Between the Emergency Room and Life.

There was a time when writing came easily—when I could pause long enough to make sense of how I felt, what I was going through, life in general—and capture it on this blog. Today, time feels like a luxury I can no longer afford. Life has grown hectic in ways I never imagined, leaving little room for reflection—except in stolen moments like this one.

Yet, on the brighter side, I make it a point to write at least one Quackdoses article every month. The joy it brings me is difficult to explain—when those articles are widely shared on WhatsApp, when colleagues (even within my own organization) tell me they wait for them, and when doctors I meet casually say they love the content. In a profession that rarely pauses to acknowledge anything beyond patient outcomes, that quiet validation means a lot.

I often think back to the time I was admitted to the ICU at Holy Spirit Hospital during COVID. The intensivist, after reading my name and learning about my profession, asked me, “Are you THE Mohit Garg who writes articles and poems?” I remember being unsure whether to feel proud or uncomfortable—especially when, at the back of my mind, I wondered if I would be in a body bag within a week. Life has a strange way of putting things into perspective.

Over the past few days, my thoughts have been unusually restless. There has been a lot churning inside my head, and writing felt like the only honest way to process it all. (I’m wide awake at 1 a.m. on my daughter’s birthday as I pen this.)

Emergency medicine is an exceptionally demanding branch—not only for me as a Head of Department, but even more so for junior doctors. The Emergency never truly slows down. High-pressure decision-making, limited manpower, and the simultaneous management of multiple critically ill patients are routine. In comparison, wards and ICUs, despite their challenges, offer some structure—defined rounds, documentation, and a sense of closure to the day. This imbalance is one of the many reasons retaining junior doctors in Emergency Medicine is so difficult.

In the last ten months alone, I have seen eight doctors leave the department (same problem in most hospitals, in this specialization particularly). The reasons vary—postgraduate exam preparation, better financial packages, newer hospitals, marriage, or plans to train abroad. What is particularly disheartening is that most leave after just five to six months, despite committing to at least a year at the time of interview. This period includes nearly two months of intensive training and induction to familiarize them with departmental protocols and systems—an investment that is rarely recovered.

In general, Emergency medicine is also a largely thankless specialty, much like anaesthesia or diagnostics. Much of the work happens quietly, behind the scenes. Many consultants remain unaware—or unconcerned—about the constraints we operate under: stretched teams, operational KPIs, quality indicators, audits, meetings, workshops, and continuous training. It becomes easy to criticize junior doctors and nurses, sometimes even speaking to them discourteously, for issues beyond their control—why a patient was shifted to an inpatient area without being reviewed in the A&E for the sake of their convenience (no one likes to wait for the lift), why non-urgent investigations weren’t completed in the Emergency Department, or why delays occurred due to logistics such as beds, samples, pharmacy, or transport.

Everywhere, the Emergency Department often becomes the hospital’s emotional and operational punching bag - an easy target to put the blame on.

Over the years, I’ve developed a certain resilience—perhaps even a thick skin. I no longer tolerate unjust criticism directed at my team or my department. I respond immediately, clearly, and firmly. That part of me is non-negotiable now. I am no longer interested in being a people pleaser or seeking external validation. Jo dil mein hai, woh zubaan pe hai.

Then comes the administrative side—constant scrutiny over timings, leaves, and schedules. Ironically, these are the very same aspects that are heavily negotiated during recruitment and contract renewals. The DOUBLE STANDARDS are hard to miss—and sometimes hard not to laugh at—ESPECIALLY WHEN RULES DIFFER FOR DIFFERENT CONSULTANTS. It erodes morale and demotivates you, when you honestly give more than your 100 % to the organization. I often wonder why I can’t also be mediocre and uninterested like many others, just be a silent spectator, and why I need to be so obsessed with perfection.

Accreditation bodies like NABH, however, remain close to my heart. Becoming an NABH assessor transformed my understanding of how hospitals truly function—from water and electricity consumption per bed, to biomedical waste generation, infection control metrics, and quality benchmarks. It reinforced a simple truth: good healthcare is as much about systems as it is about clinical skill.

The same holds true for AHA. It has been fourteen years since I became a senior faculty member, and my belief in the power of structured training has only deepened. Teaching those courses continues to be one of the most fulfilling parts of my professional journey.

Life outside the hospital has become just as demanding. I leave home at 7 a.m. and return by 5:15 p.m., only to head out again at 7 p.m. for my clinic, finally getting back by 9:15 p.m. Add to this the constant calls and messages—from the department, patients, relatives, and friends—and the day rarely feels complete.

I am acutely aware that I don’t spend enough time with my family and children. Yet, this phase of life also demands growth, stability, and financial responsibility—running a household, caring for aging parents, raising children, repaying a home loan. These thoughts linger constantly, quietly taking a toll on mental and physical health. In the process of caring for everyone else, we often forget to care for ourselves.

I still choose optimism. I try to spread positivity, to smile, to keep the energy around me alive—even on days when it feels harder than it should. I hope the fighter in me never gives up.

For me, ownership and responsibility are intrinsic—they are not job roles. They are values.

And as long as I wear this coat, it will always be MY patient, MY hospital, MY department, MY team.