There are some things you don’t forget for the rest of your life. Some good. Some painful.
This was one such night. One of my 24-hour shifts as an anesthesia resident at a busy government hospital in Delhi. Like many large public hospitals, the emergency room here was a world of its own, divided into three zones: the triage area, where junior doctors directed patients based on severity; the green zone, for less critical cases; and the yellow/red zone, for patients needing ICU care, ventilation, or immediate surgery.
We were usually posted in the red zone, but for one month during our residency, we were rotated through the green zone, managing junior staff, coordinating specialist consultations, and helping with medicolegal cases. My posting happened to fall in December, during the bitter Delhi winter. This was one of my first overnight duties for that month.
The ER was its usual chaotic mix—patients with fever, trauma, accidents, and even police bringing in the accused for medical examination before arrest. But sometime after midnight, the crowd thinned, and I decided to take the first rest shift while my colleague covered.
Just half an hour into that break, I saw a group of anxious people rush in, one of them clutching a blanket tightly. I went out to meet them. They handed me a referral letter from a government hospital, nearly 200 km away, stating that their premature newborn urgently needed NICU care, which was not available there.
I opened the blanket. The baby was breathing rapidly, visibly cyanosed, turning blue.
For some context, in the government system, ICU beds are a rare commodity, and NICU beds are rarer still. There are often no available beds unless someone recovers or dies at precisely the moment a new patient arrives. Access is also often influenced by connections: someone “higher up” might get a bed faster, regardless of clinical severity.
I immediately called our outborn NICU, which handles babies born outside our hospital. The answer was predictable: no beds. I tried the inborn NICU too, even though they don’t usually accept external referrals but again, no luck.
My heart sank. I asked my junior to seat the baby’s father while I mentally prepared myself to deliver the bad news.
He sat down across from me, a daily wage worker, worn out by the day, but still holding onto hope. I told him gently that we had no beds. His face dropped into a look of quiet devastation.
He began explaining that they had already gone to all five major tertiary hospitals in Delhi, all of whom turned them away. This hospital was their last hope, and even that was now slipping.
I had no answers. The only thing I could do was ask him to go to the NICU and plead directly with the staff, something I wasn’t supposed to encourage. Later, I got a call from the pediatric team, frustrated that I had sent the family their way, knowing full well they would have to refuse too.
The family left, heading back to their village hospital, praying that minimal care would somehow be enough. I wasn’t too optimistic about the baby.
A police constable posted in the ER came up to me as I stood quietly afterward.
“Sir, this is normal here. Happens every night,” he said. “Ambulance drivers do a full round of the big hospitals, and only when all fails, or the patient dies do they land here. Don’t take it to heart. Come, let’s have some tea.”
I did continue with my work. But that night left an impression that hasn’t faded. It was my first intimate encounter with the fragility of healthcare access for India’s common man.
Just a few weeks later, I witnessed the exact opposite.
One night, around midnight, a staff member of a prominent minister was brought in with signs of a stroke. The patient, like all others, waited for initial evaluation and scan. Nothing urgent. No VIP treatment. That is, until they informed the Health Minister himself.
He called the emergency physician on duty, demanding immediate neurosurgical care. The answer came back: “They’re all busy.”
Then, without warning, the minister arrived in person at the ER.
Within minutes, the atmosphere shifted. Neurosurgery residents—on duty and off—appeared in the red zone. A consultant neurosurgeon showed up shortly after. The scans were done, the surgery prepped, and by 1 AM, the patient was being operated on.
I stood there, watching how the machinery of the hospital—usually slow, reluctant, and unresponsive—shifted into perfect sync. One powerful person’s presence, and the system that fails so many, suddenly worked like clockwork.
A neurosurgery resident once confided to me, “For the average stroke patient, it depends more on luck than logistics. If the OT’s free, the scan room isn’t occupied, and the resident on duty is not exhausted—we go ahead. Otherwise, they wait.”
For this VIP patient, there was no waiting.
Later, while working as a senior resident in the ICU of another government hospital, I saw a darker side of this inequality.
This hospital served patients from a backward area, people with almost no resources. One morning, after admitting a group of patients overnight; septic shock, hepatic encephalopathy, renal failure; I was accompanying the consultant on rounds.
Instead of discussing how to save these patients, the consultant began casually discussing what to write on their death certificates.
“Septicemia. MODS. Hepatorenal syndrome,” he rattled off. “This one should go tonight. That one by morning.”
There was no urgency, no hope, no empathy. Just cold, administrative finality, as though poverty stripped the patient of worth. It wasn’t just clinical realism—it was apathy. It felt as though their survival didn’t matter, and I was expected to accept that.
In another incident at the same hospital, a stroke patient sent by a local politician was brought in. The patient’s attendants were visibly uncomfortable with the care standards. Despite the cost, they took the patient back to a private hospital, where they had previously received treatment but had avoided this time due to rising fees.
It struck me how even influence wasn’t enough to make people stay—that the gap between public and private healthcare was so vast that the people had no real options, and even the moderately connected felt abandoned.
Not all stories end in despair.
Once, a pregnant woman in her second trimester was referred from another hospital after a fall from height. She was intubated, with a poor GCS, and needed urgent ICU care. That hospital lacked both CT and ICU facilities.
A call was made to our emergency physician—not to confirm admission, but just to ask if a bed might be available. Somewhere along the way, that inquiry was mistaken for approval. The woman was transported and directly brought into the ICU, without formal paperwork. The nurses accepted her, assuming the documents would follow.
When the ICU consultant found out, he was shocked that no surgeon had been informed, no formal consent, no case summary.
But once the facts were clear and her critical state was evident, no one asked to send her back. Everyone just did their job. She was stabilized, scanned, and monitored. Within days, she improved. She was extubated, regained consciousness, and was discharged home a few weeks later—with her baby still alive inside her.
It was a case of protocol failure that saved a life. And to me, it felt like more than chance. It was mercy, quietly delivered.
Healthcare in India is improving in many ways. More AIIMS institutions, more PG seats, more infrastructure projects. But these don’t always translate to last-mile care for the poor.
The reality is: India is only as developed as the services available to its poorest citizen.
We don’t need a medical college in every Taluk. But we do need better-equipped secondary care centers, staffed with people who care, not just people who report.
And as doctors, citizens, and fellow human beings, we must ask: What kind of system are we building if survival depends more on luck and influence than medicine and compassion?
Until that changes, we owe it to each other to be kind, to be attentive, and to speak up when the system forgets to care.
