Obituary - Dr Deepthi Attygalle

Deepthi Attygalle (nee Mendis) was a medical luminary, a teacher par excellence, whose dedication and commitment to the highest academic and clinical standards of postgraduate training in anaesthesia in Sri Lanka is legendary.

She is most revered by over a hundred consultant anaesthetists who have been personally coached by her, many of them serving in the NHS.  Countless others have been impacted by her exceptional lectures in respiratory physiology. Others from various specialties remember important lessons learned in clinical medicine, patient care or communication after just a single encounter with her in an operating theatre, ward, ICU or corridor! She is not easily forgotten - and not just because she was beautiful; as even more than her captivating smile, it was her brilliant intellect, ready wit, strong personality, infectious laughter and engaging conversation that made everyone fall under her spell!  She had such charisma, with a charm and commanding presence that drew attention.

The daughter of the renowned pioneer scientific historian Dr. G.C. Mendis, she was a star pupil and head girl at Ladies College, Colombo. She entered the University of Colombo in 1958 with the last batch of medical students for whom the 1st MBBS was compulsory and obtained the MBBS in 1964 with 2nd class honours winning the prize for Midwifery.  She married Dr. Lakshman Attygalle, son of Sir Nicholas Attygalle, Vice Chancellor of the University of Ceylon.  In 1966 she proceeded to Liverpool with her husband, he to undergo training in genitourinary surgery and she to obtain both the Diploma in Anaesthetics and Primary FFARCS within ten months.

In December 1971 she again went to the UK as a British Council scholar, returning within 9 months with the FFARCS. She served as consultant anaesthetist at the then General Hospital Colombo from August 1972 till her retirement in 2000 and was always at the forefront of uplifting the standards and safety of anaesthesia making far reaching innovative changes with the introduction of new technology, techniques and drugs.

Possibly her greatest contribution was the raising of the profile of anaesthesia within the medical profession, laying the emphasis on academic teaching and clinical training based on the fundamentals of basic sciences, mainly physiology. Respiratory physiology was her favourite subject and her 10 lectures on the basic sciences course were the most popular. Questions of how and why in the operating room or ICU were always exacting, sometimes intimidating, and had to be answered in basic physiological terms. She was not interested in just imparting textbook knowledge, but tried to train young minds to think rationally, objectively and critically. The aim was to teach how to think rather than what to think - think for themselves, rather than load the memory with thoughts of others!  Many vouch for her commanding yet inspiring teaching style, and lessons given with clarity, passion and deep insight.

"How does anaemia affect the A-a gradient?” A well known researcher gratefully acknowledges that that single question from her inspired the foundation of his academic career. Another reminisces the way she traced the journey of the oxygen molecule from the cylinder to the mitochondria. Everyone wondered “how one small head could carry all she knew”! She urged them all to “Keep on teaching, and you will never forget”, and “He who dares to teach or treat patients must never cease to learn”.

She authored the Handbook of Anaesthesia in 1990 to reach out to junior anaesthetists serving in small peripheral hospitals without immediate consultant supervision to have expert practical guidance literally at their fingertips. It continues to be popular 35 years later - now a 530 page book in its 6th edition with many contributors.

A founder member of the Ceylon College of Anaesthetists (1972), and president of the College of Anaesthesiologists and Intensivists of Sri Lanka (1989 and 1990), she was the main driving force throughout the 1980s and 90s. Through her visionary leadership and unwavering dedication, the specialty was elevated to an entirely new level.

She was also a founder member of the South Asian Confederation of Anaesthesiologists (1991) and its president from 1995-1997. She was in great demand at numerous international congresses and conferences as a lecturer and resource person. She conducted one-week workshops in physiology in Malaysia and Nepal and was a visiting examiner for anaesthesiology examinations in the University of Malaysia.

Highly respected internationally, she made long lasting, professional connections and close friendships with leading anaesthesiologists across the globe. As her international reputation grew, she was elected to the board of the Asian Australasian Section of the World Federation of Societies of Anaesthesiologists (1990-1994), executive committee member (1996-2000), deputy vice president (2000-2004), and vice president (2004-2008).

Deepthi was a member of the Board of Study in Anaesthesiology of the Post Graduate Institute of Medicine of Sri Lanka from its inception in 1980, developing a comprehensive, highly structured training program with detailed documentation of skills, attitudes, knowledge and performance. She was examiner for Part 1 and Part 2 of the MD Anaesthesiology examinations from 1981 to 2000 and was instrumental in ensuring that examiners from the RCoA would be co-examiners and those obtaining the degree were exempted from the Primary FRCA at a time when all other countries were refused this privilege. She was Chairperson of the Board from 1990 to 1999 and after retirement in 2000 was appointed to the Board of Management.

“So where was training better - in Sri Lanka or abroad?”  was a standard question she would put to those returning after training overseas. She was proud of the fact that most had no difficulty in obtaining the FRCA or the FANZCA and that their ability and adaptability were adequate to navigate the pitfalls of working in a foreign environment. She recognised that they returned with greater self-assurance and better communication skills that exposure to the outside world adds, and tried to impart that confidence by teaching them to stand up to domineering surgeons and discuss preoperative optimisation and outcomes.   

In 1984 she took over the management of the Recovery Unit which was designated for the care of postoperative patients.  However as there were hardly any other intensive care units in the country at that time, all critically ill patients (e.g. poisoning, haemorrhage, vital organ failure) were transferred here. As the unit had only 4 beds this created a huge dilemma.

Tetanus was then common and created special problems as these patients needed artificial ventilation for a month, draining costly resources with patients often dying of the complications of long-term ventilation.  This stimulated her special interest in researching the management of tetanus with magnesium sulphate infusions to control severe spasms with the aim of avoiding deep sedation, paralysis and artificial ventilation thus keeping the patient awake, alert and aware of their surroundings (Anaesthesia 2002).  Her thinking was way ahead of the times.  She encouraged visitors at a time when ICUs were a locked in space. She instructed the nurses to smile with and talk to patients, relieving their anxiety, to minimise long term psychological effects.   This patient-centric approach is becoming popular today but in the 1990s it was inconceivable.  She gave the SLMA oration on this subject in 2001. At the 150th anniversary of the Colombo Medical College she received an award for her outstanding services.

Apart from her professional responsibilities she strove to uplift standards of education as President of the OGA of her alma mater Ladies College (2007-2008) and School Manager (2009-2016). She was also involved with the work of the Deaf and Blind School and the Chitra Lane School for the Disabled.

Her husband Dr. Lakshman Attygalle, a pioneer, reputed urological surgeon predeceased her in 2019. She was a most devoted mother to their son and two daughters (one of whom, Ayoma, is a histopathologist at the Royal Marsden) and adored her four grandchildren.

She was the ultimate role model, inspiring many generations of anaesthetists in whom her legacy will live on.   “To live in the hearts and minds of those who love, is not to die.”

Dr. Nalini Rodrigo  MBBS, FRCA, FCOAISL