Second Suns

by David Oliver Relin

  “I’m sending you to Biratnagar,” Ruit told Tabin while they were both scrubbing out after surgery one day. “Let’s see if you can be of use there.”

  Biratnagar? Tabin thought, scanning his mental map of the country. Wasn’t that way down in the south, where it was broiling hot … and boringly flat? Tabin leaned against the hospital’s cool tile walls, trying to absorb what Ruit had said.

  “I wanted to settle the question that troubled me. I didn’t know if Geoff was a climber or a doctor,” Ruit says, with the startling giggle that often slips out when something especially delights him. “So I decided to test him by sending him as far from the mountains as I could.”

  Biratnagar sits at sea level near the country’s border with India, on the flat portion of the Gangetic Plain known in Nepal as the Terai. When Tabin stepped out of the propeller plane that bumped to a stop on the Biratnagar airport’s single runway, he was hit by such a comically oppressive blast of heat and humidity that he laughed out loud. “After walking a few minutes from the plane to the terminal, my shirt was completely soaked through with sweat,” Tabin says. “The thermometer on the terminal wall read one hundred and four degrees. And the humidity must have been one hundred percent.”

  The northern horizon was completely obscured by a shimmering screen of heat haze. To the south, a sere, scorched-looking agricultural landscape extended to the Indian border. Before dispatching him to the airport, Ruit had made Tabin’s mission clear: The Golchhas, one of Nepal’s wealthiest families, who’d made their fortune from jute mills and steel foundries, had recently built a modern eye hospital in Biratnagar. It was staffed by two senior ophthalmologists, but Ruit had been receiving disappointing reports about the quality of their surgeries. Tabin’s task was to help raise the hospital’s standards.

  On his ride from the airport to Golchha House in a chauffeured black sedan, Tabin felt as if he’d entered another country. Off the main highway, the streets were rutted tracks. Motorized vehicles were rare. And bicycle-rickshaw drivers with weathered, sun-darkened faces lounged under the awnings of their pedal-powered carts on every corner, immobile as lizards, following the limousine with their eyes only, as if turning their heads took too much effort in the heat.

  The Golchhas provided Tabin with a private suite in one wing of the sprawling white marble mansion they’d built in a walled compound at the center of Biratnagar. A staff of ninety cooks, cleaners, chauffeurs, and gardeners attended to the Golchha family, as well as the livestock, orchards, vegetable beds, and meticulously pruned ornamental gardens that surrounded their home.

  Tabin was assigned his own valet, Sunil, an older, stooped gentleman with unfortunate teeth who hovered constantly at the periphery of Tabin’s vision and insisted on carrying the doctor’s ophthalmoscope and day pack on Tabin’s walk from the compound, past the Tip Top Tailor Shop, the Sweetie Pie pastry store, and the Lord Buddha Nursing College, to the Golchha Eye Hospital, a mere two blocks north, at a busy intersection on Goshwara Road. “I felt pretty silly with Sunil walking behind me with my bags,” Tabin says. “But the Golchhas were unbelievably generous. It took me weeks to convince them I didn’t need a chauffeur to drive the two blocks. But I never persuaded them that I didn’t need a servant waiting on me twenty-four hours a day.”

  Tabin’s reception by the senior staff of Golchha Hospital was considerably chillier. “The doctors weren’t openly hostile the first day I arrived at work,” he says, “but they were cooler than most Nepalese, and it was obvious they were offended by the idea of a young Western doctor telling men who’d been in ophthalmology for decades what to do.”

  The elder of the two surgeons, the balding, round-faced Dr. I. C. Biswas, pointed out to Tabin that he had practiced in Biratnagar for more than twenty-five years and had previously served as president of the local medical association. “Young man, I’ve seen every eye condition that exists,” he told Tabin, asserting his status in a country consumed by caste and rank. “Furthermore, I haven’t needed to consult a medical text in more than twenty years!”

  “That last comment really alarmed me,” Tabin says. “Because I knew how radically eye surgery had improved in the last few decades.”

  Dr. Joshi, a decade younger, thinner and lighter-skinned, seemed equally aloof. The doctors suggested that since Tabin spoke very little Nepali, he wouldn’t be of much use dealing with the examination and diagnosis of the patients. So they suggested that he shoulder the heaviest surgical load during the months he remained in Biratnagar.

  “As I got to know him, I realized Dr. Biswas was in fact a lovely guy, a dedicated doctor and a pillar of the community. But his name was a real misnomer. He may have been known as I.C.,” Tabin says, laughing, “but very few of his patients could.” Both Biswas and Joshi still clung, stubbornly, to outdated intracapsular cataract surgery. “Dr. Biswas boasted that his eyes were still so excellent he could operate perfectly well without a microscope,” Tabin says. “So I watched Dr. Biswas and Dr. Joshi slice patients’ eyes nearly in half, forcibly wrestle out the lens with forceps, and sew the eyes shut with sutures as large as those used for general surgery in America. After the surgery, patients needed a week to recover in the hospital’s filthy wardrooms. And when their eyes healed they were discharged with the kind of thick Coke-bottle glasses that, at best, horribly distorted peripheral vision, if they didn’t break when they returned to lives of hard labor in their rural villages. It was considered a good result at Golchha Hospital if postoperative patients could avoid walking directly into objects in their path.”

  Since its construction, the hospital had completed only a few hundred cataract surgeries a year, in a region where it was the only facility serving nearly a million and a half people. “I thought the staff was doing a pretty miserable job of serving their patients,” Tabin says, “and the more I watched them work, the more I struggled to keep my criticism diplomatic.”

  One morning an eight-year-old girl arrived after suffering extreme trauma to her eye. She and her father had walked for three days from their village to buy basic necessities in the big city. While strolling the streets of Biratnagar, the girl had been playing with a stick, spinning and tossing it, when the sharp end stabbed her in the eye, lacerating her cornea.

  With Dr. Joshi translating, Tabin examined the girl. Her wound was so deep that her iris, the colored tissue that contracts and expands to control the flow of light through the pupil, was prolapsed, bulging outside of her eyeball. The girl was in great pain, and Tabin struggled to calm himself and think clearly. He asked Dr. Joshi to explain the situation to the girl’s father: Her iris needed to be coaxed back within her eye and the wound sealed to prevent infection; if nothing was done, she would lose her eye, and it was possible that an infection could travel to her brain along her optic nerve and kill her. Surgery was the only option, and Tabin instructed Dr. Joshi to prepare the operating room while he ran back to Golchha House, to consult his textbooks on the exact dose of general anesthesia a girl her age and weight would require.

  Tabin returned twenty minutes later, drenched with sweat and trailed by Sunil, carrying his medical bag and a spare, freshly laundered shirt. Dr. Joshi sat in an examination room, drinking a cup of tea. The girl and her father were nowhere in sight.

  “Where are they?” Tabin asked, panting from his run in the midday heat.

  “They are gone,” Dr. Joshi said.

  “What do you mean, gone?”

  “They have returned to their village,” Dr. Joshi said, calmly sipping his tea.

  “Didn’t … didn’t you explain the girl could die if we don’t operate?” Tabin said, his voice rising to a shrill, accusing complaint.

  “Yes,” the doctor replied. “I told them. But her father decided it was best not to wait for surgery. He said he needed to return to his village.”

  Tabin’s long-simmering disapproval finally boiled over into scalding criticism. He was appalled by the low standards and wasted resources in a region where a million and a h
alf people needed better care. And he told everyone, from the administrators and surgeons to the technicians and janitors, how he felt about the hospital, how unclean and inefficient it was, despite being stocked with modern equipment. Diplomacy had never been Tabin’s strength. He spoke bluntly to the staff at Golchha Hospital, aiming his harshest criticism at Drs. Biswas and Joshi, whom he accused, point-blank, of failing their patients.

  The next morning, as he was about to sit down to the lavish breakfast of mango, pineapple, and papaya salad, spicy masala dosas, and feather-light puffs of puri the Golchhas’ chefs knew he particularly liked, he was summoned by Sunil to the hallway for a phone call.

  “What the devil are you doing down there?” Ruit’s voice bellowed, clearly, from Kathmandu. “I’ve heard how disrespectfully you’ve been speaking to the staff! What are you thinking? They haven’t had the advantages you’ve had in life, or your training. Your duty is not to beat them down. Your responsibility is to lift them up! Are you capable of that? Because if you’re not, you should pack your bags and leave for America today.”

  While Tabin fumbled for the right response, he heard Ruit slam down his desk phone. Then the line went dead. When Sunil ushered him back to the breakfast room and heaped the usual delicacies on his plate, Tabin could only stare at his food.

  “Ruit can be rough,” Tabin says. “In the years I’ve worked with him, he’s said a lot of harsh things. But I’ve never been reamed out like that, before or since, by someone I respected so much. The worst thing about what Sanduk said to me was that I knew he was right. I’d been sent to Biratnagar to lift the staff of the hospital up. I didn’t know if I was able to do that, but I decided to start trying. And I figured the best chance I had was by doing what Ruit did so well—leading by example.”

  For the next two months, Tabin dedicated himself to improving his own skills. “I worked methodically on the small-incision extracapsular surgery Ruit taught me,” he says, “making sure to go slowly enough that the patients would end up with excellent vision. I averaged only ten surgeries a day, but the good results began to add up.” Each afternoon, Tabin returned to Golchha House for lunch, where he’d find a freshly laundered shirt laid out on his bed by Sunil. And when he came home at the end of a long shift he’d spent hunched over the microscope, he’d shower before dinner and change into his third shirt of the day, which was always neatly pressed and awaiting his return, a gift he wasn’t sure he deserved.

  Siddhartha Gautama, known by the name he chose, the Buddha, or “the enlightened one,” was born in Lumbini, far to the west of the hills where Tabin ran to clear his mind. As the story goes, Siddhartha, born into great wealth and privilege, grew disenchanted with his comfortable life when he witnessed the poverty and suffering of ordinary Nepalese beyond the gates of his family’s walled compound. Meditating on the inequity and misery that defined the lives of much of humanity, he abandoned his wife and children, took a seat under a pipal tree, and resolved not to leave until he discovered a way to release himself—and, by extension, all of humanity—from the endless cycle of birth, death, rebirth, and suffering.

  Tabin may not have achieved enlightenment running past the sorts of trees where the Buddha once sat, but he did have time to refine his priorities. None, he realized, ranked higher than alleviating suffering. When he returned to Golchha Hospital, he not only focused on curing his patients but labored to repair his relations with Dr. Biswas, Dr. Joshi, and the entire staff. All it took was respect and, perhaps most crucially, compassion.

  After two months, so many of the formerly blind had walked out of Golchha Hospital the day after Tabin operated on them with excellent vision that word had spread, and new patients began arriving every day, asking for the foreign surgeon. Seeing irrefutable proof that Tabin’s results were superior to their own, Dr. Biswas and Dr. Joshi finally took an interest in learning Ruit’s technique and began scrubbing in to watch Tabin work.

  “Both Dr. Biswas and Dr. Joshi had done phenomenal numbers of operations in their careers,” Tabin says. “And they both had excellent, steady surgical hands. Once they adjusted to the novelty of working under a microscope, and learned how to construct small wounds and implant IOLs, they quickly began achieving excellent results.”

  As the flow of people seeking treatment at Golchha Hospital increased, Tabin helped to raise the skill level of the hospital’s general staff as well. He had noticed that two young technicians, Mukesh and Bhupendra, were extremely bright and capable but weren’t being asked to do much more than serve as orderlies. Tabin challenged them to work to the limit of their abilities, as Ruit demanded of all of his employees. He taught them how to recognize and care for most minor eye problems, how to prescribe glasses, and, most critically, how to properly anesthetize patients’ eyes for surgery. Tabin noticed how quickly they thrived with their added responsibility, how they began to take pride in the hospital, how committed they were to keeping it orderly and clean. “I finished surgery each day ecstatic that we were finally managing to create the atmosphere of excellence that our patients deserved,” Tabin says.

  After work, he returned to Golchha House not tired but rejuvenated by the progress he knew he was making. The extended Golchha family had a dozen young children, and Tabin would greet them all by name with a barrage of high fives, then entertain them in the evening with sleight-of-hand tricks, making red sponge balls disappear between his fingers and pulling them out of the mouths and ears of the astonished Golchha children.

  “We’ve had many foreign doctors stay in our home over the years, and help with the hospital,” Madame Rajluxmi Golchha told me one morning, years later, while I was visiting the family compound with Tabin. “But I’ve never seen a person as dedicated as Dr. Geoff. Maybe ‘dedicated’ isn’t the precise word,” she said. “I mean ‘fanatical.’ ”

  Since establishing the eye hospital, Madame Golchha hadn’t withdrawn to a life of ease within the gilded walls of her palace. She has been hard at work providing another service for the citizens of Biratnagar: building a school for children with special needs. When I asked why she didn’t just stay at home and enjoy the pleasures of Golchha House, she simply pointed at Tabin. “I blame him,” she said. “Geoff is literally the most inspiring person I’ve ever met. He was always running to the hospital night or day if the patients needed something. How could I sit inside these walls when he set such an example? You know, the children and I had a special name for him.” Madame Golchha laughed as she retrieved it. “We called him Dr. High Five!”

  On one of his last evenings in Biratnagar, Dr. High Five left the hospital after a satisfying day of surgery just as the leading edge of a tropical storm swept into town. His familiar two-block walk took on the flavor of an adventure as he squelched through ankle-deep mud and leaned into the liquid wind. Sunil tried to cover him with an umbrella, but it was blown inside out. Children celebrated escaping the heat by jumping and splashing in puddles.

  Tabin gave up any hope of remaining dry and turned his face up into the commotion, welcoming the change in weather. He didn’t know what plans Ruit had for him, or where he was bound next, but he felt his time in Biratnagar had been an unequivocal success; he was now firmly on the path he’d been trying to follow ever since the day he’d seen the Dutch doctors working minor miracles. Tabin hadn’t known the question Ruit had asked about his American apprentice’s dedication to doctoring, but he had answered it for himself. He was now there—hundred percent—for his patients. Geoff Tabin had spent years seeking a kind of clarity in the earth’s high places. As the rain fogged his glasses in the flatlands of Nepal and he tried to find his way through muddy crowds toward the gate of Golchha House, Tabin felt he’d never had a clearer vision of his future.

  The Wave Is Water

  Do not accept any of my words on faith, believing them just because I said them. Be like an analyst buying gold, who cuts, burns, and critically examines his product for authenticity. Only accept what passes the test by proving useful and benefi
cial in your life.

  —Siddhartha Gautama, the Buddha

  Ruit wiped the window with the meat of his palm and squinted into the rain. He couldn’t see a thing. Somewhere out there, hidden by impenetrable clouds, were Cho Oyu, Makalu, Lhotse, and Everest, four of the ice giants of the Himalaya. Only the rumble of the plane’s jet engines hinted at the speed they were traveling past the peaks.

  They were flying north, through angry gray storm clouds, soaring over the sort of steep high passes and smoke-blackened villages his father and his caravans would have trudged through, on month-long treks to trade goods in Lhasa. But they were due to reach Tibet’s capital in a mere two hours. It wasn’t the sort of travel Ruit could appreciate. There was no time to study the land as it rose, scouring away all but the hardiest plants and people, no opportunity to ponder the collision of the Indian Plate and the Tibetan Plateau that had thrust these mountains five miles into the atmosphere. In this thrumming aluminum tube, with windows that looked, to Ruit, as scarred and scratched as traumatized corneas, he couldn’t even say if they had crossed into Chinese airspace or whether they were still flying over his own country. During his childhood, not knowing which side of the border he was on might have meant the difference between life and death. How odd it felt that they could simply soar past it.

  In the aisle seat beside Ruit, Geoff Tabin twitched with nervous energy, gulping his handful of roasted peanuts all at once, while Ruit tucked the package into his rucksack, where it might come in handy while they waited out a landslide blocking one of Tibet’s rural roads. Tabin wanted to talk, but Ruit had too much on his mind to make polite conversation and kept his face pressed to the window. After Fred’s death, the Hollows Foundation had grown into a large and prominent Australian institution since the massive funeral they’d arranged and promoted in the Australian media with the slogan “Don’t bring flowers. Bring a fiver.” Ruit hoped that might mean a reliable source of funding for Tilganga, but he concluded the Fred Hollows Foundation was more interested in mining Tilganga’s success for publicity than in funding it. Still worse, the FHF had written to Australia’s latest ambassador in Kathmandu, Brendan Doran, warning him that the foundation planned to work with doctors countrywide, and not to become exclusively involved with Ruit.