THE YEAR OF THE INTERNSHIP

 THE YEAR OF THE INTERNSHIP- KUMAR GUNAWARDENE- PART 1

That was the year that was. I knew it the moment it commenced, and fifty years later still think of it as “l’ annee de gloire” the year of glory. 

IN THE BEGINNING

After qualifying ,from the Colombo Medical School I was assigned to the Galle General hospital in Mahamodera, the hospital by the sea.It was a homecoming. My parents hailed from the south; father from the ancient village of Baddegama ,home to the “Hadidemalakande Vihara”,the temple built by King Dutugemunu with South Indian prisoners of war. Mother whose ancestors were renowned Hela physicians, hailed from Habaraduwa a village south of Galle. 

I was born in the Elpitiya district hospital ,in the Galle district ,during world war two;my mother was sent there as the Japanese were bombing Colombo, and a cousin was the  hospital chief. 

Sunna (Sunil.R.de Silva), a good friend was in the same group which was a relief and he invited me to travel with him in his father’s Renault Dauphine. We were friends in Medical School. He was an old boy of Royal College which had a close affinity with my school, St.Thomas’ Mount Lavinia. We ribbed each other endlessly; to him we were outstation boys and to us he was the Colombo central schoolboy; it was all in fun. He was very witty and although quiet had a good sense of humour and the ridiculous. 

On the appointed day ,we sped along Galle road which ran parallel to the coastline. Sunna drove like a race- car driver, but safely;there was then only a fraction of the present day traffic and we were able to chat and enjoy the unspoiled beaches fringed by tall coconut palms, magnificent bays and sleepy villages. 

We reached our destination, in the mid-afternoon and were given a warm welcome by the incumbent residents, some of whom were leaving the next day.We knew many of them and a senior remarked how happy we looked.We were cheery as at last we had become doctors and could look,the world square in the eye. 

The three cottages which were to accommodate us did not appear enticing, but in our excitement we would have settled for anything. Sunna and I chose to share a room in the middle chalet. Our room bordered the path which led to the nurse’s residence,and we became privy to lovely girls passing by,at all hours. A large Araliya (Frangipani) tree shaded our room,but still allowed the cool sea breezes to flow steadily. There were two beds and two desks in the spacious whitewashed room.I chose the high hospital bed next to a window on the side; Sunna got the low single bed near the front window. The gloomy bathroom adjoining had a concrete tub which stored water from which we could douse ourselves each evening. In the four other rooms there were eight colleagues altogether. The sitting room was Spartan with only a few chairs and a single telephone to summon on call doctors. The nurses had been given explicit instructions not to call after 10 pm , but to send a wardsman with any messages. How they remembered the location of each doctor is still a mystery to me. Fronting our house was a large untended scrubland. Through the middle of it ran a ditch which overflowed in the monsoon season. And over it was a narrow bridge. A small patch of garden beside the front cottage, where we played softball cricket adjoined a metalled road and the hospital screened by a high wall. The dining room where we gathered for meals was in the front cottage. The most senior houseman Vipula A had a single room there. 

There was strict segregation of the sexes, in the living quarters with all the the girls being confined to the third cottage. In the staid old town of Galle , having single males and females living in the one house would have been scandalous. If memory serves me right, there was only one male in this house; being a ‘Senior’ and a Thomian he was considered ‘ safe’ 

About half of our group were girls.I hardly knew any of them,in Medical school but by the end of the year we all were good friends ;Rohini A,Sriyani B, Swarna W, Chitra and Dharmini P and Chandra S; a happy convivial group.The closest was Rohini S,a pretty petite lass with all the fabled charm and sophistication of a Ladies college alumnus. 

The boys were an exceptional bunch too.Many of them Damon Runyonesque characters; Cassa from Dickwella , perpetually chased by marriage brokers dangling fat dowries,MBS forever on romantic escapades, Ranjan gaunt but affectionately called ‘Charles Atlas’. Jupiter constantly chaperoning his consort inviting many risqué comments, our immediate neighbours. Fully and Mudan a pinup boy and the always affable Percy K. 

The house rules had been laid down clearly. We had to share equally the cost of meals and other household expenses. It was the ‘‘Buth master’s’ (food and beverage manager)duty to buy the rations, be in charge of the domestics, and in general be responsible for the menus and the quality of the meals.The tenure was only for a month ,then someone else had to take over..The chore earned more brickbats than bouquets. A witty guy grumbled regularly ‘ mekath kemakda- is this what you call a meal. ’As juniors we had to remain silent.If someone was having more than his share , he would say ‘meke badakda ,lindakda;is this a stomach or a deep water well’. Sunna volunteered to be a ‘Buth master’, later on in the year and by common agreement was one of the best ever. 

WORK

The following day we had an ‘audience’ with the medical superintendent. He was a slightly built dour man, in a two piece white suit and spectacles concealing a squint. We had to listen to a long lecture about the do's and don'ts and finally warned ,” you must wear the long white coat at all times. otherwise, you will be fined”.This was a needless burden in the hot humid wards. The only man who stood up to him was the switchboard operator; in spite of being ordered to respond to calls in English, he persisted in saying “Huwamaru” the Sinhala term for the switchboard; he became an acquaintance and was in fact a very amiable man.

I was assigned to the Obstetrics ward under Dr V.Ganshan’s tutelage. He was a nice enough man, but the most fascinating colleague was Siri or MBS as we called him.An exuberant extrovert he gave me the lowdown of the unit and it’s personnel. It was a good lesson in life. He warned me that a nurse who was helpful to me was actually a gangster’s moll, and to keep off. With a twinkle in his eye, he also said that most nurses were friendly and good-natured and would do your bidding if approached politely and respectfully. We became friends for life. I was best man at his wedding;he married a very elegant junior, Kumi his long-standing heartthrob. 

Vasanthy T the other colleague was reserved but instructed me on the routine of the ward,the theatre and the delivery room. This was invaluable, particularly as she was the chief’s favourite. There were many interesting people who enlivened the atmosphere;one was a female attendant ,’yakada nona-iron lady’ whose phraseology was colourful. When asked to call the doctors she would ask ‘andu case da,thattam case da- is it a forceps case or breech case’. An unforgettable episode was when I had to manage all night ,and on my own a pregnant woman with mitral stenosis(narrowed heart valve due to rheumatic fever which was very prevalent then).She was alternately in heart failure and shock(low blood pressure).She survived due to or in spite of me and delivered a healthy child the next morning. The chief was very happy with my efforts. I still value that experience highly as our therapeutic tools then were very limited. 

Dr Ganeshan was transferred after three months, and there arrived Dr Wilfred Perera one of the most remarkable medical men I have encountered in my practice in four countries in four continents. A brilliant clinician, he was also one of the best surgeons whom I have worked with;this includes the many skilled cardiac surgeons with whom I was associated. Once he performed an urgent hysterectomy (removal of the uterus)in about ten minutes on an eighteen-year-old girl. She was virtually bleeding to death after giving birth to a child. We inserted saline and blood infusions into every available vein and sprinted to the theatre with the trolley on which she lay moribund.What a pleasure it was to meet the plump teenager a month later with the infant clinging onto her breast. He also performed the most complicated of all gynaecological operations, the Wertheim's operation faster than anyone else. I still can picture the dissected pelvic organs displayed as in an anatomy text.

I missed out working with him in the theatre for much of the term, as I sprained my wrist at cricket. This was a lucky break for my new coworker , Chitra Perera who went onto become a distinguished obstetrician and gynaecologist in NewYork.Dr WP also moved out to Colombo and soon was one of the two top practitioners of his speciality. He and Chitra have remained good friends of mine ever since. 

Our first weekend off was a moment we looked forward to eagerly. A couple of extra hours was gained by taking short leave on the Friday afternoon. By good luck Rohini S also had the same weekend off and we decided to travel together.I met her up in the surgical ward where she worked and the charge sister who had observed us walking down the sun dappled corridors had commented what a beautiful couple we were. The railway station was only about a mile away and from there we embarked on an express train to Colombo Fort. Although the train was not crowded , there was no completely empty compartment. We had to share one with a busybody who threw surreptitious glances at us from time to time. I enjoyed the journey as much or even more than the car ride. It was the company and time passed much too quickly..R’s father was at the station to meet us and after dropping them off the chauffeur deposited me at my home.She came to pick me up on the Sunday,but we missed each other.I was visiting a school friend and came home too late.I cursed him profusely and made the return journey by bus, alone. My mother remarked what a nice girl R was.I was surprised as she was usually wary of any and all-female companions of her two precious sons. But R was already spoken for, and I, either a gentleman or a perfect fool ,kept to my side of the fence. 

I wanted badly to do medicine under Dr Anandaraja, who had the reputation of being a good clinician and a teacher, but once again I drew the short straw and was allocated to Surgery. The chief was Piloo R a young surgeon who was filling in for the occupant temporarily away on a scholarship. He was adventurous and tried even complicated surgery with help from his colleague Tony Gabriel. The gossip was that he was planning to emigrate to Australia and wanted to acquire as much experience as he could. 

One new thing I learnt from PR was the management of intermammary cysts. These occurred in young girls with big breasts and there were many in Galle. One attractive patient with this, must have taken a fancy to me as she always sought me in the clinic. When finally admitted for surgery she was constantly complaining of chest pain and finally persuaded the nurses to call me. They being young and well aware of the ploys of girls, made sure I was chaperoned at all times. 

I also learnt many smutty jokes from PR, mainly in the operating theatre. These went over the heads of the nurses, but embarrassed my lady colleague AS.She was a pillar of strength being not only knowledgeable but possessing skilled hands. I remember one occasion she helped me out. We were stitching a large forehead gash and the young man was very restless and posed a danger to us. The local anaesthetic was ineffective. The theatre attendant, who was with us grabbed the gas cylinder and placed a mask over his face. The patient went quiet and we were petrified but completed the job quickly and without further problems.

A, had a good knowledge of astronomy too, and on a moonless night standing close to me on the small bridge spanning the stream in front of our house, named many stars of which I had not the faintest idea. It remains a fragrant memory. She must have sensed a growing fondness on my part; for, by ourselves in the dimly lit sitting room of our cottage she confided “I have a beautiful sister, she is the right person for you”. 

Sunna was on call the Sinhala/Tamil New Year day and was overwhelmed by the number of casualties; this was expected on account of drunkenness and the brawls which followed. We all chipped in , with A taking the lead. 

On the day she was leaving Sunna and I dropped her at the railway station .The previous night we had taken her and a close friend out to dinner in the only good Chinese restaurant in town. As the train drew away, I consoled myself “goodbyes are not forever and are not the end”;but it was with heavy hearts that we returned to the hospital.

PART 2 to follow in a few days -

PLAY

Work was demanding, particularly being on call after a hard days work