MEDICAL SCHOOL MEMORIES= Part Ii

MEDICAL SCHOOL MEMORIES - Part II (Part I appeared on 4^th of June 2021)

Kumar Gunawardane 

THE INTERREGNUM

Anything after the ‘Block’ was likely to be a letdown, an anticlimax. The novelty of Medical School had worn off and we were drained by the first two tumultuous years. The third MBBS was the interregnum between the “Block” and the make or break final year. We felt the need to relax, let our hair down. Still, from the educational aspect, we needed to imbibe vast loads of basic knowledge, before we could be let loose on hapless patients. The principal subjects were Pathology and Pharmacology, but there was in addition, bacteriology, parasitology, forensic medicine and public health.

OUR TEACHERS

Our teachers varied as much in their ages, as well as personalities. The most senior and most formidable was the Professor of Pathology G.H.( path) Cooray. A man of average build, bespectacled and overtly humourless, he  didn’t tolerate any levity or indiscipline. There was usually a pin drop silence in his classes. No one  dared even to  sneeze. For all that he was a superb teacher, whose lectures in general pathology were classics; the  words were precise and well enunciated. Unforgettable was his declamation of the features of inflammation; calor,dolor,rubor and tumour, once heard , never forgotten. Behind his stern facade, he may have been benevolent, as one of his nephews confided  that he liked students ,past and present, to socialise with him at parties  and weddings.

His predecessor, Professor W.A.E.Karunaratne was a legend in his lifetime. 

A world renowned pathologist , he was a charming gentleman of whom it was said that “to have known him was to have loved him”. He visited the department, chauffeur driven, almost every day of the week. A venerable gentleman with long silvery hair, dressed in a three piece suit and a shirt with upturned collar he inspired respect by his very demeanour. For us of greater interest was his secretary, a pretty young girl who was not averse to conversing  with young medicos. One day, a friend and I were chatting her up when the respected don ambled in. She  had no option but to abandon us.

The next term Dr Daphne Attygalle took over the lectures. She appeared stern but was kind and approachable. She succeeded G H Cooray as professor and subsequently was the Dean of the faculty. 

Pharmacology was relevant and interesting and so were the teachers ; the diminutive Professor Kottegoda, a pioneer in medical ethics and a photographer of repute, whose “Flowers of SriLanka” is a classic and the elegant and articulate Dr Lionel, a renowned authority on clinical pharmacology. The lectures were held in the physiology theatre of which we had fond memories. 

The other stand out teachers were the Professor of Forensic medicine , H.V. J Fernando, tall and dapper; he, perhaps to induce more recruits to his discipline, said,  if one is a forensic medicine specialist , one will be socially in demand. Professor of Parasitology A.S.Dissanayake was an eminent scientist and also an affable Don who made a boring subject palatable. 

The magister magistrorum , however, was the Professor of Public Health and the Dean of the Medical School O.E.R.Abhayaratne. He cut an imposing figure with his paunch and a belt straddling the ample waist, but in reality was a kind and fatherly man who had the interests of all students at heart. By a coincidence, his daughter was in our year, and he may have looked upon us slightly more favourably, than we deserved. In spite of his best efforts, we regarded his subject as not being pivotal; but we  did look forward to the field trips to such  exotic destinations,as the psychiatric hospital and a sewerage plant. His able deputy, the sartorially elegant Dr Earl Fonseka had more success, leading the Colombo Philharmonic Orchestra than teaching us statistics. Only much later in our careers did we grasp its importance. 

A story that gained wide circulation then was, that a senior who had obtained the same qualification (MPH),as the Dean at Harvard, had failed his public health at the 3rd MBBS. His excuse was that  in the USA  the issue was obesity, while it was malnutrition in Ceylon. The Dean of course had the distinction of having been awarded the degree Summa cum Laude. 

We were very fortunate to have such accomplished and scholarly teachers; Ceylonese medical graduates were highly regarded in Britain and the Commonwealth and also in the USA. Once at an interview for a Registrar job in a London teaching hospital,I was told that being  a Ceylonese graduate,  I was very acceptable; but the order of preference was Britain ,Australia and New Zealand and then Ceylon. 

WALKING THE WARDS.

‘Real’ medicine began in the third year. We had two month appointments with physicians and surgeons and other miscellaneous consultants. Our first stint was with Dr D.J.Attygalle. A tall well groomed man of few words but poised and dignified, he would teach for about ten minutes after he had completed the morning rounds with his juniors. I can still remember one of his pearls;rheumatic fever “licks the joints and bites the heart”. Tragically this was true for many youngsters who died prematurely from rheumatic valvular heart disease, which was so prevalent, and for which surgical treatment was  not available then. Prior to the class we would occupy ourselves seeing patients allotted to us by the house officers. They were friendly and free with us. 

The next spell was with Dr Oliver Medonza. It intrigues me now, the consultants wearing jackets and ties in the stifling heat of Colombo. No ward was air conditioned and the huge complex of the general hospital was walled in with no big open gardens or cooling breezes. The house officers wore ties and spotless white long shirts  with rolled  up sleeves  and white  trousers. The European nursing nuns who had a reputation for dedicated care of even  the poorest patients had left by 1963 and the wards were staffed by local nurses and attendants. The nurses were well trained and efficient, but always in the background, not militant and stood  in awe of the doctors. Their starched uniforms with caps would have been uncomfortable but gave them an air of authority. Colombo not being so congested then ,the weather was perhaps milder. Dr Medonza was quite exuberant and had an interesting turn of phrase. When referring to a reflex breathing pattern , he called the lung receptors the Hering-Breuer chaps. 

An unpleasant incident,which is best forgotten but remains indelible, occurred during the early part of the term.  A left  wing member of parliament and trade union leader, Robert G  visited a patient during rounds; an enraged OM ordered him out, perhaps unreasonably,and this infuriated the rambunctious politician.  The saving grace was the dignity and decorum of his wife who remained tranquil. The timely arrival of a senior  administrator too saved the day. There may have been political overtones as OM’s father-in law had a large estate in the electorate of Robert G’s  famous brother Philip G, the “Boralugoda Lion). They were in opposite camps. We were stoutly behind our chief, but I did have a sneaking sympathy for the politician. 

At the end of the term he invited us all for dinner at his palatial home. His statuesque wife joined us for a while but the pretty daughter stayed with us all the way through. The dinner was delicious and whisky  which was a luxury for us flowed freely; the conversation was uninhibited, as was the host. 

Surgical terms followed. The first was with Dr Drogo Austin, a colourful and fearsome personality with a penchant for decorum and propriety. It was said that he once flung out a student , dragging him by his collar; the boy had boarded the lift bypassing Dr Austin and his team. The rounds were decorous, with a strict order of precedence; the chief,the juniors and then the nursing staff. He was renowned for his wildlife expeditions, and photography following the footsteps of a mentor Dr R.L.Spittel. Characteristically he was very caring of his junior staff. On his ‘take’ day we had to clerk and observe patients over the full twenty four hours. A head injury patient escaped our attention, and the following day had a unilateral fixed dilated pupil, an ominous sign. The neurosurgeon, called in, was furious and threatened dire consequences for the intern. DA however reassured him; “don’t worry,I will take care of him, he was my intern too”. The intern later became a well known surgeon. Later on in the year, I lost my Appointment book,which had  the signatures of the consultants, with whom I had worked.I approached DA with much trepidation, but he signed without any questions. 

The next term was with the fabled Dr P.R.Anthonis, a brilliant surgeon and clinician. Not only was it an education in surgery but also of life. A master of public relations  he was courteous to all including the ‘floor’ patients; before reaching each of them, he would ask for the name from the accompanying attendant. The patients were thrilled that ‘Loku Mahaththaya’- the chief, had addressed them by name. It was the same in the clinics. The students were kept amused with a fund of stories while the patients were dealt with courteously and efficaciously. In UK, he said, he attended the operating sessions of one surgeon, primarily to learn what not to do.   Dr Anthonis was generous to him too,  adding that he was a good teacher but never the same after his son died in a train accident. His humour could border on the salacious.One of our colleagues when asked to do a back passage examination, said “sir I haven’t done this before”. The prompt retort was “ I shay if your father had told that to your mother ,you wouldn’t be here today” 

We looked forward to his Thursday afternoon operating sessions; the students ,acting as assistants marvelled  at his skills and were later  regaled to cakes and canapés and stories in the surgeon’s tea room. 

Paediatrics was a delight. The chief C.C.De Silva was the personification of a Professor. Tall,handsome, silver haired and well spoken, he was the pioneering Paediatrician, who had given up a thriving private practice, to become an academic. An expert on malnutrition and blood diseases, the department achieved worldwide recognition. He was a good clinician too, who loved his little patients. They included emaciated waifs who were  sometimes picked up lovingly as he would his own grandchildren. In turn he was loved by all; children, staff, colleagues and students. The rounds were not only educational but entertaining interspersed with music and laughter. Two Australian exchange students with us were requested to sing Waltzing Matilda, which they did with aplomb. We had to sing popular Sinhala songs in exchange. Much to our regret he retired at the end of our fourth year and was succeeded by one of his protégés Dr Priyani Soysa. Many years later his daughter Ilica, a well-known journalist, interviewed Kanthi and me for a feature article about us. She was elated when I mentioned my recollections of her father. To her he was not only ‘her father but idol, mentor and guide’; the article  on us was adulatory. 

CLINICAL LECTURES

These commenced in the fourth year. The most entertaining was Milroy Paul, Professor of Surgery. He was an excellent speaker and raconteur and had a good sense of humour. Once he had operated on a boy with an umbilical  hernia ,and the mother had complained “ sir me lamayata  den buriyak ne-sir this boy doesn’t have a belly button now”. This brought the house down,with waves of laughter rebounding  for about five minutes. At the end of the day however, our total knowledge of surgery had increased only marginally. This was in contrast to Professor Navaratne who succeeded him. A  dour man with a monotonous voice, the lectures bored us stiff , but were loaded with the essentials.  An enterprising student copied his lectures verbatim and made a killing from their sale. They were cyclostyled, the pinnacle of our in-house print technology then. His ward classes were edifying too. These prepared us adequately for the final examination which was a bloodbath. In his first year at the helm. “Nava” was gentle and kind even to the undeserving. He went out of his way to request a consultant to readmit an expelled student. The boy was asked to be the ‘control subject’ and expose his abdomen at a ward class. He refused. Nava fell for the cooked up story, that the reason for refusal was a torn vest. 

Medicine lectures commenced with Professor Rajasooriya. They were excellent factually but laced with his noxious wit. The barbs were aimed at his perceived opponents in the faculty. Particularly embarrassing to us were the darts directed at the Dean whose daughter was in our year. Both she and her father were popular and we all squirmed in discomfort. Later on he was joined by Dr Oliver Peiris,a consummate teacher; he commenced  his lectures on Kidney diseases ,by announcing up front that they were a summary of a standard text. One of a new breed of educators, he migrated to New Zealand after only a few years in the job. He liked to mingle with his pupils ,and was a regular in the canteen for a mid-morning cup of tea. Occasionally he brought in a visiting luminary to talk to us. These, even if  Srilankan appeared alien to us. One such was Dr Tony Don Michael, a flamboyant cardiologist, inventor and educator. The motive may have been to stimulate us to aim for the stars.

The obstetrics and gynaecology lectures may have started in the fifth year. They were boring , particularly as the Professor was didactic and may have wanted us to learn by rote. He himself when a student, had read his notes three times over before alighting from the train. As the  underground trains were quick, frequent and regular, for the journey to be so long drawn out, he would have lived in the periphery of London. 

PERADENIYA INFLUX

In our fourth year a bevy of beauties descended on us from the Peradeniya faculty. We were not complaining. They were charming and added glamour to our year. There could never be a surfeit of pizzazz for the young bucks. S was particularly charming, and for me enchanting; but we were like ‘ships that pass in the night and speak to each other in passing’.  In Henry Longfellow’s deathless words  

 “So on the ocean of life,

  we pass and speak one another,

  only a look and a voice,

  then darkness again and a silence” 

The eulogy for her, I wrote with a heavy heart, one of my saddest compositions.

“I was deeply saddened by the passing away of another of our valued colleagues. To those who didn’t know her well , she was a glamorous but distant figure. But her intimates knew her to be kind, gracious, unassuming and affable, capable of inspiring lifelong friendships. As Rohini Ana  and Srianee have affirmed, she was an amazing human being who bore the ‘slings and arrows of outrageous fortune’ with fortitude and equanimity. 

We first met in our late teens at a lively party at her cousin Romesh N’s home. He, I  and other Thomian classmates were members of an esoteric group the Saint’s Club.The  name was inspired by Leslie Charteris’s  Saint series. LC’s brother Rev Bowyer Yin was the school chaplain. Regular invitees included sisters, cousins and girlfriends of members. Sue stood out even amongst that bevy of beauties. I got to know her well , while we were doing the professorial gynaecology term. In  that dimly lit, forbidding ward she was a ray of sunshine. Male and female students were paired to appraise bemused patients. She was my colleague and a superb mentor, to the callow and diffident youth I was. She would introduce ourselves to the sometimes fearful patients, gently elicit a history and lead the examination. A treasured memory. Sadly I did not foster the bond after that appointment. We last met at the 1992 reunion in London. Twenty five years on she was as lovely as ever. She was accompanied by her two daughters. To  them I offer my profound and deepest sympathies. Your mother was a great lady. “A good heart has stopped beating; a good soul has ascended to heaven”

May she Rest In Peace. “May the Good Earth lie softly on her” 

There was a sprinkling of boys too from Peradeniya; none more outstanding than Cyri Ernest. Sportsman extraordinaire,  and a perfect gentleman. We became lifelong friends later on. 

BLOEMFONTEIN

In the fourth year I joined the men’s medical hostel ,the Bloemfontein; a squat building painted in garish red and blue within  walking distance of the hospital and medical school. The prolonged travel from home after a long day’s study and clinical work was telling on me. My father concurred, but mother was unhappy to let me go, as her other son was away too; he, an engineer, was in distant outposts at work and came back only infrequently at weekends. 

It was a fateful decision. While my social horizons widened and amusement expanded,   learning declined to a certain extent. Bloem was notorious for its rags and heckling of the girls who passed by. It had been subdued, somewhat by disciplinary action, following a serious clash with some newcomers from another hostel. Bala, my roommate, was a senior  and was able to protect me from the worst; as did another senior Sivarajasingham who safeguarded me and also Bora later on. I did see a fresher ,who was made to  worship the abode ,and being anointed with a bucket of water from upstairs. 

After the rag we all became friends and acquaintances. I was amazed at the numerous seniors who were total strangers to me. They were the ‘chronics’, or “ Chroniyas a la Bora”with whom I built a rapport; they who had started with so much hope,and were now lagging behind their comrades, some by a few years. Many of them blossomed in later years to become successful and respected physicians. Bora adds, the mother of all ‘chroniyas’ had never stepped into the library in his long  medical school career. On the day he qualified ,his friends had dragged him there and had a party to end all parties. The Dean had been furious, but nothing came of it. Three of the ‘chroniyas’ later practiced in a small town in New Zealand and were well respected family physicians.  After a few years they moved to Britain. The local newspaper banner headline was “Brain Drain to the UK”.  A Kiwi Prime Minister ‘Piggy’  Muldoon, famously said New Zealanders emigrating to Australia ,improved the IQ of both countries. 

They were never or rarely seen in the common room or at lectures; but  were good companions outside. Our rooms on the second floor were small but functional. There were two bunk beds( me on the upper), two desks with desk lamps and a wardrobe partitioned in half.  A small balcony overlooked the old house where we had meals, and the surrounding unkempt garden. The washrooms and the showers occupied the midsection of the floor. The extra time gained, by not travelling, regretfully, was not spent on studying. Late night films at the nearby Empire cinema, long chats at meals, and  in the downstairs lounge, and the occasional ‘booze’ were the diversions and life experiences. These also are the lingering avid memories and not poring over books burning the midnight oil. The meals were reasonable, but the quality varied according to the “Buth master’s- food and beverage manager’s” managerial skills. One, Dinil W,  a senior, was exceptional and the quality of our meals improved hugely. I looked forward to the infrequent weekend at home. Mother would prepare the delicacies I liked, and also give homemade sweets to take away. Her specialty was milk toffee which was a favourite of  my father as well. When they were courting, he had scoffed a plateful in one sitting.He may have passed the gene to me.

We rarely associated with domestics who made our lives comfortable, but were inconspicuous except at mealtimes; the exception was one young man, with a pleasing manner and good looks who  interacted with us and was very obliging with errands and minor chores. Their lives and ours were unhappily far apart; we were content in our world and imagined they were in theirs. Consumed with our studies and other activities, we did not delve into their lives. I look back with regret at our lack of social conscience at that time. In contrast I’m proud of what my parents did to help our domestics and villagers; mother would feed little boys,who in turn performed some odd jobs for her; thus they did not feel that it was charity. She would spend time talking with vendors who went away happy not only for the sales, but also for uplifting their self esteem. 

Our hedonistic mates were not entirely devoid of spiritual ideals. On Wesak day the Buddhists hung gaily coloured lanterns and lit clay oil  lamps; these were placed in the crevices of the concrete lattice framework in front of the building.The effect was breathtaking. We did also go to the nearest temple for religious observances.The Hindus celebrated Diwali and the Christians  tagged along with the SCM (students Christian movement) , singing Christmas carols at the houses of consultants; they were entertained lavishly. 

WEEKEND  ESCAPADE

Youth is impetuous and insouciant, living, perhaps  only for the day. We had no concerns about our basic needs,well taken care of by adults. The past was distant ,the future an enigma, only the present seemed to matter. One Saturday morning, on the spur of the moment ,Bala,Bora and I decided to set out to Chilaw , fifty miles away. We were to spend the night with Bala’s friend. We had ten rupees amongst the three of us. Hitchhiking, which was safe then, was to be the mode of transport ; Bora was given the role of thumbing lifts. He had a lucky first strike. An eminent Civil Servant driving to his coconut estate obliged. That we  were clean and well dressed ,may have helped. Bora sat in front as he was the best conversationalist. We told him that we were his son’s ‘classmates’; Bora with wide angle vision spotted the arrack bottles on the floor.“But I haven’t seen you at his parties. Sir ours is a big group of one hundred and and fifty in all.” “What do you do in your leisure time. We drink and party. OK, open a bottle and have a swig. Can you sing. Not very well sir”. 

On the way he stopped at a Toddy tavern. We were offered the best seats on a sprawling bench, and the sweet fresh liquid just off the tree. Still it was a heady mixture for us. The chief was unaffected, chatted affably and dropped us at our destination before noon. Unfortunately ,Bala’s  friend had left town and we tramped to the house of the friend’s friend. Bora was sick in the garden; Bala and I ,weary and intoxicated, fell onto a bed. The slumber was short lived as the friend’s friend too hopped in. We jumped out and with Bora made our way to another friend, Dr Jeyaratnam, a family physician, the elder brother of one of our mates. He was a perfect host and we had an enjoyable and untroubled stay. 

Next day after a hearty breakfast we were on the road again. We hitch hiked to Kandana, about ten miles away from Colombo. Hunger pangs were beginning to surface,when we spotted the rooms of a family physician, Dr Waas. He welcomed us warmly, when we introduced ourselves as medical students and directed us to his beautiful house next door. Happily he was a cousin of our Professor of Anatomy. We were given a free run in his ensuite to freshen ourselves. Bora and I just made ourselves presentable but Bala shaved and showered. As is usual in Catholic homes in these parts, Sunday lunch was sumptuous and our hosts were very gracious. The next leg of the trip was by bus and the ten rupees was finally spent. 

In spite of distractions, I did manage to successfully negotiate all subjects at the examination, except forensic medicine. The downside was the partial loss of time and resources for the final year, in repeating the referred subject.