FACE 2 FACE with Athula Withanage - the simple uncomplicated surgeon
by Dr. Tilak S. Fernando from London

Athula Withanage, the Clinical Director, Lead Clinician in General Surgery, at Withybush Hospital Haverfordwest, Wales, and the surgeon remembered as 'putting back a severed limb of a seven year old boy who was brought to the hospital with his arm in a bucket full of ice', can be described as a man with compounded ambitions and achievements from medicine, surgery, literal activity to drama - with the scalpel in one hand and the pen in the other!

Born in Gonagalapura in a southern town of Sri Lanka, he received his primary education at Gonagalapura Mahavidyalaya, later at Ananda College in Colombo before he left Sri Lanka for further education. Graduated as a medical doctor, he was trained in Ireland. He worked in Ireland for ten years, during which time he was elected a Fellow of the Royal College of Surgeons in Scotland, Ireland, England and a Fellow of The International College of Surgeons in General and Vascular Surgery.

In recognition of his services to the people of Pembrokeshire for 21 years, first he received the 'Medical unsung Hero's Award'. Soon after this, he was invited by Lord Chamberlain to the Buckingham Palace for Queen's Garden party. Mastering from general to vascular surgery he has performed countless number of successful operations. As recognition of his skills and successful surgical record he was twice nominated for The Silver Scalpel Award, sponsored by The Smith and Nephew Foundation and finally received the award for excellence in Surgical Training for the best surgical trainers in UK .

Apart from surgery, Athula has contrasting hobbies such as writing and drama. His first Sinhala novel was published in 1974 called " Noriena and Wasantha". He has also authored three English fictions, a medical thriller called 'Living Capsule', Night of the Angel and Flowers Dust and Stars. His Sinhala publication 'Saman Mali Sandamali' has been made into a Sinhala tele drama called ' Pahan Kanda. His latest book in Sinhala called 'Gagarin' is in the final stages of completion.

As a young man in England he ventured into English drama and became a member of the Claberston Players Group in the UK and diversified and proved his latent talents by appearing in the play Dick Whittington as Sultan of Barberry (1984); Bard of the Whisten Castle (1986); Wasir in Sinbad the Sailor (1985). In the Republic of Ireland, Athula Withanage became the first ever Asian to take part in the Irish play, 'Citi', which won the first prize at the '|All Ireland Festival'. He played the role of a doctor by learning the lines by writing in Sinhala. I met up with this great personality in Wales in the comforts of his living room to have a Face2Face conversation.

TF. Athula, you are a man of such versatility that I don't know where to start from! What was your experience in Ireland ?

AW. I started working in Ireland as a surgeon in 1970. Having done so for 10 years, I moved to Wales in 1980, from which time I am still here at the same hospital.

TF. How do you find surgery? Interesting & rewarding from a humanitarian aspect or as a highly paid job?

AW. My main aim as a surgeon is to give back life to human beings who are critically ill. In such a capacity surgeon becomes accustomed to his work and soon it becomes routine, like in any other job. I have operated on thousands of patients over the past 30 years. After the general surgery experience, I branched off to Vascular Surgery on obtaining my Fellowships from all the three Royal Colleges of Surgeons as well as the Association of Surgeons of Great Britain and Ireland. Fellowship from the International College of Surgeons and FRCS England were just awards.

TF. What is the deciding factor for an operation on a patient? When I say this, do you consider or disregard the age factor apart from the illness or ailment?

AW. In my book I have always looked at giving the quality of life to a patient, irrespective of the age factor. The oldest patient I have operated on was 94 years of age, despite some raised eyebrows from my colleagues. It was a touch-and-go case, but I took a chance and saved him. Later the patient came to see me in the hospital to thank me and left a 'thank you' card' with a huge wall chiming clock, which I treasure it to this day.

TF. Many may have sent you so many such cards but what is so special about this particular card?

AW For one thing, I am proud to this day of my own decision to operate on him to save his life; secondly the words in that card touched me very much: " Doctor you gave your time and I am giving you the time." How I interpret his feelings is that I gave him more time to live and he is giving his blessings for me to carry on with surgery for many years to come.

TF. Where does the Vascular Surgery fit into your career?

AW. From general surgery I developed skills in vascular surgery. At Withybush I have done two near-amputations as a result of trauma- i.e. Replantations of arms - over the last ten years. I learned the technique while I was working at St Vincents Teaching hospital Dublin. First arm we put back in was of a seven year old boy whose mum brought the arm in a bucket full of ice'. I still remember his name. Then I went on to master the skills on Key Hole surgery.

TF. What is Key Hole surgery?

AW. It is major surgery mainly on the gall bladder. The operations are done using tiny cuts, telescopes and long operating tools introduced through these tiny "key Holes". In this set up, virtually your operating field view is on your screens. I call it the miracle of modern day surgery where everyone in the operating theatre can see whatever is done by the surgeon on two screens. One can compare this senario to a British X-mas pantomimes where audiences participate, for if you and your team are seen doing something wrong immediately it can be detected and observers can say ' oh no' or ' oh yes'. But, of course, as the responsible specialist, the final decision is yours and yours only.

TF. You are also a Clinical Tutor in Key Hole surgery, are you not?

AW. Yes, I am a tutor covering the whole of Pembrokeshire, attached to the Cardiff Minimally Invasive Institute. I train the post-graduate section at Withybush to prepare them for the MRCS Surgical examination with the help my surgical colleagues.

TF. Were you not nominated for the Silver Scalpel Award for your services both in surgery and teaching?

AW: This is a special award given to surgeons on their skilful record and it is a nationwide competition. Even a nomination to such a prestigious award is an honour. I was nominated twice. In 1991 for the Silver Scalpel Award out of 870 contestants from all over the UK. From the whole of Wales only Mr. Brain I. Rees, Consultant Surgeon and I, from Withybush, were nominated. Local papers were happy that we put our hospital on the map.

TF. What were the qualities do you think that made you stand out as a Good Surgical Trainer

AW. I have always passed on theory as well as skills to the trainee and endeavoured to train them by taking each one through all the steps of any procedure. We now have one of the best staffed equipped surgical skills room in country.

TF. Was training an extra responsibility with additional revenue for you?

AW. It's an Additional responsibility all right, but not for extra money. My teaching has always been voluntary and involved members of all the units.

TF. Did you have any special formula as such to become an outstanding trainer?

AW. I videotaped most important operations, with patient's permission of course, and took trainees through each step of the operation over and over again at our weekly sessions.

TF. What, in your opinion, are the most requisite qualities required to be a good surgeon?

AW. Patience is paramount. Never be sarcastic or irritable and always be tactful and considerate. Never put any of your colleagues or trainees down or criticise in front of patients or colleagues or in the absence of the trainee. One must cultivate time to point out any problems privately and the advice has always to be friendly and constructive. In any case we present all our complications in Audit and Clinical Governance meetings and continue to update and improve our practice.

TF. What happens if things do not go according to plan during operations?

AW. Patient safety is paramount. We select the cases watch every move of the trainee with an eagle eye and take over when needed. You have to be very diplomatic. There is no need to scream and one must never destroy the trainee's confidence. In my case, I have always intervened rather tactfully. There is always a method to deal with in any given situation. It has not been my nature to be the surgeon to sweat down the forehead and to blame the assistants for the so-called difficulties. I have always known how best to draw on the optimum output of the assistants. Even during a repairing job on a leaking aortic aneurysm, I have time to talk about steps.

TF. How does your teaching differ from others?

AW. May be I could transform any situation to a teaching session. I make it a point to simplify any difficult information or theory to trainees. During the early part of the six month period I point out to them, at the beginning of any operation, and request them to observe the whole scenario of the operation in the examination point of view. It's my idea that trainees imagine themselves right inside the theatre or on the ward in answering questions during an MRCS examination- eg: "Doc, Place your imaginary patient right on Ward 3 where you work, and do the things you do normally to diagnose and treat him or her."

TF. Withybush Hospital once managed to win the Sunday Times award for the Best General Hospital. As the Director of Surgery how would you see the role of a hospital or a hospital team as such?

AW: Such competitions provide with an ideal opportunity to highlight our aspiration to reach out to excellence of service in the healthcare. The goal, therefore, has to be the delivery of timely and effectual healthcare to the people - in our case in Pembrokeshire. This can be achieved only if each individual is determined to do one's best at all times. This has been our prime aim in this hospital and what I have seen for the past 25 years.

TF. Would you like to discuss your family?

AW. (With laughter). We are an ordinary simple family and nothing great to talk about. I have to say that I am proud that my daughter Triona Dilukshi MD in Medicne is now fully registered with General Medical Council and works with me as a House Officer in Surgery, which is a little unusual.. The name Withanage sometimes becomes a confusing factor as my name is on patients' bed, and on an emergency the nursing staff summons the wrong person! (Laughter).

My son is still a medical student and my wife Nelum, with her new found Clin IT skills, is responsible for Pembrokeshire Cancer Data Base. She has made a major contribution to develop a revolutionary new data base on Breast and Colorectal cancer patients called BASO ( British Association of Surgeons and Oncologists) and ACP ( Association of Coloproctology) with her own research. She was recently involved in presenting a paperin the Welsh Surgical Society with well known colorectal surgeon. Information from WGH programme which she is responsible for is being used right throughout the UK in the National Health Service today as a data base for cancer patients.

TF Talking about your literal skills, I note that you are rather disappointed about the Sinhala teledrama, Pahan Kanda, which was your story from a fiction you wrote in Sinhala as "Samanmali-Sandamali.

AW. Yes. This teledrama has been based on my book, Samanmali Sandamali. I was rather irritated at first for not even consulting or seeking my permission to use it as a film, and more disappointed to note that the story line too had been changed to suit the producer and director, which I do not approve at all.

TF. You could have taken them to task, couldn't you? Today cowboys who copy film videos and audiocassettes in Sri Lanka are being haunted and brought to book .

AW. I could have but its not in my character, I was just sad that they destroyed the story..

TF. Do you have any intentions of producing any tele drama with your own stories?

AW. No, I am only a surgeon? I'll leave it to my famous brother Bandula and his son Nalaka who are already well into the Drama world'

TF. What is your latest achievement?

AW. Only a few days ago I obtained an MSc (Cert) in Hospital Management, and received a merit in Cost and Accountancy.

TF. So you are happy man who has achieved a lot in life with an equally blessed family ? Any regrets ?

AW. (With laughter) I am a simple guy who had to work hard to achieve what I have professionally earned today. Being a medical man it is part of my work and responsibility to keep up with the ever advancing medical field, as otherwise I'll end up as an Aspirin, antibiotics, paracetmol doc. Tilak, I may have five Fellowships but I am still the same old Athula, a simple uncomplicated surgeon doing a service. Every success bring enormous pleasure and every little complication brings a heartache.