Pakdokter would consider Chapter 43, captioned " Matters of the Heart" - as one of the chapters that pakdokter came out feeling most impressed with and satisfied, after reading it. This is one chapter pakdokter can develop and feel much empathy and understanding - perhaps aided by the fact that pakdokter is himself a medical doctor to begin with.
Here Mahathir wrote about his experience suffering from the first heart attack, the bypass surgery he went through and the recovery and rehabilitation processes he undertook back to normal health that kept him fit and working for another 18 years! In Tom Plate's book, "Doctor M : Operation Malaysia" - which was released not too long ago - Mahathir admitted that his decision to have his heart surgery done in Malaysia by Malaysia's own surgeons was partly and to a lesser degree, a political decision ( for political capital) aside from his own faith, confidence and trust in our own doctors' capabilities in carrying out the operation. And he also admitted that he had, by then, come to terms with his own mortality.
Being a " Made-in Malaysia" doctor himself, pakdokter has always believed that we are as good if not better than doctors from the other parts of the world. And also personally knowing most of the doctors in the team who operated on Mahathir ( a few of them were pakdokter's own classmates in medical school at the University of Malaya) - knowing their skills and work records - pakdokter had full confidence in them and pakdokter would not hesitate to put pakdokter under their care should one day pakdokter become in need of such a service.
It so happened that on the afternoon ( this 'time and date' recollection stands to be corrected) before the day Mahathir was to be operated, a reporter from Utusan Malaysia walked into pakdokter's office and asked for pakdokter's opinion on Mahathir's choice of having his heart surgery being done at home by our own Malaysian doctors. Pakdokter's answers should be obvious. Pakdokter said that Mahathir had given us, Malaysian doctors, his recognition of our capabilities. To pakdokter, this would be a great boost in building up our self-confidence.( Many previous leaders and dignitaries had mostly gone to the Mayo Clinic in the US or to London - and their outcomes - honestly - to pakdokter - had not always been that impressive!) And if pakdokter's memory is not wrong - pakdokter's comments and photograph made it to the front page of the Utusan Malaysia the next day. ( Unfortunately pakdokter never had the habit of keeping cut-outs of pieces like this.)
Going through a heart surgery is not simply just opening up the chest and suturing up the by-pass across the clogged-up artery. The emotional and psychological preparation and the emotional and psychological support after it are equally if not more important the surgical procedure itself. Where else could one get the better of this than at home where the surroundings are familiar and the people close to you are readily available? Imagine yourself in Mayo Clinic, suffering after the surgery, fearing for your life with only your wife or husband next to you, and the team of nurses and rehabilitation personnels are mostly insensitive and ignorant of your social, religious and cultural norms. On this score alone, pakdokter would have recommended such a surgery to be done at home if such a service is available. ( There are many studies that have established the fact that psychological and emotional preparation/preparedness and support before and after the surgery greatly influence the outcome of surgeries and, pakdokter did, in pakdokter's small way present one such a paper on this topic at the Annual Congress of the Academy of Medicine of Malaysia many years ago.)
Mahathir went on to remain fit and healthy for another 18 years before he finally agreed to another round of surgery. That in itself was a record - the general assumptions were that a by-pass is generally good on the average for about 10 years. Mahathir's description of his experience recuperating from the second surgery - the disorientation, confusion, hallucinations during the acute phase and the depression that followed should be made a recommended reading for medical students and would be helpful too for patients intending to go for surgery to help them get some ideas as to what to expect pre- and post-surgery.
In pakdokter's humble opinion, effective ( and sometimes we have to be aggressive about it) treatment of the depression during the post-surgery period will facilitate recovery and rehabilitation of the patient.
When the IJN ( the National Heart Institute) was first set-up, pakdokter was invited ( pakdokter could not now remember how and by whom) to meet, set up and lead a support group for patients who had undergone heart surgery. During pakdokter's residency psychiatry training, pakdokter's dissertation for the Master's Degree was a small project looking at the prevalence of psychiatric morbidity in a group of patients who had undergone kidney transplants as well as their donors. As in several other similar studies conducted earlier in other parts of the world, pakdokter's research simply replicated similar findings as earlier studies. Most of the tranplant patients and their donors suffered various forms of depression and anxiety disorders warranting psychiatric treatment and psychological support.
Pakdokter's assumptions when facing the group of heart surgery patients were the same and pakdokter was not surprised when many among the crowd ( the patients and their significant others) opened up and discussed their emotional and psychological experiences ( ranging from various forms of anxiety, phobias and depression) which became a handicap to their return to normal life despite having gone through successful surgeries.
And some of them went on to become pakdokter's clients for some time after that.
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