Sarah Elliott, who worked as the Nepal program manager for the Fred Hollows Foundation at the time, remembers being stunned by the discourtesy of her organization toward the man she so admired. “Ruit was never content to sit on his accomplishments,” she says. “He was always worrying about sustaining what he’d built, and those plans depended on our support. I did my best and tried to calm him down, without much success. Ruit felt like we’d betrayed and abandoned him, and I couldn’t blame him because I felt the same way.”
Ruit, as always, took inventory. Tilganga was nearly in a position to sustain itself. He had structured patient services on a cost-recovery model: middle-class and wealthy Nepalese paid for their surgeries on a sliding scale, which enabled Tilganga to offer free care to as many poor as were able to make it through the hospital’s doors. But keeping the best staff meant being able to offer competitive salaries. The outreach and expansion he had in mind would take more substantial funds than they could raise in Nepal. Ruit knew he needed a foreign partner, but the future with the Hollows people was looking bleak.
Despite the positive reports he’d received from the staff at Golchha Hospital about Tabin’s dedication, the inexperienced American doctor beside him, now polishing off his carton of mango juice like a greedy child, might have had all the ambition in the world, but ambition without fund-raising experience couldn’t pay for the sort of expansion Ruit had in mind. He had invited Tabin to the eye camps in Tibet both as a reward for a job well done in Biratnagar and to gauge his commitment firsthand.
Just before the air turbulence struck, Ruit was considering just how poor his own Buddhist practice had become. He knew he should be grateful that Tilganga had reached the capacity of patients he’d designed the hospital to treat each day and was running smoothly, but he seemed incapable of living in the moment, except when he was at his microscope. Otherwise, his mind was always sprinting ten years ahead, toward the plans he was forming to expand quality eye care across the Himalaya. Ruit recognized a strain of that impatience in Tabin and appreciated that he, too, dared to leap toward the unknowable, striving toward something larger than the comfortable life of conventional doctoring.
The turbulence grasped them like the great hand of one of the scowling gods of his childhood that had so scared and fascinated him in the charged gloom of his village monastery. It shook the plane so violently he was sure the wings would snap free of the fuselage, and kept shaking it as they passed over the crest of the Himalaya, bouncing off the jet stream while the winds buffeted the solid metal aircraft like an illustration of the mutability of matter. While the flight attendants rushed to strap themselves into their jump seats and tried, unconvincingly, not to let any fear show on their smooth, doll-like faces, Ruit was living very much in the moment.
He reached out and grabbed Tabin’s hand.
“Ever since I’d met him, patients had always told me how gentle Dr. Ruit’s hands were.” Tabin says. “But not then they weren’t. He had me in a death grip, and I was shocked by his strength. I was afraid he was going to break my fingers.”
The turbulence continued without relief. “I didn’t like it much either,” Tabin says, “but I’d flown a lot more than Sanduk, so I just started talking, trying to calm him down—anything that came into my head, really, how I’d been through worse in little tents on big, windy mountains, how much I’d enjoyed the breakfasts at Golchha House, but none of that seemed to help.” So Tabin turned to a subject sure to engage Ruit and asked what his plans were for Tilganga, what he could do in the future if they could arrange funding and support from American sources.
Once he’d confirmed that the wing was still attached to the fuselage, Ruit pried his eyes away from the window to look at Tabin. He discussed the importance of not settling for taking shelter within a shiny new facility but expanding efforts to reach patients across the crests and folds and crenellations of the Himalaya, so the Kamisya Tamangs of the world wouldn’t have to waste away for years in isolation, waiting to be released from darkness. He confided that he could no longer depend on the Hollows Foundation and he needed to find a new source of foreign capital.
Tabin talked about an idea that had been fermenting since he’d gotten to Biratnagar: creating a formal connection between Tilganga and American medical schools, so ophthalmic fellows could train in Kathmandu, where they were sure to find more challenging caseloads than at American hospitals, and Tilganga could benefit from the funding and prestige associated with bettering the skills of America’s up-and-coming ophthalmologists. Tabin was a graduate of some of the world’s most famous universities, he told Ruit, but he’d learned more about surgery in the months since he’d met Ruit than those institutions had been able to teach him in years. Other Western doctors, he said, should have the same opportunity.
They flew on, threshing out the details of how this sort of partnership might work. It was not lost on either of them that Tabin, technically, was unemployed. So finding a job at a university would be his first task after he returned to America. He would need to land at an institution that supported international health initiatives and permitted frequent foreign travel. It would take some searching, Tabin said, but he was sure it could be done. And though the turbulence tapered off soon after they crossed the highest point of the range and reached Tibet, Tabin noticed, as they approached the stony, sunbaked plain surrounding Lhasa, descending along their glide path through mercifully smooth air, that Ruit was still holding, though no longer crushing, his hand.
Since his last trip to Tibet, Lhasa had become another sort of city, Tabin thought. They rolled into town on a freshly paved, four-lane highway from Lhasa Gonggar Airport. During his first two visits as a climber, Tibetans in traditional dress had dominated the population. The Potala, where a succession of Dalai Lamas had lived among the palace’s thousand rooms and served as their people’s spiritual guides, still hovered over the heart of the town like a man-made mountain.
When Tabin had come to take his second crack at the Kangshung Face, in 1983, heavily armed Chinese soldiers had stood guard outside the stronghold of Tibetan Buddhism, barring entry. But by 1995 the Potala and many of Tibet’s religious monuments had become tourist attractions, besieged by armies of camera-toting Han, the ethnic group that made up more than 90 percent of China’s population. As their bus neared their hotel, Tabin noticed that the majority of faces they passed in the street belonged to ethnic Chinese in Western clothes. And the historical center of Lhasa, with its low, wooden traditional homes, seasoned by centuries of wood smoke, was surrounded by a modern Chinese city, which encircled the Tibetan quarter like a stockade.
What Beijing hadn’t been able to do by force—crush the heart of a Buddhist rebel movement that resented China’s occupation—they were trying to achieve by dilution, by making Tibetans a minority in their own land. During the last decade, tens of thousands of Han Chinese had accepted Beijing’s offer of cash incentives and relocated their families to Tibet.
Tabin’s sense of discomfort only increased when he and Ruit arrived for their first day of work at Lhasa City Hospital. Drs. Olo and Kesang had continued their studies since Jiri, and they hoped to hone their skills further alongside Ruit and Tabin. But many of the hospital’s senior staff were Han Chinese, and Tabin was appalled by the generally low medical standards. “Lhasa City Hospital, despite the grandeur of Lhasa relative to Kathmandu, was a backward and unsanitary place compared to Tilganga,” Tabin says. “And seeing how bad it was, I had even more admiration for what Ruit had been able to build.”
Tabin says he witnessed a devastating breach of medical ethics his first day at the hospital, when he saw poorly trained Chinese surgeons attempt to perform an appendectomy on a teenage boy. They were unable to locate his appendix and ruptured several blood vessels trying to reach it, Tabin says. He watched the boy’s abdomen fill up with pus and blood as each probe and thrust of their scalpels made the situation worse. “I was kicking myself,” Tabin says, “because if I’d jumped in right
away, I could have performed a reasonable appendectomy. But by the time they’d made a mess of his bowels, repairing the damage was beyond my abilities.” Tabin watched the doctors give up and sew their doomed patient’s incisions shut. “Later, I learned they told the boy’s parents that they’d found incurable cancer and informed them that he was likely to die.”
Tabin wanted to pursue the matter and report the doctors to the authorities, but Ruit restrained him forcefully. “You can’t do everything at once, Geoff,” he told Tabin, something he would repeat to the man who would become his partner so often over the years that it would become a kind of mantra. “We have to choose our battles strategically.”
Ruit and Tabin operated side by side, as Drs. Olo and Kasang observed. Ruit was still much faster, completing four surgeries to every one of his, but Tabin hoped the progress he’d made in Biratnagar was apparent. He looked over at Ruit’s table each time he finished a case, hoping for a sign of approval or encouragement, but none came. Ruit appeared oblivious to his surroundings.
After four hours, Tabin stood up and prepared to scrub out for a bathroom break.
“Where are you going?” Ruit inquired the second Tabin pushed back his stool.
“Out to take a pee, back in a flash,” Tabin said, but something in Ruit’s tone of voice as he’d asked the question kept him rooted to the spot instead.
“You know, Geoff,” Ruit said gravely, “you really must learn to control yourself better.”
Tabin, gritting his teeth, sat back down. While working on patients, the sensation was bearable, but after he taped the eye of each completed case shut and swiveled on his stool, tapping his feet, waiting for the next Tibetan to be led to his table, the pressure was intolerable. After two more hours, Tabin could take it no longer. He pushed back his screeching stool, scrubbed out, and jogged toward the hospital’s mercifully vacant squat toilet. He could hear Ruit’s high-pitched giggle all the way down the hall. “I don’t know how he does it,” Tabin says. “I’ve seen him operate sixteen hours without a break. If the Guinness Book had a category for bladder control, Ruit would hold the world record.”
That evening, Tabin and Ruit sat on the balcony of their hotel, continuing their conversation about collaborating after Tabin returned to America, as the sun sparked fiery reflections in the tiers of windows that climbed the Potala toward the darkening sky. “This morning your post-op patients looked really first-rate,” Ruit said, pouring each of them a tumbler of whiskey. “Your surgery is coming, Geoff, don’t you think?”
“I’m trying,” Tabin said.
“You’re trying hard,” Ruit said. “Now we have to get our Tibetan friends up to snuff.”
Tabin liked the sound of that “we.”
Their final morning in Lhasa, the last batch of postoperative patients assembled on benches in the hospital’s courtyard. Tabin and Ruit bent to examine each of them. Ruit used a cheap plastic flashlight and Tabin studied their handiwork with a climber’s headlamp, but they both saw the same results: All 155 of the eyes Ruit and Tabin had operated on appeared clear and without complications. Olo and Kesang’s clumsier surgeries had mildly traumatized some of their patients’ eyes, but the redness and swelling would disappear in a few days, and both Tibetan doctors had progressed to the point that they were now capable of operating on their own. All in all, a cause for celebration. Ruit threw his arm over Tabin’s shoulder as they walked toward the hired bus that would take them toward the surgical camp they planned to conduct in Medrokongga, three hours from Lhasa. “Well,” he said, “we’ve managed to light two more candles, isn’t it, Geoff?”
North of Lhasa, the paved highway disintegrated into a gravel road, then a rutted track, as it left the plains and climbed along the Tsangpo River Gorge. The river coiled back on itself as they rolled along the wall of the canyon it cut, into the mountains that towered over Medrokongga. They were able to see the route they would have to travel, miles ahead, where the road doubled back in their direction, following the river, clinging to the face of the gorge. And they could clearly make out the series of pale scars that blighted the hillside, where the road had been washed out by landslide or flood and local workers had buttressed it against the sheer slope with stones.
At thirteen thousand feet, the site where they planned to operate in Medrokongga County looked more like a nomad encampment than a permanent settlement, Tabin thought. Hundreds of families had settled on the stony grounds of a dilapidated clinic, warming their hands over yak dung fires or stirring tsampa in blackened pots. At the sight of the medical staff disembarking from the bus, the hundreds who could see stood as one, cupped their hands together in blessing, and bowed. Tabin could feel the longing and hope rising from them as palpably as the smoke from their cooking fires.
Ruit was touched to see that even in these modern times, when foreign influence obliterated so much tradition, many of the families greeted them in the venerable Tibetan way, sticking out their tongues respectfully. He had chosen to come here because preliminary screening had indicated that this community had the highest percentage of blindness he’d ever encountered. Among Medrokongga’s eight hundred residents, nearly two hundred were suffering from severe cataracts.
The optimistically named Medrokongga County Hospital was, in fact, a one-story bunker with peeling paint that had once been white. The hopes of the crowd outside the door weighed on Tabin as he inspected the place where he was expected to cure them. “There was no heat and no power,” Tabin says, “and somehow it felt even colder inside. The place was ripe with the stench of excrement and stale urine. Welcoming committees of flies greeted us in each of the three rooms. I was only relatively sure we could make this place sterile enough for surgery.”
He stepped back out into the early-afternoon chill and saw that the sun had already sunk behind the canyon’s western wall. Tabin stared at the crowd, mentally adding up the hours it would take to cure such a quantity of blindness. Beyond them, on the trail that descended from the upper settlement, more blind patients in rags rolled toward them on flat carts with wooden wheels, pulled by rusty tractors.
When he looked away from the smoke and filth and torn clothing and turned to his colleague, Tabin was stirred by the expression on Ruit’s face. Ruit stood on the hospital’s stoop, looking over the encampment, beaming like he’d never been happier in his life.
“Don’t you see how perfect this is, Geoff?” Ruit said, pointing toward the swelling crowd, elated to accept the absolute fact of their suffering, and the power he had to make it cease. “This is where the people need us!”
Buddhist scholars preach the importance of learning to distinguish between relative truth, samvrti-satya, and absolute truth, paramartha-satya. To understand relative truth, the Vietnamese Buddhist monk and teacher Thich Nhat Hanh explains in The Heart of the Buddha’s Teaching, study the movement of water. Watch how a wave moves, absorb the temporary beauty of its unique shape as it swells, crests, and collapses. To comprehend absolute truth, he teaches, look deeper, and remember that, whatever form it takes, the wave has always been, and will always be, water. “It would be sad,” Thich Nhat Hanh says, “if the wave did not know that it is water,” if it thought, “when I arrive at the shore, I will return to nonbeing.”
Growing up privileged in a Western world that offered him limitless opportunities, Tabin had flowed like a shape-shifting wave through the ocean of relativity that is modern American life. He could be a tennis player, a bungee jumper, a magician, and a mountaineer. He could commit to medicine. Or he could try to be all these things at once.
Since the day Tabin had made eye contact with Ruit over an operating table at Tilganga, he had learned more crucial lessons more quickly than he had imagined possible. Confronting suffering at Tilganga and Jiri and Biratnagar, he had learned to lessen it, as Reeta had taught him, by wielding a blade like a fencer’s foil. He had learned that the best way to lift others up was by example. And he had learned about the bone-deep satisfaction that comes from
working to the limit of your abilities. But standing beside Ruit on the steps of the Medrokongga County Hospital, and staring at these people, his patients, he got a glimpse of a deeper, more absolute truth. He hadn’t come to this windswept settlement to find his path, further his training, or win Ruit’s favor. He was not only a wave; he was water, at one with this ocean of humanity who looked toward him and Ruit with such hope. He was here because he was needed. And now he needed to get to work.
Over the next three days, Ruit and Tabin operated in the dank room where the staff had scrubbed and disinfected every surface before nailing plastic tarps straight into the concrete ceiling and over all four walls. When their generator ran out of fuel, which was often, they continued working while technicians held flashlights over their patients. After the quarts of sweet tea Tabin drank at breakfast, trying to stay hydrated and warm, he still had to schedule his surgeries around the clarion call of his bladder. Ruit no longer made mention of his absences, other than allowing himself a brief smirk of pride.
“I had learned something important about Geoff,” Ruit says. “He was a persistent cat. Like me. He kept climbing over whatever obstacles I threw in his path. And I saw that he was relentless in the best way. You don’t often find people with such stamina. What we were doing was hard—no one had ever tried to cure people in this place—but I never heard him complain. There aren’t many like that, who are willing to stand by you hundred and one percent.”
Second Suns Page 22