Dr. Lalani Kapuruge - Iron lady of cardiology

The untimely demise of hearty-healer Lalani Kapuruge on November 16, 2019 is a great loss to the field of cardiology. It is not often that you come across a lady who enters this male-dominated arena of interventional cardiology and excels in the art of healing diseased hearts.   

Her quest for knowledge was so intense that she ventured into many subfields of interventional cardiology to equip herself well in order to be able to deliver the proper therapy to patients seeking her services. This was, at times, seen as an indomitable challenge to their supremacy by some of her peers and she was often the envy of everyone around her. But Lalani, intelligent and smart as she was, bravely trod her chosen path undeterred and paved the way forward with pioneering efforts in the field which nobody can deny. 

The following firsts have gone on record to her credit: First reported CT Angiogram (At Asiri Surgical Hospital in collaboration with the Radiology Department); First Primary Angioplasty at the General Hospital; First Septal Ablation for Hypertrophic Obstructive Cardiomyopathy; First Graft Angioplasty; First intervention by Radial Approach.  

FIRST RADIAL APPROACH IN ANGIOPLASTY 
There was much skepticism about this approach when she was doing it by herself in 2001 – some thought she was crazy. The seminal paper she presented at the annual sessions of Ceylon College of Physicians after completing the 50th case in Radial Approach stimulated a lot of discussion and criticism at that time because many were unaware that this was going to be the technique of the future in intervention.This is proof of her power of clairvoyance.This became a major advancement in the delivery of Interventional Therapy due to the many superior benefits over the usual Groin Approach and was later accepted as the better   option for access to the site of treatmentin terms of less trauma to the patient, less bleeding complications, fast recovery and minimal overall cost.This has now gained popularity globally and Lalani was truly the ‘Queen of Radial Approach’ in interventional procedures in Sri  Lanka. Today, many foreign doctors come here to learn this technique. Even Americans have adopted this technique quite late. It would do well for all budding cardiologists to be appreciative of the lasting contributions Dr. Lalani Kapuruge made to the field of interventional cardiology, particularly the popularisation of Radial Approach. Her name is worthy of praise along with other pioneering greats in the field. 

This brings me to a humorous episode linked to our first Distal Radial Approach performance last year. This technique is an advancement of the Radial Approach where you reach the artery more distally between the thumb and index finger (Snuff Box). We learnt this technique from foreign doctors who pioneered it in their countries. We watched them perform it many times and were quite eager to do it here for the first time. On that big day, I started the procedure and midway through, had to attend to another emergency patient. I paused the first procedure for a while and went out. When I came back, Lalani was all smiles. She had completed the procedure herself during my short absence and I was thus left out of that honour. 
She was the first cardiologist to be trained in electrophysiology in Australia. However, there were dedicated electrophysiologists in the field by then. Therefore, she did not pursue that path. She was a very sharp lady with extreme intelligence and the ability to read the minds of people and foresee the future. That is how she brought into this field quite a few firsts. 

At the early stages of Sri Lanka Heart Association, she was one of the main contributors to its development. During the early days of Nawaloka Hospital, where she started Primary Angioplasty, she was passionate about the concept ‘time is muscle’ in relation to her patients who suffered sudden heart attacks. When patients were referred to her, irrespective of the time of day, she used to rush from home, at times in the dead of night, driving all alone, just to save their lives. That was one strong feature of her character; dedication to the task. Another instance that amply displayed the philanthropist in her was the voluntary service she rendered by doing echocardiography to patients of the Cancer Hospital in Maharagama and Army Hospital in Narahenpita who were virtually stranded without a cardiologist. This, she did, while working in the private sector. 

Her quest for knowledge was so intense that she ventured into many subfields of interventional cardiology to equip herself well in order to be able to deliver the proper therapy to patients seeking her services

In the 15 years of close professional association with me, I could understand how her mind worked in all professional matters, how she engaged herself while performing surgical procedures. The catheterisation laboratory would always come alive with Dr. Lalani Kapuruge’s presence. Everybody would be energetic and feel her presence at every step of their work. The ambience would be magical. Today, they are all saddened to miss this unique experience. 

When confronted with a difficult diagnosis, she would not take ‘NO’ for an answer and would not rest until her part is complete. Even in the private sector, she was always patient-centric and would often go the extra mile to help out a deserving patient. This magnanimity won her many hearts among the patient community. True to the Hippocratic Oath, Lalani stood for upholding ethics, justice and fair-play in her field of choice. She was quick to react to anything wrong and irregular and would fight tooth and nail to put it right. Her open and frank criticism of weaknesses observed was read by some as being unfriendly. However, those who were close to her knew that deep inside this iron lady was a soft and truly feminine heart who wept for the suffering of others. 

She was very concerned about the wellbeing of her son and daughter. It was so much so that she had to skip many advance medical conferences and foreign fora just to be with them. The two children are already following in her footsteps and are very likely to fill the void created by the abrupt departure of their beloved mother from the medical field. I wish them well. Towards the latter part of Lalani’s life, her deep attachment to Buddhism was more to be seen. She would often be seen with a Buddhist book in hand, and during the short refreshment breaks, she would get us drawn into her interpretations of life as per Buddha’s teachings. Being a Hindu, I am so privileged to have had the opportunity to learn from her the Buddhist philosophy. 

Just two months before her death, she had told a patient of hers: “In case I am not here, my friend who is here will look after you.” She had so much of confidence in her loyal friends to entrust such tasks. It is very rarely that we come across people of these qualities. 

Dr. Lalani Kapuruge had a dream, a dream of fulfillment in doing her bit, in a society where strict precedence would be given to ethics, justice and fair-play. Alas, she could not live to see the light of that day. She had to depart this world the day the leader of her choice was elected the President of Sri Lanka. 

In conclusion, a very apt remark made by a friend of mine who had been a close associate of hers as well, comes to my mind: “A fair, fond flower withered in the wilderness,” he said, and I cannot differ from his poetic comment on this hearty-healer’s untimely demise. 
May she attain the supreme bliss of Nibbana! 
Dr. S. Mithrakumar, 
 Consultant Cardiologist