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Wednesday, July 27, 2016

Creative Spot by Zita Perera Subasinghe

Move House. What is it about?

From the day we are born
We have to change our abode
From the placenta we are torn
Then in a cot we are ‘stored’

First, in a pram we are pushed
By night we move to a bed
Then suddenly, we may be rushed
To a little cot instead

Then with family in a little hut
It’s the best we can afford
Then, to school few hours but
It’s also a temporary abode

To uni we go, in our late teens
So to the hostel we must move
That’s provided one has the means
To get into this new groove

The very first home of our own
Is hardly more than a shed
That’s only till the kids have grown
We’ll soon need to think ahead

Now a ‘two- up, two- down’ semi
Will just do, for a few years
Till our boy, good old ‘Sammy’
 Finally leaves home in tears

Yes he’s moved to live with wife
And now there are more to feed
Another move? Sure! That’s life
They do need three rooms indeed!

From our old home, we must move
As children now have flown the nest
We have nothing more to prove
Just our weary bones to rest

The final move, it could be rough
Pearly Gates are not for all
Of Brownie points, have I enough?
That’s surely my downfall!

By Zita Perera Subasinghe

Note: Why this poem? A friend was moving house recently and his tone and manner made me realise what a stress it was for their family. It made me think ‘yes we do this all the time in our lives and we take for granted that’s how it should be. Can we have any constancy amidst all this?’  I suppose the ‘inner you’ remains the same in relation to the universe as we are a just a spec in it. This thought could make it all bearable.

Thursday, July 21, 2016

My Tryst with Destiny - for the second time

 By Dr Nihal D Amerasekera

My first brush with death was as a child when I had a tonsillectomy. I have written about it to this blog some years ago.

My professional life ended in April 2007 with my retirement. I wanted some peace and quiet and time to travel the world before old age caught up with me. I achieved my objectives to reach where I am today. Society encourages us to extend our youth until at some stage our body and mind tells us otherwise.

On the 15th of February 2016 when I was spending time with our elder son in Birmingham I noticed a bit of ‘red confetti’ on the toilet pan which I assumed was the work of my grandkids playing with coloured paper. This happened again in my own home.  I went to see my GP who confirmed it was haematuria. Now the clock started to tick and my journey into the unknown began.  Urologists got involved with a gamut of investigations. The cystoscopy showed a red patch in the bladder and they wanted to arrange a biopsy. By now I had signed the legal papers to move house to a flat in London 50 miles south. I was to stay with my son until our own flat was ready. The Urologist said it was urgent but I told him I am not ready and will get it done after the house move is completed. He wasn’t best pleased.  if it is cancer this has to be dealt with swiftly. I have passed the biblical age of 3 score years and ten, my obligations were done and felt I am ready to unfurl my sails to see the world beyond.

Cystoscopy is a procedure that requires great care by the urologist. There is a tendency nowadays to be blasé about sterility because of the plethora of antibiotics available. Still there are many who die of septicaemia and infections caused by resistant strains of bacteria. After the cystoscopy I developed the most severe attack of cystitis with a fever, rigors and a painful dysuria of the worst kind. I was in a wilderness of confusion. At no time have I felt closer to death. Passing urine was like cutting the urethral lining with a knife. Luckily  the doctor had given me some antibiotics which took 48 hours to take effect.

First we moved in with our son.  It was more than  a month later we were able to move to our own flat. If I was harbouring a tumour, the time bomb was ticking. I managed to see a GP and get a referral to a Urologist at the Royal Free Hospital in London. I was seen on the 26th of May when they repeated the Cystoscopy. There was no change. Further investigations took a great deal of time and effort. Finally a biopsy was done on the 24th of June. I cannot fault their professionalism, care and expertise. Discussions with doctors about one’s health is never easy. The advice is coloured by the rules and regulations in healthcare, its limitations, political correctness and disclaimers. This makes it all difficult for the patient to comprehend.  I wish I was aware of this in my own professional years. After the procedure they told me it would take 2-3 weeks for the report.  I awaited the results of the biopsy with some trepidation and also surprising calm.

On looking back it is strange to be a patient sitting on the wrong side of the table after being a doctor for 40 years. Diseases only happened to others!! An interest in what lies beneath the skin and behind the symptom has been our concern and now we are the symptom.  I have often wondered when one is a patient if that medical knowledge is a help or a hindrance. On the one hand one worries about the rare complications and unlikely side effects and on the other one is aware of the endless possibilities and how to make best use of the situation and the advice.

The continuous news of death and disease of family and friends are a reminder of one’s own mortality. Awaiting the biopsy results was at times a nightmare. A lot of the time I felt strong and was able to put those negative thoughts behind me. Occasionally I was overcome by darkness and why me and why now? What if it is malignant and required further surgery radiotherapy/chemotherapy. This requires regular visits to clinics with countless blood tests and investigations. Such a restrictive life would never be pleasant and may not be worthwhile. What if it all has spread beyond the bladder and was terminal. Such thoughts did cross my mind. Fear took me to a terrifying place located at the outer edges of human tolerance.  During those times of despair life turns round 180 degrees. Habits of a lifetime of acquiring wealth, gloating on achievements, avarice, greed, hatred and pride – all these things just fall away in the face of death. What remains is what is truly simple and basic. Even current affairs and news items somehow seem irrelevant. The future, the next year and even the next month seem distant, elusive and unreachable. The deep and gnawing pain and sadness of separation from my immediate family was always foremost in my mind.

Why can’t there be a better way to exit this world without all this torment and anguish? I also discovered that eventually one learns how to incorporate death into one’s life. It becomes an unwanted traveling companion that stalks you day and night. At times I couldn’t hide my feelings of utter grief, distress and wretchedness. This must have been hard for my wife to bear. I think finally human beings are programmed to accept the end of life. Then things fall into place and serenity and calmness prevails.

There are many of my batch who have now departed this world. I have often wondered how they coped with the inevitable and what thoughts crossed their troubled minds. I remember the final call I made to “Claude” Bernard in his death bed. He said “ND, I am not frightened to die but wish to live to be at my daughter’s wedding in a few weeks”. Sadly his wish wasn’t granted. His voice still echoes in my ears.

On a fine summers day in July I received a call from the hospital to attend their Urology Clinic the following week. This heightened my awareness of the possibilities but I was able to remain calm.  Being in the waiting room to be called by the Urologist was the longest half hour of my life. I resorted to meditation and mindfulness to bring some peace and serenity to my soul. We shook hands when he gave me the all clear. Immediately I was transported to a blissful paradise and felt young, elated and energetic once more.

This ordeal has changed my life forever. It has concentrated my mind on what is important. Religion has never played a dominant role in my existence except when I was growing up in Nugegoda,  living a Christian life. The ten commandments and the teachings of Jesus Christ gave me a good grounding on how to live my life. As a teenager and later a medical student I drifted away from all this and became an agnostic.  This remained with me almost the whole of my adult life. This last episode has brought me closer to the merits of meditation, the benefit of mindfulness and the virtue of the five moral precepts. The 5th precept however is harder to keep as I love a glass of wine!! I will try to follow the 4 noble truths.  “Nirvana” the elusive state of final liberation from the cycle of birth and death still seems so far away.

The “Mozart Effect” with classical music is tremendously helpful in bringing about peace to one’s soul in stressful situations. Listening to the classics is something that can be done in the confines of your own home. Music of Chopin, Beethoven and Mozart was of great help to me all through my ordeal.

I am the beneficiary of hard work in my youth and have had a life well and fully lived. Despite some disappointments along the way, much to my surprise, I am happy, and often sublimely so. The fine lyrics of that famous song “My Way” does echo my feelings overall. I prefer that 1959 Edith Piaf favourite   "Non, je ne regrette rien",  NO REGRETS.  Shirley Bassey belts it in English with much gusto and feeling. Well actually, I do have just the one despairing regret – not being with my parents in their hour of need at the end of their lives.  I am confident they will forgive me that huge dereliction of duty.

Wednesday, July 20, 2016

My first impressions of the Physiology Lecture Theatre

Dr Mahendra Gonsalkorale

We walked in through the large wooden doors and gazed in awe at the imposing lecture hall with semi-circular seating using benches ascending in tiers to the back of the hall. Each row of benches had a flat board in front to keep writing material. There were about 10 rows, may be more. The walls were wood paneled and right in front, between the two entrance doors, was a long rectangular Desk about 4 feet high and placed on a wooden platform with sufficient room behind the desk to place several stools for the lecturers to sit if needed. The wall behind the lecturer was a vast expanse of black board with a long chalk holder tray at the bottom.

I had seen nothing like it before and my feelings could be compared to how a visitor to St Paul’s Cathedral might have experienced on his first visit.

We were seated in alphabetical order with the Abeysuriyas and Ahamats in the front rows and the Wickremasinghes at the back. Very different from school days when the bright sparks sat in front and the trouble makers at the back. On the centre of the back wall was a large analogue clock. Right through Medical Faculty, this adherence to the alphabet was honoured and to this day, our closest associates tend to be our alphabetical neighbours. Generally speaking, the De Silvas know the Fernandos well as do the Wickremasighes know the Vishweshwaras of this world.

Soon, the hall was filled with that general nondescript noise generated by a multitude of voices speaking at the same time. One is reminded of the noise made by a gaggle of geese.

Soon the noise gradually abated to almost a hush as the lecturer walked in through the door, ascended the platform , sat on the tall stool, glared at us and after a pregnant pause, wished us good morning before commencing his lecture.

This was the arena where in our first two years, Prof Koch, tall, bespectacled with thick black circular rims and “bottle bottom lenses”, black hair combed back and held in place with liberal amounts of Brylcreem attempting to hide a spreading bald patch, and always dressed impeccably in a light coloured suit, held forth in his own inimitable style.

In our third year, this Lecture hall was also used by the diminutive Prof Kottegoda for his ramblings on Pharmacology, illustrated with a piece of chalk which traced a tortuous and apparently meaningless path on the black board from the top left hand corner to the bottom right hand corner. Many a time, he would pause and gaze at the ceiling. Was it for inspiration or hidden notes engraved on the white ceiling, I shall never know. But my lasting memory was how I saw him behind the desk, sitting on a stool as we walked in, and waiting for all of us to come and settle down. Then he stood up and virtually disappeared from view! Having not met him before, I didn’t realise that although he may have reached great intellectual heights, he was somewhat lacking on the physical aspect.

Monday, July 18, 2016

Recent Mini- Reunion in London

This is a link to more photos of the recent meeting held in London when Sanath Lama was visiting.

Sunday, July 10, 2016

My visit to 'the' Clinic

By Razaque Ahamat

This posting is something away from my garden as the weather is not conducive for that kind of activities, will soon get back as warm/hot weather is long over due-- 'Dream baby Dream'!!!

Recently my GP referred me to The Clinic!!! Let me rest your wandering minds at rest right away. It was not the STD Clinic anyway........ satisfied ????.
In the last few months I noticed that the front of my upper body was getting 'bigger'. In fact my BOOBS were getting bigger and painful!!  The GP thought that it was prudent to get a scan done. So she referred me to The Breast Clinic.

Now my sublime friend, Mahen, you must be grinning away in view of our recent dialogue on my posting referring to my experiences in handling 'Udders'. in my early life!!!!  You must be thinking that " what goes round comes round" & now it has come round to "bite my ASS"---- you will see if you are right!!!

At the Clinic I treated with utmost respect & great professionalism by all staff. The Consultant examined me before I went to be scanned. In the scanning room the Radiographer asked me to 'strip to the waist'. I asked her politely "DOWN to the waist or UP to the waist"??. She replied "We do not scan down there at this unit ,you know" Then she realised that I was a doctor and she said " I should have expected that from a doctor!!. We all had a good laugh and the scan was done in a few minutes. Then, I had to see the Consultant again and she reassured me that it was Gynaecomastia. . She went through my medications and the culprit was traced. This really allayed my anxieties, as earlier I was having visions of me raiding my wife, Farina's wardrobe looking for some 'material' "SUPPORT"!!!!!.

I left The Clinic and on the way out I felt that I needed to visit the toilet for a 'Number One' Went into the Hospital  Visitors' Toilets--- 'top heavy & bottom heavy'----- "Bara-ta-Barae"!!! As I entered the toilets & walking towards the urinals, I saw this guy struggling with his fly down to get his "Gadget / Equipment" out. Of course my imagination was running riot, thinking "Is it THAT BIG" that he has difficulties or is it so small and "lost in the BUSH" that he is unable to find it??? By the time I finished my 'business", the guy had gone!!--- I shall never know the answer ---- I wonder if any of you can throw some light???

Saturday, July 9, 2016

Our date with the Don

 By Dr. Nihal D Amerasekera

Mahendra, Zita and I have made our lives in the UK.  The seasons and the vagaries of the British weather  have now been incorporated into our psyche.  Our first mini reunion was held in London in 2015. We were delighted to hear that Sanath  will be in London in June/July 2016 and will be free to meet us.  It is said “If you want something you ask a man. If you want something done ask a woman”. This old adage still rings true. Zita despite her busy life rallied the troops and organised a get-together in a plush French restaurant in the Soho district of London. I am now a Londoner living just a stones throw away from the heart of that great city. Mahendra travelled all the way from Manchester to be with us on that afternoon. Zita came from far away Kent. We reached our destination through the dust and grime of road repairs and flying debris of building works.

After the incessant rain we’ve had this summer the sun shone brightly for us. Even the British weather greeted our valued guest. I had not seen Sanath since the early 1970’s when we sat the MRCP part 1 examination in the hallowed precincts of Medical College at Kynsey road. As we eagerly awaited our guest, Sanath walked in with his usual broad smile and warm greetings.

After the pleasantries we ordered the usual social lubricant of wine and beer which helped us to relive and reconnect. It was truly wonderful to talk of old times and of mutual friends. They were indeed our golden years.  Sanath is a fine raconteur and kept us entertained with his enormous repertoire anecdotes. These were re-told with his characteristic no nonsense - matter of fact style. That is his hallmark, something we all recognise and have come love. The medical fraternity is not immune to controversy. Way back, there has been some intrigue, chicanery and mystery in medical politics in Sri Lanka. Many of these had taken place after we had emigrated.  Those events were brought to life by Sanath in his own inimitable Hitchcock style, laced with his own brand of humour. Sanath has the most remarkable memory for detail. His limitless self confidence was a pleasure to experience.

The medical profession, patients and the general public value his skill, care and compassion. They respect his opinion enormously. He still gets much satisfaction from teaching and travels to Rajarata Campus to impart his knowledge to his students to whom he is a great role model, mentor and guide. Sanath has had an illustrious career in Medicine and made an outstanding contribution to higher education in Sri Lanka.

Sanath remains a gentleman to the core and always scrupulously honest, extremely kind and very generous. He made use of his profile to attract investments from abroad  and spoke most warmly of his efforts to help his students, patients and those with disability.

We relived our years in medical school with great relish.  Touching on those departed brought back memories. In our minds they will always remain youthful as we saw them first. It was wonderful to recall the events like the final year trip which has had a lasting impression on the many who joined in.

After the sumptuous lunch Zita took us to “Just Joe’s” for a cappuccino where we continued our banter. These meetings are sadly a rarity and would indeed be increasingly so with the passage of years. Time is something we don’t have in such great abundance. We said our goodbyes and parted with the usual promise to keep in touch. The warmth of our friendship will linger in our memories for a lot longer.

The flood of daily emails generated by his computer will continue to arrive on our PC’s to maintain the lines of contact open.

Friendships are one of life’s great gifts. Those made in the heady days of our youth are simply priceless. We are immensely proud of Sanath’s professional achievements. He has brought honour to our batch. Our sincere thanks to Sanath Lamabadusuriya for making an effort to meet us. May we have the good fortune to meet again.

“A good head and good heart are always a formidable combination. But when you add to that a literate tongue or pen, then you have something very special.” 
Nelson Mandela

Monday, July 4, 2016


By Srianee (Bunter) Fernando Dias

I was sitting in my porch (American version of a verandah) enjoying my morning coffee, and happened to glance at the bottom of the nearby bookshelf.  I saw several old textbooks that have survived my many moves and transitions and thought that I should compare notes with my friends to see if they have saved any, and whether there were special reasons for hanging onto them.  Here is my list:

1) Anatomy, Regional and Applied by R.J. Last (Second Edition). This was first published in1954 and the second edition in 1959.  I treasure this book for many reasons.  I love the illustrations done by RJL himself, and found this book very useful during my career as a pathologist.  This is one of the books that my father bought for me when I entered Medical College.  Sadly, he died suddenly just two weeks after I started my medical education.

2) Cunningham's Manual of Practical Anatomy (Upper Limb and Lower Limb), revised by James Couper Brash (Twelfth Edition).  I couldn't bring all the volumes to the U.S., so I just brought this one along to remind me of my hard work in the anatomy lab, where I spent almost the entire first week reflecting just about two inches of the cadaver's skin. Talk about culture shock, I came from an all female school to a cavernous room filled with cadavers exuding formalin! (This book was also one that my father bought for me.)

3) Hutchinson's Clinical Methods, by Donald Hunter and R.R. Bomford (Fourteenth Edition).  I referred to this book many times over the years even though I stopped seeing patients after arriving in the U.S.  The photographs were very useful when friends and relatives approached me with weird rashes and swellings! The photos depicted clinical signs, which are no longer prevalent in the developed countries.  According to the Preface, Sir Robert Hutchinson wrote the greater part of the book at the age of twenty-five, when he was a resident at Great Ormond Street.  The remainder was written by Dr. Harry Rainy, University Tutor in Clinical Medicine at Edinburgh.  It was first published in 1897.

4) A Short Practice of Surgery by Bailey and Love (Twelfth Edition). I did not have the heart to toss out this gem because of the extensive illustrations and photographs (again!) A few years ago when I was reading "Cutting for Stone" by Abraham Verghese, I found out that the author had based one of the main characters on Hamilton Bailey: A surgeon who was missing a finger, just like Hamilton Bailey.  Verghese, in the introduction, wrote that there was a photograph of Hamilton Bailey's hand in the textbook.  I lost no time in looking for that photograph in the book, but was disappointed because it had been edited out in the twelfth edition, which was the one I owned.

When I retired from my full time position in pathology, I began giving away most of my pathology reference textbooks to younger colleagues.  There is one that I have kept, mostly for sentimental reasons.  It is "Gastrointestinal Pathology" by ParakramaChandrasoma, who was about five years junior to us in Medical College and is now a Professor of Pathology at the University of Southern California.  It is one of the best texts on the subject, with outstanding microphotographs.  He was my neighbor when my siblings and I were all very young and lived down 5th Lane, and was a playmate of my brothers.   He attended the "other" school, Royal College!  One of these days I think I will give the book away to one of my pathologist friends, because it is too good to sit idle on my shelf.