Fond memories by Lakshman Karalliedde
L. C (Chokka)
Fernando-the genial humane mentor
When one is an octogenarian,
it is not unusual to look back at life- events and setbacks and the people who
made a difference to one’s life. Of
persisting undiminishing importance is of course the family. As a professional,
for over five decades, there are individuals who have made unforgettable
impressions –not only with skills but life in general-simply, how to be a
decent human being and a professional. This belated attempt is to pay a tribute
with affection and gratitude to one of my earliest mentors-better known as
Chokka Fernando.
His demeanor was
certainly an influence for me to begin training in anaesthesia at General
Hospital Kandy in June 1966. There were two consultants in anaesthesia at Kandy.
Along with debonair and daring Upali Weerakkody, they ensured a wholesome
welcoming unit with about seven house officers. There was never an unfriendly
or acrimonious encounter within the unit, remaining glued together with “UHU”,
united at all times with the confidence of unstinted support of the two
consultants. The house officers were individualists; pig headed at times and
did not refrain from showing their dissatisfaction and often contempt to those wielding
the scalpel irrespective of the grade or status. Commandeering the house
officers was the ever empathic and tolerant Mrs. Appadurai. House officers were
not the easiest bunch to please with duty rosters and other aspects of
administration, yet unity prevailed and when discontent did occur momentarily,
a colleague stepped in to resolve the issue to the satisfaction of everyone.
This gives me an opportunity to recall affectionately the Pakstuns,
Batholomeuses, Rajah Gooneratne, Rama Karthigesu, Kumar de Silva who remain the
few I could recall accurately.
Kandy Hospital in
1966 had a change of “status”, becoming a Teaching Hospital for the new Faculty
of Medicine at Peradeniya. The new faculty certainly contributed to the
harmonious environment within the hospital. The attitudes, values and role of
those holding teaching posts were quite a contrast to those at the faculty from
which we graduated –The faculty of Medicine, Colombo. Comparisons are the biggest pitfalls while
writing-the risk is considered worthy. Mention must be made of the Kandy
Hospital cricket team, managed and led by Dr. K.B. Sangakkara with senior
clinicians VC de Silva, Dago Gunawardena, academics, Chubby Arsecularatne and General Practitioners such as CDL
Fernando. These men had excelled in some form of sport at school, University
often captaining their sides. Chokka Fernando captained St Anthonys’ at cricket
and went on to represent the University of Ceylon.VC de Silva was one the
highest ranked lawn tennis players in the country. CDL Fernando was outstanding
at cricket and rugby for Royal. A few of us formed the Kandy Hospital table
tennis side to compete at tournaments held in Kandy. A remarkable aspect was
that the Consultants- surgeons, physicians and the lot met more frequently on
the tennis courts than in the Consultants lounge.
The theatre was easy
to get adapted to. For us, the rubber tubes with clips to control the rate of
infusion, anaesthetic machines with the basics without any of the modern
monitors, mercury sphygmomanometers, often requiring patching of punctures to
the inflating balloon, laryngoscopes, where the light bulb had to be tightened often
at the beginning. Cylinders of oxygen, nitrous oxide and cyclopropane were
attached to the machine as were the vapourisers for ether and trilene. Halothane had being introduced to
Sri Lanka and was so expensive that one bottle was kept locked, to be used
either by a consultant or under consultant supervision. Inducing ananesthesia
with ether required patience and great skill. Trilene was used less frequently
on its own as induction of sleep was much longer. The key features were keeping a close watch
on the patient, feeling the forehead or extremities to monitor body
temperature, observing the size of the pupils and a finger on the pulse all the
time. Blood pressure was often measured when a nurse or medical student was
available. The easier method was administering spinal analgesia. Upali
Weerakkody introduced epidural anaesthesia and it was a treat for us watch him
identify the correct space to introduce the local anaesthetics. The muscle
relaxants were suxamethonium, curare and gallamine. There were occasions when
we used ethyl chloride spray of a gauze swab to induce crying and restless
children quickly. With such few choices, the emphasis was what was the safest to
use- when and where. Few times, we had to use nitrous oxide only without oxygen
for quick induction –hypoxic induction-a daring technique. Two major advances
in the specialty took place. The hierarchical structure of the profession
considered that anaesthetists would do as they are told as they were incapable
of “higher intellectual function’. Thus surgeons used to write or consult
consultant physicians regarding a patient’s fitness for anaesthesia. It is an
understatement that this was an imposed irritant and humiliation of the
specialty. Fortunately, when David Chanmugam was Consultant Physician of the
Out patients Department at Kandy Hospital was required to provide such an
opinion as probably the other Consultant physicians were too busy. He responded stating briefly- “This opinion should be
obtained from an anaesthetist as it is they who administer the anaesthetic, not
me”. This changed the practice of Physician referrals on fitness for
anaesthesia ever after, though of course we sought the expertise of physicians
regarding the care of patients with severe medical disorders. Following a
request from the relatively new Dental School located at Augusta Hill, Chokka
decided to provide a basic anaesthetic service once a week to the dental
school. We packed our gear in a vehicle – anesthetic machine, laryngoscopes,
cylinders of oxygen and nitrous oxide, bottles of ether, and trilene, suction
apparatus and took off to Augusta Hill to assist the Dental surgeons amiable
and appreciative, with a few difficult extractions, often in children.
Chokka was the
supreme clinician, and the basics he taught us helped us through our careers in
Sri Lanka and overseas. No one has ever heard Chokka to be rude or arrogant. He
walked away a on a couple of occasions when arrogant surgeons complained that they
could not see what they were doing and rather curtly asked him to adjust the operating theatre
lamp. He did not utter a word, walked off, ensuring that the patient was safe.
What came out most from Chokkas mouth was laughter, not at others, but at him.
He was never rude to minor staff or nurses and was always, without exception,
very kind to his patients. As young medics, we were taught life changing lessons
on more than one occasion. Once when I called on the theatre attendant to
“bring the next case in”, he called me out ad simply said, it may be the next
case for you but for the patient ,it was the only case- go , lower your mask as
he had seen you pre-operatively and wheel him in with the a theatre
attendant. What more should one learn
about the care of the sick.
Circumstances led him
to leave for New Zealand, taking up a Consultancy at New Plymouth Hospital. He
was essentially born and bred in Kandy. At a point of time when I was
uncomfortable in Sri Lanka, I decided to take up an appointment in New Zealand
and of course as usual and expected, he was the guiding light. Being a restless
soul, I returned to the UK after three years in New Zealand. However, during my
employment with the University of Peradeniya, I took the opportunity of
revisiting New Zealand during my sabbatical leave. Good fortune brought us to
within striking distance of New Plymouth and his residence. He was a great
source of strength to us as with three children under the age of 7years,
periods of insecurity and ill health necessitated the presence of a God Father
and God mother. His ever cheerful wife, Mallika, entertained all of us sharing several
moments of absolute bliss providing us with the strength through difficult
times. The expansive garden of their home was the cricket field for Chokka and
our three boys. The meals were delicious –simple, homely, Sri Lankan (the pol
sambol was a smasher). We were living adjacent to Mount Egmont, a heart-warming
view, every morning from our quarters. The most memorable event was when the
boys wanted to climb Mount Egmont, Chokka joined us and half way through the
climb carried our youngest son on his shoulders, displaying the fitness and
agility he displayed on the cricket field. Mallika and Kanthi became very close
friends, strengthened during their visits to us in London.
During this phase of
my life, reading eulogies has become more frequent resulting in regrets o due
to the inability to express our gratitude to people before they departed. Sir
and Mallika, this is written with immense affection and gratitude to wish both
of you many more years of happiness and contentment. We are aware as to how
well you enjoy being a nonagenarian, watching all the sporting events on
television. When another trainee of his visited us in Kandy, he reminded me of
another noble aspect of Chokka’s conduct. He never spoke ill of anyone. If he
did have a different view, he just
walked away pretending not to have heard a word spoken by us. Thank You Chokka
and Mallika.
Lakshman Karalliedde. .
