The Administrator’s Chair

This chapter is about choice, chance, and how roles shape us.

In September 2009, the trajectory of my career shifted without warning. I was a Professor of Medicine, content in my familiar world of wards, rounds, students, and research, when a letter arrived from Dr. (Mrs.) P. Narang, Secretary of the Kasturba Health Society. It was brief, formal, and decisive. I had been appointed Medical Superintendent of Kasturba Hospital.

I read it twice, as if a second reading might change the meaning. It did not. I felt two things at once — apprehension, and a faint, helpless amusement. The management had sanctioned a special allowance of ₹500 per month for the post. Even in 2009, it was a token amount, almost ceremonial. I smiled for a moment. Then the smile vanished. The sum felt inversely proportional to the headaches the job would bring.

The vacancy had opened because of a regulatory technicality — the kind that looks harmless on paper but rearranges lives. Dr. K.R. Patond, our Orthopaedic Surgeon, had been running the hospital with calm efficiency. But the Maharashtra University of Health Sciences enforced a strict rule: one person could not hold two administrative positions simultaneously. Dr. Patond had to choose between being Head of Orthopaedics and Medical Superintendent. He chose his department — understandably — and the superintendency landed, with quiet inevitability, on my table.

I had not applied for the post. I had not lobbied for it. In truth, I had spent most of my career avoiding it.

***

A Chair With Shadows

My hesitation was not only about workload. It was about legacy.

To sit in the Medical Superintendent’s chair in Sevagram was to step into a long shadow. Kasturba Hospital had been run by men whose names were spoken with a particular kind of respect in corridors and committee rooms: Dr. P. Nayar, Dr. Karunakar Trivedi, Dr. O.P. Gupta, Dr. R. Narang, Dr. V.N. Chaturvedi, Dr. A.P. Jain, Dr. S. Chhabra, Dr. K.R. Patond. They were administrators of a different era — firm, authoritative, and entirely comfortable with power. They could still a room with a glance. They could resolve a crisis with one sentence.

I was not cut from that cloth. I was a physician who preferred the bedside to the boardroom, the patient’s story to the committee’s agenda. I had always believed that the best decisions in medicine are made close to the patient — where breathlessness can be seen, not merely described; where pain is not a complaint but a face.

I had done nothing to prepare for this role. I had not enrolled in any of the hospital administration courses that some doctors pursue, and occasionally mention on social media. I had no idea what I was getting into. Honestly, I am not sure I wanted to know.

Consider what I knew of Medical Superintendents before I became one. Back in the 1970s, when I was a registrar in Medicine at GMC Nagpur, I had only the vaguest sense of who ran that hospital. We walked past his office almost every day — it sat beside the Indian Coffee House, where we gathered before ward rounds or after — and I cannot recall a single occasion when I had reason to go in. The Medical Superintendent was a creature who existed, presumably, behind a closed door. We did not need him. He did not need us. The arrangement suited everyone.

Sevagram was different. Dr. Karunakar Trivedi had, through force of personality and institutional will, made the Medical Superintendent’s office as consequential as the Dean’s. That tradition held. In Sevagram, the post carried real weight — a fact that surprised me further when I later discovered the position had no formal standing in the university’s own statutes. It was, in effect, an office that derived its authority entirely from the person who occupied it. Some found that liberating. I found it unsettling.

Administration, to me, was a foreign country: files, permissions, budgets, politics, and meetings that began late and ended later. It was not that I looked down on it. I simply knew I did not belong there — the way a man who has spent forty years reading fiction knows, without embarrassment, that he cannot write a balance sheet.

I accepted the chair. I never quite got comfortable in it.

***

Twenty-Four Hours

The letter gave me little time. In Sevagram, decisions like this are rarely made slowly. The hospital runs on urgency; even leadership changes must not interrupt the rhythm of admissions, deliveries, emergencies, and ICU alarms.

In that narrow window, I did what many people do when they are unsure: I called someone who would tell me the truth without softening it. I rang Dr. Rajnish Joshi, a close colleague whose intelligence I trusted and whose humour I had learned to respect.

He listened quietly. Then he said, “My condolences.”

I laughed, because it was funny. I also laughed because it was accurate.

Rajnish assumed — perhaps correctly — that a man shaped by academic medicine would not survive the friction of administration. I assumed the same. In my mind, I would do my duty for a few months, endure the chaos, make some improvements if I could, and retreat gratefully to my ward rounds and postgraduate teaching.

I could not have been more wrong. I remained in that chair for twelve years.

***

The Nature of the Beast

I learned early that the Medical Superintendent’s job in a teaching hospital is a paradox dressed as a title.

You are expected to lead, yet you are constantly negotiating. You must speak for the faculty, the residents, the nurses, the technicians, the clerks, the patients — and remain answerable to the Society, the Board, the auditors, and the budget. In one hour you might be discussing ventilators and ICU mortality. In the next you might be arguing about a broken autoclave, missing linen, or a water tank that refuses to fill. A superintendent must be a visionary one moment and a plumber the next.

Unlike the President of the United States, who is granted the luxury of a first hundred days, a Medical Superintendent gets no honeymoon period. The judgment begins on day one, often before you have learned where the keys are kept. The emergency does not wait. The OPD does not shrink. The wards do not become quieter out of sympathy.

Success in administration is a peculiar thing. In clinical medicine, you can measure improvement — blood pressure, oxygen saturation, fever chart, appetite, sleep. In administration, you measure success by the absence of catastrophe. The day goes well if nothing collapses. It is like financial planning: wealth is built not by spectacular gains but by avoiding ruinous losses. In a hospital, you are constantly trying to prevent the one mistake that can undo years of goodwill.

***

A Manifesto in an Email

Once I accepted the role, reluctance could not be my personality. If I was going to sit in that chair, I needed to set a tone — at least for myself. I did not want to become a caretaker who signed files and attended meetings. I wanted the post to remain anchored to what mattered most: patients.

On September 4, 2009, I wrote to Mr. Dhirubhai Mehta, President of the Kasturba Health Society. It was not a formal acceptance letter. It was closer to a manifesto.

***

From: Dr. S.P. Kalantri
To: Mr. Dhirubhai Mehta
Subject: On taking charge
Date: September 4, 2009

Dear Dhirubhai,

May I thank you for the wonderful letter you wrote asking me to look after our hospital.

Managing a hospital is a challenging task. It gives one a unique opportunity to introduce changes that could positively influence the way health professionals function. Incidentally, the word “hospital” comes from an old French root which originally meant shelter for the needy. Curiously, the words hospital, hostel, hotel, and hospice owe their origin to the same root — each indicating a place that offers succour.

And yet, if public perception is anything to go by, given a choice, nobody likes to stay — let alone visit — a hospital. Hospitals evoke pain, stress, fear, uncertainty, and insecurity. A good hospital is one which responds not only to the explicit concerns of patients, but also to the unvoiced ones, and tries to make their visit a little more pleasant.

Today’s New York Times reports that Johns Hopkins Hospital was ranked as the best hospital in the US because it received the highest scores for quality and efficiency. Of the 100 hospitals judged, compared with the poorest performers, the best-performing quintile had 25% lower death rates, 19% fewer medical complications, and 13% fewer patient safety incidents — even though their patients were sicker and their average hospital stays were significantly shorter.

Not an easy task to achieve these standards in our setting. But that should not deter us from trying. I am on a learning curve right now and hope to learn quickly the tips and tricks that good managers use to make hospitals more professional and patient-friendly.

With regards,
SP

***

When I read that email now, years later, I can see my nervousness hiding behind formality. I can also see something else: a stubborn hope. I was telling Dhirubhai — and perhaps telling myself — that even in a rural hospital with limited resources, we could still aim for quality, dignity, and trust.

What Keeps You Sane

I did not know then how many times that hope would be tested.

What I did know — and what I have never forgotten — is a passage from Vinod Mehta’s memoir, Editor Unplugged. He wrote that as long as you do not let success go to your head, as long as vanity is kept in check, as long as you treat fame as an impostor and remember that those who applaud your fluency will not recall a word of it five minutes after the television programme ends — you will retain your sanity.

I kept that close.

And I was helped, more than I can say, by Bhavana. Whenever she sensed that I was growing proud of the post — the chair, the title, the small privileges that come with it — she would quietly, firmly, cut me to size. No speeches. No arguments. Just a look, or a word, that brought me back to the ground. It is an occupational hazard of anyone who occupies a position of institutional authority: the gradual, almost invisible inflation of the self. Bhavana was my corrective. She still is.

The chair was mine. The hospital was waiting. And I had, by some fortunate accident of marriage, exactly the right person to keep me honest.