by Ming Wang
I opened the door to see Gwen dressed in a beautiful jade green chipao, the traditional Chinese evening gown that I had bought for her during a trip to San Francisco. The color matched her eyes. She smiled happily at me, and her father was as friendly and warm to me as he had been when we first met. He apologized for being late, glancing tentatively at Gwen’s mother, who stood there suppressing a scowl. She was clearly in charge.
I was nonetheless overjoyed that they had finally come! I took them around the room, introducing them to my friends, and explaining that 1995 was the Year of the Pig on the Chinese lunar calendar. I shared the meaning behind each of the decorations, and told them I would be serving a traditional Chinese soup right after the piano performance.
As soon as I finished my first piece, Gwen’s mother stood up abruptly, eager to leave. They hadn’t even had a bowl of my special Chinese soup yet! Gwen pleaded with her mother to stay and enjoy the rest of the evening, but she simply flashed a fake smile and headed for the door.
Defying social etiquette, I left my other guests in the apartment all by themselves while I accompanied Gwen and her parents on the twenty-six-floor elevator ride down to the lobby. I glanced at Gwen and was reminded of one of the first times I had seen her, in an elevator not too different from this one. She was still so beautiful, vivacious, and cheerful. However, regardless of how close Gwen and I had become since the beginning, her parents’ behavior toward me made Gwen seem still so distant and inaccessible. I felt so frustrated since I still did not know why I went from being loved to being rejected. We talked on the descent—Gwen ebullient over the party, her father happy and interested—as her mother remained cold and silent.
The next time Gwen saw me, she apologized for what had happened. With tears in her eyes, she reluctantly explained the truth behind her mother’s complete rejection of me. The problem wasn’t that I was a new Christian; it was that I was Chinese, not Anglo-Saxon. That was all that mattered to her mother.
I realized what a big mistake my Chinese New Year party had actually been, as it had only worsened the situation! Despite my good intentions, the party only emphasized my cultural and ethnic origin … and our cultural differences.
I was stunned. They had loved me when Gwen and I were just friends, so why was my ethnicity an issue now that we were dating? Christianity seemed to be a faith that embraces people no matter what their race or national origin is, so how could these Christians not accept me into their family solely because I wasn’t white?
By that time, I had been in the United States for twelve years. I had embraced this country, had become a citizen, and although China was my country of origin, I was now an American and had worked diligently to serve my adopted country. In the early years after arriving in the U.S., I had faced discrimination and prejudice from people like Drs. Miller and Anderson, men who never took the time to know me beyond my ethnicity. In contrast, Gwen’s family did take that time, and they grew to like and care for me as well. But somehow I had crossed a line; I was acceptable as their daughter’s friend, but not as a potential son-in-law, and there was nothing that I could do about it! The blow was devastating. I came to the realization that racial discrimination tends to exist on the deepest and most personal level. Even though one can accept another person as a friend, or sometimes even as a very good friend, one still may not actually be willing to accept another person wholeheartedly into one’s own family through marriage.
Gwen’s mother did everything she could to talk Gwen out of seeing me. “Can you imagine having a mixed-race child?” her mother asked her. “I don’t think you would be happy.”
“You know I don’t agree with her,” Gwen said to me. “I love you, and I love everything about the fact that you are a Chinese-American. I don’t think your ethnicity is a problem at all.”
The problem, if not my ethnicity, was how devoted Gwen was to obeying her parents’ wishes. She was thirty-one years old but her parents still ruled over all aspects of her life, from what time she came home at night to where she worked. Since I was still completing my residency in Philadelphia, her mother’s strategy was to push her to take a job as far away from the city as she could.
“It’s crazy for you to leave Philadelphia,” I said. “Your family, your schooling, your residency, your physician contacts, and your patients are all here … and I’m here! You have every reason to stay.”
“She doesn’t want me working in Philadelphia, or in Pennsylvania, or in any neighboring state for that matter. This is what we’re up against, Ming.”
We were sitting in one of our favorite Chinese restaurants. I contemplated for a moment how the green of her eyes rivaled the jade dragon that hung on the wall behind her. The carved dragon was pursuing a jewel just out of its reach. I felt trapped in the same perpetual pursuit, with no assurance I could hang onto this gem that was only an arm’s length away. How could this family who had embraced me so endearingly, who had encouraged my Christian journey, now turn and say that I was not good enough to be part of their family just because of my ethnicity?
Three months later, Gwen made the announcement I had both expected and dreaded.
“I’m taking a job in Ohio. I’m leaving in two months.”
“At least Ohio is a neighboring state,” I said, trying to be lighthearted. But I looked at her with incredible sadness. “You know you hate the cold. You’re going to freeze there. It’s even colder there than it is here in Philadelphia!”
Gwen loved warmth. She would practically freeze whenever the weather dipped below fifty degrees. She had been so much happier in sunny Florida during her fellowship. We both knew she would be miserable. She couldn’t respond, so we sat in silence for several minutes until Gwen sighed deeply.
“Dad misses his time with you,” she finally mumbled awkwardly.
“I miss him too.”
Gwen left for Ohio in August of 1995. I went to see her as often as I could, but during my visits, I could sense her mother’s control all the way from Philadelphia. Gwen never allowed me into her apartment, not even the lobby of the building.
The following summer, after I had completed my residency at Wills Eye, I left for a corneal fellowship of my own at Bascom Palmer Eye Institute in Miami. Gwen was envious of my retreat to warmer weather, and I hoped that my living in perpetual sunshine might finally draw her to me. We continued our long-distance relationship, enduring her mother’s standoff while holding onto the belief that as long as we love each other the geographic and cultural distances would eventually be bridged.
Chapter 14
The Two Letters
I left my apartment early in the morning and drove south along A1A in Miami Beach, with the sapphire and emerald waves of the Atlantic Ocean on my left, and bright, colorful Art Deco buildings on my right. The road was lined with palm trees whose leaves were still in the quiet of the dawn. The colors of the sunrise were spilling over the horizon and across the water. Miami Beach was breathtaking, and the area was alive with an abundance of fun things to do. Unfortunately, I had very little time to enjoy it because after I finished seeing patients all day, much of my evening was taken up with a certain company of rabbits.
While I was more than willing to travel the more than 1,200-mile trip to visit Gwen, who was busy building an ophthalmology practice near Cleveland, Ohio, she preferred to escape the cold and come my way so she could enjoy sunny Florida. Every time she arrived in Miami, we would hit the beach, soaking up the warmth from the rays above and the sand beneath. Despite her mother’s continued resistance, Gwen seemed to become even more committed to our relationship, so I felt confident that it was just a matter of time until we would win over her parents so we could finally be together.
In between Gwen’s visits, I was immersed in research to find a way to prevent scarring and the resulting blindness after corneal injuries. Seven years after my encounter with the patient at Massachusetts General Hospital who had been blinded by scarring after a corneal trauma, I could finally delve
into the question that had plagued me ever since, as I was now doing a corneal fellowship and had more time to devote to the study of corneal trauma and injuries. I still hoped to figure out how stem cells and fetal tissue could be tapped to improve the healing process in a human cornea after injury, but without harming the fetus. For years, a solution evaded me and I had nearly given up trying to reconcile this conflict between stem cell and fetal tissue research and the sacredness of life. But I felt empowered and transformed by my newfound Christian faith, and supported and encouraged by Gwen. I also kept in mind what Gwen’s dad had told me early on at a dinner—if we are patient, God will grant us wisdom in time.
After that conversation, I kept a piece of paper in my pocket on which I had written out the Bible verse, James 1:4, which says: “Let perseverance finish its work so that we may be mature and complete, lacking nothing.” My life’s journey had taught me over and over again that nothing worthwhile came quickly or easily. Just because the solution to the conflict between scientific research and Christian faith was elusive, that didn’t mean the solution didn’t exist. I needed to persevere and trust that God would show the way in His perfect time.
At Bascom Palmer, I had chosen Professor Scheffer Tseng—a world-renowned specialist in ocular surface disease and reconstruction—as my research advisor. I shared my qualms, conflicts, and confusion with Professor Tseng, as I had done with Gwen’s father.
“I don’t see how we can avoid this research, since fetal tissue has magical scarless healing properties,” I said. “But I don’t want to hurt the fetus. I’ve been wrestling with this question for years. How can we benefit our adult patients without harming unborn children?”
He shared with me that his lab had actually reintroduced the use of the amniotic membrane very recently.
“The amniotic sac has the same biochemical properties as fetal tissue, so we’re exploring whether the membrane that lines the sac holds the same healing power outside the womb.”
Professor Tseng’s words truly excited me. I began to read about the amniotic membrane’s use in medical treatments. The amniotic membrane is part of the tough, transparent amniotic sac where a baby grows in the womb. At the turn of the twentieth century, doctors had started using the amniotic membranes from placentae to reduce scarring in procedures like stomach surgery. In the 1950s, doctors again experimented with the membrane to reduce fibrosis in general surgery. The application hadn’t come into widespread use because of inherent limitations in the bioengineering of amnion tissue during those years.
Nearly a century after the first experiments with amniotic membranes, Professor Tseng was applying the idea to ophthalmology. I felt an immense swell of excitement at the possibility that perhaps the time had finally come for a solution to the problem that had puzzled me for so many years. I was grateful to God that my life’s path had led me to Dr. Tseng’s lab in South Florida, so many years and hundreds of miles away from my earliest questions at Harvard Medical-school.
Dr. Tseng and I collected amniotic sacs donated by mothers who had delivered their babies via Cesarean section, which was the only way to keep the amniotic sac intact and usable after birth. We began testing the amniotic membrane on lab rabbits to see if we could recreate the fetal environment, the membrane’s rapid regeneration and scarless healing properties. Following laser treatments on each of a rabbit’s eyes, I covered one eye with the amniotic membrane for a week and left the other uncovered, in order for the experiment to be controlled and the results compared.
After several weeks of observing the rabbit’s corneas, I then invited Professor Tseng and Bascom Palmer’s cornea specialists—including Professors Richard Foster, William Culberson, Andrew Huang, Carol Karp, Eduado Alfonso, Khalil Hanna, and Stephen Pflugfelter—to inspect the corneal scarring and note their impressions of the results.
“No one knows which eye was treated with the amniotic membrane,” I told them. “Just take a close look and grade the amount of corneal scarring in each eye.”
This double-blind study confirmed what I had witnessed myself, that is, that the eye that was covered by the amniotic membrane had 75 percent less amount of scarring than the eye that was left uncovered. I was elated that the healing power of the womb was, in fact, still present in the amniotic sac tissue, and since the placenta was simply discarded after birth, the use of this tissue presented absolutely no harm to the baby.
I was very curious about the molecular mechanism by which the amniotic membrane reduced scarring. When I took a closer look, I discovered that the eye treated with the membrane had less inflammation. By covering the cornea within twenty-four hours of the laser treatment, the membrane inhibited the natural, exaggerated wound healing response. Less inflammation meant less cell death, which ultimately resulted in less scarring. We published the first paper in scientific literature that demonstrated laboratory success in reducing corneal scarring and cell death with amniotic membrane transplantation, and we explained how the treatment helped restore sight.
Our work had been a dramatic leap forward in the quest to capture the healing power of the womb, but when we explored how to apply our findings to the clinical setting for patients, we hit a significant roadblock. We had been working with sedated rabbits in a highly controlled laboratory setting, but in a real life trauma situation, it would be very difficult to suture a membrane onto a patient’s painfully damaged cornea. Additionally, injured eye tissue would be vulnerable to perforation from suturing, which could expose the eye to dangerous infection and blindness. Furthermore, the technique to perform the minuscule sutures necessary to attach the amniotic membrane also required highly specialized surgeons who might not be on hand when needed. The amniotic membranes also had to be available at all times so patients could be treated within twenty-four hours of their injuries.
We needed to come up with a much better way to apply the amniotic membrane to a freshly injured eye in a safer, more effective and more timely manner.
We were so close to the long-awaited ethical solution to using fetal tissue to treat corneal scarring, but now we faced this new challenge. I felt frustrated by this break in our momentum, but I was still convinced that we could advance medical breakthroughs while staying consistent to the principles of faith. Having come this far, I couldn’t be daunted by the obstacles. I repeated to myself the words Gwen’s father had said, and I trusted that God would help us find a way to make the healing properties of the womb widely available to patients with eye injuries. I just needed the right idea, and it did come in time thanks in part to the help of my brother, Ming-yu.
In July of 1997, Ming-yu flew down to Miami from Boston to help me move to Nashville, Tennessee, where I had accepted a new job at Vanderbilt University. We hitched a U-Haul trailer to the back of my car, packed with everything I owned in the world. Gwen couldn’t get away for the long drive to my new job, but she was planning on a visit shortly after I settled in. I appreciated having my brother along for the trip, as I had taken care of him throughout his childhood, and now he had arrived to help me.
Ming-yu slammed the trailer door shut, yanked on the padlock to be sure it was closed securely, slid into the passenger seat, and I pulled the car onto the I-95 North out of Miami.
“How’s your amnion research project going?” he asked me as he leaned forward to turn up the air conditioning.
“The amniotic membrane transplants were successful on the rabbits, but for actual patients, we still need to find a better way to deliver the membranes to injured eyes, hopefully without having to suture them to the corneas, since suturing poses too many risks and often cannot be done immediately.”
I gripped the steering wheel and maneuvered through traffic, the white lines on the interstate whizzing quickly past us. As I considered the benefits of the amniotic membrane, I wondered how I would find the solution I was seeking. I told Ming-yu I had been pondering this issue, praying to God for a creative solution, and trusting that God would again grant me wisdom.
I
glanced over and saw Ming-yu pull out a bottle of eye lubricant to moisten his contact lenses.
At that moment, an idea came to me.
“That’s it!” I shouted.
“That’s what?” asked Ming-yu. His head was tilted back as he squeezed a few drops into each eye.
“Contact lenses!” I said with a rush of excitement.
It seemed so straightforward that I couldn’t believe I hadn’t thought of it sooner. People had been putting contact lenses into their eyes for decades. We could fuse the amniotic membrane to the underside of a contact lens, package them in bottles, and store them in emergency rooms around the world. Anyone with basic medical training could insert a contact lens onto a patient’s injured eye. I realized that Ming-yu’s question and my reaffirmation of my trust in God had brought about the inspiration of this simple and beautiful idea, and the answer to my long quest for a solution that aligned faith and science.
I laughed out loud, and then reached across the front seat and threw a playful punch at my brother’s shoulder.
“Thanks, Ming-yu!”
“I didn’t really say anything, but you’re welcome.”
As soon as I landed in Nashville, a friend and I sent paperwork to the U.S. Patent and Trademark Office for two patents on the amniotic membrane contact lens, one for chemical injuries and another for laser corneal treatments. The patent process could take a year or two, so in the meantime I continued my research using the traditional method of suturing the membranes onto patients’ corneas. The amniotic membrane transplant would play a crucial role in the reconstructive eye surgeries I performed in the coming years.
* * *
During my fellowship at Bascom Palmer Eye Institute, I had been fully trained in cornea and laser refractive surgery. Throughout the late 1990s, the FDA rolled out a number of approvals on LASIK, which ushered in a new era in refractive surgery. Bascom Palmer bought its first laser in preparation for the first LASIK procedure at the institute. I used my expertise in laser physics to help the engineers set up the laser and calibrate it for surgery. After recruiting the first group of patients, I performed one of the first LASIK surgeries at Bascom Palmer, becoming part of history at the institute.