Finding my feet as a doctor in London and other stories

Another article by ND. This was first published in the Sunday Island on 7th September, 2003.

Finding my feet as a doctor in London and other stories

Dr. Nihal D Amerasekera FRCR, FRCP
Consultant Radiologist (UK)

I qualified as a doctor from the Colombo Medical College in 1967. After my house jobs my career prospects became a part of the Health Department lottery. For 7 years I drifted from one job to another and finally decided to pack my bags to seek my fortune abroad.

The decision to leave my family, friends and country was not taken lightly. I still recall the sleepless nights, the agony and the anguish which almost tore me apart. I wanted a different life from that I saw around me and was attracted by the bright lights and the sophistication of a life in London.

The day of my departure came all too soon. The Katunayake Aerodrome as it was called then was fast becoming an International Airport. I remember vividly waving goodbye to board the Swissair DC10 bound to London. The flight was long and unpleasant. The plane vibrated violently and shook every bone in my body as my mind was in turmoil. I didn’t know then that the DC10 had the worst safety record in modern aviation history. I travelled with my friend and colleague, Asoka Wijeyekoon. We comforted each other until we disembarked at Heathrow airport on that cold and wet June afternoon in 1974.

I was met at the airport by Dr. Cyril Amerasinghe who most kindly gave me food lodging and lots of helpful advice to survive the rigours of an alien culture.

My first job was at Harefield Hospital near London. It was a clinical attachment in pathology to assess my work and suitability for a substantive post in the National Health Service. All I can remember of my fortnight there is the utter loneliness and the hollow emptiness I felt. For hours I gazed at the blue summer sky often regretting my decision to leave my country.

It is the help of a complete stranger which is most deeply etched in my memory. I was allowed `A350 by my government, half of which went for registration with the General Medical Council and the rest was the fee for Medical Defence. How I survived until my first pay was not their concern. A lady doctor from New Delhi who was completely unknown to me often paid for my meals and I borrowed the rest from friends to whom I am still grateful. Those were the darkest days of my time in the UK.

Roller Coaster Life

I started my ephemeral and roller coaster life at Harefield Hospital London. New people appearing and disappearing from my life in quick succession unnerved me. I stood there in awe in my white doctors’ overcoat in the most elegant and magnificent corridors of one of the world’s finest chest hospitals. My past with all its bouquets and brickbats were now forgotten. What mattered most was the present performance. I had a brand new identity now. The iconic position I held as a doctor in Sri Lanka had just melted into the distance. Outside the confines of the hospital I was a Mr. Nobody. This was a shock to my system but I soon overcame this without much heartache.

My first proper job came via the kind courtesy of Dr. Titus Perera who has since remained a lifelong friend. Chase Farm Hospital is situated at the north end of London in beautiful countryside. I lived in hospital accommodation in a single room which wasn’t lavish by any means. Although I had an English education and spoke with an Oxford accent taught to us at school, many in England spoke a strange mix of regional slang which was incomprehensible. It was the British doctors and the television news readers who spoke the English I was used to back home. It took me several months to overcome this hurdle.

Speaking on the phone without the help of body language and hand signs wasn’t easy. Working in pathology was peaceful and I cannot recall ever breaking into a sweat. My first pay was a godsend although a meagre `A3180. I managed to settle my debts and buy myself a few essentials. I had made a suit in a well known tailoring establishment in Colombo Fort which I had worn since my arrival in Britain. It clung to my body like a wet suit. The left sleeve of my jacket was longer than the right (Sunday is longer than Monday!!). I couldn’t raise my right arm above 90 degrees. The trouser flapped about in the breeze like a sarong. The shoes that I brought from home lasted the summer. In winter it shrank losing its shape awkwardly. Water seeped in from the cracks in the sole creating a sorry mess within. I had to purchase suitable clothing to restore some of my lost pride.

I was born with the sun on my face in a tropical paradise. I had now to endure the vagaries of the four seasons. The spring in England was most colourful. The lovely well kept gardens and beautifully manicured lawns looked very pretty indeed. The summer with its long days gave us plenty of time to enjoy the warmth of the sun. The autumn ushered in the short days of the winter when we never saw the sun. The prevailing south westerly wind brought the moisture laden clouds from the Gulf of Mexico and rain in Britain is never far away. The incessant thin drizzle is characteristic of the type of rain here which never seem to stop in the winter.

Despite this it amazes me how sometimes in the summer there are water shortages and hosepipe bans. The British are a very tolerant race accepting this with amazing grace. There are 50% more deaths amongst the elderly in the UK in winter and many suffer from the seasonal affective disorder (SAD), a psychiatric illness brought on by the lack of sunlight. I enjoyed the first snowfall of the winter immensely and looked up in awe as the fine sleet and snow fell from the sky. As it settled, it formed sheets of ice and became like a skating rink. Many slipped and broke their wrists clogging up the casualty rooms in hospital.

Racism

I had heard about racism in Britain and experienced it first hand very soon after my arrival. Wednesday was my half day off from work and I got onto the W8 bus to Enfield Town. I sat in the upper deck in a packed bus. Although there was an empty seat next to me no one was willing to sit beside me. Many passengers preferred to stand all the way to the bitter end. In those days there was institutional racism in the NHS where jobs were not given to the most deserving. I also had to accept the NHS has some obligation to employ their own graduates. Now Britain has come a long way to become a multi-cultural society with equal opportunities to all. In general the British are a tolerant and a caring race. Their generous welfare state and the social services depend on the heavy tax paid by the rich and middle classes. The free healthcare and education have been the envy of the world and is a heavy burden on the public.

The British are a reserved people. They tend not to speak to you unless they have been introduced. This is sometimes mistaken for racism. They hardly know or speak to their neighbours. It amazes me how silent they remain travelling in the buses and tubes reading books and newspapers. Once I was travelling in an underground train with my sandwiches (this had dried prawns and chillies). It started to smell a bit and the smell got worse. The travellers in that confined space found it intolerable but they couldn’t locate the culprit. I pretended it wasn’t me. A man seated opposite thought he had trampled something awful removed his shoes to look at the sole. Fortunately the train stopped at the station and I jumped and hurried out, like the rest.

The British love queues and seem to form them even when they are in their cars. In my memory Sri Lankans form queues only until the bus arrives. After that it’s the law of the jungle!! It took me awhile not to throw litter on the road and refrain from spitting. I believe I have turned the corner now after 30 years.

Jobs in the UK are for specified periods and my post finished in a year. Meanwhile I had found a suitable job in Prince of Wales Hospital, Tottenham. There was a large West Indian community in the area and ethnic food was freely available. I moved very soon to its sister hospital a mile away to a clinical post to sit for the MRCP examination. This was the busiest job I had ever done. On-call every other night and every other weekend. A hectic schedule by any standard. It is here that I appreciated the teaching I received at the Colombo Medical College.

I cannot praise my old teachers highly enough. The years of toil as a medical student in the Ragama section of the General Hospital Colombo came to my rescue at the examination. Sadly I never appreciated their efforts at the time having only 24 hours in a day to complete the endless tasks thrust upon me. I was fortunate to complete my MRCP within 2 years of my arrival in the UK.

It was not all work there was much happiness and camaraderie too. I made some good Sri Lankan friends. We stuck together through thick and thin over many years. On weekends we gathered together at ‘Daneland’ the home of Tissa Ranasinghe who was a lecturer at a local Polytechnic. We had numerous parties there with plenty of booze and baila. It was a refuge for many young Sri Lankan doctors and was the place for an authentic curry. I recall the many Christmases and birthday parties we celebrated in that house. It still amazes me how the neighbours tolerated our raucous evenings and sing songs.

Kalu dodol

Home cooked food sent from Sri Lanka was a luxury. Once I recall Dr. Agrabodhi Fonseka receiving a parcel of kalu dodol which arrived here with a consistency of concrete. Half an hour in an oven restored its softness and the flavour. We undertook daring projects to help friends back home. Cars were a luxury then in Sri Lanka and Titus decided to send an old car home to a friend. Colin De Silva who has never driven for 10 years took a vehicle without wipers to Tilbury docks on a rainy day driving on bald tyres. There were times when it wasn’t clear if the car was on the road or in the drain. I was a passenger in that car and wouldn’t dream of doing it now.

Colin was a Police Inspector at Gampaha in the late 1950’s. He came to London and qualified as a Solicitor. Colin was a "Human Rights Lawyer" helping foreigners to obtain permanent residency in the UK. He was a man with heart of gold often taking tremendous risks to help others. He sadly died in 1992.

The Ceylon Students Centre near Lancaster Gate Station was a magnet for all young Sri Lankans in London. It was run in grand style by its Warden, Mr. J. C. A. Corea, a former Principal of Royal College. The Centre went into decline when he retired. I often found long lost friends, old teachers and relatives there. Some wheeling and dealing, always ready to give me a bargain. You can also buy a Rolex watch for `A35 which will only work until you reach home. Once when I asked a friend how to get to the Centre, he asked me to follow the curry smell from the Lancaster Gate Station. He couldn’t have given me better directions. Its closure was a great loss to the Sri Lankan community in London. This was yet another short sighted penny pinching decision of our government at home.

I saw a change in many of my Sri Lankan friends. All Lankan cultural events were well attended. Those who never saw the inside of a temple whilst back home suddenly became religious visiting the Chiswick Buddhist Temple, taking part in meditation and almsgivings. This was indeed to be admired. I have always remained an agnostic. I disliked the repression of religion and remained rather superficial making the most of life. I refused to see why it is a sin to live it to the full. Meanwhile life was pleasant both physically and intellectually.

Some immersed themselves in politics of the kind practiced in Sri Lanka. They preferred to hover around our High Commission in London pandering to the politician when they came to London. Our community here is always ready for a party and a booze despite the various strictures and limitations imposed by the work ethic in Britain.

In London, we have the two most famous cricket grounds in the world. Lords and the Oval attract thousands of cricket mad Sri Lankans in the summer. I am yet to meet a Lankan who has no love for the game. In the late afternoon when the alcohol level has risen they even break into song although the jungle drums are prohibited. Our World Cup win in 1996 has given an extra zip to our love for cricket. Aravinda De Silva’s batting at a NatWest Trophy match several years ago must be the best innings I have ever seen.

Festival of Cricket

Old boys of the Sri Lankan schools organise interschool cricket playing limited over matches. This is an annual event now called the Festival of Cricket. It has a carnival atmosphere with food stalls and Lankan music. To have a big match — Royal-Thomian, Ananda-Nalanda or Josephian -Peterite in a foreign land is an achievement in itself. Some of the ageing cricketers show off their exceptional talents with the bat and ball. When fielding, although the spirit is willing the flesh seems weak. Nevertheless it is a fun day for all if the British weather plays fair.

All foreign doctors had great difficulty in reaching the top of the profession in the popular specialities like general surgery and medicine. Many moved laterally to take up posts in care of the elderly, psychiatry, pathology and radiology. I carefully weighed my chances and went into radiology. Luck was on my side as radiology came to the forefront of medicine with ultrasound, CT, MRI, nuclear medicine and computerisation. Now a job in radiology is like gold dust.

It is every doctor’s dream to work in a London Teaching Hospital for a good training and a valued entry in the CV. I needed a bigger pond in which to swim, more excitement, greater challenge and better prospects. It was Dr. John Laws, the Director of Radiology, who saw me first. He was charming and courteous and asked me to apply for the post. Perhaps it was the MRCP that helped me to get a job as registrar in Radiology at Kings College Hospital London. When I got the good news I went to see Tax Bygraves in concert at the London Palladium. London is the culture capital of Europe. The central square mile is a paradise for theatre goers. A wonderful place to relax and unwind.

Working with Dr. John Laws though trying was excellent experience. His technical skill was exceptional and his diagnostic accuracy was admired and respected by all. He later became the President of the Royal College of Radiologists. For me, learning the trade was hard work. There were 2 more exams to complete the first of which included radiation physics. I spent my time travelling by underground and buses attending courses. There was little time to relax, meet friends or keep in contact with folks at home. After each busy day at the hospital, I studied until one or two o’clock in the morning.

On looking back those were some of the most difficult times of my career in the UK. After the first examination I found a job as a Senior Registrar at University College Hospital in London. Life was less claustrophobic here and I was so pleased to complete my examination without undue delay. After almost five years training in radiology I was asked to apply for consultant posts. These interviews were an ordeal, but I was fortunate to find a job just 50 miles north of London and not too far away from my friends.

Hardwork rewarded

I started work in a District General Hospital 50 miles north of London. It was then a new hospital commissioned in the 1960s and completed in the early 1970s. The Radiology Department was being developed and my two older colleagues were to retire soon. The 675-bed hospital quickly grew and specialised to house many new departments including Cancer, Renal, Plastic, Urology and Cardiology services. I now have six colleagues in a most modern Imaging Unit fit for the 21st century. Like the perks, the responsibilities of the job were many. I had now reached the top of my profession in a foreign country that prides itself in an excellent health service. Eight years of hard work was finally fully rewarded.

Needless to say working as a boss is much easier than being a junior doctor. There were times when the weight of responsibility wore heavily on me. People management was a skill I had to learn on the job. When there was a problem in the department or complaints the buck stopped with me. Although the professional burden was heavy at times it was outweighed by the interesting clinic work and teaching commitment to medical students and doctors. It must be said I’ve had more rewards in my professional life than I deserve.

There are doctors who consistently perform below an acceptable level of competence and we must deal with them as a profession. We now live in a litigious climate. This at times is counter productive as fewer doctors will be prepared to take up the difficult cases. The bureaucracy of covering one’s back will indeed hamper clinical research. The day is not far away when this problem will reach Sri Lanka if it hasn’t touched it already.

I like the concept of the National Health Service (UK) that no individual should suffer ill health for the want of money. Private practice has been the bane of the health service since its inception in the UK. It is sad to see medicine becoming a business and lose its respected position as a noble profession. Despite its good intentions as the cost of hospital care, investigations and treatment reach staggering proportions, it is only a matter of time before charges are gradually introduced with a free service confined to the poor, elderly and terminally ill patients. It is an impossible task to fund an all singing, all dancing free health service in the 21st century. The rise of private medicine is the result and appears to be the only alternative.

Once a Sri Lankan is always a Sri Lankan. I miss my homeland dearly. While I was carving up a career a new generation has been born in Sri Lanka and many of my parents’ generation have gone to a world beyond. I am now a stranger to this new generation. Living in exile I have missed the births, marriages and the deaths of my close relatives. This I find hard to bear despite the material and career success abroad.

As a young man my career ambitions took precedence over all else. Alas it comes at a price. Having said this I have immense job satisfaction now, a steady income and a peaceful life. My life does not depend directly on politicians’ whims or that of their cronies. The British have given me their top job within eight years of my arrival here for which I am so grateful. When I recall the in-fighting and bickering at the General Hospital Colombo during my years of service I am thankful for my peaceful environment at work in the UK and the wonderfully supportive colleagues and staff.

I have had tremendous good fortune to work in two of the most famous Teaching Hospitals in London and also in several of the centres of excellence in the City. It was indeed a fine experience to work with the great and the good in Radiology.

I will be retiring from active work in a few years. The sleepless nights and the stress of work has indeed taken its toll. Although I feel full of energy and vitality as work piles on sometimes a sense of age and weariness steals over me. On looking back on my career in medicine what I would remember most of all would be the courage of the patients who had just a few days to live. The images of some of them will stay with me forever. We live such a brief and uncertain span of life.

Regret

I do have one regret that often comes to the surface of my mind. A regret I didn’t sufficiently return the love of my parents. Perhaps I never tried hard enough to understand them. I wish I had the words and the courage to explain the multitudinous slights and hurts I have given them. I owe my parents much. Living in Britain hasn’t helped to draw us closer. Sadly sometimes when a life’s path is chosen there is no turning back.

It amazes me how soon time has flown since that fateful day in June 1974. The journey through life has often been laborious. Yet it has been worth the effort and has brought its own joy and satisfaction. — TEMPUS FUGIT

I dedicate these memoirs to my friends Titus Perera, Cyril Amerasinghe, Tissa Ranasinghe and the late Colin De Silva. When I arrived in London virtually penniless and homeless they provided shelter, funds and friendship expecting nothing in return. I cannot praise them highly enough.