There is a particular moment in every anaesthetist’s career when you stop relying on instinct and start relying on memory. You remember the rare biochemistry result, the obscure syndromic presentation, or the third-line drug you last read about in the British Journal of Anaesthesia five years ago.In the United Kingdom, those moments are infrequent. At SKIMS (Sheri Kashmir Institute of Medical Sciences), serving the entirety of Jammu & Kashmir’s two Union territories—a vast, rugged population of nearly 12 million people—those moments happen before breakfast and dinner.

I came from a well-oiled NHS trained in top tertiary centres like University College London and Cambridge Centre and working as a consultant for 20 years in district General and private practice. I left my comfort zone somewhere over the Himalayas. What I found at SKIMS was not just a job; it was a two-month immersion into the very marrow of clinical medicine. And it has been, to put it mildly, incredible. I have found the current director of SKIMS as inspiring leader surrounded by inspiring teams of heads of departments, to mention least Dr Akbar Shah, Dr Arif Hamid, Dr Iqbal, Dr Sons Ullah Shah and all other faculty acknowledging their strengths and weaknesses and have a plan to improve the quality of care for patients and staff well-being The Clinical Kaleidoscope

In the UK, we pride ourselves on protocol. In SKIMS, they pride themselves on survival. Because this hospital is the apex referral centre for 12 million souls—from the mountainous reaches of  Ladakh to the dense urban warrens of Jammu—the pathology is unlike anything in the West. You do not see the common cold here. You see the end-stage, the neglected, and the miraculous. You see a young adult with a stroke flown from Ladakh or a child with massive intracranial bleeding requiring urgent craniotomy.

Walking through the ICU or the pre-operative wards is like walking through a living, breathing textbook. One bed presents a case of rheumatic heart disease with multi-valvular pathology and infective........

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