The Stethoscope and those memories of a lifetime By Dr Nihal D Amerasekera

The Stethoscope and those memories of a lifetime

By Dr Nihal D Amerasekera

“If you cry because the sun has gone out of your life, your tears will prevent you from seeing the stars.”― Rabindranath Tagore

My early childhood was spent in Nugegoda. I stayed with my grandparents smothered with love and affection. My father was helping to grease the wheels of the government far away from the Metropolis. My grandpa was an apothecary caring for the sick and the suffering. He was often seen leaving the house with his stethoscope. Whenever I fell ill he used this instrument to listen to my chest. I was simply fascinated and intrigued by this device with its brown tubes and black bell. These are my earliest recollections of an awesome instrument that changed the way doctors diagnosed heart and lung disease.

Laennec painted by ND

The stethoscope has become a talisman and so much of a part of every doctor. The word stethoscope comes from the Greek words stethos, meaning chest, and skopein, meaning to explore. The amazing story of the invention of this astounding instrument is steeped in history. 

In the autumn of 1816, Dr. Rene Theophile Hyacinthe Laënnec, a French Physician was walking in the courtyard of the Le Louvre Palace in Paris. He observed two children playing. Each one had a piece of wood placed on the ear. The pieces of wood were connected by a taut string. The taps from one piece of wood reached the other piece. In those early days the heart sounds and beathing was heard by the doctor placing the ear on the patient’s chest. Once when a young lady came to Dr Laënnec for treatment, he was bashful and felt uneasy to place his ear on her chest. He made a tube with a sheet of paper and placed one end on the chest to listen. This wasn’t perfect but caused less embarrassment to the patient and the doctor. He remembered the acoustic phenomenon used by the 2 boys. 

Laënnec spent several years trying to perfect an instrument and decided on a hollow wooden tube that amplified the sounds. This became the forerunner to the modern stethoscope. Doctors used wooden tubes as stethoscopes until the latter half of the 19^th century. It took many more years to develop the modern bell and diaphragm type of stethoscope. In 1861 an Irish physician named Arthur Leared created a binaural model with two earpieces on the ends of stiff metal tubes. In 1862, George P. Camman of New York perfected the design using flexible tubes with smaller ear connections. 

This binaural stethoscope was commercially produced. In appearance, his instrument is similar to the ones used today.

After I entered the faculty of Medicine in Colombo, I learnt the inherent magic of this device and how to use it as a diagnostic tool. No other symbol so strongly identifies a doctor than a stethoscope. In Sri Lanka the device became an icon of intellect and skill. Hence, doctors enjoyed great esteem from the public. Some of this adulation filtered down to medical students. Even as a student I took great pride in displaying my stethoscope prominently. I had it round my neck on my long walks in the hospital wards and corridors. This self-assured hubris among medics have now waned. The stethoscope is ubiquitously used in hospitals and surgeries by many different healthcare workers.

After I ended my professional life, there is always an irresistible desire to return to my roots. As a Diagnostic Radiologist, I never used a stethoscope. Now, when I see a stethoscope, it takes me back many decades to the time I spent with my grandparents. It is now a symbol of my childhood more than my profession. This transports me back to Nugegoda and those happy years.  

My grandparents

Nugegoda then was a sleepy little town that prided itself on its peaceful ambience. People were charming, friendly and helpful. They were religious and converged on the temple and the church for refuge and direction. The landscape was green and its beauty touched us with grace. The mornings were magical as the dew on the grass shone brightly. The shady streets were lined with tall flamboyant trees. The town was a paradise for birds. There were vast stretches of uncultivated green land through which ran a few narrow dusty gravel roads. There were hardly any cars. Heavy commerce and trade hadn’t arrived here yet. There was no large industry in and around Nugegoda and jobs were scarce.

As darkness descended hundreds of bats took over the skies. I still recall how quiet and dark the nights were. We heard the eerie croaking of frogs and the din of crickets. The fireflies always remind me of Nugegoda of the 1950’s. It was only the rumblings of the Kelani Valley trains that punctuated the silence. There was no respite from the mosquitoes that tormented us every night.

My grandpa was a softly spoken, quiet, noble man from Kandy. From the time I can remember he had grey hair. He took life easy but worked diligently. The locals knew he was a medical man and came to him at all hours for help. He was much more, a philosopher, an expert in country lore, an amateur astrologer and an old character of a type that was endangered and nearly extinct. He was not interested in money except the bare minimum to sustain his family. The people respected him enormously and he relished the adulation.

My grandma was a qualified nurse in the Mold of Florence Nightingale. She was kind and caring and grew up in Ibbagamuwa near Kurunegala. Grandma was a sprightly, intelligent woman with lots of courage and foresight. She helped to drive the family forward through uncertain times.

Time passed swiftly and relentlessly. The ravages of time affected my grandparents. In the autumn of their lives, they had the respect and love of the extended family. As their eyesight and hearing gradually failed, they were mostly confined to home. Whenever I visited them, I saw their decline. They had a huge repertoire of old family stories and amusing anecdotes which they shared on our visits. Grandma kept touching mementoes of our family, like photographs and paper cuttings, which she cherished immensely. To her every photo spoke volumes.

Their end came peacefully. Grandpa passed away aged 89. I was then in London and felt the loss deeply. After his death, for grandma life became an ordeal. She led a quiet life and remained fit but frail. I have often seen her sitting alone wrapped in her own thoughts. Memories of the past stared at her from every room, as did photographs and family occasions. The great void in her life could never be filled. Grandma passed away at the age of 86 years. They both served their communities with pride and worked for the Health Service with dedication and devotion. I will always remember grandma’s diligence, energy and enthusiasm and grandpa’s calm, reflective kindness. To me it was an end of an era.

More than seven decades have passed since I first set foot on Nugegoda. During the past 50 years I have lived in the UK and visited Sri Lanka occasionally. On a visit to Nugegoda in 2012, the changes that greeted me were astonishing. Our former house didn’t survive the wrath of the bulldozers. It was demolished and became a car park. The town is now bustling and busy. Prosperity has come to the town with better shops, fine supermarkets, wider roads, modern communications and good transport. Bristling billboards and signposts line the roads. Many of the old houses have been pulled down. The few that remained look like relics from a lost civilisation. The nouveau riche preferred to live in large, detached houses, behind high walls and security gates.

Urbanisation of a town is inevitable but seemingly it has taken place randomly. Nugegoda has experienced a devastatingly rapid, unsympathetic expansion. The industrial and residential areas are mixed with office space. There is no designated green belt to preserve as an area for peace and relaxation. The result is a cauldron of light, noise and environmental pollution, a serious health hazard. This is what remains of the once austere, puritanical Nugegoda of the fifties. Its past elegance lay buried under layers of asphalt and concrete.

I have rambled on and revived ancient and half-forgotten memories of a town with its own personality, heart and soul. Although the magic of the old Nugegoda still haunts me, the loveliness and enchantment of that peaceful town I knew is now a distant memory. Within the time frame of a single generation, it has changed beyond recognition. It hurts when I think about its former glory and the people who made it so special.

I have painted a portrait to honour and respect Dr. Rene Theophile Hyacinthe Laënnec for his brilliant and important invention. The Stethoscope transformed healthcare. But I dedicate this narrative to the memory of my grandparents. They both gave me life and hope. It is only now I realise the depth of their influence on my life. Their love, warmth and encouragement will never be forgotten.

The iconic “Old Anatomy Block” By Dr Nihal D Amerasekera

The iconic “Old Anatomy Block” - the end is nigh!!

By Dr Nihal D Amerasekera 

In the words of the Greek Physician Hippocrates:

"Ars longa vita brevis" (learning the craft takes time and life is short).

How very true!! 

For readers who are unaware of the old Anatomy Block it is the large and impressive grey colonial building in Francis Place.  It lies behind the main premises of the Faculty of Medicine Colombo at Kynsey Road. This majestic building with tall gothic columns and ornate carvings stands as a sentinel paying homage to Dr Albert J Chalmers, the Registrar of the Ceylon Medical College from 1901-12. He helped to design and construct this fine edifice. The Anatomy Block was opened on the 3^rd of November 1913 by the Governor of Ceylon, Sir Robert Chalmers. The architecture could be described as Edwardian Baroque style. Despite its years and the grisly goings-on behind its closed doors, the elegant facade retains its colonial personality and charm. The Old Anatomy Block is a fine tribute to the many who learnt the trade here and have proceeded to serve humanity, providing medical care all around the world.

My epic journey in medical education began at the tail end of 1962. I remember most vividly, as if it were yesterday, entering through the portals of that great grey building in Francis Place. Flushed with excitement, the aura and the occasion simply took my breath away. It inspired a lifelong professional career. This was affectionately called the “Block”. It is the oldest building in the Faculty of Medicine, and student life began right here. I still recall so graphically being in a cavernous hall with rows of cadavers laid on marble slabs. It just seemed like the abode of the Grim Reaper!! We soon got accustomed to the pungent smell of the place, which never left our noses. Within its concrete walls, we dissected those human bodies rather dispassionately. Tearing a body of a real person apart from head to toe despite its immersion in formalin still makes me shudder. Our youthful enthusiasm and our search for knowledge gave us some protection. As I write, I’m amazed we could face this ordeal day after day for two long years. I couldn’t face that same task with that same detachment now. The life and times in that great institution have now entered the folklore of the Faculty of Medicine Colombo. We now remember our teachers and the friends who shared those years with great nostalgia.

While in the “Block” we learnt anatomy well and in such great detail. We were expected to know the minutiae and the small print. The regular tests we had in the form of weekly ‘signatures’ and termly ‘revisal’ generated a toxic culture. It must be said we were forced to learn the subject completely and thoroughly. As a practising Diagnostic Radiologist, this knowledge was essential to me for which I will remain forever grateful.

Away from the books, study and examinations, memories of the “Block” are many. Even in that challenging environment, our youthful spirit never deserted us. They began with the infamous fresher’s rag. Then came the Law-Medical match, followed by the Block Concert and the Block Night.  These events are intricately woven into the fabric of life in the Block and remain treasured memories for many of us. Although these events occurred away from the iconic building, they reflect those memorable years spent in that great institution.

Recently there was an email riding the ether that the Old Anatomy Block was to be demolished. I was surprised and dismayed to lose such an iconic building of our time. Prof. Sanath Lamabadusuriya promptly enquired from the Dean of the Faculty of Medicine, who reassured him that the “Block” would not be demolished but would be restored to house the Faculty Museum and a Centre for Research, Development and Innovation. I am confident he will do whatever is necessary to preserve its historical content. This iconic monument to medical education has a long and distinguished history. I am so pleased it will not be reduced to clouds of dust and a pile of rubble.

The building has served us well for over a century. In that time, much has changed in the teaching of anatomy. The difficulties in getting cadavers and its high financial cost have significantly contributed to the development of alternative teaching techniques. Web-based medical technology has resulted in the development of virtual dissection programs. These have been found to be a cost-effective way of teaching anatomy. They are now preferred to cadaveric dissection. The modern techniques do away with some of the emotional and ethical concerns. The debate to dissect or not to dissect still rages on. The teaching of anatomy has changed.  Hence, I do understand the issues which may have influenced the Dean and the Faculty of Medicine in Colombo to take a stand.

A centenary celebration was held for the Old Anatomy Block in 2013. It was wonderful to read through the souvenir and acknowledge the deep affection the former students have for this great institution. With the passage of years, the sun and rain and atmospheric pollution have affected the structure of the building. A crack has appeared in a wall and some damage to the wooden floor has been found. It is heartening to know that the architectural conservation division of the department of archaeology has been consulted.

To conserve our medical history, it is important to broaden the discussion. The General Hospital in Colombo, now the National Hospital, was established in 1864. The associated Medical School was founded in 1870. Both these institutions have old buildings that may not be fit for purpose anymore. Some may have fallen into disrepair from neglect, a lack of funds, and the weather. I hope there is greater consultation before sending in the bulldozers and excavators for demolition. It is wonderful to see the Victoria Memorial Eye hospital built in 1903 still being used and kept in good repair.

We, as a country, have done tremendously well to preserve our ancient heritage and archaeological remains. But the preservation of our more recent history appears to be less secure. I am unaware of the existence of a listing of historical buildings or a National Register for this purpose. Hence it is incumbent on the general public and interested individuals to gather support, cajole, harass and make a noise about preserving our past.

“Heritage building” includes any building which requires conservation and preservation for historical, architectural or cultural purposes.

One way of acknowledging our history is by preserving historic buildings and structures.

Historic building preservation helps to remember a place or an institution and its interesting past. These old buildings are visual reminders of an area's cultural heritage and the people that once played a key role in being part of it. Historical buildings are best adapted for reuse as architects are looking at ways to make these buildings more sustainable.

If we didn’t undertake historic building preservation, there would be nothing left of our history in architectural terms. Demolishing an old building could mean an important part of our history is gone forever. Many of the old buildings are a treasure trove in architectural terms that tell us something important about our historical past.

I do accept that in Sri Lanka, we must do what is feasible and appropriate for our country.  It is, however important to pick up from other countries how they deal with common issues. In London, space is precious and is at a premium. St Thomas’ hospital was established in 1100, Guys Hospital in 1720 and King’s College Hospital in 1840. All those hospitals have had many facelifts and extensions to accommodate new technology and more patients. The Medical Schools are closely connected to those hospitals. Whenever possible, they have preserved the original façade of the old red brick buildings which have been included in the National Heritage List to be preserved for posterity. I wish we can preserve the façade of that iconic Anatomy Block and the other parts of historical interest like the old anatomy lecture hall built like a Greek-style amphitheatre.

I am immensely grateful to Prof. Sanath Lamabadusuriya, who brought this to my attention. We are fortunate to have a person of his calibre and wisdom. He is the current President of Colombo Medical School Alumni Association and is greatly respected by all. We are so pleased Sanath will take an interest in the progress of this process of refurbishment and restoration. I can rest assured he will deal with this project thoughtfully and with sensitivity.

The Golden Era of anatomy in the Medical Faculty comes to an end as the Old Anatomy Block gives up being a place for human cadaveric dissections. It has served us well for over a hundred years. The building will stand as a tribute to the learned Professors and Lecturers who walked those hallowed precincts and taught anatomy to generations of students.  Their photos adorn the walls of the main hallway. Some had tempers that would terrify even the boldest. Their voices must still swirl in the ether of that great institution. Meanwhile, if you are ever in the neighbourhood, do wander around. That's the closest you'll ever get to soaking up the atmosphere of an era that will soon disappear into oblivion.

We deplore the war in Ukraine

WE DEPLORE THE RUSSIAN INVASION OF UKRAINE

Dear Friends,

 

The Blog was and will never be a Political Forum but I was tempted to post this after I read a message from the President of the RCP. Andrew Goddard MD PRCP, extracts from which I post below. I hope you agree that it is entirely appropriate to show this. To quote Friedrich Wilhelm Nietzsche, “Silence is worse; all truths that are kept silent become poisonous.”

 

“All of us at the RCP send our thoughts and love out to those affected by the crisis. I suspect many of us also have friends with links to Ukraine

 

The actions of Putin have had immediate and dramatic effects on the healthcare system in Ukraine and experience tells us that the health of that population will suffer in unseen ways for many years to come. The movement of refugees across the EU will have an impact on the neighbouring states.

 

Ukraine has its own national health system (NHSU) which was created in 2017 and has been making significant strides towards a fair and equitable system for both population and employees since. Although somewhat younger than the UK NHS, the problems NHSU has had are not dissimilar. There has been a succession of health ministers which has created rapidly changing political policies and a fear of slipping back to the cronyism of pre-NHSU days. The involvement of UNICEF and others in procurement for medicines in 2015 showed how transparency can reduce corruption and medicine prices – something we can all learn from. The NHSU (before the war) was struggling with a move towards decentralisation and creation of local healthcare systems. The tensions between the politicians at the centre and local groups of those responsible for delivering healthcare seem oddly reminiscent of the current reform in England.

 

Let us hope that stability and normality will return quickly to the Ukrainian people and the improvements that were seen in NHSU can be the centre of attention, rather than the need to fight for their freedom and lives”.

 

I was so pleased to read this. I have no words to describe the abhorrence I have for President Putin (“putin it mildly”) for his uncaring and inhuman attitude of considering individuals as disposable pawns..

 

When Leaders of Countries go to war, the real sufferers are the people as you see from these images.

 

As responsible and caring citizens of the World, we must take every opportunity however small, to show our solidarity with the people of Ukraine and help them in whatever way we can.

A war has no winners – only losers.

 

Mahendra

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.                 

The year of Internship- Part II

The year of Internship- Part II Kumar Gunawardene

PLAY

Work was demanding, particularly being on-call after a hard days work. But we were young and hardy; we would silently abuse the call boy who tapped our window deferentially when woken up from a deep slumber. Thus we managed to extract joy even in the most trying situations. 

The mornings would begin with a hurried breakfast, with little time for small talk. This was made up for at the morning tea break where tittle tattle dominated. Lunch was leisurely with much humour and cross talk. The quality of the food and the parentage of the cook came in for questioning often, albeit discreetly on account of the female company. 

We then retired for the afternoon siesta, joined often by Titus D of the blood bank who became part of the trio of Sunna , him and me. We talked incessantly of men(women too) and matters. His faithful nurse had told him that a pretty nurse was in love with me. He had rejoined, my friend has no such leanings. But we did have trysts in the shade of the Araliya tree, the scented blooms and cool breezes enhancing the pleasure. Titus tagged, Sunna and me to his nurse’s wedding in a village off Matara. This was the first traditional Sinhala wedding that we had attended. The beautiful bride herself welcomed us with a glass of water and we were given a honoured place at the dining table. The food was typical village fare and topped off with the best Ruhunu curd and Kithul treacle. We also spent a night with Titus and his parents in their ‘Mahagedara’ which awakened many memories of my grandparents' house and the village. 

Another close friend was Lalitha, the Dermatology resident who travelled daily from her ancestral home in Boosa. A Peradeniya graduate , she was friendly with us and ready and willing to join in all the fun and games. She stayed overnight on festive occasions and there were many of these. The biggest was the farewell for Vipula, the Senior resident;it was on a balmy evening, out in the open under a cloudless starry sky. Food was abundant and drinks flowed freely. I who had imbibed not wisely but too well embraced all my favourites.They didn’t protest. 

A different highlight was the variety performance in the Boosa racecourse clubhouse. C.T.Fernando sang live with a number of other artistes. All the residents who were not on call and many consultants and nurses joined in. The chiefs shouted drinks for us, the first being Dr Anandaraja. Naturally it was Beehive brandy. Baila dancing followed. Late at night, DBS a senior gave Sunna and me a lift in his VW beetle. We were crammed into the back seat with a couple of nurses. The ride was delightful. 

Every payday we had a feast.The toast was with Beehive brandy, the most expensive local drink at the time; followed by ‘Pol’-coconut arrack if we were in luck or ‘Gal’ arrack-raw ethanol flavoured with the real thing. The singing would commence with decent favourites - CT ‘s and other popular melodies. Byrd G a senior,high minded and serious accompanied us on guitar. Soon, bawdy ballads followed much to the disgust of Byrd who would walk away. The more ‘spirited’ ones called out ‘Oi cock Byrd come back’. The evening ended with the launching of ‘Ahas Gundu’ -sky rockets to the nurse’s quarters. They enjoyed the show as much as we did and hurled back their own rockets. However late the party went on we were back at work at eight o’ clock, the following morning notwithstanding thick heads.

Most evenings we played badminton with nurses and fellow residents. The single nurses were young, attractive and companionable. Looking back it’s with a tinge of sorrow that I acknowledge their hard work, solitary lives and aspirations. Many of us went onto have fulfilling careers, but these girls who were equally intelligent, languished for want of opportunities. As was said by Claude Chabrol “you have to accept the fact, sometimes you are the pigeon,and sometimes you are the statue”; or perhaps more precisely some are pigeons and some are statues. During the cricket season we played softball matches in the front patch, more gravel than grass. Being a former schoolboy cricketer, I was chosen to play in the annual law medical match;this was held in the Galle esplanade which is now a renowned test match venue. I do not remember the result but do recall the merriment and also the sprained wrist, the result of a diving catch. 

Some nights we played poker. MBS was a spirited enthusiast, but Sunna was usually the winner even with poor hands. He had a ‘poker face’ which registered no emotion; I on the contrary displayed all emotions. Naturally I was a loser, but the stakes were small, one cent. 

Some moonlit evenings we wandered to the nearby Unawatuna beach the famed Welle Kovila.Tourism hadn’t touched it then and we were free to cavort by ourselves swimming in the shallow warm sea and drinking beer. Girls joined us too, making the evenings that much more enthralling. We all crammed into Fully’s car, and he being a teetotaller transported us safely. 

Sunna loved to travel and I joined him on many occasions. One was to a friend’s (Raja W)house beyond Matara. The ride in pitch darkness, sans helmet was hair raising. No alcohol passed his lips and we returned safely after midnight. 

The trip to Yala and Lahugala was next. Sunna was the chauffeur of his father’s Land Rover, Ranjan F, the wildlife expert the guide and MBS the most vocal participant. Sunna’s and his ideas of what was worth watching differed widely. MBS wanted to stop by every deer and wild buffalo;the rest were keen to see leopards, elephants and bears. At one spot we spotted the lotus like paw marks of a leopard, and foolishly got down. Suddenly we saw its ferocious face in the undergrowth and sprinted back to the Jeep. Luckily he did not spring. We spent a night in Lahugala in the watcher’s hut. He had a campfire going and we saw herds of wild elephants strolling leisurely on the opposite bank of the reservoir. Next morning, Ranjan led our pack from the front and would summon us with a sweeping wave of his arms if there was anything worth seeing;in spite of his precautions, we were nearly charged by a pack of wild buffaloes. 

At the end of our term Titus and I went with Sunna to Nuwaraeliya, where A was working. We arrived unannounced,but she graciously hosted us at her brother’s home. It was very cold , and we were grateful for the roaring fireplace and the many blankets she managed to get. The next morning she came with us to her home in Kandy, and then to Colombo. Her younger sister joined us for lunch.She was indeed a typical Kandyan beauty. The sweetest memory of that trip was A, singing “Somewhere my love ”Doctor Zhivago had just hit the screens in Ceylon and the song was on the lips of all young girls; I thought her version was better than Connie Francis’s.!! 

All good things must come to an end and so did “l’annee de gloire”.The farewells were tearful. It was a wrench to leave the hospital by the sea where so much had happened in a year. We were unemployed now and had to go our own ways. I stayed on in Galle for three more months, working as a GP locum arranged by MBS with a friend, Dr A.S.H.De Silva. It was different to hospital work but interesting. As the evenings were free his brother Kingsley and I strolled on the Galle fort ramparts most days ending up with our favourite beer Lion lager. Sunna too did some locuming before going off to USA. Titus stayed on in the blood bank at Galle. Rohini S came back to Colombo.