Memories of the Physiology Department of the Colombo Medical School



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 Carlo Fonseka


[Excerpted from Glimpses of Time (2014) launched today (9/7) by the Colombo Medical School Alumni Association (COMSA)]


I enrolled as a student in the Colombo Medical School (CMS) in June 1955. I was brokenheartedly obliged to resign from its Chair of Physiology at the end of 1989. The reason for prematurely severing my existential bonds to my beloved medical school which made me what I am; and the place where I spent most of my waking hours between 1955 and 1989 had to do with the horrendous socio-political reality that prevailed in the country at that time. With an estimated murder rate of over 100 per 100 000, Sri Lanka in 1989 became literally the bloodiest place on earth. I left the country in early March 1988, two weeks after the cold-blooded murder in broad daylight of my nephew Vijaya Kumaratunga, the film idol and charismatic political leader. Following his spectacular televised funeral on 22 February at which I made a highly emotional speech, I was told that VK’s murderers would come for me. So I hurriedly left the CMS and the country for Helsinki, Finland with permission obtained verbally from the Head of State. I realize that my stream of consciousness narrative with inevitable fragmentation of time and space begins by focusing on the end of my association with the CMS. Allow me now to recount my memories of the Physiology Department in a more orderly way by starting at the very beginning.


Joining the Department


Having graduated MBBS in 1960 and completed my internship under Prof. K. Rajasuria and Senior Surgeon Dr. Noel Bartholomeusz at the General Hospital Colombo (as the National Hospital of Sri Lanka was then called), I opted to serve as a medical officer at the Base Hospital Mihirigama because it was the hospital nearest to my native village of Divulapitiya. After a brief period of intensive service at Mihirigama, on 1 January 1962, I joined the Physiology Department of the CMS as a lecturer. I always felt that I had been born to care for sick people, but at the end of 1961 I deliberately changed the course of my career and chose to teach the non-clinical, unglamorous subject of Physiology. I did so due to an extraordinary concourse of circumstances.


I remember very clearly the moment I decided to quit clinical work. As it happened, I married my childhood sweetheart in 1961 during my internship, after which I went to work at the Mihirigama Hospital because I wanted be of service to the poor people of my village. The hospital had seven wards including a children’s ward, a maternity ward, and a ward for bhikkhus. I loved my work, which I did enthusiastically and tirelessly; the people of the area came to regard me as a sort of ideal doctor. In fact, my chief virtue as a doctor may well have been my availability. (Like former Prime Minister Sir John Kotalawala’s concept of the ideal woman whose three most desirable attributes are availability, availability and availability, I too was readily available to patients at all times.) Of the three medical officers serving Mihirigama Base Hospital, the DMO was a benevolent senior doctor who administered the hospital, attended courts and avoided night calls. The DMA, who was preparing to get married at that time, was understandably more interested in courtship than in his hospital duties and thus was on leave most of the time. Consequently, as the junior doctor, I was almost literally worked to death.


The straw that broke the camel’s back came in the form of three successive emergency calls between 9 and 10 pm when, after a tiring day, I went to sleep with my newly-married beloved. One call was to see an infant with febrile fits, the next call was to treat a case of threatened abortion, and the third was a call to attend on a diabetic bhikkhu with central chest pain. The successive calls came while my wife and I, like the Moor and Desdemona in Shakespeare’s play Othello, were engaged in "making the beast with two backs." Those who know the stages of the human sexual response do not have to be told how excruciatingly frustrating it is to be interrupted three times during what we were taught to call "the act of sexual congress." Irritated beyond endurance, I decided to apply for a lectureship in a non-clinical subject which I had seen advertised in the Ceylon Daily News that morning. Prof. ACE Koch, who had been inordinately impressed by my memory for physiological trivia when I was a student, was delighted to recruit me to his Department, although I did not have a distinction in Physiology.


Three Teachers


In retrospect, physiology was the subject I most enjoyed in the CMS. Three men—Elsley Koch, David Jansz and Valentine Basnayaka—taught the subject with such enthusiasm that when I decided to abandon a clinical career, it was physiology that attracted me. For one thing, the teacher in the CMS who had been most lavish in his praise and hearty in his approbation of me as a student had been Prof. Koch, the first Sri Lankan to hold the post of Professor of Physiology in the CMS. Very early in my career, his praise won for me the admiring attention of my peers. For another, physiology was the subject in which I had got the highest marks in the batch in the first-ever term test we faced in the CMS. In my answer to a question on the milieu interieur I had quoted Claude Bernard in French, and Prof. Koch thrilled me by referring to that fact during a tutorial. It was from him that I imbibed the profound truth that the constancy of the internal environment (milieu interieur) was the condition necessary for us to lead "free and independent" lives. Even as a student I began to understand that our happiness depends more crucially upon our physiology than upon our philosophy. It was much later that I gradually sensed the full importance of physiology and came to regard it as the "proper study of mankind". Time, perhaps assisted by ageing, elucidated for me the reason why one of Alfred Nobel’s five original prizes was for Physiology or Medicine.


Dr David Jansz


From Dr Jansz I learnt above all the value of defining concepts precisely and clearly. I still know by heart his comprehensive definition of the nerve impulse. Believe it or not, he was more interested in astrology than in physiology, and he tried his best to kindle in me an interest in the subject which I disdainfully dismissed as fantastically imprecise pseudoscience. On the 25th of September 1959, when the Prime Minister of the country, Mr. SWRD Bandaranaike, was shot and brought to the General Hospital, work came to a standstill. So I went to my room in our hostel Bloemfontein. At about 2.00 p.m. there was a knock on the door of my room and when I opened it I saw Dr David Jansz. Straightaway he said, "David Jansz has come to the fantastic conclusion that he is a genius. Carlo, you are an honest man, now be a sport and tell me whether or not I astrologically predicted this fate of Mr. S.W.R.D.B." My reply was instantaneous. "Of course you did, Sir. You told me to remember four D’s—danger, destruction, disability or death—were what the stars decreed for Mr. B." He was mightily pleased when I quoted his words. His pleasure somewhat dissipated, however, when I reminded him that for my part, on purely political grounds, I had told him that given the primordial human impulses Mr. B had unleashed and the flip-flopping way he was governing the country, his reign would likely be brief. But that is another story. Of all the physiology Dr. Jansz taught us, the only thing that has stuck and taken deep root in my brain is his rhetorical declaration: "No brain, no mind." I gradually came to realize that his remark encapsulated the modern view that all human behavior is the result of brain function and that what we call the mind is simply the set of operations carried out by the brain.


Valentine Basnayake


Valentine Basnayake was the gentlest teacher I ever had in my life from the kindergarten upwards. Lamentably, he passed to his eternal rest on the 10th of June this year. He taught us the physiology of the digestive tract and the special senses (vision, hearing, smell and taste). Recently returned from the University of Oxford with a D. Phil., he happened to be the only one with such a doctorate in the Department of Physiology. Prof. Koch, who lectured to us during the first two terms, was an Oxford man himself and he never tired of telling us what a marvelous place of higher learning Oxford was. So we had been primed to be taught by VB. I vividly remember the day he first lectured to us. In a spotless, creaseless white overcoat he walked into the physiology lecture theatre with his slight limp (acquired from childhood polio), stood on the podium behind the solid table, smiled benignly, and began to speak so stylishly, elegantly and cogently that within a few minutes I became hooked on him for life. He profoundly touched my heart and mind, but this is not the place to assess his life and work.


PhD in Edinburgh


When I joined the Physiology Department in 1962, Prof. Koch was the Head and Dr. VB and Dr. M S Nesaraja were the only other teachers. The rest of the staff had moved to Peradeniya to the new Medical School. Prof. Koch had worked at Oxford with the world-famous respiratory physiologist CG Douglas. They had published a paper in the Journal of Physiology on Carbohydrate Metabolism and Muscular Exercise. In early 1964, Prof Koch persuaded me to go to the Department of Physiology at the University of Edinburgh in Scotland for my doctoral studies. This is how it happened. One day in late 1963 Prof. Koch received a letter from Dr. Reginald Passmore of the Department of Physiology at Edinburgh where Dr. KN Seneviratne had made a great impression as a PhD student under Prof. David Whitteridge, FRS. Because of Dr. Seneviratne’s excellence, Dr. Passmore rashly assumed that another person from Ceylon couldn’t possibly be a dullard. So Dr. Passmore wrote as follows to Prof. Koch: "I read Douglas and Koch at intervals and have frequently thought about the need for a further step forward. So far as I know the subject is just as you left it over 10 years ago. However, we now know that Non-Esterified Fatty Acids (NEFA) are an important fuel of muscle and that their level in the plasma rises during exercise in the post-absorptive state. It would be interesting to see how glucose given before exercise in the post absorptive state affects this rise. It is also known that pituitary Growth Hormone mobilizes NEFA very rapidly in the blood. We have coming to Edinburgh soon a man who has a new technique for assaying GH in the blood. I am sure the time is now opportune to go back to your old experiment. It would be very nice to have someone from Ceylon to be at the centre of the work." Prof. Koch was elated by Dr. Passmore’s invitation and he asked me to go to Edinburgh as soon as possible. So I went to Edinburgh to obtain my PhD.


The 7th edition of the Textbook of Physiology and Biochemistry by Bell, Davidson and Scarborough carries a figure from my PhD thesis. The figure was incorporated into a paper I wrote with Passmore and Hunter which was published in the Quarterly Journal of Experimental Physiology in 1965. Our paper was the first to demonstrate convincingly that GH is secreted not continuously but in a series of intermittent "bursts". When I returned home in 1967 with that solid discovery to my credit I decided that I should now concentrate on becoming a better teacher than researcher, and a popularizer of the modern scientific outlook among the common people of our country whose mindset was largely medieval. I continued to do so up to date.


Galaxy


When I returned home in early January 1967, Prof. Koch was still at the helm of the Physiology Department of the CMS and Dr. KN Seneviratne (universally known as Bull) was the rising star in the Department. (Many reading this will remember the old joke about Physiology in the CMS being a Koch and Bull story!) Prof. Koch had also recruited to the Department Drs. Asoka Dissanayake, PLR Dias, Colvin Goonaratna and T. Ooriyalankumaran. Prof. Koch retired in 1968 and his much lamented death in 1969 was a great sorrow to me. He was truly my fairy godfather. By 1970, the Physiology Department of the CMS consisted of Prof. KN Seneviratne, Dr. MS Nesarajah, myself, Asoka Dissanayake, PLR Dias, Colvin Goonaratna and T. Ooriyalankumaran. By common consent we were a galaxy of teachers such as the Physiology Department never had before or since. With my chief claim to fame as that of a scientific firewalker, I was the odd man out in regard to serious academic research. What I lacked in solid scientific research I compensated for by getting huge publicity for the Department. People still remember the fire walking stunts I performed during the centenary celebration of CMS in 1970. Eventually Sir Arthur Clarke earned worldwide publicity for me by devoting a full 45-minute program to fire-walking and hook-hanging in his series of nine programs on Yorkshire Television called Arthur C. Clarke’s World of Strange Powers.


The few glorious years in the 1970s we worked together in the Department of Physiology under the leadership of Prof. Seneviratne were among the happiest working years of my life. We got on together like a house on fire. We were a closely knit family of equals respecting each other as persons and for what we had individually achieved. There was never any backbiting or bickering or undercutting. Frequent acrimonious academic arguments aside, we never exchanged so much as an angry word. We had no personal feuds or agendas. Alas, nothing is permanent in this world. Though nobody was to blame, things began to fall apart. Perhaps the Physiology Department was too narrow a place for us to fully fulfill our legitimate aspirations. Prof. Seneviratne focused his attention on the pioneering work of setting up the Post Graduate Institute of Medicine and later joined the WHO as a regional director and died prematurely. Dr Asoka Dissanayake, the gastroenterologist who had a D. Phil from Oxford, moved to greener pastures in Malaysia. Dr. Nasarajah emigrated to the United States.


In the end, I was left with headstrong Colvin Goonaratna as my colleague and crony. Both of us had spells in Saudi Arabia. We became involved in public affairs. In retrospect, among all of us in the Physiology Department of the CMS in my time, Colvin Goonaratna has emerged as the highest achiever. During his PhD studies in the UK he found time to sail through the MRCP, making him a fully fledged physiologist and physician with three years of training at London’s famous University College Hospital. As a medical editor he is nonpareil. He elevated the Ceylon Medical Journal to the level of a prestigious international publication. He has published high class writing extensively. He has written the best exposition of medical negligence in Sri Lanka. He was President of Sri Lanka Medical Association (1996) and President of the Sri Lanka Association for the Advancement of Science (2003). He is the distinguish recipient of the Presidential Award of Vidya Jothi and Prime Minister Sirimavo Bandaranaike Award of Vishwa Prasadini. He ran the State Pharmaceutical Corporation as a model state enterprise. He also served in the country’s exclusive Constitutional Council. His elegant English style is something I can only envy. I have greatly enjoyed reading even his occasional (private) invectives against me. He has flown higher than all his medical contemporaries. When comes such another!


Brilliant pupils


Undoubtedly my most cherished memories of the CMS are associated with the many brilliant students in whose medical education I had the privilege of playing a minor role as the teacher of a non-clinical subject. Those who come readily to my rapidly failing and therefore pardonable memory are naturally those with whom I have direct contact currently. Among those my old brain remembers as having earned distinctions in Physiology, Janaka de Silva, Nilanthi de Silva, Ruwan Ekanayake, Saroj Jayasinghe, Charith Fonseka, Diyanath Samarasinghe, Ranjani Gamage, Anula Wijesundara, Susirith Mendis, Hemantha Perera, SD Jayaratne, Gamini Galappatti,Chandrika Wijeratne, Manori Senanayake, Harendra de Silva, Kamani Thenakoone, Deepaka Weerasekara, Shantha Raj and Saman Gunatilake have gone great guns and excelled their old Physiology teacher by a wide margin. Other luminaries like Lalitha Mendis, Sudhira Herath, Rizvi Sheriff, Neville Perera, Imalka Fonseka, Mohan de Silva, Nalaka Mendis, Kamini Mendis, Raveen Hanwella, Anuruddha Abeygunasekera, Senarath Jayathilaka—how can my porous old memory possibly remember them all—have made their distinctive mark on the practice of our profession. I trust that none of them sustained any permanent damage from being exposed to me. I am immensely proud of them and I bask unashamedly in their reflected glory. Without malice aforethought I have deliberately weeded out of my memory the international stars like Sir Sabaratnam Arulkumaran among my former pupils not because I love them less but because they defected from our nation and devoted their brilliant talents to serve "them" and not "us". The tribal brain tends to delete "defectors" from our conscious memories.


Towards a dusty end


I am now going on 82. Having strutted and fretted my time on earth, I am ready to embark on the journey to "The undiscover’d country, from whose bourn/No traveler returns". When my medical friends ask me how I am doing these days, I have a ready answer: "Except for a left bundle branch block associated with a degree of tricuspid incompetence; chronic obstructive pulmonary disease with moderate pulmonary hypertension; a prostatic cancer which I gather will not kill me before something else does; primary open angle glaucoma; and chronic allergic rhinitis with two big nasal polyps, I am fine." It is the caring, compassionate competence and unfathomable kindness of my erstwhile pupils, in particular Ruwan Ekanayake, Neville Perera, Anuruddha Abeygunasekera and Imalka Fonseka, that keep me alive and kicking. Knowledgeable Colvin is reliably around to bolster my courage when it fails. I have left firm instructions to my family that when I kick the bucket one of these days, my body, which is a minor pathological museum of sorts, should be made available to medical students to help them to broaden and deepen their knowledge of pathophysiology. When that happens, you can if you care to sum up my lengthy earthly existence in Shakespeare’s words: "Nothing in his life. Became him like the leaving it."


 
 
 
 
 
 
 
 
 
 
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