A typical day at Matale Base Hospital in 1969

Dr Mahendra Gonsalkorale

It is 7.00 am and I just woke up. I don’t really want to get out of bed as I am sleepy and tired after a very busy night on call. I went to bed at 11.45 pm after doing a night round to make sure that I had attended to everything and done preventive work in anticipation to ensure as far as possible that I won’t be disturbed, such as prescribe those PRN medications and advising nursing staff on what could wait till the morning and what needed urgent action. I went all round the hospital as there was only one junior doctor on call after 5 pm till 9am the following day. Our wards included Paediatric, Obstetrics & Gynaecology, Medical and Surgical wards, spread over what appeared like miles of corridors. The hazards of night rounds included dealing with unwelcome growling dogs. But camaraderie and bonds of friendship were strong. If calls got heavy and I needed to be in several places at the same time, I had no hesitation in calling for help from my colleagues and they would willingly help.  There were no disclaimers to fill and no working hours directives.

There were no bleeps. At night you are awoken by a knock on your door with a voice saying gently, “Sir, call ekak”. After a few expletives uttered almost reflexly which the poor chap always never took personally, you open the door and read the message on the book – “Patient Piyadasa in ward 7 is having a fit, please come and advise”. By now, I am wide awake. I gather my stethoscope and getting into my trousers, hurry to ward 7. There was a time when as a mere intern house officer I slept fully clothed, ready for action, but one does mature!

Returning now to the story I began, there were many such calls and my sleep was badly interrupted but I had to be  in the Medical ward at 8.00am latest for the Ward round by Dr RanjithMunasinghe, one of the most capable, honest and caring doctors I have ever come across.

I grab a quick breakfast and reach the ward bleary eyed and partly refreshed by the strong coffee made by Letchiman, the House Do-it-all based in our residential quarters. “Good morning Sir” and Dr DRM replies “Good morning Gonsal, shall we start?”

Just to digress for a moment, I mentioned our House Do-it-all Letchiman. Most readers know how we managed our daily needs while being resident in Hospital accommodation, but just to refresh your memories, all our meals had to be organised by us. There were about 8-10 of us (only the MO, OPD being not resident) and each month one of us took turns to be “Buth Master”. His/her duties included managing the “Do-it-all”and his young assistant Supramanium(including their salaries) and all the shopping, cooking, devising menus etc. Each would pay an advance to the BM and at the end of the month; a true detailed account is produced by the BM and residual dues collected. This was done in the most amicable way with complete trust and worked very well. Some BMs were more enthusiastic than others. Jeff Babapulle comes to mind. He once provided each of us with a small chicken for lunch. Bacon and eggs meant much more than a rasher and an egg – there was enough bacon and egg to feed 25 people! That month, we ate exceptionally well. The bill  was as you would imagine, a bit higher but nobody minded.

Back to my ward round with Dr DRM. We came to an empty bed and DRM asked what happened to Nalliah, the patient who should have been there. The Nurse very proudly announced that although he had left against medical advice, she made sure that he signed the Bed Head Ticket (BHT) before he left- “pothaassankeruwa!” DRM asked about his medication and future care and the nurse again proudly said that as he went “pothaasankarala”, he was not given anything-“Eh minihatapissu! Kotcharakiwathahuwenaha” (he is mad; he did not listen at all to my pleas). DRM told the retinue (there was always a retinue, not as big as these days with a plethora of all types of health care workers), that in future, this is not the way to deal with those who insist on leaving against medical advice. Firstly, the doctor on call must be notified if attempts by nursing staff failed. Secondly, if he still insists on leaving after seeing the doctor, he must be issued with a few  days’ supply of medication and a handwritten note must be given with  a short history, investigations performedetc. and he must  be told that he must present this to any doctor he sees subsequently. He must also be told that if ever he changes his mind, he is most welcome to come again but always note the exact time and date of his departure in the BHT. He said that in his view, people have all sorts of reasons unknown to us why they appear to behave irrationally and we must never treat them as outcasts or punish them. This was a real eye-opener for me. DRM was the most humane and understanding “boss” I have come across and his message on why we choose to be doctors and the responsibility that we must carry, left an indelible impression on me.

Ward round over! Hurry back to Quarters for a tasty lunch cooked by Letchiman. He is there with his ever present mischievous smile with profuse apologies for not providing the Beef steak that Jeff wanted. He says “Chir, ada arak musivarai, ekanisa vegetable beef steak aduwa”.

And then the siesta on chairs (a few lucky ones on the haansiputuwas)till 2 pm for those who had clinics and 3 pm for those with ward rounds. This was one of the most welcome times of the day. It was hot; we were tired, happy after a tasty meal.It definitely wastime for that most civilised of activities, the afternoon siesta!

It is wake up time and back to the ward. Those doing Obstetrics could do anything from a breech delivery to a caesarean. The “Boss” would train you first and your first few Caesareans  are done with him supervising you, the next few with him having a fag in the doctor’s room and always available to help if needed. The same applied to surgery. We did the minor ops list and if we were that way inclined and showed interest, may even be allowed to do hernias and haemorrhoidectomies. No wonder we felt so important. When we went to Matale town, we were well known and vendors sometimes refused to take money for our purchases- “Eh mahaththuru ispiritale dostarawaru”. But none was as elevated as Senarath Panditharatne. The harmless and ineffective DMO at the timewho shall remain nameless, was over fond of the amber nectar and there were more times when he was under its influence than off it! Pandi stepped in with authority whenever required and was the real boss.

That’s it! A day’s work done and I am not on call today! Hurrah! At dinner time, it is time to catch up with all the gossip and plan that coming weekend trip to Dambulla. We will take our gas burner, eggs and bacon and have a picnic lunch at a picturesque spot complete with a stream and a pihilla. Such weekend outings were common and thoroughly enjoyed by all. Once a month or so, it was the long train and bus trek to see my parents in Nawala.

The gossip turned toward me and I was asked whether I still wake up and peer out of the window in quarters at 7.00am to catch a glimpse of one of the nurses I  found very attractive leaving the next door nurses quarters for work. Yes, I did! Sadly, I never plucked up enough courage to do anything constructive about it. My only physical contact was when she assisted me at the Minor Ops list and those brief touches spread as an erotic tingle enveloping my entire body. It was a case of being grateful for small mercies!

This was Matale in the late 1960s, a time I shall always treasure.  The friendships I made still linger, the lessons I learnt still shape me, and my memories of that important period in my life will continue to make me happy and say “After all, life is not that bad- I am truly grateful”