That Fateful Day - Dr Suriyakanthie Amarasekera

That Fateful Day - Dr Suriyakanthie Amarasekera

Note from Speedy: Time to move on after a fascinating discussion on Palmistry and Astrology conducted with good humour and respect for divergent views. 

Suri sent me this article with this note. I was very happy to post it. So many of our Batch colleagues have distinguished themselves in so many ways. We are justifiably proud of them.

The article “Recalling that narrow escape” of the Parliament terrorist grenade attack of ’87, published in the Sunday Times of 15th August 2021 prompted me to write my own personal recollection of details of that fateful day…

That Fateful Day

Dr Suriyakanthie Amarasekera

DA.RCP.RCS , FRCA , FSLCA

Rtd. Senior Consultant Anaesthetist SJGH

Past President College of Anaesthesiologists of Sri Lanka

Past President Sri Lanka Medical Association

 

Eighteenth of August 1987 began like any other Tuesday, when I provided  Anaesthesia for a busy surgical list for Dr Yoheswaran in theatre five at the Sri Jayawardanepura General Hospital. We had come to the end of the second case - a vesicolithotomy (removal of a bladder stone) - and just as we walked into the corridor within theatre complex, an announcement was made over the PA system “Dr Yoheswaran  please come to the ETU immediately”. Yoga remarked, “That’s a strange request – I wonder what it’s all about?” I opined perhaps a VIP patient must have come to the ETU to see him. We continued to walk toward the theatre door when the announcement was repeated. Yoga asked “Should I change out of my theatre clothes?” and Dr Kenneth Perera who was there said, “Just go as you are and see what they want.” Yoga walked out of the theatre sliding doors and entered the lift just outside to go to the ground floor. 

Barely minutes after Yoga left, I got an irresistible urge to run down to the ETU. I felt that someone needed me desperately – call this compulsive feeling: Extra Sensory Perception, Thought Transference, or what you like. Being a Christian I believe that it was Divine Direction. I ran out in my theatre scrubs and shoes, without even putting on my white coat or changing my theatre shoes, a thing I would do only when summoned for a Cardiac Arrest. I remember running down the single flight of stairs without waiting to summon the lift, running as fast as I could pushing at least three people bodily out of my way. I had a hazy impression of surprised faces as I rushed past them down the stairs, past the Physiotherapy Department, Corridor, Out Patient Department, and then through the swing doors of the Emergency Treatment Unit. 

I came to a halt near a trolley around which several people were standing apparently frozen into immobility with shock.  I saw a well-built figure in blood-spattered white clothes, lying semi-prone on the left lateral side with his right arm hanging over the side of the trolley. I instinctively reached for the hand and groped for the radial pulse – it was imperceptible. When I looked down at the figure lying so still, taking an occasional gasping breath, and a glazed look in his eyes, to my shock I recognised it was Lalith Athulathmudali. I felt as if I had been hit in my solar plexus. My first thought was that it was my husband Mahendra Amarasekera’s beloved “Sir” (Lalith had been his Lecturer in Jurisprudence in Law College, and he had moved closely with him ever since). 

I said “quick get me a cannula”, and grabbed a green Venflon cannula that was being held by an E.T.U. doctor, and inserted into a vein at the back of the right hand. The circulation was so poor that there was no “flush back” to indicate that I was actually in the vein, but I knew I was in – I couldn’t afford to miss! I connected a normal saline drip to the cannula and opened it fully. I realized that it was not good enough and asked for a “Haemacel” – a blood substitute and started squeezing the plastic bottle with both hands so that the fluid was literally pouring into the vein. When about half the bottle was transfused, I could feel the pulse coming back – thready at first, and then stronger - what a relief! I looked up at Dr Rangith Attapattu who was standing there and said “It’s alright now Sir”. I started another drip on the left arm and sent blood for cross-matching. The blood pressure was only 80mm Hg at first, but soon came up to 90mm Hg. 

Yoga did a quick assessment of the injuries. There were shrapnel wounds on both legs, back of chest and buttocks, and an alarming entry wound just below the left nipple. We were relieved to confirm that it was not a penetrating chest injury on examination. It was also a relief to see clear urine on catheterization, indicating that the kidneys were functioning and not damaged. 

Suddenly Lalith opened his eyes and asked me “What is my pressure? Is it low?” and I replied “It’s a little low Sir but not bad” Then he said “I normally have a low pressure ask my GP she will tell you” When I asked him if he could remember the actual value he said “about 60”. I told him that he must be thinking of his pulse rate and not blood pressure. I asked him if he knows his blood group and he replied “The common one”. A Blood Bank doctor rushed up with a bag of blood. I asked if it had been cross-matched and when she said “no” I said, “please do an emergency cross-match and bring it, I don’t want to take the risk of giving uncross-matched blood, I can hold his pressure till then”. 

Yoga was puzzled by the initial state of collapse. He concluded that it was “neurogenic shock” as there was no evidence of any internal bleeding at this stage… Kenneth came down from the theatre and he gave some Morphine Intravenously. We then started wheeling the trolley out of the ETU Lalith asked “Where are you taking me taking me?”  and I replied “First to the X-Ray department and then to the Intensive Care Unit for observation”. Once the Minster was lifted onto the X-Ray table everybody hastily left the room before the films were taken. I stayed back as I did not want to leave him alone when his condition was far from being stable. I said “I don’t think you can remember me Sir, I’m…” before I could complete the sentence he smiled and said “I know, you are Mahendra’s wife” I was rather surprised as I had only met him twice before the last occasion being two years ago, at Mahendra’s induction as the President of the Rotary Club of Mt Lavinia- at the Mt Lavinia Hotel, when the Minister was the Chief Guest. 

He was rather concerned about an injury to his left thumb, so I got them to take an X-Ray of his left hand as well. It was only later that I learned that the Lalith was left-handed. One pint of blood had been cross-matched by now and brought to the X-ray room, and I started the transfusion. 

We took him to the I.C.U. and Yoga assisted by nurses from the theatre started cleaning and dressing the wounds. Lalith said that his chest was hurting and I assured him that there was no injury to his heart, and that any pain he was feeling was due to a superficial shrapnel wound. He then said, “I feel rather sleepy – can I close my eyes?” I told him that had been given him some Morphine and that’s why he is feeling sleepy. I said “Go ahead and sleep – we will look after you” No grumble or moan escaped his lips though he must have been in pain – particularly when the wounds were being cleaned and dressed. 

We got the X-Ray films and to our horror, we noticed several shrapnel that had obviously penetrated the abdomen. There was one that was near the 1st Lumbar vertebra, dangerously close to the Aorta. The blood pressure, which had been steady between 90–100mmHg, started dropping. Yoga examined Lalith’s abdomen repeatedly. At first, the Minister said had no pain only discomfort, a little later he admitted that he felt pain. Yoga was able to elicit “rebound tenderness” which is evidence of peritoneal irritation. The blood pressure had fallen to 80mm Hg by now. Yoga asked Dr Premarartne another surgeon at SJGH to examine the Minister and give his opinion. He agreed with Yoga’s findings. In spite of differing opinions expressed by others present (wait and see) Yoga made the correct decision to proceed to do a laparotomy. He explained it to Lalith who showed no fear at all. He asked “You have to open me? go ahead” Then he asked “Will you do it under Local or General Anaesthesia?” I explained to him that we have to give him a General Anaesthetic. I said, “It’s better for you to be asleep during the operation Sir”. 

Suddenly his wife Srimani was there. She stayed quietly by Lalith’s side, not getting in the way, outwardly calm, though she must have been so distraught, as indeed we all were. We took Lalith to the Operating Theatre and having lifted him onto the table connected him to the monitors and started inducing anaesthesia. Kenneth injected “Pentothal” through one of the cannulae while I held an oxygen mask over Lalith’s face. As the anaesthetic began to take effect, Lalith slowly drifted off to sleep. I secured his airway and connected him to the anaesthetic ventilator. 

Yoga began the surgery and when he opened the abdomen there was a total of 4000 ml of blood in the peritoneal cavity. Yoga and Premaratne first removed the ruptured spleen that was bleeding briskly. Then they proceeded to look carefully for less obvious but equally life-threatening injuries. There were several perforations of the bowel which were meticulously sutured by Yoga. He found a haematoma near the pancreas, which after much deliberation,  decided to leave alone. Finally the difficult but correct decision to perform a “temporary de-functioning colostomy”. The whole procedure took 4 ½  hours and we had to transfuse 11 pints of blood in all. Though we did have a few anxious moments, Lalith’s condition remained remarkably steady throughout the procedure. Once the surgery was over we took him back to the I.C.U. 

The time was about 4.00 p.m. One by one the others left – but I did not want to leave. I know only too well the problems that could follow major surgery and massive transfusion. I took a blood sample and sent to the lab to check the clotting profile. My fears were justified when I saw the reports. The Haematologist and I got down “Fresh Frozen Plasma” and “Platelet Concentrate” urgently from the Central Blood Bank in Colombo to counteract the effects of the massive transfusion. 

I was still standing by the bed with Srimani when Lalith opened his eyes and asked  “Was it worth it?” and I replied with a heartfelt “Yes Sir”– had we not opened him up, or even delayed the operation, the result would have been disastrous. Then he asked “How are the other injured? Am I the worst injured?” I saw Lalith’s Chief of Security Muthubanda making frantic negative signals,  conveying to us not to say anything about Keerthi Abeywickrama who was killed in the blast. Srimani said “The others are alright, Percy Samaraweera is also here, he also had an operation.” I was touched by Lalith’s concern for others in spite of being mortally wounded himself. He slowly drifted back to sleep again. 

I arranged for a hospital vehicle to bring Yoga back for a night round, and left specific instructions with the SHO Anaesthesia on duty to call me at the slightest change in Laliths’s condition and then drove home. It was pitch dark and pouring with rain. I was rather nervous driving alone and was relieved when Srimani instructed Lalith’s Security to escort me.   

Surgery in progress

   (Dr Yoheswaran in the foreground) 

I got home at about 8.00 p.m. mentally, physically, and emotionally exhausted. I tried to eat but had no appetite, though I had not eaten anything the whole day. I tried to sleep, but sleep evaded me. I stayed awake for hours – my whole being lifted up in earnest prayer for Lalith, asking God to heal him. We had done our utmost, - all that was humanly possible. But healing comes from God. And thank God that my prayers and that of many thousands of others were answered, that fateful day.