A Doctor in The House: A Memoir of Tun Dr Mahathir Mohamad (89 page)

ENDNOTE

[1]
  For the full account of that election, see Chapter 40: A House Divided.

I first felt a slight pain in my chest about a month before I had my heart attack in 1989, but I ignored it. I was at Genting Highlands, attending an alumni meeting of the King Edward VII College of Medicine. Many of my classmates and their children were there and everyone was having a good time. I was watching them when the young people pulled me on to the dance floor. As the dance went on I began to feel breathless and pain in my chest, but they stopped after I sat down. The next day I went horse-riding and again experienced the same breathlessness and pain. I didn’t want to admit to myself that it might be a heart attack and so I told no one, and simply hoped it would go away. Even if you are a doctor and you know the signs and symptoms, you don’t want to admit that you might have a problem.

In those days I didn’t have regular medical checkups. I do however remember going for an extensive medical examination in London on a doctor’s advice after having a slight blood pressure problem. It was a real nuisance as the checkup took a long time and I was forced to wear a small ECG machine that bulged from my waist. I had to attend a dinner with the machine strapped to my body and it looked like I was carrying a gun.

A month after the Genting party, I had dinner at a Thai restaurant at The Mall with Hasmah and Marina’s husband to celebrate Mokhzani’s birthday, even though he wasn’t there. There should have been four of us but Marina didn’t turn up, so there were only Hasmah, Didier, Marina’s husband at the time, and myself. We had ordered food for four and I ended up eating most of Marina’s share—perhaps as a result of wartime deprivation, I dislike wasting food. When we got home, I began to feel pain in my chest and breathlessness that this time refused to go away. I tried lying down and sitting up but the pain remained just as severe. Hasmah called up a specialist friend of ours at the Kuala Lumpur General Hospital, my former classmate Dr Jimmy Eapen. She described my symptoms over the phone and Jimmy came over immediately. He diagnosed a heart attack or cardiac infarction, but needed to return home to get his portable ECG machine. When it confirmed his suspicions, I was immediately sent to the hospital. I felt well enough to walk but they insisted I use a wheelchair.

I should have known that it was a heart attack as the symptoms were classic. My history of chest pains and breathlessness after the exertion of dancing and horse-riding also fit. Heart attacks are also precipitated by worry, by long journeys or by having too much food during a meal, and I did eat too much food that night. I should not have brushed off the pain the first time I felt it and should have admitted to myself that I was having a heart attack.

I was admitted into the Kuala Lumpur General Hospital on the night of 17 January 1989. There, Datuk Dr Robaayah Zambahari confirmed that I had had a heart attack and gave me an injection to relieve the pain. She told Hasmah to call our family, which made us realise how serious the situation was. She also called Tun Ghafar Baba, then the Deputy Prime Minister, waking him up from his sleep to tell him what was happening.

After completing the standard checks, they decided that I needed an angiogram. Coincidentally, Dr Simon Stertzer, a heart specialist from California, was in the region and he was asked to be present for the procedure. He and Dr Robaayah concluded that I had had an infarction and needed a bypass. They gave me a choice of either going to the US for the operation or having it done in Kuala Lumpur. Without hesitation, I decided I would have it done here. I had to have faith in our Malaysian doctors and knew that if I didn’t make an example of myself, no one else would have confidence in our medical service. Previously, all our VIPs had gone abroad, but I knew that Datuk Dr Rozali Wathooth had performed these operations successfully at the Kuala Lumpur General Hospital. He had already left Government service to work at the Subang Jaya Medical Centre, but there were other heart specialists at the General Hospital, including Tan Sri Dr Yahya Awang. I knew that Dr Yahya was quite experienced and I decided to entrust my life to him.

As a doctor myself, I knew the risks. I knew there was a possibility that I might not survive the operation as it was not, at that time, a common procedure. People still feared letting doctors open up their chests and fiddle with their hearts. But I told myself that if I was going to die, then that was it—I would leave it to Allah and the skill of the surgeon. It may sound dramatic now that so many people have successfully undergone heart surgery, but once I had accepted the possibility of death, I felt quite calm.

I rested for four days before the angiogram, which confirmed that I needed the operation. Dr Stertzer again offered the option of having the bypass done in California, although he also said that Dr Yahya was as competent as any heart surgeon in the US. When I was left alone with Hasmah, I asked her to call Dr Yahya and when he entered the room, I told him simply that I wanted him to do it. I had known his father well. Dr Awang had been a very good doctor and had been a Member of Parliament when I was also an MP from 1964 to 1969. At the time of my heart attack, Dr Awang was the Governor of Penang.

My admission into hospital precluded my attending the weekly Wednesday Cabinet meeting. The doctors warned that I could have no visitors, and Hasmah decided she would enforce the doctors’ order herself. Many people came and insisted they had to see me but Hasmah was very firm, allowing only a few to peep at me as I lay sedated in bed. There was a by-election at that time and rumours were raging that I was critically ill. Some even said I had died. Hasmah never left the hospital and she stayed by my side the whole time. Dr Robaayah offered to give her a sedative that first night, but she was determined to stay awake to make sure no one came and bothered me.

On the eve of the operation, a phone call came at about 10pm from Lee Kuan Yew. He was very concerned and talked to Hasmah as I had already taken medication to get ready for surgery. Lee asked her to persuade me to postpone the operation because he had a medical team ready to fly to Kuala Lumpur, with the well-known cardiac surgeon Dr Victor Chang, a Singaporean living in Australia, to do the surgery. He said Dr Chang had a lot of experience, having performed more than a thousand such operations. When he asked who was going to be the surgeon, Hasmah named Dr Yahya, whom Lee had never heard of. But Hasmah said I had already made up my mind and the family agreed with me. She thanked him and promised to call as soon as the operation was over. She knew that once I had made up my mind, I would not change it. Hasmah was also very confident that Dr Yahya could do the job. Apparently, Lee did not only appeal to Hasmah, but also contacted Tun Daim Zainuddin to ask him to intercede with her. Despite our many differences throughout the years, I appreciated Lee’s concern.

Our three boys were away at the time and Marina was in Singapore. Ineza, her daughter, was sleeping in a cot in our room. In her haste to get me to hospital, Hasmah had almost left her locked in the room the night of my heart attack. She remembered just in time and shifted the cot to the children’s room. Marina and Mokhzani, who was in Miri, flew in the very next day. Mukhriz was in Boston and Mirzan in Philadelphia, but both of them managed to return to Kuala Lumpur on the eve of the operation. Just before the surgery, they sent in Hasmah and then the kids one by one to kiss me. That was when Hasmah broke down for the first time.

The problem with being a doctor is that you know what they are going to do to you during surgery. In heart surgery they stop your heart and lungs and pass your blood through a heart-lung machine. I did not relish the idea, especially as the procedures were relatively new and the equipment was not as sophisticated as what is used now. Tun Hussein Onn had had a bypass and never really recovered afterwards. Another VIP who had undergone the procedure, Datuk Jaafar Hassan, the 
Mentri Besar
 of Perlis, died some time after. I asked Dr Yahya only one question—how would they open up my chest? He said they would use an electric saw. “Thank you very much,” I said, “I do not need to know more.”

As they lifted me onto a trolley and wheeled it into the operation theatre, I vaguely remember seeing the ceiling as I was rolled along the corridors and into the anteroom next to the theatre. I heard some soothing words from the anaesthetist as he went about his work. Then I was lifted onto the operating table and told to count backwards from 10. The next thing I knew, I was in the recovery room. In that respect, modern surgery is a miracle.

The operation took about six hours, though to me it seemed no more than two seconds. It was my family that had to sit and wait it out. The doctors took veins from both of my legs and constructed five bypasses. Dr Yahya, Dr Rozali and their assistants did a good job and there were no complications. These days invasive surgery is less necessary and angioplasties give ever better results, while dieting and regular exercise can reduce the incidence of coronary atherosclerosis and infarction. Some say dieting can actually reverse the atherosclerosis of the arteries, which is what I am trying to do now.

When I woke up, all I could think about was the fact that I was still alive. I remember the discomfort though, as it hurt even when I tried to turn in my bed or coughed. There were tubes in my body, a drain in my abdomen, and an oxygen mask on my face. I was in the hospital for two weeks and took a much longer time than others to recover.

It was very isolated and surreal in the ICU. There were no windows and it was easy to lose track of time, and I found I could only keep track of the hours from the changing shifts of nurses. It was all quite depressing—I was 64 years old and it was the first time I had been admitted to a hospital, and for a major operation to boot. I had worked in many hospitals before, but had never been a patient in one. Being shy, I was also embarrassed by having to be cared for by the nurses.

My physiotherapist was a terror and would force me to cough to avoid any build-up of fluid in my lungs, which could lead to pneumonia or a lung infection. I may have resented her insistence then, but when I succumbed to a serious infection after my cardiac surgery of 2007 I could better appreciate her intentions and reasoning. In the meantime, I had to put off travelling and I avoided presiding over the Cabinet for a while.

During this time, one of the events which boosted my spirits was the Barisan Nasional’s victory in the Ampang by-election the day after my operation. Stuck in the ICU, I heard a commotion and at first thought that we had lost. But when Ahmad Razali, Hasmah’s brother, came in and gave me the thumbs-up sign, I realised the news was good. Sadly, however, Tun Ghafar’s son, who was campaigning with him, died of a massive heart attack on the day of the election.

At the time of my stay, the operating theatre in the General Hospital was not very well equipped. Space was needed for the necessary equipment, including gas cylinders for the anaesthetics. The General Hospital’s operating theatres were not really meant for highly complex heart surgery, and the surgeons and anaesthetists barely managed. I realised they were working under tremendous constraints and pressure, which was not fair to either the doctors or patients. But up until then, the Government had shown scant interest in their needs. After I had recovered, the doctors were not shy to point out the urgent need for better facilities.

They argued that instead of fully equipping the surgical theatres at general hospitals, it would be better to set up a special centre for heart diseases. I agreed and decided the Government should allocate adequate funds for this purpose, which was how the National Heart Institute or Institut Jantung Negara (IJN) was established.

Building and equipping such a facility was easy enough—it was staffing that posed a problem. Our specialists were leaving government hospitals in droves because of low pay; yet, we could not increase their salaries without other government employees demanding the same. This was simply unaffordable. We decided that while the specialist centre should be owned by the Government, it should also be run like an independent corporation. IJN was thus corporatised, which allowed it to draw up its own pay scheme, bonuses and the like. Terms of employment were still not as good as in the private sector, but good enough to permit committed specialists to stay and to greatly reduce the number of specialists leaving government service. Most of IJN’s patients were government employees, and their treatment was paid for by the Government.

The whole experience of my heart attack was a tremendous strain on my family, perhaps more than on me since I had already resigned myself to the possibility of dying. To this day, Mokhzani gets worried around the time of his birthday, as many unfortunate events have uncannily taken place then, such as the first Gulf War, his breaking his ankle, and my operation. But none of the family, not even the children, tried to talk me into early retirement after I recovered. They knew that such a suggestion would only add to my stress and that I would make my own decision.

I have never felt much pressure when working but obviously the job of being Prime Minister entailed a constant undercurrent of stress. I always went about my work in my usual manner and tackled problems calmly, never getting unduly excited and rarely losing my temper. I would sometimes feel tired but always woke up the next day feeling refreshed and ready to go back to work. I enjoyed my job and the opportunity to do things which only a Prime Minister had the power to do. The challenges that I faced in 1986 and 1987 when Tengku Razaleigh Hamzah and Tun Musa Hitam tried to topple me must have been a great strain, as was Ops Lalang. But I had managed to handle them and did not feel any great undue pressure. At a deeper level, I suppose, my system must have reacted differently and experienced greater strain than I could recognise.

I was told to take three months off after my operation before making any decision about my future, but this was unnecessary as it never occurred to me to stop working. After leaving hospital, I was eager to go back to work, but my family and my doctors insisted that I take a vacation. So we went to Morocco and Spain. Even so, I resumed my old routine as soon as possible, going to my office, seeing my staff and Cabinet colleagues, meeting visitors and getting briefings on everything that was going on.