In August I wrote a post that said: you will die, and the hospital will replace you in 72 hours. The roster will not even show a gap.
More of you saved and privately forwarded that post than almost anything I have written. Very few reacted to it publicly. I understand why. It is not something you want your hospital to see you agreeing with.
So this week I want to do the arithmetic behind that sentence, slowly, with real numbers from my own working life. Because the 72 hours is not a metaphor. I have watched it happen, more than once, in my own department.
I've seen many surgeons and anaesthetists leave over my tenure at my present hospital, and several of them were hardworking people who really, really worked hard. But once they leave and the accounts are closed, there is no mention of those people at the workplace. There's nothing to say or do about them, because the present and the future do not include them. Nobody remembers them, nobody wants them, nobody desires them, because they are not accessible anymore.
We keep an unofficial WhatsApp group where the doctors who left still belong. More than 40 doctors in total now, over a dozen of them departed, with a couple responding once in a while. Note the word unofficial. In the official hospital groups, the departed cannot exist. Their accounts are removed. The group of record has no memory.
One of them, doctor M, gave more than a decade to the hospital. He took the risky cases. Because of that, I was able to do my surgery completely, and I'm grateful to him for it. I sit back sometimes and think exactly that. But really, nobody in the hospital thinks about him even for a second. Why should they? The present work doesn't need him.
A decade of risky cases, and the institutional memory of it fits inside one colleague's private gratitude.
Years back in Chennai, a gastro resident came to me with what he thought was a delicate problem. His consultant depended on him for a lot of things: the clerical work, the patient follow-ups, getting the investigations done. He told me, "I'm about to leave, and I don't know how to break the news to my consultant."
I asked him why he was hesitating. It was good news for him. He was moving on to something better and bigger.
He said, "My consultant may be hurt or may be taken aback that I'm leaving."
I told him in no uncertain terms: "You will not be missed. You will not be missed in the department. Don't think so. You'll be replaced. Somebody else will come in your place. It doesn't matter to the consultant that you left. It doesn't matter to the hospital that you left. It doesn't matter to anyone except yourself. You're creating something out of nothing here. You may ascribe to yourself importance, but to the hospital and to the consultant, you're nothing."
It felt as if he was hurt by it. Then he left, and he came back and told me: "Yeah, it went very smoothly, and there was nothing."
That's how it's going to be, every time. We unnecessarily ascribe importance to ourselves when our consultants like us. As registrars, and later as practising surgeons, we think the hospital will miss us. They don't. They may give us the appearance that they will miss us if we leave. But once we leave, the account is closed. It's done. Nobody's going to miss you. Nobody in life is going to miss you, except maybe your mom.
I was harsh with that resident. I would say it again, word for word, because the kindest thing a senior can do is stop you from pricing loyalty into a ledger that only you are keeping.
Now hold that thought and look at what the same ledger says about your hours.
On paper, I work 8 hours. Biometric sign-in, sign-out. 4 hours in the morning, 4 in the evening. That is the record the hospital keeps.