A Man of Implacable Wisdom: Professor Dr. Faisal Masud Part 2(1954-2019)

By: Dr. Ali Madeeh Hashmi

Part 2

(If you missed Part 1, you can read it here)

My next memory of Faisal sahib is thankfully more pleasant. We had graduated medical college and I had done well enough in my final exams to earn a spot near the top of my class. The next step was a ‘house job’, a one year apprenticeship in which all of us would be attached to Mayo Hospital as junior doctors and would learn how to diagnose and treat patients. Sadly, most of us had no idea what to do. Our education system in King Edward, with its heavy emphasis on rote learning and minimal focus on the applicability of the knowledge had not prepared us at all for actually standing next to a patient and talking to them. Some of my class fellows, obviously smarter than I, had spent time, on their own, in the hospital wards and hung around with the doctors working there. There was no formal system of training them but those with some initiative had figured out ways to learn in spite of that. I was always more of a ‘follower’ and had drifted through medical college, much like how I had drifted into it. In addition, the way things were taught, the way exams were conducted, the (as it appeared to me) callous disregard for the thousands of destitute people who thronged to Mayo every day; all of it had made me increasingly cynical and disconnected. This, combined with my laid back attitude, meant I was singularly unprepared to take care of very sick patients, most of whom could die if I made a mistake or didn’t know what to do in a critical situation.

I was not sure what I wanted to do now that I was a doctor, not sure what kind of doctor I wanted to be or if I wanted to be a doctor at all but of one thing I was sure: the four months that I had to spend working in the medical wards, had to be with Faisal sahib. We were all scared of him, afraid of his anger and desperate for his approval, in equal measure. Such was the charisma of the man and our hunger for role models that even though we knew nothing about him other than that he was a brilliant teacher, we wanted to be near him. I was not the only one in my class who felt that way. Newly graduated medical students could choose which wards they went to and the choice depended on your grades in your final exams. Invariably, despite his fearsome reputation as a hard task master, Faisal sahib’s department had the highest merit. Only the brightest, highest achieving students got to work with him.

In North Medical Ward where Faisal sahib was Associate Professor, we rarely ever saw our professor. For all intents and purposes, Faisal sahib was in charge. He would swoop in imperiously around 9 or 9.30 am and begin his rounds. Everyone in the ward was expected to attend and the presentation would begin with the junior most doctor relaying the ‘history’ of the patient he had taken the evening before. In theory, since most of us were complete novices at this, someone should have been assigned to help us take the history, put it in order, show us how to work towards a diagnosis and develop a rough plan of action, all of it before we had to present it to Faisal sahib. I do not remember anyone ever doing that for me. In fact, I remember vividly that work at the ward would start with rounds and end around 11.30 am and then everyone would apparently disappear leaving some of us junior doctors hanging around forlornly trying to figure out what we were supposed to do the rest of the day.

One memory stands out because it was the first time that I earned a word of praise from Faisal sahib. A patient had come in and I was taking a history. He may have suffered from headaches, a very common complaint. Somehow, I decided that perhaps his headache was related to ‘Temporal Arteritis’, an inflammation of the blood vessels in the temple. I knew I had to present the case the next morning to Faisal sahib and so got out my book, read up on the condition and laid out the history as systematically as I could (while remaining convinced that Faisal sahib would tear it to pieces the next morning). I must have been working in the medicine ward for a few weeks and probably had picked up the rudiments of taking a patient’s history and putting it together from watching my peers, listening to other doctors and perhaps reading some things on my own.

In fact, I was to learn later, this is the only way to actually learn any hands on skill: listen, watch, do, repeat. And later, another step is added: teach. In medical parlance, it is also sometimes referred to as ‘see one, do one, teach one’. This ‘apprenticeship’ model has been prevalent in medical teaching and practice for hundreds of years and despite many scientific advances in teaching and learning, has never quite been replaced. In Pakistan, because of our constant resource constraints and severe lack of skilled personnel, it is applied rather haphazardly and most students and junior doctors are left to fend for themselves, often at the expense of patients.

At any rate, at rounds the next morning, Faisal sahib did not interrupt me early on in my presentation and as I continued to present the history, emboldened, he continued to listen with everyone else around him following his lead. I laid out the history, enumerated the symptoms of temporal arteritis (in the negative since I had ‘ruled it out’ i.e. that this patient did not have that condition) and was rewarded by a brief ‘well done’ from Faisal sahib; praise that I still treasure to this day. He moved on to the next patient with the rest of the ward staff in tow leaving me to breathe a sigh of relief at having passed my first test in the ‘Faisal sahib school of learning’.

Despite my disinterest in the subject of medicine (or Internal Medicine as it is now called), I must have made some kind of impression on Faisal sahib (or perhaps it was only my rather imposing physique that made me stand out) because I remember him asking me as our medicine rotation ended what I planned to do in my career. I learned later that this was Faisal sahib’s way of acknowledging someone’s intellectual brightness. He only inquired in this way about someone in whom he saw some potential. I responded that I wanted to study psychiatry in America upon which he immediately wrinkled his nose in distaste “People who go to America are all about money; that’s all they think about”. He then proceeded to tell me that I should go to England and study medicine, his chosen subject.

I know now, after having worked with him as a colleague and medical teacher that this was the highest compliment that Faisal sahib could offer: inviting someone to follow in his footsteps. But I had zero interest in going to England and even less in studying medicine. Both of my parents had studied in the USA and of course, to a young person growing up in 1980s Pakistan, America was the land of opportunity: a magical, faraway place that was as far from the heat and noise of Lahore as the moon. Psychiatry I was less sure about but having grown up as the son of a US educated psychologist, it certainly seemed more interesting than what I had studied in medical college so far. I had worked in the surgical department of Mayo for four months as well and had loved the clean simplicity of surgery. Surgeons were very sure of themselves. I was not yet aware of the popular American aphorism ‘The only way to heal is with cold steel’ but the people that I had met and worked with in surgery (including two older cousins both now eminent surgeons in England) seemed far cooler than the dour doctors I had met in Medicine (with the sole exception of Faisal sahib, of course). But when the time came to apply to America, I knew that the surgeons’ lifestyle with its long hours and relentless routine was not for me. I liked to read, reflect, write, run and just be. I didn’t want to be working all the time, round the clock.

So despite Faisal sahib’s disapproval, off I went to America to become a psychiatrist. And that was the last I was to see of him for fifteen years.

To be continued...