Anecdotes from a Surgeon’s life in Sri Lanka

Author: Channa Ratnatunga
ISBN No: 978-624-96467-0-4

Reviewed by Anuruddha
Abeygunasekera amabey@sltnet.lk

Prof. Channa Ratnatunga (CR) is one of the most committed, versatile and accomplished surgeons and medical teachers among Sri Lankan medical doctors of our generation. Known to his friends as ‘Chester’ because he resembled the world- renowned English cricketer and umpire when on field, he is also a scientific researcher of distinction and a prolific writer of fame. Above all he is a compassionate man, loved by his patients, subordinates and colleagues alike for his selflessness. The unpretentious objective of CR’s latest book is concisely described in its prologue – to document his experiences, over five decades as a doctor, to educate and inspire. In his own words those were the stories he used as ‘commercials’ during his teaching sessions. Therefore, the book is a scintillating mix of brief autobiographical notes, memorable anecdotes, reminiscences, unusual medical conditions, both good and bad human qualities that he encountered among those whom he had to interact and lessons learnt the hard way. Events, scenes, experiences and other delicious tidbits follow one another in quick succession, but the style is characteristically CR – a perfect blend of clarity, brevity, objectivity and eloquent language.

The book, which documents 58 such anecdotes to be precise, is titled ’Anecdotes from a Surgeon’s life in Sri Lanka’. It consists of 128 pages and is reasonably priced at Rs 500.

The anecdotes have all the characteristics of a best seller- clarity, brevity, objectivity, humour, simplicity, relevance and genuineness. Objectivity without emotions makes it stress-free reading. Every anecdote has a simple lesson to learn which the reader himself has to work-out. As they are true stories, lessons sink into the heart of the reader rather than traversing superficially over the brain. Grammatical terms of an eloquent English scholar makes it good reading material for students learning English literature.

A concise introduction takes novitiate readers through CR’s school and university life, highlighting the random events that led him to select a medical career. Just like in all chapters but more in this, CR’s modesty is clearly evident. No wonder CR always introduces himself as Dr Channa Ratnatunga and never Professor Ratnatunga! Incidentally, the anecdote where his paternal grandmother who was a Ranatunga from Badulla had to add a ‘t’ to become a Ratnatunga and settle down in Tangalle in order to save her neck from British invaders, may surprise historians.

Some anecdotes are very informative and educative while others are intriguing and hilarious. How a ferry operator got a block in his water pipe, why a senior teacher from a reputed school could not tolerate students’ questions and wanted to commit suicide, the dead son who came back to nurse’s womb, how an astrologer prophesied about the baby who would take her mother’s life, fabricated story of leaving a scissor in the abdomen, the hospital dhoby who wanted to know whether the surgeon was a man or a woman, the CTB driver who almost died but could not get his compensation, the drummer who left the intensive care unit just one day after a complex operation to perform perahera duties and how a single erroneous lab report ruined a young girl’s marriage prospects are some such anecdotes.

Importance of history taking, etc

In many anecdotes, CR stresses the overarching importance of history taking and proper physical examination of patients at no additional cost to the patient or the doctor but may save a life. His thirst for accuracy and objectivity is displayed in many tales highlighting the importance of good record keeping. He teaches doctors that accuracy and objectivity are duties, not virtues. In this regard CR was a master. He was a prolific researcher and always collected the data by himself in order to ensure accuracy and completeness. It was surprising to see a senior surgeon himself collecting the data for his research studies. CR’s inquisitive and probing mind of a talented researcher is evident in his effort to locate the ‘Endarunatta’ he found in an abdominal cavity, in order to plant it to assess its viability after remaining inside a human body for three years!

CR was honest to a fault in all his dealings and there are many anecdotes confirming this. On his way home, after abandoning a difficult surgery for an advanced cancer, he soon realised ‘everybody wanted to live’. CR rushed back to the operation room and begged the anaesthetist and other operation room staff to recommence the major operation and remove the cancer come what may. He could not believe his eyes when he met the same patient in a supermarket after 20 years.

It is said that one major obstacle to impart professionalism among present day medical doctors is a lack of role models. In this regard CR was a role model – par excellence. Saturday morning was the only day where the surgical ward of the Peradeniya Teaching Hospital was less crowded and had few empty beds in early 1990s. On one such Saturday, the silver-haired Professor of surgery in his usual open neck shirt and sandals, arrived at the ward for the business ward round as it was called. He noticed that a patient was in a bed close to the toilet with several empty beds before. The patient was a woman in her sixties working as a tea plucker of a rural estate. He was furious of this and called the ward sister. The nursing officer who was doing the rounds tried to explain the reasons but to no avail. He wanted the despondent patient moved to the first bed in the special cubicle reserved for patients requiring special attention.

Compassion

This was the only instance I saw CR losing his temper during my stay of over one year at the surgical unit of CR. He did not leave the ward until the patient was shifted to the first bed and next morning, he put a cheeky smile when he saw the thankful patient for receiving VIP care. That was the compassion CR displayed to his patients which went beyond the boundaries of cast, creed, nationality, religion or social status. Every patient rich or poor, and whether in a state hospital or in the private sector, received CR’s whole-hearted attention. CR practiced what he preached so his trainees learnt lessons from their heart not their brain.

This book aptly demonstrates the value of reflective thinking and wise clinical judgement which are essential ingredients for a compassionate and skilled doctor. The correct attitudes essential for a medical doctor are described and displayed with their relevance in real time clinical practice in these anecdotes, so that those values will be embedded deep into their character. Therefore, it should be recommended as essential reading for undergraduates and postgraduates in medical sciences. If I am given a chance to select a handbook for intern medical officers who are about to start their professional career, I would have no hesitation in choosing this book rather than a book full of technical details of patient care which they can find easily using their smart phones.

Passion for teaching

A large number of anecdotes display his passion for teaching. As a junior doctor who witnessed his marathon teaching ward round on every Sunday starting at 2.00 pm and going on until 8.00 pm in the evening, I realised teaching was his priority and only priority. Nothing could overshadow it. His penchant to conduct continuous professional development activities for his junior team members was phenomenal. As the registrar I had to organise the weekly Journal Club of the unit. This was scheduled after lunch on Mondays, only free time slot for all members. To our dismay everyone was tired and sleepy after the emergency surgery list on Sunday night going on till early hours of the morning. When several members of the team left on transfer, I was relieved that the Journal Club would not be held as I was the only postgraduate trainee left. Happily, I arrived for the possible final Journal Club and CR was the only person in the audience. But he was cool as usual and listened to my presentation and continued the discussion thereafter highlighting many important learning points. As we were leaving the tutorial room, he said it was not fair to ask me to present every week thereafter. CR volunteered to present the journal article alternatively. My hopes of having an afternoon nap on the post-casualty day were shattered. Next week, as planned the Professor of Surgery made the presentation whilst I was the only member of the audience. This left an indelible mark on me. Even after 30 years I am not at all interested in the number of people in the audience when I teach. That was the power of his exemplary professionalism and commitment. He taught his juniors by example.

Devotion

The anecdotes vividly show the exemplary zeal and unrelenting dedication with which CR has delivered the duty of a surgeon which is nothing more or nothing less than patient care and caring for patients. The stories depict his devotion to the surgical care of his patients with sustained intellectual energy, highly skilled dexterity and expenditure of enormous time. Anecdotes confirms how this was greatly and gratefully and effusively appreciated by his patients even though he did not expect it. Like George Bernard Shaw used the medium of a popular story to convey social messages, CR has used his anecdotes to highlight important lessons to be learnt by practicing doctors. Personal bias might well be the reason, but I found the book fascinating from end to end and literally unputdownable. CR shows how to write briefly and clearly without using superfluous words and padding. Some of the words and phrases CR uses are literary marvels. CR has used medical terms sparingly and even then, with a simple explanation so that even non-medical readers can enjoy the book thoroughly.

CR finishes his last anecdote with the piquant remark – “Despite the hyped humbug we are daily inundated with, by the media, there exists in this small country of ours, touches of beauty that transcends all. That merits our effort for its future progress. So join in.” Marx said “History does nothing; it possesses no immense wealth, fights no battles. It is rather man, real living man who does everything, who possesses and fights.” Read CR’s book to understand how he did, possessed and fought. I wish him good health so that he could write many more books for the benefit and enjoyment of both medical and non-medical readers.