Friday, August 12, 2022

Personal memories of Dr N.A.J Niles- N.D.Amarasekera

My personal memories of Dr N.A.J Niles, Consultant General Surgeon at the National Hospital in Colombo, 1958-73

By Dr Nihal D Amerasekera 

Dr N.A.J Niles was born in Manipay in 1913. His father was a District Judge. After his early education at Jaffna Central College, he moved to Wesley College (1928-32). There he had an outstanding career, winning several prestigious awards. After being successful in the Cambridge Senior examination, he proceeded to the Ceylon Medical College.

He came from a staunch Wesleyan Methodist background. His religion meant a lot to him, and it made a deep impression on his life. This also shaped the way he approached his medical career. He considered his skills as a God-given gift and used it in the service of humanity. 

Remarkably diligent, Dr Niles had an illustrious passage through Medical College. He won the Rockwood Gold Medal for Surgery at the final examination. In 1936 he qualified as a doctor aged 23. He proceeded to England in 1940 and was soon successful in the FRCS (Eng) examination. On his return to Ceylon, he served as a surgeon with great distinction, working in several hospitals in the ‘out station’. Dr Niles was appointed surgeon to the General Hospital Colombo in 1958. 

I first saw Dr Niles when he drove his posh Humber Hawk into the school drive bringing his sons to Wesley College. His elder son, Wesley Niles was in my class in the 6th form. 

Dr Niles worked as a general surgeon. Among his contemporaries were Dr Noel Bartholomeusz, Dr L.D.C Austin, Dr Clifford Misso and Dr P.R Anthonis. He was hugely popular and deeply respected by his consultant colleagues in the General Hospital Colombo. His photo hangs proudly in the Consultants’ Lounge at the National Hospital as a thank you for his dedication and service to the hospital and his patients. 

Tall, suave, sartorially elegant and articulate, he could have been a matinee idol.  Dr Niles’ photo brings him back to life with a flood of memories. I met him in 1964 when I started my clinical work as a medical student. He taught me Surgery until I qualified in 1967. This was a time when the Surgeons and Physicians in hospital benefitted enormously from private practice. Dr Niles was one of the few consultants at the time who never went out of his way to enhance his private income. Hence, he was never party to the competitive bitterness that existed in the realm of private medicine. Not chasing after money made him a minimalist, proceeding to surgery only when all other less invasive treatments have failed. He was a fine dedicated surgeon who gave his all to his patients whether they were fee-paying or not. His surgical skills were exemplary. He worked tirelessly and with great empathy for the benefit of his patients. He had a brilliant mind, but his erudition was lightly worn. 

Although he might appear tough at first meeting, this was misleading. With his fine ability to teach and educate, Dr Niles took on his duties as a tutor seriously. He trained and educated us in the basics of surgical diagnosis and treatment in a way we could remember. He explained, simplified and clarified. We recorded in our notebooks his insightful nuggets of wisdom. He taught the students in a rather avuncular manner that reflected his personality. I vividly recall his unstoppable flow of conversation. His talks during ward rounds were amusing and educational. In the harsh environment of medical education of the era, he showed us tremendous kindness and sympathy. This is not an attempt to deify Dr Niles. Very occasionally, his fits of fiery vexations would shatter the serenity of the ward. And in the blink of an eye, it was all over. His kindness always shone through. 

I remember working in his ward as a student. He was a natural storyteller with a wonderful talent for mimicry. He mimed the pain of a gastric ulcer by holding his abdomen, squirming and rotating his body. For the colicky pain of kidney stones, he writhed and wriggled his torso to one side. These amazing gifts he possessed added colour and lightened the endless burden of hard work in the ward. Dr Niles was a born entertainer. His teaching ward rounds were delightful theatre. They were witty and spiked with surgical humour. He had a multitude of funny stories about his experiences with patients. A student asked Dr Niles if he would operate on a very sick man. He rolled up his eyes into the heavens and said “this patient wouldn’t be fit for a haircut”. One of his female patients had a long and difficult gall bladder surgery.  He spoke to the woman several days later saying “ Oh Gosh!! It was like going down a deep cavern to reach your gall bladder. I really needed ladder”. She simply whispered her thanks. Once on a ward round, a patient told him he passes ‘piti’ or flour-like stuff in his urine. The patient in the next bed told him he passes sugar in his urine. Dr Niles told them both, you pass flour, and this guy passes sugar why don’t you both join up and start a bakery! These amusing and priceless stories have entered the folklore of the Colombo Medical Faculty. Dr Niles had the unique ability to see the funny side of day-to-day life.  There is a vast repertoire of Dr Niles’ anecdotes which are recounted by those who have been with him. We all adored and cherished his eccentricities, and there were many. He was a legend in his own lifetime. 

As a student, I count myself fortunate to have had Dr Niles as a clinical tutor. He inspired us all by his intellect, competence and courtesy. He provided a tremendous service to his patients. He enlightened and entertained us. His students judged his teaching as superb, while his juniors, assistants and successors attributed to him all the best qualities of a skilful surgeon. He radiated charisma, influence and inspiration. Many will fondly remember his many charming ways, immense kindness as a surgeon and his excellence as a clinical teacher. 

Dr Niles retired in 1973 after 35 years of dedication to the Health Service, leaving a stream of emotions and many happy memories. He never amassed great wealth and lived a frugal life but was forever happy and content. In retirement, he maintained his sense of humour, seeing the funny side of life. Dr Niles remained a warm and friendly person as always until the very end.  He passed away in 1978 age 64, far too young to leave this wonderful world. May his Soul Rest in Peace.

18 comments:

  1. Thank you, Nihal for that warm and well deserved tribute. Sadly, I was never taught by him as he was away for some reason when out group was attached ti him. I had heard a lot about him and was looking forward to what was not to be.
    Again, my admiration to you for the beautiful prose you used for this eulogy.

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  2. Mahen
    Thank you for the kind comment. Dr Niles was a fine teacher as has been said and a wonderful surgeon. I think some of us medical students at the time, including myself, didnt quite understand his mindset and ethos believing he was rather lazy and unwilling to operate. He was a good man largely misunderstood. I hope he will receive his just rewards in the way of plaudits and praise for his work.

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  3. Nihal
    What an excellent tribute to Dr.Niles. You are a great writer. You should write books. My cousin who is a Doctor ( older than us ) is still writing books. Why don't you ? Better late than never.
    Shall I suggest something? Why dont you write a book about our teachers with your excellent portraits? I am telling you seriously. It would be a best seller ! All the best.
    I never had the oportunity to work with Dr. Niles as a student nor during internship. I did my internship at the General Hospital Colombo with Dr. Clifford Misso. Swyrie and Zita worked with me.
    One night I had a call from ward 1 saying a man was hanging from the roof. I got the shock of my life and went rushing from quarters above the Radiology block. He has had a Prostatectomy done and commited suicide. It was a terrible experience which I will never forget.
    Chira

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    1. Your experience of the man hanging from the roof must have been awful! I too had my sig with Dr Misso, a gentleman to the core.

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  4. Chira
    Thank you for the lovely words of encouragement to write. I have written an autobiography for my grandchildren, a very personal one for them to know about my relatives and ancestors in Sri Lanka and also about my childhood in a beautiful tropical paradise. This is a very personal and private account only for my family and not on sale.
    I write for fun and enjoy it. Writing a book is a lot of hard work. All what I have written including the portraits of those great teachers in the faculty are on our blog for everyone to read. Much about my schooldays and the teachers and friends are in my school website called Double Blue International which I maintain and edit. This keeps me busy.
    Thanks Chira for your immense contributions to the blog to keep it alive and for the encouragement to the other contributors and to Mahen.
    Take care and stay safe

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  5. Hi Nihal, I enjoyed your account of the one and only Dr Niles. I do agree with you that he was a teacher par excellence!

    I clearly remember how he taught us the danger of probing a wound on the abdominal wall.
    He enacted a Court Room scene where a young doctor was called to give evidence. The smart Defence lawyer keeps questioning the doc and asks " did you orive the wound

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    1. What I like about your comments Suri is that you are always totally honest. You never hesitate to give praise where praise is due but will also indicate weaknesses as you perceive them. Well done! Makes your comments impartial and honest.

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  6. Sorry my finger slipped ....
    " did you probe the would doctor ? "
    The young doctor says " yes I did, I wanted to check the depth of the injury "

    At which point the lawyer turns to the judge and a
    says
    " Your Honour I wish to submit that my client is innocent of murder. The wound he inflicted was not a penetrating wound. This doctor however turned it to a penetrating wound by his probing and caused the death of the victim ! "

    At this point they release the accused and the doctor is charged with murder and put in the box for the accused! Dr Niles took the part if each character and had us convulsed with laughter, but also left us with an unforgettable lesson !

    But I do not agree with you about his surgical skills. I have had the chance to anaesthetise for him many times during my 4 1)2 years at GHC from the middle of 1968 to 1972, first as a trainee working with a Consultant for 6 months and the on my own.
    While I found him pleasant to work with , with his endless supply of anecdotes , he simply did not match Antho , Batho ,Austin and Misso the Surgical giants of that time for who again I had the privilege of providing
    anaesthetic services

    I also recall that Dr Niles was one if the examiners for my Anatomy Viva for the 2nd MBBS. He asked me to na! me the lesions in Fallott's Tetralogy! By God's grace I was able to recall them accurately .
    May he Rest in Peace.

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    1. Suri, I heard the same about his surgical skills- how the SHOs got patients listed for operation to sign against medical advice and discharge themselves to be spared the "Niles (k)Nife"!

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  7. Dear Suri
    It is lovely to see you on the blog as always. Pardon my delayed response. The weekend I was on family business far away from home.
    As you are an anaesthetist I must be guided by your considered opinion on Dr Nile’s surgical skills. At least we can give him his due as a fine teacher.
    Thank you so much for your amusing anecdote. I can just picture Dr Niles enacting the court room scene with facial expressions and imitating the voices.
    If you can recall any further stories do jog our memories as there were so many swirling the ether of the faculty of medicine of the 1960’s. Thank you Suri for the comment

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  8. FROM BORA
    Hi Nihal
    I enjoyed the article about Dr Niles very much. Apologies for the late response - just returned from Canada. Dr Niles was an interesting character and I have heard numerous amusing anecdotes from our batchmates.
    Immaculately dressed, Dr Niles was approaching the ward followed by his entourage when he spotted a person squatting (anna gahagena) on the well maintained lawn adjacent to the ward. Nilo pointed his finger towards this man and very confidently announced to his golayas, “Look! That is the typical posture of a man with piles.”
    He ordered B.L. Perera to go and ask the man the leading question. When BL started the history taking the irritated man stopped him immediately and replied, “There is nothing wrong with my bottom. I have come to take Simon Aiyah home after he has been discharged.”
    I was very impressed with Suri’s honest opinion and the spirit in which Nihal responded. I understand that Dr Niles was a very capable surgeon when he started. During the years he spent as V. S OPD at the General Hospital he may have lost some of his skills for major procedures.

    Kind regards,Bora

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    1. Bora
      Thank you for your kind comment. There were a plethora of Niles memorabilia floating in the ether when we were students but much of it has now disappeared from memory. If you can recollect please write them down for posterity.

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  9. Hi Nihal

    I hope that you find this anecdote amusing. A 50 year old man presented with a bizarre history of episodes of chest pain which radiated like a current to the abdomen and then to the left groin. The current then spread down the thigh to the knee cap. Dr Niles very patiently listened to this story. Then told the patient the next time this happens, take an electric bulb and when the current reaches the knee, place the bulb on your knee cap. The bulb will then light up and you will be relieved of pain.


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    1. Bora
      That is excellent and has all the characteristics of a Niles joke. I can still imagine his hand and body movements and facial expressions while saying these.

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    2. Bora I like your other story about cutting the neck and "Marenna puluwang"

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  10. He refused to operate on a chap with duodenal ulcer. When we asked why he said after the surgery against all medical advice he will go to the nearest thosai boutique and have the hottest chillie curry in the world and come running back to the OPD with a recurrent ulcer. He even enacted the guy running squirming and rubbing his stomach. It was simply hilarious.

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  11. Consent for a thyroidectomy; Bella kappanna thiyenewa,lay hugack nathiwaywi,marennath puluwang.Kamathithe.
    Consent for partial gastrectomy; Badda kappanna wennewa,itta passe bath kanna ba.

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