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Friday, December 18, 2020

Bora's Banter Series 1. Episode 3

Series 1, No 3 December 2020

 
Who eats “Meat Bones”?

A very close friend of mine, Sanath, migrated to England in 1975. He was a qualified veterinary surgeon and had found work in the meat industry. Not long after he arrived, he had the following encounter with his local butcher.    

Sanath enjoyed good food and was an excellent chef. He had invited Kumar (his cousin) and me to lunch that weekend. He had promised to give us a tasty meat curry, something our taste buds were yearning for. So he went to his local butcher for fresh meat. Whilst in the queue, he noticed a pile of small, fleshy meat bones.  A wonderful beef curry with lashings of bone marrow must have flashed before his eyes! 

When Sanath finally reached the head of the queue, the butcher asked him, “What can I do for you Sir?” Pointing to the pile of bones, Sanath started to reply, “Those meat bones look ideal for a curry….” The butcher abruptly interrupted him and said loudly and condescendingly, “If you eat those bones, what will you feed your dog with?” 

Sanath smiled mischievously and replied, “I feed him Fish and Chips”.

Burt the Colostomy Stoma

I started to play golf in the early nineties. I formed a regular three-ball with Jack, a very nice English gentleman, and Sarath, a Sri Lankan doctor. Jack had a past history of Ca colon followed by colectomy and colostomy. He used to refer to the colostomy and stoma as “BURT”. 

One day, while he was with his granddaughter, the colostomy began to play up, making him grimace with pain. She asked, “Grandpa, what is bothering you?”  

“Oh dear, Burt is giving me problems” said Jack. She shouted in exasperation, “Burt is a bloody arsehole!!” 

A Matter of Life and Death: Objectively or subjectively interpreted?

A very good friend of mine was a fanatical football and rugby fan. He was ecstatic when he managed to get tickets for a F.A. Cup Final at the Wembley Stadium.  On the day of the match he had an early morning, short elective surgical list of minor operations. Postoperatively, he discharged all his patients from the private hospital he was working at and gave very clear instructions to the ward nurses not to bleep him, except in case of a life and death emergency. This was a time when mobile phones were not freely available and doctors had to be (contactable) out of hours through “bleeps”. 

As you all probably know, the F.A. Cup Final is like the Super Bowl: a hugely popular event and a sellout.  Over 70,000 fans attend. The surgeon and his wife had an uneventful journey to the stadium. They were at the turnstiles, about to enter, when, much to his surprise, he was bleeped. He had to get to a telephone booth immediately.  He rushed out, saw a telephone booth, but with a queue of people waiting to get in. He looked around for help and spotted two mounted policemen. He rushed to one of the policemen and explained his predicament. 

The policeman got to grips with the situation immediately and proceeded on his mount to the booth. Within seconds, his megaphone boomed: 

“We have an emergency. A surgeon needs to call his hospital urgently. This is a life and death emergency. Vacate the booth and let this doctor have access to the phone”.  

Within minutes, the surgeon was in the booth.  People had gathered outside the booth to witness how the surgeon was going to deal with this emergency. 

All eyes were on the surgeon whilst he phoned the ward. The nurse who bleeped him apologised profusely and told him that she had received a call from a very agitated Mrs X whom he had discharged that day. When asked whether the call was urgent, Mrs X had declared that it was indeed urgent. 

She said, “My husband is eager to find out when we can start having sex again!” 

A Judicial Check on Executive Power!

Mistaken Identity

Mr L.W. De Silva was a famous Thomian: a contemporary of Warden R.S. De Saram and S.W.R.D. Bandaranaike. Like the English Prime Minister Boris Johnson, he was a Classics Scholar who composed and translated Greek poems into English and vice versa. It was LW who translated “Garland of the Muses” (“My mind to me a kingdom is. Such perfect joy therein I find” Sir Edward Dyer I think).

I got to know him well through the Old Thomians Association, U.K and I would visit him at home. He related the following story to me. 

When Mr L.W. was working in Ceylon in the nineteen fifties, he was the Commissioner of Assizes. He had an appointment to see his minister at the Secretariat which was behind the Old Parliament in Galle Face. 

He got into a crowded lift. As the doors were closing, a nondescript looking man charged in, pushing the existing passengers aside. Mr L.W. gently tapped this man on the shoulder and politely asked, “By the way Sir, do you happen to be a Minister?” The man, delighted to be mistaken for a minister, asked Mr L.W, with a broad grin, “I am not, but what made you think I was one?” L.W. promptly replied, “Because you are behaving like one”. 

ANATOMY VIVA: Give us another one just like the other one

A Block Senior, Jega, was repeatedly failing in anatomy (like the Thomian, whom I have already referred to, who compared his failures at the SSC to successive pillars in the College Assembly Hall). This was no surprise as his priorities were W,W and S + gambling. He had no time for books and had not visited the college library. At a viva the Prof gave him a skull. Prof pointed to the foramen magnum and asked him to describe what went through that opening. Jega very confidently said, “Many a pint of Beer Sir”. The viva ended there and unsurprisingly, Jega was unsuccessful.   

Jega’s friends picked an opportune moment to approach the Prof to plead on behalf of their friend. The Prof went soft and told his friends to tell Jega to choose two bones and study them thoroughly for the next viva. At the viva, the Prof asked Jega to select any bone and describe its anatomical relationships in detail. Our friend selected the Right femur and gave a very satisfactory answer. 

The Prof was very pleased and told Jega, “Well done. Pick up another bone, repeat the performance just like the other one and I will pass you”. 

Jega beamed and picked the Left Femur! It was a déjà vu for the Prof who, realizing that Jega had outwitted him, nevertheless stuck to his word and passed him! 

The Multi Faceted “WAL”

The word, “wal” was used in different ways in the Sinhala language: as part of a name and in idiomatic expressions. Look what happens when we use it abroad. 

Going back in time…..

A Sri Lankan doctor was doing his residency in a North American Hospital along with a few other Sri Lankans. One day, the Registrar reprimanded him. Our compatriot got a bit stressed. For a moment he thought that he was in Colombo and blurted out, “Dr Smith ekak kiyannang, wal part dammanne Epa.”(Dr Smith I will tell you one thing: do not act in an odd way). 

Amusing  Introduction…..

I was invited to lunch by my friend and neighbour Derek. His lovely wife Chitra sat me by a couple and very innocently made the usual introduction: “Bora meet Mr Walrajah and Mrs Walrajah”. I was familiar with names like Walgama, Walgampaya but I had not heard of Wal Rajah. Subsequently, I found out that his name was actually Rajaratnam. It is likely that his initials were W.A.L. Incidentally, his sister Shanthi is married to a very close friend of Lucky’s, Daya W. 

A difficult venepuncture

A friend of mine was working at a hospital in North London. He was in the operating theatre and heard an irritated sounding voice making utterances in Sinhala: “Mita Molowapang”.

It was the voice of Dr Artie Stone (a traditional name from Ratnapura), a Sri Lankan male Anaesthetist, who was performing a venepuncture on an obese man. Obviously he had for a moment thought he was back home and slipped back into his native language! 

Wishing all readers a very Happy, Merry Christmas and Prosperous New yea r- Bora

86 comments:

  1. Bora is back to put us all in a good festive mood. What a collection of stories! Looking forward to similar anecdotes from readers.

    I can start be relating a true story. A few Sri Lankan girls were walking to Selfridges and saw a man with what can be described as an ample bottom in front of them. One girl remarked, "ara minihage passa paththa wattakka gediyak wage" (that man's bottom is like a pumpkin) The girls were stunned and ashamed when he turned round and said "Umbalage rate heri kala" (after eating Jak fruit in your country).

    Fortunately he was a good natured chap and started a friendly conversation with the girls and recounted how he lived and worked in Sri Lanka for nearly 5 years. This by the way, is a true story- it actually happened.

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    1. Hi Mahen
      Thanks for the introduction.The story about the man's posterior was very funny.I had a similar experience in 1975 when working at Edgware General.I was walking on the road when I heard familiar Sri Lankan sounding voices behind me,making comments.Not about my bum which was in good shape those days but my clothes.I surprised them by telling them "Bassawa Therenawa",I understand the language.Probably they were nurses from the hospital.
      Looking forward to stories from our batch mates

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  2. Hi Bora
    We all Welcome Bora's Banter in this time of Covid. As always with humour what is important is not if is fact or fiction but does it have the desired effect of raising a smile and bringing some good cheer. No one does it better than Bora as we have known since those faculty days. The only thing we miss is his presence to deliver it with a poker face without even a glimmer of a smile. We all have a special affection for the medical humour that is closer to our hearts bringing back memories of our own.

    Thank you for those good wishes and may you and Harshi have a great Christmas and a Happy and healthy New Year.

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    1. Pardon the poor grammar caused by autocorrect. I do accept I am a Godaya still half naked running in paddy fields in distant Kegalle.

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    2. Hi Nihal
      We go back a long way,thanks for your comments.Due to the Blog, I found that we had many common friends like Deryck,Sentil,Tilak ,Razack.I enjoy reading your post,the English is exceptional. Cannot imagine how the
      Burgher buggers at Wesley laughed at your grammer.Stay safe.

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    3. Bora
      I read in the blog an account written by Lucky Abey about Tilak D and the tragedy and turmoil in his life. This brought me great sadness. Tilak was an exceptionally nice guy. In addition to his academic achievements he was a fine artist an interesting raconteur after a drink or two. He had a wonderful sense of humour. I am so pleased our paths crossed in the faculty. He often gave me a lift to Nugegoda in his Ducati. There were hair raising moments travelling with him on the High Level road weaving through traffic at 80 MPH. That is when We reaped the benefits of the Kavadi dancing and Supplications at Kataragama. Tilak burst into song at the dinner when our medical appointment with Dr K.S.De Silva came to an end. Razaque relates the story that when he met K.S.De Silva in New Zealand his wife has asked about Tilak as he sang about a Dutch girl and she was Dutch.
      We eagerly await your story about the trip to Kataragama with Sanath. You are right when you mentioned writing can be a dangerous occupation when names and events are mentioned.

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    4. Nihal
      The Kataragama story and follow up, has interesting incidents and full of fun.I have given it a lot of thought and decided it is not Bloggable.A chap like you would have relished it.Maybe we can talk about it at reunion.

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    5. I recall Tilak very well. His brother Deepal was a classmate at STC Kollupitiya. Deepal was great artist and apart form that, what I recall best is his ability to mimic a test cricket commentary on short wave radio (remember those?). He would go "In comes Davidson shshshweew from the Vauxhall end and ssshhhh wweee bowls to Trueman who make a wild ssshhhewwshh slash and edges it...". Tilak was such a quiet guy and some of the stories related above sounded strange to me! Maybe because I didn't know hin that well.

      Going back to STC, FVC Mendis (Chrishanta) was with me and I lost contact with him after I went to Royal and he went to "the other school!) but a few years ago reestablished contact as he was a friend of my brother Daya as they were together in the EFac.

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  3. Thank you Bora for those humourous anecdotes. When my frind JG Wijetunga was doing Prof Rajasuriya's appointment, he was requested to present a case. JG had a patient with a right sided hemiparesis.Whilst relating the past history, JG mentioned that the patient had an ear discharge. When Prof Raj asked him which ear, JG's reply was 1965!The rest of us started to laugh and Raj thought that JG was attempting to pull his leg and chased him out!

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  4. Sanath
    When I did Prof Rajasuriya's appointment as a student I had a patient with meningitis.I was asked how I would manage this patient if I was DMO Kahatagasigiliya.My answer was due to the limited facilities available I would transfer the patient.He was not impressed and told me you are the type who would transfer your patients and spend your time at the club with the SI,lawyer,surveyor etc.A few days later he noticed that I did not have a wristlet,told me to feel the patient's pulse and tell him what the rate was.Resulted in my getting chased out.

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  5. Bora and Sanath
    When I did the Rajasuriya's appointment Bernard Randeniya had a patient with typhoid and a palpable spleen. Bernard poked into his tummy as did many others for about a week. I hadn't felt a typhoid spleen and went with Bernard to this patient. As soon as I put my hand on his tummy the patient went berserk shouting out he's had enough of people poking his tummy. He took his clothes from the locker wanting to go home. The prof had just arrived and was talking with the registrar. Bernard and I panicked and pleaded with the man to stay but he was adamant to go home. There was a huge commotion and our lives were at stake. Bernard put his hand into his pocket and pulled out a Rs.5 and gave it to him. The man quickly put it in his shirt pocket and went back to his bed. I learnt to duck and weave and hide successfully and the rest of my time with Prof was uneventful.

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  6. The two month professorial appointment had its lighter moments too. Prof Rajasuriya had a tremendous sense of humour some of it directed to his professional colleagues. I had a repertoire of his priceless comments which I knew as a medical student but many have been lost in the mist of time. He once said one doesn’t need a brain to practice Obs and Gynae – just 2 fingers. When one day the Prof arrived earlier than usual only a few male medical students were there. He quipped “Where have all the flowers gone?”. This was then a protest song against the Vietnam war that was raging at the time.
    In those days we accepted the idiosyncrasies of our teachers with good grace, assuming their intentions were honourable. In the harsh environment of education of that era we had very few rights, only a mass of rules. It was also our salad days of youthful paranoia. Life as a medical student was not a bed of roses and neither was it a bed of nails. I take the cue from the title of the 1996 song by that English Rock Band - Oasis – Don’t look back in anger.

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  7. I am sure most of you know my views on the late Prof R. I admire him as a dedicated physician and long serving patriot but I don't share his views on how students should be treated. I believe that Medical students are adults and should be treated as such. Respect has to be won, not demanded. I know many won't agree with me but I have always been that way - a person who regards humanity in all its forms as worthy of equality and justice irrespective of labels. For me teachers such as Wickrema Wijenaike, Oliver Pieris stood out.

    The only "joke" I recall is how lots of students assigned to him would take their Hutchison small text book book and make it dirty with soil to give the appearance that it has been read many times!

    I also met him many times when he was DHS as believe it or not, I was Vice President of the GMOA at one time. He was always courteous and respectful because I was no longer a lowly student I suppose. Having said that, I had no encounters with him as a student but recall the sense of fear and apprehension I experienced during ward classes or during the "appointment". That is not the sort of atmosphere conducive to learning.

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  8. I had a narrow escape during the Professorial appointment. I was told by DRM(Munasinghe) Registrar that it is my turn to present the case. I never new where the list of names were kept and started to panic. Fortunately, Prof was late and I had sufficient time to take history, examine and do the necessary tests. Prof was impressed when he heard that the patient had met a Ayurvedic Physician who had given a medication to treat his vitiligo. Incidentally, he was an Insulin dependent diabetic. It was plain sailing and the bath consisted of Prithi Rajapakse,Rajasooriyar and Cunningham and names of others,I have forgotten.Prof had a joke with Rajasooriyar by asking him whether he was related to Prof.

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  9. Speedy,I remember Oliver Pieris very well.He was Physician,OPD, before becoming the Senior lecture,in Medicine.He was cool as a cucumber, never lost temper.I remember his lectures in Renal Medicine.I understood the terms acute nephritis,nephritic syndrome, Nephrotic syndrome, clearly.Srilanka lost him and NZ gained.

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  10. Mahen
    I agree Prof Raj was a good teacher but too strict with the students.A few years ago I attended a friends funeral and seated next to me was Prof's sister who resided at ward place.Prof was not married and he lived with the sister.During the course of conversation I told her that the brother was a very good teacher but very strict and how I got chased out.

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  11. Does anyone have information about where D.R Munasinghe and Oliver Peiris. Where are they now? H.B Karunaratne I know passed away some years ago. I met him in Florida and he invited me home. He was married to an American lady who was most welcoming and friendly.

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    1. I had contact with DRM sporadically till a few years ago. He and his wife Beta were good friends of Piyadasa and Anoma Ranmuthu. I met him physically a long time ago. He was the RCP Tutor I think at Joyce Green and was held in high respect as a brilliant teacher. It took a long time for me to pluck up courage and call him Ranjit as he wanted. When he first told me, "Mahendra, you and I are now Consultants and you must stop calling me "Sir" and call me Ranjit and my response was "yes, Sir"!. He was one of the most humane doctors I have ever come across and for me was an absolute role model. I have written about him and my memories of working with him at Base Hospital Matale. He neither had airs nor graces! I think their daughter is a doctor, could be a Pediatrician but I am not certain. I know he had some health issues and I am hoping he is well.

      My claim to fame with HBKaru was that he was favourite to top t he MD(Ceylon) in 1973 but I beat him to it!

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  12. Bora, thank you for these stories, they made me laugh out loud! I especially liked the one about feeding the dog fish and chips! About Prof. R., I am in complete agreement with Mahen, he was a good teacher, but his treatment of students was appalling. It was not necessary to terrorize the students. I was lucky, because when I did the professorial appointment he was out of the country and it was Oliver Pieris who was in charge. At the final exam also, I somehow was not quizzed by him. I don't remember who did! Nihal, I think Oliver Pieris also passed away many years ago. (I am not 100% certain.) He was an excellent teacher and a gentlemen!

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  13. Srianee
    Glad that you enjoyed the stories.I have not told many English friends about the fish and chips.Oliver Pieris had to be a gent, after all he was a Thomian.

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  14. Sanath LamabadusuriyaDecember 20, 2020 at 7:40 PM

    Oliver Peiris Emigrated to Sydney in the early 1970s. I did my internship with him and Prof Raj. Russell was mu co-intern.Oliver is Asoka Wijeyekoon"s uncle. As far as I am aware , Oliver is still around. I will check with Lubber when I meet him at Senarath's over dinner on the 29th of December.Few days ago, Lubber invited me for drinks and dinner at his residence in Narahenpita; LAW Sirisena and Nalaka Mendis were also there.
    Buddhika worked with DR Munasinghe at the Joyce Green Hospital in Kent in 1979. Later we entertained him for dinner in our residence at Karapitiya.I am not sure whether he is still around.

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  15. Oliver was physcian at Repatriation hospital in Sydney.Hope he is alive and well.He lectured to us on Kidney.The first thing he said was not to take any notes as he was summarising De Wardner.He once tagged along Tony Don Michael for a lecture;TDM was flamboyant and aloof.Used to see him at American Cardiology conferences.
    OP was friendly and good natured and I was so glad that I did my professorial term with him.
    Other Thomian consultants I remember were A.M.Mendis (VOG who migrated to Perth) and P R Wickremanayake Physcian at Royal Prince Alfred in Sydney PR’S daughter Shemara is the highest paid CEO in Australia (Macquarie Bank) and was 29th in the list of most powerful women in the world.
    They were all gentle and good natured ;could be something to do with soft breezes of the school by the sea !!!

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  16. Bora,
    As you are aware Sanath was more a friend and confidant to me than a cousin.You Will remember the time he served us a fine French red and we thought it was a ‘Kahata ‘ wine.Both of us are more sophisticated now !!!
    He was somewhat boastful, but ,innocently so and was nicknamed ‘Big Operator ‘at STC.He was the proud owner of a mini minor,and once tried to race a bgger car.When we stopped at a traffic light ,the girls in that car called it a matchbox.That deflated him but not for long.
    He was the chauffeur to both of us Bala and two girls for the Bloem dance.My partner wanted to see my room,but when we went up ,he was fast asleep in my bunk !!!I I didn’t have the heart to chase him out. C’est la vie.
    The lunch in London was a conciliatory gesture.I had facilitated him getting a visa to UK through a good friend of Mrs B; he left without even calling me.But he more than made up by helping both of us in various ways.I’m really sad that neither you or I have been able locate him in UK.
    I sincerely hope he is well and safe and not alone.

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  17. Kumar
    Sanath your cousin was a very sincere friend and sadly missed. In 1976 he invited us to his apartment in Hyde Park Corner for dinner, on this occasion it was roast lamb (butcher would have been pleased) and the wine tasted much better. I last saw him in 1984 when he visited me at Brentwood.
    I remember the Blom Dance 1966,Sanath ruined your plan A ,Instead you, Bala and the guests went to the the light house.Incidentally the motto of one the girls school in Colombo was "We Scatter Light".

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    1. Bora,
      Sanath is sadly missed.
      There must be mechanisms for locating missing persons.Perhaps ND or other UK friends maybe aware and could help.
      Also if you are in touch with Sydney ,please give him our compliments of the season.

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    2. Kumar
      What is his full name? Where was he living? British Telecom and the Internet may help. If the info is confidential please send it to my email. I will try my best to locate

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    3. Thank you ND.Will email his details.

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  18. Sanath
    Could you please give my regards to Lubba Wijeykoon when you meet him on the 29th.We went on a cruise to New York on the QE 11 a week before 9/11.I am surprised that dinner parties are allowed in Colombo.We have to confine ourselves to our household/bubble.

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  19. FROM SANATH
    "I remember Tony Don Michael quite well. In our final year, he conducted a lecture -demonstration and used a stethoscope which had multiple attachments consisting of many diaphragms as well as bells.. He auscultated
    a patient and claimed that he heard all four heart sounds!
    Later on, during one of his regular visits to Colombo, Monty Jayawickrama who was a minister, consulted him. After looking at his ECG, urgent by-pass surgery was recommended for Monty J. in his unit in California. Monty J. sought a second opinion from a specialist in Harley Street London. He was advised to take a brisk walk around the block of buildings and an ECG was taken. After looking at the ECG, Monty J. was advised that his heart was perfectly normal and no surgery was required! This story was related to me by the doctor who accompanied Monty J. to London.
    Tony DM was a rather flamboyant character who represented St. Peters College in cricket. I think Darrell Weinman played in the same team."

    Kind regards,
    Sanath

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  20. This is a true story which I remember like yesterday. I was doing the surgical appointment with LDCA, the surgeon. He was operating that day and Bernard and I went to the theatre early. There was a quiet corridor painted a light blue with subdued lighting before entering the surgical area. Bernard and I were seated in a bench and chatting away. We saw LDCA and his retinue arriving. We avoided Eye contact more through fear than respect. The ‘great man’ went passed us and turned back towards us. He looked fearsomely angry and grinding his teeth. LDCA was a big man. He held me by my collar and raised me up. I felt my feet dangling several inches above the floor. When he dropped me down like a sack of potatoes he said “ Where are your manners. Don’t you know to stand up when I pass by”. I was shocked by the extent of his huge ego. I survived the 2 months without further turmoil. I still don’t know what to make of it. This was nothing less than a common assault which should have been a criminal case but what rights did we have in those distant days. I am reminded of Sir Lancelot Spratt in the Richard Gordon “Doctor series” of books. To LDCA’s credit he was a fine teacher and I learnt a great deal during the long 2 months. The junior doctors who worked with him praise him for his civility and for his support. Although this incident stands out I don’t hold it against him. There were several specialists who couldn’t contain their egos and behaved as if they were God’s gift to the profession to save humanity.
    On my many visits to SL, Bernard and I reminisced and recalled this incident and saw its funny side.

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  21. Nihal, You will remember that we had to wear ties during his attachment and he was indeed an imposing figure. He nearly failed me at the Final for not giving the answer he wanted when questioned about splenic rupture and the behaviour pulse. In simple words the answer he wanted was not rapid pulse but increasing pulse. My answer was rapid pulse.
    To my great relief he told that he was not going to fail me. Simple mistakes affected to final out come of exam results.

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  22. Nihal I wondered how Randeniya and you could have been in the same group. Then I realized that he was called Bernard

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    1. In the faculty Bernard's name was R.A.D.W Bernard. After he got married he changed it to Bernard Randeniya.

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    2. He must have been Randeniyage Bernard KDPR Perera was Dambawinnage Perera I think. This usually works but not I think with Gamage! I don't think their name was "Gama"!

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  23. When I was working with Raj we had a patient with an amoebic liver abscess The patient was referred to a newly returned Resident Surgeon who was Eaton. The patient was sent back without any intervention Two bottles of Anchovy sauce pus was aspirated and sent to the RS with Raj’s compliments

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  24. My travel companions from Wattala in the faculty days were Razaque and Bernard. They were like Laurel and Hardy getting into scrapes all the time. We all had a medical examination for entry to the faculty. I recall mine which was pretty brief and quick. Bernard described his encounter with Dr A. He had to strip below the waist. During the examination Dr. A may have suspected an inguinal hernia. He squeezed Bernard’s scrotum and Bernard started to laugh. Dr A was so irate he asked Bernard to “get out of the room”.

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  25. Sanath
    During a ward class either Raj or Wijeynaike told me to describe the colour of the aspirate from a liver abcess,when I mentioned Anchovy Sauce.I was then asked whether I had ever seen this sauce,my answer was no.I was advised to use the term "woodapple cream"/"Divul Kiri" which was more appropriate for Sri Lanka.
    When I was W.A.S DeSilva's SHO at Kalutara Hospital,we used to aspirate liver abcesses in the ward.Inserting a wide bore needle through the intercostal space with the maximum tenderness.When Sinha Wijeykoon replaced W.A.S,he stopped this practice and referred the cases to the surgeon Tudor .Perera,like Eaton he refused and things got nasty.

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    1. Bora,I worked under WAS De Silva in Ratnapura General and he allowed us to aspirate all Amoebic liver abscesses, diagnosed mainly on clinical grounds. X-Rays were hardy used. The aspirates were sterile in most cases and chocolate coloured. Divul kiri colour was associated with secondary infection and had the typical smell. I am sure Srianne too would have done many aspirations during her time. We had lot of amoebic abscesses and cases of typhoid in our wards.

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  26. Lama,
    The stories about the experts getting wrong at times is fascinating. T Don Michael might have been too quick to read the ECG. That shows even the Professors can go wrong. Failure on the part of HL Eaton to diagnose a simple thing like a liver abscess is appalling. I am not boasting about my competence in aspirating Amoebic liver abscesses during my internship. In our unit, we hardly ever referred any Amoebic liver abscesses to Surgeons. The aspirations we did were uneventful and the aspirate was non purulent and chocolate coloured. Where there was secondary infection aspirated was dark brown in colour and had a typical smell of pus.
    As for Bernard's full name, I would like to remind the name of your College mate Samaraweera, who qualified from Peradeniya. He rattled Bernard's full name, in one breath when I met him at HO's quarters, Anuradhapura during 68/69."RANDENIYE ARACHCHILAGE DON WIJESIRI BERNARD".I have not forgotten the name at all.

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  27. Sumathy
    How interesting that you and Srianee worked with W.A.S de Silva.In Kalutara too Liver abscesses were common, we used to have about seven cases at any given time.There was a theory that heavy toddy drinkers were susceptible to Amoebic Live abcscesses and Kalutara was a toddy area.Correct me if I am wrong,patients with suspected Amoebic liver abscesses were first given a 7 day course of Emmetine injections, it was like a therapeutic test,response confirmed the diagnosis.W.A.S told us that Wiel's /Leptospirosis was common in Ratnapura.

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  28. Leptospirosis was common in Ratnapura because gem miners used to get infected in the deep pits.At the MRCP viva in June 1972, I was given a urine report and requested to comment As it had bile, protein and RBC, I said it is from a patient with leptospirosis and the examiners were quite impressed

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  29. Sor.ry,Bora.I have failed several times to enter the blog and waisted several hours.
    Lama has answered the question about the incidence of Leptospirosis in Ratnapura.
    Amoebic liver abscess were common among the poorer class and some came from surrounding tea estates.
    Diagnosis was based on history and clinical examination. X-Rays were used very rarely. The treatment was with IM Emetine 3- 6 days followed with chloroquine. They were not administered simultaneously owing their Cardiotoxicity.
    Srianne joined us a few months later and I was unfortunate not to have her as my CO-HO. Preethi Rajapakse was my CO_HO.
    Srianne did her Medical Appointment with Dr Balakumar who emigrated to NZ.
    We managed Amoebic liver abscesses efficiently. Typhoid was treated with chloramphenicol, the only drug available until Ampicillin appeared. I can not remember using Emetine as a diagnostic tool during my time.

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  30. Srianne's boss at Ratnapura was Balakumaran and not Balakumar.Sorry Srianne about the mistake in typing.
    Take care!.

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  31. Yes, Sumathi, Dr. Balakumaran was my boss, and he was a wonderful boss and an excellent teacher. (No need for an apology, BTW)) On ward rounds he would often digress into philosophical discussion! Rohini Ana told me that he passed away about a year ago. (He was a good friend of Ana.)

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    1. Thanks, Srianne.No wonder he had phylosopical discussions during the ward rounds,as he possessed a Diploma in Psychiatry (DPM).I do remember it very well.

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  32. Sanath and Sumathy
    Thanks for the info on amoebic abscesses and Leptospirosis.
    Sanath that was a clever interpretation of the urine report,I had no idea how common this condition was in the UK. I recall Prof Raj during his lecture on Weil's disease listing sewer workers and agriculture workers being at risk and he referred to a film called "Bitter Rice" where women were working in muddy fields.

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  33. Amoebiasis was more prevalent among toddy drinkers.I remember Raj postulating that perhaps the toddy that was collecting in clay pots at the tops of coconut trees getting were getting contaminated by crows with amoebic ova being passed with their faeces.I am not sure whether this theory was proven or not.
    The cardiotoxicity of Emetine came in to focus in 1975 when there was an epidemic of shigella dysentery in Sri Lanka. In Jaffna there were few deaths in some patients who had diarrhoea with blood and mucus and were being treated as for amoebic dysentery with IM Emetine. Dr Velayuthapillai who was a microbiologist cum epidemiologist at LRH was sent to Jaffna to investigate. He brought back samples of stools for culture for amoebiasis as well as shigellosis. The stool cultures grew only shigella. The mistake was due to motile macrophages together with ingested red cells in the stool smear being mistaken for amoebic trophozoites. (I have seen this phenomenon myself). This outbreak started in Bangladesh and then spread to St Martin's Islands which was a group of coral islands in the Bay of Bengal and then to Tamil Nadu. During this time many Sri Lankans used to visit Tamil Nadu on a daily basis to watch Tamil films and smuggling activities. Apparently they returned with shigella in their baggage!
    Shigella dysentery was due to Shigella Shigae or dysenteriae Type 1 ,which was the most virulent of the four strains of Shigella, others being, Sonnei, Boydi and Flexneri. A common complication was haemolytic uraemic syndrome leading to acute renal failure. I had to perform peritoneal dialysis to save them. Since then, Shigelosis has been endemic in Sri Lanka. At Karapiya too I had to dialyse many patients.
    I have published a few articles regarding shigellosis.

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    1. Lama,we knew about Cardiotoxicity of Emetine, well before 75.

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    2. How many of you are aware of the effectiveness of Emetine against Malaria. A colleague of mine, Prof Niroshini Nirmalan has done some pioneering work using Emetine derivatives and chemically altered products which retain the cidal activity but dramatically reduces the cardiotoxicity. She gave a Keynote speech at the College of Physicians in Sri Lanka this year but had to do it via Zoom because of the pandemic. She gave the PBFerando oration. Prof P B Fernando Memorial Oration
      “Antimalarial drug discovery: Searching for our roots”
      Prof Niroshini Nirmalan (UK).Resistance acquisition to ALL categories of
      antimalarial drugs and the paucity of new drugs
      in the developmental pipeline, make a
      catastrophic void in the antimalarial drug market
      a very real possibility. With developmental
      pipelines for a new drug taking 15-17 years, drug
      re-positioning or re-purposing could offer a
      viable alternative route to fasttrack discovery.
      The work presented represents a linear
      continuum of a body of research initiated in
      2010, one of the very first research ventures to
      optimize repositioning studies for malaria.
      Following the screening of a large patentexpired, FDA-approved drug library, the plantderived anti-amoebic drug emetine
      dihydrochloride showed nanomolar antimalarial
      efficacy. Historically, fortuitously discovered
      natural product drugs (e.g. Quinine, Artemisinin)
      have been the mainstay of antimalarial control.
      The rationale for the selection of emetine and its
      subsequent chemical derivatization is presente
      presented to highlight relevance not only for
      drug-resistant malaria, but also rather ‘topically,’
      for SARS-Cov-2.
      S

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    3. Mahen, this is new to me! Good luck to those who are pursuing the research!

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  34. Sanath, thanks for this very interesting account of of shigella! About macrophages being mistaken for amoebae, I can imagine how that can happen very easily. When international travel became commonplace it was not too rare for an occasional tropical disease to show up in a hospital in Connecticut. There usually was a history of international travel. I can remember the excitement generated when we made a diagnosis of Malaria on a blood smear!

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  35. Srianee, the same mistake happened in a Central American country. There were deaths due to cardiotoxicity of Emetine injections given for patients with diarrhoea with blood and mucus due to Shigellosis wrongly diagnosed as Amoebic dysentery, because of the motile macrophages with ingested red blood cells. A visting team from the WHO had to sort out the problem . Sri Lanka did not require help from foreign experts as Dr. Velayudhapillai did it by himself most probably because he was a microbiologist cum epidemiologist. I worked very closely with him before I moved to Ruhuna.

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  36. Sanath
    I recall when we were med students there was a cholera epidemic. It was brief and well managed. I believe it came from East Pakistan/Bangladesh where it was endemic. Is it still a problem in the Indian subcontinent or has it been relegated to medical history.

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  37. An interesting bit of information: One of the most prestigious centers for the study of tropical diseases is in the city of Hamburg, Germany, The Bernhard Nocht Institute for Tropical Medicine (BNITM). It was set up there after the cholera epidemic of 1892. Bernhard Nocht was a Naval Physician and decided to establish the hospital in Hamburg because of the large harbor bringing in overseas traffic and many sick seafarers. Apparently Robert Koch objected to the selection of Hamburg as the location! Many discoveries in tropical disease research were made there, and the researchers at BNITM continue to conduct much of their research abroad.

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  38. Srianee
    Thank you for that information. I will visit the website in Hamburg. There is a famous Hospital for Tropical diseases in London too. They confer the degree DTM&H which some of our former teachers proudly displayed after their names. I recall Rajasuriya lecture on Cholera when he described the stools as rice water. Being so long in Radiology much of that sort of info has disappeared into oblivion. The first to go was pharmacology. Sorry D.R Laurence. I just looked at shadows and images.
    The disease always reminds me of Gabriel García Márque's epic "Love in the Time of Cholera". What an amazing story of "Amor vincit omnia". Well not quite living happily ever after.

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    1. The researchers at BNITM were very involved in the Ebola outbreak. My grandson claims he saw the plane bringing in one of the early Ebola patients to Hamburg flying over their house!
      I have a recommendation on Netflix for those interested in the history of Medicine. The TV series is called "Charité," and the fictional story is set at the end of the 19th century when amazing advances were being made at Charité Hospital in Berlin. Luminaries such as Robert Koch, Rudolf Virchow, Emil von Behring and Paul Ehrlich are portrayed by actors. I guess you would call it "historical fiction." It is a German production, but can be watched with subtitles. I found it fascinating. In 2002 while visiting my family in Berlin, I persuaded my German son in law to help me find Virchow's pathology laboratory and museum at the Charité. It wasn't easy, but we finally found it and it was quite a thrill to see the historic specimens collected by Virchow himself. I think our own collection of pathology specimens at the Colombo Medical Faculty was also quite impressive.
      A sequel called "Charité at War" is set in 1943 and portrays how the hospital functioned under Nazi rule.

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  39. Most recent Cholera Epidemic occurred in early seventies, when I was MOH,Hambantota.We had prevent people going to Kataragama,by erecting barriers.Businous community in Kataragama and the Hambantota Kachchari also started to panic.Situation was similar to Covid infection.Tennyson Edirisuriya was the local MP.He intervened acted illegally and removed the barriers.He escaped any punishment.Fortunately very few died.

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  40. Many years ago Thiagu from our lower batch and I were at the American college of OB-Gyn in Las Vegas when we spotted a gentleman who looked much like us. Thing commented in Tamil, egaa oor al pole irrikithu Looks like a person from our country. This man must have heard as he walked up to us and started speaking in Tamil. He was Dr. Perianna Kumarasamy one of the pioneers in InVitro fertilization in the world and was attached to Columbia university. What a small world!!!

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  41. Usually at the tail end, Zita, thought it's time I looked at the Blog, having been away from it for more than a week! My goodness, what a treat was waiting for me! Bora's Banter this time, surpasses all past ones ever, and I felt so cheered up and relaxed. Thanks! I 've had a terrible week with family illness and Festive season looming up. And I had a good laugh and feel completely happy and relaxed. Thanks, Bora! You are a genius!

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  42. Nihal ,Sumathi, Srianee and others,Cholera has been eradicated from Sri Lanka but is still endemic in Bangladesh,India,Pakistan,Afghanistan etc.When we had the cholera epidemic in the early 1970s,Senaka Bibile was the Chairman of the SPC.As the organism was sesitive to tetracycline, large quantities of it was required. Bibile wanted to import generic tetracycine and capsule it locally. Pfizer had the only capsuling plant at that time and they refused to oblige. They mentioned that only Pfizer tetracycline would go in to their own capsule and nothing else. There was a significant price difference between the two. When Bibile informed the PM who was Sirimavo at that time,she threatened to nationalise Pfizer.Pfizer contacted the American Ambassador who then informed the relevant authorities in the US about it and their response was that if Pfizer is nationalised, the PL 480 aid scheme (subsidised wheat flour imports) would be terminated. It was international blackmail against a Third World country, but Pfizer won the battle.
    In the 1960s there were frequent epidemics of cholera in Bangladesh with several deaths due to severe dehydration.As thirst was a predominant symptom, the patients drank gallons of water,but still died. Glucose water did not help;neither did oral saline. However when a glucose/saline solution was given orally, there was a dramatic improvement. This was because of sodium coupled glucose transport via a carrier protein, across the jejunal mucosa. This was postulated by Crane in the 1960s. As a lot of potassium and bicarbonate are lost in the diarrhoeal fluid, KCl and Sodium Bicarbonate were added to the oral solution as well. Later sodium citrate replaced sodium bicarbonate for logistic reasons. This research was conducted at the International Centre for Diarrhoeal Disease in Dhaka, Bangladesh. The discovery of ORS was hailed as the most important medical discovery of the century by the Editor of the Lancet; it was because it saved more lives than penicillin.
    In the 1970s when I was working at the LRH, I was in charge of the diarrhoea section and the majority of patients were treated only with ORS.Once the Superintendent of the LRH, Bertie Silva, informed me that there was a complaint agianst me from the Private Secretary of a Minister, that I was only giving water to patients with acute gastroenteritis and nothing else! When I made further inquiries,I gathered that the Minister was Cyril Mathew and his daughter Manel was his private Secretary. I requested Bertie Silva to ask her to contact me but she never did. Few years later,when I met Manel, I teased her about this episode!

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  43. Zita
    Thank you very much for your comments,made me feel good on this dull and dreary morning in Essex, not far from you.Have a good Christmas despite the Tier 4 restrictions.Looking forward to the vaccine,keep safe.

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  44. Bora
    Thank you very much for your humourous anecdotes which brought a smile to my face, followed by laughter at some of them. Your sense of humour has brought Bora's Banter very relaxing. I am surprised how you remember all these.
    So Late J.G. Wijetunge and you were chased out by Prof. Raj during your appointment.! J.G. Obtained the Diploma in Ophthalmology and was President of The Ophthalmological Society in 1988/1989.
    He used to do Channeling and spend a lot of time with each patient, writing a long history etc in his notes.He got married late as his mother was against it. I met his wife several times at our annual congresses. I went to his funeral house in Wellawatte.
    I will mention a story I heard. You guys had gone on a trip and stayed in a house and went out for dinner. When you all came back the gate was locked. Srikantha had a brainwave! They all got off the car and lifted the gate off the hooks, drove the car in and put the gate back in place! You might be able to enlighten me on this.
    Please convey my Seasons Greetings to Harshi. I met you and Harshi at this years February Get Together at Cinnamon Grand. I had a chat with Harshi at the 2017 Get Together in Jetwing Blue Negombo. Please tell her to look at my last painting the Greetings Card and my Cross Stitch work. All the best. Chira

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  45. JG was my bestman.He was a member of our joint study group together with Senarath, Bertram and Maheswaran; Indra used to join sometimes. JG used to play tennis with me at the College House courts regularly during our final year.

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    1. I played bridge with Cases and JG at Cassa's home in my third or fourth year.JG was my roommate at Ratnapura General,where he did Paediatric & Surgery.During his Post-Grad training in Wolverhampton,UK,he visited alone with Ranjith Dambawinna to my family,in Moseley.
      Few years before his demise, Ranjith conveyed about his debilitating illness.I had no say of contacting him before or after his illness.

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  46. Chira
    Glad that you enjoyed the stories,Norman Sri Kantha was a character,I can't remember the "lifting of the gate",he would have had many hilarious tales for the Blog.Harshi had already seen your cross stitch on the Blog and was full of admiraton.

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  47. Lama,we have revised and learned a lot about the management of gastroenteritis and bacillary dysentry.When I was at Anuradhapura as MO OPD,Mrs(Dr)Abeyratne, close relative of yours was the Paediatrician.She was much loved person by her patients and staff.I joined her ward rounds and learned that she had a magic formula for treating bacillary dysentery, named TOSS therapy.Lama you should know it.I remember tetracycline and the sulphonamides.I have no idea what O stood for.

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  48. Sumathi, Tetracyclines are not used in children because of the side effects. We used Furazolidone initially and later Nalidixic Acid.
    The ABS kept on changing frequently. How did you come to know that Kamalika was related to me?

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  49. U am sure you mentioned that Kamalikas father was your mothers brother,who was to become the OBS&Gyn Prof.Didn't he delivered you at DMH?

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  50. Sumathi, Prof George was an uncle of my mother and he delivered me in Ward 3 of DMH on the 30th of December 1942 (which is tomorrow in another 35 minutes time). In 1975, I was the first winner of the George Wickramasuriya reseach prize for paediatrics.

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    1. Many happy returns of the day,Lama.Now that Kamalika and her HO at that time Neil Halpe are no longer with us, the only person who may have some idei about TOSS therapy is Lalani Seebert,who was locum Consultant with her DCH.It is unavailable in the blog.

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  51. Happy birthday, Sanath! Wish you many more happy and healthy birthdays in the years ahead! Srianee

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  52. Happy birthday Sanath. Wish you many more productive and happy years.

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  53. Thank you very much Mahendra,Srianee,Sumathi and others. Although I am a cricket fanatic, I was not talented enough to score a century at any level, not even in French cricket under the tamarind tree! Therefore I am determined to score a century with my life! Twenty two runs more slowly by gradually!
    It has been a series of parties during this festive season.Last night, Hemantha and Senarath entertained us at their residence. Asoka W., Lucky and Mangala, Indra and Rani and Pram were the others present. We had a very enjoyable time reminiscing old times!

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  54. Sanath
    Many Happy Returns of the day. Wishing you all the very best. May you live long and achieve your target of a century. Chira

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  55. Sanath
    Happy Birthday my friend. We look forward to seeing you in London at our reunion when the situation permits. Meanwhile take care and stay safe.

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  56. Thank you Bora for your amusing anecdotes all the more enjoyable because they relate to actual
    incidents.
    Many of you have recalled stories about several of our great teachers. I notice nobody has mentioned "Ernie" Pieris.I did the 2nd 6 months of my internship with him in 1968 and found to my delight that he had a great sense of humour and more amusing because he would say it with a deadpan expression.
    I recall that during a ward round he remarked " this patient has the Chelsea flower sign " I was puzzled as I had never heard of it and timidly asked "Sir what is that? "
    He replied with a twinkle in his eye_ You can grow all the flowers in the Chelsea Flower Show in his umbilicus !"
    I also recall dear old Medonza . I am sure Lama you may remember how he was doing a round during our Medicine appointment and coming up to a young man who was " paralysed" not moving all 4 limbs even to a pin prick suhhenly pulled his sarong down . The paralysis was instantly cured by the patient making a defensive covering of his private parts with both hands !!

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  57. Suri,good old Oliver Medonza used to address male patients as Kolla and Kollo.He had that atrocatic way of addressing patient even though he was kind to his patients.He was one of my examiners in the Finals.

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  58. Hi Suri
    Happy that you enjoyed the anecdotes.You will find several references to Ernie Pieris in the comments to Nihal's post on Cassa alias Argyl.I enjoyed Ernie's ward classes.There was a very amusing story about Oliver Medonza taking a history from a young patient,not bloggable,some medics still recall the incident with much laughter.

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  59. This comment has been removed by the author.

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  60. i remember very well a confrontation between Oliver Medonza and Robert Gunawardene MP.The latter had visted the ward outside visting hours and Medonza had confronted him. They almost exchanged blows but Rajah Salgado who was Medonza's registrar restrained him and an attendent refrained RG.Medonza admonished him saying that he may be a MP today but not forever, unlike him, because he would work until retirement. These were prophetic words because RG was defeated at the next election!

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    1. Politicians are a law unto themselves worldwide. I just wonder how the present day consultants will react to that situation???
      Medonza was a fine teacher I have the greatest respect for him. I recall the memorable dinner he gave us at the end of the 2 month appointment.

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    2. Sanath, I remember this confrontation too! I think I was in one of the adjoining wards with Dr. Wijenaike's group (?). We heard the hubbub and looked over (they were open wards, remember?), and saw the 'intruder' being escorted out! You remembered that it was RG.
      And Nihal, in response to your rhetorical question, I doubt that the present day consultants would stand up to politicians that way. I could be wrong, of course!

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  61. I remember Dr Medonza very well and have a lot of respect for him. Even before I became a medical student I knew him as he was "The Specialist" my father consulted for any medical problem he felt was beyond the capabilities of our GP. He always had plenty of time for us and was most kind. I am not sure but I think his fee was about Rs 20 for a consultation those days and there was no pressure at all to dismiss you and see the next one. I can't remember his son's name but I think he was a Royalist. Dr Medonza was a Benedictine and he played cricket for his school as well as for the University.

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    1. Mahen
      Dr Medonza's nephew Ana played cricket for STC Mount,he may have been with you at the Prep school Colpetty.The Doctor enjoyed a drink or two at the SSC.

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    2. Ajith De Silva who was a couple of year senior to us was Dr OM's nephew. He was there at the end of appointment dinner. Ajith now lives in Australia and became a Radiologist.

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    3. Bora, my elder brother confirmed that Ananda Medinza was a classmate of his..

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