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Monday, September 5, 2011

Dreaming aloud - On being a medical student forty years ago

This article by "ND" appeared in the Sunday Island of 13th July, 2003. As we march up to our 50th Anniversary and a fitting Reunion, it's certainly worth a re-read.

Dreaming aloud - On being a medical student forty years ago

By Dr. Nihal D. Amerasekera FRCP, FRCR (Medical College Colombo 1962-67)
Consultant Radiologist (UK)


In the 1960’s in Sri Lanka career choice was rather limited by parental influence. Those who were clever studied medicine. Those who were good with their hands (no brains needed?) went into engineering. Those who were crafty and cunning chose law! The many who were not good at anything went into politics. I was the odd man out being in the last category. I chose medicine. It is hard to describe my excitement at entering Medical College. I felt in some strange way this was my destiny. Nothing else was more important. I looked forward to hard work anticipating the fabulous goal ahead. I felt the romance of being a bohemian medical student. I felt special. I was proud and arrogant. I presume I am allowed to have these delusions of grandeur as a teenager with all my life before me. I must confess, now approaching the end of my medical career I see it all differently.
Then there were only 2 medical schools – Colombo and Peradeniya. They were both excellent and maintained the highest academic standards. As for rivalry there was none. Each respected the other and some even moved from one to the other with a bit of "influence". With many new medical schools in Ragama, Galle and Jaffna the situation may be different.

We had a baptism of fire in the first week of the rag. It won’t be fair to apply the liberal values of the 21st Century to those days 40 years ago. Walking to Medical College with a brinjal round my neck left many onlookers bemused and bewildered. I in turn ragged my juniors. It was done without any malice and with due consideration to the feelings of the recipient.

We had the ignominy of being ragged twice for our misdemeanours during our Law-Medical match. The intrusions into a girl school and a cricket match in Colombo 7 brought out the best and the worst in us. We were all packed into an open top truck used to transport cattle. There were two large barrels, one filled with toddy which smelt and tasted like water from the Beira. The other had draught beer minus the froth and fizz. We took generous gulps from the barrels and the molasses arrack which was passed round. The decoction felt like a lighted stick of dynamite placed in my liver. The truck travelled the busy streets of Colombo amidst the cheers and jeers of onlookers. None were sober and I cannot recall a single ball being bowled on that day. Our excesses were graphically exposed in the daily papers and The Dean, Prof. Abhayaratne, called a meeting of the first years. He said every person who took part will be identified using a special photo microscope (there is no such thing) and punished severely. On looking back we realise how cleverly he handled the situation without allowing the Police to take any action. I presume it must be in our personal files. We were suspended for 2 weeks and fined Rs. 50.

Life at Medical College began in the "Block". There we dissected the human bodies dispassionately in our youthful enthusiasm and our search for knowledge. Tearing a body of a real person apart from head to toe despite its immersion in formalin still makes me cringe. As I write this I’m amazed we could face this ordeal day after day. Perhaps our youth and the need to learn gave us some protection. I couldn’t face that same task with that same detachment now.

The fortnightly tests called signatures in the "Block" were a nightmare. Those standing around the "convicts" who were being questioned always knew the answers. Prof. Waas often brought some light relief to the otherwise electric atmosphere. He asked a student "what passes through the foramen magnum?" Pat came the answer "food, Sir". Waas not willing to be outdone said "Its gallons and gallons of booze".

The detailed anatomy we learnt which had no relevance whatsoever to clinical medicine evaporated even before we crossed Kynsey Road. The physiology went completely over my head and Samson Wright (our text book) couldn’t help me and neither could Prof. Koch and Carlo Fonseka. A name that has stuck in my mind from physiology is that of "Prick Perera". He pricked our finger to get a drop of blood for us to perform a blood count during the practicals. There were 3 girls in our batch who were inseparable and always together. They were rather unkindly called Anorexia, Nausea and Vomiting and the names stuck until they left Medical College. Even to this day when I see them it is as if those names are tattooed on their foreheads.
In those days everyone knew his place. The master and servant, teacher and student, rich and poor, parent and child accepted the situation gracefully. These associations have now changed mostly for the better. The third year was relatively easy as there were no exams but the many lectures and copious notes kept us busy. We copied the lecturers every word including the jokes, inadvertently. The third MB was dominated by Pathology and Pharmacology. Path Cooray our Professor of Pathology was an institution and I remember to this day his mastery of General Pathology. His notes were our Bible and the only way to heaven. Prof. Chapman’s Bacteriology and Prof. Dissanayake’s Parasitology were a lot of work for little reward. I would always remember Prof. HVJ Fernando and Dr. WDL Fernando (then JMO Colombo) for their superb rendition of the well known song about the "Officers daughter who hanged and died" during a function at the Health Department Sports Club at Castle Street. Their Forensic Medicine only comes a close second.
Dr. NDW Lionel’s Pharmacology lectures were interesting and complete. He had a keen mind and a kind soul. His demise must have been a great loss to Pharmacology in Sri Lanka. Prof. Abhayaratne was affectionately called "Pachaya". Despite his broad exterior he was the quintessential gentleman. His Public Health lectures were a masterly collection of English prose. The breeding grounds of the mosquito were "tins and cans and pots and pans". The disadvantages of a tin roof – "Hot during hot weather, cold during cold weather and noisy during rainy weather". He spoke as if he designed the lavatory squatting plate . I saw in a peripheral unit which had a squatting plate with the toes together and the heels wide apart. What contortion would be needed to do the daily ablutions.

The wards brought us in contact with patients and the Visiting Physicians and Surgeons. They were our teachers. What great characters some of them were! I hope they still are. Their physical features, anger, smile and even the smell seem printed in my mind. Some had tempers like erupting volcanoes. They somehow seem indestructible. Even now after 40 years it gives me a shock and a pang to read of the death of an old teacher. The teachers at Medical College, Physicians and Surgeons seem permanent and the majority stayed on until retirement. Although they had lucrative Private Practice they had great loyalty to the students. They considered the studentship in medicine as an apprenticeship and took us under their wing. I often feel that many of our older teachers, some of them though eccentric, may turn in their graves at the disloyalty and opportunism of some of our modern teachers. When I now look at some of the old photos and even see the names of those doctors, their faces, mannerisms and voices come easily to mind.

Medical students were held in high regard by the general public as clever and hard working and we drove the point home carrying the naked human skull in buses and trains for all to see. There were reports of old women and young children fainting at this ghastly sight. Displaying the stethoscope prominently was another trick up our sleeve. The students walked the corridors with an air of authority and sometimes briskly as if rushing to save a life. Behind this facade the student were worked to the ground and lived in constant fear of professorial appointments and the oncoming examinations.

The appointments (the 2 month learning assignment) of Rajasooriya and Ranasinghe were a nightmare. They practiced zero tolerance. It was like being in the front line in a war. Many got "shot" but some survived to move on. There must be a better way to learn a trade!! Wijenaike, Medonza, Ratnavale, Attygalle, Ernie Peries, R. P. Jayawardene, P. R. Anthonis Darell Weinman , Cabraal, K. G. Jayasekera , Austin , Milroy Paul, Prof. Navaratne and DFDS Gunawardene during my time were an integral part of the institution that moulded our lives. The appointments with them were a great pleasure and often ended with a grand dinner. They taught us the bedside manners, clinical signs and the nuances of medicine not described in books. I learnt my trade with Dr. Thanabalasunderam who is one of the finest teachers I have had. I fear, I give the impression that these teachers were virtuous and without fault. They were human and in one way or another difficult, egotistical, strong minded and demanding. They loved teaching and their profession. They made good friends. I wouldn’t want them as enemies. Having said this I have the greatest respect for many of them.
As we read and saw patients with real clinical problems I saw some of those clinical features in my own self. I have diagnosed myself to be suffering with diseases ranging from stomach ulcer to rheumatoid arthritis. We realised the fragility of life and also our own mortality. Using the stethoscope to time the heart sounds and murmurs caused me immense grief. On many occasions I must have imagined bronchial breathing and pericardial rubs. Looking for clubbing and feeling for the spleen became second nature to me. The patients with ‘good‘ clinical signs never had any peace from medical students. Some mistook this for research and special attention for the greater good of humanity. Mostly they had little choice.

My lasting memory of my days as a student are the long corridors that criss-crossed the grounds of the General Hospital Colombo connecting the wards, clinics and theatres and the many pals who joked and laughed with us during those long treks. The hospital of about 2500 beds with at least a thousand under the beds was a store house of clinical material.

We were all in our late teens or early 20’s and the hormones were at their peak with tensions bulging at the seams. The Block Nite (Annual Medical College Dance) and the Colours Nite (both held at the University in Reid Avenue) were an opportunity to give vent to our feelings. Many were on the prowl looking for "bits". Sam the Man provided the music and for many of us the words of the Rolling Stones "I can get no satisfaction" described our feelings.

The lucky ones took their female companions to dance the night away. Some found happiness in the back seat of a Morris Minor whilst others got drunk to end their frustrations. I once took a partner twice my size for the dance. As everyone in the dance floor was gyrating and clicking their fingers I was pushing a 2 ton truck up Kadugannawa. The halitosis nearly killed me. I envied the frustrated onlookers around the dance floor who were scratching their groins to calm the nerves. The Block Nite started with a hilarious concert by the ‘block virgins’ and our actors who provided fabulous entertainment for some of the Professors and other students who had the courage to attend. Like at all Medical College social events the booze flowed freely and only a few were sober by the end of the hard days night. It is some comfort that the drug scene had not reached us yet.

The Bloemfontein Medical hostel was home to about 100 students. It had a pernicious reputation and was famous for its camaraderie and unity amongst its inhabitants. Many of the mischief attributed to the medics were planned and executed by them and were feared by most.

The women’s hostel was the "Hopper House" next to the Nurses Quarters. The nurses called "CODS" dominated the dreams of many "Medicos" They made our lives worthwhile during those traumatic times in Medical College. I spent my final year at the Jeevaka Buddhist Hostel in Colpetty. It was a peaceful and happy place with its own brand of Lankan humour.

The buildings of the College form a large part of my memories. The "Block" was built in 1913 as shown in a large plaque at the entrance. The smell of the dissected bodies will last in my memory for many years longer. The "New Anatomy lecture theatre" was airy and well designed. The Administration, Physiology and Pathology buildings were of Colonial architecture and surrounded the quadrangle with a small animal farm to house experimental animals. The clock tower, milk booth and the cycle shed are a part of our memories too. The Common Room was our refuge and the domain of the male of the species. No female dared to use it and few who passed through were greeted with whistles and catcalls. For some it was a second home. They were the chronic failures who were the pillars of the Common Room.

I still recall an honourable senior who completed a half hour game of billiards without removing the fag from his lips. Obviously he has done so for the past 8 years. "Uncle" managed the canteen which was the place for a "tea punt". Dr. Alles the College Medical Officer was often seen here enjoying a fag with Prof. Abhayaratne. In those days Bristol and 4 Aces were the affordable popular brands of cigarettes.
For some love blossomed at Medical College but for others the blossoms withered away.. The lucky ones paraded their partners in the evening along the byways around the General Hospital Colombo. The stench of the wide drains at Norris Canal road was hardly conducive for a romantic stroll. Some associations were purely recreational whilst others had the stamp of permanency.

"Final year medical student" meant many things to many people. To me it was the light at the end of the tunnel. To our parents it was time to look for fat dowries and start bargaining with marriage brokers. To the general public we were full of the latest medicine had to offer but lacked practical experience. It was a nice feeling indeed to be wanted and appreciated. The next best thing that happened to us was the final year trip. We all went in a coach first to Kurunegala where we stayed at the Masonic Hall and then to Badulla and Ratnapura. I recall a famous power cut during our dinner at Kurunegala and the only time we could see the food was when there was lightening . The doctors treated us with great respect and the hospitality was superb. In turn we provided our usual entertainment of jokes and play acting. It was all done in the best spirits as alcohol was never in short supply. The trip brought us closer together as a batch. All the students at Medical College by tradition belonged to one brotherhood and showed tremendous unity. The intimacy, laughter and kinship of those years still linger in my mind.

Past midnight after a whole day of study sometimes we indulged in watching "XXX films". The physical activity on celluloid was often too much for the audience who were at the verge of a nervous breakdown. For some the volcano erupted even before the show ended. Others even saw the 8mm films in reverse. Thank goodness such actions are physically impossible in real life.

The "Finals" as it was called then went on for nearly 6 weeks and we were taken in and out of rooms like cattle for slaughter. The wear and tear on our coronaries must have started then. It was not as difficult as we had imagined and most of us got the licence to practice medicine. I remember the day when the results were posted on the notice board at College. Many were ecstatic. I said my goodbyes to friends many of whom I never saw again.

I cannot believe it is 40 years since those happy days. It seems like yesterday when I walked into Medical College for the first time. I am convinced we couldn’t have had a better medical education anywhere else. On looking back, self fulfilment and happiness in life finally depended on our destiny and not on the grades we achieved in our medical exams. We had little or no control over our fate.

With all the medical knowledge available on the internet, books, magazines and journals you may think the doctors will be made redundant. The words of Mark Twain come to mind "Be careful of reading health books, you may die of a misprint".

I dedicate these memoirs to my parents who had confidence in my ability when I had doubts.

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