Saturday, February 2, 2019

Speedy Dialogues



THE SPEEDY VIRTUAL INTERVIEW SERIES
Speedy Dialogues
Episode 3, January-February 2019

Speedy with Appu Sumathipala

On, “Ward Classes, our Clinical teachers and anecdotes”

Speedy: Good morning Sumathi. Thanks for being my 3rd subject. Shall we start?

Sumathi: Good morning Speedy. I am ready and thanks for inviting me to join your series. I have enjoyed reading the first two.

Speedy: I am glad you did Sumathi. Let me begin the dialogue. Our clinical training included "Ward Classes" where cases were presented to the teacher by the student at the patient's  bedside and discussed. Can you recall any amusing incidents or moments of great teaching during them?

Sumathi. Let me try and answer your question.

My recollection is that most of the ward classes never ended up well, as there were pending lectures and we had to rush to attend them. Some of the histories taken were laboriously done and not relevant to the clinical problem. Eliciting of clinical signs was not very precise, and there were no proper demonstrations by the tutors.

Speedy: I myself think that there was quite a variation and while most tutors were excellent, some left much to be desired. Ward classes by Dr Wijenaike, Dr Ernie Pieris, Dr RienziePieris, Dr George Ratnavale, Dr Thanabalasunderam, just to name a few, were excellent. Can you recall teachers who stood out in your opinion?

Sumathi: Physicians with outstanding teaching qualities I recall were Drs P R Wickramanayake, K S de Silva, D J Attygalle, R S Thanabalasunderam (he was a maestro in interpreting ECG findings.) I still remember his words, left axis deviation-horizontal heart, right axis deviation-vertical heart. Prof Raj had a high regard for him. In fact, Prof. used to ask us about previous Consultants who taught us.

Speedy: What about surgeons?

Sumathi: DF de S was a soft spoken surgeon, slow and steady in contrast to Antho, who was fast and very precise.

Speedy: DF de S certainly was very soft spoken and we used to joke about his “secrets of surgery”.  Antho was the confident showman.

Sumathi: I had the privilege of having my surgical attachments with them. Last but not least, Dr Niles, who I can remember conducting a tutorial few weeks before the finals and appealing to the students to ask questions. He used the word "now or never". I am sure our Yoga did his 6 months Surgery with him. He was known to be a good theoretician but no one was sure about his surgical skills. I also remember assisting Prof Milroy Paul during my days in the Surgical Admission Unit (most probably during the final year). There was a case of acute abdomen on the day the Professorial unit was on take. The patient was taken to the theatre and I assisted Prof. He showed me the obstruction in the large bowel which he resected. The end to end anastomosis was superb. I never had a chance to follow up the case. His surgical lectures were full of sarcasm towards some of the UK Surgeons.

Speedy: Yes, the Paul brothers were quite distinguished. His brother as you know was ATS Paul, 
Cardiothoracic Surgeon. Prof Milroy had what we called the “triple”, the FRCS, MRCP and MRCOG, which was possible those days. He was the first Professor of Surgery at the Ceylon Medical College and the first Ceylonese to deliver the prestigious Hunterian Oration at the Royal College of Surgeons and he did that three times!

Sumathi: That reminds me of a story about his experience at the Royal College of Surgeons when he went to deliver his Hunterian lecture which you just mentioned. According the story, he was the first to attend and the person who came next wanted to know whether Prof was sitting for the Primary. His reply was that he had already passed. The next question was whether he was sitting for the Finals. “No, I have already passed that too” said Prof. Then to his amazement, Prof told the guest that he had come to deliver the Hunterian lecture. I am sure the guest could hardly believe that a small made chap of Asian origin had come to deliver a prestigious lecture to a very distinguished audience.

Speedy: That is a great story. I heard it slightly differently. It was the doorman who questioned him but the essence of the story is the same. How about some funny anecdotes?

Sumathi: I can think of several Speedy. When we did our attachment with Prof Rajasuriya, a question was asked about the creature that caused scabies. One bright student said that it was scabies scabiei . When it came to my turn I gave the correct answer,sarcoptes scabiei. Would you believe, that very student did well at the final? Not only that, he got his MD (Cey) and became a Consultant in General Medicine and migrated to UK, after getting early retirement from the Health Service.

Speedy: I wonder who it is, but I won’t press you. Just shows that a thorough knowledge of Parasitology is not essential!

Sumathi: You can guess! Only two from our batch passed that prestigious MD (Cey). You were one of them and the other person is pretty obvious. He and I did combined studies during the third year but missed out during the final year.

Speedy: His ears must be burning!

Sumathi: There was another interesting Surgical tutorial,where a question was asked about the clinical diagnosis of fracture of neck of femur, whether it is intracapsular or extracapsular. I was ready with the answer as I had read Hamilton Bailey. The Consultant was a Sri Lankan Muslim and I have forgotten his name. He also mentioned that cases with hip diseases were presented at the Final FRCS. Anyway, the Consultant was very impressed with my knowledge of Orthopaedics. During the Orthopaedic attachment we had a few cases of missing arms and limbs from birth. I used to tease Virginia, who was in my group as she was clueless about the Medical terms for those conditions. Remember terms Amelia and Phocomelia?

Speedy: I can’t remember whether at that stage I would know those terms. I would have thought that Amelia was a girl! I sympathise with Virginia.

Sumathi: I know you are teasing me! There were a few “colonial types” that I remember. When we did our attachments with Dr Austin, we had to wear ties and he was a terror.

Speedy: I remember Dr Austin very well as I had ward classes with him; quite an imposing character. Can you remember the eye surgeon, I think he was Dr Weerakone who  insisted that we wore ties for his ward classes?There is a story about him and Geri Jayasekera. Geri forgot his tie and borrowed a theatre nurse’s green cloth belt and put it round his neck like a tie. Dr W lined us up as usual and gazed at everybody one by one and when he came to Geri, he paused for just a moment and carried on the inspection and Geri escaped!

Sumathi: I can well imagine Geri doing that. He had such a great sense of humour. You know of course that he was good singer too. Remember his song with his brother Perrin, called Maluwelenda?

Speedy: Of course! The famous Jay Brothers. Any more juicy stories?

Sumathi: I can recall some hilarious encounters during Antho's teaching rounds.
I was in a group which included Patas, HN, Virginia and some others. Antho asked Patas to do a PR examination on a male patient. Patas was dumbfounded and after waiting for a couple of minutes, told Antho that he had never done it before. Antho wasted no time and told Patas “Mr Ratnesar, if your father told your Mum that he had never done it before, you would not be here".

Speedy: Ha! Ha! That is priceless!

Sumathi: HN was asked to examine a man's scrotum and he was wondering how to get on with it. Antho told him,"Look Mr Wickramasinghe, when you have to give something hot, you don't waste time”. I am sure  you get the meaning Speedy!

Speedy: I can imagine! There are a few things that come to my mind, one of which involved Punsiri Fernando. During a ward class with Dr Burhan, Dr B asked whether anyone knew the main constituent of anti gasgangrene vaccine. We were all quiet till Punsiri put his hand up timidly. Burhan said, "at least one of you donkeys know. Yes?” he said, looking at Punsiri. Punsiri said, completely deadpan, "Sir, it is 90% water". We all laughed but Burhan chased him out of the class!

Sumathi: Punsiri, great guy, sadly no more. He rose to great heights in Sri Lanka and was Head of the Anti-Malaria Campaign.

Speedy: I met him a few times on my visits to Sri Lanka and I used to bring him stamps as he was an avid stamp collector. Few more stories Sumathi?

Sumathi: Well I could go on and on Speedy! I recall some stories connected with Prof Ranasinghe, or Ranaya as we “reverently” called him! At the time we did the appointment, the Registrars to Ranaya were, Mahasara Gunaratne, P C Induruwa and Ashmore Attapattu. The trio were boring and never taught the nitty gritty stuff in examination terms. Ranaya did a couple of Utero-vaginal prolapses via vaginal route and allowed his registrars to do the rest.

Speedy: I am afraid I wasn’t a great fan of the trio who treated us like errant schoolboys. Ranaya was an imposing figure and a very didactic teacher. Good for evening Academy type but not at University level in my opinion. I recall him saying, “There are 5 causes of post-menopausal bleeding and they are No 1 (flexes his thumb), No 2 (flexes his index finger), carrying on till all fingers are flexed and when a student regurgitates this at the viva Ranaya’s fingers would flex in the order he has given and if the student gave 4 causes and missed the 3rd, he would ask the student “what is this, what is this?” showing his middle finger! Viswa on the other hand was an excellent teacher. He would not allow us to take notes while he was lecturing but gave us 15 minutes at the end to write what we had heard and understood.

Well Sumathi, all good things have to come to an end. Thanks a lot for agreeing to take part and I wish you all the best.

Sumathi: Speedy, I enjoyed looking back and reviving old memories. I am happy I was able to contribute to our most valuable Blog. I hope our batch mates enjoy reading this Dialogue and post comments of their own recollections.


32 comments:

  1. My thanks again to Sumathi. We had excellent clinical teachers. They taught us well on basic clinical skills but not much on ethics and communication.

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  2. Thank you Mahen and Sumathi for that walk down memory lane over a coffee. It is most interesting to hear of Sumathi's take on the life and times in the Faculty. To me Sumathi was a serious guy hitting the books hard but friendly and affable at the same time. As someone clever said "It is unfair to look at the 20th Century with 21st Century glasses". This applies specifically to the harsh environment of medical education of our era in Colombo. Despite this I too still complain!!
    Mahen has a wonderful approach to these chats at Starbucks. He does a lot of hard work in the background to make the dialogue readable and interesting.

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  3. Speedy and Sumathi- Thank you for an interesting dialogue.
    Sumathi, thanks for sharing your memories with us- I thoroughly enjoyed Milroy Paul’s lectures !

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    1. Thanks Rohini,I am sure you could still remember our happy days during clinical attachments.I am sure,Antho tried to catch you once by asking you either perform a PR examination or to examine scrotal region of a man.If it was not you,it must have been Virginia.


      See you in the blog dialogue,soon.

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  4. My thanks to ND and Rohini. I commented on ethics and communication, not for the first time in these columns. It was not a major criticism but more an observation. From what I hear from my colleagues of our vintage in this Country, these aspects were not touched on much in the medical curriculum in that time even here in the UK. I have been fortunate enough to work in Teaching hospitals most of my time here and was quite involved in teaching medical students and communication was a much neglected area till about 20 years or so ago. I am so pleased that it is given a high priority here now.

    You may be interested to know that the SLMDA conducted some communication skills workshops in Sri Lanka which proved very popular with a request to do more. I didn't take part last year but was involved indirectly because we made some teaching videos where I and my friends "acted". My particular one involved dealing with a junior colleague who was upset at the way I (as "Boss") dealt with her for a lapse on he part and we did two scenarios. Firstly, how NOT to do it and then a repeat with HOW to do it. These things evolve and tends to keep pace with other developments which identify the need for it.

    On the whole, I think we had excellent teachers and I am very grateful to them.

    On the subject of Speedy dialogues, there are two more I am working on with the utmost cooperation from the "victims"!

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    1. Speedy, I would be very interested in seeing the videos you refer to above if it is possible without too much effort on your part.

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  5. Hi Speedy and Sumathi thank you for taking us down memory lane. Yes I do remember Antho's comment at the ward class very well, in fact when I got home I did tell my father , and my father being a good friend of Antho laughed and said thats typical of Antho. A few notes of our teachers, I ember Niles's ward class which was packed just before the final, he went round asking the class 'What is the one thing in life you cannot be sure of?" . After he had asked each of us who were there, and no one gave him the answer he wanted he said "your Father!!"

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    1. Your father was obviously a very broadminded person Rajan. I remember meeting him many times in your house. He always looked busy!

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  6. It was interesting to read all the comments. Strangely, I have been bombarded with lot of stuff by way of contributions from members of the batch. So much so that I have to keep them in line and post them strictly in the order in which they were received. I would also like to remind you that there may be inevitable delays if your article or poem does not appear for some time. Each post has to be given at least two or three days exposure for comments. But rest assured that nothing will get misplaced or lost with myself at the helm!

    With the late Prof. Milroy Paul very much in the news these days, I have been holding back an article by Dr. Harold Gunatilake (much senior to us) now domiciled in Australia. It has been hanging fire for some time, and even if you have read it before, I shall publish it shortly for the benefit of those viewers who had missed it. It might soon get outdated. So, watch out.

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  7. Yes,Lucky,I remember Harold
    Gunathilake very well.He was a resident surgeon in Colombo General,worked under DFde S.Having obtained FRCS,he was posted as a Surgeon at General Hospital,Galle,where our own Susil did his Internship.Among the Resident Surgeons and Physician,during our era,one cannot forget the names of Oliver Peiris,who became a Senior lecturer in Medicine,Resident Surgeons such as Michael Abeyratne,who showed me how to close the wound appendectomy,with purse string sutures.I,met Michael later during my work at Anuradhapura.He was RS,married to Kamini(very close relative of Lama).Michael advised me not to waste my time in OPD,but to sit for Primary FRCS.He knew I was very keen in what ever I did in Medicine.Dr Yogeswaran was an interesting character as a RS.He did work with both Antho and DFdeS.When,I went as an internee to Ratnapura General,he was a Consultant Surgeon,who recognised me,immediately.It was a pity that his routine operations were sabotaged on several occasions by the Anaesthetist at that time.That anaesthetist was backed by the Political party ruling the Country at the time.With change of Government,he was demoted and sent to Anuradhapura General.That particular.I gathered,later that he left the Country and settled down in NZ.Dr.Ravindran allowed me to close the wound after foot surgery.I met him in Ratnapura General,when I was stationed at Rakwana.Dr.P.W(Wilfred) Perera,who worked as a RS,allowed me to close the abdominal wall after surgery on one occasion.He told me what he studied for his Final FRCS.It was Hamilton Bailey's book.I have mentioned about Rudra Rasaratnam
    when he was RS,Colombo.We had to translate to English,the history given by the patients,his Sinhalese was very poor.No wonder!having been domicile in UK for very many years.

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  8. That was a wonderful and most interesting dialogue between the two of you... Sumathi and Mahen.
    You two have gone through our Med. student days with some very vivid insight to the trials and tribulations that we all went through in our Med. School days and of course supported by in-put from ND, Rohini, Lucky,
    Srianee(Bunter)and you Mahen & I am sure that many 'non Subscribers' to our Blog who have seen it will agree but not comment.
    Why oh why all this "shy gotten have"???
    As for me I have had my fair share of trials and tribulations in my last couple of school life and my Med. School years. I have since followed my policy of " NOT LOOKING back, NOT WALKING back and NOT THINKING back" That has stood in good stead as I LOOKED AHEAD and MARCHED ON to what I am today.
    By the way I was amazed and intrigued by the photograph on this posting.
    It's great MIRROR IMAGE ... not sure of whom???

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    1. Lovely to see you again MSF. Trials and Tribulations, Phials and Fibulations! Your policy is mine too. When I drive, I occasionally look at the rear view mirror but my eyes are mainly on the road in front.

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  9. Hi,Razaque,Thank you for your comments.Hope,you have recovered from your tinnitus,by now.I had a condition called BPPV(benign paroxysmal positional vertigo.I recovered from it by doing Epley's manoeuvre.Every time,I get the sensation that there is an impeding attack,I perform the manoeuvres by myself.
    Coming back to failures in life,that haunt me,there is very little that I can do except resorting to meditation.Speedy and I have grey hair and a bit of similarity,in spite of the age difference.

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  10. A comment from Cyril Ernest:

    Dear Lucky/Sumathipala,

    Read with much interest the interview of Sumathi by Speedy. He mentions the trio of Mahasara Gunaratne, Induruwa and Ashmore Attapattu. This brings to mind of a hilarious incident during our Medical School days during a rotation in Pro. Ranaya’s Obstetrics/ Gyn classes. As medical students we were afforded the privilege of assisting the Senior Registrar’s during surgical procedures. During one such episode, Lareef Idroos was assigned the task of assisting Dr. Induruwa during a vaginal hysterectomy. In the course of the surgery, Dr. Induruwa was demonstrating the Fothergill suture to finish up the hysterectomy. This stitch was quite involved and one had to carefully get the mucosa of the vaginal area circumferentially and tie the knot. Dr. Induruwa with great skill and precision demonstrated the initial procedure and during the tying up of the suture the suture snapped. So he had to once again with great diligence and care repeated the procedure and once again in the process of tying the suture it snapped. Now there was hardly any mucosa left to tie this suture, but he had no choice and he once again very carefully gathered together the scant mucosa left and finally was able to get the suture tied. However to the detriment of Dr. Induruwa’s skill, Lareef cut the suture under the knot. This was quite a hilarious moment for all the students watching the surgery. Needless to say Dr. Induruwa was livid. I cannot recall how the surgery finally ended.

    Cyril Ernest.



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    1. Hi Cyril! Thanks for commenting. I can just picture Induruwa! Full marks to him for patience. I wonder which manufacturer made the suture, or was it just brute strength?

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  11. Very interesting saga,indeed.Lareef was certainly lucky,to survive in the theatre to finish up with the op.Dr.Induruwa was not a rude person.He decided to revert to General Surgery,in place of Obs&Gyne.

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  12. This is Zita. Just testing whether this comment will appear. I am sorry, dear batch mates that I have been away from contributing and commenting for awhile. I hope to be back soon. Zita

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    1. Rohini,please tell us about your experiences during the 5+1 yrs(student and intern period).

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  14. Welcome back Zita. I am sure you will get more time soon to devote to the Blog of which you are and has been a great supporter.

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  15. Zita,I am sure,you have wealth of information about your experiences during gruelling 6 yrs at the faculty and the teaching hospitals.
    A bientot!

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  16. Mahen and Sumathi, I enjoyed your 'conversation' and reminiscences immensely. Overall, I think we had many great teachers, who taught us important clinical skills about history taking, observation and eliciting physical signs. (I have fond memories of people like Dr. Ernie Pieris, Wijenayake and others.) In the present era of high tech medicine, unfortunately, these old fashioned skills are not valued. I did not like the teachers/professors who expected us to regurgitate their notes! Ugh! I also did not appreciate those who took pleasure in humiliating the medical students. I hope that kind of behavior is not tolerated these days. We put up with a lot of s--t! I'm like Razaque these days, (Hi Razaque!) not looking back, but rather focusing on the present, and looking forward.

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  17. "Not looking back, but rather focusing on the present, and looking forward". My model is driving a car which requires the occasional look at the rear view mirror but more than anything, keeping focused on the road in front of you.

    On the Dialogues, I look forward to my future one with you Srianee!

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  18. Hi,Speedy,
    I forgot to mention a very significant event that took place at the Physiology lecture theatre,on the day of the Law-Medical match.At the end of the lecture by Prof Koch,most probably on the effect of alcohol on human body:Yoga released a cock/cockerel to the immense surprise of the audience.I am sure it was no insult to good old Prof.I am sure he took with a sense of humour.I hope the poor animal was unharmed.Glad to see Yoga doing very well in US.

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    1. Sumathi. I have heard that story before and it is recorded somewhere in our blog. I thought it was Suri who recalled it but I am not sure.

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  19. Thank you,for that.I hope,lot of our batch-mates will not forget that memorable incident.

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