Chapter 15

Chapter 15

England 1966-72


For a Doctor who had worked for only eight months in the country, taking the eighteen week long primary FRCS course offered by the Royal college of surgeons in London was an ambitious financial undertaking. Examinations would be held another few weeks after the course ended. Expenses for lodgings, food, transport for a six month stay in London and the fee of the course, books and sundry expenses would come to a substantial amount of money. I discussed the issue with a friend who had accompanied me on the flight to London. We were in the same financial boat. After several sessions we came to the conclusion that we would just be able to make it. We also discussed the financial out lay with other classmates and friends who were planning to embark on the same course. They had been in the UK for longer. One of them had worked in Saudi Arabia for two years. Compared to us they were well heeled. But they encouraged us, and very generously offered to give us loans to tide us over. One doctor who had been a house surgeon with me in Karachi had already passed the examination. He gave me all his books and notes of the lectures.
Saudi Arabia played a significant role in the lives of Pakistani doctors and other health personnel in the nineteen sixties and seventies. Health services in the country were largely manned by Egyptians. Saudi King Faisal was apprehensive of the influence Nasser of Egypt had over the Arab world and especially over his own countrymen. Faisal had oil money, but the Egyptian leader had caught the imagination of the Arabs . Faisal suspected Egyptians of constituting a fifth column in his country. They had an inbuilt advantage. They spoke the Language. The King decided to throw them out. He offered a generous salary structure and found a ready and plentiful resource in Pakistan. In a matter of months he was able to replace nearly all Egyptian doctors with Pakistanis. He could, however, not find as many nurses, and other cadre. Some of the medical health providers had acquired Saudi nationality. They could not be thrown out.
Residual Egyptians naturally resented that Pakistanis had supplanted their compatriots. They tried all means, fair and foul, to undermine the new comers. They were initially quite successful. Pakistanis, devoid of even rudimentary skills at the language, could not communicate with the average Saudi. They lacked roots in the society as well. My friends related several horror and a few funny stories to me. I would narrate a few. A dead body was brought to one of my classmates. The Egyptian male nurse in the clinic told the attendants that the person was actually not dead, and incited the relatives of the deceased to ask the doctor to give the body an injection. He was hoping to put the blame of death on the doctor. My friend refused to comply with the request. A crowd gathered and was turning nasty. Fortunately for my friend, a notable of the town whose child he had treated successfully happened to pass by. The man spoke a few words of Urdu and could communicate with the doctor. He managed to pacify the crowd and slapped the nurse .
We decided to take the plunge and started looking for cheap lodgings and found one in a rather dubious neighborhood. A notorious maximum-security jail was at a stone’s throw. One of us had come across a three-storey house owned by Pakistani of Kashmiri origin, which had a “Rooms to Let” sign on the door. The man was crude and ill mannered. But he was obsequious to us. It was an honor that doctors would deign to live in his humble abode.
The premises were shabby and poorly maintained. Wallpaper was peeling off all the visible surfaces. Tiles were missing from the floors. Carpets were dirty, windows ill fitting, stairs hazardous, and sinks dysfunctional. We had not seen such an example of decrepitude in Britain. But it was cheap. Six of us rented three rooms, one with three beds, another with two and one cubbyhole with a single bed. The man’s wife would give us breakfast and supper. She, poor soul, appeared to be much more sophisticated and was kind hearted too. The husband exercised strict control over her, but she would manage once in while to cook a decent meal for us.
Our lodgings did not boast of central heating or running hot water. To be fair, few private homes in the country did at the time. We had to put coins in a slot to get gas to heat water for shower and to heat rooms. The heater in the room I shared with two of my friends was defective. The flame would abruptly shut off and gas would keep on running. It was quite a hazard. We could not go to sleep with the gas heater lit, lest the flame go out and we be found in eternal sleep the next morning. To add to our misery one of us was a fresh air fan. He would surreptitiously open a window. The room would get ice cold. The other roommate would shut the window. The two would break out in loud arguments in the middle of the night. I not only had to mediate the recurrent disputes but also had also to be on a look out for the antics of my roommates. We finally agreed to take turns in opening the windows and lighting the fireplace. The owner made many promises to get the heater fixed, but never did.
It was a good twenty minutes brisk walk from the house to the Tube station (Subway in NY). With a change of train mid way, it took another half hour to the Royal college of Surgeons near Holborn tube station. The classes had started in January. It was quite an uncomfortable commute; especially the walk to the station in cold freezing and at times snowy weather. Roads used to get quite slippery. London City Corporation was not very efficient in plowing roads or sprinkling salt. A few years later I had the nerve-wracking experience of being in the middle of dozens of motor vehicles careening out of control on the London Bridge. For FOBs, (Fresh off the boat, an American college slang derisively applied to new comers) hitherto used to the tropical weather back home, it was bitterly cold. I remember I used to shiver on the evening train journey back from London to Guildford, in the middle of my first English summer.
About one hundred fifty doctors were enrolled in the course. Most were non-British. Lectures and laboratory sessions started at 8 am and lasted till 5 pm. We were allowed fifteen minutes for tea at 10.30 am and half an hour for lunch at 12.30 in the afternoon. It was quite hectic. We were exhausted at the end of the day but could not afford to relax*. (I did take an hour-long nap between six and seven in the evening, a practice I have been able to keep to for as long as I can remember, though not necessarily or always at a fixed time). There was not much of a social life to speak of. We studied till late at night, and got up early. Weekends were also spent poring over books. Once in a while we would go to a restaurant near Warren Street, which sold cheap Biryani*. (It is a spicy and delicious rice and meat dish, very filling and soporific. It is believed to owe its origin to the Nawab period of Indian Hyderabad). We did not have any spare funds, to speak of any way, to fritter away on a good time. The ones with regular girl friends were forced into abstinence. Nearly all were forsaken by the delicately nurtured. If the studies got to be too much we would visit the few friends with in fairly easy commuting distance. They would as infrequently return our calls, and marvel at our living conditions. Over all impression I retain is that of dark evenings, cold rooms, poor lights and oppressive books. Things got a bit better as spring approached, but then the examination was around the corner.
We had discovered, ruefully, that the Anatomy, Physiology, Pathology and Biochemistry, we had been taught in Karachi were outdated and bore little resemblance to our current teaching. We were completely out of our depth and had to make up in a hurry. The teachers were, however, excellent, masters of their subject and good orators. Professor R. Salome of Physiology, R.J. Last of Anatomy and A. Cunningham of Pathology impressed me most. The last named had a rather expressionless face, but was lucid, to the point and easy to follow. During the eighteen lectures that he gave us, he told a single joke. While discussing the relationship between ultra violet rays and skin cancer and the vulnerability of fair skin to sunlight, he became lyrical and wistfully declaimed “ if you are fair and young don’t go to Australia”. I think he had lost a fair object of his passion to the continent.
Professor Salome spoke rather fast but intelligibly. He once asked the class “ who wanted to become a consultant” We, with one voice shouted yea". Salome then recounted this story. A young and good-looking girl lived in an apartment building. She had a tomcat for a pet. Of an evening she would go out. In her absence, the tomcat would gather all the cats of the neighborhood and they would cause a racket. The neighbors protested but the girl confronted them with the “pets allowed” clause in the lease. The victims hit upon a plan. One young man offered to take the girl out and keep her till late in the evening. The tomcat was castrated in the interval. All was quiet for a few weeks. Then one evening all hell broke loose in the girl’s apartment. Curious, the dwellers of the building went to the apartment to see what was it all about. They found the tomcat sitting on a table and supervising a score or more of cats and tomcats. On enquiry as to why he was still interested in amorous activities, he said that he had become a consultant!
R.J. Last us told us of tricks of writing essays. In the first paragraph define what you think the question is about and how you are going to go about dealing with it. The examiner would most likely not read beyond the first page or two. He was right. I will relate later how I got by using the trick.
We had a solitary South Asian girl in our class who looked, at least to me, more like a fashion model than a doctor. She dressed the part too. I took her for A Hindu girl. One tends to romanticize objects out of easy reach. Urdu and Farsi poetry is replete with references to the beloved as Hindu, Kafir and Turk. I have yet to find a good explanation why Turkish girls are classed with the infidel of the sex.
One sublime couplet says it all.
“Agar Aan Turk e Shirazi Badast Ara Dil e Ma Ra
Bakhal e Hinduash Bahhsham Samarkand o Bukhara Ra”
In my inelegant translation it means that if my Hindu-Turkish beloved of Shiraz would only hold my heart in her hands, I would give away cities of Samarkand and Bokhara for the mole on her cheek*. (The King had the poet Hafiz Shirazi hauled up in his court and quizzed him. He the King had won Samarkand and Bokhara in hard fought battles and the poet was giving them away for a mole on the face of a girl. Hafiz shot back. That is the reason you are a King and I am a pauper!)
This damsel also reminded me of a rather fetching classmate I had, from fifth to eight grade, back in India. I had my first crush on her. Nearly every one in my class did. During a visit to England in 2001, another classmate from those days showed me her rather faded photograph. He would not part with it, neither would he agree to give me a copy.
Nearly all my friends and others in the course, Asians and natives alike, tried to attract the attention of this lady. Over the next few weeks she started mixing up with other South-Asian Doctors. I discovered that she was from Pakistan. I was terribly attracted to her, as were dozens of others in the class. But I hid my passion in a cloak of strong reserve. That was to be my undoing-literally. She took me for a strong silent type. We inevitably came across each other, during classes, laboratories and in the cafeteria, and discussed topics of our academic pursuit. At times we talked about our future plans, careers and ambitions.
I had been an activist during my days at the University of Karachi and the medical college and had read books on all topics on earth and was particularly well informed in current affairs. I had earned a reputation as an “intellectual”. Doctors from my college tended to look up to me. The ones with me were rather more under my influence. Two of my classmates were particularly smitten by her. I had frequently to keep them from getting at each other’s throats, but they did come very close to blows once.
One fine day she did not show up for classes. We were all concerned. We eventually found out, I can’t recall how, that her mother was very sick She had flown to Pakistan to visit her. She returned a week or so later, none the worse for the long journey. She had missed classes and her studies at a critical time. It was just before examinations. But she still managed to pass the examinations. Beauty and brains, it was almost too good to be true. She belonged in dreams.
I did not pass the examination; my Achilles heel, my bane – Anatomy had let me down. I was very depressed. She encouraged me. There would be other examinations. It was not the end of the world. I felt almost happy at my failure. If I had been successful she would not commiserate with me. We had about a week before proceeding to our new jobs. She had not had enough time to apply for one. Our group, which now included her, did the rounds of all the tourist spots including the Tower of London, Hampstead and Buckingham palaces, and Kew Gardens etc. I recall once that on the spur of the moment we decided to go to a restaurant in Piccadilly. We did not realize that the place was very expensive. An immaculately turned out waiter respectfully seated us. The décor shook us a little more. The menu finished the job. If my memory is not playing tricks, it was she who suggested that we should slip away while the waiters were looking the other way. I was impressed by the presence of mind and lack of pretensions.
During our wanderings, she and I would often fall back and indulge in private conversation. She talked of the future, our hopes and aspirations. I dwelt on art, poetry literature, politics and current affairs, in a by now, conscious effort to impress her. There was plenty to keep me riveted to her. I could not, for the life of me, see what she found in me. She could only have been taken in by my intellectual pretensions. I am short, bookish with looks girls don’t write home to their mothers about. But my friends had started getting jealous. One of them came straight to the point. My interest was not platonic, he told me and it was not fair that I monopolized her attention by pompous monologues on philosophy and history. He went on to warn me that girls do not like serious discourse. I shot back that in that case he did not have anything to worry about.
At the end of the all too short holiday, I asked her if she would like to apply for a job in the Hospital I was going to work in. I fully expected her to decline the invitation. In those days, this kind of offer amounted to a proposal of marriage, or at any rate as near as one could get to, with out saying so in so many words. To my utter surprise, and under the circumstances, profound elation she agreed.
The next day we took a train to Swansea in Wales where I was to start working in neuro-surgery. The following day we called on the Medical Superintendent, who surely enough gave her a locum (temporary job) in Orthopedic Surgery. We were happy. Using the standard Pakistani formula, I had introduced her as my cousin. I thought our idyll would continue. But she had other ideas. She exhorted me to resume study for the primary FRCS examination immediately. She even bought a watch for me to time my essays. I would have preferred to gaze into her eyes, hold her hand and tell her how good life was. But girls are pragmatic. And in the state of mind I was in, I would have pursued a doctorate in nuclear physics if she had asked me to. In a few weeks she got a substantive job.* (Substantive jobs had a fixed term duration of which was related to the grade. A house surgeon would be appointed for six months, a senior house surgeon for a year, registrar for two years and so on) in a hospital an hours train ride away. With primary FRCS in hand, she could have opted for a more prestigious job at a distance. I was flattered that she had elected to stay near me.
One evening, a Doctor fresh out of India, who had arrived in the hospital only a few minutes ago knocked at my door. I was deeply engrossed in my studies and did not like the interruption a bit. The poor man was hungry and did not know where the dining hall was. I took him there. It was past the regular suppertime. The dining room staff told me that service was over. I had to tell them rather forcefully that the doctor was new, had just come off the railway train and they must feed him. They could certainly make an omelet and toast etc. They acceded to my demand with ill grace. About half an hour later the doctor knocked at my door again. I asked him quite testily what did he want now? He sheepishly asked me if I would like him to make coffee for me. I consented to the service quite gruffly. The man not only made coffee for me then, but also cooked for me and catered to me till the day I left for London to take the examinations. I have never been repaid so generously for one single act of kindness.
He was a good mimic too. He was adept at imitating singers, Moulvis and Pundits. I recall many a pleasant evening of entertainment when we would get together and enjoy his antics. He was a good cook too. He was from a good family in Lucknow. They had a flourishing lumber business, which they had lost after independence. He blamed the atrocious discrimination practiced against Muslims in post-partition India. But he was far from bitter. He had a carefree, happy go lucky disposition and soon spent most of his time chasing girls. I gave my lecture notes to him to encourage him to prepare for postgraduate examinations. He thanked me sincerely but did not change his ways.
When they learnt that I was preparing for the primary FRCS examinations, other hospital staff members gave me full consideration, as did my consultants.
Welsh people are nearly as laid back as Indians. If it was only their concept of punctuality, consistency and good fellowship, you could not tell them apart. The hospital was seven miles from the city center and the railway train station. Public transport was poor. We had to take a taxi to town for shopping etc. Once I had to catch a train to London. The Taxi driver was late. I scolded him. I would miss my train. He said, “I will be back in a minute” and took about five. I was more annoyed and told him off. He laughed and asked me to hold my horses and drove like a manic. I wished I was a religious man so could pray to the Almighty for safe deliverance from the lunatic. On arriving at the station, he screeched to a stop barely avoiding a truck, and with a twinkle in his eye asked me to keep the money to purchase the ticket ready. I ran to the station certain that I had missed the train. A man in uniform asked me if I was the doctor for the London train. On my affirmative nod of the head he gave me the ticket, took the money from me, promised to return the change when I came back, and pointed to the train. I boarded the train and it took off immediately. I asked the guard what was all that about. He smiled like a minor saint in the act of blessing a penitent. The taxi driver had called the stationmaster and asked him to hold the train for me. Next time, he went on, I should make sure to get another taxi driver, this one was surely crazy as a coon .
I had formally proposed marriage to my ladylove before she left for her new job. She had agreed but would like to put it off till both of us passed the Final FRCS examinations. I did not want to wait but she won’t budge. It had to be a proper wedding with all the customs and ceremonies. She did not to make it seem as though we were eloping. I did write to my mother who wanted to know more about her, but did not say no. My sister was very exited. The news soon spread through the very active Pak-Indian grapevine and I was inundated by calls of enquiry, felicitations and dire warnings.
I went to London to have another shot at the examination. To keep my spirits up, she would call me at least once a day. A doctor from Pakistan was staying in the same hotel. He got quite envious of the calls and complained to his English girl friend. She sneered at Pakistani girls. His feelings and pride were hurt, and broke off ties with her.
This time I passed. She deserved most of the credit and I told her so. She graciously accepted the tribute. As an award for good behavior and for passing the examination she agreed to spend a weekend with me in London. She stayed with some cousins forty-five minutes train ride from the city. I think she told them that she was attending a medical conference. I bunked with friends and told them I had to leave early to be at the Royal College. We met at a cinema showing “Moghal-e-Azam”. We saw it twice in one day. My friend was very acute. He slyly remarked that he had never seen any one so happy after a full day of lectures. The next day we saw “ Ganga Jumna” twice again. For the uninitiated, Indian movies are three hours long. We must have set some kind of record of holding hands for six hours, two days running. On Sunday evening we missed the fast train and had to take one, which stopped at every blooming station. I have a suspicion it tarried in places with out stations too. I got to my station at four am and had to wait for three hours for the bus. Her stop was mercifully three hours further down.
The hospital I was working in was not high ranked. We had quite a few doctors from the India and Pakistan. (Bangla Desh had not seceded from Pakistan yet) Hospitals were informally rated by the percentage of native doctors among the junior staff. The teaching hospitals (in the USA all Hospitals style themselves as teaching institutions. In the UK only the ones attached to Medical Schools were so designated). Overseas doctors were generally a cohesive lot. I remember some native doctors had refused to eat with some of the Pakistani doctors in another hospital in the town. The latter had complained to our doctors. A delegation from our hospital had visited the other hospital to protest.
I had an interesting experience in the hospital. I had taken care of a patient with a serious head injury. He had recovered and had invited me for a weekend visit to his pub. In those days innkeepers had a room or two on top of the pub and rented them to the occasional visitor. He promised to entertain me lavishly. Food drinks and room will be on the house. I could bring my girl friend too. I did not have a girl friend, in the usual sense of the word, so did not bother to take him up on it. A few weeks later I was shopping at Marks and Spencer; a very large store in the city. I heard a person shouting my name from the other end of the store and asking, “Doctor why did you not come to my pub”*( It is an abbreviation for public house as the bars are called in the UK). It was quite disconcerting. People around were quite amused. They thought they were looking at a doctor who was a habitué of bars. Doctors were supposed to be very sober, serious and dignified persons. I had to pacify him that I was busy in my examinations and had to promise to visit soon. Welsh, Irish and Scottish people are very out going and friendly. English people used to be very reserved, snobbish, and cold (they have changed since).
I had a rather disconcerting experience too. A patient, thirty-five years of age, an accountant by profession, was admitted for surgery on a brain tumor. He had had headaches and double vision, neither of them very severe, for a few months. Surgery lasted most of a day. He died early next morning. I decided the specialty was not for me
Neuro-surgery was not highly prized specialty for training purposes. I anticipated some difficulty in getting the next job in General Surgery, which was highly thought of. It was deemed essential training for the Final FRCS, which was ninety percent general surgery based. A year in it was a requirement for the test any way. Paying court to her had distracted me from my work. I am not a good worker any way. But with primary under my belt I did not think it would be too hard. I had two consultants, one a very polite and urbane Englishman who never complained of my work. The other was a Scot, very gruff, blunt and did not mince words. He often told me that with the attitude I had I would never amount to any thing in life. He had let me get away with a lot when I was studying for the examination but would be d… if he would tolerate slackness in work now etc. I naturally gave the Englishman’s name as a referee. I hardly got any interviews, though with primary FRCS I was eminently qualified for further training. And when I did get called to one, I was not offered a job. In one of the interviews, one board member whom I had come across in two previous interviews, took pity on me, and took the highly unusual step of showing me the Englishman’s description of me. It was quite unflattering. He told me that I would never get a job unless I changed my referee.
I went, with cap in hand, to the Scottish gentleman. He told me how could I expect to be considered for a job. I was irresponsible, no good and should take up another profession. He gave me an enlarged version of his usual lecture. He had been lenient with me when I had been preparing for Primary FRCS. I couldn’t be quite retarded as I had managed to pass the examination. After he had exhausted himself with the tirade, I asked him sheepishly “ Sir What am I going to do” This started him off again. But the verve, the enthusiasm and the passion were missing. He told me that if I promised to work hard in my next job, he would get me one. But if he heard any thing adverse about me, he would drive to the Hospital I was working in and get my consultant to dismiss me.
He was true to his word. At my next interview I was offered a job in General Surgery under a well-known consultant. The department had an active final FRCS prep program; my consultants was an honorary tutor at the Royal College of Surgeons in London and conducted Sunday evening tutorials at his home.
My new hospital was in a small village called Aberdare, in Glamorgan County, Wales. It had been a busy mining town. Mining industry had seen better days. The train station had been closed “temporarily’ a year ago. If you did not drive, you could only get in and out of town by an infrequent bus service. I had spent all my money on the primary course, and had a balance of minus twelve pounds when I arrived in Swansea*. I had started to save for the finals course, so had not been able to buy a car. I could not drive any way and was to find it a difficult skill to learn. My ladylove was better off. She counted five pounds in her worldly goods. Luckily the village bazaar was with in walking distance. It boasted of a few grocery and general merchandise stores and three eating-places, which, by no stretch of imagination, could be called restaurants, though they styled themselves so. By way of exotica, there was a Chinese take away. We did not have many pubs either. Unemployment had soared after the mines ran out of coal. A cinema house opened its doors on weekends. People subsisted on welfare, which was enough to keep body and soul together. With a bit of care they could afford to visit a Pub one or two evenings a week.
We did not have much of a social life. The major city Cardiff was forty minutes drive away. One of its cinemas exhibited an Indian movie on Sunday after noons. W used to take a bus to the city. On one occasion the bus was a few minutes late. I told the driver that we did not often get to see an Indian movie, and would miss a good bit of it because of him. He asked us what cinema house we wanted to go to. We told him. He drove, like a bat out of hell, and omitted to stop on any bus stops on the way as well. The other passengers protested. He would only say that the doctor was from India. He is lonely. He does not get to see an Indian movie very often. There is little else for him to entertain his girl friend with. . He works hard. There is not much to do in Aberdare. I will drop you one the way back. He stopped the bus with a flourish right in front of the cinema house.
There was not too much work in the hospital. We did not have an active Casualty (Emergency) department. We worked nine to five three times a week and had two half days off. Evenings and weekends were free, with not many calls even when we were on duty. I alternated calls with a Doctor Sen Gupta from West Bengal. He was a very nice man and had a subtle sense of humor. We were housed in spacious quarters, with good kitchen facilities. He offered to wash the dishes if I would cook. I said you cook. But he insisted. I called around asking my friend’s wives for recipes and technique. They laughed, asked me not to be funny, bur relented when I told them that not in a million years would I be able to cook even half as well as they did. I remember I made beef curry and boiled rice. It was passable. Over confident, the next venture resulted in a barely eatable concoction. I called Sen Gupta. He said not to worry. We will invite guests. I said you are out of your mind. He would not explain and called all the native doctors. I made an omelet as a precaution. They came and ate up all the “curry” with obvious relish. Sen Gupta, who had been in the UK for much longer, told me that he had learned early on that the natives did not have a sense of smell or taste!
Besides us we had two Indian couples, one was the surgical registrar and his wife, the other a house surgeon in ObGyn and her husband. And a single Indian girl. This girl lagged in the department of looks, but more than made up for it in her voice and sang like an angel. Nurses were many and not bashful. The registrar’s wife and the married lady doctor encouraged me not to repel their advances, solemnly promising to keep it from my lady love. I think they were jealous of her looks and my devotion. I was sorely tempted, but I promise, I never gave in.
My friends bless them, made aware of my isolation, and took to visiting me more often than they were normally wont to. One of them, having driven several hours from Liverpool to Aberdare, asked for directions to the hospital and was told that it was by the river Dare. He went around driving in circles, getting exasperated at not finding the river. He asked for directions again. This time the person volunteered to accompany him to the destination. The river turned out to be a narrow channel under the hospital entrance! I had not noticed it though I “crossed” it several times a week. We became hysterical with laughter. We were used to the Indus and Ganges and looked down upon the Thames as a mid sized tributary of our mighty rivers.
By now our “honey moon” was over. It had not lasted long. My emotional life was hurtling on a mind-boggling roller coaster track. We had started quarrelling on the most trivial things. I have a temper. She did too. I do not have a calm demeanor. She was very excitable .She was used to having her way, I to mine. I am a feminist and a liberal. But I am, nevertheless, too much of a product of the East to contemplate a domineering wife with equanimity. She admittedly did not have any reason to play the second fiddle. But she had no right to be overbearing either. She was bright, smart and good-looking. I had a proven record of leadership, and harbored intellectual pretensions. Just to be contrary, she would want to do just the opposite of what I would. I was, I must confess, jealous of the attention paid to her. I was to discover, much too late though, that she could be irrationally jealous too. I was far too much in love to manage the war of nerves, as it should have been. But we kept on meeting for the next year or so and kept to the routine of fighting and making up.
We decided to take eight weeks off to attend a prep course for final FRCS. Our uneasy and uncertain relationship continued in the now routine erratic fashion. For South Asians it is never easy to part, even after an informal compact. After a particularly bitter quarrel we decided on a cooling off period. I decided to take the finals immediately after the course. She wanted to study more. I passed the examination and called her. She congratulated me half-heartedly and wished me success in my career. By the time I left the hospital in Aberdare, we had broken off all communications
London FRCS was more theoretical; you miss a step and fail. The patients presented for discussion were professionals with history and management going over decades. If they liked your looks, they would give you diagnosis, treatment and future plans. If they didn’t, you had it, floundered over details and failed. The examination was held in a conference hall not in a hospital ward. Examiners too were usually septuagenarians, big names in the profession, generally titled “SIR” and above, looked down at you over half moon glasses, with a deep frown on the face, giving the impression that they wished they were some where else, and not have to deal with dregs of humanity. They do not ask direct questions like diagnosis but “well what have you found”.
I took my first final FRCS examination in London and failed. I took the next examination in Edinburgh where the patients were picked out of ward cases undergoing treatment, and waiting for operations etc. The examiners were younger, pleasant though no less accomplished than the London ones. My long case had a stone in the kidney, scheduled for surgery the next day. He told me all about his management so far, with disarming frankness. In sharp contrast to London, examinations here were held in a hospital ward. The examiner asked me the diagnosis. I blurted out that it was stone in kidney and scheduled for surgery the next day. He looked at me enigmatically and asked me how did I know all that. I told him. By now I was very nervous, and sure I would flunk. He smiled to reassure me, told me that there is not much to see in the patient any way, and let us go to the Sun Room (it was January and very cold in Scotland) and talk comfortably. He was gentleman. It was as though a kind teacher was leading a promising pupil through a rite.
It is a quaint, but charming custom that they entertain successful candidates to a sherry party the same evening. It is a bit cruel and awkward too. At the end of the day all examinees present themselves in a lobby to hear the announcement of results. A functionary, with a mien of a plenipotentiary about to confer the freedom of the city, invites the successful candidates to an inner sanctum. The unsuccessful ones are supposed to take it in good cheer and congratulate the fortunate ones. It so happened that among the former was one of my classmates from my medical School, a study mate and a close friend as well. I did not feel like going to the party but my friend insisted that I do so.
In all the party examiners are in attendance, very polite now and treat you as colleagues. They talk to you about your plans, hopes and aspirations, offer advice on the pitfalls, when to stick to your guns, when to yield, and relate experiences of their own early life. They are, one and all, highly accomplished in their chosen field and it is really a privilege to be able to spend a few hours in their company. It was all very solemn; though there were light moments too. I recall an Egyptian, who had had a drop too much, tell an examiner that it was his sixth attempt; he did not know how he had passed this time. The examiner, with a twinkle in his eye, said my boy you shouldn’t have told me this, your results can be revised yet. The Egyptian went ghastly pale. The old man hastened to reassure him and plied him with more liquor.
Primary FRCS on the other hand is a basic sciences examination, Anatomy, Physiology, Pathology, and Biochemistry but grounded in patient management. It was the toughest examination I have taken in my life. South Asian system of education is rather adynamic and mechanical in teaching. You memorize figures, functions, and properties of drugs, signs and symptoms with out relating the knowledge to live patients. In those days the latest medical and diagnostic tests were not available in the third world, so we had difficulty in relating findings to clinical situations. As I mentioned earlier we tended to treat symptoms with out looking too closely into the underlying cause. In short the emphasis on theory divorced from practice did not prepare you adequately for the UK system. Multiple failures were the norm for overseas graduates; even for local doctors two attempts were the average.
Numerous stories were in circulation about the examination. They sound anecdotal, but are based on actual happenings. One particularly good one was about a Frenchman, a nephew of the foreign minister of the country. He had failed many times, so a friend advised him to have a drink before the test as confidence booster. He overdid it. On being asked about the diet of Eskimos, he said they ate whatever the Canadian government gave them. The examiner looked over his long nose and hissed that he did not appear to be very bright. The candidate very calmly and with a straight face, informed the examiner “Sir” if you were sitting on my side of the table you won’t appear very bright either.
It would be far too tedious to go into the circumstances of our getting together again. Suffice it to say that we did and during a period of reconciliation we allowed ourselves to get our respective families involved. It was a triumph of optimism over reason, but we did not know that and planned to go to Pakistan for the formal ceremonies.
In Pakistan she was in Lahore and I was in Quetta a distance of seven hundred miles as the “crow flies”. We could not meet each other and indulge in our favorite past time of hurting each other. Difficult though I find it to believe yet both us thought that things would settle down after the wedding. We got married in November 1968. I left for England soon afterwards. She joined me a few weeks later.
I have covered rest of the story in the chapter on my children.