Of Empathy, Reading Fiction And Coins From A Different Realm

Retirement is that stage of life when a working person looks forward to transition from the daily grind of work to a leisurely slow-paced life. However, it does not always pan out that way. Many retirees just can’t adjust to the new life of leisure and long for their working days. It is particularly true of those in the medical profession. A great majority of them work until they are stricken with infirmity, asked to retire by the hospital they work at – or just drop dead.

In 2004, at the age of 68, I decided to call it a day. My friends and many acquaintances were surprised and worried about my decision. They all thought, naively, that after retirement my life would be confined to a proverbial rocking chair. I am pleased to say that my life after retirement has been as full and as enjoyable as before. After retirement, I continued my interest in literature, art, photography and exploration. I stopped subscribing to medical journals and stopped attending conferences in my specialty of cardio-thoracic surgery. Since the day in 2004 when I did my last operation and walked out of the operation theater, I knew I was leaving that part of my life behind. I have not looked back since.

There is a group of enthusiastic Pakistani heart surgeons working in the US and Canada. They communicate with each other and also with their counterparts in Pakistan. Last year, they decided to form a WhatsApp group to bring their professional conversations online for discussing new surgical techniques, difficult cases and provide a springboard for younger surgeons. The group is moderated by a Saqib Masroor, head of heart surgery at the University of Toledo. He and a few others very graciously invited me to join. I think it was more in deference to my age and grey hair than my dated expertise in the field. I guess every group needs a greybeard or two to connect the present with the past. I decided to join.

It is dynamic and highly skilled group. They discuss difficult cases, teach each other new and innovative techniques and, above all, they are not reluctant to share their failures. There is only one problem: most of the time I don’t understand what they are talking about.

The Quranic Surah Kahf (18:11-26) tells the story of seven pious young men and their dog, who, while fleeing religious persecution around 250 BC, took refuge in a cave. They fell asleep and woke up after 300 years to find a changed world. The coins they carried in their pockets were from an earlier and long forgotten realm.

There is also the story of Rip Van Winkle by Washington Irving. Van Winkle falls asleep after imbibing alcohol and when he wakes up, 20 years later, he finds a changed world.

If I had my way, I would make it compulsory for medical students and residents in training to carry in the pockets of their white coats a book of fiction or poetry along with the ubiquitous medical pocket guide

The world has indeed changed since my retirement 18 years ago. Like the character in the Washington Irving story who missed the American Revolution, I also missed the revolution in cardiac surgery. There have been significant advances in cardiology and cardiac surgery in the interim. Thanks to those breakthroughs, now a surgeon operating on complex heart problems takes the anesthetised patient on a surreal journey during which the patient’s heart remains motionless, and blood circulation is altered in such a way that is not compatible with life. But the patient is brought back to life after crossing many metaphorical Rubicons.

I was surprised to be invited as one of the speakers at the inaugural meeting of the group in mid-July. The organizers left the choice of topic and contents up to me. However, they hinted that I could consider giving the group a few pearls of wisdom.

There is an interesting anecdote attributed to Pitras Bokhari. When a friend asked his feeling about becoming a ‘buzurg’ (بزرگ or a wise old man), the witty and erudite Bokhari said that while old age was upon him, the wisdom of old age or buzurgi was not part of it. For me, however, to claim buzurgi in my remarks to the cardiac surgeons would have been just hollow words devoid of any real wisdom.

There is, however, a subject that is and has been dear to my heart. And that is the inherent arrogance of medical profession. Among members of the medical profession, the brain surgeons top the list, with heart surgeons following close behind.

Arrogance, professional or otherwise, is not limited to just medical profession. It can be found in all professions, but not to the degree that is found in the medical profession.

But before I address the main theme of this essay, allow me to introduce two cardio-thoracic surgeons who also spoke at the gathering.

Dr. Mansoor Mohiuddin is by now a familiar name in the field of heart transplantation the world over. A graduate of Dow Medical College, Karachi, Dr. Mansoor, through deft manipulation of the genetic structure of pigs, made it possible for his team at the University of Maryland School of Medicine to implant a pig heart into the chest of a human being. The patient lived for two months.

What he did has never been accomplished before. It was not the first time that the genetic barrier between animals and humans was crossed, but it was the first time an animal heart sustained life for two months in a dying patient. At the meeting, Dr. Mohiuddin discussed steps of this elegant research that ended in transplanting a pig heart in a human being.

The world has indeed changed since my retirement 18 years ago. Like the character in the Washington Irving story who missed the American Revolution, I also missed the revolution in cardiac surgery

The second presentation was by Dr. Sohaila Ali – who was once my student at Khyber Medical College – and she talked about her perilous journey from her student days at Khyber to a successful cardio-thoracic surgeon in Karachi and then in Baltimore. It is not surprising that in a male-dominated world, all kinds of hurdles were placed in her way. All academic institutions in Karachi declined to give her a job just because she was a woman. The surprising thing is that she overcame those obstacles and eventually the same institutions, including Aga Khan Medical College, offered her to head the cardiac surgery unit, which she accepted. She went on to build the cardiac surgery service in that hospital.

Before going back to Pakistan at the end of her training, she went into labour while taking the examination of the American Board of Thoracic Surgery. She was rushed to the hospital, where she delivered a baby boy. Her tenacity of purpose was evident when the very next day she took the remaining examination. Passing the Board examination is the most important step for practicing cardio-thoracic surgery in the US.

Now back to the inherent arrogance of medical profession and how to remedy it.

At present, the medical college curriculum is chock-full of science subjects. It was assumed, erroneously, that reading anything other than the course books was a waste of time. We were discouraged to take interest in humanities, the arts and music. However, research has shown that the reverse is true. Students who take interest in literature, arts and music turn out to be more compassionate, empathetic and caring doctors. Though there are required courses in English and humanities in premedical education, they are not enough.

It is ironic that in the mid-1800s, students applying for medical education in the Indian Subcontinent were required to have not only proficiency in the English language but were also required to analyse a passage from Milton’s Paradise Lost, be familiar with Robertson’s histories and other classic works. Unfortunately, the premedical curriculum in the US (and in most other countries in the world) currently lacks substance and depth.

But all is not lost. One can always inculcate interest in literature, music, the arts and the broader field of humanities even later in life.

Doctors overall have only one interest: to practice medicine and occasionally take a week or two of vacation. I believe one can have an ongoing vacation where an excursion into the realms of non-medical areas, will provide enough distraction from medicine to keep the spirits high and rekindle the intellectual pursuit.

Sir William Osler (1849-1919) was a Canadian physician considered one of the greatest physicians in history. He co-founded the famous Johns Hopkins University in Baltimore. He advised his students:

“While medicine is to be your vocation, or calling, see to it

that you have also an avocation – some intellectual pastime

which may serve to keep you in touch with the world of art, science or of letters.”

For a cardio-thoracic surgeon who got off the professional wagon almost two decades ago, I look at the coins from another realm in my pocket and take heart that I may not be at the cutting edge of surgery – no pun intended – but thanks to my interest in the humanities, I find my life interesting and full.

So, my advice to my fellow surgeons and for that matter to all those who are fully absorbed in their chosen fields is to let in more sunshine in your lives by reading fiction, listening to music, or learning about the arts.

What to read?

Anything that is not part of your profession. In Urdu Munshi Prem Chand, Qurat-ul-Ain Haider, Rajinder Singh Bedi, Saadat Hasan Minto, Intezar Hussain, Mumtaz Mufti, Bano Qudsia and her husband Ashfaq Ahmad and the like. In English, the names of Danielle Steele, George Eliot and Toni Morrison come to mind.

Fiction helps us peek into the minds of characters, some good, others rotten but each one with a message. It is reading fiction that we begin to understand human nature and appreciate human travails. And in the process, we can get a bit more humane and empathetic.

If I had my way, I would make it compulsory for medical students and residents in training to carry in the pockets of their white coats a book of fiction or poetry along with the ubiquitous medical pocket guide.

The coins in my pocket may be from another realm, but I hope when I cross the final Rubicon, they will be valuable assets for the new realm that I will enter.