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Sunday, November 30, 2014

Sriani Snippets - 7

WHO WE WHO WE WHO?…..WHO CARES ! 
  
Upto a generation back, most Sri Lankans were very interested in the “Who’s Who” of everybody.  In the 40s and 50s, when the population of Colombo was one tenth of what it is today, the upper and middle classes of Colombo’s Society knew the genealogy of all the other families, and one had to just mention a name, and the person was immediately slotted in as being So and So’s, So and So. This habit is gradually dying out, and most of today's youth are not in the least bit interested in the”who’s who”of anybody, unlike their grandparents. 
 
My  mother at eighty one, is a good example of that dwindling minority that still wants to know the who’s who of every name mentioned to her, and she in turn cannot relate an incident without giving the ancestry and connections of all the people mentioned or connected with the incident. On most occasions I miss the crux of the matter, or what she is trying to tell me, for she has to only mention the name of one of the people involved in the incident, and off she goes at a tangent telling me who’s who that person was. By the time she has elaborated on that, the primary objective has been forgotten. 
 
One day she phoned and informed me that she had just returned from the Dentist’s, and I was concerned and interested to find out the nature of her dental problem. I never found out as to what took her there, for she began by telling me that she had been to a new Dentist, who she said was my sister-in-law’s, sister-in-law’s, sister’s husband!!! As my sister-in-law has eight brothers and sisters, it took quite some time to trace the dentist, and her enthusiasm in tracing this relationship overshadowed the dental problem that I was interested in, and the matter ended there. 
 
When she gets invited to a wedding, she cannot rest until she has gathered “who’s who” the other party is, and even when I get a wedding invitation, she just can’t understand why I do not display much interest in tracing the ancestry of the bride or groom.  Recently, on receiving the invitation to a nephew’s wedding, the first question predictably was “who’s who is the Bride”? I had to only say it was Barbara’s daughter, and the next question was “Barbara who”? “Is it Barbara X, Barbara Y or Barbara Z.”?  The computer in her brain ran through all the Barbaras programmed there, and she would  not rest until I sorted out the “correct” Barbara, who fortunately happened to be a friend of hers, for otherwise I would have had to trace Barbara’s family tree for some distant relative that she had heard of, so that her curiosity could be satisfied that she knew who’s who the bride was. 
 
Even today I find that often, when one is introduced to someone, the conversation does not flow smoothly until that person has asked a series of questions, and established who’s who you are. Nine times out of ten, when I have been introduced to someone , the first question invariably is “Are you anyone of  S… & V… Basnayake”? When I answer in the negative, they go through all the Basnayake’s they have heard of, and are never satisfied until I have been “slotted in”. It is only then that the conversation begins to flow. 
 
This brings to my mind an unforgettable incident that took  place inside a plane, at Singapore Airport. I had just boarded the flight back home, and sat down in an aisle seat, when a Sri Lankan gentlemen made his way towards my seat. I knew who he was, though he did not know me. He had been allocated the window seat in the same row, but before getting in, he stared hard at me, and carried on the following conversation while still standing by my seat, impeding the smooth flow of traffic down the aisle, and ignoring the pleas of the flight stewardess to kindly move into his seat.
 
Question - “ Are you R…..De Saram”?
Answer  -   “No”
 
Question - “Sure, you are not R…..? You look so much like her”
Answer -   “Sure.” (I felt flattered, and thought how insulted R…. would have been at this comparison)
 
Question -  “ Are you a De Saram”?
Answer -    “No.”
 
Question -  “Are you related to R..De S, even distantly”?
Answer -   “Very distantly”
 
His face lit up, and he tried probing a little further.
 
Question -  “How are you related”?
I was not quite sure myself, and gave him what is called in common parlance a “D-rope”. 
 
Question -    “What is your name”?
Answer -      “Sriani Basnayake”
 
Question -    “Then you must be related to S..…and V….”.?
Answer  -     “No” 
 
By this time the Chief Steward had been summoned, and Mr. Nosey Parker (hereafter referred to as NP) was politely but firmly ordered to occupy his window seat. A few seconds later the middle seat was also occupied by a gentleman [Mr. “X”], and I heaved a sigh of relief, and took up the in-flight magazine, glad to be rid of NP.  Five minutes had not gone by before NP leaned over Mr. “X” and wanted  to continue from where he left off. He then went through all the Basnayakes he had heard of, and since my answers were in mono syllables, he did not make much progress in getting on with establishing “who’s who” I was. 
 
By this time the plane had ascended to 35,000 ft, and Mr. “X” (through sheer exasperation I believe) asked us whether we wanted to change seats so that we could continue our interesting (ugh!) conversation. Mr. N.P. excitedly said “yes, thanks awfully” and undid his seat belt, and simultaneously I said a firm “No thank you” in such a tone, that Mr. “X” got the message, and stayed put. 
 
For the next half an hour I was questioned and cross questioned by Nosey Parker, as to my school, my job and various other facets of my life, in an attempt to establish my who’s who. At that point--alas-- Mr. “X” got up to go to the toilet, and NP leapt into the vacant seat so that he could continue his interrogation at a closer range. 
 
He then got a new lead, and asked me what my maiden name was. I replied “Dissanayaka”.
 
Question  -  “Dissanayakas from where”?
Answer  -    “Nugegoda”.
 
NP’s face lit up.
 
Question -   “Was your father in the Police”?
 
Though I was tired and irritated, I thought of that little game we used to play as children, where we hid something ,and the other person went round the room looking for it, and  when they came somewhere close to the hidden object, one said “warm-warm”, and if they got very close, you were supposed to shout “hot-hot”.
 
I nearly burst out laughing, for I wanted to say “hot hot”.       “Yes” I answered.
 
He only did not jump out of his seat. “Jingle or Jungle”.?
 
“Jingle”, I answered.  A look of utter relief swept over his face. “why didn’t you tell me all this time that you were Jingle’s daughter? My uncle was your Father’s Bestman, and  my parents knew your parents,and my so and so and so and so, and … a long list of relatives who were supposed to be good friends of ours.”      “ Yes, I knew it, I know that you are Mr. So & So” I said, with what I imagined was a  smug look on my face.
 
“You mean, you knew who I was all the time”?
 
“Yes” I said, and flew off to the toilet, leaving a stunned but satisfied Nosey Parker. It is unbelievable to what lengths a person will go just to know who’s who a fellow passenger happens to be. 
 
Even today, many Sri Lankans are concerned about the who’s who of people they meet, and what others may think about their own family connections. 
 
Recently, I heard a story about a politician who was all ruffled and angry that some person at a function had made an insinuation that he (the politician) was a nobody. He tried to explain the situation to a group of foreigners who were with him, and shouted “knowing people know, who we who we who !!!”
 
(“Danna minissu dannawa api kargay kauda kiyala”)
 
 Dr Sriani Basnayake  
(This article was published in the “Lanka Woman” in 1998)       

Saturday, November 29, 2014

Hamilton Bailey FRCS, FACS - Surgical Tutor par Excellence

 
By Nihal D Amerasekera

Tombstone
Hamilton Bailey


 
 
 
 
 
 
 
 
 
 
                                                                                                                                                                                                                                             
 
 
To medical students and doctors the name Hamilton Bailey is synonymous with  Surgery for his extraordinary contribution to surgical literature. His books Demonstrations in Clinical Surgery  and A Short Text Book of Surgery which he co-authored with McNeill Love became our text books.  They were  bench-books for surgeons during their training.  His book titled Emergency Surgery was greatly respected by practicing surgeons.  These books are still in print, updated and widely read. They still command worldwide sales. With such knowledge and expertise I assumed he lead a charmed life of luxury basking in his wealth and affluence. I thought he was an eminent consultant in a prestigious London teaching hospital with a lucrative Harley Street practice. I was proved wrong on both counts. 

For many years, in September, I have followed the swallows in their migration to southern Spain for the luxury of autumn sunshine. The Costa Del Sol is a paradise for sun-worshippers. I made my annual pilgrimage to a quiet corner away from the hordes that descend on this magical place. On one such occasion I visited the city of Malaga, the largest coastal city in Andalucia. It is a fascinating place with Moorish and Roman ruins and the Picasso Museum.  As I walked its pretty tree lined streets I came across an English Cemetery and decided to take a stroll along its well-heeled passages. As usual I read some of the tombstones as I passed by and amazingly came across the name of Hamilton Bailey. This aroused my curiosity and fascination to research his life to find out why he lay in a distant foreign field. 

Hamilton Bailey was born to Scottish parents in 1894. His father was a doctor and his mother, a nurse. She suffered from depression and drank heavily. His sister had schizophrenia and was in and out of mental institutions.  Thus his childhood wasn’t ideal.  Despite his difficulties he  entered the London Hospital Medical School at the age of 16 and qualified in 1916. While training in surgery at the London Hospital he developed an infection in one of his fingers which had to be amputated. This was the era before antibiotics. It was a tragedy for a budding surgeon. 

 In 1927 he published his first book Demonstrations in Clinical Surgery. A Short Text Book of Surgery soon followed in 1932.  His co-author was his friend and colleague McNeill Love.  His wife who was a photographer did the magnificent illustrations for his books. Meanwhile he made many unsuccessful applications for consultant posts in several hospitals.  In 1930 he finally got his break at the Royal Northern Hospital in Holloway, North London. It was not considered an elite London teaching hospital.  His reputation spread as a charismatic teacher and a fine lecturer. He was one of the first to organize a drill for cardiac arrest. Hamilton Bailey became a Hunterian Professor at the Royal College of Surgeons. 

With his large frame and self confidence he was demanding and domineering. Those who knew him have said he had few social graces, had no respect for authority and no rapport with patients or colleagues. It is a sad indictment for an elegant author and a superb lecturer with so many publications to enhance the profession. 

Tragedy struck his family when his only child died in a railway accident in 1943. His mental health suffered and his behaviour became erratic.  His temper was uncontrollable at times. In 1949 Hamilton Bailey gave up his surgical practice and sought psychiatric help.  He was sectioned and incarcerated for 3 years  and was unresponsive to treatment. When they were planning a prefrontal leucotomy  a young registrar suggested trying out a new drug.  He was started on Lithium.  Although he made a remarkable recovery he never worked in medicine again.  In 1951 he retired and bought a house in the hills near Fuengirola close to Malaga, in Spain, to enjoy its Mediterranean climate. There he continued to write and maintained contact with his surgical friends in England. 

While enjoying his retirement he developed signs of acute intestinal obstruction. He was rushed to the hospital in Malaga where he had an abdominal operation. Hamilton Bailey died in 1961, aged 66,  of septicaemia and peritonitis after surgery to remove a cancer of the colon. He was buried in the English cemetery in Malaga, Spain.  There are many doctors who visit the grave to pay homage to this brilliant teacher. They come not only from the UK but from all over the world. 

There can be few doctors of my generation who do not remember Hamilton Bailey gratefully. Unlike many consultants of his era he never chased money nor accumulated wealth for himself.  His erratic behavior and tantrums are perhaps due to his difficult childhood and mental illness.  I sincerely hope history will judge him kindly and remember his many contributions to surgery and his brilliance as a teacher and author.  He changed the face of surgical teaching in the 20th century.  

None of our lives are what it appears from the outside.  When I delve into the lives of famous people I realize amidst their success they too have their share of misfortunes and tragedies. There are many events in our lives that are beyond our control.  What amazes me most, in our lives, is the awesome force of destiny. 

I dedicate this short biography to my friend Bernard Randeniya  alias Claude Bernard . He was my constant companion all through Medical School and beyond. I have vivid memories of criss-crossing the long corridors of the General hospital Colombo with Bernard  looking for “good cases”. The agony and the ecstasy of exams, dancing and prancing, the music and the laughter of those years come easily to mind. He became a valued administrator in charge of the Cancer Institute in Maharagama.  Bernard had so much to offer society when his life was cut short.  Destiny was never kind to him. I will always remember him most fondly for his friendship, generosity and loyalty. His loud laughter still rings in my ears.  May his Soul Rest in Peace.

C’est la vie 

Lives of great men all remind us 
  We can make our lives sublime,
And, departing, leave behind us   
  Footprints on the sands of time; 

                                       - Henry Wadsworth Longfellow 

 
 

Friday, November 28, 2014

Sriani Snippets - 6


To be or not to be……..

                   (what my daughter wants me to be)……that is the question. 

Should I be what I am, or what my dear daughter (hereafter referred to as DD) wants me to be? I wonder whether there are other mothers in this same situation?
 
From the time DD was a little girl, she thought that her mother was not a “proper mummy”, be it my size, mode of dress, my make-up, my abilities etc…etc…. Over the years it has given me so much joy and amusement listening to her persuasive pleas of trying to change her mother to fit her image of what a “proper mother” should be. She has since grown up and married, and mother has grown old and retired, but DD still continues her valiant efforts to “re-fashion” her ageing mother. 

When DD was a little girl, I had to pay numerous visits to her school to meet the Principal on official matters. On these occasions, when she returned home, her one plea would be, “Ma, please don’t come to school wearing a sari….. no other mother wears a sari…..can’t you wear a dress or slacks?” The fact that I dropped in at school on my way to work, or during my working hours, and that sari was my official attire, did not satisfy DD. 

Then came the criticism of my culinary skills. I used to put in considerable effort in making different types of sandwiches for DD to take to school for her morning snack. However, on most days she used to come back and inform me that she had eaten someone else’s sandwiches, and that they were “yummy”. I heard that A and B and C’s mothers made “yummy” food, and that her lunch was much below par. My only salvation was my cousin Shanthi, one of Sri Lanka’s foremost cookery experts, and she used to give me tips on new fillings, and how to “improve” on my sandwiches. With all this added effort, I still did not receive any compliments, until one day I happened to casually meet one of DD’s little friends, who said, “Aunty, Shari brings some “yummy” stuff to school, and we all tuck into it”. It made my day. The euphoria did not last long.

DD used to walk across the road from school to cousin Shanthi’s house to wait to be picked up and taken home. Often this happened to be just after one of Shanthi’s cookery classes, and DD used to sample the leftovers of the gourmet dishes turned out by Shanthi. Then, for the next few months it was “why can’t you learn to cook like Shanthi Akka…her food is simply out of this world.”  I fully endorsed these sentiments, but as to reaching Shanthi Casie Chetty’s standards was definitely out of the question. 

Next came constant criticism about my sewing skills, and my not being able to turn out dresses and costumes as when the demands were made. “Niro’s mother can sew a dress in one day, why can’t you?” I didn’t see the necessity of having to turn out a dress in one day, but after much coaxing; I was “sent” to a sewing class on Saturday afternoons, as all “proper mothers” knew how to sew their children’s clothes. I enjoyed my sewing classes conducted by my dear friend Barbara, but sad to say, I never graduated to producing instant outfits for DD.

After leaving school, DD spent the next decade teaching me the art of applying make-up, and trying to get me to shed the tons of fat built up over the years. When it came to her wedding, it was of paramount importance that Mother had to be knocked into shape, and boy, what an effort that was. First it was to a Beauty Salon. Where I was ‘measured’ and then had a rotating belt massaging the excess adipose tissue. In less than five minutes I had fainted, and had to be given first aid. Next it was “Dead Sea Mud”. Fantastic results initially, which made me a “presentable” mother of the bride. However, my penchant for sweet snacks “undid” the good work. 

Even after marriage DD did not give up her mission of “molding” her aging mother. I was constantly being reminded of the svelte figures, perfect skin textures and good looks of Aunty Swyrie,(our batch-mate Swyrie) Aunty Dhushy and other dear friends, and whenever she found me looking grubby and disheveled, she would say, “Why can’t you be like Aunty Swyrie? Do you ever see her with her hair looking like as if she has come through a cyclone?” Hard luck…few women can match up to Aunty Swyrie…. forget it. My accessories also don’t seem to match up to DD’s standards. I was told that my wristlet watch resembled one worn by Dubai-returned housemaids…(come to think of it, I did buy it at the Dubai Duty Free shop!) and why couldn’t I buy a Philippe Charriol like the one worn by Aunty Meropie. The fact that my timepiece serves only to check the pulse rate of people was not a convincing argument. In desperation she presented me with one of her discarded watches. 

Then there came the point in time when I had to contend with an additional critic, my dear Son-In-Law (SIL). SIL is very polite, and does not address his observations directly to me, but they get conveyed to me via DD. It appears that SIL is also concerned about my vital statistics and general appearance. As such, one day I was informed that SIL had been critical about the condition of my feet, which sent me flying for a pedicure. The result satisfied both DD and SIL…but only where my feet were concerned.

The next jolt I got was when I heard that SIL had remarked to DD that I now resembled a boat! Hubby tried to soften the blow by saying that there are boats and boats, and that he could have been referring to a rowing boat/ catamaran/ Dvora FAC or other “medium” sized boats, but I knew he was referring to something closer to the “Queen Mary” or the “Titanic”. Oh dear…when does one “let go” as Clare Senewiratne aptly wrote a few months ago. 

As a last resort I went to a famous Dietitian in Colombo, who gave me good advice and a diet sheet. The fat began to melt, and the needle on the weighing scale kept moving anti clockwise, and I was floating on cloud 9 for a few weeks…..till….till hubby decided to have ‘Tiffin’ every evening, and came home waving ├ęclairs and cream buns tantalizingly in my face. It was not fair, for he knows that I have no will power to resist a cream bun when it is held one inch from my mouth. Wallop it I did, and that was the end of the diet. 

Next came my birthday and DD had presented me with a birthday gift of an array of cosmetics, various types of eye make -up, anti-wrinkle creams and perfumes. . That evening, I made a great effort to apply all that ‘beauty stuff’ so lovingly given, hoping to be complimented on my ‘new look’ by my dear daughter. Imagine the shock I got when all she said was “Ma, what have you done to your face? You look like a Panda”!!! I read the other day that Pandas are becoming extinct, but not to worry, there is one big one still roaming around in Nugegoda! 

I give up……and let go. No more diets, no fancy make-up, no trying to compete with Dvoras. I will sail into the next world like the QE2.  I will be just myself, and my feelings are well described in a poem by an anonymous author, irreverently titled “ The 23rd Pound”. 

The 23rd Pound

My appetite is my shepherd, I always want.

It maketh me to sit down and stuff myself.

It leadeth me to my refrigerator repeatedly.

It leadeth me in the path of McDonalds for a Big Mac.

It destroyeth my shape.

Yea though I knoweth I gaineth,

I will not stop eating,

For the food tasteth so good.

The ice cream and cream buns, they comfort me.

When the table is spread before me, it exciteth me,

For I knoweth that soon I shall dig in.

As I filleth my plate continuously,

          My clothes runneth smaller.

Surely bulges and excess weight shall follow me

          all the days of my life,

And I will be fat forever. 

Dr Sriani Basnayake. 

(This was published in the “Lanka Woman” in the late 90s)

Thursday, November 27, 2014

Mini - Reunion at Hyde Park Residencies

Pram hosted a dinner at her Hyde Park Residencies last night to welcome Speedy.
Standing L to R: JC, Suri, Chandra, Swyrie, Speedy, Lucky, Lama, Kusuma, HN
Seated: Sriani, Chirasri, Sura and Pram.
(Wasantha, Senerat and Gnanis are not in the picture as they had already left). 
 
To see the full album, please click on:
 
 
 

Wednesday, November 26, 2014

Sriani Snippets 5


IT ONLY HURT WHEN I LAUGHED - The Reality of a Hysterectomy
Sriani Basnayake

Hysterectomy or the surgical removal of the womb is a very common operation today. Unfortunately, many women are terrified at the thought of undergoing this operation, and the explanations of their gynaecologists seem to be nullified by the negative facts trotted out by every woman they subsequently meet, who has had a hysterectomy, or knows someone who has had one. I suppose human nature is such that one tends to believe the story of someone who has actually experienced the procedure, rather than the doctor who advises them not to worry, that it is a simple operation etc…etc..for they feel that somehow he hasn’t undergone the procedure himself.

This is what prompted me to write this article to ‘Lanka Woman’, for I had a hysterectomy done three weeks ago, and I thought that I would be able to help and reassure many women by sharing my experiences as a patient.

Fortunately there wasn’t much of a time lag between the decision to operate, and the date of the operation. However, in that week, everyone whom I met who had undergone the procedure, or had stayed with such a patient in hospital, told me that it is extremely painful for the first two, three or four days, (it differed in different cases) but not to worry for the pain  will gradually decrease with time. Even though I was a doctor, some went to the extent of kindly volunteering to relate various rare complications that occurred in their patients. All in all a pretty grim picture was painted. Even though it did upset me at the start, I chose to forget the negative thoughts, and placed myself in God’s hands.

The evening before my operation, the Archdeacon anointed me, and at the end of his prayers, all my residual fears and apprehensions vanished, and a wonderful calm settled over me.

My brief sojourn in hospital can be summarized as follows – The operation was performed on a Thursday morning. On Friday morning, I got out of bed, walked out of my room, and was sitting on the verandah outside when my Gynaecologist came on his morning round. My stitches were removed on Saturday, and I was discharged on Monday morning, and advised to take a bath. So I came home, and stood under the shower and felt thoroughly refreshed. On the seventh day I was gently pruning my rose plants despite violent protests from my daughter.

Due to the post operative sedation, my recollections of Day One are hazy, but I must emphasize the fact that I had absolutely no pain whatsoever from the second day onwards. I dare say there was that slight pain when getting in and out of bed, or coughing, but that was all. This is the absolute truth, and for a person like me, whose pain threshold is very low, it was remarkable not to experience any post operative pain. Those who visited me in hospital will vouch for this, for some remarked that I didn’t look as if I even had a tooth out, while others said that I looked the same as I did sitting in office.

The only time I experienced pain was when I was visited by an eminent surgeon in the General Hospital, who is as well known for his transplant surgery as for his inexhaustible storehouse of jokes. He used to pop into my room each morning while on his rounds. His jovial disposition was an instant mood elevator for any patient, which I’m sure, accelerated my recovery process. Each day he left my room cracking a naughty joke, and that was the only time when my wound really hurt, for I could not stop laughing for the next five minutes.

I must be grateful to have been in the hands of a wonderful Gynaecologist, whose personal charm equals his surgical skills, and I feel that both these attributes are equally important as far as the welfare of the patient is concerned.

I know that very few patients would have the good fortune that I had of having one of my medical batch mates as the skilled Anaesthetist in attendance. Additionally, I had that extra bit of luck to have a caring niece as the House Officer.

ADVICE TO PATIENTS

Carefully follow the instructions given by your doctor both pre and post operatively, and you will have no problems. Never compare instructions with those given to your friends, for each case can be different.

I was advised to get operated on at the General Hospital Colombo, and I am ever grateful for that advice, for despite a few other comforts or privileges one may enjoy at a Private Hospital, you can’t match the Theatre and Emergency facilities, and availability of trained nurses, as found in a Government Hospital.

ADVICE TO RELATIVES

I know how anxious family members are to be with their loved one before she is wheeled off to the Operating Theatre. At such a time, please do try hard to look bright and cheerful, and crack a joke if you can, for the way you look during those vital few minutes can have a profound effect on the morale of the patient. On many occasions I have seen relatives stand round the patient and gaze down at her like the chief mourners at a grave side. The poor patient may feel that she is being given a tearful final farewell. I felt like that momentarily when my Mother bent down and kissed me before I was wheeled out to the Theatre. The look on her face, (I don’t blame her, she may have been terrified) and the kiss had only to be coupled with the words “deepest sympathies” and she could easily have been at a funeral house. Fortunately this was counteracted by the beaming faces of my daughter and cousins, together with the thrill of going down in that ancient contraption of a lift in Merchant’s Ward, which is manually operated on a system of pulleys and ropes.

ADVICE TO VISITORS

Be thoughtful enough not to visit a patient for 24 hours, or preferably 48 hours after major surgery. You don’t need to be a doctor to be able to look at a patient’s face and gauge whether she is in pain, or in a mood to carry on a conversation with you. If she doesn’t look up to the mark, make your visit as brief as possible. Please don’t keep talking endlessly and then ask the patient “how do you feel”, for she can never tell you plainly “I feel like throttling you”!

I had such a pleasant stay in hospital that I could hardly believe that I had undergone major surgery. In addition to the expert surgical and medical attention provided by the doctors and hospital staff, there were so many other factors which I feel contributed to my comfortable and happy stay in the ward.

The care, concern and kindness shown by my friends and colleagues, some of whom arranged a roster to be with me for the first two days, was overwhelming. I go crazy over flowers, and many showed their concern by saying it with flowers. It was wonderful to come out of anaesthesia and find myself surrounded by masses of exquisite flower arrangements and roses sent by thoughtful friends.

The humorous episodes are also unforgettable. My four year old niece Amrita had been taken to a hospital on very few occasions, and these had always been to visit Aunts after childbirth. So you can imagine her disappointment when she searched all over the room (and under my sheet) and couldn’t find the baby!

Children, these days, are very advanced. Amrita and my five year old nephew Caesar wanted to know where the cut was, its length, was it sewn up with thread, or pasted with sellotape, gum or paste, plus a whole host of other ‘surgical’ details. By this time they had climbed on to my bed, and were perched precariously over my abdomen, and as curiosity would not only have killed the cat, but their Aunt as well, I agreed to a “special exposition” just for the two of them!

I hope that my experience will help to allay the fears and anxieties of Lanka Woman readers who may have to undergo a hysterectomy in the future. Should your gynaecologist advise you that such an operation is necessary, don’t hesitate or postpone it, for today it is a very simple procedure, and you can take it from the horse’s mouth – it only hurt when I laughed.

(This article was first published in the Lanka Woman paper on the 8th of May 1991)

It was written mainly to allay the fears of so many women who are terrified at the thought of having to undergo a hysterectomy. After the article appeared in “Lanka woman”, I got at least 20-30 calls from unknown women, thanking me for dispelling unwanted fears, and giving them the courage to face the operation.

 

 

Tuesday, November 25, 2014

Some Thoughts About Rugby

By Nihal D Amerasekera



The beautiful game of rugby is quintessentially British.  It started as a sport in 1824 at Rugby School which is 90 minutes drive away from my home in England. I have had the good fortune to visit this great school established in 1567 when my elder son played 1st XI cricket for a rival public school.   The elegant sweep of the 500 year old school buildings is breathtakingly beautiful. The view of the school as a backdrop to the lush green sports ground is stunning. It was the British who brought over the ethos, curriculum and the sports to Ceylon from their own Public Schools. Eton, Harrow and Rugby were the breeding grounds for the army officers and administrators who helped to govern the colonies of the Great British Empire.  The novelist George Orwell wrote: 'Probably the battle of Waterloo was won on the playing-fields of Eton’. Thomas Hughes attended Rugby School from 1834-42 and has written a graphic account of his life as a boarder in “Tom Brown’s schooldays”.  He recounts the camaraderie, friendships, the highs and the lows in ‘vivid technicolour’. I have posted a photo of Rugby School in the  hope that when you watch your next game of Rugby you will reflect on where it all started  nearly 200 years ago.

I dedicate this short account to my friend and batchmate Sidath Jayanetti who played Rugby for Royal College. His fearless tackles and sweeping runs will be long remembered as will be his friendly smile and genuine kindness. I remember with much fondness our happy time together in Kurunegala all those years ago. How time has flown !!

A Get-together of old friends

Mahendra (Speedy) Gonsalkorala is on a short holiday in Sri Lanka.

Sunday, November 23, 2014

Sriani Snippets - 4

THE BRADBY – AN OLD AUNT GOES DOWN MEMORY LANE
Sriani Basnayake 

Come June, and Bradby fever grips a fair percentage of Royalists, young and old, and at times ‘infects’ loyal supporters in distant climes who faithfully make their annual pilgrimage to that sacred shrine – ‘The Bradby’. 

One feature of ‘the Bradby’ has been that there has been no gender bias, for even though the game itself is an all male affair, the interest in the game is shared by a large segment of the female population, ranging from sisters, admirers, girl friends, friends of girl friends, mothers, aunts and even grandmothers. In my life, I seem to have gone through all those categories. 

Being a sentimentalist, in recent years I have viewed the Bradby with a mixture of extreme happiness tinged with some sadness. At the 125th Royal Trinity Bradby encounter, when my handsome nephew sporting his no: 8 jersey ran on to the field, I basked in reflected glory, and floated on cloud nine for one long glorious hour, for it was the first time in the history of the Bradby that three generations of one family, three Dissanayakas (father, son and grandson) had played for Royal. My father (S.A.Dissanayaka) played for Royal in 1931 and captained in 1932. My brother Laki played from 1962-64, and his son Gemunu from 1996-98. Cruel fate prevented my brother  from achieving one of his life-long ambitions, that of seeing one of his sons playing in the Bradby. I am sure he and his father would have cheered lustily with all the other Royalists on that far brighter shore, when in 1998, his son as Vice Captain, played brilliantly to humble the Trinitians on their home ground, and win the Bradby Shield for Royal. 

As mentioned earlier, the female of the species gets interested in Rugby for reasons beyond the game. I first went to a rugger match as a young teenager, and knew next to nothing of the rules of Rugby.  It happened that I went only for matches involving the Royal team, for those were the matches that my brother went for, and as I had to be chaperoned by my dear brother, I was sent with him, and my parents were blissfully unaware that he abandoned me from the moment we reached the grounds until it was time to depart.

I took great delight in watching my handsome rugby heroes run on to the field, and was dazzled by their flying tackles, brilliant solo runs and the excitement of the rucks and mauls. My heart missed a beat when my shining knights in armour got tackled, trampled and squashed, and at times injured, and ended up looking a “bloody muddy mess’. 

Gradually I gathered the finer points of the game, but by this time I was interested only in my brother’s rugby skills, and kept my eyes glued on him throughout the sixty minutes. The tension and excitement was too much for me when he got ready to execute one of his famous drop kicks, and I still remember those legendary drop kicks at the Nittawela grounds that helped Royal to thrash Trinity 14/6, and win the Bradby Shield in 1964. 

A quarter century later, his two sons followed the family tradition and played under 17 rugby, and their ageing aunt’s interest in the game was re-kindled. By this time, the effects of advancing age were affecting their aunt’s vision to such an extent that I could spot my little hero on the field only by the number 8 on his jersey, or later by his scrum cap. In addition to the ill effects of the natural process of ageing, my concentration on the game, (or to be more precise, on my nephew) was constantly interrupted and disturbed by other distracting elements which are now part and parcel of popular rugger matches…. viz ..Vociferous female supporters. 

A rugger match is a place for females of all ages to display their fashions, their anatomical endowments, and to see and be seen. The numbers that fell for tackles in the stands may have far surpassed those tackled on the field. The antics in the stands often convinced me that there were much faster numbers on the side lines than the fastest three quarters on the field. Females with little knowledge of the game keep shouting instructions to the players, and one wonders whether their high pitched screams of “tackle low”…  “pass it….pass it”  or “go boy go” etc were meant for the players on the field or those sitting by them in the stands, who were either tackling too high, or had not found touch even though they had covered considerable ground up and under. When fashion decrees that the hemlines go higher and higher each year, the 22 metre line has coincided with the 5 metre line, and the playing area has been so drastically reduced that any blind man will be able to touch down between the posts without the slightest chance of being off side during the entire operation! 

As I pen these lines in this millennium year, I do not know whether I will have the pleasure of watching still another Dissanayaka take the field, but even otherwise, I can enjoy the evening in the company of the ageing Bradby heroes of yesteryear, go down memory lane, and sing:

                        “And we their loyal sons now bear

                         The torch, with hearts as sound as oak,

                         Our lusty throats now raise a cheer

                         For Hartley, Harward, Marsh and Boake.
(This article was first published in the Royal College Bradby Souvenir of 2000, when Sriani’s nephew Gemunu Dissanayaka was Vice Captain of the Royal College 1st XV).

Monday, November 17, 2014

Study Finds Alternative to Anti-Cholesterol Drug

Photo

Dr. Robert Califf, a Duke cardiologist, led a six-year study of a new cholesterol-lowering drug.      
Jeremy M. Lange for The New York Times          

For the first time since statins have been regularly used, a large study has found that another type of cholesterol-lowering drug can protect people from heart attacks and strokes.
 
The finding can help millions at high risk of heart attacks who cannot tolerate statins or do not respond to them sufficiently. And it helps clarify the role of LDL cholesterol, the dangerous form. Some had argued that statins reduced heart attack risk not just by lowering LDL levels but also by reducing inflammation. The new study indicates that the crucial factor is LDL, and the lower, the better.
 
The six-year study, reported Monday at the annual meeting of the American Heart Association, involved 18,000 people who had had heart attacks or episodes of chest pain so severe they went to a hospital. They were randomly assigned to take a statin or a combination of a statin and the alternative drug to further reduce LDL levels.             
                       

Both groups ended up with very low LDL levels — those taking the statin, simvastatin, had an average LDL of 69, and those taking simvastatin and the other drug, ezetimibe, or Zetia, in a combination pill sold as Vytorin, had an average LDL of 54. No clinical trial had ever asked what happened when LDL levels get below 70 because, said Dr. Robert Califf, a Duke cardiologist and the study chairman, “many people were nervous about going this low and imagined a lot of possible toxicities.”
 
Statins lower LDL by preventing it from being made. Ezetimibe lowers LDL by preventing cholesterol from being absorbed in the gut.
 
The drugs were so effective that there were few cardiac events among the participants but eventually a difference emerged. There were 6.4 percent fewer cardiac events — heart disease deaths, heart attacks, strokes, bypass surgeries, stent insertions and hospitalizations for severe chest pain — in those assigned to take Vytorin. The amount corresponded to what was predicted from the extra degree of cholesterol lowering with the combination drug.
 
Those results translate into 2,742 events in those taking simvastatin and 2,572 in those taking the combination drug. That means, said Dr. Christopher Cannon, a principal investigator and cardiologist at Brigham and Women’s Hospital, that two out of every 100 people who would have had a heart attack or stroke by taking the statin avoided those outcomes by taking the combination drug.
And, adds Dr. Califf, the study found no side effects from ezetimibe — no excess cancer, no muscle aches no headaches. “It looks like placebo,” he said.
The study was sponsored by Merck, the maker of Vytorin, but the investigators had the right to publish what they wanted, with final say over what they wrote.
“Fantastic,” said Dr. Sekar Kathiresan of the Broad Institute and Massachusetts General Hospital who studies the genetics of heart disease but had no part in the study. “A truly spectacular result for patients.”
Dr. Harlan M. Krumholz, a Yale cardiologist not associated with the study, said he wished there was a peer-reviewed journal article instead of a presentation of the results at a meeting — the data analysis was completed just last week — but, assuming the result holds up, “this is the result we were hoping for.”
 
At the same time, and by sheer coincidence, two other groups of researchers reported genetic studies that supported the trial’s conclusions. One, led by Dr. Brian A. Ference of Wayne State University School of Medicine found that gene mutations mimicking the effect of ezetimibe and ones mimicking the effect of statins had the same effect on heart disease risk for a given reduction in cholesterol. The implication, he said, is that “lowering cholesterol with ezetimibe, or a statin, or both, should each lower the risk of heart disease by about the same amount.”
 
The other, led by Dr. Kathiresan, examined mutations that disabled one copy of the cholesterol absorption gene, producing the same effect as ezetimibe. The result was a 50 percent reduction in cholesterol absorption — the same as produced by ezetimibe — and an LDL reduction of 12 milligrams per deciliter of blood, also the same amount as produced by ezetimibe. The mutation, which gave people the equivalent of a lifelong exposure to ezetimibe, reduced the heart attack rate by 50 percent.
 
The study’s results are making many wonder about the latest cholesterol guidelines, which did not mention any drug other than a statin. And instead of providing goals for cholesterol levels, they simply advised those at high risk to take a statin.
“The guidelines didn’t say they didn’t believe in cholesterol, but they made it clear that the evidence is for a statin, not for any agent that lowers cholesterol,” said Dr. Eugene Braunwald, a study chairman who is a cardiologist at Brigham and Women’s and a longtime leader in the field.
 
Dr. Neil Stone, the head of the guidelines committee and a cardiologist at Northwestern University, has a more nuanced view of what the guidelines say, but adds that the study result “gives doctors another option if they have a patient who can’t tolerate a high-intensity statin.”
 
The new data are in sharp contrast to what happened in 2006, when ezetimibe seemed useless. The study was small, with just 750 participants, all of whom had very high cholesterol levels. Instead of looking at heart attacks or strokes, the researchers looked at a surrogate, the buildup of plaque in the carotid artery of the neck. That made the study quicker and easier than waiting for people to have heart attacks. But it was not clear whether those carotid plaque measurements really reflected heart attack risk.
But ezetimibe had been approved purely on the basis of its ability to lower LDL. With that stunning negative result, the question about LDL’s lowering could not be avoided. Perhaps statins, the exemplar for the benefits of lowering LDL levels, were effective for more than just their effects on LDL.
“This is as bad a result for the drug as anybody could have feared,” said Dr. Steven Nissen, the chairman of cardiovascular medicine at the Cleveland Clinic, when the 2006 ezetimibe results came out. The results, he said, were “shocking.”
The drug, Dr. Nissen noted in a telephone call Friday, had reached 17 percent of market share for cholesterol-lowering drugs with no evidence of benefit.
“Now we have the result,” Dr. Nissen said. “They were successful, and that’s great. But at this point, it really doesn’t matter. They made their $30 billion.” The drug will be available as a generic in 2016, Merck says.
That the drug was promoted and sold for so many years without evidence that it helped was inexcusable, Dr. Krumholz said.
“The fact that the trial exists says there was uncertainty,” he said. “The company and the investigators and the scientific community were uncertain about it. This is a cautionary tale.”
“The results could easily have gone the other way,” he added.
For Dr. Cannon, the study has a broader lesson. “It reminds us that lowering LDL prevents heart disease,” he said.
Now, Dr. Braunwald said, the arguments over cholesterol lowering should be settled.
“People can stop yapping.”
 
Correction: November 17, 2014
An earlier version of this article misspelled the name of a drug in the trial. It is Vytorin, not Vitorin. It also misspelled, in two instances, the name of another drug. As the article correctly noted elsewhere, it is ezetimibe, not ezetimide or ezitimibe. And it mispelled the surname of a doctor not involved in the trial. He is Dr. Harlan Krumholz, not Krunholtz or Krumholtz.