As Time Goes By

 By Nihal D Amerasekera

Life as they rightly say is a thief of time. How time has flown since I qualified. I now sound like a retired doctor put out to grass. I complain about the vulgarity of contemporary life, the ‘pointlessnoise’ of modern music, fake news of social media and the irresponsible deceptions of politics. But, thankfully, there are blissful and sober moments too when I reflect on thelife and times now long gone.

The death of HN Wickramasinghe recently brought back a collection of memories of those happy times we spent in Kurunegala. Those memories swirled in my mind for days until last night I dreamt I was back in the distant past beginning my internship. As I have lived nearly most of my life, such a dream is predictably uplifting and alarmingly prophetic. But there is also an overwhelming sadness that many of the players of that memorable drama are no more.

Internship in medicine is the culmination of five years of hard study and sleepless nights. It is the light at the end of a long tunnel of multiple examinations, strife and psychological trauma. After the results of the ‘finals’ there was a mass dispersal of our batch into different hospitals. Still there was an awful lot we just didn’t know. We began our apprenticeship working under supervision before we were released on the public. It certainly felt like a breath of fresh air.

Thus far I was lovingly clothed, fed and cared for by my parents. Now it was time to find my feet in a fast-moving world and a competitive career. I do have regrets not saying a proper thank you to my parents for their love and care.I recall with nostalgia the train journey from home to Kurunegala, the taxi ride and the short walk to the House Officers Quarters. I can still remember the smell of stale Arrack as I entered the house.Everywhere I looked there was the detritus of misspent youth. So began my step of destiny, a journey into medicine and real life.It would be remiss of me not to mention the menace of malaria and the mosquitoes that tormented us every night.

As I recall 1960’s was a peaceful time in Sri Lanka. Kurunegala then called Ethugalpurawasthe capital of the Kingdom in the 13^th century.Now it is a small city with a busy General Hospital.The majestic Elephant Rock is stillits most iconic landmark and the spiritual heart of the town. The Medical Superintendent was Dr Bertie Wijeratne, a kindly gentleman who had to serve the masses and balance the books. He was renowned for his wisdom in dealing with interfering politicians and local unions who were the bane of his life. He juggled his many impossible tasks admirably and with a smile. The Kurunegala hospital served a large area extending from Galgamuwa and Dambulla in the north to Anamaduwa and Nikaweratiya in the west; Alawwa and Polgahawela in the south and Galagedera in the east. The town bordered the dry zone where the people’s lives depended much on the rainfall. They endured a tough life growing their food in this parched and dusty landscape. Those wonderful people of the Wanni were poor andever so humble.They had such volcanic tempers towards their own. This often resulted in stabbings and shootings for rather trivial squabbles like stealing a Jak fruit.

The Kurunegala hospital occupies a strategic location at the edge of town. Initially this has been a small cottage hospital to treat the South Indian labourers on their way to the plantations in the hill country. There has been a hospital in the premises since 1899.The current administrative block was built in 1942.The hospital grew in size, stature and importance expanding into the35 acre coconut plantation.What I saw in 1967 was a most remarkable collection of buildings with airy wards and long open corridors.All the wards had that characteristic 1960’s smell of ether that was ever present. There was a small private wing with posh rooms and a wide verandah. This was separated from the rest of the ‘riff-raffs’ by a lawn and a garden of flowers.

Three of us interns started in Paediatrics together in July 1967. This was our entry into the real world of medicine, a significant moment in our young lives. We were all aware of the massive gulf between the theory and practice of medicine and its effects on real live patients. Caring for children was tough. There was no direct history and we depended on information from parents who were illiterate village folk. Examining kids for clinical signs was a special art which we hadn’t mastered as yet. Taking a sample of blood was noisy and needed skill, courage and a whole lot of patience. On looking back I wonder how I got through the first few months of this ‘ordeal’.

In children, diphtheria and gastro-enteritis were the killers, both of which were so easily preventable. It is said a family never recovers from the death of a child. I still recall the deep distress and the wailing in the ward after a death.Those sad images haunted me for days. We were fortunate to have Dr Chandra De S Wijesundera as our boss. He was a quietly spoken,unassuming andintelligent clinician. “Uncle“ as he was affectionately calledwas inspirational and showed great kindness to the staff and the doctors.  C De S had tremendous empathy for the children under his care and for their parents.

In this strange new environment it was a great relief to see aknown face. H.N Wickramasinghe and K Adikaram were my colleagues for those memorable 6 months.Sanath de Tissera and Priya Gunaratna joined us in October that year. HN, Sanath and Priya, I had known from the Colombo faculty.Adikaram was from Peradeniya.With his mop of distinguished curly hair, self-assuredness and zest for life, HN soon charmed us all and became our leader and spokesperson. His immense loyalty to his friends was his hallmark. I recall with much nostalgia our time together in Kurunegala. The evenings were hot and so peaceful. After work we went on long walks ending up in the Rest House to cool off with a beer. We talked a lot about our lives thus far and our aspirations for the future. It is a matter of such great regret I saw HN only once in the past 50 years.

We were fortunate to have Priya with us. Her sincerity and obliging presence held a unique place in the hearts of all those who came to know her. With her school-girlish air of mischief she was a glamorous girl who broughtcharm and elegance to the medical community.Shewas indeed our girl next door who had a calming influence on us all. Priya was ever willing to cover our busy on-calls. She had the natural ability to deal with kids and we learnt to appreciate her presence as a blessing.

Sanath and I were close right through medical school.It was such a great pleasure to have him with us. He had tremendous confidence and the ability to remain unruffled in the mostdifficult of situations.Sanath had a sound sense of right and wrong and was never a push-over.I write this as a compliment that he was never afraid to criticize or disagree. Sanathqualified as a psychiatrist in the UK. I have fond memories of our meetings in London when he arrived in his posh sporty Ford Capri.He later emigrated to Perth, Western Australia. His courteous manner concealed a sharpness and grasp that took him rapidly to the top of his profession.On my travels,some years ago, I was a welcome guest in his house in Perth.

Adikaram was anexceptionally talented medic, a wonderful friend and a caring doctor. He was full to the brim with his own brand of dry humour. His amusing narratives of daily life delivered with habitual flair was a crowd puller. “Adi” became a great friend of the nursing staff.We were never short of thosedelightful cakes that were so lovingly baked in the Nurses Quarters.

It brings me great sadness to think that of those interns only Sanath and I are alive today. HN had a successful career as a GP in Hanwella. He passed away in November 2019from cardiac failure. Priya married an engineer and had a family. Whenever there was a batch reunion she never failed to inform and entice me to join in. She lived and worked in Colombo and died in October 2014.Adikaramemigrated to the UK and worked in paediatrics in Wales. “Adi”died in the 1990’s from the complications ofmyelofibrosis.

My second 6 months was in Surgery with Dr Rasiah. He was even-tempered with an easy-going attitude to life. This was a far easier appointment than paediatrics. My colleague was Tudor Wickremaratchi with whom I shared the work. With a stentorian voice, at times he was an angry young man. But he had a softer kinder side to him too. Those were days when the cigarette was a fashion accessory. It was hard to see him without a fag. Tudor had a natural rapport with people from all walks of life which was his hallmark. He had a prodigious capacity for drink and was the life and soul of any party. Those were a tremendously happy time. After internship he had a spell as DMO Dambulla. When I visited him he seemed happy and well settled. But I was surprised to hear he too had emigrated to the UK. In England there was an enormous transformation in the Tudor we knew, becoming a much-subdued family man. He worked as a forensic pathologist in Bristol. Tudordied unexpectedlyon a Golf course in November 2005, aged 66.

In the House Officers Quarters we had the luxury of electricity and running water butthe toilets were squalid. There was a cook and a helper. The cook was an asthmatic.We called him Ronchi Rajapakse. We all had our turn to be the ‘buthmaster’ who was in-charge of the finances for our food for the week. This was our introduction to domestic finance. Every week there was a budget deficit which never amounted to much.We put it down toRonchi Rajapakse’s cigarettes and betel. The weekly verbal reprimand was just water off a duck’s back. We forgave his misdemeanours for his unwavering loyalty and being such a fantastic cook. Our laundry was done by “Lensuwa”. I could still picture him, a pleasant young man with a broad smile. The laundry was delivered to us spotless and creaseless.

There was much friendship, a common bond and a deep-seated loyalty amongst the interns. In my House Officers Quarters there were 2 others from our batch, M.H.SCassim and W. Rajasooriyar.  While the rest of us floated on a tide of alcohol, MHS and WRwere the only teetotallers for miles around. They were the only guys without the unpleasant dystonia, dysarthria and dyspepsia in the morning!! MHScompleted his internship in Obs and Gynae and Medicine. After completing his FRCShebecame a respected Eye Surgeon in Colombo. W.Rajasooriar had his internship in Medicine and Surgery. His greatest attribute was an infinite willingness to put in the hours to his hospital work. WRcompleted his Fellowship in Anaesthesia and went on to become a Consultant in SL. He later emigrated to the UK with his family. After retirement he developed pulmonary fibrosis and sadly passed away in January 2015 of a heart attack.

The House Officers’ Quarters had become a social hub for the bachelor government servants working in town. We played badminton in the evening until dusk. Our badminton court next to the Quarters was ideally located with the elephant rock as the backdrop. Two Assistant Commissioners of Income Tax,Sabapathy and LasathPerera, Veterinary Surgeon Siri Abeyratne and dental surgeon AponsoWickramasuriya joined us in the badminton and in the banter.We enjoyed the evenings immensely and often proceeded to a few cans of beer and a chatin our quarters. Kapoor Rajasekeran(Registrar in Pathology) and DisampathySubesinghe(MO/OPD) joined us in the badminton and the fun later. N.K Gunatilleke (Nihal) from our batch was a regular visitor staying on at the quarters as he had relatives in the town. Later he became Relief M.O and spent more time with us.

The Visiting Surgeons and Physicians kept their distance and rarely mixed with the junior doctors.They were rich and lead privileged lives. Kurunegala was a hotbed of private practice with a wealthy clientele.The word spread that the consultants resorted to unscrupulous practiceat the expense of the non-paying patients. Many of us juniors were deeply troubled and disgusted by this behaviour.News of the rift became a hot-topic in the confined space of the hospital bubble. I still remember the hysteria that it generated. Misinformation and gossip spread like wild-fire and the conflict turned tribal.Eventually an iron curtain fell between the consultants and the junior doctors. The Juniors carried out a campaign of attrition against those ‘shameful’consultants.A most unpleasant and a tense atmosphereprevailed in hospital. Compromise seemed dead and civility with it.

In retrospect, it was the junior doctors’over-zealous and misguided youthful idealism that was part of the problem. This was made worse bythe arrogance of the egocentric Consultants. The disharmony between the seniors and juniors caused more harm to patient care than the private practice.Thinking back in the cold light of day, there was only one particular consultant whose behaviour was questionable. All this was just a storm in a tea cup!!It has been my life-long belief that healthcare just like education should be free to every citizen.Knowing its financial implications,for most countries, this is an impossible dream. Should doctors in government service be allowed private practice? Thisis a difficult question to answer without prolonged debate and discussion.If the doctors are adequately remunerated why should they be treated differently from other government servants? That was merely a question and not and answer. Living abroad it would not be wise for me to proclaim judgment on this issue. Returning to the troubles of long ago - I wish those consultants were alive today to read my take on the all-consuming conflict of 50 years ago. As for the juniors, our main crime was being young, callow and starry eyed.

The GP’s in Kurunegala were a wealthy bunch. The two names that come easily to mind are Drs Riley Fernando and Bernard Weerakoon. They were ever ready for a good time. The young DMO’s in the surrounding hospitals joined us too. DMO Gokarella- W.S.L de Zoysa, DMO Galagedera- Dr UpaliPerera were regulars to our many functions. We all liked to escape the pressures of doctoring by partying. The Law-Medical cricket match was the highlight of the year.Thisbegan with cricket and ended in a concert and a dance in the Town Hall. PerrinJayasekera was a popular colleague who had completed his internship in Kurunegala and was DMO at Galgamuwa. He was already well known for being part of the famous singing duo, Jay brothers, with his equally illustrious brother Geri. The highlights of the concert were the humorous sketches and the elegant ballet dancing of Perrin. It was like a re-run of what we had at the Medical Faculty. He was such a talented comedian, singer and dancer.Perrin was a force of nature and a phenomenon. Performing to an audience came naturally to him. Hecontributed his many talents to society with modesty, intensity anda great deal of humour.So sad he died so youngduring coronary by-pass surgery in New Haven, Connecticut, USA.Dr Riley Fernando passed away in Colombo in 2003 aged 75.  Dr Bernard Weerakoon died in York Hospital, UK in 2013 age 80.

There were two social clubs in town. The upper club was frequented by the upper echelons of society and the lower club by the so-called working classes.The Bolsheviks in townbelieved the lower club was for the proletariat and the upper club for the bourgeoisie. This class distinction was an unwanted relic of more than a century of British rule. In my naivetyI thought the upper club was given that name as it was built on a hill.The ethos of the clubswere different too. The doctors went to both clubs and enjoyed the best of both worlds.The dances in the clubs were well subscribed. Music of the Beatles were popular.EngelbertHumperdink and Tom Jones were on the cusps of their success.‘The green green grass of home’was the popular belter at these events and sounded heavenly after the amber nectar. Those were chivalrous times when we were gallant young men and the ladies were modest and genteel.Despite our youthful exuberance, honest! there was no hanky-panky.

There was also high intensity work to be done in hospital. Having been trained at the Temple of Wisdom in Kynsey Road, we were no strangers to hardship and hardwork. Doctors worked from 8am to 12 noon and 3 to 5pm. Kurunegala was hot as a furnace between 12 and 3 and we all had a nap. We were on ‘call’ once every 3 days and once in 3 weekends. The calls were busy and a good night’s rest while on call was a luxury we never knew. Without the bleeps in those days the dreaded emergencies were notified by a man on a bike who knocked on the door “Sir, call ekak”. This often resulted in loud cursing and a barrage of unparliamentary language.

As we didn’t own cars to get about and there was no Television our free time was mostly spent partying in the House Officers Quarters.This included lots of hard drinking and loud singing. CT Fernando songs were popular and we knew the words of them all. We remember how the parties started but very few remember their end.Until we completed our university education many of us were used to an orderly life. What we had now was completely the opposite and we were simply intoxicated by it.

When not on duty the weekends were peaceful beyond belief. It was so blissful waking up late into the warm sunshine. I befriended Siri Abeyratne who owned a rugged and reliable 1950’s VW Beetle.We often planned trips to appreciate the beauty of the countryside. Our favourite destination was the Batalagoda Tank by the rustic village of Ibbagamuwa. It wason the road to Dambulla. BatalagodaWewa as it was called is around 2000 years old and has the most remarkable and distinguished history as told by the British irrigation engineer and historian Henry Parker(Ancient Ceylon – 1909) and also recorded in our own epic chronicle, the Mahawamsa. Its locationistranquil and idyllic. The lake is one of the most picturesque I know backed by the tall peaks of the Matale hills.There were no tourists, no holiday chalets and no motor-boats. It was just the two of us. There was the occasional man on a catamaran casting his net on the still blue waters. There were several untouched villages off the beaten track to explore. We parked our car and walked for miles along the water’s edge.Minimalism wasn’t even invented then, but all we had for lunch was a home-made sandwich and shared a Lanka Lime. We often spent the whole day in that pristine wilderness to return home in the late evening with our batteries recharged and our minds refreshed. Siri rose up to become an Assistant Director of Agriculture in Kandy.In his retirement he followed his children to Florida, USA. We speak occasionally to reminisce and relive those wonderful years in Kurunegala.

A year passed at the blink of an eye. By then theinternshad formed a warm and supportive community. Soon it was time to move on. Despite the hard toil, mostly the good times come to mind. I clearly remember the sadness I felt saying goodbye to my friends, some of whom I never saw again.Although I felt “the show must go on”, it never did as marriage and family got in the way. On looking back It was such a privilege those friends were in my life. I continued to work in Kurunegala OPD for a further two years. During this periodwe were deeply saddened by the demise of Ronchi Rajapakseafter a brief illness. He was so much a part of the Quarters scene.  The doctors were his next of kin.We gave him atraditional Catholic funeralin the General Cemetery Kurunegala. He will be remembered for his fine culinary skills, toothless smile and his wheezy banter. May his Soul Rest in Peace. As I stepped out of the hospital for the last time the sun broke out of the rain as if to wish me goodbye. After leaving in 1970, I never returned to the town or the hospital ever again.

Many of us followed the slogan of the American author and newspaper editor Horace Greely “Go West young man”. There was a mass exodus of doctors to the USA and UK in 1968. I was to remain in Sri Lanka for a further 7 years. I had learnt from my father to believe in the value of working for the government. I believed and still do, it was a respectable and honourable thing to serve the people of my country.Being cripplingly naïve, my life took many twists and turns. The turmoil in my life made it impossible to live and work in Sri Lanka. Both my personal and professional life became darkened by uncertainty. But I never lost hope. It was only then, though with great reluctance I decided to leave my country.I too joined the rest of the herd into greener pastures.Everything has a price!! I hadstepped on the treadmill in the competitive world of hospital medicine, a seismic shock to the system. It was more study, several more examinations and innumerable job interviews. Thankfully, the work ethic and the discipline instilled by my parents and my old school kicked in.

The time flew. Socially and politically it was a period of bewildering change. I continued to serve humanity although in a different continent. My workwas still dominated by an ethic of public service. After retirement, here I am in London, where the grass is greener and the concrete is warmer. London is a convenient place to meet those living in the UK. I met with Kapoor Rajasekeran, S.Balakrishnan and DisampathySubesinghein the summer of 2018 at a Chinese restaurant near to the Victoria Station. Despite a few infirmities we have all weathered well. Our conversation oftenreturned to our roots, to those shared memories and to the magic of those years in Kurunegala. Amidst thehappiness and laughterthere was some sadness too of lost friends.

I am now happily writing of my dreams of the life and friends I’ve left behind. I do have regrets and wish I had kept in closer contact with those who shared my youthful years. I will add this to my long list of regrets. Not having seen some of them grow old I do remember them as I saw them last, young, energetic and smiling. But I am sure I will treasure and revisit those memories which I have garnered inKurunegalaall those years ago.

These were the remarkable and enduring events that defined my internship. I dedicate this narrative to all the doctors who came into my life during those years in Kurunegala and have now departed this world. They enriched my life beyond measure.May they find the ultimate bliss of eternal peace.Despite the passage of years the fun and the laughter will swirl in the ether of that simple but memorable house, for many decades to come.

The past is another world we cannot enter but only reminisce. Although the mind has kept a record of it all, much of it has melted away.We have to be meticulous as an archaeologist to resurrect them. I remember with fondness and friendship each and everyone in our batch who have been on this journey of life. We have spent too long fretting over our careers, children and grandchildren. In this year New Year it is the present that matters more than the past. It is so importantwe take care for ourselves.  May you continue to appreciate the goodness of people and the beauty of this world. Let the 3^rd decade of this century be the best you’ve had so far. May you all have good health and happiness now and forevermore.