Second Suns

by David Oliver Relin

  I climbed out of Hilda like someone trying to readjust to level ground after riding a roller coaster. “Did you enjoy the drive?” Ruit asked with a wicked giggle, putting his arm around my shoulder. “How about you, Alan? Any nausea?”

  “Nope,” he said. “I even got a few hours of sleep.”

  The operating rooms of the Hetauda Community Eye Hospital were almost exact replicas of Tilganga, down to the floors of locally quarried marble and the green-tiled walls. Crandall and Ruit faced each other across the bigger of the rooms, closely observed by Kishore Pradhan, the young surgeon Ruit had chosen to run the hospital. Tabin went to work in a smaller OR next door, with a cheaper microscope. (In my travels with Tabin, I’d noticed that he always volunteered to operate at the most poorly equipped table wherever he went, ceding the better gear to his peers or the doctors he was training and relishing the challenge of making do with less.) On his first shift, Crandall was treated to eight hours of Lata Mangeshkar’s greatest hits. Mangeshkar, whose startling birdlike voice had skittered across the soundtracks of more than a thousand Bollywood films, was one of Ruit’s favorites. Tabin, in a separate room, had a selection of electric blues playing on the iPhone he placed on a shelf behind his head. I tried to be helpful, guiding patients to operating tables and leading them down the stairs to recovery rooms inside the tent.

  I missed the arrival of the next woman to land on Crandall’s table, since Tabin had called me into his room, asking me to cue up Coltrane on his iPhone. She was covered by a green surgical drape by the time I returned. One hand protruded beyond the draping, immobile as a corpse’s, and I was struck by how different it looked from the hands of other patients. Regardless of their age, most of their hands and feet were scarred and callused from agricultural work. But this hand belonged to someone whose life so far had spared her hard manual labor. It was a young hand, with manicured nails painted pink.

  I studied her chart and saw that her name was Kiran Kumari and she was twenty-two years old. Ruit saw me looking. “This young lady had an accident with a propane rice cooker,” he said. “It exploded in her face while the grains were still hard and did lot of damage. The wounds have been untreated since then, and I advised the family to wait for Alan. They’ve brought her here from Kathmandu because he’s very expert at this sort of surgery.”

  “What sort is that? The kind you make up on the fly?” Crandall said, studying Kumari’s eyes through his microscope. “You know, I teach a course in Utah called ‘Worst Case of the Year: What Would You Do?’ This is that case. The explosion really fused the layers of her eye together, and I’m going to have to figure out a way to gently peel them apart.”

  “Thank you, Doctor,” said a soft voice from beneath the green draping. Kumari was awake and would have to summon the courage to face a complicated surgery with only local anesthetic. Crandall sat utterly still as he dissected the paper-thin layers of Kumari’s sclera and cornea and the inner capsule of her eye, excising the scarred tissue. He retreated into the silence I’d seen overtake Ruit and Tabin when their skills were pushed to their limits and remained there for most of the hour and a half that he operated. Occasionally Kumari whimpered softly with fear beneath the drape. During all that time, Crandall said only two things: “Okay, we better go with Plan B” and, thirty minutes later, “Well, looks like this might work.”

  After he removed her drape the young woman’s lustrous-haired, high-cheekboned loveliness was apparent. Kumari means “living goddess” in Nepali, and, if her eyes healed properly, she would once again embody her name.

  Unlike the surgeons, I could leave the operating rooms when I craved disinfectant-free air. I used those breaks to stand on the third-floor balcony and watch the crowd of patients stream inside the walled courtyard. When we’d arrived, there were only a few, but by midafternoon of our first day hundreds of the blind and their families had gathered, getting their eyes examined by technicians beneath a sign that read, GIFT OF SIGHT: FREE INTRAOCULAR LENS IMPLANTATION.

  After completing more than one hundred surgeries that first afternoon, our team retired to our lodging, a large colonial-style structure called the Motel Avocado. All the members of Ruit’s board of directors had driven down from Kathmandu to inaugurate their most ambitious project since Tilganga. For three hours, we stood on the hotel terrace, as it grew increasingly dark and cold, while waiters in apple-red V-neck sweaters passed platters of gristly wild boar bristling with toothpicks, unidentifiable fried tidbits, and curried meatballs made of goat. Vietnamese, Chinese, Thai, and North Korean surgeons who’d come to be trained in the Tilganga system joined the party, and sniffed suspiciously at the food. “I have instant noodle in my room,” one of the Thai surgeons said to me, passing on a plate of goat meatballs. “I think I’ll wait for them because … diarrhea.”

  I passed much of the evening with Graeme Lade, Australia’s ambassador to Nepal, the latest diplomat from his country to support Tilganga. We were joined by another Australian, Virginia Sarah, the international outreach director for the Fred Hollows Foundation. The FHF had a new CEO, Brian Doolan, who was determined to make amends for the foundation having cut back their support of Ruit when he’d needed their help the most. “The break with Ruit happened before my time,” Doolan told me. “But as far as I’m concerned, Tilganga’s one of the crown jewels of international eye care, and we’re going to give them all the support we can.” Doolan’s pledge wasn’t just talk; the FHF had made a small contribution to help build the Hetauda hospital, and Virginia Sarah was in Nepal to figure out the most effective way for Hollows to help Ruit and Tabin in the future.

  Ambassador Lade was unusually mild and introspective for a man in his position. “Ruit’s taught me a lot about Nepal,” he said. “He’s explained that it’s the simple quality-of-life advances that Nepalese people really need. You know, before I came here, I never thought I’d get excited by a toilet. But when we spend six or seven thousand dollars to put sanitary facilities in a village, you see how much pride and self-respect such a little thing brings to a community.”

  I wondered why there were no American officials present, particularly because so much of the funding for the HCP’s string of successes had been donated by USAID. “I can’t even get the American ambassador to answer my phone calls,” Tabin explained.

  Ruit overheard our conversation and said, irritably, “We don’t have time to be knocking them, they should be knocking us. They have more to gain!”

  “It is crazy,” Tabin agreed, “because we’re giving them the best humanitarian PR bang for the buck they’ll ever get. That is, if they’re smart enough to publicize it.”

  “Hey,” said Alan Crandall, steering the conversation toward another subject close to Ruit’s heart. “The Buddha was from somewhere around here, right? Was he born in India or Nepal?”

  Ruit, who’d been chatting up his Chinese Australian donors, lunged into the middle of our conversation. “He was very much born here! Lot of people out of ignorance think Buddha was born in India. He received enlightenment there. I went also to India, for my education. But that makes me no less Nepalese. Lord Buddha was very much born in Nepal. Very, very much!”

  After a jarring seven-hour drive, a day standing and watching surgery, and three hours of consuming Johnnie Walker with curried goat, I was beginning to wobble on my feet. “I think I’m very much about to be the sleeping Buddha,” I said, turning toward my room.

  Tabin clapped a firm hand on my shoulder and fixed me in place. “It’s never dinner in Nepal until you see the rice,” he said. “You wouldn’t want to offend anyone, would you?”

  At midnight, with a platter of mutton biryani soaking up some of the Johnnie Walker, I stumbled down the unlit hall of the hotel, past an open door through which I observed three Thai doctors cooking instant noodles over a propane stove by flashlight, and found my room by feel. I scratched at the dark door with my key until I located the lock. After a few moments of listening to my stomach wrestle with wild boar, whisk
ey, and goat meatballs, I collapsed into a deep and dreamless sleep, a sleep that seemed to have lasted only about fifteen minutes when Tabin banged on my door at 5:00 the next morning.

  “I’ve been reading this book called The Female Brain,” Tabin said. “The author’s thesis is that most women believe they can change the men in their lives. Why do you think they think that?” We were walking, much too quickly for my precaffeinated body, toward the hospital. For someone with so little spare time, Tabin was remarkably well-read. At dawn, Hetauda’s sidewalks were strewn with trash and sweepers were already at work separating the refuse into piles, so we walked in the street, where a wildly painted transport vehicle on its way to India roared past us only inches from Tabin’s shoulder. “When I was a bachelor, women would say, ‘Geoff’s crazy, but once he has kids he won’t run all over the world. He won’t wake up at four-thirty to climb a peak with his skis before work just because eighteen inches of powder fell overnight.’ ”

  A platoon of government soldiers in full camouflage were running, in formation, down the center of the street toward us. Though the Maoists now controlled the country, a few extremist factions of the rebels had broken away, refusing to accept the slow pace of change that could be achieved through a political process. They had detonated several small bombs in Hetauda, and the government had increased the number of soldiers stationed there, as a show of force.

  I don’t think Tabin even noticed the soldiers jogging past us. “I mean,” he said, “I’m the same person I was before I married. I’m just slowing down a little. Now I have to wake up at four if I want to have time to reach a summit and ski before work, but that’s the only difference.”

  I remembered something Cliff Tabin had said to me when I went to visit him in his genetics lab at Harvard Medical School, to discuss the little brother he obviously adored. “The thing about Geoff,” he said, “is that he’s always hungry. He’s got a lot of mouths to feed. Mouths inside him.” And I realized that no matter how many times Ruit advised him that “you can’t do everything at once,” Tabin wasn’t ever likely to quit trying.

  “Take my international work,” Tabin said. “I’m going to be spending more time in Africa soon, and that’s going to really—”

  He was interrupted by the blaring horn of a long-distance express bus bearing down on us. I grabbed Tabin by the neck and spun him away from traffic, toward the curb.

  “Wow,” he said, looking at the grease stain the speeding bus had left on the shoulder of his hospital scrubs, without thanking me or appearing particularly shaken. “That would have been a broken arm. At least!”

  We turned off the main road and passed a brick wall painted with an advertisement for Shaka Laka Boom instant noodles, a fire-blackened gasoline tanker with no tires, and a hand-lettered banner on the dirt lane leading to the hospital that read, HEARTLY WEL COME TO ALL DISTINGUISH GUEST AND PATIENTS.

  “So I worry that with the time I’m going to be spending in Africa, things are going to get even weirder at home than they already are,” Tabin said, his thoughts continuing to chug along at precisely the point where our conversation had been interrupted, as if he hadn’t nearly been flattened by a bus moments earlier. I had a vision then of Tabin’s brain, laid out like a railroad switching yard. I saw rows of parallel tracks too numerous to count, and the force that animated Tabin pushing each of those individual, unstoppable trains of thought along toward destinations only he could discern. “Every time I come home now after a long trip,” he said, exaggerating for effect, “Jean has taken in a new three-legged cat or a traumatized llama. It’s almost like she’s punishing me.”

  Or surrounding herself with creatures that will give her what she wants, I thought: the reliable companionship her husband can’t provide when he’s on the road for several months each year.

  “It’s got to be tough on her when you’re away so often,” I said.

  “She knew what she was getting into when she married me,” Tabin said. “We have such a terrific time when we’re together. I’ve got to figure out a way to make it work better. If you find an Internet café, can you send her an email while I’m in surgery? Tell her I’m fine but we’ve got five hundred cases and no Internet access, so I’ll be out of touch. And tell her that I love her.”

  “Geoff,” I asked, “why don’t you just travel with a satellite phone?”

  He didn’t answer. It was too late; his switching yard had already rerouted his thoughts from friction at home to the challenges he faced as we entered the gates of the hospital. On the far side of the courtyard a stage had been constructed for the official opening ceremony. Between the stage and the crowd of patients recovering in the colorful tent, hundreds of new visually impaired arrivals sat on the freshly seeded lawn like plants requiring care and water before they’d be able to thrive. Their families looked up hopefully at Tabin as he speed-walked past in his scrubs.

  We entered the tent, and I left him examining the first in a long line of postoperative patients. The handiwork of Tabin and two other surgeons was evident in the one hundred bandaged Nepalese resting on quilted blankets, each patched eye marked with one of the doctors’ initials. I watched staff nurses removing the bandages. And I saw the patients, after their eyes adjusted to the tent’s dim, carnival-colored light, searching for and finding the expectant faces of their families, where they leaned in from the tent’s many doors to watch the transformation. Witnessing so much unmitigated joy never loses its power. It felt no less humbling and true the thirtieth time than it had felt the first morning in Rasuwa. If your hands were capable of such restoration, I wondered, wouldn’t you be obliged to spend much of your life traveling to the world’s worst pockets of blindness, too?

  I noticed Kiran Kumari waiting for the nurses to remove her bandages. She sat cross-legged between her seventeen-year-old sister, Ranju, and her thirty-year-old brother, Bisheswer. Ranju was as beautiful as I hoped her sister would be once the bandages were removed. She had Kiran’s long hair and prominent cheekbones. Bisheswer hovered protectively, worried about what he might see when his sister’s eyes were revealed. Parbitra Gartaula, a young, newly hired nurse, slowly unwound the layers of gauze that covered Kiran’s head, then peeled back her bandages as her siblings leaned in anxiously. When Kiran blinked, and her lovely, fully functional eyes turned to take in the faces of her brother and sister, all three siblings began to cry, though Bisheswer coughed and brushed away his tears, trying to mask his emotion.

  “Thank you, Doctor,” Bisheswer said to me. “You’ve given my sister back her future.”

  “I’m not a doctor,” I said. I’d lost track of how many times since meeting Ruit and Tabin I had tried to explain my presence in places where a foreigner was presumed to have useful technical skills. I took a picture of Kiran and showed her a close-up of the eyes that Alan Crandall had repaired so elegantly.

  “Now that you have your future back,” I asked, “what will you do with it?”

  Her brother answered for her: “Before her accident, she was doing social work. She was teaching the illiterate village women how to read and such. She hasn’t been able to continue this work because of the damage to her eyes. So she will begin again.”

  Finally, Kiran spoke for herself. “Mainly, my brother worried that with my disfigurement I would never find a husband. Now,” she said, smiling, “I will be marriageable.”

  After Ruit, Tabin, and Crandall completed 634 surgeries over the course of four days, we brought one patient back with us to Tilganga; his wounds required facilities not yet available in Hetauda. We stuck to the paved road on our return trip, which turned out to be a mistake. Halfway to Kathmandu, we hit a lineup of immobilized vehicles that stretched for miles toward a mountain pass. Ruit sent La La out to ask what was happening and sighed when he heard the news. “A bus driver hit and killed the young daughter of a digger who works at a rock quarry at the top of the hill,” Ruit told us. “The quarry workers have blocked the road with their trucks and demanded the death
of the driver before they’ll allow traffic to pass.”

  We waited out a two-hour delay—with Tabin twitching impatiently beside me in the rump of the White Elephant—until the diggers downgraded the price of passage from death to a lump sum of rupees, and arrived in the capital just before midnight.

  Early the next morning, I stood outside the door of Tilganga’s eye bank, watching Tabin pace back and forth until its director arrived for work. The passenger we’d transported to the capital from Hetauda was a farmer turned Maoist soldier who’d been severely injured four years earlier by a bomb. He’d lost both forearms in the blast, which had also destroyed his left eye and traumatized his right so severely that he could only make out shadows. Tabin was hoping to repair the man’s remaining eye, but he needed a cornea—or preferably two, in case he made a mistake—before he could operate. He was anxious to perform the surgery himself, and soon: He was due to fly home to Utah the following day, to spend Thanksgiving with his family.

  At precisely 8:00 A.M., Shanka Twyna strolled toward Tabin, looking distinguished in a wool houndstooth sport jacket with leather elbow patches, and, moving slowly and deliberately, he unlocked the eye bank’s door.

  “Do you have my corneas?” Tabin asked breathlessly.

  “Patience,” Twyna said, smiling. “Let the donors die.”

  While Tabin paced, waiting to learn when the eye bank could expect a delivery of suitable tissue, I darted across four lanes of fast-moving traffic and down an embankment, past piles of funereal wood, to the Pashupatinath complex. I hoped to meet Krishna Thapa, the cremator Ruit had told me so much about. And I wanted to see the spot where corneas were harvested from corpses that could give the living second sight. Walking along the left bank of the Bagmati, I admired the collection of tiny, ornate brick temples built to honor Shiva. But to my right, the river was little more than a trickle of filthy, foaming water passing through embankments of trash. I’d visited the Indian equivalent of Pashupatinath, at Varanasi, and had left convinced that drinking from the holy Ganges, as I’d watched pilgrims do, would leave me fit for cremation, a victim of its tainted waters. The Bagmati made the sacred stretch of the Ganges look like a pristine mountain stream.