Lessons I Still Remember - 4

Sent in by Lakshman Abeyagunawardene

William Harvey and his discovery of blood circulation in the human body.

By the end of Term Two during our 2nd MB days, we had got quite used to the "Sigs" that we had to face ever so regularly in the Anatomy Block. It was about this time that the same system of continuous evaluation was introduced in Physiology as well. Whether we liked it or not, we had to prepare for these Physiology "Sigs" in addition to the regular "Sigs"in Anatomy.

Being the first few names in the batch in alphabetical order, Lakshman Abeyagunawardene (that's me), Sunil Abeysuriya, Surangani Abeysuriya, Rohini Abhayaratne and Lalantha Amarasinghe were in the same "Signature" group. One of the first "Sigs" in Physiology was taken by Dr. Carlo Fonseka who was then a Lecturer in Physiology. His first question to the group was "Who discovered blood circulation in the human body"? He added that whoever gave the correct answer will get a "Very Good" straightaway. Lalantha Amarasinghe lost no time in raising his hand and saying "William Harvey". True to his word, a highly impressed Dr. Fonseka took Lalantha's signature card and marked "Very Good". All of us went through the rest of the oral test, but as advised by Dr. Fonseka, I made it a point to read (or re-read) that relevant section in our Physiology text book. I have not forgotten William Harvey and his momentous discovery to this day. It's a lesson I still remember.

It was not by reading Samson Wright's "Text Book of Applied Physiology" that I learnt the above fact. It was through the "Phys Sig" that Dr. Fonseka conducted.

                                                         William Harvey (1578 – 1657)

 

Lessons I Still Remember - 3

Note from Speedy

I am really pleased to see early and hopeful evidence of others taking up my request to share what they learnt from our great teachers. Zita’scontribution is most welcome. Let us hope that more will follow. As promised, here are a few more recollections. 

From the best clinical teacher I ever had, Dr Wickrema Wijenaike. I was privileged to be his SHO and he laid down a few ground rules when I started which after 40 years are still relevant to sound medical practice.

(a)    If you request an investigation, you must justify them by telling me why you asked for them and how the results would help in the diagnosis and management of the patient.

(b)   You can prescribe a drug only if you can give me why it is indicated and show me that you are aware of  the side effects of the drug and how to manage them. To memorise the dose is not important, you can always refer the Formulary.

2. From Dr. George Ratnavale, Consultant Neurophysician (preferred term for Neurologist those days in Sri Lanka), probably one of the best dressed and polished clinicians in our time, tall and elegant with a graceful walk. In one of his Ward Classes, he asked us to take a history from a young patient with a severe headache which was relieved by the application of a wet cloth soaked in Eau-de-cologne on his forehead. The young man had a Pituitary Tumour and was dismissed by earlier clinicians on the basis that a headache which responds to such a “placebo” could not have a serious underlying cause. The lesson was not to be distracted by what seems a dismissive feature in a patient but to be thorough in your evaluation and take account of the whole clinical picture.

 

 

A Day in the Hospital Clinic

By Mahendra Gonsalkorale

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Some sit on chairs very still
Others shift hither and dither at will
Thin ones, fat ones, tall ones, and short ones
Brave ones and the frightened ones

The New ones look lost and uncomfortable
The seasoned, resigned with magazine from table
Many occupy time with a Doodle
The Technos check Facebook with a Google

The Curious look around to see
Pretending not to be nosey
Somebody slumped with his eyes shut
Wakes up suddenly with a jerky start

Some sit erect giving that important look
while reading newspapers or a even a book
Some half asleep, but others more dense
The sound of loud snoring breaks the silence

As people enter they sit carefully and wait
leaving empty the chair between them and the next.
Some keep coat and bag on next chair, that's unfair
pretending not to see person looking for a chair.

A few in discomfort looking very glum
Scratching their heads and chewing gum
A restless child starts to annoy his mother
Her stern stare makes the poor child wither

Someone farts and pretends it's not him
Another starts looking for a waste bin
Some are laughing and some are groaning
Many talk loud and others are whispering

Nurses keep coming and nurses keep going
TV on the wall with nobody watching
Doors banging, telephones ringing
Receptionist looking busy phoning and talking

One picks nose, another stifles yawn gracefully
And the restless child gets even more lively
Mother shouts and waggles finger making him flinch
Child howls, they all stare and the mother turns pink

Quiet periods mixed with busy ones abound
Patter of shoes as clinic staff keep moving around
Doctors in a huddle, nurses in a muddle
Doctors and nurses, muddle and huddle

Suddenly the pale one vomits there
and another falls from his chair
Nurses rush and make oh such a fuss!
This dull place gets lively all at once

Name called repeatedly, an old lady wakes up.
Name called again and and the wrong one gets up
Another name called, and the previous name called
wants to know why she wasn't called

Name called repeatedly but nothing response-wise
Could it be the nurse's soft and rather delicate voice?
She calls a name, with struggle pronouncing
A man with a long name stands up grinning

Someone asks where the toilet is, can't wait
Another complains it is now 80 minutes late
Many getting angry by the minute, late to see doctor
Some get irate and demands to see a manager

Some look bored, resigned and listless, such a crime
Others check their watches for the umpteenth time
There are the staring ones with that unseeing expression
Resembling statues with a massive dose of depression

Someone walks in late, not well spoken
pauses at door, bemused with mouth half open
looks around hopefully, something wrong here
wrong clinic, wrong day or wrong time, oh dear

It's all in a days' work for the clinic staff,
conditioned and insensitive, always ready for a laugh
Patients will continue to trudge in and trudge out
It matters not a hoot if they are satisfied or nowt

Lessons I Still Remember - 2

(from my good old Batch ‘62 days)

 Sent in by Zita Perera Subasinghe

I am glad Mahendra (Speedy) started this feature. I think it is a great way to give tribute to our old teachers and share memories with our batch mates. I hope others continue this chain so our batch blog remains an active forum for discussion. 

Here are two of my examples of  “Lessons I still remember” 

1.      A precious line from Prof Carlo Fonseka’s lecture on Pain:

To try to define Pain is to render something that is simple in terms of something more complicated. (Those might not be the exact words).

I learned that definitions should not make the subject more complicated. 

2.     From Professor Rajasuriya: we all have anecdotes, one liners and lessons we shall never forget.

I remember him asking us to feel the pulse of a patient after we had had an extensive ward class on pulse and arrhythmias. 

Each one had to feel the pulse and give a diagnosis. Out came various weird and wonderful terms like bundle branch block, loud second sound, thrill and murmurs of all kinds. Finally, one girl felt the pulse for a few seconds and just said ‘Slow pulse’. Prof was delighted. And he asked ‘what would you say the rate is roughly?’ and she replied 60 which again was very close. 

We all learned: Look at basic physical signs and think of simple diagnoses first.  

By the way, the girl who got it right was Manel Rathnavibushana.

(Hi Manel!)

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Lessons I Still Remember - 1

This is a new series suggested by Speedy. Others in the batch are welcome to contribute.
Speedy starts off with the first in the series: Lessons I Still Remember. Please see Speedy's note below.

Lucky

I am sure batchmates will agree that we were very fortunate in having wonderful teachers, both in Medical School and in the Hospitals where we had our clinical training. I am very keen for all of you to contribute to this series which I am starting today, which I call "Lessons I Still Remember". I do hope that many of you will add to this list. I have a few more I can recall but shall keep them for another instalment.

Speedy

10 point analysis of pain

By Mahendra Gonsalkorale 

 I first learned the “10 point analysis of pain ” from Dr R.S. Thanabalasunderam. This has served me well over the years and I have passed it on to many young doctors and medical students.  

1.       Site

2.       Intensity

3.       Duration

4.       Frequency

5.       Character

6.       Radiation

7.       Provoking factors

8.       Relieving factors

9.       Aggravating factors

10.     Accompanying factors 

“What is required for the safe removal of foreign bodies from the ear” comes from Dr “E.N.T”. Rasanayakam. He said that it should be attempted only if you have the following:-

1.Good light

2.Good equipment

3.Good technique

 
 

 

 

Donation of books and computers to the Colombo Medical Faculty Library

President of the Sri Lanka Medical Association of North America (Western Chapter) Lareef Idroos and Nadarasa Vishveshwara who are both members of our batch, paid a visit to the Colombo Medical Faculty Library recently. SLMANA (Western Chapter) has donated books worth Rupees two million to the library. Vishve has agreed to provide 12 new computers to the library as most of the old computers are not in working order. The donations were made through the Colombo Medschool Alumni Association (CoMSAA).

These donations by two distinguished alumni of the Colombo Medical Faculty have been greatly appreciated by the Dean Professor Rohan Jayasekara and present day students.

JC in High Company

A picture of JC (Fernando) with HE the President. With them is President's Counsel and former Attorney General C.R. de Silva.