Dr. Nihal D Amerasekera FRCP FRCR

After the results of the final MBBS, pushing, pulling and jostling for a good hospital began in earnest. Uncles in high places were in great demand. The euphoria of the MBBS with all its trappings of fame and fortune was only dampened by the stress of the internship. Overworked and underpaid is an apt description. We were now to practice the trade we had learnt for five years. The finer points and the small print had evaporated even before the examinations. I could now barely hang on to the basics which were far less volatile. Remembering the mass of facts we learnt was a nightmare.

For those of us whose local geography has been a casualty of the permissive sixties, Kurunegala is a sleepy town at the edge of the dry zone on the way to Anuradhapura. Most years the monsoons deserted the town and the clouds just passed it by. The elephant rock stands majestically in the middle of town. During the day the sun beats on it mercilessly and in the night it dissipates its heat keeping the town oven hot 24 hours of the day. The 400-bed hospital is built in a coconut estate. In-patient numbers far exceeded the number of beds.

It was 1967 and the middle of July. I remember as if it were yesterday walking up a narrow street by the hospital into our House Officer’s quarters which was to be my home for a year. Armed only with a suitcase and a sagging confidence I took up my task seriously. The caretaker was an elderly man who had severe asthma. He was affectionately called Rhonchi Rajapakse. His cooking left a lot to be desired and reminded me of the chemistry book description of oxygen - tasteless, colourless and odourless.

The hospital was managed by Dr.Bertie Wijeratne, a kindly gentleman who had to serve the masses and balance the books. Interfering politicians and local unions were the bane of his life. He juggled his many impossible tasks admirably and with a smile. The Kurunegala hospital served a wide area extending from Galgamuwa and Dambulla in the north to Anamaduwa and Nikaweratiya in the west; Alawwa and Polgahawela in the south and Kandy in the east. The west and north being in the dry zone, the people’s lives depended much on the rainfall. They were mostly poor, humble and had volcanic tempers towards their own. This often resulted in stabbings and shootings for mundane trivial issues. Those from the south and east were relatively affluent and knew their rights but were rather placid.

My first appointment was in paediatrics with Dr Chandra Wijesundera. I couldn’t have wished for a kinder boss. I had H. N. Wickramasinghe and Adikaram as the co-workers. “Adi” sadly passed away and H.N is a successful GP in Hanwella. In children, diphtheria and gastro-enteritis were the killers, both of which were so easily preventable. It is said a family never recovers from the death of a child. I still recall the deep distress and the wailing in the ward after a death.

Thanks to our teachers we have had a good allround training. The art of breaking bad news and counseling the bereaved were sadly lacking in our repertoire. We learnt these on the job. I recall one day when a seriously ill child of 2 years was brought to the children’s ward. I diagnosed diphtheria and gave the appropriate treatment. Within 30 minutes the child was in great distress with breathing difficulty. I called the surgeon who came promptly and when the child was taken to the theatre for emergency surgery went pale and died of asphyxia. It is a well known complication of the condition but this has remained in my memory ever since.

We were on ‘call’ once every 3 days and once in 3 weekends. The calls were busy and a good night’s rest was a luxury we never knew. When not on call, the evenings were spent playing badminton.

The Visiting Surgeons and Physicians kept their distance and rarely mixed with the junior doctors. I believe channeling, tunneling and funneling private patients kept them occupied. One who mixed with us regularly was Dr.Upali Ratnayake. He sadly died of a cerebral haemorrhage during our time there.

The doctors were the elite in town and were recognized and respected. The shops gave us special discounts and the local cinema flashed our names on the screen to say we were urgently needed in hospital ‘to save a life’. The doctors were automatically made members of the Upper Club. It was an exclusive social club in Kurunegala where the upper crust congregated. Every weekend was a party in the quarters or in town and the booze flowed freely. Sing-songs were an integral part of the fun. The general public and the local police waived off our youthful indiscretions.

It seemed the flushing toilets had not reached the dry zone yet. The quarters had bucket latrines and the daily ablutions were a tricky business. Those at the back of the queue in the morning had to endure the worst. S.C. now a senior ophthalmic surgeon in Colombo, had his own answer to the problem. He had a generous stock of Bulgarian cigars (Bulgarian bog punt) which produced acrid fumes to counteract the smells. The non-smokers had to make a quick exit cyanosed and blue poisoned by the fumes and driven by the stench.

The many colourful colleagues living in the house gave it the character it deserved. “Raj” was an honourable senior who had been there for 6 years. He orchestrated the misdemeanors, arbitrated the disputes and collected the funds for the daily consumption of booze. Rajasooriyar was our resident hermit. Being a teetotaller, he cared for the sick and the suffering and provided the aspirin when we needed it most.

The young Kurunegala damsels as they went past the house were greeted cordially. After dusk the girls saw more of us. Many of the girls blushed and hurried past but a few retaliated with some strong local language. We spent many happy evenings drinking and chatting and putting the world to right. Many of the topics had a sexual connotation. There was a strong and healthy relationship with the nursing staff who were invited for our fun evenings. For some love blossomed. For others it was a temporary state. The house officers quarters were a honey pot for marriage brokers who came from far and wide on fact-finding missions. Big bucks were mentioned and “fit-ons” were arranged. Deals were done in a backroom. Those who volunteered information were on our payroll and the routine was well rehearsed.

On weekends we made trips to Kandy, Anuradhapura, Sigiriya, Dambulla and Puttalam which were a striking distance away. Once we went to Sigiriya and S.C took a gun with him and shot a wild duck. Rhonchi Rajapakse cooked it for us. We still may have lead shots lodged in our guts to remind us of those happy times of our internship.

The Law-Medical match was the highlight of the year, which ended in a dance in the Town Hall. It was similar to what we had in Medical College with a hilarious concert before the dance. The drinking began at midday and some of us forgot the lines being completely ‘stoned’ during the show. Those acting as angels could hardly stand. Few could remember how it all ended. Many had total amnesia for the event.

The second appointment was surgery with Dr. N. Rasiah with T. W. as a colleague. The latter enjoyed breaking branches off trees after a night out with the boys. This was a strenuous six months with many knife injuries. During this period of 6 months I had to deal with 4 murder cases which were committed to trial in the Supreme Court. Once a woman was brought with a vaginal prolapse bitten by a dog, while she was asleep. The husband had more sympathy for the dog than I expected.

Mist Sodi Sal and Carminative formed the bedrock of our treatment. Aspirin tablets were given out like Smarties. Once whilst returning for lunch there was an almighty commotion by the gynae ward. A man in national dress was shaking his fist unable to contain his anger and one of my doctor colleagues was calmly explaining to no avail. It transpired the man was accusing the houseman of stitching the episiotomy (a suturing done during child birth) too tight. The doctor finally asked the man to mind his own business, which left him rather speechless.

Soon the months rolled by and it was time to move on. The colleagues who shared our house had become a close knit family. Despite the hard toil, mostly the good times came to mind. I distinctly remember the sadness I felt saying goodbye to my friends some of whom I was never to see again.

Many of us took the advice of Rudyard Kipling when he said “Go West young man”. There was a mass exodus of doctors to the USA and UK in 1968. I was to remain in Sri Lanka for a further 7 years. My future was decided by politicians in head office and depended on whom I knew and not on my ability. My career development was at a standstill when I decided to join the rest of the herd in a greener pasture.

I dedicate these memoirs firstly to the many doctors who have walked the long corridors of the General Hospital Kurunegala and who are no more with us. Secondly to the simple, kind and generous rural folk of the Vanni who had implicit faith in our powers of healing and thirdly to the nurses who taught us practical medicine and provided warmth and comfort during those difficult times.

I wish to make special mention of a dear friend, Dr. Bernard Randeniya, Director of the Cancer Institute Maharagama, who lost his battle for life in November 1999. May his Soul Rest in Peace.

Health warning: This is a record of events of 35 years ago when male chauvinism was at its peak and women’s lib was non-existent. So please excuse my sexist comments. Even God can’t change the past. (only politicians can!!)