The Graveyard of Paper

A medical case record is not merely a stack of paper. It is a biography of suffering and survival.

At its best, a case file carries a story that begins with fear and ends—if we are fortunate—with relief. It should tell us why the patient came, what we saw, what we suspected, what we missed, and what we finally understood. It should record not only the diagnosis, but also the thinking behind it: the false trails, the turning points, the quiet triumphs, and the occasional regrets. A good record is a witness to the struggle between life and death.

In Sevagram, however, our case papers had stopped being witnesses. They had become props.

The Fiction of the Files

For weeks after I took charge, I found myself staring at piles of case papers heaped in precarious stacks across the wards—paper towers leaning like tired men at the end of a long day. They were everywhere: on trolleys, on tables, on window ledges, inside cupboards that would not close properly. The sight was not merely untidy. It was a silent monument to our administrative failure.

Curiosity made me do what most administrators do not: I began to read them.

What I found was disheartening. Many papers were blank, not even decorated with the doctor’s trademark illegible scribble. Others contained histories so brief and cryptic that I almost envied the clinician who could apparently diagnose complex human misery in three sentences.

The most tragicomic part was the “vital signs” chart. If those sheets were to be believed, the patients in our wards were blessed with a miraculous physiological stability. Day after day, pulse, respiratory rate, and blood pressure appeared as near-identical numbers—so neat, so uniform, so unchanging that they defied the chaos of biology.

The cover page might scream a terrifying diagnosis—Septic Shock, Perforation Peritonitis, Acute Abdomen—but the inner pages offered no narrative to support it. If these records were true, patients arrived with burst intestines, had them stitched by ghosts, and went home alive—not because of their doctors, but despite them.

I knew what the truth was, of course. Our clinicians were working hard. The wards were busy. Emergencies did not pause for paperwork. Yet the gap between what was done and what was written had grown so wide that the file had become a work of fiction.

And fiction, however tidy, is useless in medicine.

The Avalanche: 18,000 Papers

By September, the problem had reached critical mass. We conducted a census and arrived at a number that stunned even those who were accustomed to chaos.

There were eighteen thousand incomplete case papers scattered across the hospital.

Eighteen thousand.

They were choking the Ward-in-Charge cupboards, crammed into drawers, wedged into lockers, and hidden under tables like contraband. Papers that had once been crisp and white had turned a mournful yellow. We found them in imaginative hiding spots—tucked behind water coolers, gathering dust atop refrigerators, abandoned on tabletops, flattened under mattresses in the residents’ hostel, and buried beneath unrelated files as if someone hoped they would quietly disappear.

They were not records anymore. They were orphans.

The Great Purge

I decided to act.

I coaxed. I cajoled. I gave pep talks. I wrinkled my forehead in feigned anger and taxed my vocal cords in genuine frustration. I appealed to nurses, to interns, to residents, to anyone who might listen. My mandate was simple and absolute:

Finish the job. Send every file back to the Medical Records Department.

The response was compliance, but it was born of compulsion, not conviction. I knew nobody liked this work. And in my heart, I sympathised with them.

There is a special kind of drudgery in retrospective documentation. Writing notes in real time is hard enough. Writing them months later is like trying to reconstruct a monsoon from the dryness of a cracked riverbed.

“What do we write, sir?” the interns asked, eyes pleading. “How do we fill case records for babies who were delivered, cried, and left with their mothers months ago—when we were still studying Pathology?”

The surgery residents were equally pragmatic. “How do we compile injury reports for trauma patients we never saw, managed by seniors who have already graduated?”

Honestly, I had no good answer.

I stood there enforcing a rule that I knew could produce only one outcome: fiction. I was asking young doctors to fill sheets with reconstructed histories, invented physical signs, and neat narratives that had never existed. Even as I insisted on completeness, I kept wondering if these notes were worth the price of the paper they were written on.

Yet, I also knew the alternative was worse. An incomplete file is not merely inconvenient—it is dangerous. It is a medicolegal liability. It is a teaching failure. It is a betrayal of the patient’s story.

So I pushed.

The Graveyard of Data

Over four grueling weeks, the purge was completed. Those eighteen thousand case papers travelled their final kilometre—from the chaos of wards to the silence of the MRD.

But even there, what awaited them?

The technicians in the MRD would do what they had always done. They would sort the files by number, bundle them, label them, and shove them onto cold steel racks. A handful might be resurrected—pulled out for a court case, or retrieved by a postgraduate student planning a thesis based on “chart review,” a research method I had begun to view with increasing skepticism given the quality of the data.

The rest were destined to die an unsung death.

After five years of gathering dust, they would be shredded and recycled, their “stories” never read, their data never analysed. The hospital would move on, and the patients who had once filled those beds would vanish into anonymity, leaving behind only paper that no longer meant anything.

That was when the thought became unavoidable: we were not managing records.

We were managing a graveyard.

If Sevagram was to truly modernise, we did not need better penmanship or stricter scolding. We needed a revolution. We needed to stop writing fiction on paper and start capturing truth in bytes.

And so the decision was made.

The MRD would go digital.

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