Dr. Raghavan Kulanayagam: An irreplaceable clinician and mentor | Daily News


Dr. Raghavan Kulanayagam: An irreplaceable clinician and mentor

As the year 2018 was marching inexorably to its inevitable closure, we bade farewell to Dr. Raghavan Kulanayagam.

He was widely known in the country as a senior consultant psychiatrist who stood for high professional standards, and in the medical profession as a giant in Psychiatry, who served as a role model for many. Those close to him also knew how his life celebrated diversity and enlightenment. In youth, he mastered the piano and played the cello in the Colombo Symphony Orchestra. His wide reading across many subjects, especially literature and philosophy, produced a salutary effect on his thinking, without losing wisdom in the knowledge nor meaning in the information.

He combined the best traditions of moral thinking from many sources, especially Hinduism and Buddhism, engendering his endearing, upright character. To all, he offered kindness, patience and generosity, irrespective of station or stature. But I am not really the expert on these aspects of his life—only a wayside spectator. So let me write instead about what I knew him well for, from my days as a medical student in the North Colombo Medical College.

First, the clinician. As a medical student in the 1980s hopping from one clinical appointment to the next, I could immediately see that his clinical skill was exceptional, perhaps the best two or three out of over three-dozen that I saw and learnt from. Every ward at the Angoda mental hospital was literally teeming with hundreds of patients, and he saw several wards each day. His rapid assessment of every patient—in a specialty that had no blood tests or X-rays to rely on—was incredible. His diagnostic logic was often based on the subtlest of mental signs, picked up unerringly, evaluated carefully and turned into a precision tool, in a fascinating encounter of mind with mind.

Secondly, the clinical teacher. Anyone would be forgiven for forgetting the medical students in that rush, but he didn’t. He not only looked out for us and welcomed us, but also made sure that we all had chairs whenever he himself was seated. In the ward round, amidst quick questions to the nursing officer about a patient or the general administration in the ward, he also had questions for us. They were questions that made us think—not merely recall rote learning.

And our answers weren’t merely confirmed or refuted—they were analysed for the right and wrong turns in our diagnostic logic. In this way, he didn’t just inform us—he tutored us too, even in that rush. It was he who introduced to my own mind the idea that a book must be read with an understanding of who its author was—a personal statement on an invariably wider subject.

His knowledge was not limited to facts and practices of the day: he also gave fascinating accounts of the history of that knowledge.

He wouldn’t merely teach us about hallucinations: he taught us how ideas about hallucination have evolved over time, from Freud to the landmark work on psychopathology by Jaspers. In this way, Psychiatry was transformed into a magnificent mirror on the mind itself. We could see why the mind was called the final frontier.

Thirdly, the classroom teacher. Dr. Kulanayagam’s lectures were a treat to behold. He would walk in with empty hands, latch on the FM mic to his shirt, and start by asking us what the day’s topic was. An engaging conversation with the audience would ensue, as his trademark, grammatically-perfect, elegantly-phrased, effortlessly-fluent spoken English kept us enthralled for an hour and beyond.

He would deliver not merely the facts of the subject and its genealogy, but also his vividly described, priceless experience.

I still recall how my hair stood on end when he described how one eerily lonely, freezing winter night in Toronto, Canada, where he was doing his fellowship, a psychotic patient walked into his outpatient consultation room and sat opposite him and, when asked what the problem was, simply drew a gun, pointed it at him, and said, “Doctor, I have an urge to shoot you.”

Fourthly, the examiner. To him, it was just as important that we were prepared for the world in front of us as it was that we knew a little bit about his subject. We were given two, half-hour essay questions in Psychiatry. One was on a basic topic that we could answer with ease. The other was an invitation to freely explore an idea. For this, for our batch, he gave a quote by Oscar Wilde about how “examinations are a humbug from beginning to end” and asked us to discuss it vis-a-vis psychological theories of personality! One might think that this would have been no less frightening than encountering the man with the gun, but by this time, we had absorbed the lessons of composure and negotiation from his Canadian story, and survival was not that hard.

Dr. Kulanayagam was an examiner who rejoiced ebulliently in the achievements of his students. He was particularly pleased with my ‘examinations are a humbug’ answer, and sought me out to congratulate me, took me and my girlfriend (now my wife) to dinner, gave us both gifts and, I felt, perhaps tried to convert me into choosing Psychiatry as my postgraduate career. It was with more than a little remorse that I turned down the suggestion, but he himself was quite all right about it.

In later years, he often inquired about my career progress. He proudly attended my ceremonial induction as the President of the Ceylon College of Physicians and the ceremonial inauguration of its annual academic sessions, last year. The path to the peaks of our careers is paved with, and made more comfortable by, the encouragement we get from our teachers.

Dr. Raghavan Kulanayagam combined immense learning with great humility; a penetrating understanding of the world with all the patience for it; and a keen awareness of its deficiencies with the readiness to remedy them. He took very little from the world for himself, made the most of the little, and enriched the world with his commitment and uniqueness.

He is irreplaceable. Hopefully, his touch has enriched us adequately to live, through our own lives and the lives we might ourselves enrich, forever.

It must have been such human beings that Bertrand Russell described as ‘free’ in his essay “A free man’s worship”:

“The life of Man, viewed outwardly, is but a small thing in comparison with the forces of Nature. The slave is doomed to worship Time and Fate and Death, because they are greater than anything he finds in himself, and because all his thoughts are of things which they devour. But, great as they are, to think of them greatly, to feel their passionless splendour, is greater still. And thought makes us free men; we no longer bow before the inevitable in subjection, but we absorb it, and make it a part of ourselves. To abandon the struggle for private happiness, to expel all eagerness of temporary desire, to burn with passion for eternal things—this is emancipation, and this is the free man’s worship. And this liberation is effected by a contemplation of Fate; for Fate itself is subdued by the mind which leaves nothing to be purged by the purifying fire of Time.”

Such human beings are then, timeless.

Dr. Panduka Karunanayake

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