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Appreciation
Dr. P. R. Anthonis

Fifty years of doctor-patient relationship

"It was all blood!"

"Frank?"

"Yes, sir."

"Anything like that before?"

"No, sir."

"Any pain?"

"A bit at the end."

"Fever? Chills?"

"None, sir."

After introducing who I was, that was the telephone conversation with Dr. P. R. Anthonis.

When I passed urine, the toilet bowl turned pink. Most unusual. I examined myself. There was no visible injury, scratch or bleeding point. Anxiety was overwhelming.

"Tuck, tuck." A knock at the door.

"Kopee eka, sir."

The morning coffee had arrived. Being not too hot, I gulped it down.

Passed urine again. The initiation was painless. The stream was clear at the start but soon turned pinkish and then red. The end was bloody and ticklish.

Differential diagnosis of painless hematuria whirled in my mind. Etiology? Site of bleeding? Kidneys? Ureters? Urinary bladder? Urethra? Injury, infection, neoplasm?

Rang in my ears my mother’s words, "Monkeys and modayas mess themselves trying to treat themselves."

Dr. Anthonis was unruffled. He proceeded with his inquiring questions. "I shay, can you be here before eight?"

It was getting close to 7am.

My counterpart, Christine, was gracious and helpful. She guaranteed she would cover up for my absence, inform the boss (Prof C. C. De Silva), and alert the nursing sister in charge of our ward.

At the entrance to Lady Ridgeway Hospital, I waited for a taxi. Base Line Road (presently Dr. Dannister De Silva Mawatha) was traffic thin. A CTB bus, several push cycles, and a "Black Maria" prison vehicle went past. A rickshaw conveying a sick child and a mother wearing a house coat pulled toward the Outpatient Clinic. The tinkling bell of the rickshaw made a weak noise. A yellow topped black

Morris Minor taxi beckoned me.

Ahead was Boralle junction which I knew all my life.

As a patient, I had been here before. For frequent coughs and colds, of my brother and me, our parents took us from our home at Kalapaluwawa on our Kalu Vassa driven buggy cart to Boralle to be checked by the only available physician, Dr. Gunasekera (who was later knighted by the British monarch as Sir Frank). Boralle had evolved much but the Bo tree and the public latrine was still there. The pungent malodor of the latter refreshed the olfactory memories. A bigger than life size picture of Jeevarani in the recently arrived Rand Muthu

Duwa dominated the east view. A street corner vendor was stacking the newspapers. That was the spot where Tissa the red shirted medic used to hawk the "Samasamajay" paper of his uncle’s party. The taxi veered off a green double decker trolly bus.

Ward Place was lazy and quiet. So was the multi-named Dr. Soyza circle, Lipton Circus, Eye Hospital Junction, and Es Wattuwa Handiya.

A parapet wall screamed in large, uneven red letters, "Down with Capitalism!" Hammers, sickles, and the digit four were painted around.

The taxi driver needed no directions. He turned at Turrett Road (presently Dharma Pala Mawatha) and stopped at Dr. Anthonis’ residence, the green and white, two storied architecturally esthetic abode. It reminded me of a beehive.

Dr. Anthonis was in a full white suit. He wore a blue shirt with small white squares. The red tie was kept in place by a gold pin.

"I shay, come inside."

The examination room was neat, spotless, airy and spartan.

After eliciting further details of the clinical history, he performed a careful, thorough physical examination.

The surgeon’s hands exuded confidence.

He ran through the possible etiologies and ordered urinalysis, complete blood count, and a plain x-ray of the abdomen with anteroposterior and lateral views.

"Although there is no obvious infection, I want you to take this

antibiotic," and he wrote a prescription.

"Take rest for these days, drink ample water, and let me know in a week."

At the door, he said, "Don’t hesitate to contact me if you need in the meantime."

Except for the urine report which expectedly had a "field full of red cells with no casts", the other investigations revealed no leads. Drank plenty of water. Symptoms disappeared fast.

When Dr. Anthonis was contacted for follow up, he recalled the facts of the case clearly and narrowed down the diagnosis.

"I shay, we have to distinguish between a silent stone which you passed, a neoplasm of the urinary bladder or filariasis." For further work up, he referred me to his house officer, Danny. (Dr Daniel Somaratne and I grew up together at Ananda College. He later excelled in neurosurgery at the famous Great Ormond Children’s Hospital, London.)

I was lined up for an intravenous pyelogram, a cystoscopy, and a retrograde pyelogram.

The intravenous pyelogram was unremarkable.

"I will peek into your bladder under a spinal. Charley will do the anesthesia. You know, he is really great," reassured Dr. Anthonis.

Dr. Somaratne did the pre-operative details and fixed me for the surgical theater.

Dr. Charles Herath Gunaratne performed spinal anesthesia. I was awake.

After the cystoscopic view, Dr. Anthonis said, "Your bladder is really good looking and I will pass two catheters up your ureter to inject the radio opaque dye."

Several radiographic pictures were taken while the patient was on the table.

"I shay, come and see in a week."

He removed his surgical gloves and put them in the trash can.

Turrett Road at dusk was brightly lit. Dr. Anthonis was strolling among his flower beds. His bush shirt fluttered in the breeze from Victoria Park (presently Vihara Maha Devi Park).

"Your kidneys, ureter, bladder, and the entire GU system are clean. There is no pathology. What you had was a silent stone. You passed it down and it caused a bleed."

Looking straight into my eyes, he advised, "Guard yourself against a recurrence."

I have been following his advice every day for the past half a century. No more leaking blood

Dr. Anthonis, my dear sir, may you attain NIbbana. With the Blessings of the Triple Gem.

A. A. W. Amarasinghe, MD
Consultant Psychiatrist
Atlanta, Georgia, US

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