A Man of Implacable Wisdom: Professor Dr. Faisal Masud (1954-2019) - Part 1

A Man of Implacable Wisdom:

Professor Dr. Faisal Masud (1954-2019)

By

Ali Madeeh Hashmi

"For Leon Daudet, Charcot was a diagnostician and observer of genius, a man of vast erudition and 'implacable wisdom', whose case summaries were as concentrated as an Ingres drawing; he was without leniency towards humanity (though full of pity for animals), found the illness more interesting than the patient, and 'observed the malfunctioning of the human machine as an astronomer observes the movement of the stars'.

                                                                              Alphonse Daudet- “In The Land of Pain”

My first two years in medical college were, by turns, excruciatingly boring and intensely terrifying. In the first two years of medical college, students, most of whom are bright, inquisitive, motivated people, are subjected to a martial regimen of lectures and tests. This is both a reflection of the authoritarian mind-set of the people who teach ‘basic sciences’ (the disciplines which form the foundation of medical knowledge like human anatomy, physiology and the most dreaded, biochemistry) as well as a valiant attempt to impart an enormous amount of factual knowledge to students who have no prior familiarity with it.

The medical college which I joined in December 1985, King Edward Medical College (now King Edward Medical University) had honed these twin duties to perfection. We were subjected to lecture after lecture, class after class; in most of which we sat clueless and bored. This was followed by test after test after test, one after another until we were exhausted and came home tired and scared. 

I vividly remember my initial experiences of carving up dead bodies in the Anatomy ‘dissection hall’ which reeked of formalin and exuded a menacing air with human corpses laying on dissection tables covered by sheets. The first few weeks of medical college, I would wake up startled at night certain that the people who we had been ‘dissecting’ had come into my room at night and were standing around me. It did not help that many of our teachers in these sciences were, to be charitable, less than enthusiastic about their jobs.

This went on for two years and finally, after passing our ‘first professional’ exams, we were in the third year of medical college where the general atmosphere in classes was more relaxed and we finally got to go to the hospital where we felt like ‘real’ doctors.

It was also in third year that we got to see Dr. Faisal Masud in action. Generally, classes of medical students are taken by senior faculty, usually a professor. If the professor is not available, then the next most senior person is assigned to take the class. Dr. Faisal Masud made an immediate impression on all of us (not an easy thing to accomplish with 200+ potentially rowdy medical students).

Credits: Humans of KEMU

To this day, I cannot remember what he taught us (more a reflection of my general disinterest in lectures combined with my day-dreaminess). And to this day, I can still picture him in my mind: unruly salt and pepper hair which often fell like a mop over his forehead, piercing eyes darting around from behind horn-rimmed glasses, impeccably dressed in elegant suits (in the winter) and safari suits or a shirt and tie in the summer, holding a mike in one hand with the thick black wire training behind him, a chalk in the other hand with which he would write or draw a figure on the board and a complete, encyclopedic mastery of his subject. He was a mesmerizing figure. 

Even back then, when he walked into the classroom, an immediate hush fell on the room. He had (we knew) come back after completing his post graduate medical training in England. That alone, like many of his peers made him stand out. We could tell, even back then as relatively novice medical students, that those of our teachers who had studied abroad had a far more comprehensive grasp of their subject than those who had not. In addition, they appeared more polished, more humane, more inspiring, and just more fun; or at least that’s how it appeared to me.

And Faisal sahib (the moniker we all adopted for him) was in a class of his own. He would hold forth on the topic at hand, prowling the front of the classroom, speaking into the mike with the wire trailing behind him. Occasionally he would saunter over to the blackboard and write some notes or make a figure on the board and then go back to speaking, his fierce gaze darting around the lecture hall.

It would be difficult for the medical students of today, most of whom are girls, to imagine a classroom full of medical students back then. Girls were restricted to a ‘quota’ which meant that only the very highest achieving girls were admitted to our co-education medical college. In our class, there were around 25 girls and upwards of 200 boys. The girls sat on the front two benches while we sat behind them and filled up the lecture halls with their stair step seating almost all the way up to the ceiling. The rowdiest boys sat in the back benches and spent most of their times chatting, joking, throwing chalks or crumpled papers at each other or sometimes at the teachers if the lecture was particularly boring.

I remember a class by a junior lecturer in our 3^rd or 4^th year of medical college when we had long ago overcome our fear and awe of being ‘medical students’ and were focused on having as much fun as possible. I think the subject was pharmacology and the poor man had obviously prepared some notes which he started reading to the class, no doubt hoping to get through the session as quickly as possible. 

But students are like sharks; they can smell fear and inexperience. Within a few minutes, the boys at the back started talking loudly, then joking and cat-calling. The lecturer, now slightly panicked, continued staring at his notes and reading them but it was no use. He had lost the attention of the class and while he stood there helplessly reading notes to which no one was listening, the din in the lecture hall became deafening. I still remember the expression on his face: a mixture of misery, helplessness, and fear. I felt slightly sorry for him.

But Faisal sahib’s lectures were the exact opposite. When he talked, there was pin drop silence. His complete mastery of what he was teaching, the way he delivered his lectures, his demeanor, his clothes, his body language, all said ‘I know what I am talking about and you better listen if you know what’s good for you’. And we loved and feared him in equal measure. So much so that graduating medical students fought over the privilege to work with him in the hospital in their ‘house job’: the one year practical experience that all new medical graduates are required to have before they can obtain a license to practice medicine.

My first personal interaction with him, though, was a little painful. We were in our 4^th year of medical college and had been assigned to ‘North Medical Ward’ for our medicine rotation. Mayo Hospital, the main teaching hospital of our college, built in 1871 is named after Richard Bourke, the 6^th Earl of Mayo (a county in West Ireland) who had also incidentally, served as a Viceroy of India. It is the largest teaching hospital in Pakistan with 3000 beds and a multitude of departments and specialties.

On a typical workday, being inside Mayo (those of us who have studied or worked there refer to it, affectionately, as just ‘Mayo’) is like being inside a beehive; people jostling for space on sidewalks and inside corridors; cars, motorcycles and rickshaws zipping back and forth narrowly missing pedestrians and each other; nurses and doctors scurrying around gazing at their cell phones while dodging traffic; patients and their families wandering around looking slightly forlorn and, during the summer, the relentless Lahore sun beating down mercilessly on everyone. 

Mayo has a large department of Medicine with four ‘Units’; individual hospital wards with male and female sections capable of housing upwards of 100 patients each. For medical students, Medicine is a ‘core’ specialty (along with Surgery, Obstetrics and Gynecology and Pediatrics). Every graduating medical student at King Edward/Mayo is expected to master the basics of these four specialties before they graduate since they form the heart of medical practice (the list does not include Psychiatry but more on that later). 

When I was a medical student, we were all assigned to a month-long rotation in Medicine in each of our 3^rd, 4^th and final year of medical college. This is supposed to be a ‘compulsory’ rotation which means you attend classes and see patients in the Medicine ‘ward’ (this includes the large common area where patients are admitted and reside along with at least one, sometimes more family members as well as doctor’s offices, class rooms and administrative offices). At the end of the month-long rotation, we all had to sit for a ‘Ward test’ which you have to pass in order to complete the rotation. Technically, you cannot sit for your final exam for that year unless you have passed the test for a major specialty.

On the day in question, I and my classmates arrived in North Medical Ward to find that our class was to be taken by Faisal sahib. We were delighted and apprehensive in equal measure: what better than to be taught by the Master himself? I can’t speak for the rest of my class fellows, perhaps 7-8 in all, but I for one was afraid that I would get picked on and be unable to answer a question that Faisal sahib had.

Medicine was not my favorite subject to begin with. In fact, like most of my class fellows, I had sort of drifted into medical college; quite a feat considering one had to have achieved top academic honors over a long period of time in school and college to get in. Like most of my peers, I had been good in studies. I had a voracious appetite for books and a photographic memory. It had helped me navigate school even though (I now know in retrospect), the education system in Pakistan had not encouraged or even acknowledged my natural curiosity and eagerness to learn. 

I had, with some difficulty, mastered the rote system of learning; of memorizing large amounts of factual information and then regurgitating it onto an exam paper. The subjects where memorization didn’t work so well like Mathematics and Physics were my weak points. I gravitated towards Biology and when, after finishing class 10 it came time to choose what I wanted to study in class 11 and 12 prior to applying for college, my father gently suggested that I think about becoming a doctor. 

In retrospect, his suggestion seems rational and was the same advice that thousands of parents gave to their academically high achieving children. The fact that career choices in Pakistan at that time (and to some extent still today although less so) were limited to “Doctor” or “Engineer” probably also had something to do with it. At any rate, I knew Engineering with its heavy emphasis on Mathematics and Physics was not for me, so I was happy to go along with his suggestion.

Once I got to King Edward, I realized that a good memory by itself wouldn’t get me very far since the sheer volume of information that had to be mastered could easily defeat the best brain. Luckily for me, medical college also included oral exams where my fluent English (thanks to my English grandmother) and my acting skills (learned on stage before I got to medical college) came in handy.

But today was different. Not only did I not know much about Medicine, Faisal sahib’s chosen subject, I knew that any attempt to worm out of a question by beating around the bush would be immediately detected. And who knew what Faisal sahib would do to someone who was found trying to deceive him by pretending to know something he didn’t? Such was the aura of the man that all of us, outwardly confident, strapping young men who had already begun to dismiss our own fathers as ignorant were shaking in our boots.

It turns out I was worried about the wrong thing. Faisal sahib never asked me a question; he did something much worse. Since we were still junior medical students, he began to teach us about ‘Clinical Methods’ or how to take a ‘history’, a systematic account of the patient’s symptoms and ‘physical examination’ of the patient. In the hands of an astute doctor, these two components of a medical examination are usually enough to establish an accurate diagnosis the majority of the time without the need for expensive laboratory tests which are hard to do in a huge, resource-constrained hospital like Mayo. 

While teaching us how to examine the chest and lungs, Faisal sahib decided to use me as a mock patient; possibly because I was the tallest in my class and thus more prominent. As he sat behind me and put his hands around my upper chest to demonstrate to my class fellows how the chest expands when one takes a breath, he asked me to take in a deep breath. I did and then waited. Nothing happened. Faisal sahib didn’t say anything, and he still had his hands around the back of my upper chest. He asked me to take another deep breath and I did it again. I glanced around furtively to see what he was doing and saw a displeased expression on his face.

“Usually, the chest expands as a patient breathes in deeply” he said in his British-accented English “but he is so obese that his chest is not moving at all”. I could hear the scorn dripping from his voice. Faisal sahib himself was thin and angular with broad shoulders and a narrow waist (which would thicken with age when we became colleagues and friends years later). I found out later that he had been an avid tennis player in college and was a finicky eater (although he loved to try out new cooking ideas). 

I had struggled with obesity my entire childhood and continued to try and balance my love of unhealthy sweets with an obsessive regimen of running to try and work them off. For someone I idolized, like Faisal sahib, to comment on my weight, and that too in front of my friends, was a like a dagger to my heart. I don’t remember anything about the rest of the class, probably because I was too mortified to pay any attention to what he said subsequently. 

To be continued…