The Eyemaker, Chapter 2

I PASSED my first night alone in fitful slumber, tossing to the ceaseless percussion of tom-toms, which I associated in my mind with war-like tribesmen, and wondered if my last hour had come.
But presently the drumming gave way to a Bacchanalia of a high order, which, in my somnolent and lonely state, induced nostalgic recollections of student days, and mild resentment that I had not been asked to the party.
The reason for these events soon became evident. Looking over the jungle tree-tops from my bed on the flat bungalow roof (where I slept for coolness), I noticed that there was an eclipse of the moon, and therefore, to both Santal and Hindu, it was in process of being eaten by demons. The general uproar was their attempt to frighten these demons away, an effort from which they obviously derived satisfaction when the penumbra passed off. I watched it for a time, and then composed myself to sleep.
The following morning the hospital seemed unusually quiet. With the exception of the large cataract party which had settled down comfortably in the shade of a vast banyan tree, most of the patients had made a clandestine flitting from hospital in the night, either to join in the celebrations, or on account of my unfortunate succession to the jungle hospital.

But Mongra Tudu reassured me that it was quite common for hospital to empty during any kind of holiday or celebration, such as Divali, the pretty Festival of Lights, or the bawdy fertility celebration of Holi. So in this case a rare celestial phenomenon had 'saved my face', and patients soon began to trickle back to hospital, having recovered from their hangover.

On my morning walk to hospital, I ran a gauntlet of throngs of waiting patients, and paused good-humouredly with a word here and there - 'piche .. piche,' (afterwards) - as was the custom. They were mostly blind people, accompanied by a more able relative, or even a whole family who had travelled a long distance, occasionally from as far as Nepal, Tibet or Afghanistan.

Today on my left a blind Mohamedan knelt on a prayer rug, invoking Allah, and on my right a Hindu sadhu, brow smeared with the trident of Vishnu, greeted me as 'Gharib Parwar' (Cherisher of the Poor).

A clink of heavy silver anklets, and a group of purdah women in the background sent a whispered message forward that they wished a private consultation at my bungalow. Later, squatting beside each in turn on my verandah, I coaxed them to unveil one square inch of one eye; then it was hastily covered, and I resumed persuasion in the hope of examining the other.(When I was in Calcutta I met a Xian doctor who had a stethoscope with a long enough rubber tube to go through the door into the next room to examine purdah women!)

Next in line came a Dogra army pensioner, complete with medals and proud of his service with the British raj. No servility here; when I paused to examine him, he came to attention, saluted and took two paces forward. Then a smartly dressed lawyer from Calcutta with a pearly cataract in one eye. He argued I would acquire religious merit by restoring his sight, so the question of a fee need not arise.

Still they came, pilgrims carrying earthen pots of sacred Ganges water, their minds obsessed with the need to escape a cycle of re-births, wearers of 'Gandhi caps', bearing the device - 'Throw off the foreign yoke!' , an Afghan from the North-West Frontier with baggy, wide pajamas, plum coloured velvet waistcoat and rifle, a Gurkha with his deadly kukri, a leper with stubs for hands.

Not all patients had cataract. During the months that followed, I treated a variety of eye conditions less amenable to treatment, and such as I would not see at home in a lifetime. Many of these were due to malnutrition, neglect or lack of medical facilities, and as time went on I sometimes looked in my mirror to see what healthy eyes were like. Even today, after many years, I remember some of these eyes, and the names of their possessors.

Grave decisions had sometimes to be taken alone, one day the greatest of all: would I blind a child to save her life? Lakshmi's right eye shone with a telltale greenish light that meant a glioma tumour, which if left alone would spread to her brain and cause her death. Her other eye was already slightly affected, and the removal of both eyes would give a chance (but not a certainty) of saving her life. The parents were educated, and well understood the agonising dilemma. The fatalism of the East - the karma of Lakshmi's past existences that was the cause of her present misfortune, was the deciding factor. The parents decided that nothing should be done, and went away sorrowful.

The strange jungle hospital that was the stage for these dramas consisted of a high brick tower, visible for many miles around, an operation theatre gifted by a wealthy Marwari (Hindu) merchant out of gratitude for regaining his sight on a dusty verandah, and a small outpatient surgery-cum-dispensary. For the rest, there were only a few rows of tumbledown shelters, some with stone slabs for beds. There were no sanitary arrangements. The majority of patients and their families preferred to sleep in tents, or on the ground under shady trees. The accommodation and standards were thus very remote from those of a city hospital, and could best be described as a permanent eye camp or field hospital, which had grown haphazardly as need demanded. As a young doctor fresh from a teaching hospital, I penned red hot letters describing conditions to my appointing board at home.

To have built and equipped a 500 bedded hospital and staffed it would have cost a fortune, and would not have appealed to the humble villager who had never slept between sheets in a formal hospital ward. There was a further fact, important in eye surgery. By approximating hospital conditions to his own mode of village life, he was put at ease and became relaxed, consequently making a surprisingly good and successful recovery. Lastly, there was a much bigger turnover of patients at low cost.

In this gypsy encampment it was difficult to tell in-patients from outpatients and impossible to do a formal ward 'round'. So each patient carried a small card on which his name and a brief medical history was noted, which he kept knotted in a corner of his clothes.

On a late evening visit to hospital to see a particular patient, which often ended my day, a Santal orderly would guide me stealthily in the shadows of the great encampment to avoid discovery. Around me some hundreds of shadowy figures crouched round camp-fires cooking their evening meal, making the air reek with acrid smoke and pungent spices; or if chillier nights had come, they huddled closer to the flames they could not see.

If these first few months brought shocks and problems, there were lighter moments of the unexpected - the party of strolling players and acrobats who put on a show in exchange for a consultation and a bottle of medicine, or the dacoits (robbers) who evaded the police by getting themselves admitted to hospital. But in this doctor's forcing-house I had to do my best to become a competent surgeon, general as well as ophthalmic.

More than a generation before me, the pioneer Scots doctor in this same jungle had paid his first timid patients a fee, to induce them to submit to operation. Fortunately I had attained sufficient skill not to have to resort to this expensive custom.

My temperament seemed to suite the delicate surgery of the eye, my fingers quickly becoming deft and confident, where the misjudgment of a millimetre with a tiny instrument could spell blindness that was irretrievable.

Many of the patients suffering from general diseases had been long neglected, and were in urgent need of surgery. Without help from X-rays or laboratory diagnosis, the decision on whether to operate, the onus of life or death, often lay entirely on my youthful shoulder. At night I brought out large reference books on operative surgery, and paced my study or bungalow roof collating and comparing arguments for and against. By chance in these early days, I stumbled on a motto for a jungle doctor in Albert Schweiteitzer's book More From The Primeval Forest, which I took as my crusader's device: "He who cuts boldly......"

Once the decision to operate was finally taken, I slept on it, and in the morning personally boiled the required surgical instruments in a cooking pot kept for that purpose in my bungalow kitchen. There were still, however, several hurdles to cross. My patient might change his mind on the operating table, or his grandmother rush in after the first incision to withdraw her consent. Sometimes the patient would fly by night, either before or soon after operation. Or he would tell me at the last moment that he had consulted an astrologer, who had told him the day inauspicious.