Second Suns

by David Oliver Relin

  “Ruit was really in his element,” Douglas says. “He operated as quickly and confidently as if he was in a hospital back in Kathmandu. I’ll never forget the next morning. One woman had been blind for about ten years, and had never laid eyes on three of her own children. When her bandages came off and she saw them, we all just sat there on the ground and cried, me, Ruit, the woman, and her children. It was just so emotional.”

  Michael Amendolia proved worthy of the risks Ruit had taken to bring him along. He burned through roll after roll of black-and-white film, capturing indelible images of the harshly beautiful landscape, as well as the patients’ elation. In the most famous photograph ever taken of Ruit at work, Amendolia caught a seventy-eight-year-old shepherd named Pemasumta at precisely the moment the doctor removed his eye patch. “I’m not only seeing the sun, I feel I am the sun!” Pemasumta said as Amendolia’s shutter clicked, raising his hands and pressing them together to bless the man who had returned light to his life. Ruit is grinning so exuberantly, so soulfully in the photo, you’d think it was the first time he’d ever cured a blind patient.

  “Michael captured the essence of Ruit right there,” Douglas says. “I’ll tell you a story about Ruit you don’t have to believe, but it’s true: Ruit is like a godfather to our son Zac and visits us whenever he’s in Australia. Well, Zac was stricken with encephalitis before one of Ruit’s visits, and even though Sanduk was late for a conference, he insisted on stopping by the hospital to check in on our boy. By then, Zac was in a coma, and my wife and I were sick with worry. Ruit sat next to Zac, took his hand in his, and at precisely that moment, Zac came out of his coma and sat up. I can’t explain it, but if you spend enough time around Ruit, it doesn’t seem so strange. In all my years as a diplomat, meeting prime ministers, presidents, and kings, he’s the pinnacle. The greatest, most inspirational human being I’ve ever had the privilege to know.”

  Their last morning before turning for home, the members of the team were served their morning tea along with the news that an elderly monk had died in the night. They were invited to witness his sky burial. In an alpine region of permafrost, interment in the frozen earth is not a practical option. And wood is far too rare a commodity to consume for a funeral pyre. So the funereal tradition known as jhator, or sky burial, persists in high-altitude Tibetan communities. The literal meaning of jhator is “giving alms to the birds.” And in a Buddhist worldview, where a corpse is an empty vessel and the soul has moved on toward rebirth, it’s considered fitting that human flesh nourish other living beings.

  Charang’s living monks carried the body to the crest of the nearest hill. Two men serving as rogyapas—the word translates literally as “body breakers”—slit the monk’s stomach open and summoned the vultures that had already begun to circle the hilltop by imitating their eerie cries. When the birds had consumed most of the monk’s flesh, the rogyapas crushed his bones and mixed them with tsampa to spur the vultures on. And when only a skull remained, the men shattered it with a mortar and pestle and mixed the bone and brain matter together with tsampa and yak butter. They set the offering on a stone, and a lone black vulture circled the funeral party, beating its heavy wings. It was larger than the other birds, and they fled when it touched down to eat. The funeral party retreated stealthily; if the last remnants of the monk were not consumed, their hosts explained, his reincarnation could not be assured.

  As the members of the medical team mounted their horses and rode through the narrow lane at the center of Charang, villagers crowded around Ruit’s horse, touching his legs and straining to reach high enough to pat his arms as he passed. Douglas recognized several patients who had been blind days earlier, running confidently alongside Ruit and reaching out to touch him.

  “Why are they doing that?” Douglas asked a young monk who was accompanying the pack train on the trip back down to Jomsom.

  “Because they believe he is a god,” the monk said. “Can you blame them? They’ve seen him perform miracles.”

  June 7, 1994, was one of the most memorable days in Sanduk Ruit’s life. The facility he’d been struggling to bring to his country for years, an eye hospital capable of providing uncompromising care, was about to throw its doors open to any Nepali who needed its services. King Birendra and Prime Minister Koirala joined Ambassador Douglas to cut the ribbon officially opening the Tilganga Eye Centre. It was a landmark moment not only in his life but in the nation’s history; it was the first time, Ruit says, that Nepal’s royal and political leaders had ever appeared together in public.

  The king, the prime minister, and the ambassador stood in the sturdy brick building’s courtyard, surrounded by a cheering crowd. Amid the lush greenery Douglas had picked out himself, overseen by a larger-than-life portrait of the departed Fred Hollows peering wryly over his trademark half-glasses, Tilganga’s first patients were led toward benches where a different sort of pilgrim would now gather on the site of the former festival parking lot.

  The laboratory that bore Hollows’s name, run by Rabindra Shrestha’s team of Nepalese technicians in sterile, blue-hooded suits, struggled at first, but after retooling its assembly line, it began turning out hundreds of first-world-quality intraocular lenses a day, at a cost of $4 apiece. Ruit had overcome the prejudice of Kathmandu’s elite, attempted sabotage by his former superiors at the Nepal Eye Hospital, and doubts that such a facility could be built in a developing country. Rex Shore remembers standing off to the side of the ceremony, away from the VPs, as flowered garlands were exchanged and news photographers snapped pictures, biting his lip to restrain the emotions that threatened to spill out. Against all odds, it had happened. The vision had materialized in brick and mortar. The combined efforts of a dead man, a former ambulance driver, and an ambassador had helped a Nepalese doctor realize his dream.

  The Most Eyes on Earth

  If you don’t know the kind of person I am and I don’t know the kind of person you are a pattern that others made may prevail in the world and following the wrong god home we may miss our star.… I call it cruel and maybe the root of all cruelty to know what occurs but not recognize the fact. And so I appeal to a voice, to something shadowy, a remote important region in all who talk: though we could fool each other, we should consider—lest the parade of our mutual life gets lost in the dark. For it is important that people be awake, or a breaking line may discourage them back to sleep; the signals we give—yes or no, or maybe—should be clear: the darkness around us is deep.

  —William Stafford, “A Ritual to Read to Each Other”

  Tabin ran through Thamel, past shops selling counterfeit mountaineering gear manufactured in China, past galleries displaying psychedelic thangkas of grinning or scowling gods, past T-shirt shops pitching their yins and their yangs to hippies, past metalsmiths, hammering sets of singing bowls. He jogged at an easy pace, noting how comfortable his body felt in the clear air and mile-high altitude.

  Running past one of the neighborhood’s innumerable bakeries, he caught and held the lovely eyes of a woman setting out a tray of sweet pastries. They were rimmed with black kajal, and a red tikka jewel sparkled at the center of her forehead. He was considering stopping and trying to strike up a conversation when the spell was broken by an auto-rickshaw carrying a swaying load of bamboo building materials; it passed between them with its engine belching blue smoke, and he ran on.

  It may be possible that the Nepalese have the world’s most striking eyes; it is also likely that Nepal contains the most eyes, per capita, of any country on earth. There are the third eyes, or tikkas, that peer out from so many Hindu foreheads. There are the eyes framed by the carved wooden windows of Kathmandu, surveilling all that passes below them in the capital’s crowded streets. There are the eyes that stare out from the headlamps of transport vehicles, painted there by drivers hoping for the foresight to avoid a collision. There are the all-seeing eyes of the Buddha, gazing mindfully from the flat surfaces of stupas, mani stones, and monasteries where they’ve been painted
. And there are the commercial versions of these eyes, embroidered on the T-shirts, sweaters, and handbags marketed to tourists, who yearn to preserve a fragment of the visions they’ve experienced, to capture and carry them home.

  Tabin picked up his pace, turning down a narrow alley that led to the Bishnumati River, running past the stalls of butcher shops, where the skinned and charred heads of goats and sheep rested on blood-slick counters and seemed to regard him with their blank, blanched eyes as he sped past.

  Could Tabin be blamed for seeing eyes everywhere he turned? In Kathmandu, it was hardly possible to avoid them. But his life was now centered on diagnosing and repairing eyes, in a way it had been focused only once before—on mountains.

  Hugh Taylor had sent him from the Royal Victorian hospital in Melbourne to Kathmandu, where his training would be put to the test. Taylor had developed great affection for Tabin after supervising his corneal fellowship; he had come to appreciate how useful Tabin’s manic energy could be when properly directed. “Geoff may be untamable, but as a physician, he’s first-rate,” Taylor says. “He was certainly one of the best fellows I ever worked with. Geoff was hyperactive, superactive, but totally focused on learning. He asked endless questions. And every morning, when we began rounds at the Royal Vic, Geoff insisted that we climb the eight flights of stairs from the lobby to our patients. It’s a practice we continue to this day.”

  Tabin ran across a bridge over the reeking Bishnumati, continued up past steeply terraced rice paddies, swerved to avoid a snarling dog with a skin condition, and reached the steps of the Swayambhunath Temple complex. Like the eight flights of stairs at the Royal Victorian hospital, this run was his routine each morning in Kathmandu. Through the Fred Hollows Foundation, where he served on the organization’s board, Taylor had arranged for Tabin to work with Ruit. “I didn’t know much about Dr. Ruit other than hearing he had a reputation as a maverick,” Tabin says. “But I figured, I’ll be back in Nepal. I’ll be near the mountains if things don’t work out. How bad can it be?”

  Tabin ran between twin Buddhas guarding the stairs to the hilltop temple, quickening his pace. A homeless girl of five or six slept peacefully on the outstretched palm of the left-side statue. Beggars lined both sides of the staircase, their heads lowered and hands raised. Even if he wanted to put a few rupees into those hands, Tabin carried no cash in his jogging shorts. He was here to help people like them, he reminded himself as he sprinted up Swayambhunath’s 365 steps. He’d help them not with money but with specialized skills he’d acquired from Hugh Taylor.

  He paused at the top and leaned against a giant golden vajra, the thunderbolt that eradicates ignorance, to catch his breath. Buddha’s eyes were painted on all four sides of Swayambhunath’s central stupa, watching over, it was said, all the people of Nepal, regardless of religion. Tabin straightened up to take in the view. The dense, jumbled center of the city looked less frenzied from this height, surrounded by green parks and paddies. He scanned the brown ridgelines of the mid-hills, and beyond them he saw the unforgettable outline of the Himalaya. How satisfying, how familiar it felt to be back at the site of his greatest accomplishments, to return to his second home.

  “I was blown away by Tilganga,” Tabin says. “There’s no other way to put it.” Despite the heat and dust outside its gates, and the patients who crowded its corridors, he says, “The place was spotlessly clean—no garbage, no dirt, no dust. It reminded me of an American or Australian hospital, not a third-world facility.”

  He put on scrubs, entered Tilganga’s operating theater, and stood in front of Ruit’s table, waiting to announce his arrival. He’d prepared a short speech about how excited he was to be back in Nepal and how much he looked forward to working alongside someone Hugh Taylor had described as one of the world’s standard-bearers for their profession. But if Ruit noticed Tabin’s presence, he gave no sign. He finished his case and bandaged his patient’s eyes with brisk, efficient movements. He looked up from his stainless steel operating table only after technicians had led the man away and slotted an emaciated blind woman into place. The doctor’s dark, intense eyes gazed out, levelly, between his sky-blue mask and surgical cap. He fixed those eyes on Tabin and acknowledged him with a grunt before turning to his next patient.

  Though the greeting was less welcoming than Tabin hoped, he’d been swept aside by the egos of eminent surgeons at Harvard and Brown and the Royal Victorian hospital, and the terrier in him had managed to win most of them over, eventually. Tabin ascribed Ruit’s coolness to his total concentration on his patients and felt sure that when they were able to spend time together socially, the distant technician, the hard-closed case that Ruit seemed to be in the operating room, would warm to him.

  But in their first days together, Ruit never offered Tabin that opportunity. After mutely observing as Dr. Ruit and Dr. Reeta Gurung performed one flawless cataract surgery after another in a matter of minutes, Tabin was finally given a turn at the operating table. During his hour-long struggle to remove one of the largest cataracts he’d ever encountered from an elderly woman’s eye, he felt someone breathing by his side, and looked up to see Ruit observing his work through the microscope’s second eyepiece. “Gently, gently,” Ruit said, “not so much thrashing about.”

  Tabin felt off-balance and confused. “I’d never operated on a cataract as challenging as the one Ruit watched me try to remove at Tilganga. And I struggled with the microscope, a mediocre seven-thousand-dollar machine, not the crystal-clear seventy-five-thousand-dollar model I was used to.” But he told himself he’d come this far; he’d win Ruit’s confidence.

  If Tabin thought his credentials from Yale, Oxford, Harvard, Brown, and Melbourne would dazzle a surgeon from the medical backwater of Nepal—one who hailed from a village without a school—he was mistaken. “Truly, when I first met Geoff, I wasn’t impressed,” Ruit says. “He was so hyperactive he made everyone nervous. And his surgical technique was still pretty lousy. Lots of foreign doctors came round in those days. Most wanted to do little bit of work and have a nice mountain vacation in Nepal. I chalked him up as just another one of those jokers.”

  When Nabin Rai announced plans for an upcoming cataract camp in Jiri, Tabin jumped at the opportunity to join the team. Jiri, the trailhead on his trek to Everest, was a place where he’d departed for one of his life’s high points, and he looked forward to the chance to bond with Ruit on the long drive into the hills.

  Ruit sent Tabin ahead, in a rented jeep with a junior ophthalmic assistant, to screen patients and decide which of them were suitable for surgery. Jiri was where Tabin had tugged on skintight spandex tights during the monsoon and begun his fruitless battle to keep leeches from establishing intimate contact. After enduring the bumpy ten-hour ride, he sprang out to stretch his legs on the muddy grounds of the school where the Tilganga crew planned to operate and was struck by the difference between the lighthearted, irreverent tone of mountaineers setting out on a long trek and the grim facts he was faced with on a medical mission. “There were more than a thousand people packing the school grounds, waiting for us,” Tabin says. “There was no time to eat, drink, or even pee. It was straight to the examination table.” Tabin had only a flashlight and an ophthalmoscope, a relatively crude magnifying device. But for many of the patients, his naked eye was enough to assess the damage. As the patients pressed forward, often accompanied by several anxious family members, Tabin could feel their hopes crowding around him. He had the wrenching task of telling too many of them that there was no chance they’d regain their sight.

  On his first day, Tabin saw more pathology than he’d ever encountered in America or Australia; nearly every eye condition known to science was present, and many of the diseases had reached their terminal stages, something he’d never seen in the West, where most eye ailments were treated early. He found people blind from the effects of tuberculosis and leprosy, people who’d suffered severe untreated trauma months earlier, children with tumors that engulfed their eyes�
��death sentences, sure to travel up their optic nerves to their brains. “Telling their families that nothing could be done for them,” Tabin says, “was one of the saddest things I’ve ever had to do in my life.”

  Tabin worked twelve hours that day, sifting the human ore for patients whose sight could be saved. He found 248 of these patients, these people.

  That evening Ruit and his senior staff arrived in the white Land Cruiser that Gabi Hollows had pressured Toyota to provide Tilganga at cost. There would be no more riding the roof of VW buses for Ruit. He now had a reliable off-road vehicle in which to travel the high roads of the Himalaya, and a former ambulance driver at the wheel who had fitted the rugged Land Cruiser with frilly lace headrest-covers and christened the vehicle Hilda, after a powerful Scandinavian Valkyrie.

  When Hilda rolled into the schoolyard, Tabin felt the center of gravity shift. Ruit’s reputation was well established in the mid-hills, and Tilganga had run ads on the local radio station and handed out flyers announcing that the doctor was coming. Families of patients clustered around Hilda, straining for a look at the man on whom so many of their hopes rested. Ruit climbed out and strode through the crowd to the examination room, requesting, in Nepali, the count of patients screened for surgery. He listened with his head cocked and nodded.

  “Busy day tomorrow,” he said to Tabin. “Better get some rest.”

  Then he climbed a hill to the room he’d been given in the school headmaster’s house. “Ruit’s house had electricity and running water,” Tabin says. “I stayed in the student barracks, with the junior staff, and was given a bunk next to two doctors from Tibet that Ruit had convinced the Chinese government to let him train.”