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would become another of his trademarks: for instance, their "low average intelligence quotient".[44]

After graduating, Dr. Mahathir spent only four years in government service in Penang and Kedah before resigning to open a private practice, while his wife was to work as a doctor for the government for 25 years. Although the immediate reason for his quitting was the failure of a superior to support his application for a posting to study in a teaching hospital in Penang to be a surgeon, he also wanted to remain near his aging parents. Borrowing money from a brother-in-law, he opened in Alor Star the MAHA Clinic — a name meaning "great" in Malay that combined the first two letters of Mahathir and Hasmah, his wife[45] — in 1957. As one of only five private doctors in the town and the first Malay, he came to be known as "Dr. UMNO", with his office often identified as the "UMNO Clinic".

Dr. Mahathir acquired the reputation of being a caring doctor, willing to make house calls at any hour and trudge across padi fields in the dark to treat patients. If they could not afford his fee, they settled by installment or paid what they had. But he never missed an opportunity to scold Malays when their performance fell short. Observing hard-working Chinese farmers next door producing more rice, he would ask idle Malays with more than a hint of sarcasm, "No rain this side?"[46]

While the sarcasm was never far away, Dr. Mahathir would carry much of his bedside manner into politics: Even his sharpest comments, which stung, cut and wounded, were usually delivered in dulcet tones, as if advising an ill farmer to take his pills three times a day. Mukhriz Mahathir saw his father lose his temper and curse only once: when it was discovered just in time that someone in Dr. Mahathir's re-election campaign office had incorrectly completed his nomination papers in an attempt to sabotage his candidacy. The expletive was mild, Mukhriz said. "In Kedah, especially that generation, they swear somewhat politely."[47]

Dexterous, Dr. Mahathir spent his spare time in a home workshop on carpentry, wood turning and metalwork. He built boats powered by outboard motors and used machinery to fashion wrought iron into name plates, lamps and chandeliers. "I like the feeling of building things, of working with wood or metal and creating something," he once told a British journalist. No one who witnessed him at his hobbies doubted he would have made a surgeon.

Dr. Mahathir and Dr. Siti Hasmah were also involved in welfare and public health activities. While he, as President of the Kedah Tuberculosis Association, visited Indian workers on rubber plantations to treat and give advice to TB sufferers,[48] she threw her weight behind the Kedah Family Planning Association. At Dr. Mahathir's request, Shaari Daud, a federal bureaucrat and friend, helped him establish a private education association to finance the studies of disadvantaged Malay children.[49]

The couple lost no time in starting what became a sizable and happy family: A daughter, Marina, arrived in June 1957, ten months after they were married. Altogether, the Mahathirs had seven children, five of whom joined the household in under nine years and lived for a while in Alor Star. Years later in Kuala Lumpur, when they had left home to study overseas or marry, Prime Minister Mahathir and his wife, finding it "a little bit lonely" as empty-nesters,[50] and "fed up" waiting for grand children,[51] started what amounted to a second family. Dr. Mahathir built on his father's "strange liking for the letter M", as he once put it.[52] Where Mohamad Iskandar gave all five sons names starting with M, Dr. Mahathir did the same for his three girls as well as the four boys.

Three of the kids were adopted in two different and unusual circumstances. The couple's third child, Melinda, actually chose Dr. Mahathir and his wife as her parents, rather than the other way around. They became her godparents in a traditional ceremony at the age of six months, after Dr. Mahathir cured her of a minor ailment. When he visited her house to treat her brother years later, she wanted to follow Dr. Mahathir home. He agreed, as did her parents, farmers who worked their own land at Tokai outside Alor Star. Siti Aisha Abdul Rahman joined the Mahathir family in 1960, aged six and with an M name, remaining until she married in 1982. She was treated the same as her brothers and sisters, except that she returned to the farm to spend school holidays with her real parents.[53]

Dr. Mahathir was inspired to expand the family again on a state visit to Pakistan in 1983. Invited to review a national day parade by President Zia ul-Haq, he was struck by the "very good-looking children" in national dress. "I thought, wow, they look very nice to me. I thought I would adopt Pakistani children".[54] Later, a close friend who also wanted to adopt, visited Pakistan and selected four babies from an orphanage, and returned to Malaysia with them. In October 1984, the Mahathirs got a fourth son, Mazhar, nine months, and a third daughter, Maizura, seven months. Dr. Mahathir was 59 and Dr. Siti Hasmah 58.

Growing up in Alor Star, the older children remember "an almost idyllic childhood", especially after they moved into a new, split-level brick home at Titi Gajah, 11 kilometres out of town — on the prestigious northern side.[55] Designed by Baharuddin Abu Kassim, the architect responsible for the National Mosque in Kuala Lumpur, the house featured modern conveniences unknown to most locals and sat in spacious grounds that backed onto a river and opened at the front to a vista of almost endless green fields. Both parents stressed the traditional and religious values that had been drummed into them: honesty, gratitude, respect for elders, hard work and discipline, along with the importance of education and the value of money. Dr. Mahathir laughed when the kids entered newspaper contests involving a certain amount of luck. He told

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