It was the putrid professional ethics or lack of it, mentioned before, which took its toll.
Though I had seen scars of cholecystectomy with the gall bladder with stones still in or thyroidectomy scar on the neck with patient still suffering from symptoms of hyperthyroidism, I attributed them to professional incompetence, but two cases which I saw convinced me that there was deliberate lack of surgical ethics. I will state my case by describing two cases.
The first was an old friend and the deliberate mismanagement of his paraplegia touched me to the core. Aziz and I had played marbles and flown kites together as school kids in Bantwa.
After Marie and I arrived in Karachi, he invited us home for dinner for old time’s sake. His house was a one-room shack in one of the fast developing slums of Karachi.
There was a mattress on the floor with their seven children sleeping side by side like sardines in a tin. On one end of the mattress was a pillow for him and on the other end, one for his wife.
It was a pathetic sight, which Marie was seeing for the first time in her life. To instil some humour in the sad situation, I said to Aziz: "With this formidable seven tiered barrier, I don’t see the prospect of further addition to the family!”
Aziz laughed and replied, “You don’t know your friend’s ability to leapfrog and the indefatigable demands of the human flesh!”
At dinner served on the floor, I persuaded him to let me carry out vasa ligation under local anaesthesia as outpatient with no cost to him saying, "You can then satisfy all your carnal needs without a heavy price to pay.”
By profession, Aziz was a building contractor and slogged whole day in the sweltering heat to earn a pittance, major portion of which he spent to pay school fees for his numerous children.
One day, he fell from the first floor of a building he was supervising, and broke his spine leaving paralysed from his waist, losing his sensations as well. He could not feel his bladder and bowels and could not evacuate.
I was called to see him at home by his wife, not as a surgeon but a friend. I took his history, examined him and saw the X-rays of his spine, taken in a backstreet nursing home and of poor quality.
When I finished, he asked me the usual question, which I have heard from many paraplegic patients. “Will I be able to walk?”
Though not highly educated, he was too intelligent to be fobbed off with a false reply, so I candidly replied: "Unfortunately, we can’t repair a transacted spinal cord to regain its function. We advise rehabilitation in a dedicated spinal centre. I don’t know if there is one here but if not, we can raise funds to send you to England, where I know of a centre in Aylesbury where Guttmann has pioneered such treatment."
I left him but could not get him off my mind as I was driving and thought of plans to raise funds for him.
Three days later, I went to a nursing home belonging to the president of various high-fluting medical organisations in the country to see a private patient.
Surprise, surprise, there was Aziz there as an inpatient. When I asked him how and why, he seemed very embarrassed and replied. “This surgeon tells me that he can operate on my spine and guarantees that not only will I walk after his surgery, but also I will be able to return to my building construction business.” I could understand how Aziz was lured by this false claim.
Aziz died a few months later at home with fulminating urinary infection and multiple bedsores, leaving behind a young widow with seven mouths to feed.
The final straw that broke the camel’s back was sad and sordid. It was that of a Muslim priest, a pesh-imam, who conducts prayers in the mosque who walked into my office, stinking to high heavens.
He wore a small beard, a skull cap, a long, loose full length kaftan and telltale dark patches on his forehead, result of lying prostrate on the floor five times a day.
When I asked him what his problem was, he just raised his long robe above his waist when I saw a sight I will never forget.
Staring at me was a festering wound on the dorsum of his penis with presumably a dead bone-graft jutting out from the wound.
On prodding him, I gathered that the man of God suffered from impotency and consulted a qualified surgeon who took a slice of bone from his tibia and grafted in his penis and charged the earth for the surgery, which was collected from his “parishioners”.
When the money ran out the patient was discharged from the surgeon’s outpatient care. There was nothing for me to do except to remove the sequestrum after persuading my anaesthetist to do it gratis, as I did.
I gave antibiotics samples left by “medical reps”, who came to detail me on new drugs to the imam postoperatively whose wound infection cleared and helped his wound to heal.
That evening I went home and cried. “Do I want to pass my professional life in this unethical atmosphere?” I asked Marie who tried to comfort me.
“What about the Karachi Family? They will be devastated if we leave,” she echoed the thought uppermost in my mind. “They will be shocked but will eventually understand my position.”
Initially, I took Janmohamed and Zainab in confidence, shared my anguish with them and gently informed them of my drastic decision.
After a lot of recriminations and flood of tears on both sides, they resigned to the inevitable with a tired remark. "We don’t want to stand in the way of your happiness.”
So on a dull and drizzly evening of December 22, we climbed the gangway of S.S. Paramatta, an Australian cargo ship for Liverpool.