an itinerant observer

For over two decades, I’ve navigated the labyrinthine halls of some of the world’s most prestigious academic medical centers. Fifteen years in one of the largest healthcare systems in America, spanning renowned medical institutions, followed by over a decade at a leading academic healthcare center in South Asia. These years were filled with purpose, bureaucracy, triumph, and disillusionment in equal measure. But somewhere along this journey, a quiet restlessness began to grow. A persistent question hovered at the edges of my thoughts: Is this still my north star? I found myself staring down the existential dilemma so many seasoned academics face: whether to stay within the familiar walls of institutional academia or step outside into the untethered expanse of something different. In a way, this essay feels like a continuation of thoughts I began exploring several years ago in "Sir? No Thank You!" , a reflection on institutional inertia, misplaced loyalties, and the uneas...

It wasn’t an ordinary day at work. I’d been called into the proverbial ‘supervisor’s office’ for a discussion about my recent projects. Fair enough, I thought. I’ve led programs in emergency medicine, innovation, wellness, and research. But no. This wasn’t about any of that. Seated across from me were two senior colleagues, firmly rooted in the traditions of academic medicine; faces tight, as if I'd ‘Zalsa’ed’ over a patient chart. Yes, you read that right. Not a research misstep, not an issue with departmental operations - dancing. Specifically, the Zalsa sessions I lead, share about, and - horror of horrors - post on social media. “It’s unbecoming of someone of your stature,” one said, with a look so grave you’d think I had performed a Zalsa routine on the hospital helipad. The other nodded sagely, as if this intervention might save me from further professional disgrace. For a moment, I wondered if I was in a workplace sitcom. Was this an episode of The Office: Acade...

~ Act II ~   A Letter to the Father Who Returned   Dear Father, You came back to the ER yesterday. Alone. Your eyes searched for the place where your children had been, as though the walls might still hold their shadows. You wandered, lost, and when the tears came, they came quietly at first; grief without sound, until they could no longer be contained. I stood there, silent, because what can you say in the face of such loss? Your grief took me back to 2019, when another father arrived; with his five children, also victims of phosphine poisoning. They had come to Karachi from Quetta on a short vacation, staying in a modest guesthouse. No one knew that a cheap fumigant, silently seeping through the rooms, had already marked them. They were Dead On Arrival (DOA in our lingo). Five small bodies laid side by side, from the youngest, a baby, to the oldest, a teenager. I remember the starched white sheets, how they barely moved as we covered those bodies. I remember dr...

Prologue I thought I’d prepared myself. My last shift in the ER, after 13 years, landed on Friday the 13th - the most infamous day on the calendar. It felt like a joke the universe was playing, so I leaned into it. I imagined the absurdities, the chaos, the dark humor that define life in a pediatric ER. I even wrote about it preemptively, anticipating the madness. But the universe had more to offer. What I thought would be a final hurrah of irrationality turned into something far heavier. A father, a family, a tragedy that echoed through time. This is my farewell to the ER in two acts. Act I – The chaos I expected. Act II – The weight I couldn’t see coming.   ~ Act I ~ 13 Years, Friday the 13th, and the Madness of the ER Coincidence or predestiny? After nearly 13 years of adrenaline-fueled chaos, sleepless nights, and a steady diet of chai and calamity, my last ER call lands squarely on the unluckiest day of the calendar. I could’ve chosen to laugh, but ...