Prof TJ Danaraj would take us weekly during our Medical Posting for the Case Conference. This was a small group tutorial with about 12 – 15 students participating. A student would clerk and examine a patient, and then at the appointed time wheelchair the patient to the Conference room together with all the investigation results.

Selecting the student to present was a most difficult task as we were all so scared of TJD. Typically we will draw lots to decide who would be the ‘sacrificial lamb’ for past experience had shown us that NO MATTER how detailed the history or how METICULOUS the physical examination, when it went under the microscope of TJD, Cavernous gaps will be exposed and obvious physical signs missed!

Hence the Case Conference was usually saturated with tension from the moment he walked in. Silence filled the room, a pin drop would be loud! The student would present and he listened quietly, when the student finished, TJD would ask for many details not elaborated in the history….  which came first, what is the sequence of events, etc.

Once my classmate presented a patient with Myasthenia Gravis, after the history was discussed TJD turned around and asked the first student “Tell me the physiology of swallowing!! – he boomed! The first student did not know…. ohoh, he turned to the second, now an eminent Datuk in service (I was the 3rd in that row). In my heart, I was prepared to run to the library to look up the answer should my neighbour also not know the answer as such is the usual fate. To my great delight, he actually recalled! Prof Raman (our Prof of Physiology) would have been so proud of him! To this day, this is one of my favourite questions whenever students present patients to me with dysphagia!

The session would continue as the student proceeded to demonstrate the physical signs. TJD would interrupt every now and then to either point out an error in technique or to demonstrate the clinical method himself.

Once a patient with a Neurological problem was presented. The patient was lying on the examination couch when TJD asked us to demonstrate to him how we would examine this patient. We proceeded to do the examination with the patient supine but TJD said ‘NO, show me how you would examine this patient SEATED up!’ We froze as we were NOT taught by our clinical teachers to examine in a seated posture, in the wards the patient was always lying flat on the bed. TJD said that as doctors later on, a lot of our patients in the clinic would be examined seated upright…  and he proceeded to demonstrate to us how to conduct the Neurological exam with the patient seated. It was a wonderful demonstration of a Great Clinician’s mastery of the examination techniques, and to this day I teach my students the same way.              

We learnt early on NEVER to present to him with the opening statement “This is a CASE of ….” for swift will he strike back with a Question…  “Is this a PILLOW CASE OR SUITCASE OR BOLSTER CASE????” The patient is first and foremost a Human Being, never a Case!

The importance of the power of observation is a lesson he taught us well. Once he walked into the Conference room, looked at the patient seated on the wheelchair, turned to us and boomed “What is your diagnosis?” We were stunned for nary a word had been discussed yet! He proceeded to analyse in detail the signs the patient had on general inspection which betrayed the diagnosis! For our young tender minds, this really opened our eyes, and I use this same technique on my students whenever the opportunity arises, most recently when they presented a patient to me who was obviously Hypothyroid.

The same strict man evolved to be a sweet gentle teacher when he took us for revision classes in medicine during the 2 weeks break before our Final Examinations in fifth year. He showed us slides of physical signs and challenged our minds with MCQs. These classes for the whole cohort were held in the Clinical Auditorium, a large steep theatre-like hall, and TJD would wave the long pointer to emphasize his points or to pick on a student to answer his questions. These were the days before the laser pointer and the shadow of his pointer cast by the light of the slide projector would fall across the screen to his target.

He was absolutely patient during these 2 crucial weeks, and tolerant of our deficiencies. He knew we were all highly stressed and when we were despondent over forgetting our basic sciences, he reassured us that he too had to look up the basic texts many a time to recall.

And we finally graduated! Meeting Prof in the corridors, he was warm and treated us as young doctors, now that he was not only our teacher but also our colleague, and he made sure that we knew and felt that.

When our postings for Housemanship came out, I was posted to a ‘small’ General Hospital, not University Hospital as I had hoped. I met Prof along the corridor and I told him of my being ‘exiled’ (it looked like that to me at that time!).

Prof however was very happy! He told me to go out and serve in the General Hospital assigned and assured me that I would mature much faster than my classmates at University Hospital. In a low voice he said “They will just be clerks while you will be a doctor!” And he smiled and assured me that the universities will always be there and in the future I can always return to the academic circles when I am ready. It is only many years later that his prophesy came through when I returned to academia after 20+ years.

I came under TJD’s teaching again a few years later when I returned to my alma mater for an “Advanced Course in Medicine” in preparation for the MRCP part2 examinations.

The bedside teaching and slide quizzes that we had with him are still fresh in my mind. At the bedside, he demonstrated a sharpness for the most ‘invisible’ of physical signs that is uncanny, and his demonstration to us on how to reach the precise diagnosis of valvular pathologies WITHOUT the use of a stethoscope but utilising observation, pulse, and palpation is a lesson to behold. If there is a lesson to be learnt, it is to OBSERVE with a capital O.

The slides that he had spent a lifetime accumulating is a treasure trove of Physical Signs. He showed us fingernails GREEN in colour, adults with floppy necks and Blue cyanotic and clubbed TOES with normal fingers! I now regularly use these same slides to teach my students and about a year ago, had made a Blog with the help of my students to show and preserve some of these Physical Signs for future generations of students.

The post grad students held a dinner for Prof and Prof HO Wong at the end of the formal course. It was at a restaurant in PJ and after the dinner, Prof invited us over to his house for tea. I felt touched and happy to be so honoured. Students today do not realise nor appreciate the degree of respect and awe we had for our teachers 3 decades ago.

I passed my Post Grad exams and at a medical conference later, met up with Prof again. He was now frail and rather weak in his legs. Prof HO Wong had asked me to help him about and throughout the duration of the day, I sat with him and helped him with his movements. A few days later, he wrote to me in his characteristic cursive handwriting to thank me for taking care of him. That letter is a treasure I have kept with me all these years.

Another letter from him a couple of years later arrived typewritten. I knew that he must be even more frail by now and his handwriting affected. These letters are now posted on the blog “We stand on the shoulders of Giants”

Dr Wong Yin Onn,

Clinical Associate Professor,