The art of learning mental gymnastics: navigating a healthcare system on the other side of the world

May, 2024 was a real life lesson on the Pareto Principle. For those of you who don’t know Pareto Principle states that 80% of outcomes come from 20% of the work. In other words, majority of life’s significant learnings come from a minor percentage of the experiences. This is true in professional teams: a significant chunk of the results come from a small portion of the effort in the right direction or working on something that stuck. It’s true for the number of technological innovations with transformative impact. It’s also true for revenue generation for a lot of businesses: 80% of revenue is generated from just 20% of the users. This intro is a long way of emphasizing the extent of impact that a single month in the Himalayas had on building mental strength and toughness, easily surpassing the seemingly infinite hours of training I put into running and biking long distances over the last few years.

Mental toughness in terms of endurance events is different from mental resilience when dealing with emotionally challenging situations. My month in Shimla in May 2024 entailed a mix of both: physical resilience in pushing my body to step up to the challenges ahead, and strengthening the mind to prevent it from crumbling under stress and pressure.

It was 6AM when I got the call that upended my life: my parents had just been in a head-on car collision while enroute to a relative’s house in the Himalayas. My dad was mostly okay with minor chest injuries, but my mom had sustained multiple fractures in her hips and legs along with contused ribs. After a frantic couple of hours of applying for family leave at work, booking emergency flights, and figuring out transportation from the capital, Delhi, to a town in the Himalayas, I was seated in the lounge at SFO sending the last couple of messages to coworkers about my uncertainty of coming back, unable to imagine what life would look like for the next couple of days.

I picked up my 20 lbs backpack from the car a little bit after midnight, as my cousin dropped me off at the emergency entrance at IGMC (Indira Gandhi Medical Center). “She’s in room 621,” he instructed as he was about to head off to look for parking on the skinny road that stretched alongside the mountain. “He expects me to navigate this eerie looking fortress in the middle of the night by myself? How do I find my dad? Why aren’t they in the same place?” A flurry of questions spiraled through my head. “OK, see you soon,” I responded, genuinely uncertain when and where I would see him again. In that environment, I couldn’t accurately predict the next 5 minutes. My mental models of navigating were stripped down to NULL as I was transported to a completely different part of the world. That too in a hospital, the one place in the world I was deathly afraid of.

As I entered, I was greeted with the sight of a 24/7 tiny chai stall that seemed to be the only part of the hospital bustling with people enjoying piping hot tea in the cold crisp mountain air. The hospital had no heating system. People were wearing classic himachali caps and trussed with sweaters and shawls. “Get to the 6th floor,” I reminded myself. Climbing the stairs I saw something that would define the underpinning of the rest of my time there.

An endless row of people lined the hallways, where they had setup camp for the night with blankets and mats. I was shaken to my core. As I climbed up floor after floor I observed the same pattern. There must have been hundreds of people (and kids) sleeping on the floors of the main IGMC building. What did I say about not being able to predict the next 5 minutes?! And this was just one building out of many that spanned the hospital campus.

Once I made it to the top, I passed by an armed soldier to enter the “special ward.” The special ward had private dual capacity rooms available to patients who could afford to pay more. I later learned that the ward had armed soldiers during that time because Prime Minister Modi had plans of visiting Shimla in the coming days, and they had preemptively put security in place to prepare for unforeseen circumstances.

IGMC is an established government hospital offering services to the general population in the state of Himachal Pradesh. Though the doctors are some of the best in the whole state, the care fell below subpar. There were two parts to the room, with 4 beds total: two for the patient and two for the caretakers to spend the night. It was luxury compared to what the rest of the patients’ caretakers had to go through.

I carefully entered room 621 and saw my immobile mother laying on the bed with both of her legs covered in plasters. Two of my mom’s sisters were in the room, cleaning up after her in advance of her surgery the following morning. I unpacked sanitizers, wet wipes, gloves, masks and isopropyl alcohol that I packed in anticipation of situations like this one. My mom was in so much distress that although she was relieved to see me, she showed no emotion. All our minds were on the big surgery day that followed. After cleaning up and preparing my mother for bed, lights were promptly shut and I was sternly instructed to sleep (and not go anywhere else because India is generally considered unsafe for women). The three of us (my two aunts and I) squeezed onto the college dorm sized bed, praying rest come greet my mother for a good 7 hours of sleep before her surgery.

Everyone but me was knocked out from sheer exhaustion. My blood still had adrenaline pumping through and I had a clear goal in mind. I tried not to wake anyone up and carefully released myself from the blanket and tiptoed around the chair my cousin was sleeping on. The task was clear: find dad. I couldn’t imagine a person with the strongest OCD in terms of cleanliness being in a hospital with a dearth of necessary cleaning supplies. Grabbing my backpack once again, I slipped back into the halls of IGMC around 1:30AM. I went back to the chai stall, hoping to ask someone for directions to the emergency ward, where my father was. It took a quick 10 minutes to find him as I walked past each bed in the ward, scanning for him. The space was not large. Yet each bed had multiple people sleeping on it. I’d heard of crowded hospitals from my lived experience in Delhi, yet never directly experienced anything quite like it before.

My dad was fast asleep with my uncle sleeping right next to him in the opposite direction. I stood still for a couple seconds, taking all the sacrifice and care that radiated from the scene, took a picture and gently nudged my dad. I had so many questions to ask him, “what’s the name of your condition? How long will it take to get better? Why are you in the emergency ward and not in a separate room? how are you able to tolerate the conditions of the ward?” Instead, I just hugged him, asked how he was doing, offered the supplies I’d brought, and asked if he needed anything from the chai stall or the pharmacy. I ran a few errands for him and took my time getting acquainted with the hospital hallways and routes a bit more. My pace had changed from frantic to measured. I wanted to take it all in before everything changed the following day.