Features
Death in many guises
By Dr Upul Wijayawardhana
We are not sure whether Andare is a legendary figure or a ‘Matara Man’ born around 1742 in the village of Udamalala, who went all the way to Kandy to serve King Keerthi Sri Rajasinghe. But we can be pretty sure that the exploits of this famous court jester will not cease to entertain for generations to come. Only Andare could get away with daring antics but, unfortunately, on one occasion he went too far, greatly annoying the King who, in a fit of rage, condemned Andare to death. In desperation, he pleaded, “Your Majesty, considering that I have been your humble servant for so long please allow me to choose the mode of death”. The good King did not have the heart to refuse and agreed to this request, under the impression that Andare would choose the mode of his execution but when Andare quipped “Your Majesty, I like to die when I am old”, and the King burst out laughing! Like Andare, we all would love to live to a ripe old age to die. But then, we do not want to drag on with a life of infirmity. Perhaps, the best way to leave this world is with a sudden death in old age!
Death comes in many guises: some die in-utero, others in childhood, yet others in the prime of youth and the lucky live to a ripe old age. Some have a long-drawn out deaths whilst others die suddenly. As I wrote in a song, during my medical student days, “Andagena upanne, andawa merenne, me sansare oba kohida yanne” (we are born with a cry, make others cry when we die, do not know where we go in this cycle of life).
Although sudden death is a nice way to go, if it does not happen too early, it can create huge problems the dear ones of the deceased. Sudden deaths often necessitate a post-mortem examination but, in some instances, even the PM examination may not show the exact cause of death although it would help to exclude foul play. Someone living alone, who dies suddenly, may not be found for days leading to decomposition, which makes the job of the pathologist doing the PM examination even more difficult. This was highlighted by the recent unfortunate sudden death of Zacky Jabbar, the Deputy Editor of this newspaper. Three months ago, a regular contributor to this newspaper, Rajeewa Jayaweera died under tragic circumstances; unfortunately, he took his own life: yet another guise of death. We live in an era of uncontrolled social media and the irresponsible, baseless rumours spread that these two deaths heralded a killing spree by the government, added to the distress of the families.
Sudden deaths are often due to problems of the heart although, on some rare occasions, they can happen as the result of a massive stroke or the rupture of a main blood vessel, usually due to weakening of the wall and dilatation forming an aneurysm. Sudden deaths due to heart problems are referred to as Sudden Cardiac Deaths (SCD) and result invariably from abnormal heart rhythms, the most common being ventricular fibrillation (VF). The main pumping chambers of the heart are the ventricles, which pump blood to arteries by coordinated contractions of muscle fibres but in ventricular fibrillation the muscle fibres contract in an irregular discordant manner like a ‘bag of worms’ without any effective emptying. VF can be caused by the ventricular muscle not getting enough blood due to narrowing of the coronary arteries, the vital arteries that supply blood to the heart muscle itself, sometimes made worse by a blood clot developing on the narrowed vessel, causing complete obstruction: Coronary Thrombosis. VF also can occur due to abnormalities in the ‘wiring system’ or the electrical activation system in the heart.
Very rapid heart rate, tachycardia, too can cause sudden death. Blood that returns from various parts of body is taken by the venous system to the right side of the heart to be pumped to the lungs where replenishing of red blood cells with oxygen, oxygenation, takes place. Oxygenated blood returns to the left side of the heart to be pumped around the body. If the heart beats too fast there is no time for the pumping chamber to fill, so that even if effective contraction occurs, there is no blood to pump out resulting in collapse. These rapid rates can occur with significant underlying disease but in some instances occur on a structurally normal heart, due to electrolyte disturbances, drug interactions etc.
Too slow a heart rate is also detrimental and the heart rate needs to be around 60 – 70 beats per minute at rest. In addition, the rate needs to increase with increased activity, to keep pace with the metabolic demand. For this, as well as to give electrical signals for the synchronised working of the various chambers of the heart, there is an electrical conducting system with built in pacemakers, buried in the tissues surrounding the heart muscle. When there is a block in this circuit, heart block occurs. This block in the electrical circuit of the heart causes slow heart rates or bring the heart to a complete standstill resulting in death. In such deaths, there are no PM findings unless detailed microscopic studies are done on the conducting system but this laborious process is hardly ever done.
Fortunately, in heart blocks there are warning symptoms like fainting, blackouts, sudden and transient giddiness, etc. When patients present with these suggestive symptoms Cardiologists arrange monitoring of heart rhythm using various devices. Once confirmed, heart block is one of the easiest and the most cost-effective conditions to treat with a permanent pacemaker. In fact, I set up the permanent pacemaker programme in the Cardiology Unit [Colombo] way back in late seventies.
There are many rare and perplexing rhythm abnormalities that occur in a structurally normal heart, some of which are brought about or exaggerated by chemical and electrolyte imbalances. The trigger for contraction of the heart muscle is an electrical impulse, very tiny in strength, which depolarises the muscle. For the next contraction to occur the cardiac muscle has to repolarise and this period of repolarisation is vulnerable to many factors. Some genetic abnormalities affect this period causing syndromes like ‘Prolonged Q-T syndrome’ and ‘Brugada syndrome’. A dangerous rhythm could be precipitated in susceptible individuals by drugs which affect depolarisation. By regular monitoring of drug reactions and interactions we are able to avoid prescription of drugs that may cause potential harm. Unfortunately, various preparations used in alternative medical systems like Ayurveda contain multiple plant-based derivatives whose safety has not been tested adequately. The argument that plant based products are harmless is fallacious as plants have many toxic compounds. Further, compounds that may not have direct harmful effects may interfere in the repolarisation process of vulnerable individuals. An expert eye may detect subtle ECG changes in these conditions but for confirmation, specialised invasive tests are needed. Deaths due to these conditions are impossible to detect in PMs, as the death was due to a functional abnormality, not structural.
Another cause of sudden deaths is cardiomyopathies: abnormalities of the heart muscle itself. There are many types, the commonest being dilated cardiomyopathy associated with heart failure. In this condition the chest x-ray shows an enlarged heart and an echocardiogram (ultrasound examination of the heart) would confirm poor function. However, the lethal variety is hypertrophic cardiomyopathy, where there is unnecessary and unregulated thickening of the heart muscle, to varying degrees. Sometimes the thickening of the muscle is so great that it obliterates the ventricular cavity but more commonly what it does is to obstruct the outflow. Patients with hypertrophic cardiomyopathy are liable to have sudden deaths, especially when they undertake sudden, severe unaccustomed to exertion: they virtually drop dead. The cause of death is easy to establish in these cases as there are obvious structural abnormalities. Hypertrophic cardiomyopathies are often inherited, and once an unfortunate case is detected what is important is family study: to identify family members who may be affected and treat them appropriately to prevent sudden death.
The realisation that someone who had sudden cardiac deaths had hearts that are ‘too good to die’ gave rise to the concept of cardio-pulmonary resuscitation, which has saved innumerable lives around the world. It has evolved over time and is much simpler now. Pressing the breast bone down against the spine, about 50 times a minute, could imitate the pumping action of the heart, though to a lesser degree, but that could enhance the survival of the brain for some time and has saved many lives. This was coupled with mouth-to-mouth breathing, at the beginning, but it was later shown that this step, which some found difficulty in complying with, does not make a significant difference. Thus, the present CPR technique is simple and should be taught to all upper school children. Even the young can have sudden deaths and a simple procedure like CPR coupled with prompt treatment in hospital has the potential to save many lives.
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There’s an ill more dangerous and pervasive than the Coronavirus that’s currently sweeping Sri Lanka. That is the fear to express one’s convictions. Across the public sector of the country in particular many persons holding high office are stringently regulating and controlling the voices of their consciences and this bodes ill for all and the country.
The corrupting impact of fear was discussed in this column a couple of weeks ago when dealing with the military coup in Myanmar. It stands to the enduring credit of ousted Myanmarese Head of Government Aung San Suu Kyi that she, perhaps for the first time in the history of modern political thought, singled out fear, and not power, as the principal cause of corruption within the individual; powerful or otherwise.
To be sure, power corrupts but the corrupting impact of fear is graver and more devastating. For instance, the fear in a person holding ministerial office or in a senior public sector official, that he would lose position and power as a result of speaking out his convictions and sincere beliefs on matters of the first importance, would lead to a country’s ills going unaddressed and uncorrected.
Besides, the individual concerned would be devaluing himself in the eyes of all irrevocably and revealing himself to be a person who would be willing to compromise his moral integrity for petty worldly gain or a ‘mess of pottage’. This happens all the while in Lankan public life. Some of those who have wielded and are wielding immense power in Sri Lanka leave very much to be desired from these standards.
It could be said that fear has prevented Sri Lanka from growing in every vital respect over the decades and has earned for itself the notoriety of being a directionless country.
All these ills and more are contained in the current controversy in Sri Lanka over the disposal of the bodies of Covid victims, for example. The Sri Lankan polity has no choice but to abide by scientific advice on this question. Since authorities of the standing of even the WHO have declared that the burial of the bodies of those dying of Covid could not prove to be injurious to the wider public, the Sri Lankan health authorities could go ahead and sanction the burying of the bodies concerned. What’s preventing the local authorities from taking this course since they claim to be on the side of science? Who or what are they fearing? This is the issue that’s crying out to be probed and answered.
Considering the need for absolute truthfulness and honesty on the part of all relevant persons and quarters in matters such as these, the latter have no choice but to resign from their positions if they are prevented from following the dictates of their consciences. If they are firmly convinced that burials could bring no harm, they are obliged to take up the position that burials should be allowed.
If any ‘higher authority’ is preventing them from allowing burials, our ministers and officials are conscience-bound to renounce their positions in protest, rather than behave compromisingly and engage in ‘double think’ and ‘double talk’. By adopting the latter course they are helping none but keeping the country in a state of chronic uncertainty, which is a handy recipe for social instabiliy and division.
In the Sri Lankan context, the failure on the part of the quarters that matter to follow scientific advice on the burials question could result in the aggravation of Islamophobia, or hatred of the practitioners of Islam, in the country. Sri Lanka could do without this latter phobia and hatred on account of its implications for national stability and development. The 30 year war against separatist forces was all about the prevention by military means of ‘nation-breaking’. The disastrous results for Sri Lanka from this war are continuing to weigh it down and are part of the international offensive against Sri Lanka in the UNHCR.
However, Islamophobia is an almost world wide phenomenon. It was greatly strengthened during Donald Trump’s presidential tenure in the US. While in office Trump resorted to the divisive ruling strategy of quite a few populist authoritarian rulers of the South. Essentially, the manoeuvre is to divide and rule by pandering to the racial prejudices of majority communities.
It has happened continually in Sri Lanka. In the initial post-independence years and for several decades after, it was a case of some populist politicians of the South whipping-up anti-Tamil sentiments. Some Tamil politicians did likewise in respect of the majority community. No doubt, both such quarters have done Sri Lanka immeasurable harm. By failing to follow scientific advice on the burial question and by not doing what is right, Sri Lanka’s current authorities are opening themselves to the charge that they are pandering to religious extremists among the majority community.
The murderous, destructive course of action adopted by some extremist sections among Muslim communities world wide, including of course Sri Lanka, has not earned the condemnation it deserves from moderate Muslims who make-up the preponderant majority in the Muslim community. It is up to moderate opinion in the latter collectivity to come out more strongly and persuasively against religious extremists in their midst. It will prove to have a cementing and unifying impact among communities.
It is not sufficiently appreciated by governments in the global South in particular that by voicing for religious and racial unity and by working consistently towards it, they would be strengthening democratic development, which is an essential condition for a country’s growth in all senses.
A ‘divided house’ is doomed to fall; this is the lesson of history. ‘National security’ cannot be had without human security and peaceful living among communities is central to the latter. There cannot be any ‘double talk’ or ‘politically correct’ opinions on this question. Truth and falsehood are the only valid categories of thought and speech.
Those in authority everywhere claiming to be democratic need to adopt a scientific outlook on this issue as well. Studies conducted on plural societies in South Asia, for example, reveal that the promotion of friendly, cordial ties among communities invariably brings about healing among estranged groups and produces social peace. This is the truth that is waiting to be acted upon.
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By Sanjeewa Jayaweera
It was on 3rd January 1972 that our family arrived in Karachi from Moscow. Our departure from Moscow had been delayed for a few weeks due to the military confrontation between Pakistan and India. It ended on 16th December 1971. After that, international flights were not permitted for some time.
The contrast between Moscow and Karachi was unbelievable. First and foremost, Moscow’s temperature was near minus 40 degrees centigrade, while in Karachi, it was sunny and a warm 28 degrees centigrade. However, what struck us most was the extreme warmth with which the airport authorities greeted our family. As my father was a diplomat, we were quickly ushered to the airport’s VIP Lounge. We were in transit on our way to Rawalpindi, the airport serving the capital of Islamabad.
We quickly realized that the word “we are from Sri Lanka” opened all doors just as saying “open sesame” gained entry to Aladdin’s cave! The broad smile, extreme courtesy, and genuine warmth we received from the Pakistani people were unbelievable.
This was all to do with Mrs Sirima Bandaranaike’s decision to allow Pakistani aircraft to land in Colombo to refuel on the way to Dhaka in East Pakistan during the military confrontation between Pakistan and India. It was a brave decision by Mrs Bandaranaike (Mrs B), and the successive governments and Sri Lanka people are still enjoying the fruits of it. Pakistan has been a steadfast and loyal supporter of our country. They have come to our assistance time and again in times of great need when many have turned their back on us. They have indeed been an “all-weather” friend of our country.
Getting back to 1972, I was an early beneficiary of Pakistani people’s love for Sri Lankans. I failed the entrance exam to gain entry to the only English medium school in Islamabad! However, when I met the Principal, along with my father, he said, “Sanjeewa, although you failed the entrance exam, I will this time make an exception as Sri Lankans are our dear friends.” After that, the joke around the family dinner table was that I owed my education in Pakistan to Mrs B!
At school, my brother and I were extended a warm welcome and always greeted “our good friends from Sri Lanka.” I felt when playing cricket for our college; our runs were cheered more loudly than of others.
One particular incident that I remember well was when the Embassy received a telex from the Foreign inistry. It requested that our High Commissioner seek an immediate meeting with the Prime Minister of Pakistan, Mr Zulifikar Ali Bhutto (ZB), and convey a message from Mrs B. The message requested that an urgent shipment of rice be dispatched to Sri Lanka as there would be an imminent rice shortage. As the Ambassador was not in the station, the responsibility devolved on my father.
It usually takes about a week or more to get an audience with the Prime Minister (PM) of a foreign country due to their busy schedule. However, given the urgency, my father spoke to the Foreign Ministry’s Permanent Sectary, who fortunately was our neighbour and sought an urgent appointment. My father received a call from the PM’s secretary around 10 P.M asking him to come over to the PM’s residence. My father met ZB around midnight. ZB was about to retire to bed and, as such, was in his pyjamas and gown enjoying a cigar! He had greeted my father and had asked, “Mr Jayaweera, what can we do for great friend Madam Bandaranaike?. My father conveyed the message from Colombo and quietly mentioned that there would be riots in the country if there is no rice!
ZB had immediately got the Food Commissioner of Pakistan on the line and said, “I want a shipload of rice to be in Colombo within the next 72 hours!” The Food Commissioner reverted within a few minutes, saying that nothing was available and the last export shipment had left the port only a few hours ago to another country. ZB had instructed to turn the ship around and send it to Colombo. This despite protests from the Food Commissioner about terms and conditions of the Letter of Credit prohibiting non-delivery. Sri Lanka got its delivery of rice!
The next was the visit of Mrs B to Pakistan. On arrival in Rawalpindi airport, she was given a hero’s welcome, which Pakistan had previously only offered to President Gaddafi of Libya, who financially backed Pakistan with his oil money. That day, I missed school and accompanied my parents to the airport. On our way, we witnessed thousands of people had gathered by the roadside to welcome Mrs B.
When we walked to the airport’s tarmac, thousands of people were standing in temporary stands waving Sri Lanka and Pakistan flags and chanting “Sri Lanka Pakistan Zindabad.” The noise emanating from the crowd was as loud and passionate as the cheering that the Pakistani cricket team received during a test match. It was electric!
I believe she was only the second head of state given the privilege of addressing both assemblies of Parliament. The other being Gaddafi. There was genuine affection from Mrs B amongst the people of Pakistan.
I always remember the indefatigable efforts of Mr Abdul Haffez Kardar, a cabinet minister and the President of the Pakistan Cricket Board. From around 1973 onwards, he passionately championed Sri Lanka’s cause to be admitted as a full member of the International Cricket Council (ICC) and granted test status. Every year, he would propose at the ICC’s annual meeting, but England and Australia’s veto kept us out until 1981.
I always felt that our Cricket Board made a mistake by not inviting Pakistan to play our inaugural test match. We should have appreciated Mr Kardar and Pakistan’s efforts. In 1974 the Pakistan board invited our team for a tour involving three test matches and a few first-class games. Most of those who played in our first test match was part of that tour, and no doubt gained significant exposure playing against a highly talented Pakistani team.
Several Pakistani greats were part of the Pakistan and India team that played a match soon after the Central Bank bomb in Colombo to prove that it was safe to play cricket in Colombo. It was a magnificent gesture by both Pakistan and India. Our greatest cricket triumph was in Pakistan when we won the World Cup in 1996. I am sure the players and those who watched the match on TV will remember the passionate support our team received that night from the Pakistani crowd. It was like playing at home!
I also recall reading about how the Pakistani government air freighted several Multi Barrell artillery guns and ammunition to Sri Lanka when the A rmy camp in Jaffna was under severe threat from the LTTE. This was even more important than the shipload of rice that ZB sent. This was crucial as most other countries refused to sell arms to our country during the war.
Time and again, Pakistan has steadfastly supported our country’s cause at the UNHCR. No doubt this year, too, their diplomats will work tirelessly to assist our country.
We extend a warm welcome to Mr Imran Khan, the Prime Minister of Pakistan. He is a truly inspirational individual who was undoubtedly an excellent cricketer. Since retirement from cricket, he has decided to get involved in politics, and after several years of patiently building up his support base, he won the last parliamentary elections. I hope that just as much as he galvanized Sri Lankan cricketers, his political journey would act as a catalyst for people like Kumar Sangakkara and Mahela Jayawardene to get involved in politics. Cricket has been called a “gentleman’s game.” Whilst politics is far from it!.
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Believe me, seeing certain videos, on social media, depicting action, on the dance floor, at some of these entertainment venues, got me wondering whether this Coronavirus pandemic is REAL!
To those having a good time, at these particular venues, and, I guess, the management, as well, what the world is experiencing now doesn’t seem to be their concerned.
Obviously, such irresponsible behaviour could create more problems for those who are battling to halt the spread of Covid-19, and the new viriant of Covid, in our part of the world.
The videos, on display, on social media, show certain venues, packed to capacity – with hardly anyone wearing a mask, and social distancing…only a dream..
How can one think of social distancing while gyrating, on a dance floor, that is over crowded!
If this trend continues, it wouldn’t be a surprise if Coronavirus makes its presence felt…at such venues.
And, then, what happens to the entertainment scene, and those involved in this field, especially the musicians? No work, whatsoever!
Lots of countries have closed nightclubs, and venues, where people gather, in order to curtail the spread of this deadly virus that has already claimed the lives of thousands.
Thailand did it and the country is still having lots of restrictions, where entertainment is concerned, and that is probably the reason why Thailand has been able to control the spread of the Coronavirus.
With a population of over 69 million, they have had (so far), a little over 25,000 cases, and 83 deaths, while we, with a population of around 21 million, have over 80,000 cases, and more than 450 deaths.
I’m not saying we should do away with entertainment – totally – but we need to follow a format, connected with the ‘new normal,’ where masks and social distancing are mandatory requirements at these venues. And, dancing, I believe, should be banned, at least temporarily, as one can’t maintain the required social distance, while on the dance floor, especially after drinks.
Police spokesman DIG Ajith Rohana keeps emphasising, on TV, radio, and in the newspapers, the need to adhere to the health regulations, now in force, and that those who fail to do so would be penalised.
He has also stated that plainclothes officers would move around to apprehend such offenders.
Perhaps, he should instruct his officers to pay surprise visits to some of these entertainment venues.
He would certainly have more than a bus load of offenders to be whisked off for PCR/Rapid Antigen tests!
I need to quote what Dr. H.T. Wickremasinghe said in his article, published in The Island of Tuesday, February 16th, 2021:
“…let me conclude, while emphasising the need to continue our general public health measures, such as wearing masks, social distancing, and avoiding crowded gatherings, to reduce the risk of contact with an infected person.
“There is no science to beat common sense.”
But…do some of our folks have this thing called COMMON SENSE!
