Success in a hospital is a fragile thing. When Govind walked home with his new heart, in the chapter before this one, we felt invincible. We had scaled the summit. But the air at that height is thin, and the footing treacherous.

Not long after, a twenty-four-year-old mother walked into my OPD asking us to close a simple hole in her heart. What happened to her — the surgeon’s easy confidence, the routine operation that ran five hours instead of three, the bubble of air that reached her brain, the husband who blamed destiny rather than our hands — is a story I have told once already, in full, elsewhere in this book. I will not tell it twice. But I have to tell you what it did to me, and to the programme.

As Medical Superintendent, this was my failure. I had built the theatre, recruited the team, and given the programme my blessing. In that one afternoon, I understood we had the technology but not yet the deep, ingrained culture of fail-safe checks that cardiac surgery demands. We had reached for the summit and forgotten that at that height, a single bubble of air can be a landslide.

I did not have the courage to continue. I let the cardiac surgery programme at Sevagram go dormant. I chose the safety of the non-invasive over the risk of the cutting edge — a decision born as much of caution as of a wound I could not yet name. I retired as Medical Superintendent with that summit left unscaled. It took another full year after my retirement for the hospital to find its footing and restart the programme, and even then it began in fits and starts, still haunted by what had gone wrong.

For a long time afterward, I was haunted by the finality of that failure. In an ICU, when technology fails, it fails loudly and catastrophically, and it leaves you feeling that medicine is nothing more than a high-stakes gamble with machines. But as the months passed, and I moved into my final year as Medical Superintendent, I began to see something I had missed. Our obsession with fixing the heart had blinded us to the soul of the person carrying it.

I had hit the brakes on cardiac surgery because I feared another sudden, violent death. But in doing so, I started looking more closely at the quiet, slow deaths happening every day in our wards — the cancer patients, the elderly, the forgotten. I realised that if we could not always guarantee a miracle on the operating table, we could at least guarantee dignity in the hospital bed. A doctor’s duty does not end when the cure becomes impossible. In fact, that is often where the most important part of the work begins.