The Diminishing Likeability Quotient

One evening, my daughter Amrita looked at me with that devastatingly clinical gaze children reserve for their aging parents. “Papa,” she said, with a bluntness that would have made the late Vinod Mehta proud, “your likeability quotient has significantly diminished during your tenure as MS.”

It was a classic Lucknow Boy observation—candid, stinging, and inconveniently true. For thirty years, I had lived on a steady diet of affection. In the wards of MGIMS, I was the “Good Doctor,” the teacher who was always accessible, the physician who listened. I moved through the hospital corridors in a warm haze of smiles and respectful nods. But the Medical Superintendent’s chair is a strange piece of furniture; it is upholstered in thorns. The moment I sat in it, I realized that my job had fundamentally shifted. I was no longer the man who said “Yes” to a patient’s recovery; I was the man who had to say “No” to a friend’s request.

In a small, close-knit ecosystem like Sevagram, a “No” is rarely taken as a professional decision. It is felt as a personal withdrawal. I began to sense the change almost immediately. The smiles in the hallway grew a fraction tighter. Conversations that used to linger over tea became brisk and transactional. People started looking past me as if I had turned into a piece of office equipment—functional, necessary, but ultimately unlovable.

Take Ulhas. He was woven into the fabric of my life long before he ever sat across from my desk. During my student years at GMC Nagpur, I looked up to him as a role model. He was the “Bhaiya” who nudged me toward editing the MFC Bulletin and stood rock-solid when sorrow knocked on my door. I trusted him with the kind of blind faith one reserves for an elder brother.

But as MS, the radio signals between us began to fade. Ulhas ran the Department of Medicine like a seasoned captain—quiet, disciplined, and “fauji-style.” He expected me to be his ally in the administration, the “inside man” who would ensure the department got whatever it needed. But I now wore two caps. In the ward, I was his colleague; in the office, I was the custodian of a hospital with a shrinking budget and a thousand competing priorities. When I couldn’t bend the rules for the department, it wasn’t seen as administrative integrity; it was seen as a betrayal of our shared history. A cold, invisible fog settled over our relationship. We spoke, but we no longer communicated.

Then there was the “Mars and Venus” dance with the Microbiology department and my neighbor, Dr. Vijayshree Deotale. Vijayshree was not just a colleague; she was my former student and a friend whose family I had looked after for years. When the opportunity arose, I had recommended her as Head of Microbiology with great hope. I had a vision of our microbiologists as front-line detectives—leaving the laboratory sanctuary to walk the ICUs and labor rooms, helping clinicians choose the right antibiotics and hunting down hospital-acquired infections.

I pushed for a firm antimicrobial policy: single-dose prophylaxis for surgery, fewer broad-spectrum drugs for minor ailments. To me, it was evidence-based logic; to the department, it felt like an administrative overreach. People guard their boundaries with a ferocity that would surprise a border patrol officer. Soon, it felt like we were living on different planets. I was shouting from Venus, she was listening from Mars, and the vacuum of the hospital hierarchy swallowed the sound. By the end of my tenure, the warmth had been replaced by a silence I could feel in my bones.

The friction reached its zenith with Nitin Gangane. Nitin belonged to the first batch I ever taught. We had an easy, three decades-long warmth until 2009. But Nitin was ambitious—he wanted the administrative experience required to become a Vice Chancellor. With me in the MS chair, his path felt blocked. I was unaware at the time that he had begun contesting my appointment in the university and the courts. The “insider-outsider” irony of it all was that I was blissfully ignorant of the legal battle while he was looking away whenever we crossed paths.

In October 2012, the tension erupted during a College Council meeting. It was a scene straight out of a political drama: words rose, voices hardened, and a room full of colleagues watched in uncomfortable silence. I walked out of that room with a literal, crushing pain in my chest. Having undergone angioplasty just two months prior, I was rushed to Nagpur for an angiography. My heart, the doctors said, was physically fine. It was my spirit that had taken the blow.

The MS chair has a peculiar alchemy; it turns friends into “factions.” You become a “Manager,” and in doing so, you lose the “Man.” You become a target for the frustrations of an entire institution. If the oxygen is low, it’s your fault. If the canteen tea is cold, it’s your fault. If a promotion is delayed, it’s your fault. You spend your days firefighting, and in the process, you get covered in soot.

However, the most beautiful part of this story is the “After.” The “Sevagram Boy” knows that power is a lease, and when the lease is up, the man returns. The moment I stepped down in January 2023, the air cleared with a speed that was almost magical. The “Invisible fog” vanished.

Ulhas, my dear Bhaiya, began showering me with the same old affection, as if those strained years had been nothing more than a bad monsoon that finally passed. The “fauji” chits were replaced by warmth and long talks. And Vijayshree—she remains incredibly dear to me. We returned to being neighbors and colleagues, the antimicrobial disputes forgotten like yesterday’s newspaper. Even with Nitin, the edges softened. When the time came, and I was asked by others about his capability for high office, I spoke of his merits without a hint of hesitation.

I learned a profound truth late in life: the real villain is often the chair, not the person sitting in it. The chair changes how others see you and how you see others. It creates a temporary amnesia of the heart. Today, as I walk the campus, the “Likeability Quotient” has returned to its natural state. We are back to being what we were meant to be—friends, healers, and fellow travelers in the dusty lanes of Sevagram. The friction was the cost of the office, but the love was the profit of a lifetime.

Why did I Step Down?

After serving as Medical Superintendent for nearly thirteen years, I decided in the summer of 2022 to step aside and pass the baton to younger colleagues with fresher perspectives. My predecessor, Dr R. Narang, had held the position between 1990 and 2000; I had already exceeded that tenure. Longevity, however, is not a virtue in itself. Institutions, like people, need renewal. And I had begun to sense that my continued presence might now impede rather than enable change.

The decision was not sudden, nor was it easy. Hospital administration is an all-consuming role. For years, I had thrived on the complexity—overseeing multiple departments, managing people and budgets, negotiating crises, and ensuring that patient care did not falter. But somewhere along the way, fatigue crept in. The early excitement of experimentation gave way to routine. I felt myself becoming cautious, even conservative. Burnout is insidious; it dulls curiosity before it extinguishes energy. When I realised that I was no longer looking forward to trying new ideas, I knew something fundamental had shifted.

More troubling was the quiet distance that grew between me and the two roles that had originally defined my professional identity: teaching and patient care. Administrative responsibilities steadily crowded out time for students and bedside medicine. Patients began to see me less frequently in the OPDs, and some drifted away to physicians who were more consistently available. I could hardly blame them. That erosion of connection—slow, almost imperceptible—was perhaps the clearest signal that it was time to return to my roots.

There were also institutional realities that weighed heavily on me. Over the years, the leadership structure of the hospital began to show signs of strain. Trustees who had served the institution for decades appeared increasingly tired, resistant to change, and entangled in internal power struggles. Decision-making slowed. Succession planning was deferred. Even as urgency mounted, difficult conversations were postponed. The gap between faculty and management widened, and with it came frustration and disengagement.

Faculty concerns often went unheard. Efforts were not always recognised. Growth pathways stalled. Promotions were delayed or denied. Unsurprisingly, some of our most talented colleagues began to look elsewhere. Over the past decade, several medical schools—including AIIMS—opened in the region, offering better opportunities and clearer trajectories. MGIMS began to lose its edge. I remember, with a sense of quiet regret, colleagues who left to join AIIMS: surgeons, physicians, paediatricians, ophthalmologists, anatomists, community medicine specialists. I repeatedly urged the management to address this attrition, but the warnings went largely unheeded.

There was an elephant in the room, and no one wished to acknowledge it.

The consequences were visible. Cynicism crept into the corridors. Departmental expansion slowed. New facilities were discussed but rarely realised. Even motivated groups—such as the urologists seeking space, staff, equipment, and autonomy—found their proposals stalled by indecision at the top. Plans languished. Momentum was lost. What troubled me most was not resistance, but inertia.

The numbers told their own story. In 2010, the hospital recorded 42,400 admissions; by 2022, this had risen to 45,851—an increase of just over 8 percent across twelve years, translating to an annual growth of about 1.7 percent. Outpatient visits grew from 449,349 to 696,474 in the same period—an incremental rise of 55 percent, or roughly 3.3 percent per year. These figures reflected effort, yes, but also underscored the limits of growth without renewal.

Institutions do not decline overnight. They stagnate quietly, one deferred decision at a time.

By then, it had become clear to me that the hospital needed younger leadership—people with energy, imagination, and the freedom to question entrenched assumptions. My staying on would not solve the deeper structural issues. It might even delay their resolution. Stepping down felt less like an exit and more like an act of stewardship.

Around that time, I came across a line by Morgan Housel that resonated deeply and ultimately found its way into my resignation letter:

“Those we admire most in sports, business, politics, and entertainment tend to share one quality: they knew when it was time to quit, time to pass the baton, time to disappear, in a way that preserved—even enhanced—their reputation. Nothing diminishes past success like overstaying your welcome.”

I could not have put it better myself.

Leaving was painful. But staying, I realised, would have been harder—to justify, to sustain, and to defend. Sometimes, the most responsible leadership decision is knowing when to step aside.

And so, I did.

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