The Barefoot Surgeon Read online

  leaping about wildly. ‘The room looked like a prison, with its iron bars and dim lighting, and smelled like a zoo.’

  The keeper was a small, dark, taciturn man who was

  perpetually chewing betel nuts. There were strict limits to

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  how much time students were allowed in the laboratory, so

  Ruit took to bribing him so he could stay longer and longer.

  ‘I spent so many hours up there operating on the monkeys

  that I used money, whisky and fancy cigarettes.’

  Together, Ruit and the keeper would catch one of the seven-

  kilogram packages of muscle, tooth and claw, anaesthetise it, then inject the bacteria into the back of the eyeball to see if it would cause a lesion and an infection, leading to blindness.

  With his heart in his mouth, Ruit would open one of the

  doors with the keeper and after a wrestling match, inject

  the monkey with Nembutal until it fell asleep. Often it would bite and scratch and Ruit ended up with huge scars all over

  his arms. Afterwards, the monkeys would be painlessly

  euthanised.

  ‘Some people might say it’s cruel to operate on monkeys,

  and of course I was appalled at the thought of hurting any

  living creature. But in those days, it was the only way a cure could be found for diseases such as TB, smallpox and the

  measles. There are many instances in which great advances

  have been made in medicine by experimenting on animals.’

  It was thanks to his ‘long meditations on monkeys’ that

  he was able to master microsurgery, a craft that was in its

  infancy at that time.

  Although AIIMS had the latest microscopes, microsur-

  gery was still a highly specialised skill that took thousands of hours to learn, much like playing the piano or learning ballet.

  But once Sanduk learnt how to do it, it was like entering a

  beautiful microscopic universe. Australian ophthalmologist

  Dr David Moran regards it as ‘like going down the rabbit

  hole in Alice in Wonderland, it’s like a parallel universe. You 55

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  learn to step away from yourself. After a while, the process

  hasn’t got much to do with you. You are simply the eyes,

  the hands and the brains that are going to benefit the patient lying in front of you.’

  At first, the subtlest of movements seemed wildly exag-

  gerated under the lens of the microscope. But with endless

  repetition, straining over the monkey’s eyes, about the size of a child’s thumbnail, Ruit learnt how to coordinate what he

  thought he was doing with his hands, and what it looked like

  through a microscope.

  No-one else would go up to the research laboratory. Ruit

  had the top floor domain all to himself. He would practise

  all day until his eyes were blurry. Today, when he goes to the monkey temple, Swayambhunath, in Kathmandu and sees

  the monkeys scampering around, he gives thanks to them.

  ‘It is purely because of the hundreds of hours I spent experimenting on their eyes that I became so skilled in microsurgery.

  All those hours with them went on to benefit thousands of

  patients. So, I always tell them how grateful I am.’

  It was while Ruit was in New Delhi that eye doctors in

  the West began using a revolutionary new technique to cure

  cataracts, an operation that had always been one of the most

  challenging types of surgery. For centuries, the most common

  technique for extraction, dating back to the Middle Ages, was a crude technique known as ‘couching’. This involved using a

  curved needle to push the clouded lens into the rear of the eye and out of the patient’s field of vision. It was done without an anaesthetic and often resulted in a patient remaining blind or with only partial vision (see Appendix for the history of

  cataract surgery).

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  But new advances meant that, if you lived in the West,

  cataracts had become something that were easily fixed. Days

  after surgery, patients could return to work, read books, play sport, even sit a driver’s test.

  ‘It was completely revolutionary because it finally did

  away with the thick Coke- bottle glasses,’ Ruit says. ‘Once any surgeon gets the hang of intraocular lens surgery, it seems like malpractice to do anything else. We knew it was being done

  on a lot of patients in the West, and that it was very expen-

  sive, complicated, and took a long time. But still, everyone

  was thrilled to think that one day having cataract surgery

  would be a straightforward procedure. It was an exciting

  time to be in ophthalmology.’

  One of the AIIMS professors who left a lifelong impression

  on Ruit, Professor Madan Mohan, taught him the art of what

  he called ‘cruising the eye’.

  ‘He was a natural surgeon and a very smooth operator. His

  surgical skills were beautiful. It looked like he’d never made a mistake. Every movement he made on the surgeon’s table

  had a purpose. The eye is the finest, most delicate tissue in the body, and you need to be extremely careful.’ Ruit soaked

  it all up, watching and then trying to emulate his rhythm, his precision, and the infinite gentleness of his every movement.

  ‘He helped me to fall in love with the eye, which, when you

  look at it, is an object of great beauty. Every layer, every part of it has been developed by nature and by evolution to perfection. And it’s so beautiful to look at, with multiple facets, each perfect, much like a jewel.’ He also taught Ruit the art of really caring for his patients. ‘He used to say, “Ruit, there’s no harm in calling a patient ‘Sir’ and putting your hand on

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  their shoulder. Nor is there in looking at your patient directly, and explaining quietly and clearly what you are going to do.

  It doesn’t take much to make them feel more comfortable.”’

  Those teachings in patient care—and the trust and faith that

  engendered in his patients—were to remain a bedrock in

  Ruit’s career.

  Ruit’s graduation from medical school in Lucknow had

  been low- key, but the results of the end- of- year examinations of his postgraduate degree in Delhi saw Ruit basking in the

  limelight, whether he liked it or not. He had come second

  in the entire university. It was quite a win for a boy from

  the border of Tibet, who had grown up expecting to be a

  salt trader. His peers celebrated by trooping into his dormi-

  tory room and pouring rum all over him. Armed with his

  ophthalmology degree, and doused in spirits, Ruit was finally on his way.

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  6

  Every little

  thing she does

  Ruit was a newly minted ophthalmologist, in his early thirties, working in the Nepal Eye Hospital, Kathmandu, when he

  met her. By the mid- 1980s, he had started to hit his stride as a surgeon. The speed and dexterity of his work meant Ruit was

  rapidly earning a reputation as one of the best eye doctors

  in Nepal.

  He
was also teaching anatomy to the new ophthalmic assis-

  tants, the paramedics who are the lynchpin of the operating

  theatres, at the Nepal Eye Hospital in the evenings. Tuesday

  evening became the highlight of his week because a very attractive young woman would always be there, sitting at the end of the second bench, chatting with her friends. Ruit didn’t know her name, or anything about her really, other than he liked the way she held herself; she was tall, and had a beautiful posture and a lovely smile. Every day she wore a different coloured sari, or arranged her hair in a different fashion. He was captivated.

  He was too shy to talk to her. But he was desperate to

  impress. The only way he figured he could do that was to make 59

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  meticulous diagrams of the inner workings of the eye for the

  lectures. Looking back, he says he can’t imagine many women

  falling in love because they were dazzled by his perfect sketches of the retina or the cornea. At the time, though, it was the only thing he had to offer her.

  He would stroll up and down the aisle, making a point

  of approaching her so that he could see her face, hoping for

  a sign. Just a flicker of interest. Anything. Sometimes there was just the barest hint of a smile. It was enough to keep the young doctor’s hopes alive.

  He found out her name was Nanda. When she started assist-

  ing in Ruit’s operating theatre, he realised she was a first- rate nurse, finely attuned to each of the surgeons, to the point of almost being able to anticipate their needs. And she had those qualities some women have which cannot be taught—she had

  charm and poise. ‘I was filled with a sense of wellbeing just watching her work, and being around her,’ he recalls.

  But when Ruit asked about her among his friends, his heart

  sank. She was a Newari woman. Her family was from the presti-

  gious Hindu caste who were the original settlers in Kathmandu, building many of its magnificent ornate palaces and temples.

  Ruit, on the other hand, was a Walunga, one of the lowest

  castes; they comprised the northerners and nomad traders

  who had migrated to Nepal from Tibet. Nepal’s caste system,

  one of the oldest in the world, segregates people into rigid

  social tiers according to profession and religion. In those

  days, it was completely unthinkable for a Newari woman to

  marry someone of such humble origins.

  ‘It was a completely impossible relationship. I knew we

  would have been shunned by both our families and that it

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  would be very awkward for everyone,’ says Ruit. ‘There was

  so much disapproval of marriages between castes.’

  But love was not going to obey the rules. ‘When you’re

  really in love, you adore everything about your darling, don’t you? I loved the way she walked. Her hairstyles. The way she

  moved her hands. The way she spoke. She was so pretty, and

  modest, and had such a lovely attitude, as well as being so

  caring and practical. I really thought she was the right person for me.’

  Ruit had achieved the unthinkable before. He was a village

  boy who had won a scholarship to study medicine at one of

  India’s most prestigious colleges, and then graduated in ophthalmology at a world- class university in New Delhi. In Nepal,

  something like this had previously seemed impossible. Could he dare to be as courageous with a relationship as well? To go for what he really wanted, no matter what anyone else said?

  ‘I’m a bit of an introvert but I have a lot of courage. And

  I have a strong belief in destiny,’ Ruit says. A few weeks later, it did seem like the gods were approving of his infatuation.

  They were both sent to a surgical camp a few hours out of

  Kathmandu, in the foothills of the Himalaya. ‘There was

  a strong inner voice, telling me that we were meant to be

  together.’ Away from the constraints of Kathmandu, and the

  scrutiny of society, they could finally talk freely, and at length.

  Once Ruit could see the attraction was mutual, they went

  on long walks together. Detached from duty after the day’s

  operations were done, romance blossomed. There were lots

  of silent glances and meaningful looks. ‘No one guessed at

  all that we were falling in love. We were very careful,’ says Ruit. But it was a different matter when they returned to

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  Kathmandu. The shutters came down. Ruit had to ask Nanda

  out for about a year before she finally agreed to have tea with him after work.

  ‘She wouldn’t say yes, but she didn’t say no,’ he says. ‘She

  would say “Um, ah, I’m busy”, you know, all the things girls

  can say, or “I have to see my parents”. But she kept turning

  up in the operating theatre, so I knew my interest was not

  unwelcome. Otherwise, she would have asked to be trans-

  ferred somewhere else.’ It was tantalising to have her working so close by, and yet be so unobtainable.

  For almost two years, all he saw of her was her hands, and

  what he could see of her face above her surgical mask as she

  buckled down to work in his operating theatre. ‘Every now

  and again, I would ask her out,’ he recalls. ‘Almost satirically, I would say, “I know you’re going to say ‘no’,” before I asked her out. But, somehow, I knew. I felt there was a strong response inside her even though she didn’t express it in words, so I just didn’t give up. Our relationship was not a modern type of

  whirlwind romance. It was much more of a slow- moving river.’

  Finally, one day, Nanda agreed to let him take her out to

  lunch. Ruit was nervous about sharing his dream with her

  of giving sight to the poorest of people. He was worried she

  might have been more interested in a comfortable lifestyle

  rather than something more challenging, but she seemed to

  approve of the idea.

  Their courtship started sedately, with a date once a month,

  and did not run smoothly. ‘When I could see she was falling

  in love with me a little bit, I told her how much I admired her and that I thought it would be a good idea if we got married.

  But when she could see how serious I was, she started putting 62

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  up walls, saying that it was not going to work. I think she

  brought up the subject at home, and they had been disap-

  proving of the match.’

  ‘There will be so many objections,’ she kept telling

  Ruit. ‘I’m Newari, you are Walunga. We simply will not be

  accepted.’ The stakes were high. Nanda was very close to

  her family, and she was scared of the repercussions, of being ostracised by her family, or worse, completely disowned.

  The pair really did look like they came from two different

  worlds. Nanda was tall, slim and fine boned, so elegant that

  she could have easily been mistaken for a movie star. Ruit, on the other hand, was a bear of a man; thick set, with broad

  shoulders, big lungs and strong legs—built, like his ancestors, for durability. Ruit’s parents objected to the marriage as well.

  They kept trying to arrange a match f
or their son, whose

  medical degree made him eligible for respectable women

  from Kalimpong and Darjeeling in India, rather than those

  from small Nepalese villages. They showed him photographs

  of attractive young women from good families, encouraging

  him to meet them.

  But it was no use. He had to marry Nanda. He knew

  instinctively how rare it is to look forward so intensely to

  meeting up with someone, even for a cup of tea after work.

  He just didn’t give up. ‘I’m used to the difficult path, you

  know,’ Ruit says. ‘I always expect challenges, and I always

  knew it was going to be tough for us. She would say, “This is going to be impossible,” and I remember saying back to her,

  “Nothing is impossible.” I think you can truly win a woman

  if you just keep pursuing her, as long as she is interested in you, of course, and your attention is not unwanted.’

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  Nanda made Ruit work so hard to win her, though, that

  one day he completely snapped. They were quarrelling

  in the operating theatre; Nanda was raising her objections to the match, yet again, and in his frustration, Ruit picked up a piece of broken glass and held it over his wrist. “‘If you don’t marry me!” I said to her, “I’m going to kill myself!”’ Then he cut deep into his wrist, several times, drawing blood which

  spurted all over the floor.

  Nanda, horrified, rushed about desperately finding bandages

  to staunch the flow. Ruit was close to breaking point. ‘I was really desperate and it was a kind of threat. It was a bit like,

  “Today I’m going to cut my wrist, tomorrow you may not

  see me.” And it was true. I really felt like I was going to die if I couldn’t be with her.’

  His approach worked. They arranged to meet a few days

  later to work out a plan, and then, finally, Nanda was just

  looking at him. Not moving her gaze from his face. There

  was no need for either of them to speak. ‘I was so overjoyed

  I swept her into my arms. I think she knew from that moment

  on that everything was going to be all right.’

  ‘You know we can’t get married here,’ she said, ‘Our

  parents will kill us.’

  Ruit had been waiting so long to be with her, so he struck