Life Experiences of a Surgeon & Medical Professionalism
(Excerpts of a speech made by Dr. Gamini Goonetilleke FRCS, Consultant Surgeon, Past President of The College of Surgeons of Sri Lanka at the Induction of Dr. Jayaindra Fernando, as the 38th President of The College of Surgeons of Sri Lanka on 4th January 2020)
I am humbled by your invitation and I consider it a privilege and honour to stand here this evening as the Chief Guest at this Induction Ceremony. It is no doubt a great day for you, Jayindra. To me, personally, it is also a happy day to see my house surgeon in 1991 being inducted to the high office of President of The College of Surgeons of Sri Lanka.
After I was appointed as a consultant surgeon in Sri Lanka in January 1982, the experience gained from long years of serving as a surgeon in Sri Lanka has left an indelible mark on me with many memories. As I stand before you, at this induction ceremony my mind goes back not only to those numerous pleasant and nostalgic memories I have had of my life as a surgeon in Sri Lanka but also of the days as an active member of The Council of the College of Surgeons of Sri Lanka. I would like to share some of these experiences with you this evening.
“It is through these experiences that I learnt, I grew and I learnt from my own mistakes. I hope my experiences will inspire the younger generation of surgeons present here.”
My first appointment as a consultant surgeon after returning from postgraduate studies in the UK was at the Base Hospital in Polonnaruwa. I was the only surgeon at the hospital serving an entire District of 260,000 people. Starting life as a young surgeon and having to work in an environment that had nothing more than the basic facilities, I had to adapt to the difficult situations, sacrifice much, accept and overcome challenges and do what was best for the people. I had to face many situations that I had never dreamt of experiencing as a doctor. Such experiences came to me in the most unexpected of circumstances. I responded to those challenges with faith, persistence and courage. Many were the lessons that I learnt in this remote part of the country serving especially the poor, the marginalised and the helpless. Despite all the difficulties faced during that period of 6 years and 4 months, that distant rural outpost was by far the most rewarding period in my surgical career in terms of lessons learnt in medicine and surgery, and an entire gamut of life situations, especially of the rural poor.
I also had the cherished opportunity and the privilege of treating armed forces personnel injured in the conflict in civil and military hospitals
The frequent visits to war-torn Jaffna as a civilian volunteer surgeon were in military transport aircraft. On many occasions, the seats in these aircraft had been removed to accommodate more personnel, goods and ammunition. There were times we flew to Jaffna sitting on the aircraft floor and at other times sitting on barrel bombs due to lack of space. These trips were nerve-wracking and risky but had to be done for the sake of our armed forces injured in battle.
I was elected to be in the Council in 1990 and was elected Secretary of the College for 1994 and 1995. Going down memory lane, I recall the office of our college situated in a small room on the first floor of the headquarters of the Sri Lanka Medical Association at Wijerama Mawatha, Colombo 7. The office equipment in that room were only a telephone and a typewriter. A fax machine was added later. A part-time typist helped in clerical work. That was it! You may wonder what we did with so little resources. All those were no deterrent.
We were able to organize many noteworthy events. One of them was the first joint meeting of The College of Surgeons of Sri Lanka with The Royal College of Surgeons of England in 1995. The Chief Guest at the opening ceremony held at the Bandaranaike International Conference Hall (BMICH) in Colombo was none other than Her Excellency Chandrika Bandaranaike Kumaranatunge the President of the Democratic Socialist Republic of Sri Lanka at that time.
In 2001, I was elected the 19th President of The College of Surgeons of Sri Lanka. It was also a turbulent period in the history of our country with terrorist attacks disrupting civilian life in many parts of the country. Thus there were many challenges in organising the academic activities of the College.
On the 24th of July 2001, a terrorist attack on the Katunayake International Airport resulted in the closure of the airport after many planes were blown-up. That was just one month before our Annual Academic Sessions scheduled for August. The academic sessions had to be postponed indefinitely as our overseas guests were advised not to visit Sri Lanka. However, we were able to re-schedule the meeting for October that year with the participation of the overseas guests and concluded successfully. The chief guest was a very well known surgeon from the Royal Free Hospital, London, Mr. R M Kirk FRCS (Eng).
Shifting of the headquarters of the college
The college office moved to its new location at Independence Avenue, Colombo 7 on September 2003, the home of the late Dr. Noel and Mrs. Nora Bartholomeusz. This no doubt is a priceless gift to The College of Surgeons of Sri Lanka from that family. A long-felt need of the college was fulfilled and all surgeons in this country owe Mrs. Nora Bartholomeusz an immense debt of gratitude, more so the generation of surgeons yet to come.
Jayaindra / Medical student / House surgeon
This is Jayaindra’s day as the New President and I cannot leave without mentioning some events about his early days as a doctor. I remember Jayaindra as a student of the Private Medical College in Ragama.
I used to conduct classes in clinical surgery for these medical students at the Base Hospital Gampaha, which was not too far away. Many students from that faculty attended these classes. I am happy to see some of them in the audience today, now qualified as specialists and holding top posts in our health service. I sincerely hope the training they received was of value. Jayaindra (JF) qualified as a doctor in 1991. He was appointed to the Base Hospital Gampaha for his Internship training and had decided to train in Surgery in my Surgical Unit. It was my practice to ask the Interns on taking up an appointment one simple question. I asked that question from Jayaindra too.
Dr GG – Jayaindra, are you interested in Surgery and would you pursue a career in surgery in the future?
Dr JF’s – spontaneous response was – Yes Sir!
No doubt, you could see that he has kept that promise.
Working in Base Hospitals in the day’s gone by Daily admissions and a huge responsibility for House Officers
In those days working in Base Hospitals was no easy task. These hospitals had only one Surgical Unit with one consultant surgeon and two house officers. There were admissions to that single surgical unit every day. The Gampaha Hospital was one such institution and it served patients from a large area in that District. Jayaindra, my house officer was a very conscientious doctor and took his responsibility towards the patients very seriously. In the absence of Senior House Officers and Registrars, the Intern House officers had a huge responsibility towards patient care. This no doubt gave them a good experience too. In the absence of the facilities that are available today in many hospitals, the diagnosis had to be more clinically orientated. This is what every medical student learns during their clinical training and puts to practice thereafter. It is well worth remembering that, these basics in medical practice should not be forgotten even when we have high-tech facilities at our door-step in some hospitals.
Gampaha District was famous for criminal activity and stab injuries were common. Jayaindra became an expert in the management of stab injury of the chest so much so that I remember telling all medical students that if you want to know how to manage a stab injury to the chest, read my house officer Jayaindra’s, notes on the Bed Head Ticket. That will give you the stepwise management of stab injury to the chest, knowledge that is sufficient to pass the final MBBS. Jayaindra, thank you for all the care you gave the patients in my ward in 1991.
Surgery with limited facilities / bold decisions / taking risks / adaptation
If the diagnosis of disease was clinically orientated, surgery was no different, especially in emergencies. We had to accept challenges, make bold decisions, take risks and adapt ourselves when no alternative was available to save precious lives. When taking risks, the result could very well be either success or failure. Prudence, courage and determination become imperative in such circumstances. A golden principle of leadership is the ability to take risks.
These principles were illustrated with examples of case reports where risks had to be taken to save lives and relieve suffering.
- Gunshot injury to the chest & other injuries :
Four stories that changed my life and their
A Surgeon’s tales / Stories to inspire and educate
click the link below to read the stories
- Kidney stones
Moans, Groans and Kidney Stones!
A Surgeon’s tales / Stories to inspire and educate!
click the link below to read the story
‘Moans, Groans and Kidney stones’
- Hair ball in the stomach
“Hair Scare”-‘Hairball was found in a 14-year old girl’s stomach
click the link below to read the story :
This aspect of taking risks in surgery is aptly illustrated in an article written by the new President, Dr. Jayaindra Fernando himself in the souvenir published on my retirement from Sri Jayewardenapura Hospital on the 7th October 2014
“A Tribute to Dr. Gamini Goonetilleke”
Case Report: A young barber who was intoxicated after consuming a local alcoholic illicit brew (Kasippu) on New Year’s day in April 1991 was admitted following a self inflicted cut injury on the front of his elbow. He was bleeding profusely from the wound. It was a public holiday and there was no anaesthetist in the hospital on that day. I (DrGG) decided to perform surgery assisted by Dr JF. This was under local anaesthesia as he was already partially anaesthetised after the consumption of the alcoholic brew. If there was a delay in surgery, he could have bled to death or in the alternative there was the possibility of him losing his arm. The artery that was damaged was repaired successfully. He recovered and left hospital with an intact arm.
Medical Profession and the Professional
The last decade has witnessed a rapid and radical change in the field of medicine. In keeping with this change, there has been the demand for quality care in line with Good Medical Practice (GMP).
What is Good Medical Practice? It sets out the standards, principles and values on which good practice is built and describes medical professionalism in action
“Good medical practice as described by the General Medical Council (UK) requires that every doctor be professionally competent, honest and trustworthy, must perform consistently well; practice ethically; do no harm; avoid allowing personal beliefs to prejudice patient care; be an effective team player, and; take action if poor practice by a colleague places patients at unnecessary risk. Patient’s welfare must be their first concern; they must treat patients politely and considerately, respect their dignity, privacy and right to be involved in decisions concerning them; listen to them and respect their views; and explain medical matter clearly in terms they can understand”.
We should at all times be conscious of these values and principles when we attend to our patients and thus continue to maintain the respect and high esteem enjoyed by our profession since ancient times
Some thoughts about the surgeon and surgery
As regards our specialty of surgery, there are four conditions a surgeon should satisfy. A surgeon should be learned, ingenious, be an expert and be able to adapt himself to different situations. Surgeons should be modest, dignified, pitiful and merciful, not greedy nor extortionists of money, but rather let our reward be according to our work, to the means of the patient, to the quality of the issue and our own dignity.
Surgery is an art, surgery is a skill, surgery is a discipline. Above all surgery is an instrument to serve society. Surgeons should always be humane and must continue to serve the cause of human suffering.
Our noble profession is a vocation, a calling from God to serve humanity with love, care, concern and compassion. We must remember that the patient and the ward are sacred. In that respect a surgeon’s heart is as important as his knife. Our lives should be lives of service where we earn to live and not live to earn.
After 19 years as a consultant surgeon, I was elected the 19th President of The College of Surgeons of Sri Lanka in 2001. I wondered whether 19 was a coincidence. I invited a young surgeon by the name of Jayaindra Fernando to join the council of 24 members. He had no hesitation to accept my invitation and was appointed Assistant Treasurer of The College. He was extremely keen and energetic and made a significant contribution in organising academic activities and fundraising events at a time when the College kitty was depleted. Knowing his work ethic and morals I always wanted to see Jayaindra progress from this position to the position of the President. I am extremely happy that Jayaindra held many positions in the council and finally reached the pinnacle of his surgical career by being elected the 38th President of the Council. That has taken him 19 years from 2001. Here we go, 19 again! I guess it is no coincidence.
Jayaindra you have accomplished the two tasks that I expected from you.
- To become a Surgeon
- To be elected as the President of The College of Surgeons of Sri Lanka
Jayaindra Inducted as the 38th President of The College of Surgeons -2020
A bit of advise
Now Mr. President, the year 2020 is yours. You as the skipper must lead from the front. The college activities should be like a T20 cricket match, fast-paced and dynamic with no time to waste. I am sure you have already made your plans for this year and you, together with your council will work with dedication and determination to further uplift the standards of surgery in our country.
No doubt you as the leader of the team will have to face a few yorkers, bouncers and doosras in this T20 cricket match. With all your experience of having served the council in varying capacities over a long period of time, you no doubt will be able to overcome these challenges with ease and pride with drives, punches, scoops and mighty hits.
I am humbled and honoured, and I wish you all the luck and the very best in everything you do for the profession and the College.
Thank you once again for your very kind invitation
You Tube Link to speech …
Dear Reader, you might want to read the inspiring story which is one of the most read and appreciated of all times : Charith, The Soldier