even in the worst days after arrival in Pakistan. I knew I deserved to fail but it still hurt. I had to take the supplementary examination in the subject. I did rather well in the additional examination. I did not lose a year and was duly promoted to the final year. But I had lost confidence. Lady luck had jilted me
I got down to my books in real earnest in my final year. But recovery from neglect of three years could not be easy. Coaching and training for the final year examination begins in the third year. Students are introduced to internal medicine and surgery in that year. They have lectures in the subjects, and attend clinics and operating sessions. It is the first exposure to patients. They are expected to learn to do History and Physical and how would they manage and treat the patient on their own. In the fourth year we were initiated in Eye and Ear, Nose, Throat (ENT), Children’s diseases and obstetrics and gynecology. In the final year study of all clinical subjects were pursued intensively and exclusively.
Pre-examinations period was tense, stressful, but exciting. We were on the verge of entering the profession, which, for most of us at any rate, was a long sought and cherished goal. Part of the oral examination consisted of identification of instruments. Senior residents in various specialties would spread the word that they would oblige us at such and such time. We would congregate at the appointed time. At times we would rush from ward to the operating room to classrooms. Good students were in great demand and would conduct informal seminars for the lesser mortals. I had my own established study group, which boasted of three very good students and two below average ones. I had connections among seniors too. Adeeb Rizvi was, at the time, a senior Resident (describe RMO) in one of the professorial units in Surgery. I had known him through our mutual radical affiliations.
We started with theory papers. Multiple choice had not yet come into vogue. Rumors about the questions were rife. We chased them frantically. Some professors were given to announcing probable questions. We pestered the students who had attended classes regularly to concentrate and recall what a particular teacher had said. More enterprising among us tried to work out “guess” papers*. A few mischievous ones “published” fake papers. Even the best of students were not immune to the pursuit of chimeras. They were worked up about the top positions in the class. The lesser ones only worried about just passing the examination. In the event this part of the test passed off uneventfully.
Oral examinations required different skills. A solid base of knowledge remained essential, but mode of expression, fluency in spoken English, facility to think on ones feet, and external appearance made the difference between good and the excellent. I recall my friend Saleh Memon. He was from a poor and unsophisticated family from the hinterlands of Sindh. He had stood first in the university in the pre-med qualifying examination. He was very intelligent and hard working. His grasp of the subjects of our study was un-surpassed in our class. But he had difficulty in spoken English. His accent was heavily laden by his mother tongue. He was also a religious conformist, sported a beard, and wore his native garments. Most of our classmates had lower middle class background. But we had been exposed to metropolitan milieu and were not averse to adoption of city ways. Not Saleh. He stuck to his mode of dress and appearance. The first impression one would get on sighting him was that a “Taleb-e-Ilm had strayed from a fundamentalist seminary into the medical college.
Oral tests in Internal medicine, Eye and ENT and Surgery passed off uneventfully. In gynecology we had a Professor Siddiqi, the senior most Gynecologist in the country. She used to treat us like wayward children and did not treat other Professors with much more consideration either. She was whimsical. Every one took care not to cross her. She was also rather hard of hearing. During orals she had her Resident Medical Officer (RMO) and senior house surgeons stand behind her (SHS). (RMO, a grade anywhere after second year of training and SHS that after six months). They would prompt the candidates in whispers as the Professor was used to mumbling and would shout if she did not see the candidate moving his/her lips. The candidate was supposed to sit on a bench in front of the professor. When my turn came I salaamed her and took my seat. She seemed to recognize me, and asked me why was I sitting so far away. I pulled the bench nearer her. She taunted me. There was no consideration for sitting at her feet. I knew her staff rather well. They had been NSF sympathizers and had briefed me that I should keep on mumbling. If the professor asked me if I knew any more, I should resume mumbling.
It turned out that she had mistaken me for some one else. Another candidate who came from a feudal family-the same one who had thrown a party in an expensive hotel in the vain hope of enticing her lady love-had sent a family retainer to the professor the night before for “sifarish (recommendation for a special consideration. Professors at that time would not pay much heed to this kind of approach, but would not snub the messenger either). That examinee followed me. He was a fairly good student in his own right. Miss Siddiqi turned hostile immediately. She told the hapless man that she knew him quite well. That resulted in a satisfied and self-congratulatory smirk on his face. The smile was wiped right off at her next remark. You did not attend my classes. You sat under the tree near the lecture hall and teased the girls. I will never “pass” you. He was stunned. With out letting him explain she threw him out. It took a higher sifarish and the intercession of her resident staff to get him a passing grade.
I thought that I had done reasonably well. But the results told another story. I had failed in oral section of the examination in surgery and would have to appear at the supplementary examination in the subject again. It turned out to be a blessing in disguise. I had already failed once in the fourth year. If I had passed in the annual examination, I would be competing with students who had an unblemished record and my ranking would be too low to allow me to choose the specialty of my choice. Top ranked doctors were given the first choice. Internal medicine and General Surgery were the coveted choices. Radiology, pathology, ENT, and orthopedics were low on the totem pole. Girls chose ob/gyn by intent. By the time the turn of any one ranked fifteen or so arrived all the ‘good” slots would be taken.
Now I was poised to take a decision, which would affect the rest of my professional life. I knew that Anatomy was not a “natural” subject for me. Surgery required a good grasp of anatomy. Internal Medicine required ability to distinguish between heart sounds in health and disease and the finer faculty of analyzing heart murmurs. The latter was difficult enough for good students who had spent years fathoming the intricacies. I was hard put to telling the first heart sound from the second. I did have good analytical skills, and they would have come in handy in differential diagnosis . I had perhaps over rated heart sounds. But the real reason for opting for surgery was that I was very impressed by a stalwart of 1953 student movement, Adeeb Rizvi.
I have mentioned Adeeb a few times already, but it will bear repetition. After spending months in jail during the nineteen fifties, he had returned to the pursuit of a medical career with a vengeance, as it were. He had been a studious person before he got deep into the struggle for student rights. His rehabilitation was, therefore, not so difficult. He gave a creditable performance as a medical student. I had, of course, known him as one of the icons of the “left” in Pakistan. He was a RMO in a surgical unit at our teaching hospital and had coached us in identifying surgical instruments, which was a rather important part of oral examinations in surgery. He is the most hard working, dedicated and focused person I have come across in my life. His dedication borders on the obsessional. He embodies the saying that genius is ninety nine percent perspiration and one percent inspiration . Another story is relevant at this point. Some years later, I had gone for an interview in a Hospital in England in which Rizvi was working as a surgical registrar. (It is a midlevel job in the British medical system, generally given to person who has passed the relevant specialty examination). Before the interview I sought looked him up. He told me emphatically not to accept the job. I was surprised. One of the consultants in the department was a world-renowned. Rizvi had to run to attend to an emergency, and told me that he would catch up with me later and tell me about it.
In Britain, if you are offered a job and turn it down, the hospital would not pay the traveling expenses incurred for the interview. . For those days, with the rather low salary we were paid, it was a considerable amount of money. On the other hand if you were not offered the job the Hospital would reimburse the expenses. In view of Rizvi’s admonition I had to make sure that I was not selected for the post. I, therefore, gave indifferent answers to the interview board and behaved as though it did not matter to me one way or another. I do not know if it was that they were put off by my nonchalance, or they did not find my qualifications, experience and recommendations inadequate, but they did not offer the job to me. I rather suspect it was the airs I had put on that did the trick as a) I had FRCS diploma, b) I had sufficient experience in the specialty and c) I was successful in getting selected in the next interview, which was in a more prestigious hospital.
Rizvi was waiting for me when I came out of the interview room and took me to lunch. I was waiting with bated breath to be told what he thought was wrong with the job and what horrors would visit on me had I worked there. I could not believe my ears when he told me that there was not enough work in the department. I was stunned. A job with a low volume of work would suit me fine. Working with an internationally known authority would bring its own rewards. The man -Mr. Barlow- I would have worked with has a test for diagnosis of Congenital dislocation of Hip named after him My mentor, from his perspective, would rather see me work as hard as possible, earn admiration of my bosses and get ahead in the profession!! I got as near as I would ever be of being rude to a person I have such high regard for.
To revert to my decision on what to do after MBBS, I wanted to emulate Rizvi.
One can get carried away on a wave of admiration for a person. I was nowhere as hard working, dedicated or focused. I had a fair idea that of all the medical fields Surgery was the least suitable for me. At this juncture, one of my classmates whom we used to half-jeeringly call the athlete because unlike most of us he was keen on sports. We used to cover up for our physical weaknesses rather effectively by making fun of those who were robust of body. He told me to go ahead, try surgery for six months; it along with six months of medicine was a requirement for registration with the General Medical Council of the UK any way. He would take medicine; we will swap jobs at midyear, in the process completing the whole requirement.
A few words about this friend, Arshad Husain would not be remiss at this point. He was to make a name for himself in the field of psychiatry, - the specialty he eventually chose. He did a lot of humanitarian work in Bosnia and other sites of ethnic cleansing and assorted disasters. He is one the most street-smart men I have ever met .
In the event, when the time came, neither of us was quite willing for the swap. He was happy where he was. I had developed a little interest in Surgery. This was mainly due to the Professor I was working under, Col Saeed Ahmad of blessed memory. His was a many faceted personality. He worked day and night, (I think Rizvi, although biologically not related, takes after him), was highly unorthodox in his techniques and had a passion for reconstructive surgery and has assigned a special ward for repairing cut noses .
Col Ahmad was rather moody and temperamental and when in a bad mood, which he usually was at the beginning of the day, could argue you to the brink of exasperation. After he had had several surgical procedures under his belt, no one could be more charming. One house surgeon taking advantage of his mellow afternoon mood said to him “Sir we work the whole night to get cases ready for you and you come and find fault with us in the morning”. Col Saheb turned to him and said “do not get upset over what I tell you in the morning. If I am annoyed with you late in the day that is serious”. He was very fond of poetry and could quote whole poems verbatim.
During one late afternoon surgical session, he asked me why had I chosen a job in surgery? I rather pompously said, because it was exiting. He stared at me for a moment and came out with a compliment. You would get far in the field. I can’t express my elation in words.
He was a stickler for form and punctuality. On out patient days he would arrive in the Hospital at about 9 am, make detailed teaching rounds lasting two hours, with about ten of his medical staff, more than two dozen students and half a dozen nurses. It was quite a spectacle. He would then go on to the clinic. On operating days he would arrive at 7.30 am and would want to go to in to the theatre (operating room “OR” in the USA) immediately. If there was any delay for any reason, the RMO will get it. He would often return after his evening office hours to deal with emergencies. He expected students to arrive in the wards or the OR at 7.30 am and the RMO to take formal attendance. This practice was not followed in any other surgical or medical unit in Karachi. No other professor spent as much time in teaching.
He insisted that assistant Professors take first call from the Casualty (ER in the USA). One of the assistant professors would take calls conscientiously. . The other one Naseer Sheikh, who would have done credit to any diplomatic service, and who had been a demonstrator in Anatomy while I was a student, asked me to cover for him. I used to brief him before Col Sahib arrived in the morning. He would report as though he had attended all the cases. A casualty officer, who had been a house surgeon in our unit, hated his guts. Naseer Sheikh had been very rough with him. This doctor, Iqbal khan called me one evening while I was with Col Saheb in his private office. He picked up the phone and on recognizing the voice of his former house surgeon asked him why was he calling. Iqbal very “innocently” told him that Dr Naseer was on call, the department had several phone numbers for him but he was not available on any and would he please allow his RMO to attend to an acute emergency. Col Sahib stared at me hard, and asked me for an explanation, how long had this been going on etc. Caught on the wrong foot, I confessed all. He told me to go to the ER and call him back for instructions. I was not to call Naseer on any account.
As luck would have it we spent the better part of the night in the OR. Next morning I apprised Naseer Shaikh on what had transpired. He was visibly upset. I pleaded that I could not disobey a direct order from the big chief. Nevertheless he turned nasty. But the aftermath was very pleasant for Iqbal Khan and others who had it in for Naseer Shaikh . I have never witnessed such skillful and devastating dressing down as Naseer went through that day. It pleased me immensely.
After working for Col Ahmad for a year I left for a six-month stint as a demonstrator in the department of Anatomy. When his RMO left, Col Sahib was kind enough to recommend my appointment in his surgical unit. He liked his RMO to be in attendance all the time he was in the Hospital. Unlike most Professors of his time in Pakistan -later ones did not particularly distinguish themselves either- he was keen on research and publication of the work. Since he did not have much by the way of secretarial assistance, it fell upon the RMO to take dictation for his articles. I used to be irked by it, as were my predecessors. But the training was a blessing. I owe whatever little facility I have in writing to Col Ahmad.
Once when I was accompanying him to a lecture, he asked me if I had any money? Not quite getting what he meant, I asked him how much he needed? He turned his head towards me, smiled enigmatically and said he did not want to borrow from me. He meant how was I going to buy an air ticket to England? England ranked almost as a predestined destination for us. I said I would manage somehow, do a bit of private work and save. He did not say any thing to that. I took it as idle chat. But he started paying me generously for the work I did in his private clinic. I know it for a fact that he did not pay a penny to my predecessor who was well heeled. He retired while I was still in his unit. When he left he gave me a check for a large amount. I protested. He told me that it was his wish and I had no right to demur.
I continued as an RMO in his unit. Naseer got temporary two-week charge and discharged all the favorite patients of Col Sahib. Fortunately the permanent replacement, Professor Fazal Ilahi was a through gentleman. He asked me to spread the word around that the patients who had been thrown out by Naseer were welcome to come back.
I proceeded to England. Arshad was by that time a Registrar in Psychiatry, which is a less, sought after field. Hospitals tried to entice Doctors into working in the specialty by offering amenities un-matched elsewhere. They were given higher rank- Registrar level- as compared to that of Senior House Officer in, for example orthopedic surgery. Salary, commensurate with the senior grade, was better too. Additional facilities included much better food, greater choice of dishes, low workload, and luxurious rooms.
Arshad convinced me that surgery was too much work, had a longer training period with little prospect of promotion. One could never hope to become a consultant in surgery, while it was a given that after adequate training and passing the postgraduate examinations, one could walk into such a job in psychiatry. He arranged an interview for me with his chief, warning me that the man was a procrastinator and would promise to get in touch later. I was to tell the man that I had another interview and would he please tell me now. It did not quite work that way. I followed the script. The consultant told me to go to the interview and let me know what transpired.
Arshad even had time to accompany me to my interviews. In one of them in orthopedic surgery, I was offered the job. I told the interview board that I wanted to consult my friend who was waiting for me outside the room. The Chairman of the Board warned me not to take too long as they had another candidate for the job. I had a brain wave. I told the man that I knew who the other candidate was. He was my classmate Dr Absar Khan and we had come to London on the same flight. The man could not believe his ears. Britain was at the time suffering from acute shortage of junior Doctors. I had had twenty-five responses by letter, phone and even by telegram to my twenty-five applications. Absar had had the same welcome. We used to compare notes. We were staying in the same place courtesy of a friend Dr Khalil Ahmad. My shot in the dark had found its mark. I went outside and asked Arshad for advice. He had seen a particularly fetching nurse pass by, and told me to accept the offer. I did. Thus began my career in orthopedic surgery.
My first six months in England were rather uneventful. I had the usual problems adjusting to an alien milieu. Initially I had great difficulty in understanding the local English accent, though I was in Guildford in the south of England, where they were supposed to speak “Queen’s” English. I would often have to go to the wards, as I or the nurse I was talking to, could not make out what the other was saying. Once in a while I would actually have to ask the staff to write what they wanted! Work schedule was not heavy. I assisted at the clinics and the operating rooms, made rounds with the chief and the Registrar and did “History and physical”. This went on for two months. I was then assigned first on call in the ER.
I had a few interesting experiences in the ER. A thoroughly soaked soldier was brought in. His girl had run away with some one else and he had decided to end it all by jumping in the river. But the water was too cold. He waded out and was rescued by the police. On another occasion a drunk wanted to see for himself if the insides of an Indian looked the same as that of a white person! When the Sister (Head Nurse) remonstrated with him, he said, “Your blue uniform does not frighten me (I have described the “unusual character” of British nurses elsewhere).
I had been given a small room in an apartment building near the hospital. It was had a sink, a bed, a small desk, a chair, a lamp, a tiny closet and not much else. The hospital provided food and laundry service. I was not used to British food and subsisted on omelets and toast at breakfast, lunch and dinner for the first several weeks. Once the cook prepared a meat curry as a special treat for Indian doctors. I asked a Bengali Doctor (Muslim) what meat it was? He said it was beef. After weeks of omelets it tasted very good. Later the man told me that it was suckling pig curry. Although I was not a believer in any religion even then, I was sick for hours.
It was a small hospital in the Southeastern English county of Surrey, which is in the snobbish region of England . There was no Indian restaurant. Once in while, on a weekend, we would tell the kitchen that we would not eat in the dining room. They would give us meat, cooking oil and vegetables. One of the Indian doctors was a passable cook. We would have a good time.
Junior staff in the hospital had two social groups, the native and foreigners, with little out of work contact between them. White doctors, even though they had a monopoly in all the prized jobs, resented us, as with out the doctors from the subcontinent they could have pushed the department of health harder for better conditions of work and higher salaries. What cut them to the quick that the nurses were partial to brown skin and would go out with an Indian doctor than with a white one. That Indians treated them with much greater courtesy must have been a part of the equation.
In those days England was very formal and conservative. You did not talk to people unless formally introduced first. Once on a railway train I started a conversation with a fellow passenger. He was taken aback. You must be new, he said. I said, indeed I was and what part of England he hailed from. The color on his face rose to rich magenta. Then he controlled himself and in a grave voice told me that he would give me a piece of advice; never to call any one English unless I was a hundred percent sure. He was Irish and to be called an Englishman was a mortal insult!
During my first hospital dinner, I lighted my pipe after the meal was over. The White doctor sitting next to me was horrified. The toast to the Queen had not been drunk yet. My chief at the head of the table had noticed the “transgression too, got up hurriedly and raising his glass said “to the Queen”. We all followed him! Shops closed at five in the evening on weekdays and at noon on Saturdays. Sundays you could not even buy cigarettes if your life depended on it. Even Oxford Street in London would close its door at 12 noon sharp on Saturday. Only the pubs would open in the evening, but they too would shut their doors at 11.00pm. The British were sticklers for traditions of all kinds. In the bars, the tender would ring a bell at ten minutes to closing time for last orders. You had absolutely to leave by the appointed time.
Guildford was less than an hours train ride from London. I had half a day off every week and every other weekend was off too. After a few weeks in Guildford my friend Ali Ahmad arrived in London and was staying with his brother near Notting Hill gate. I visited him every weekend and most half days. The area has a lot of mid Eastern shops and the food was a boon. I was lonely. I had not learnt the art of flirtation, and never asked a girl to go out with me. I am not a quick study. It took me years to get the courage to ask for a date. Books were, as at most times in my life, my most faithful companions. I was into the light reading phase of my life and concentrated on P.G.Wodehouse. The author remains my most enduring passion.
Medical education, training and practice in Pakistan and the UK were (and are) very different from each other. In Pakistan, sophisticated laboratory tests were not ready to hand and had to depend much more on clinical diagnosis. We also tended to treat symptoms empirically. Peter Weismier my Registrar in Guildford, a gentleman from Malta and therefore an immigrant himself, gave me an object lesson. I had prescribed, as the standard practice was back home, an antibiotic to a patient who had developed high fever after surgery. I had not made any attempt to find out the precise cause of the fever. He asked me why had I started the patient on antibiotics. I told him, “ He had high temperature”. He let a barrage of questions loose on me- if I had bothered to find the underlying cause, if all the fevers could be treated with antibiotics, if I would treat Malaria the same way, if I had even looked at the dressings to see if the incision was inflamed etc. I was struck dumb. He relented and told me that he was a foreigner like me. We were judged by a different and a higher standard. Our work was scrutinized with greater vigilance. We had to be more careful than the natives had to be. For my own good, he added, I should learn the habits of rational thought and analysis. I took his advice to heart and have never since prescribed any medication with out first finding a good and rational reason. The other lesson I learnt during my six months in Guildford was the real value of record keeping. Only Col Saeed Ahmad among all the professors in the Hospitals in Karachi had insisted that meticulous records be kept. In fact we used to have chart rounds. But we had attributed it to a strange streak in the chief.
Indians used to get terribly upset when English men in India used to claim that all natives looked alike. We thought that the rulers were insufferably arrogant. During my first few weeks in the UK all the white men looked the same to me too! (All white girls seemed equally pretty). I told my chief of this observation. He, a rather crusty but proper gentleman on the verge of retirement, was not amused. Expressions of the spoken language were also a bit of a problem. Once my consultant told me “I would go to the library and look up something”. I did not know why he was telling me what he himself wanted to do, till the Registrar nudged me and whispered in my ear that the old man wanted me to go and read on the topic and tell him.
I wanted to complete my training, pass FRCS examination and go back home as soon as possible, and saved every penny I could for the fee of the tutorial course and living expenses for the six months of the one held at the Royal College of surgeons in London. The course would help me prepare for part one called the primary FRCS. I remember I used to get fifty pounds a month. About three or four times a month I would be asked to sign some kind of medico-legal papers for which I was paid five pounds each. With board, lodging and laundry free, there was not much to spend on except tobacco for my pipe and the train fare for the once a week visit to London and a few sundry expenses there. I applied for and was accepted for the prep course. I had six weeks between start of the course and the last day of my current job.
I started applying for a Locum (short term jobs). I had never worked in Obstetrics and Gynecology, and had had awkward moments in casualty department, (since renamed accident and emergency in the UK.), when I was asked to perform an internal examination on a female . To my surprise I was called for an interview in one such department in Leeds in the north of England for a job as locum SHO. To my greater surprise I was offered the job. Under normal circumstances, one had to train in the specialty for one year before being considered for this level of appointment.
When I arrived in the hospital one evening a few days later, I found all the junior Doctors in the department holding a caucus in the Doctors lounge. The Registrar asked me if I had any experience in the specialty. On being told that I had none, he glared at me. In what he thought was a cutting tone, and which would reduce me to a confused mass of protoplasm, he enquired of me; how on earth was I to supervise the junior Doctors and take independent call in Casualty. I told him to hold his horses. His chief had given me the job. I had sent my CV in advance, which made it very clear that I had not worked in the ObGyn before. His questions should be directed to the Chief. I added that if he would like to, we could call the boss right away, and ask for an explanation. At this he seemed to shrink visibly.
To be fair, their discomfiture was justified. Among the junior Medical staff, the department had one Registrar, two SHOs, and two Junior House officers. The Registrar shared Casualty calls with the SHOs, so they would take calls once in three days. With me out of the equation, it would be one in two; quite a heavier burden. The other SHO, a Muslim lady from Bombay was not amused either.
It was decided that I would be second on call with the other SHO, and do all minor operative procedures during the day for others as recompense. Their routine was that the doctor who admitted a patient who required a D&C would perform the procedure. I ended up doing the D&C’s for all the doctors. It was a very large department so I did about a dozen such procedures each day five days a week for six weeks. I am sure I set something of a record, as a busy practitioner does not get to do more than half a dozen a week.
On my first day at work the ward Sister asked me to do History and Physical (H&P) of a patient. I was trying to decide on what questions I would ask her. Correctly diagnosing my predicament, one of the Junior House officers, a charming young Hindu lady from India, took pity on me and offered to do my work. The relief was immense. I asked her if I could do anything for her. She said, well you could draw some blood and start a few intra venous lines. I could kiss her, and would have, but she was married and her husband worked in the same hospital.
On second thoughts I should have. From then on she did all my work in the wards and in out patients department. She was from a very sophisticated background; her grand father had been a distinguished member of the Indian civil Service under the Raj and had been knighted for outstanding performance. In those days it was rather rare for an Indian to be member of the coveted Superior services and knight hood was rarer still. The British nearly exclusively filled the slots. She was married to an Indian Doctor who was rather ordinary, not quite a hillbilly, but as close to it as can be. I am probably being too harsh to him. I must confess, I was jealous. I have never so regretted coming across a married woman.
Civilization has its drawbacks. I had to be nice to him. We actually became good friends. I took to calling my benefactress “Bhoji” . The couple followed the Jain religion, an ancient and pacifist faith in India. The adherents of the religion are strict vegetarians. They don’t even eat an egg. Any form of life has supreme sanctity for them. . In India the more devout ones go around with masks on their faces lest they inhale an insect. They do not wear shoes either so as not to crush a worm underneath. The husband was trying to assimilate and attempted to eat eggs with the same disastrous result that I had when I had mistakenly eaten suckling pig curry in my previous hospital.
We met frequently while I was in London for the primary course and they worked in a hospital in the city. They visited me in 1968 when I was in Slough. I lost touch with the couple after a few years. I did look for them when I spent a few months in the UK in 2001-2002. I found many old co-workers, but not them. It is one my more poignant and lasting regrets of life.