Syria's President Bashar al-Assad trained to be an ophthalmologist because, he said, eye surgery involves few emergencies and not much blood is spilled.
Now Assad, who abandoned his medical studies and inherited power when his father died 11 years ago, is battling a wave of protests across his tightly-controlled state in which rights groups say more than 200 people have been killed.
The demonstrations for greater freedoms, inspired by uprisings across the Arab world, have swept Syria for four weeks despite a fierce security crackdown and vague promises of reform, presenting Assad with the gravest challenge to his rule.
The 45-year-old, still portrayed by supporters as a youthful reformist, has responded with a characteristic mix of defiance and conciliatory gestures, seeking to show he would not bow to regional turmoil which toppled leaders in Egypt and Tunisia.
"Implementing reform should not be a fad. When it is just a reflection of a wave that the region is living, it is destruction," Assad told parliament last month in his only public comments since the unrest erupted on March 18.
His troops and special forces sought to crush protest in the restive cities of Deraa and Banias, but he also promised citizenship to stateless Kurds and steps to replace nearly half a century of emergency law with anti-terrorism legislation.
Critics say they expect the new law to be equally draconian, pointing to Bashar's repressive record after a brief opening up in the first months after he took power in July 2000.
At the time, Assad freed some political detainees and allowed debate on democracy and reform to flower, only to crush the "Damascus Spring" a few months later. He also kept many members of his minority Alawite faith–an offshoot of Shi'ite Islam–in key positions of authority around him.
Assad has said his decade in power has offered little opportunity to open up, saying the US military response to the 11 September 2001 bombings, its 2003 invasion of neighboring Iraq, and a Western-led campaign to oust Syrian troops from Lebanon two years later blocked any efforts at domestic liberalization.
Opponents say he has never been serious about reform.
"The revolution is at the door and the regime is still flirting with change," leading opposition figure Haitham al-Maleh, an 80-year-old former judge, said after the unrest first broke out in the southern city of Deraa last month.
Thrust into the spotlight
The tall, quietly-spoken president, thrust into the spotlight after the death of his elder brother Basel in 1994, strengthened his father's strategic alliance with Iran.
He ended nearly three decades of Syrian military presence in neighboring Lebanon under international pressure following the 2005 assassination of Lebanese statesman Rafik al-Hariri.
But the collapse three months ago of Beirut's pro-Western government, led by Hariri's son, was the latest sign that Assad has clawed back influence in Lebanese politics.
Assad, who portrays his country as a champion of Arab resistance to Israel and supports militant groups Hezbollah and Hamas, says his foreign policy protects him from the public anger which swept the leaders of Egypt and Tunisia from power.
"We have more difficult circumstances than most of the Arab countries but in spite of that Syria is stable," he told the Wall Street Journal in an interview published in January.
"Why? Because you have to be very closely linked to the beliefs of the people. This is the core issue."
But he has also pursued indirect peace talks with Israel and, despite continued Israeli occupation of the Golan Heights captured from Syria in the 1967 Arab-Israeli war, has ensured the front line remains quiet.
Assad has emerged from the Western isolation that followed Hariri's assassination, which the West blamed on Damascus, and in January a US ambassador arrived in Syria, ending a more than five-year break in top American diplomatic representation.
In the region, the Syrian leader has forged closer ties with Iran, Turkey and Qatar, and mended fences with Saudi Arabia.
At home he started liberalizing the economy, easing decades of central control and allowing limited foreign investment. But while some, including Assad's cousin Rami Makhlouf, have acquired great wealth, ordinary Syrians have seen few benefits.
Assad's wife Asma, a former investment banker who grew up in London, has helped him try to project a softer, liberal and modern image to the outside world, countering Syria's reputation as a repressive police state.
A Vogue magazine article published in March–and widely criticized for glossing over Syria's poor human rights record, jailing of political dissidents and absence of free elections–painted a picture of a "wildly democratic" Assad household.
"We all vote on what we want, and where," it quoted Asma as saying, adding that a chandelier made of cut-up comic books was chosen by the children. "They outvoted us three to two on that."
Even if Assad rides out the storm sweeping Syria, the harsh response to the protest has dented any illusion that his country and his home life are governed by the same rules.
It has also stalled the halting re-engagement with Western powers. "I wouldn't expect Bashar and Asma to be visiting European capitals in the near future," said a Western diplomat whose country was at the forefront of Assad's rehabilitation.
