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. .
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