The Pioneers of Medicine in Burma #5

Prof U Kyee Paw (Surgery)

(by dr thane oke kyaw-myint)

 

While all my teachers had made a difference in my life, a few had left indelible marks on the way I think and work since becoming a doctor in 1967. As I am more close to these teachers, I hope you all will allow me to add anecdotes about these teachers, to illustrate why they have touched my life and heart more than others.

Prof. U Kyee Paw, MBBS, FRCS, FACS, FICS, FAFPS thoracic surgeon, professor and head of the department of surgery, IM1 will always be my idol whom I try a lot to emulate but with only partial success.

I wrote earlier that Sayagyi was trained under Prof. Daw Yin May and was sent to UK to be trained as an OB-GYN. Not having a Royal College of Obstetricians and Gynecologists at that time, Saya had to take FRCS (OG) from the RCS Edinburgh, just like Prof. Daw Yin May did. Saya came back but was destined not to be an OB-GYN.

When I was in my 3rd. MB, Saya, when he was taking a bedside clinic, turned to our group and asked, "What is there in Rochester?" I stammering replied, "Saya, I only know only of the Mayo brothers and the Mayo’s Clinic. I read it in Reader’s Digest." Saya only smiled and then did not add anything else.

Only later I learnt about Saya leaving Burma again to study thoracic surgery in Mayo’s clinic. Saya went back again to study in Lahey’s Clinic for cardio thoracic surgery and thyroid surgery. Saya was the pioneer of cardiothoracic surgery in Burma.

Goitre and Iodine deficiency was rife in the days before salt iodization. At that time, only one person in Burma was doing thyroid surgery, meaning doing surgery on a significant number of cases. He was Dr. Gordon Seagrave who built the Namkhan Hospital, which still stands in Namkhan. Dr. Seagrave wrote so many books about his experiences in Burma, starting with Waste Basket Surgery, Burma Surgeon, My Hospital in the Hills, very touching stories fondly told of his time in Burma. Saya was the first Burmese surgeon to start doing surgery on goiter.

Getting back to Saya: all trained by Saya in Burma became excellent surgeons and many became thoracic surgeons. Prof. Norman Hla (Zaw Tun) was one of them. How well Sayagyi trained people could be evident from an anecdote not of Sayagyi but of his student (Norman). We were studying together in London in 1971 and Norman before taking his FRCS was asked to do a short locum House Surgeon in a teaching hospital in London. He was assisting the Professor of Thoracic Surgery, when the Professor asked Norman to watch how the lower 1/3 of the oesophgus could be mobilized before resection for Ca oesophgus. Norman replied, "We did it differently in Burma, sir." The professor sarcastically looked up and sarcastically said, "If you know a better way, why don’t you show us how it is done in Burma." Norma thinking it was a genuine offer, switched places, and used Sayagyi’s technique of resecting the carcinoma. He did it so well and so fast (as taught by Saya) that Norman did show the technique taught by Saya, and also finish the operation in less time. As he finished, the doctors watching, the anesthetists and registrars gave a loud applause for his performance, and the Professor suddenly threw down his gloves and hastily left. Poor Norman told me that may be his career was ended as he unknowingly upset his professor.

The next morning Norman got a call from the Professor’s secretary to come and see the professor immediately, and he in turn called me saying that he was being called to probably terminate his locum contract. But there was a happy ending, Norman was called by the by the professor, who took him to the hospital administrator, not to sack Norman but to tell the administrator that seeing how well trained Norman was, that he be paid at a Registrar’s pay and not as a pre-registration house surgeon. If Saya’s student was that good, I am sure that readers could imagine how excellent a thoracic surgeon Saya is (I still like to use the present tense for Saya, as I am sure that if he be well now he would still be doing thoracotomies with the same dexterity).

How had Sayagyi touched the lives of so many of his students and so many of his patients? It was not only by his brilliant surgery but setting examples to us by showing what a "thamar" should be and teaching us what proper best side manner was, including personal appearance and attire.

In Part 1, Ko Myo Myint (present Rector, IM1) and I were very priviledged to learn from Saya just the two of us. Knowing that we were keen to learn, Saya told us that if we two would come and help out his OPD in Myin Pyaing Gwin OPD, he would teach us surgery. Saya would finish seeing patients about 5.30 and start off with his minor surgery till about 7.30 or 8.00 and then start teaching us surgery mainly based on cases which we saw in the evening. Saya would even drop us home after the session. Saya was very poetic, he would say things that made it easier to understand and remember. One evening, before he started, he said, "Maung Myo Myint and Maung Johnny, I will teach you now what you should consider as the Rule of Three: the surgery will take you three minutes, you will be paid three hundred kyats and if you are caught, you go to jail for three years." He was to teach us vasectomy that evening!!!

Saya’s sense of humour and choice of words was another thing I will always remember when if we did something not to the level of his expectation, he would look at the student concerned and would say, "Saya Ta Pyae Ga, Htone Pone Htone Pan Nae, ta gae kyei daw, tae ah dar go". The first couple of times, I thought Saya was saying. "You look quite astute but in reality you are quite dumb." What Saya actually said was " You look quite dull but in reality you are quite dumb."

I was Sayagyi’s house surgeon in 17 & 18, I could still remember the post op nights and mornings. Every morning at 4.00 a.m. we could see a light coming on in Saya’s residence as Saya woke up, at 4.30 a.m. We could hear Saya starting his prayers in his altar room (the room above the car port in the old house in the hospital compound across the street). If one listened from Wards 7 & 8, we could even hear Saya starting his prayers every morning with "Aw Gar Tha, Aw Gar Tha." By 5.30 a.m., he would finish his prayers. Then, this was when the house surgeons would better be ready. No calls could be made around 6.00 a.m. to Wards 17 & 18 because exactly at 6.00 exactly a call would come, from Saya to ask about the four thoracacotomies done (each operation day) – is the drainage OK? Have we taken a recheck portable that morning to see that the lungs remain inflated? What is actually draining out and volume? Was the patient given good pain control overnight? Is there fever? These would be standard questions that Saya would like to know if each of the thoracotomy patients and woe betide the HS who had not done what should be done and who could not correctly report the above. This was just one example of how (a) this famous surgeon started his day, always with prayers (b) his concern for each of the patient whom he operated on.

"The youngest member of the team must be the first to arrive in the theatre" another of Saya’s expectation, "If I can be in the theatre at exactly 7.00 a.m., I would expect my assistants to be here at least half an hour before me, and you as a house surgeon to be here at least half an hour before the assistants." I listened (as all HS must have done) arriving at the theatre often even before the night staff had gone off duty.

"Johnny, I saw that the patient was brought into the theatre, pushed by the ward boy. " Saya would say, "In my opinion, every house surgeon must bring in pushing the trolley himself. What if the ward boy did not know and one of the arms fell off and the patient got hurt? Or do you consider that it is beneath your dignity to push the trolley on which the patient you are responsible for?" I had read Dr. Charles Mayo’s biography when I was a boy and Saya’s words reminded me of Dr. Mayo’s words to people training under him (Or more correctly, as I had never met Dr. Mayo’s, I was thinking that Dr. Mayo must be someone like my own teacher).

Putting drapes on properly and taking them off properly and correctly was another lesson that we learnt from Saya. Saya would say, "Sister, let him do the draping and put on the towel clips and let us see." Then he would come and pulled on the drapes: if any came out or the drapes got disturbed in a way they shouldn’t be, Saya never became angry with anyone but would only say looking at the "offending" HS and say, "Buffalo, harp, buffalo, harp." with a smile (meaning Kywe Par Saung Tee).

After one major operation which I assisted as perhaps the third assistant pulling on retractors as directed, Saya turned to me and gave me one of the unforgettable lessons in surgery. He said, "Johnny, take off the drapes one by one and hold them up and tell me what you see." I did as ordered by Saya, carefully removing each drape and holding up, turning around and wondering what I was to see. In the end, Saya said, " Johnny, what do you see? I replied, " Saya, I do not see anything." Saya’s reply which I can still hear in my ears, ‘Remember that is evidence of bloodless surgery." True enough, Saya always performed excellent control of bleeding that even the drapes next to the incision would not be stained in blood.

I am sure that if Saya should read this, Saya would not remember what he told me as follows. Saya told his assistants (Dennis Tun Thaung was one of them) to let me have chance to do more than others. I was curious why Saya would say that as the fact to become a surgeon was not my ambition and I had told Saya about wanting to be a pediatrician during one of the evenings in Myin Pyain Gwin OPD. My curiosity was such that before my house posting in 17 & 18 was over, I asked Saya why he asked that I be given more chance than others. His reply was typical of Saya’s wisdom, " This is because you have told me that you would like to pursue and become a pediatric physician. You may never have another chance to do surgery after this posting. If and when you do become a paediatrician, I would not like my "ta pae’s" (student’s) reputation as a paediatrician be marred because you missed a surgical condition in a child. Such was Saya’s "cetana’ for a student whom he knew already had never intended to be a surgeon.

I never became a surgeon as everyone who is close to me knows but the years during which I was Saya’s student and posting as his house surgeon had left me with so many lessons for life which made me a better person and a better doctor than I would had been, had I not the good fortune to have been a student of such a gifted teacher, a man of moral courage, a man of sincerity and integrity, a doctor who lived the Hippocratic Oath that he made on becoming a doctor till now.

I do not know who will get to read the above words that I wrote about Saya from a student’s perspective, a student who had worshipped him since the sixties and who still continue to do so. A student who is only trying to pay homage to his teacher, not with flowers but with words of remembrance of Saya’s teachings.