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Tuesday, October 27, 2015

A Tribute to a Great Teacher - Dr R.S Thanabalasundrum

By Nihal D Amerasekera

On starting Clinical work at the General Hospital Colombo in 1964  I was immensely fortunate to belong to a generation taught by a plethora of superbly dedicated and gifted teachers. Although they lead busy lives with a thriving private practice they never failed to give their all to the students. I am greatly indebted to all of them for their dedication and commitment. In that firmament of shining stars I would consider Dr Thanabalasundrum as the one that shone the brightest.

My first clinical appointment as a medical student in Colombo was with Dr Thanabalasundrum. Then he was at the zenith of his profession and remained as one of the best teachers of clinical medicine in the country.  He was a brilliant professional and a consummate physician. He took teaching seriously and introduced a system and structure into history taking.  He brought logic into our clinical methods, diagnosis and treatment.  When presenting cases nothing incorrect went past his sharp intellect.  He always tested and challenged the student’s narrative. The little book of Clinical Methods by Hutchison and Hunter held more reverence than the bible. His pearls of wisdom filled our notebooks.

 Dr R S Thanabalasundrum was focused and thorough in everything he did. He made certain we learnt medicine whether we liked it or not. He didn’t mince his words and was a strict disciplinarian.  Although stern he had the welfare of the students at heart and respected their dignity. To his patients he showed great kindness and empathy. His bedside manner was immaculate and impressive. Although he enjoyed a lucrative private practice he never neglected his duties to his students and patients in his non fee paying wards.

Dr Rajadurai Selliah Thanabalasundrum was born in Kokuvil in 1922.  His father was a doctor. After a stint in the local primary school he entered Royal College Colombo where he had a glittering academic career. He was drawn into the profession of his father and Joined the Colombo Medical College.  Dr Thanabalasundrum lived in the Brodie hostel which had a notorious reputation for its pranks even in those distant days.  He worked diligently in that environment to obtain first class honours in all examinations  achieving the rare feat of distinctions in Medicine, Surgery and Obstetrics in the Final MBBS in 1946.  After obtaining his MD in 1954 and MRCP (Lond) he returned  to become the Visiting Physician in Jaffna. He was appointed Consultant Physician to the General Hospital Colombo in 1956. In that same year he was married to Pamathy Sivagnanasundrum.  They had two daughters and a son.

He was elected a Fellow of the Royal College of Physicians in 1974. As a physician his interests were wide ranging. His gentle approach to patients and their problems led to his being much in demand as a consultant.  It was during these years that he became our family physician and we were at the receiving end of his kindness and first rate clinical care.

Dr R S Thanabalasundrum was an excellent tutor and treated his ward staff and doctors with courtesy and kindness.  He made time to train his junior doctors who went on to good consultant posts in various parts of the world. His patients had enormous respect and affection for him. His straightforward manner and integrity made him a reliable and loyal colleague.

After retirement from the GHC he continued with his private practice in Colombo for many years until he became the Professor of Medicine of the North Colombo Medical College in 1985.  There he remained until 1995. As Professor he was greatly respected as an exceptional lecturer and good colleague. In recognition of his long years of service to the nation the Government bestowed on him the honour of Deshabandu in 1998.

Despite his stern outward appearance he showed tremendous humanity and warmth to those who came to know him. He could be disconcertingly candid. Dr R S Thanabalasundrum will be long remembered as a brilliant teacher a superb clinician and a kind and generous doctor with good old school values.

In his final illness he was treated by Dr HHR Samarasinghe. The anecdotes suggest he still had the interest in his profession to be aroused by clinical problems of the day. While his talents were great and his professional achievements many, the mark that he has left in the memory of his students, family and friends is his warmth, dedication and generosity of spirit.

All through the political upheavals and the grim era of ethnic tensions his love for the country of his birth sustained him and never wavered. He continued to live at Horton Place Colombo 7 until his death in November 2007. His remains were cremated with Hindu rites at the General Cemetery Kanatte. The likes of him are a rarity and irreplaceable in this selfish and egotistical world.

His name will be etched in the Hall of Fame of Medical greats in Sri Lanka to be remembered for all time.

May he find Eternal Peace.


11 comments:

  1. That was a great tribute to a great teacher and brilliant Physician.
    However, I regret that I did not have the good fortune to do any appointments under him as a student nor as a Doctor to appreciate more of his great & good god given talents other than on an occasional clinical ward teaching session!!! . Nevertheless, he did treat my Mum when she was unwell with all sorts of cardiac issues. He used to jest with Mum that she enjoyed her 'Wattalapan'(Whatt'le happen) too well!!! Mum was of course, had the greatest faith in him up to her final days. in 1989
    All I can say now is that his soul find peace and rest in eternal reincarnation and I hope I will be more fortunate, to be able to do an appointment under his patronage in our next lives if ever our paths cross.???
    Razaque.

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  2. Razaque
    Thank you for your comments.
    You did most of the appointments with me at the Faculty and it surprises me you weren't with us for that very first clinical. He taught us the basics so well. I can still picture him seated in his chair in the ward surrounded by students with some unfortunate guy presenting a case. He had no favourites and everyone was equal. What a great teacher!!
    ND

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  3. ND, Thankyou for sharing the lives and achievements of these great teachers with us -(I refer also to your previous tributes to Prof Cooray, Prof Dissanayake etc),who were admirable, and contributed to moulding our lives and careers in intangible but significant ways.
    I knew so little of their lives while I was a student and it is good to learn of them even at this late stage.
    The time spent in researching them is appreciated-
    Writing them up well ofcourse would not have been an effort for you!
    Many Thanks-- Rohini Ana

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  4. Rohini Ana
    Thank you for the comment. It is great to see my effort appreciated. History taking now is a lost art, as you may have recognised, due to the total dependence on imaging and lab tests for a diagnoses. I was often amazed to see only a couple of lines of history in the patients' notes. In the old days the history was a short biography and we got to know so much about the patients lives. I can still recall some of them with great clarity. Our teachers although at times egotistical and difficult taught us to the best of their ability. Even those who created that wicked atmosphere of fear in the wards and the faculty had the welfare of the students at heart. I wish they were taught how to teach before being let loose on medical students. The ever changing pattern of medical education is another topic of great interest as they will churn out the doctors who will be treating us and also training the new generation of medical students.
    ND

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  6. Nihal,

    it is great to read such a well written, sincere, and detailed acknowledgement of one of our best loved teachers of Medicine. I totally agree with you. We were really lucky to have been taught by these great people.

    from Zita

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  7. Zita, thank you. It was the golden era of medical education with such a fine concentration of clinical teachers at the GHC and the Faculty. We appreciate their dedication and commitment. I wish SLMA or CoMSAA have a 'hall of fame' to remember them. I hope their photograph adorn the walls of the Faculty and the SLMA. I am pleased my tribute brought back memories of those years now long gone.
    ND

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  8. I mentioned the great RST in a Blog post in June 2013. I started a series called "Lessons I still remember" but it never took off unfortunately. In it I referred to Dr Thanabalasunderam's 10 point analysis of pain. i.e.10 point analysis of pain. http://colombomedgrads1962.blogspot.co.uk/2013/06/lessons-i-still-remember.html
    By Mahendra Gonsalkorale

    I first learned the “10 point analysis of pain ” from Dr R.S. Thanabalasunderam. This has served me well over the years and I have passed it on to many young doctors and medical students.

    1. Site
    2. Intensity
    3. Duration
    4. Frequency
    5. Character
    6. Radiation
    7. Provoking factors
    8. Relieving factors
    9. Aggravating factors
    10. Accompanying factors

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  9. Mahen
    Yes, I do recall those 10 points. Whenever we mentioned the word 'pain' in our presentation he expected those points to be included. He had such points for several other symptoms like dyspnoea, haemoptysis and palpitations which was most impressive. He was such a brilliant mind and a superb teacher.
    Currently history taking seems to be less important with greater dependence on imaging and lab tests. Did you insist on a good history from your students and juniors? How do they compare with those of our generation. Medical education has changed tremendously recently and is evolving as we speak. Are the new graduates "fit for purpose"
    ND

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  10. RST and his generation were exceptional teachers. Ernie Pieris, Wickrema Wijanaike, Roly Jayawardena, George Ratnavale,PR Anthonis, Oliver Pieris, Viswanathan, DJ Atygalle- the list is long.
    About the art of history taking, I agree it is a disappearing art and it is to be lamented. I always told my Juniors and Medical students never lose the thrill gained by solving a riddle, for each patient is a riddle or "unsolved murder", and unlike in the very old days of clinical medicine when the solution wasn't always accessible, we now have the luxury of gaining "clues" from a whole range of sources and then confirming or refuting our diagnosis. I would tell them to enjoy this process, be a detective and start by first getting as much information as possible from the history, then formulate a theory before proceeding to examination, following which you narrow down possibilities and then resort to special investigations to finally nail it! No shotgun investigations and no fishing in the dark. Dr Wijenaike taught his HOs to request investigations only if they could explain to him why they were requested - a very good training point I never lost. Solving a problem and the thrill of getting it right (not all the time) is fun. Never lose that by losing the sharp focus of your intellectual searchlight by making it a broad beam which indiscriminately shines on everything and muddies the water.

    I think current medical training is much better in terms of imparting communication skills and patient and user orientation but I fell at times it lacks in providing the depth of understanding we had. The old fashioned method of giving a solid grounding in Anatomy, Physiology and Biochemistry was a good one. I would love to see a blend of the two and I am happy to say that Manchester has moved in that direction. Self learning is good but in the vast sea of knowledge, it is better for students to be given more direction in navigation by those who have done it before. Spoon feeding is bad but throwing them in the deep end to be devoured by sharks has its drawbacks as well. One thing that fascinates me is that Medical Education gurus seem to change methods without first asking the question, "are we producing the kind of doctors we need and will a change in teaching methods achieve that goal?". I may be wrong but there is precious little evaluation and audit in this direction.

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  11. Mahen
    Thank you for that comprehensive answer to my query.
    I left Clinical Medicine in 1978 for a life in diagnostic imaging. At first I missed the challenge of seeing real patients. Radiology is an apprenticeship and the course is well structured. I re-learnt medicine to diagnose from pictures. Another 5 years of hard grind and more exams. As a teacher in radiology I found the new recruits lacked the depth of knowledge in anatomy that we acquired in our medical training. Anatomy is crucial for radiology. The medical knowledge I gained as a student and doctor in SL stood me in good stead all through my career. Although I have been critical of the culture of fear and intimidation in medical education of our time, of this I am certain, our teachers taught us well and had our welfare at heart. I was a registrar to US Jayawickrema ,who took over from W Wijenaike, for 18 months. He was such a fine teacher and a gentleman. I am thankful for such wonderful memories.
    ND

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