Playing the MS Innings

As I begin this part of my memoirs—as Medical Superintendent of a busy teaching hospital in central India—I often find myself thinking of the eight superintendents who preceded me. Each brought a distinct temperament to the role. Much like cricketers, no two played the same game.

One was a classic Test player—precise, orthodox, defending his wicket with a straight bat and never taking unnecessary risks. Another was a graceful stroke-maker, soft-spoken, guiding the ball through the covers with effortless timing. One superintendent resembled a patient opener, building an innings the way he built his desk: file by file, ball by ball. Another showed early promise that illness cruelly curtailed, like a career ended too soon by injury. One chose to preserve the status quo, content to block and defend. Another led like a T20 batter, attacking every delivery with speed and force. And one, sadly, spent his days exchanging letters with recalcitrant staff, leaving little behind beyond paperwork—dot balls without momentum.

During my residency at Government Medical College, Nagpur, the Medical Superintendent was a distant figure—someone you heard about more than you saw. At MGIMS, however, the MS was a formidable presence, close enough to touch the daily life of the hospital, and powerful enough to change its direction. When I took charge, I knew I would be judged not only by what I did, but by how I did it.

I did not step into the role under intense scrutiny or tight security. Still, I understood how quickly reputations form—and how stubbornly they resist revision. After twenty-seven years at MGIMS, rising from senior resident to professor, I knew my strengths and limitations well. I had to learn fast, decide wisely, and resist the temptation to imitate those who had come before me. I needed to find my own way.

Shakespeare wrote in As You Like It that “all the world’s a stage.” Leadership often feels like that. You speak, you sign, you decide—and you are watched. Yet within two months of assuming office, I found myself drawn to something decidedly unglamorous: processes. I convened a meeting of the nursing leadership and proposed mapping our existing workflows and redesigning them systematically. It was not dramatic work. It was necessary work—the kind that prevents small irritations from turning into daily disasters.

One of the most delicate challenges was leading colleagues who had once been peers. Roles had changed, but relationships had not. Some resisted quietly; others watched for signs of favouritism. Surgeons, in particular, are keen observers of hierarchy and fairness. I learned early that firmness did not require severity, and fairness did not demand distance. The feared undermining never came—perhaps because I did not try to rule, but tried to run the hospital.

Administration, however, exacts a price. To do the job honestly, I had to step back from what I loved most—teaching and research. I delivered fewer lectures, conducted fewer bedside clinics, and wrote less than I wished. The trade-off was unavoidable, and I felt it sharply. The ward had been my natural habitat. The MS office was a different ecosystem altogether.

As my administrative responsibilities deepened, problems began to reveal themselves everywhere. I became, almost inadvertently, a detective—restless until each loose end was examined. I started taking long, solitary rounds through the hospital: registration OPD, clinics, laboratories, imaging suites, CSSD, medical stores, blood bank, wards, operating theatres, medical records, kitchens, laundries, oxygen plants, palliative care units, mother-and-child buildings, emergency departments, toilets, gardens, parking areas. Nothing felt too small to inspect, because nothing small stays small for long in a hospital.

I could have delegated much of this. I chose not to. I wanted to understand the hospital not through reports, but through observation. Often, I was accompanied by the office superintendent, matrons, assistant matrons, and biomedical engineers—a moving team, each with a different lens, each noticing what the other missed. What emerged was a long list of ordinary but essential tasks: peeling paint, leaking taps, overgrown weeds, lights burning in empty rooms, wards crowded with visitors, corridors that looked tired, toilets that looked abandoned. Each problem seemed trivial in isolation, yet together they shaped the patient’s experience more powerfully than any policy circular.

Patient satisfaction proved elusive. To listen better, I began scheduling regular meetings with nursing supervisors and administrators. Later, we appointed a Public Relations Officer, Shaily, who introduced a new system: feedback collected digitally on iPads by social workers, then analysed every month to identify patterns. The results were sobering.

Patients complained of long waiting times, especially for specialist consultations, and of weeks-long delays for ultrasound—most painfully among pregnant women. Medicines were often unavailable or expensive. Parking charges felt arbitrary. More troubling were concerns about care itself: irregular ward rounds, poor communication, wound infections overlooked, and, in one instance, a dialysis technician chewing tobacco while on duty. None of this was unique to our hospital. But as a large public teaching institution, we carried a special responsibility. These reports forced us to confront uncomfortable truths about culture, accountability, and training. We needed to listen better, respond faster, and act decisively.

Improvement, I learned, is rarely spectacular. It is incremental, repetitive, and often thankless. It happens in small corrections—in showing up, paying attention, and refusing to look away. Walking the tightrope between administration, teaching, and research was never easy. I stumbled more than once. Yet I remained convinced that a hospital does not run on policies alone. It runs on habits, humility, and the willingness to see what others overlook.

That, perhaps, was my way of playing the game.

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