In this mountainous country bordered by India and China, doctors are considered to be godlike.

That makes the fall of Dr. Shiva Lal Acharya, who left a farming village to attend Nepal's most prestigious medical school and then moved to Chicago for a residency program, even more shocking for his friends and family.

On Dec. 13, Dr. Acharya died after hanging himself in the Allegheny County Jail. He had been in custody since September, when he was charged with hitting and killing a motorcyclist on the Pennsylvania Turnpike and then running from the scene of the crash.

"I rued his wrong decision-making," said Dr. Ranjan Sapkota, a friend and classmate of Dr. Acharya who lives in Kathmandu, Nepal's capital. "As a doctor, he should have guarded the dead body."

Both in Nepal and in the U.S., those who knew the 33-year-old Dr. Acharya described him as a brilliant student who came from humble roots to excel in his studies and his career.

But his path was filled with obstacles: bipolar disorder, alcohol abuse and a failed marriage.

"His message was that he had to struggle at every step in his life," said James Joshi, an associate professor in the School of Information Sciences at the University of Pittsburgh, who visited Dr. Acharya at the jail.

Dr. Acharya grew up in the village of Padampur, a dusty backwater in Nepal's southern plains, about a five-hour drive from Kathmandu. His family farmed rice, corn and other vegetables and lived in a cramped house with a tin roof.

In primary school, Dr. Acharya finished fourth in his class. In hopes of spurring him to greater success, his older brother, Krishna Acharya, promised to buy him a wristwatch if he could get top grades in secondary school.

The young Dr. Acharya accepted the challenge. He would study for hours at time, often putting a stone under his mattress to keep himself from falling asleep, his brother said.

"Since then, he was never second in his class," Krishna Acharya said.

In 1991, Dr. Acharya headed to Kathmandu for a science program, but a bout of jaundice forced him to return home during the first semester.

He enrolled in a college near his village, and his teachers later encouraged him to take the entrance exam for Kathmandu's Tribhuvan University Teaching Hospital. Over a two-week period, he studied non-stop, eating only milk and bread, his brother said.

Dr. Acharya received a scholarship to attend the medical program, which accepts just 50 students a year. He moved back to the capital in 1996.

"He was hardworking, a better student than me," said Dr. Sapkota, who comes from the same region of Nepal. "He was very friendly and amicable."

But Dr. Acharya would turn combative when he drank too much alcohol, often fighting with friends after small disagreements.

Heavy drinking was a normal part of life for students who were away from home for the first time and were living in hostels, with two or three people sharing a single room.

Dr. Acharya also experienced a personal tragedy during his medical school years. His closest friend and fellow classmate suffered from a mental illness and committed suicide.

At some point, Dr. Acharya started experiencing his own problems with bipolar disorder and depression, illnesses that ran in the family, according to Mukesh Singh, president of the Association of Nepalese in Midwest America, who has been in touch with the doctor's relatives.

Yet Dr. Acharya seemed to overcome his troubles. He scored high grades on his medical school exams, and he became involved with research projects, including one on smoking habits in Nepal.

And he focused on going to the U.S. to continue his studies, a favorite destination for many new Nepalese doctors from his medical school.

Dr. Acharya made his journey in 2005 and lived in New York for a while, but he struggled to get a spot in a residency program at an American hospital, Dr. Sapkota said.

In 2007, his prospects seemed to brighten. He returned to Nepal for an arranged marriage with 31-year-old Sumitra Gautam Sharma, who was also studying to be a doctor. The couple married within two weeks of their meeting, said Dr. Acharya's nephew, Ramesh Lamichhane, who lives in Harrisburg.

Dr. Acharya then moved with his new wife to Chicago, where, in June of last year, he started a three-year residency in internal medicine at Saint Joseph Hospital.

He and his wife quickly had problems, Mr. Lamichhane said. She left within a few months and went back to Nepal, even though she was pregnant. Dr. Acharya would never see their son.

"He was totally depressed without her, and he was wondering about the baby," Mr. Lamichhane said.

Dr. Acharya tried repeatedly to get his wife to come back. He traveled to Nepal to try to convince her. She refused.

At the hospital in Chicago, Dr. Acharya's supervisor told him to seek support for his struggles with depression. A year into his residency, he began looking for other jobs.

On Sept. 4, Dr. Acharya was driving in a black BMW on an Ohio highway, headed to Easton, Northampton County, for an interview at another hospital, when police tried to pull him over for speeding.

A few days before, he had been stopped and arrested on drunken driving charges, and he feared a new arrest would prevent him from making the interview, he later told police and friends. So he tried to get away, hitting speeds of up to 130 miles per hour as he sped down the highway, according to police.

A Pennsylvania state police cruiser was waiting for Dr. Acharya when he crossed the Ohio border, but he still didn't stop.

About 33 miles east of the border, near Warrendale on the Pennsylvania Turnpike, Dr. Acharya lost control of his car. He slammed on the breaks and hit a motorcycle hauling a small trailer.

Keith Brown, a Wisconsin man who was driving the motorcycle, was killed in the collision. The married father of one son had been on his way to visit a sister in Virginia.

According to testimony from his preliminary hearing, Dr. Acharya got out of the car before it had stopped moving and was dragged several feet along the berm. He told police he checked Mr. Brown and determined the man's injuries weren't fatal -- but he later told friends that he didn't know he had hit anyone.

"I think he was totally scared," Mr. Joshi said.

Dr. Acharya ran, barefoot, into the woods. Police spent four hours searching for him, using infrared scanners, bloodhounds and a helicopter.

Dr. Acharya emerged from the woods about two miles east of the crash scene and surrendered to the first trooper he saw. He had injuries to his leg and a laceration above one of his eyes.

On Sept. 26, a judge ordered the doctor to stand trial on a range of charges, including involuntary manslaughter, homicide by vehicle, third-degree murder and fleeing and eluding police.

From Chicago to Pittsburgh, Nepalese immigrants banded together to raise money for Dr. Acharya's legal defense, even though many were appalled by what had happened.



"There were a lot of people who felt what he had done was wrong, based on news accounts," said Sharda Thapa, the founder of the Chicagoland Nepali Pariwar, a social and charitable organization. "All we were trying to do was make sure he got a fair trial."

Mr. Joshi and Sushil Acharya, an assistant professor of software engineering at Robert Morris University, who is not related to Dr. Acharya, went to visit the doctor at the county jail on behalf of Pittsburgh's small Nepalese community. His nephew, Mr. Lamichhane, also visited and kept in touch with relatives in Nepal.

Dr. Acharya told them that he wanted to hire a private lawyer. They agreed to help him.

About a week before his death, he met with defense attorney Sid Sokolsky, who was alarmed by his client's mental health problems.

"I got the sense he thought everyone was against him," Mr. Sokolsky said. He appeared "very paranoid."

The attorney said he had planned to ask for a competency hearing for Dr. Acharya.

Mr. Lamichhane said his uncle was taking medication while he was in the jail and was housed in a special needs pod, where corrections officers check on each prisoner every 15 to 30 minutes.

Dr. Acharya was found hanged from a bedsheet in his cell, Warden Ramon Rustin said.

His body was cremated on Dec. 19. Sushil Acharya and Mr. Lamichhane are making arrangements to send his remains back to Nepal, so his family can spread the ashes in a river near his home, in keeping with Hindu traditions.

In addition to his brother, he is survived by his parents, two sisters and a son, Khem Acharya, who was born in June.

"He loved me so much," said his father, Nanda Lal Acharya, 67.

His mother, 63-year-old Kharika Acharya, rarely speaks or eats since Dr. Acharya's death, Mr. Lamichhane said.

She had asked him not to leave Nepal.

By Deepak Adhikari and Jerome L. Sherman, Pittsburgh Post-Gazette