Here is a good and reliable way to help Sri Lanka

 Here is a good and reliable way to help Sri Lanka 

My 18 Week Ordeal of Double Trouble

 My 18 Week Ordeal of Double Trouble

By Dr. Lakshman Abeyagunawardene

I thought of writing this article in order to share with readers of the Sunday island newspaper, my recent experience as a patient suffering from two illnesses at the same time. I could describe this period as sheer mental agony as I had to bear the social as well as possible medical consequences of illnesses that plagued me over a prolonged period. Writing newspaper articles in my opinion is one of the best ways in which at least one section of the community can be educated on Health issues.

My professional career called for frequent lectures to be given to a wide variety of target audiences ranging from postgraduate doctors preparing for examinations in Community Medicine and medical students, to humble village folks like new settlers in Mahaweli areas in the late seventies and early eighties. I always made it a point to emphasise the fact that the occurrence of disease is not only a biological phenomenon but a social one as well, a point that I picked up in my postgraduate training and which has somehow got etched in my mind through conviction. Subsequent developments as described later led to the worst period when I was confined to the Guests’ Room in my home as I was not permitted even to climb the stairs that led to my comfortable bedroom upstairs. The move which was to last several weeks, involved shifting many personal items which were indispensable in day to day life.

It all began with a rash on the right side of my face involving the nose, cheek and areas around the eye. Although I suspected Herpes Zoster (commonly called Shingles) particularly because I recalled a bout of Chicken Pox over 50 years ago, soon after my Internship while working at the Colombo South Hospital. Although it is a self-limiting disease, I decided to seek medical attention because as far as possible, I try to stay away from self treatment except for very minor illnesses. Herpes Zoster is a viral infection that occurs with reactivation of the varicella-zoster virus that had been lying dormant in certain nerves for many years. Symptoms typically start with pain and a rash along the affected path of the nerve, followed 2-3 days later by a vesicular eruption.

With an all hours curfew in force, that weekend happened to be one where all “Channel Centres” were deserted. I , therefore, decided to go to the Emergency Room (ER) of Sri Jayewardenepura Hospital (SJPH) where the doctor confirmed my diagnosis and prescribed an antiviral drug called Acyclovir, pain killers Gabapentin and Panadeine. I was also referred to the Ophthalmic (Eye) Ward because my right eye seemed to be affected. Fortunately, the Senior Registrar on duty ruled out any involvement of the eye and said that my vision was normal.  This was confirmed by the Consultant Ophthalmologist (Eye Surgeon) whom I later channelled as I was very concerned about my eyesight. As always, I diligently took all prescribed drugs but at the end of two weeks, I, unfortunately, developed Postherpetic Neuralgia (PHN) which is a known complication of Shingles.

I had heard of Post Herpetic Neuralgia (PHN) but never imagined that it was so painful. In general, all pain due to Neuralgia is very painful, difficult to treat and lasts a long time. I realized through experience, what it is like to be the sufferer rather than a doctor treating a patient.

Quite apart from my present illness, I was having spells of dizziness off and on, which I attributed to Gabapentin which is known to cause such side effects. On one such occasion, it was so bad that I was about to fall. Fortunately, we were in our bedroom and my wife was at hand to prevent the fall and led me to my bed. My wife was quite helpless in such situations and called my son who lived close by and called for an ambulance. My son and the ambulance arrived almost simultaneously, but as I had not lost consciousness, I was able to explain to the paramedics that I was on Gabapentin and did not need hospitalization. Whether or not the paramedics understood what I said, they withdrew mainly because their patient was a doctor and knew what he was doing!

On a subsequent occasion, I had a syncopal (fainting) attack while I was having breakfast and my wife again had to go through the usual motions of calling my son and informing the ambulance. This time, I had lost consciousness and when I was back to normal, I myself thought that it could not have been due to the Gabapentin. Therefore, I didn’t resist hospitalization as I previously did. These two episodes clearly showed the importance of family support. I dread to think what a bachelor living alone would have done under such circumstances.

For a number of years, I have been having an irregular pulse. This drew my attention when it continued and my cardiologist referred me to a Cardiologist and Electrophysiologist who put me on what is called a Holter Monitor. After reading the report he said that I have a few extrasystoles (ectopic beats) and that accounts for the irregular pulse. He further said that it is normal for some people and I needed no treatment. Mind you, that was about six years ago.

This time round when I lost consciousness, to cut a long story short, after the necessary referrals were made, the EEG that my Neurologist ordered showed some changes and my doctors decided that the origins of the changes had nothing to do with my nervous system but that its origins were cardiac (meaning that the origin of the EEG changes could be due to some defective movement of electrical impulses in the heart). So, I went back to my cardiologist who referred me to a Cardiologist and Electrophysiologist. The latter put me on a Holter Monitor again. Based on the history and the new Holter Monitor reading, he recommended a Pacemaker.  I readily complied and he implanted a Permanent Pacemaker on September 8^th.  Sutures were removed after about a week and I had to attend a “Programming Session” on September 27^th. The doctor reported that the surgical wound was clean and that the whole procedure was successful. The implantation of the pacemaker did not bother me at all, but the anxiety of anyone facing a surgical operation was telling on me.

I had to go through the procedure of pacemaker implantation while the pain in my right eye persisted. It was after my fainting episode and pacemaker implantation was recommended that I was debarred from climbing stairs. I was confined to the Guests’ Room and this is where my agony really started. My wife did not allow me to go even to the living room which was just three steps below. Towards the latter stages, I watched the news on the small TV in the kitchen. I had to be satisfied with the laptop computer that my son brought. But it was a far cry from the Desktop I was used to. I missed my weekly shot of an alcoholic drink! I had not taken even a beer since the beginning of June.

I think I had a turnaround in my fortunes after the doctor did the Programming on September 27^th. It was this doctor’s advice that I strictly followed (more so my wife and son) because there was nothing more the Neurologist who was treating my neuralgic pain could do.  The electrophysiologist who did the pacemaker implantation asked me to resume my regular evening walk but advised me not to drive the car till the end of October.  When I asked him whether I could take my weekly shot of an alcoholic drink, he jokingly asked me whether it was Single Malt or Scotch. I replied that I take Single Malt, Scotch, Gin, Rum, Vodka, Tequila and even Ceylon Arrack in rotation, depending on availability.  More than anything else, I was happy to be back in my bedroom, using my toilet, 52 inch TV in the TV room and the Desktop in my study.

Once the Eye Surgeon said that my vision is intact and the Cardiologist had successfully implanted the Pacemaker, I was free to take some decisions on my own. As I was bothered by the persisting pain in the eye, I went back to using Gabapentin when the eye pain was severe (discontinued since that episode of dizziness). Picking up information from the Internet, I started trying some home remedies like washing my eyes and using a warm compress frequently.  I also started taking a course of Vitamin B Complex and refrained from eating Bananas and Citrus fruits to help in the recovery of damaged nerves. If I continue to recover from the eye pain and the other minor symptoms of PHN, I will not be able to pinpoint and say that it was one specific intervention named above that was responsible for the turnaround. Being a doctor myself also certainly helped in many instances.  However, I had resigned myself to think that recovery from PHN is very, very slow. As I recover slowly from PHN, I painfully realized the plight of many who are affected by Neuralgic pain and continue to suffer.

As a precautionary measure, I still keep away from my mobile phone and the microwave oven. The Pacemaker also restricts my movements of the left arm. I will continue to live with such restrictions for some more time. But I know that I have already seen and experienced the worst of this period of agony.

 

ADDENDUM by ACTING ADMIN

This is written mainly for the benefit of those who don't read Sri Lanka newspapers.

Lucky’s article appeared in the Island on-line newspaper on Sunday 25^th of October and here is the link:-

https://island.lk/my-18-week-ordeal-of-double-trouble/

Our ride into the sunset

Our ride into the sunset 

by Dr Nihal D Amerasekera

“Media vita in morte sumus” - In the midst of life, we are in death. This is the first line of a Gregorian chant circa 1300. This rings true now as it did all those years ago. Presently we battle through our lives in the midst of Covid-19. For septuagenarians like myself, in the autumn of our lives, there are many other pitfalls just around the corner.

At any age we all lust for longevity. Although we all will face it someday, our aversion to talk about death is universal. This is partly due to the fear of the unknown and also not wanting to tempt fate. During my childhood, grim legends were abound, and tales were told of death, devils and the darkness of hell. These daunting images continue to colour my thoughts even now. It is true there is little point in talking about death when we are young and healthy. The scene changes irrevocably when we become septuagenarians. This is the time to bite the bullet and face reality while still able to enjoy the good life.

Life expectancy has risen considerably in our lifetime. Perhaps, professionally, we have helped to make this happen. In the United Kingdom, the life expectancy for men is 79 and for Women 82. Living longer has many benefits. It is indeed so wonderful to see our own grandchildren grow-up and perhaps also to see their children too. But there is a price to be paid while the years take their toll on us. The sudden deaths that took away our parents and our grandparents don’t happen anymore. We just live longer. Our bodies continue to wither away as the years pass. A fistful of tablets and an earful of advice keep us going. The joints continue to creak and the backaches as we trundle along. I can feel the gradual decline and the loss of energy as the months' pass. I am not as steady on my feet as I was last year. Gravity is gradually trying to take over when I walk or try to maintain my erect posture for long. These issues that are rather trivial now will only get worse with time. If I live long enough I will need help for walking, feeding and ablutions. This may be with a carer at home or in an institution. This requires careful thought and judicious planning.

Life must have an end. A rapid exit is everyone’s dream. Unlike for the previous generations, the end for us may not be swift. Cancers or degenerative nervous diseases like strokes, dementia and Parkinsonism are some of the common ways to exit this world. Departing this life is never pleasant. Then again, we will need help in the way of a carer or be confined to an institution. These issues need careful planning now when we are compos mentis. Importantly the family should be consulted. They must be aware of our choices that may have significant financial implications. We must remember it is their pain and burden too. They must have the information to discuss with us the feasibility of our plans.

To plan ahead we must make an informed choice. For this, the doctors must provide us with the information with honesty. Thankfully, in the new millennium, the conceit and the patronising pomposity that existed in the medical profession has largely melted away. This has resulted in far better rapport between the doctor and the patient. When confronted with a terminal illness we need to know the prognosis, the positive and negative implications of treatment and also of having no treatment. It is invaluable to weigh up the implications of a range of alternatives, some of which may be “off the menu”, before making a choice.

It is wise to leave written instructions as to our care including treatments we do not want to have. This is legally binding and is called the Advance Decision to Refuse Treatment (A living will). I know some have instructions not to be resuscitated. Some want all treatment stopped including antibiotics. We can also allow someone else to make the decisions for us when we can’t. This is called the Legal Power of Attorney. Some cancer patients do not want any treatment. They do not wish to prolong life not wanting the stress and struggle of radiotherapy and chemotherapy and its many unpleasant side effects. It is imperative the doctor should discuss the quality of life on treatment. Many others show great resilience and courage in continuing and completing the treatment schedule and we respect their choice.

If terminally ill I should have the right to end my life. This issue has come into prominence in the UK in several high-profile cases of Motor Neurone Disease and Multiple Sclerosis that went to the Supreme Court. Adequate safeguards must be built in for this. In the UK there has been a shift in common morality for euthanasia and assisted suicide both of which are illegal under English law. Some go to Dignitas in Switzerland, a place for assisted suicide, to end their lives. Ending one’s life is the last resort. The National Health Service provides good palliative care as well as providing psychological, social and spiritual support.

The answers to the many questions that arise and the solutions to the many problems that surface will vary according to our personal circumstances. It is paramount that the wishes of the patients and their relatives are respected. I am merely raising awareness to a common problem we will all face sooner or later. As I write I know of 90-year-olds, like Queen Elizabeth II and the Duke of Edinburgh, who are still smiling, enjoying life and their families. But they are no doubt in the minority. Some may still have the old fashioned, laid-back and carefree attitude thinking “Que sera sera” Whatever will be will be!! This may just leave our loved ones in the dark about an issue which may be long and protracted and financially draining.

Making that final journey to exit from this world is something we must all do in the fullness of time. This challenging journey may take from a few days to a few months. Professional medical input is vital during this period to remain free of pain and to receive psychological support. We must leave behind the sadness and regrets of the past, taking with us only those happy and joyful memories. In the lonely waking hours, one may wish to walk with God for comfort and support or focus the mind on meditation and mindfulness. Some receive comfort from the “Mozart effect” of listening to soothing classical music. There is a lot of helpful advice available from professionals, carers and institutions to reach that final destination with dignity.

As much as there is no holding back the night, there is no hope of a second dawn. I feel we leave this earth never to return again. I seek the wisdom of that great Roman Poet Horace "NON OMNIS MORIAR" (Not all of me will die). Our children and grandchildren are shaped by the genes they inherit from us. They smile and laugh like us and even may think like us at times. They will carry our baton into the future.

As septuagenarians, our minds are much calmer now. There is no burning ambition or desire to chase money or position. We have done our caring for our progeny. Once we have made our choices for our parting it is so important we must return to our regular routine. It serves no purpose to dwell on death and dying. We will deal with it when it comes. It is so true we will not pass this way again. So enjoy the beauty of nature, the birds and the bees and the company of family and friends.  It is only then we can sing that famous song “Que sera sera”.

Here are my best wishes for a happy and peaceful journey's end with poise and dignity.

More about Herpes Zoster

I received this lengthy e-mail from a friend of mine who is a Consultant Neurologist in UK. He is Conrad Athulathmudali who was senior to us and a member of the "300" batch in Medical School.
I am publishing this as it might be of interest to our viewers.

Dear Lucky
I am sorry to hear that you are down with Herpes Zoster.
I started replying as soon as I saw your email but it got lost.
I may be repeating what you already know and please forgive me if I am repeating.
Herpes Zoster is referred to as “shingles” commonly.
The primary varicella infection is chicken pox.
Chicken pox is primarily an infection of children, whereas varicella and post- herpatic neuralgia become more common in adults and the elderly.
The virus remains dormant after an attack of chicken pox  but becomes reactivated later in life manifesting as
1. Herpes Zoster ( shingles)
2. Post herpatic neuralgia
While there may not be an obvious cause for the reactivation of the  virus other than advancing age there are sometimes reasons which become apparent as to the reactivation such as;
 Factors that decrease the immune function, and reduce one’s ability to fight infections are; 1. Human immunodeficiency virus infection
        2. Those receiving cancer treatment ( chemotherapy)
        3. Malignancies (cancers)
        4. Chronic corticosteroid use.
The classic condition one tends to get following the infection -herpes zoster,  is the dermatomal rash and pain (called post herpatic neuralgia)
It is called dermatomal as the rash and the pain is distributed from the dorsal spine along the route of a  spinal nerve and radiating to the side of one’s thorax.
It is a burning pain and typically precedes the rash by several days.
The pain called post-herpatic neuralgia can sometimes persist for months after the initial rash and it can be debilitating.
Treatment.
Herpes Zoster is usually treated with a drug by the name of ACYLOVIR.
The other drugs used are;
-famciclovir
-valacyclovir
These drugs are most effective when started within 72 hours after the onset of the rash.
The addition of a corticosteroid can provide some benefit in reducing the pain and the incidence of postherpatic neuralgia.
Ocular (eye) involvement in herpes zoster can lead to serious complications and merits referral to a ophthalmologist.
The pain (post herpatic neuralgia) May require narcotics such as morphine and Tricyclic antidepressants or anticonvulsants (drugs used to treat epilepsy). These drugs
Are usually given in low doses.
Others are Capsaicin, lidocaine patches.
Rarely one may have to resort to nerve blocks. Directly injected analgesics in to the dermatome ( the nerve root)
The majority do not get the complications after the initial rash vanished and hope you will recover soon
The other predisposing conditions not applicable to you but for completeness are are those patients with HIV and those with Hodgkin Lymphoma.
Another bit about shingles;
Although herpes zoster is not as contagious as the primary varicella (chicken pox) it can still be transmitted to non immune subjects.
About 20 percent with HZ can develop post herpatic neuralgia.
In some instances when the pain preceded the rash it can be diagnosed as due to myocardial infarction (heart attack )
Ocular complications occur in 50 percent of cases.
I have seen few cases of herpes with and without the complications.
I am sure you must be having the best treatment and I wish you a speedy recovery.
Very kind regards and best wishes
Conrad

Conrad Athula	12 Jun 2020, 17:28 (15 hours ago)
to me, Daya, Upali, Upali, Randy, Liyanage, Conrad, Swini

My love affair with Bloemfontein Hostel

By Appu Sumathipala

 

Kumar, I have done my best to document the names of the inmates, during my stay in good old Bloem. I have no idea how we got the name Bloemfontein. Was there some donor from South Africa, native to the Capital of Orange Free state (name Free State subsequently)?

It is with great regret that I have to tell you that I was not aware of either Bora or you during my stay at Bloem. I entered Bloem in my third year and had to undergo a minimal rag, which lasted less than a week. We had a mixture of students from the first year to the final year. As far as I remember, all were Medical students.

Our Warden was Prof Ranaya, and the Sub Warden was Dr Fernando who was Demonstrator in Physiology. After his departure,Dr.Kularatne,one of Ranaya’s Registrars, took his place.

I was the “BUTH MASTER” for two consecutive months and had the key to the telephone lock.I made sure that no one got away without paying for the calls.

I have a good memory of a vast number of the residents,upto now. They were,Marcus Fonseka, Jayasekera brothers,Makuloluwa brothers, P Kandiah,ChrstiKarunakaran,Edwin Kirubaratnam,S L Manawadu(known as SAL Manawadu),Nadanachandran(Neuro-Surgeon in Australia), Milroy Nanayakkara(Married Actress PunyaHeendeniya),P N Neelaranjitharaj,L W Ratnam,Sabanayagam,A E Singaratnam,Sivarajasingham,Milton Solonga,DenilWickramasuriya(President of the Hostel). They were from the 1960 batch.I might have missed a few.

The 1961 batch included D S C Arulanandan,A H de Silva(Ex-Thomian),Ganeshamoorthy,V Srikantha,N Satchithanandan,Yogaraj,Vivekananthan (better known as DOC VIVE), Sam Zoysa, RB Lena. Some names have evaporated from my memory.

The1962 batch was unique with multiple Professors and Consultants,all over the world. It included Con Bala,Bora,Cyril Ernest,Kumar,N S Jayawicrama, K Srikanthaand me(AHTS).

1963 Batch included P A de Silva, MHR Deen,P S Jayaratna,MNDP Jayathilake(secretary),Asoka Thenabadu,Thiagaraj(MNDP’s rowing partner) Eardley Weelathgamuwa. Some names have evaporated from my brain.

1964Batch.CJAmarasuriya,Arulanandan,Jayasiri Fernando and his roommate another Fernando,Sockkanathan and my roommate,Lafeer?.Few more namesonce again evaporated from my brain.

We also had Walter Jayasinghe from 1958 batch, famous N Rasalingam who served in NZ until his demise. I remember one Valikantha,who passed away,in his prime of life from cirrhosis.

The behaviour of our Srikantha and the big lad Sivarasingham were atrocious under the influence of ethanol, especially after their late nights.Dinner plates were often smashed, and the sub Warden was blind to their mischievous behaviour—both escaped expulsion. When sober,Sivarajasingham was a gentle giant.

These are just a few of my memories from my Bloem days.

Covid-19 - Quo Vadis ?

By Dr Nihal D Amerasekera

With Covid-19 we are in unknown terrain, wild and untrodden. It’s a new disease for which there is no treatment or vaccine. The real incubation period is in doubt. There are many theories in circulation about the virus. We do know the virus is mutating but still unclear how effective the tests and the vaccines will be. No one knows if re-infections are possible. It is still not clear if face masks are a help or a hindrance. Basically we know nothing for certain except what we know about the common cold. While learning we are playing it by ear!!

The world has been caught napping and totally unprepared. Countries rich and poor were happily getting on with waging war, amassing wealth, using up the natural resources and destroying the environment.Through our loss of common sense and lack of perspective we have become enemies of nature. We have endangered some animal species to extinction by destroying their habitat. Did the virus spread to humans from wild animals? When world bodies like the United Nations are powerless to act, out comes a virus which is making us think of our planet and its inhabitants differently. We must respect the planet its plants and animalsfor the sake of the future generations.

Busy cities have falleneerily silent likeghost towns. The Pandemic has shutdown life as we know it. The lockdowns and curfews have an enormous economic cost to the nations. There are personal costs to families and for jobs and income. Staying locked in for long periods can be mentally draining. In some countries noisy demonstrations have begun with people carrying placards wanting to start work again. This does increase the pressure on governments to relax the draconian rules. There are dark warnings that if released too early it will cause a second wave of the infection as happened in Hokkaido, Japan. No one really knows how and when to free the people from this incarceration. Politicians are under the cosh and get little sympathy from an exasperated public.

As tears fall and fear spreads many thousands have died worldwide of Covid-19. We all have become immune to the numbers as they escalate daily. Each death is a tragedy for family and friends which the statistics do not truly represent.

With a catastrophic misfortune of this scale affecting the whole world I wish there is a reset button to restart and make the world a better place, while retaining the good we have achieved so far. Despite many thousand years of human existence, religion, politics and our innate goodness we have failed to eradicate poverty and inequality.Socialists, communists and capitalists are all in it together to preserve the status quo. Countries spend many millions on firearms and nuclear weapons when people still die of starvation. How wonderful it would be to share our expertise, healthcare, food and above all our wealth with the whole world. Human greed, selfishness and avarice makes this an impossible dream.

This is a time for the countries to unite and share our resources to combat the infection. It is important we learn from this how to avoid and prevent a recurrence in the future. Let us assume there will be another epidemic sometime in the in the years ahead and be better prepared whenever it comes. Human history is studded with accounts of deadly pandemics from the plague to smallpox to yellow fever and a multitude of different types of influenza that have arisen in several different countries. Infectious diseases have been a constant human companion as we began to disperse and spread across the globe. Let us stop the blame game and remain united.

There are some unintended consequences of the lockdown. Reading and writing and spending quality time with the children are some of the many positives. A kiss on the cheek is a standard greeting in France. The French women are pleased not having to kiss anymore avoiding the halitosis of some the male work colleagues. It looks like this age old habit of social integration will be lost forever. Incidents of domestic abuse has been on the increase. Those close encounters can be serious and people need help. It seems many wives are pleased their husbands are at home and cannot disappear into pubs and bars in the evenings. They are unable to hog the television to watch cricket, rugby and football. The Biblical phrase “Idle mind is the devil’s workshop” has stood the test of time. In UK the alcohol consumption has increased severalfold during the lockdown. I tried to order some wines and many of the finer wines were out of stock. Lord Bacchus is well known for his amorous incarnations. Thankfully, social distancing ends at the front door. Much can be achieved with a bunch of roses bought online.A romantic candle-lit dinner is still possible with a rapidly delivered oven fresh pizza. They now expect a baby boom in 9 months.

Itwas illuminating and enlightening to read about an order of Nuns who live in lockdown all their lives.I did learn much from their in-depth training, discipline and wisdom. They decide early on who does what at the convent. At home I am a poor cook and do the washing up badly. As a result I’m banned from those activities. Like at the convent, at home, we maintain silence as much as possible. It is so very therapeutic, gives time to reflect, dream and meditate. In the convent there is a pecking order which is harder to establish at home where we work as a team!!Although an exaggeration this is basically true.An element of humanity and humour are of enormous help too. Finally the Nunsrecommend finding time to practise thankfulness for the good things we still have in our lives. These are quite easily overlooked in the cut and thrust of life.

Many use Technology to maintain digital contact with friends and family using Zoom, WhatsApp and Facetime. The virus is here to stay and the infection will remain a threat for many years to come. South Korea has started to use digital surveillance to trace the infected and their contacts using smartphone apps. Electronic wrist bands and phone tracking are used to trace the whereabouts of people in Hong Kong and Taiwan. This may be less acceptable in the West with a strong and long-established civil liberties lobby and legislature going back to the Magna Carta of 1215.

Social distancing, hand washing, testing, contact tracing and isolation have been the bedrock of the measures used to control the infection. Only way we can overcome this pandemic is by the use of an effective vaccine or anti-viral therapy together with herd immunity. There is much talk of research into vaccines and the production of a magic pill but nothing is available so far. I am often reminded of how long it took to get an effective treatment for HIV - not months but years. An exit strategy for the lockdown may be around the corner but we won’t be rid of this scourge for many more months or years to come.

Amidst this mayhem the saving grace has been that the children are less prone to the infection and is less severely affected than adults. They too can get the disease.Children are affected by the fallout from the lockdown. No school means no formal teaching and no social interaction with friends. The psychological effects of a prolonged lockdown are real. What we all remember of our childhood are the care-free days of playing with friends, weekends out with the family and holidays spent faraway. Now, all these seem a long way away.

The death toll in the UK is horrendously high, 20 thousand and rising. Age-wise I am in the at- risk group in the ‘wrong end’ of the age spectrum.The virus will hit us the hardest. I take comfort that I’ve lived most of my life already. How do I feel with death hanging over me? It is like being in death-row with a pending appeal and a chance of a reprieve. I’m in prison and no visitors are allowed. The sentence will be lifted only when an effective treatment or a vaccine is available. I have lost my freedom but am lucky to be alive.

WHO? Oh! The W.H.O. The part played by the World Health Organisation in this epidemic has come into question and intense criticism. A well-known politician took impish delight in an attempt to relegate the WHO into the dustbin of history. The WHO does much of their work away from the public glare hence they are less understood and less well appreciated. There are some unanswered questions about their actions and effectiveness in this present crisis. From any such organisation we all expect a good performance, transparency and cost effectiveness. There will be much closer scrutiny in the future.

It’s been doom and gloom so far. Human history is littered with predictions of the end of the world. A meteor strike ended the world of dinosaurs. The Spanish flu caused 50 million deaths and affected a quarter of the world’s population. Will this microscopic organism with a visible crown bring us total annihilation?My generation will know what I mean when I say “Laughter is the best Medicine”. In these uncertain times I appreciate enormously the subtle humour of those graffiti artistes. Their ‘Confucius’ like aphorisms have amused and entertained us since time began: “The end of the world is nigh - beat the rush and buy your lottery ticket”.

Rajan Ratnesar – My early post- graduate story in Malaysia (photo taken by Speedy in London 2019)

I have written this at the request of some of our colleagues who wanted me to describe my post-graduate experience, first in Malaysia, then England and now in the USA.

As most of you know, I left Sri Lanka (then Ceylon) shortly after the final results were released. The idea to go overseas to do my Internship was given to me by my good friend Jimmy Wickremasinghe, who also left for the UK soon after the results.

I studied for the final exam with Speedy and Lubber, and to them, I owe a great deal for instilling in me a desire to study and get a post-graduate degree. About that time, my cousin from Malaysia who was on his way to England to complete post-graduate training stopped over at my home in Lauries Road. He encouraged me to go to Malaysia for the Internship and then proceed for postgraduate studies. My uncle being high up in the Malaysian Health service, also encouraged me to go over and, arranged for the Internship at General Hospital, Kuala Lumpur, a hospital much like our General hospital Colombo.

As in Sri Lanka, we don't get to choose our speciality for Internship, and I was assigned to surgery under Mr Alhardy (a hot-headed hard taskmaster, unlike any of our visiting surgeons). He was a "Dato" (Sir) and was the physician to the Agong (king). He was a classmate of my uncle at the University of Singapore. Unlike in Sri Lanka there were only two surgical units. Each unit had the consultant, one or two senior registrars who had their FRCS, a junior registrar either studying for the primary or had passed the primary, one medical officer who had just finished the Internship, and two or three interns. The call system was managed so that each unit took care of their service, and alternated for ER calls. As for the interns, when one first starts out, call duty is everyday for approximately three weeks and after that on rotation with the other interns on your service. All admissions both elective and emergency are done by the interns. All minor surgery is done by the interns including appendectomy. When a patient is admitted with a diagnosis of Acute Appendicitis, the intern will take the case to the OR, put in a spinal and proceed to perform the appendectomy, with the help of another intern if one was available or with one of the OR nurses, most of whom had their training in the UK, which was a great asset to me because they spoke excellent English, not to mention their appearances! By the time I finished my surgical Internship, I had done a partial gastrectomy and one Total Nephrectomy. This led me to specialise in one of the surgical specialities.

The uniform for the Physicians was a "Dr Kildare" type of tunic with white pants, mainly in the surgical services. But in Medicine and Paediatrics, one could wear a shirt and tie and a white coat.

The housemen's' quarters were small one-bedroom apartments. Some of the lady Physicians would share their units. The president of the housemen's quarters had a larger unit, and I was fortunate to be elected for the post after two months. Of course, this had responsibilities, being in charge of the food, assigning rooms when new interns started, making sure the laundry was delivered on time etc.

On the social side, there were parties hosted by different Interns, mainly those who were bachelors with ready availability of guests of both sexes. As for the food in the quarters, they were mainly Chinese, sometimes quite tasty but often quite bland with a watery soup rice and either chicken or pork, rarely beef or mutton. Having grown up in Serendib island SriLanka, I was accustomed to hot curries, thanks to my uncle and aunts who would take me to their homes for a good Ceylonese meal. I soon made friends with a bunch Sri Lankan Malaysians who too preferred rice and curry and so were able to enjoy the Sri Lankan and South Indian cuisine at the local restaurants.

Most of the interns bought cars as soon as they graduated. I, for one, waited to save money to use when I decided to pursue post-grad studies. However, my fellow interns were quite understanding and would offer their cars should I need it for dates or otherwise. The daily routine always ended up with night rounds, and after that, those on-call would adjourn to the hawker stalls set up after sunset on the street by the hospital. Their food was delicious spicy noodles. One called "Kway Teow" was my favourite and of course Lion Lager or Anchor beer. If we were needed, the ambulance driver or the orderly would come and meet us at the hawker stall. If we were not on call,,we would often go the bar at the supermarket usually after dinner, to enjoy beer and a chit chat and of course, some gossip about the pretty ones of the opposite sex. My next two rotations were in Medicine and Paediatrics, and though they were interesting,  my desire was for something surgical. Once I finished my Internship, I was assigned to the OPD for a couple of weeks, and the only Pathologist had a heart attack,and I was assigned as the Pathologist. Thank god for a good PA, who did the post mortems, especially the homicides. He told me exactly what to write down in the report that needed to be submitted to the Police and for deposition. There were hardly any tissues that came for analysis, and if there were any, they were sent to the University of Malaysia. Incidentally, there were quite a few Sri Lankans in the faculty at that time, including Dr Francis Silva, Orthopaedic surgeon who taught us in Sri Lanka, Dr Puvaneswaran, Prof of Ob-Gyn who was killed in a plane crash, Dr Mahendran, Prof of Paediatric surgery both Sri Lankan graduates.

My surgical boss Mr Alhardy had allowed his Registrars leave to go on scholarships to UK and US and only had one Junior Registrar and the Interns. He requested that I be assigned to his service. This was a great learning experience for me. It was also very challenging being on call almost every night supervising the interns as the Junior Registrar was busy studying for the Primary FRCS.

At this point, I needed a car as I was no longer in the Houseman's Quarters, and though I was tempted to splurge and buy a sports car, I decided instead to buy a Fiat 850 which I had till I left Malaysia. In the meantime, I applied to enter the UK. During this time, my wife of 49 years who was an intern and I were invited to a Chinese banquet (a ten-course dinner), and it so happened she was seated next to me. I had known her as another intern and had greeted her on occasions. During the course of the dinner, she challenged me to pick up a mushroom with chopsticks and eat it well.  I succeeded, and one thing led to another, and I began dating her,and now we are man and wife!

Mr Alhardy decided to retire, and within a few weeks, I was transferred to another state in the North East coast - Kelantan. There I was Medical officer to the surgical and Ob service, and that's when I chose Ob as the speciality I would pursue. Fortunately for me, my wife then Fiancée, also was transferred to the east coast but to another state about 3 hours' drive and this enabled us to continue our courtship. About four months later, I got the approval for entry to the UK, and I still was in the studying mood and so left Malaysia. Of course, there was a long list of stuff my family wanted, and so I decided to travel by ship and what a journey that was!

There are other interesting incidents during my stay in Malaysia, but I think I have written enough and do not want to bore my friends anymore. I shall consider writing about my experience in the UK as a follow up to this.