In Summary
  • I embarked on examining Firoz. As I teach my students, I start with “Inspection” or “Look” and fully exposed both his upper limbs and looked at them for a while. That, by itself, provided an important clue.
  • Both sensations were dull though Firoz could feel and locate them with his eyes closed. Hot and cold water tubes were not available, so I skipped checking his temperature sensation. I then checked if he could actively move his elbows, wrists and fingers.
  • While I was accompanying Prof Khwaja on his teaching ward rounds, I saw a man lying in one of the beds. What caught my eye were his forearms which looked darker than his arms. “What is this case?” I inquired.

In July last year, I wrote about two weddings I attended, one in Karachi and the other in Mombasa, and ended the column with a brief surgical twist. I want to revisit Karachi and relate a moving surgical story I came across there. Before I do so, let me give my readers a brief background of Pakistan.

The new country was carved out of Mother India on the 14th of August 1946, as a result of a resolution passed by the Muslim League of India in 1940 and resolutely fought for by its leader, Muhammed Ali Jinnah. The resolution was based on the Two Nation theory, a brain child of the brilliant Urdu poet, Allama Iqbal. Arising from it, it was proposed that the five provinces of India which had a Muslim majority would form a separate country, Pakistan, and the British were urged to create it before they quit India.

I was a first year medical student in Miraj in southern India when India was partitioned and, soon after, there were riots, where my family lived. They fled and sailed in dhows as refugees and ended up in Karachi where, eventually, they settled and flourished. Not to interrupt my medical studies, it was decided that I continue studying in Miraj.

When I qualified, I decided to specialise as a surgeon. By then, all democratic institutions in Pakistan had collapsed and Ayub Khan, a military ruler, had assumed power and had promulgated martial law, under which all newly qualified doctors were conscripted into the military for three years. I was, therefore, advised to proceed directly to England to obtain my fellowship in surgery. So when I got it, I faced a tough decision, conveniently deferred. I was determined to go back to the developing world from where I came, to serve my people. The fact that I was a victim of partition did not diminish my desire to work and help the developing world I came from.

I did not want to be an early casualty of what became known many years later as “brain drain.” Also my family had invested in me financially and emotionally and I had promises to keep. The call from them was loud and clear and the fact that it emanated from a different land did not make it any less anguished.

My only constraint was that though I had left from India, where I had my roots, I had lost all connections there and had to return to Pakistan where my displaced family had settled. So after considerable soul searching, Marie and I sailed to Karachi in early March 1959. In doing so I felt like a sailor coming triumphantly home and finding that the shore had moved, the familiar lighthouse was not beckoning and the sand under his feet was not the same.

For these reasons, sadly for all, we could not settle in the radically changed circumstances and, after an unhappy stay of under a year, just before Christmas of 1959, we sailed in a cargo ship to Liverpool. What happened thereafter is well documented both in my autobiography and the Surgeon’s Diary, which I don’t want to repeat here.

What is relevant to this story is the fact that my Karachi family and we have been very close and time and distance has not affected the family affection. There have been frequent visits both ways and my last visit to Karachi with Jan was in Christmas time in 2014 to attend the wedding of my grand nephew. I have given a full account of the wedding in this column before so this time I am devoting it to a poignant surgical episode.


As usual, after the wedding, while we were waiting for the weekly direct flight to London, my hands started missing my scalpel and I was developing withdrawal symptoms. I asked my younger brother, who is a leading chest physician in Karachi and attached to various hospitals there, to arrange for me to attend surgical ward rounds.

Accordingly, while I was accompanying Prof Khwaja on his teaching ward rounds, I saw a man lying in one of the beds. What caught my eye were his forearms which looked darker than his arms. “What is this case?” I inquired.

“Oh, his name is Firoz Khan and he is a very interesting case,” replied the professor. “He comes for physiotherapy as an outpatient and I asked the physiotherapist to send him here so that you could see him.” He then threw a challenge.

“While I am teaching the students, why don’t you examine him and see if you can solve the riddle of his different looking arms and forearms. Over lunch in the consultants’ mess after I complete the rounds, you can tell me what you think.” He then gently cautioned me. “The diagnosis is in the history, so talking to the patient is strictly not allowed.”

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