A Doctor in The House: A Memoir of Tun Dr Mahathir Mohamad (26 page)

But my most harrowing experience took place when I was the Medical Officer on duty at the Alor Star General Hospital. It was a Friday and officially the weekend in Kedah, so all the surgeons and other doctors had gone to Penang. I had not expected any serious emergencies but then a woman in the maternity ward suddenly went into labour. She was almost full-term but the baby was not positioned at the birth passage. I had to make a decision right there that the best course of action would be to carry out a Caesarean section. Thankfully, I was assisted by Hasmah, who by then was my wife. As there was no sophisticated intravenous anaesthesia in those days, we had to drip ethyl chloride and ether onto a mask on the patient’s face. It was all quite primitive and you had to be careful that just enough was given. After she was under, I made the cut. To my horror, I discovered that it was an ectopic pregnancy as the foetus had developed outside the uterine cavity. Ectopic pregnancies are very rare and few doctors would deal with even one case over the span of an entire career.

There was an awful lot of blood. I tried to tie up the blood vessels but I could not stop the copious bleeding. I made every attempt but the child did not survive and neither did the mother. They were the only patients I ever lost on the operating table while I was in government service. It was very sobering and deeply upsetting for me and Hasmah.

I knew the woman’s husband personally—he ran a printing shop in Alor Star. I felt very bad for him and was very apologetic. The husband did not blame me at all but if it had happened today I probably would have been sued. Attitudes have changed considerably since that time, and litigation has become quite a regular recourse for those who feel wronged.

Perhaps this change is a good thing. But having to insure against malpractice has increased the cost of treatment. Doctors in America often refuse to treat accident cases or to volunteer their help when fellow passengers take sick on airline flights for fear of litigation. To avoid litigation they often order unnecessary and costly laboratory tests. The human touch has been lost and treating sick people has become just another business.

Overall, surgery gave me much satisfaction. My hands are still very steady though I am no longer qualified to practise, having been away from medicine for over 30 years now. I miss working as a doctor but it is surgery I miss the most. Having said that, I’m not sure I could manage or would like the kind of sophisticated surgery being done now using highly specialised equipment. For me surgery was a human skill and it enabled me to give much to others: life, recovery, restored health.

In 1957, the year of Independence, I left government service to set up my own practice. Many colleagues and friends advised against it but I went ahead. There were few private practitioners in Alor Star in those days and mine was in fact the first clinic to be established by a Malay doctor in the state. I called my clinic Maha Klinik, short for Mahathir and Hasmah, although my wife never joined me in private practice. She worked as a contract medical officer in the Government. For some reason she was never put on a pensionable scheme, so even though she worked for the Government for many years, she draws no pension now. I left my practice when I became a Minister and my partner Dr Mohamad Yaakob took over. Both he and the clinic are still there.

Although I was quite successful medically and professionally, I did not run my practice well. I left the management and the fee collection to two of my brothers-in-law, who would lend the clinic’s money to friends. I made about $2,000 per month—not much, but more than I would have earned as a Government Medical Officer. They were paid a starting salary of $730 per month but by the time I joined, the yearly increment in pay was $30, so by 1957 I was getting $790. Private practice income, therefore, was a great improvement.

I was quite a popular doctor and the number of my patients—Chinese, Malays and Indians—kept increasing. I did not like to stop to rest as long as there were patients waiting. In the first few months it was possible to see all the waiting patients before breaking for lunch. I did not go home but had a quick lunch in my consultation room. Chicken chop was my daily fare and as soon as I finished eating, I would start seeing patients again because I felt guilty making them wait. I cannot understand how counter clerks can chat with one another and ignore the waiting public. When the number of patients increased I simply worked longer hours and after that, I would do house calls.

In one instance, a well-intentioned patient said he did not want to bother me too much because he was not suffering from anything serious. So instead of coming to the clinic, he decided to have me see him at home. It would have taken me 10 minutes to attend to him in the clinic; instead, I had to travel for two hours to and from his house. One can be killed by such acts of kindness.

As the years passed, I found myself stuck in my clinic for the whole day and long after other people had gone home. Once I got into my clinic at 9am I did not see daylight again for the rest of the day. My world seemed to consist only of nights. Even weekends were not mine, as I would make house calls to see bedridden patients. I played no games and hardly had time to go to the cinema. I was also not able to be involved in politics as much as I would have liked.

One unattractive aspect of a doctor’s career is obvious but rarely mentioned—most of the people I came into contact with were sick. Some were dying, and some died in front of me during treatment. A close friend, my senior in school who was an athlete, died one day of a heart attack and I was called to certify his death. There was very little one could do for cardiac failure in those days. I was so affected by his death that I wept silently. Some of my friends noticed and I heard one of them remark that I was crying. But another countered him and said it could not be, because I was a doctor and therefore used to seeing people die. I did not disabuse him of this idea because I wanted to appear strong, but as time went by I found myself more and more prone to such breakdowns. It was a symptom of being burnt out, of having no release or let-up from the life of a doctor.

I generally feel very strongly about things. I try to control any show of emotion because I see it as a lack of manliness, but very often I fail. Even today when something affects me, I get a tight feeling in my chest and my voice breaks. When this happens during a speech, I choke and stop speaking. I feel betrayed by this weakness, by my own lack of a certain toughness and strength. This happens frequently when I talk or even think of the Malays and their failures. I get emotional and my tears well up. Hasmah tries to console me and says it is normal to break down when one feels disappointed or melancholic, but still I continue to feel ashamed that I cannot keep a lid on my emotions.

Ironically, I have a reputation for being tough, even ruthless. Maybe I am. If one wants to get things done one must be single-minded and determined. When I was Prime Minister, I wanted to redeem the honour of the Malays, Malaysians and Malaysia. I wanted to see Malaysia and Malaysians proving themselves to be as good as any other nation or people. From the beginning I knew that it would require a great sense of purpose and a willingness to fend off all challenges. It must have been these qualities that made me seem hard and uncompromising when I was Prime Minister, for nobody can succeed in politics if they do not have a tough skin. People would not know or suspect what lies beneath. What I did not want to show was how easily touched I was by tragedy and human suffering. When those feelings of compassion came to me in public situations, I would try to prevent that familiar choking and tightness in my chest.

A doctor is never far from the calamities that affect people. I have seen people, frequently relatives and friends I had known from when they were young and healthy, getting strokes and becoming unable to speak or move their limbs. Sometimes, you can read the deep sadness in their eyes as they try in vain to get their limbs to move and their lips to form words. The brain remains alive and active but the body is inflexible and unmoving. Their frustration is unimaginable.

Some died quickly, and in many ways, it was fortunate. Others would linger in this sad state for months and perhaps even years, cared for by their loved ones. For the patient, death must come as a relief. But for those left behind, the finality is staggering, even if you have strong faith in the hereafter. There is just no coming back.

These thoughts developed in my mind, probably because of my huge exposure to those who were ill and dying. Working day and night at my own clinic, depression slowly set in.

I thought of the inevitable deaths of the ones I loved, of my father and mother, the older members of my family and my friends. Invariably, I thought of my own death, of being struck with the diseases that my patients had. I thought of heart attacks and strokes and the helplessness that would follow. I grew more and more morbid.

I finally decided that I needed to take some leave. In 1960, I closed my clinic for a week to go to Hong Kong for a holiday with my wife. In those days no locums could be found. Not having someone to take care of my patients gnawed at my conscience but I had to get away or I knew I would have gone mad.

We had never been beyond Malayan borders other than to Singapore and a half-day trip to Haadyai in southern Thailand. Hong Kong amazed me. There were so many well-dressed people in coats and ties. Jeans and casuals were unknown then. I saw my first shopping complex at the Miramar
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 but most of the shops were two or three-storey buildings lining the streets. There were Chinese tailors running to and from the hotels with half-finished suits as they tried to meet their 24-hour deadlines.
 

I met a number of Chinese Malayan doctors who were working in Hong Kong and they took me to plush Chinese restaurants. They had formed a dining club to try new restaurants every week. They told me they never went to the same restaurant twice in a week, because there would always be at least one new restaurant in town. I could feel the vigour of Hong Kong keenly and I wondered whether Malaya would ever be like that.

The following year Hasmah and I decided to go to Japan, which was still considered an exotic place in those days. After the Japanese defeat in World War II, they were forced to adopt a democratic parliamentary system with a constitutional monarchy, like Britain. The Japanese had become Europeanised and they had long discarded their kimonos to wear coats, ties and dresses. But it was only a cosmetic change—culturally and intellectually, they were still very Japanese and very polite. In the event of a minor car accident, both drivers got out and bowed to each other before getting back into their cars and driving away. The Nissan cars they were using looked like poor copies of the British Hillman. There were old trucks and three-wheeled cars that rattled noisily along the poorly paved streets.

In the 1960s and 1970s, Japan was booming. It was making a surprisingly rapid recovery from the ruins of war. It was, in fact, becoming one huge factory, producing all kinds of manufactured goods and obviously beefing up its economy through exports. The dynamism was palpable. I still remembered the atrocities committed during the Japanese Occupation of Malaya, but I also had a growing admiration for the Japanese. I thought that if we could be like them in our sense of hard work, innovation and determination, what a country Malaya would become!

During our visit it was clear Japan was still in the midst of reconstructing after the devastation wrought by the Allied bombings. There were still a few wooden shops in the Ginza shopping district.
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 An elevated highway was being built from Tokyo to Haneda Airport in readiness for the Tokyo Olympics.
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 In those days few countries could afford or were eligible to host the Olympics but Japan had won the right to organise the Games in 1964. There was no great fuss, no dramatic reporting of rival bids to play host to the Games as, at the time, few countries saw it as a prestigious opportunity. But Japan had decided to host the Olympics to showcase its new economic strength and cultural integrity, and to symbolise its full return to international acceptability following World War II.
 

Japan was returning and Asia was again rising. Not everybody saw or could accept this, but some of us from Asia glimpsed this development and its significance, perhaps a little earlier than the rest of the world. Rather than feeling threatened or resentful, we admired what Japan was doing and, if it succeeded, we would be ready to learn from its example. What I saw during this trip, for example, left a permanent impression on me and influenced me when I became Prime Minister.

There was activity everywhere in Japan and roads and buildings were being constructed at a furious pace. Japanese industries were being revived and were already producing transistor radios and personal movie cameras. Our embassy friends told us not to buy local products in Japan as their choice items were all set aside for export. The Japan of that time had not yet overcome its reputation for producing cheap and shoddy goods. We were witnesses to its first steps towards becoming the cutting-edge electrical goods and electronics giant that it is today. Now, Japanese products are innovative, highly-respected and prestigious.

We also visited Osaka on that trip, flying there on a propeller-driven plane. One of our reasons for flying was that we were told we could see the famous Mount Fuji on the way. The Japanese steward, in all earnestness, wished us a “good fright”. Hasmah and I had a good laugh. The Japanese cannot pronounce “L” and invariably substitute it with “R”. The results can be quite hilarious and we repeated “good fright” many times along the way.

When the steward announced that we were passing Mount Fuji we looked out the window of the aircraft. There were snow-topped mountains but none looked like the majestic Mount Fuji we had seen in picture books.

Then the passenger in the aisle seat next to Hasmah, who was obviously Japanese, quietly said to Hasmah, “Up there, Madame.” Mount Fuji is 12,000 feet high. We were flying at only 10,000 feet in the small aircraft.