That came to pass on December 11, 1986. Nihal, a youth attached to Police Special Task Force, was travelling by train without incident. The train almost passed Welikanda, bordering the eastern province. Suddenly the whole world turned upside down before Nihal. Boom, it popped up just next to his ears. He felt a sudden pressure. Before he could fathom the nature of it, Nihal was drowned in a pool of his own blood; squirming in pain.
It was a gunshot. Its origin is clear: the LTTE, quite active and powerful at the time.
Nihal’s colleagues brought the train to a halt and took him to the Polonnaruwa Hospital many, many, kilometers away. He was admitted to the ward around 6 pm. The senior medical officer discovered that his patient’s left arm is seriously injured. The bullet had already taken a toll on the major blood vessel, the lifeline to the victim’s hand. If not attended immediately, Nihal would lose his arm. The medical officer attended to it immediately with his staff.
Nihal recovered gradually. But the wound did not settle. It started bleeding again due to an infection. He had to be admitted to the hospital once again. To make it worse, the medical officer, being a devout Catholic, was in Colombo for Christmas holiday.
All the same, he instructed his juniors to control the bleeding in whatever way possible without compromising the circulation to the patient’s hand. The patient’s hand remained viable, but was swollen with restriction of movement of his fingers. The continuation of blood could have cost him his life. The medical officer knew that he had to do something so that bleeding would not reoccur.
He was torn between: holidaying in Colombo on the Christmas eve or attending to a patient struggling between life and death many miles away? He cut short his Christmas vacation, returned to Polonnaruwa the next day and decided to perform a second operation. The patient was warned that he might lose his arm. After removing the infected part of the artery, a small segment of a vein was taken from the thigh segment of a vein was taken from the thigh and this was used to bridge the defect in the damaged artery. The bleeding stopped and gradually the circulation to the hand improved. The patient’s arm was saved.
Dr Gamini Goonetilleke’s life is consummate with such decisive moments. Every page of ‘In the Line of Duty’ bears ample testimony to his acute decision-making in his 25-year career as a surgeon. Dr Goonetilleke has experience of working as a surgeon since 1982. He has worked in many parts of this country under different conditions. As a surgeon, he has been exposed to practise surgery, sometimes with the minimum of facilities. He has witnessed many aspects of life, especially the life of the downtrodden farmers in the north central province.
“I have seen the human suffering inflicted by a never-ending ethnic conflict. This conflict began as a guerilla war and later changed into a conventional war. War leads to death, injury and disability. I had the opportunity to treat the injured in many hospitals in the war-torn areas, as well as those in the bigger cities. Only those who have treated these horrendous injuries will know the grave situation to which both combatants and civilians are exposed at a time of conflict,” Dr Goonetilleke recalls his days in Polonnaruwa.
There will be no victor or vanquished, Dr Goonetilleke adds. “Neither side can totally destroy or annihilate the other. There will be ups and downs in military fortunes. The end result will only be that harm will be done to both sides and we will end up by having more casualties to attend to.”
During his career, Dr Goonetilleke is not hesitant to add how he had also seen the deterioration of values and attitudes of some of the members of his profession.
“The conditions under which I worked in the first few years of my surgical career were truly difficult, but the difficulties were far outweighed by the joys, the lessons and the achievements that I have experienced during that period. There can be only a very few more satisfying experiences than what a doctor gets by being useful and needed.”
This is especially true of the rural areas. With limited financial resources, the rural community has only a few to turn to for help. The surgical problems that emerged before Dr Goonetilleke turned out to be vast, numerous, interesting and challenging.
“I have come to realise that our patients do not take surgical care for granted. They value it and appreciate it. Their expression of overwhelming gratitude after a surgical operation is an emotion most surgeons in the developed nations would rarely experience,”
That offered immense contentment and satisfaction for Dr Goonetilleke as a general surgeon in a developing country despite the difficulties encountered, supremely worthwhile and rewarding.
“Among the most horrendous injuries, I have seen are those of the victims of mines. Since 1983, when the ethnic war in the north and east escalated, there has been a continuous dramatic increase in the number of such victims in Sri Lanka. All of them are not military personnel. Quite a large number are innocent civilians and even children. More than 10,000 personnel of the armed forces and police have either been killed or maimed by mines.”
Writing a foreword to ‘In the Line of Duty’, Sri Lanka’s legendary surgeon, Dr P R Anthonis, makes note of Dr Goonetilleke’s exceptional qualities required very much in his field.
“Gamini reminisces about an array of encounters that brought him face to face with several missions of mercy, especially in the war-torn north and east, his call for a ban on mines that maim and kill people, his campaign for a programme to help those traumatised by the vagaries of life and his inborn compassion for his unfortunate patients, many of whom he has saved from the jaws of death through timely action even though he had to work with only basic facilities most times,” writes Dr P R Anthonis.
“The stimulus to write this book arose from the desire to record the numerous pleasant and nostalgic memories I have of my active life as a surgeon in far-flung Polonnaruwa. Starting life as a young specialist and having to work in an environment that had nothing more than the basic facilities, I had to adapt to the difficult situations and strive to improve the services to the people even under trying circumstances,” Dr Goonetilleke noted.
Dr Goonetilleke also initiated ‘Gamini’s Fund’ to assist the patients with dire financial requirements. The government already offers free healthcare, he notes. So it is hard to expect limitless fund from the President’s Fund. Gamini’s Fund is a collection of contributions by Dr Goonetilleke’s friends and well wishers in a bid to help the rural community in expensive surgeries.
These strong gloved fingers which I flex
This human hand which holds the knife
Sterile now and steady
Needs thy guiding skill
To help another life
Bless now this patient
Thine and mine
Who under thee entrusts to me
A precious life
God of the surgeon’s tireless strength
The surgeon’s finite skill
Grant that I may be guided to do thy will
Trichotillomania, the irresistible desire to pull out and eat one’s own hair was described in 1889 by Hallopeau, while the first case reported a century earlier by Baudemont in 1779. Trichobezoar is the term used to describe a collection of hair or hair ball in the stomach. They are usually without symptoms until they reach a larger size.
Rapunzel Syndrome is a rare form of Trichobezoar where there is a tail-like extension of the hair ball into the intestine, first described in 1968 by Vaughan. It is named after a charming tale written in 1812 by the brothers Grimm about a young maiden, Rapunzel with long tresses who lowered her hair to the ground from high in her prison tower to permit her young prince to climb up to her window and rescue her.
Only 27 such cases have been described in the medical literature by 2008.
Dr Goonetilleke operated on the 28th case, a 14-year old girl from Moneragala. A large hairball 700 gm in weight and 75 cm long was removed from her stomach and intestine.
This is the first case of Rapunzel syndrome in Sri Lanka.