It is more than six weeks since Prime Minister (PM) Nawaz Sharif had his operation, and we the people of Pakistan have not yet seen him or heard him on TV. On Wednesday, July 20, the media reported that the PM was going to address the nation. I waited for that to happen but not a peep, and the news just disappeared from all forms of media. According to news reports, the PM has been well enough to receive Prince Charles, former Afghan president, Hamid Karzai, and of course, his cabinet members and his family. And he travelled to Pakistan and was seen coming off the plane on TV, but no audio of his was heard. Since then he has evidently attended cabinet meetings, and has been running the country, and most recently, he left Lahore and has arrived in Islamabad. Yet why the continued silence? Some of my readers might notice that I have been sort of harping on this issue. Frankly, I had expected that within a few days after his operation the PM would have made a video message for the people of Pakistan. However, the PM has remained quiet for almost six weeks. This to me is worrisome for many reasons. From a purely medical point of view, having some experience in these matters I keep wondering about different “complications” of open heart procedures that could be behind the PM’s prolonged public silence. Fortunately, many of the complications of surgery that could make it difficult for him to speak fluently and forcefully are temporary in nature. Most patients with such problems recover full normal abilities within a matter of weeks after surgery. Other than medical reasons, there could be political reasons for the PM staying out of the “public eye.” One of the possible explanations available, and that makes most sense to me is that the PM has been slow to recover after his operation, and therefore his advisers and family members want to wait until he is back to normal before allowing him to face the public and take on his full load of work as the chief executive of the country. This makes medical and political sense. However, such a delay does open up many questions about the present political situation, and gives in to possible rumours about what happens next. One of the more persistent “analysis,” if it can be called that, is that the PM is no longer capable of taking on his full administrative and political responsibilities, and as such is slowly being phased out and will soon be replaced. This will be done in such a way that the present political dispensation is not upset. Of course, along with this assessment come the rumours about “palace intrigues” going on to determine the proper timing and the appropriate replacement. The three obvious replacements being mentioned are not in a position to take over in a quick “in-house” change, since none of them are members of the national assembly, and therefore, cannot take over as the leader of the house in the National Assembly. Within this context exists the possibility that the PM does not want to give up his position at all. This could obviously also mean that nothing much is going to change, and these rumours will die down as the PM keeps getting better and his physical condition improves. This possibility seems most likely since the PM rushed to Islamabad even though the news was that the infection in his leg incisions was going to delay his travelling plans. Some of the PM’s supporters in the general public seem to worry that the PM is not fully functional yet and is being “stage”-managed by his close relatives. But then as the PM gets more involved in managing “affairs of the state,” his level of personal involvement will become quite evident. One of the reasons why I remain worried about the PM’s condition is the recent announcement that Imran Khan and his party will soon start agitation to replace the present political dispensation. Even if we belittle Mr Khan’s repeated threats of getting rid of the PM and his government, the fact remains that a physically weakened PM is probably an easier target. If the PM is not fully in command of his minions, then a coherent response to public agitation might become difficult. More importantly, if the “third umpire” perceives weakness on the part of the PM, then a change of some sort might become more likely. From a historical perspective, an open-heart surgery does not prevent patients from becoming politically active after recovery. From American politics we have the example of General Alexander Hague who after an open-heart surgery went on to serve as the secretary of state under President Ronald Reagan. And former vice president, Dick Cheney, underwent multiple heart procedures and served in high positions including eight years as the vice president. Also former President Bill Clinton underwent an open-heart surgery soon after leaving the White House and even developed complications after his surgery, yet even today he is an active participant in political activity. In my opinion then the fact that the PM has undergone an open-heart surgery does not disqualify him from continuing as the PM of Pakistan as long as he recovers fully. While discussing historical issues the famous Sherlock Holmes story “The Silver Blaze” is worth remembering. In that story the primary clue that allowed Holmes to solve the case was the fact that silence prevailed when it should not have. As such continued silence from the PM means something, what that might be is difficult to assess. For a politician who is undoubtedly the best retail politician in Pakistan today, not taking the people of the country in full confidence at this time is definitely worrisome. However, it is entirely up to the PM to decide what it is he wants to do, and any attempt to force him out will be unfortunate. The author is a former editor of the Journal of Association of Pakistani descent Physicians of North America (APPNA)