Stories from the Clinic: Healing Beyond Words

Today, I found myself in Kondavil—a quiet village in Northern Sri Lanka—at a small Family Health Centre. It was a modest place, the kind where the walls may be bare, but the work is full of meaning. I was asked to help out by Dr. S. Kumaran and supported by a kind and capable nurse, Mr. Thuvaragan.

There was just one problem: I didn’t speak the language fluently.

Most patients spoke Tamil, and I didn’t. It could have felt like a barrier. But instead, it became an invitation to listen with my eyes and heart. Gestures, expressions, and silence began to speak volumes.

The day unfolded with stories.

A man from a nearby temple came in with a cold and fever. We spoke in Sinhalese and decided on a simple treatment—no antibiotics needed. Many others had similar symptoms. I also noticed a common trend—betel chewing, with clear signs of its effects on oral health.

An elderly lady with knee pain reminded me how strength isn’t always physical. Despite the ache, she climbed onto the bed without help. I gave her gentle care and exercises to ease the discomfort.

A young father working in agriculture told me about stomach pain keeping him up at night. Together, we traced it back to spicy meals and late dinners. He left with new medicine, yes—but also with advice he could carry into daily life.

A mother came with an itchy patch on her forehead—six months untreated. It wasn’t dangerous, just distressing. I reassured her, treated her gently, and told her we’d check back in two weeks.

A teacher showed me a lab report with high blood sugar. No symptoms yet, but a family history of diabetes was enough for concern. We talked about food, walking, rest—and the strength to act early.

One of the most emotional stories came from a woman trying to conceive for almost a year. She was healthy, hopeful, and quietly hurting. I gently explained that sometimes, it’s not just about her—we needed to test her husband too. She nodded. It felt like a shared step forward.

Then came a teenage boy, soft-spoken, shy, accompanied by his mother and grandmother. They worried he had ADHD and brought medical letters suggesting he needed a shadow teacher. But when I sat with him, I saw a sharp, capable young man—doing algebra, writing in neat English, and even a brown belt in karate. After a careful conversation with my senior consultant, we agreed: he didn’t need a shadow teacher just yet. What he needed was encouragement, friendship, and a little more faith in himself.

Finally, a middle-aged woman came in with elbow pain. A quick test confirmed it was a common strain injury. We gave her exercises and simple treatment, and she left relieved.

As the day ended, I stepped outside the clinic into the fading light, tired but deeply fulfilled. What I saw today was the essence of family medicine—not just treating illness, but listening to life. In a place with limited resources, human connection became the most powerful tool I had.

Language may have divided us at first—but care, compassion, and attentiveness brought us together.

The 32-Inch Pants: A Doctor's Unexpected Weight Loss Story

I have a story I can share with you that's very personal and inspiring. Here's how it goes.

When I started my internship back in 2019 at Diyatalawa, a beautiful and serene town nestled in the Uva province, I was excited for my first year of training in the medical profession. I remember being quite skinny back then, weighing around 65kg and comfortably fitting into my 32-inch pants. Back during campus, I played football and was physically active. My first appointment was in pediatrics, where I joined two other house officers.

Internship was a pleasant experience. I enjoyed my training under a kind consultant and with amiable colleagues and staff. There was also plenty of food around! The happy parents of children who were admitted and treated for various conditions always brought cakes to show their appreciation. My colleagues and staff also brought in food, and there were regular small occasions like birthdays. I also developed the habit of having tea almost 3-4 times a day with something to snack on. For dinner, we sometimes ordered food from outside, and on regular occasions, we indulged in delicious pizzas and submarines from a place called Pizza Hub.

My eating habits gradually became unhealthy. I ate more than I worked. My belly grew larger than that of my pregnant colleague who was 20 weeks along! I became easily tired and lethargic, but I continued to eat. My colleague's mother-in-law, who used to bring her lunch in her absence, started to suspect that I was eating her lunch instead of giving it to her! My pant size increased to 34 inches, and I couldn't wear the shirts I had bought when I started the internship. Of course, my weight increased by a staggering 10 kilos within a few months.

Moreover, the COVID-19 pandemic arrived. We were confined to the hospital and our quarters. Physical activity became less and less frequent. We had rice and curry three times a day, which was almost the same meal for about two months. You can imagine the result!

The turning point came when I asked my friend Uma, who was a Relief House Officer in radiology, to perform a scan on me. It was mostly for fun and because I had never had an ultrasound scan before. She did my scan, but her face grew dim. My liver appeared very opaque on the scan images, consistent with grade 2 fatty liver! She looked at me and gave me a stern warning about my lifestyle. I felt ashamed and realized that I hadn't practiced what I had learned or preached as a doctor. I decided to change my lifestyle.

My experiments began with my diet. I did a lot of research on what to eat and what not to eat. I read articles, books, and guidelines, watched YouTube videos, and even Netflix documentaries. I tried various things, including intermittent fasting, plant-based diets, vegetarianism, keto diets, and simply not eating. Unsurprisingly, I was unable to maintain any of these diets. I didn't cook for myself and relied on hospital canteen food, which was mostly high in carbohydrates and starchy foods with fewer vegetables. I was frustrated!

For physical activity, I achieved a modest breakthrough when I started my RHO period after the internship. I had more free time and was able to engage in regular physical activity, including playing badminton and cricket and exciting adventures like mountain climbing and exploring the hills and landscapes around Diyatalawa, Bandarawela, and Ella. My short stint working at the COVID-19 intermediate care center with army personnel also positively influenced me to engage in regular physical activity. I joined them in their physical training sessions to keep fit and incorporated them into my daily schedule.

But it wasn't enough. My weight remained the same. I still wore size 34. My BMI was 31.

Eventually, I was selected for training in family medicine in 2022, which is essentially general practice. I realized that non-communicable diseases, including diabetes, hypertension, dyslipidemia, and ischemic heart disease, are the most common burdens encountered by primary care providers. And obesity was a major risk factor for developing all of the above. One notable incident occurred during my short clinical appointment in endocrinology. The consultant took a close look at me and said I would definitely develop diabetes within another 10 years. This devastated me, as both my parents are diabetic patients, and I was going to inherit that in my thirties. I learned that a darkening discoloration of the neck, called acanthosis nigricans, along with a strong family history of diabetes and obesity, easily predicts the future of inheriting diabetes.

All of this triggered me to make a drastic change and put on the top gear. I realized that I couldn't become a good family physician unless I practiced a healthy lifestyle myself. I would be a hypocrite. While I received valuable training in family medicine and preventive healthcare, I decided to implement it on myself as I preached.

Firstly, I re-explored my diet. The biggest challenge was our regular Sri Lankan diet, which is carbohydrate-dominant. If we ordered a lunch of simple rice and curry, it was mostly rice with small portions of curries. For dinners, we cheated with fast foods such as kottu, pizzas, and burgers, which was a recipe for disaster. And I loved indulging in desserts whenever my mom made them. After doing my research, I found the calorie restriction diet using the smart plate model to be the most practical. One-fourth of carbs, one-fourth of protein such as meat, fish, or eggs, and half of vegetables, including green leafy vegetables. Potatoes, carrots, beetroot, jackfruit, and breadfruit were part of the carbs. I only served myself a cup of rice, approximately 200g, not a grain more. My mother was concerned as I wasn't eating enough rice, which is typical for Sri Lankan mothers. Gradually, I convinced her to prepare meals accordingly, and I proved that even her blood sugar levels became controlled with the same medications by simply cutting down on carbohydrates. Now all of us at home eat smartly as described above.

Secondly, I focused on my exercise routine. I didn't join a gym or engage in a regular sport. Moreover, I couldn't find the time to take regular walks around the neighborhood as the roads were very busy with fast-moving traffic and lacked designated walking paths. Furthermore, the warm, hot weather was very discouraging. Occasionally, I went cycling, but I couldn't make it a habit. Then, on Facebook, I found something that became a significant aspect of my daily routine. On my regular newsfeed, I started seeing an app called MuscleBooster. I simply ignored it for months because I thought it was just some money-making scam by Americans. But I became curious and decided to give it a try. I entered my data, including age, BMI, and my weight loss goal. I learned that there was a subscription fee involved, which was around 3000 rupees per year. I felt stingy at first, but since nothing else had worked, I subscribed to it.

The app suggested a regular routine of 10-minute personalized workouts based on my requirements. The workouts were fun, and I enjoyed doing the movements, which mostly used body weight and sometimes a bench, chair, or dumbbells. However, I didn't see any significant improvement for four weeks, but I had some faith and continued to enjoy doing them.

Then, there was something that particularly encouraged me to keep going no matter what. I was a bit of an avid reader of self-improvement books like "Atomic Habits" and was familiar with the concept of Kaizen, a Japanese concept for making small incremental changes for positive improvement. What struck me the most was that the initial period of any intervention or new habit will not lead to any visible or tangible changes. But continuous engagement for more than four weeks leads to massive improvements and skyrockets towards the target following a latent phase of 4-6 weeks. Thus, I realized the power of small habits, perseverance, a little bit of faith, consistency, discipline, and patience – one step at a time.

Healthy diet and regular physical activity became a part of my lifestyle. My diet became aligned with the smart plate model, similar to the Mediterranean style, and indulging in fast foods became less and less frequent. Exercise became a regular habit, as natural as washing my face and brushing my teeth every morning. I was always looking forward to doing my 10-minute workout. Slowly but surely, I was being transformed. I became healthier, fitter, happier, and more confident.

You must be curious now about what actually happened. Well, if you must know, I can now fit into my 32-inch pants and wear my old shirts and t-shirts that I was planning to donate to charity!

Finding Christmas

The festive season was in full swing. Christmas carols filled the air, colorful decorations adorned every corner, and the shopping frenzy was in overdrive. Amidst the whirlwind of parties, friend gatherings, and endless to-do lists, a quiet reflection began to stir within me. "Are we so caught up in the busyness of Christmas that we've forgotten the true meaning of the season?" I pondered, "Is it all about the decorations, the gifts, the parties, or is it about remembering Jesus, the reason for the season?"

A friend reached out, "What are you doing for Christmas?" he inquired. "Not much," I replied, "Just spending time at home with family." He suggested we hang out, and I readily agreed. This simple invitation sparked another thought: "What is the best gift we can truly give someone this Christmas?"

Expensive gifts, gadgets, and designer items flashed through my mind. But then, a realization dawned. In our hyper-connected world, time has become a precious commodity. We are constantly bombarded with distractions, glued to our devices, and caught up in the endless demands of life. In this whirlwind, genuine human connection often gets lost.

I concluded that the most meaningful gift we can offer is our time. To truly cherish those we love, to be present in their lives, to offer a listening ear and a genuine connection – that, I believe, is the greatest gift of all. And at the heart of it all, keeping Jesus Christ at the center of our celebrations, remembering the true spirit of giving and compassion – that is the essence of a truly meaningful Christmas.

A Limping Park Mishap

Long ago, when I was a young lad in grade 6, my little brother, still in grade 4, was utterly obsessed with Linkin Park. Our cousin, Chaturanga, had introduced him to their powerful music, and my brother was hooked.

One day, he pleaded with our father to buy a Linkin Park CD. In those days, we didn't have the luxury of iPods or MP3 players. Our only source of music was our old computer. Online streaming and downloading were unheard of.

My father, ever the indulgent parent, took my brother to a local CD shop in Malwatta Road, Pettah. As they browsed the shelves, my father asked the shopkeeper, "Do you have Limping Park?"

The shopkeeper, a bit puzzled, replied, "Limping Park? What's that?"

My brother, growing increasingly frustrated, corrected him, "No, no, it's Linkin Park!"

The shopkeeper, still confused, put the CD in a player and started the music. My father, listening intently, shook his head and said, "What is this noise! I don't think this is it, son."

But my brother was adamant. "No, Dad, it's Linkin Park!" he insisted.

It was a hilarious misunderstanding, one that we still laugh about today.

The Alchemy of Happiness

Life, a canvas painted with strokes of happiness and sorrow, is a beautiful journey. For me, true joy lies not in passive pleasures, but in active experiences that enrich the soul.

I vividly recall the thrill of childhood adventures - the excitement of birthday parties, the magic of losing myself in the pages of a Harry Potter book, and the camaraderie of cricket matches with friends. The pride of representing my school on the football field and the jubilation of scoring goals in university matches still echo in my heart.

Academic triumphs, like topping the MBBS exam, brought immense satisfaction. The collective joy of winning the Supreme Court case for internship registration was a testament to the power of perseverance and unity.

Travel has been another source of immense joy. The freedom of solo trips to Italy and England, and the shared laughter and experiences with friends on various journeys, have created cherished memories.

Helping others has also brought me profound happiness. The fulfillment of charitable work and the simple act of lending a hand to those in need have enriched my life in countless ways.

In contrast, the passive pleasures of binge-watching Netflix or scrolling through social media, while momentarily enjoyable, pale in comparison to the enduring joy of active experiences. The difference, I believe, lies in the neurotransmitters involved. While dopamine, associated with short-term gratification, may be triggered by these passive activities, serotonin, linked to long-lasting happiness, is stimulated by social interactions, physical activity, and acts of kindness.

To cultivate lasting happiness, it's essential to strike a balance between these two neurotransmitters. By engaging in activities that promote serotonin production, such as spending time in nature, exercising, and connecting with loved ones, we can experience a deeper and more enduring sense of well-being.

In essence, true happiness lies in a life well-lived - a life filled with meaningful experiences, acts of kindness, and a genuine connection with oneself and the world around us.

The Mysterious Case of the Numbness

During my third year of medical school, a young 18-year-old boy who was working in my mother's office came to me seeking medical advice. Although I wasn't a qualified doctor at the time, he approached me directly, expressing concern about unusual sensations in his body. He described a peculiar numbness in his right leg and a strange, wire-like feeling in his right arm. Additionally, he mentioned a noticeable lightening of his skin tone, particularly in patches. 

I was immediately concerned, as these symptoms suggested a potential neurological issue. While I couldn't provide a definitive diagnosis, I recognized the seriousness of his condition and advised him to seek immediate medical attention at the National Hospital OPD. 

At the OPD, he was referred to the skin clinic and subsequently underwent a skin biopsy. A few weeks later, he returned to inform me that he had been diagnosed with leprosy and prescribed a 12-month course of medication. He was also advised to involve his family members in his treatment and follow-up care.

I didn't see him for several years, but he eventually returned to visit my mother and me. He expressed sincere gratitude for my initial advice, which had been crucial in leading to his accurate diagnosis and effective treatment. He shared that he had since married and emigrated, and that he was doing well. Every New Year and Christmas, he sends his best wishes, acknowledging my role in helping him overcome a serious health challenge and embark on a fulfilling life. 

This experience marked my first encounter with a complex medical case, and it taught me the importance of careful observation, timely intervention, and patient empathy, even when one is still a medical student." 

A Society Divided: The Role of Gender Roles in Sri Lankan Violence

Sri Lanka, a South Asian nation, is deeply rooted in cultural, religious, and ethnic traditions. A significant aspect of these traditions involves rigid gender roles, often leading to societal expectations that can have harmful consequences.

From birth, individuals are assigned a gender based on biological sex. As they grow, societal norms dictate adherence to specific gender roles. Men are generally expected to be breadwinners, strong, and emotionally restrained, serving as primary caregivers and decision-makers within families. Conversely, women are often confined to domestic roles, expected to be emotionally expressive and submissive.

These societal norms carry serious repercussions. Men, burdened by the expectation to remain strong and stoic, often struggle to express their emotions, leading to higher rates of mental health issues and suicide. This is evident in numerous cases of men taking their own lives due to personal or professional failures.

Women face significant challenges, particularly domestic violence, which remains prevalent in Sri Lankan society. According to the Women’s Wellbeing Survey, one in five women has experienced physical or sexual violence by an intimate partner in their lifetime. Cultural expectations of female submission frequently result in physical and emotional abuse.

Gender-based violence (GBV) often goes underreported in Sri Lanka, particularly in cases of domestic and dating violence. When incidents are reported, the focus tends to shift towards victim-blaming rather than supporting survivors. Intimate partner violence often includes physical, emotional, and sexual abuse. 

In recent years, incidents of dating violence have surged, including cases where individuals have lost their lives due to disputes during courtship. Additionally, workplace-related gender-based violence is a persistent issue, with women frequently facing discrimination, harassment, and even assault from male colleagues or superiors.

Healthcare professionals play a vital role in addressing GBV. Victims may present with a wide range of symptoms, including unexplained bodily pain, somatic complaints, bowel irregularities, frequent clinic visits, and visible signs of trauma such as bruises or injuries. Psychological symptoms, such as depression, anxiety, and other mental health concerns, are also common.

To combat GBV effectively, healthcare providers must be sensitive and proactive. By asking open-ended questions, creating a safe and non-judgmental environment, and referring patients to appropriate support services, they can help break the cycle of violence and promote gender equality.

It is crucial to empathize with victims and provide them with comprehensive support. At the same time, holding perpetrators accountable and stigmatizing abusive behavior is essential. Encouraging reporting and fostering societal accountability are critical steps toward preventing future incidents of gender-based violence.