Khalid Hasan writing for the Friday Times
Utterly unmarked in Pakistan was the recent death of Dr Ayub Ommaya, which is ironic because with him is gone from the scene one of the world’s greatest neurosurgeons, who pioneered several life-saving procedures, and who is remembered here to this day as having performed a legendary 18 hour operation on a 36-year-old man came as close to doing the impossible.
Dr Ommaya, who belonged to Abbotabad, was a remarkable man whose talents lay in many directions, from operatic music to mysticism to working for inter-religious harmony. He graduated with a medical degree from King Edward Medical College, Lahore in 1953. His friend, cardiac surgeon Dr Riaz Haider, who was two years his junior at King Edward and who has lived and practised medicine in the United States for close to 40 years, recalled for me their days as students in Lahore. Ayub, Dr Haider reminisced, was a brilliant student, but then he was good at anything he chose to do. He was a swimmer and a debater; he sang and he could play the piano. He graduated from King Edward with honours and went on to win a Rhodes scholarship that took him to Oxford, where he studied physiology of the brain and human emotions, finishing with honours in 1956. He stayed on in England and four years later, in 1960, was made a fellow of the Royal College of Surgeons. A year later, he obtained a Doctor of Philosophy degree in clinical biology from Oxford. In 1964, he was named Hunterian Professor at the Royal College of Surgeons. Along the way, he had published 60 research papers in international medical journals.
Ommaya, first and last a Pakistani and an old-fashioned patriot, returned home because that was where he really wanted to work and be of service. What happened to him on return was exactly what happened to Dr Abdus Salam. He was not considered good enough for the position that he had more qualifications for than the rest of the field put together. He already had under his belt a coveted teaching position at the Royal College of Surgeons, named after John Hunter, an 18th century surgeon who has countless medical discoveries to his credit, including what is known as an aneurysm. It has been said of him that, “the poor could command his services more than the rich. He would see an industrious tradesman before a duke, when his house was full of grandees, ‘You have no time to spare,’ he would say, ‘you live by it; most of these can wait, they have nothing to do when they go home.’ No man cared less for the profits of the profession, or more for the honour of it.” There are three busts of his in different parts of London even today. Ommaya was like Hunter: his patients came first.
Ommaya had held the professorship named after the great Hunter, but when he applied for the post of professor of surgery, he was told to provide proof that he had the capability to hold such a position. The qualifications that he had come back with were found “insufficient.” He was told that he could be taken as assistant professor and after five years, depending on how he fared, his suitability for promotion would be considered. Disillusioned but not disgusted because he was a man with a sweet and forgiving temper, he left Pakistan and came to Washington, where one of the world’s premier medical research institutions, the National Institute of Health, was pleased to take him as an associate neurosurgeon. He rose quickly and for 10 years he was section chief of applied neuroscience research and surgical neurology, becoming chief of surgery in 1975. He also served as chief medical adviser to the National Highway Traffic Safety Administration, where he created the Agency on Head Trauma.
Dr Haider recalled that when on his way to England in 1953 as a Rhodes scholar, Ommaya stopped off in Italy and in a matter of three weeks learnt enough about operatic music, given his fine singing voice, to always be ready to perform for friends at their birthdays and on special occasions. Once, after singing an Italian aria to greet Dr Haider on his birthday, he burst into a Pushto song. Asked what the Pushto lyrics meant, Ommaya replied, “What kind of a lover are you, eating all the meat and throwing the bones in my direction!”
Dr Haider told me another story that Ommaya had recounted to him. When he was in his second year at King Edward in Lahore, he read an article in Reader’s Digest about a Canadian neurosurgeon by the name of Dr Penfield from Montreal. So inspired was he by what he had read that he decided that day to become a neurosurgeon. He also wrote to Dr Penfield, asking him to accept him as a student. The Canadian surgeon wrote back suggesting that Ommaya should instead go to London where he should study under one of Penfield’s old students, Dr Pennybecker, which is exactly what Ommaya did. There is a street in downtown Montreal named after Dr Penfield.
The celebrated 18-hour operation that Ommaya performed – which became the subject of a long write-up in Reader’s Digest titled “45 Minutes of Death” – involved a lethal mass on the spinal cord of 36-year old teacher Donald Hauck from Rochester, New York, that grew and grew until an operation became imperative; but for the surgery to succeed, the patient’s heart and brain, it was clear, would have to be shut down, making him a “living corpse.” I am grateful to Dr Amjad Hussain from Ohio for having sent me a printout of the Digest article that reads like a “ball to ball commentary” of that marathon operation, which has gone down in the annals of neurosurgery. The operation was performed at the George Washington University hospital in Washington DC by Ommaya, assisted by Dr Paul Corse. The problem was that the patient’s cluster was disturbingly close to one of the body’s life centres, the respiration-controlling medulla. If the medulla was to be found to be deeply embedded, Ommaya would have to cut into blood-carrying vessels and hemorrhages would obscure his vision. He would not be able to use a suction tube in critical areas next to the medulla and the high spinal cord as that might vacuum up the patient’s nerve cells. Ommaya decided to drain the body of blood, put the patient on a heart-lung machine, perform the operation, reheat the blood, return it to the body, restore circulation and revive regular functions. The question was whether he would be able to revive the man’s brain. Omayya’s successful operation has become a neurosurgical classic.
It is ironic that the man who was one of the greatest and most innovative neurosurgeons of his time should have developed Alzheimer’s. When the disease became progressively worse, his family decided that it would be best for him to return home. There he lived quietly on a farmhouse in Islamabad, being taken care of by his lovely wife Ghazala, and that was where he died and there he now is, buried in the earth of his beloved Pakistan.
– This is a regular column by TFT’s Washington correspondent. He can be reached at firstname.lastname@example.org