When numbers betray and the wheel sinks

There are days in medicine when you feel like Arjuna—sharp, accurate, and victorious. And then, there are days you feel like Karna—valiant, overprepared, tragically noble... and betrayed by your tools at exactly the wrong time.

Let me explain. But first, a quick recap of mythology for the gastroenterologically inclined.

Karna, the glorious underdog of the *Mahabharata*, was the kind of guy who got cursed just for trying too hard. He lied once (just once!) to learn archery, and bam—curse. Disguising himself as a Brahmin just to get into warrior school with Parashurama—who had a strict no-Kshatriyas allowed policy—Karna poured his heart into mastering archery. And he was good. Too good. But karma (or Karna's luck) had other plans. One day, while his guru napped on his lap, an ant bit Karna. Hard. Bleeding and silent, he didn’t flinch—because, respect. But Parashurama woke up, saw no Brahmin would endure that much pain quietly, and connected the dots. Furious at being tricked, he cursed Karna: “Someday, just when you're in a life-or-death situation, everything you’ve learned will go poof.” On the battlefield, when all eyes were on him, his chariot wheel sank, his memory blanked, and his arch-nemesis Arjuna landed the final blow. If there was ever a poster child for “Wrong time, wrong place, wrong curse,” it was Karna.

Now, cut to modern medicine. Our chariot is a wheeled ultrasound machine. Our Brahmastra? The *SAAG*—Serum-Ascites Albumin Gradient.

If you aren’t a medic, don’t worry. SAAG is a clever little test we use to figure out why someone has fluid collecting in their belly—a condition called ascites. We take a bit of the fluid from the belly and compare its albumin (a type of protein) to that in the blood. If the difference—this “gradient”—is *more than 1.1*, it usually points to liver-related causes like cirrhosis. If it's *less than 1.1*, we start thinking about infections like TB, cancers, or other sneaky causes.

It's like asking, “Why is your room wet?” and checking whether the water came from the ceiling (a leaky pipe) or the floor (someone spilled a drink). SAAG helps us decide whether the problem is inside-out (like liver pressure) or outside-in (like inflammation or cancer).

In theory, elegant. In practice, well… let's just say SAAG has its own *vastra-haran* moments.

Just when you think you’ve nailed the diagnosis—cirrhotic, ascites, high SAAG, done deal—the patient turns out to have peritoneal carcinomatosis. Another one walks in with nephrotic syndrome and a SAAG that does the cha-cha. You suspect TB, but SAAG throws you a number—**1.1**.

Not 1.0. Not 1.2.

**Exactly 1.1.**

Like Karna’s curse, it waits for your moment of maximum confidence—then strikes.

You stare at the lab report like Karna staring at his chariot wheel. “Wait, you too?” you whisper, betrayed.

SAAG, in all its mathematical smugness, gives you a value so borderline it could be a philosophy major.

But here’s the thing. SAAG, like Karna’s mantras, is great. Until it isn’t. It works wonderfully—until the story gets complicated and then it doesn't. It chokes quietly, leaving you to explain why the patient's abdomen looks like TB but behaves like Budd-Chiari. The wheels quietly sink into the ground. 

And that’s where the philosophy of failure begins to echo.

Karna didn’t forget his mantra because he lacked intelligence. He forgot it because *life sometimes chooses irony over logic**. You didn’t misdiagnose because you skipped a page in the textbook. You misdiagnosed because reality is often more layered than any algorithm. The number 1.1 is not a failure of math—it is a mirror. A reminder that the world is not always binary, not every problem lends itself to a neat answer, and some truths live in that narrow space between what we expect and what, actually unfolds.

Failure in medicine, like in life, is rarely total. It is not a collapse, but a misstep—a lapse in certainty, a reminder of humility. It tests whether we can continue walking, knowing that we’ve been tripped by something we couldn’t see. Like Karna, we often find ourselves armed with knowledge, prepared by training, backed by experience—and yet, still left vulnerable by timing, luck, or fate.

But failure is rarely about the test (or the event) alone. It is about **the scenario in which the test is interpreted**. A value of 1.1 has no power in isolation—it derives meaning from context. A TB patient in Ladakh and a cirrhotic in Chennai may share the same SAAG, but not the same story. Tests (like events) appear to be a verdict but are not so. They are shadows influenced by light, perspective, and the surface they fall upon. These (light, perspective, and surface) are together called the clinical scenario in medicine and life in general. The test alone can't have any value.

This is why medicine is an art dressed as science. We fail when we hold on to the tests. We cling to numbers for certainty, but numbers don’t feel. They don’t hear the cough, see the weight loss, or sense the futility in the caregiver’s eyes. And so, we fail—not because we’re not good enough, but because the number seduced us into thinking it was the whole story.

Medicine, like war, is full of uncertainty. And the physician, like Karna, must navigate a world where knowledge is powerful—but not always enough. Sometimes, the wheel sinks despite all your effort. Sometimes, the number mocks you from the lab sheet. And in those moments, it is not your brilliance that defines you—but your balance, your poise, your willingness to stay on the field with or without the wheel.

So next time SAAG misleads you with its signature betrayal—"1.1 g/dL"—take a deep breath. Smile. Order a CT if you must. But also remember: failure is not always a diagnostic error; sometimes, it is life’s way of teaching humility.

And perhaps that’s the final curse of Karna—to be right too late. May we learn to forgive ourselves in time. To accept that even the sharpest among us sometimes hold the right weapon but face the wrong moment.

And if Karna had been a gastroenterologist, he’d still be cursed—but his case presentations would be stirring, his stent placements flawless, and his journal club discussions legendary. He would cite guidelines, quote epics, and still—at some cruel cosmic moment—find his SAAG reading exactly 1.1. And with a resigned smile, he’d sigh, “Ah, not again,” jot down *‘clinical correlation advised’* (out of habit, not faith), and wheel his chariot toward the next diagnostic dilemma—forever valiant, forever just a little too late.

Perhaps Karna understood this better than most. Perhaps every 1.1 we encounter is not just a diagnostic dilemma, but a whisper from the past:

*Fight on, even when the wheel sinks.*

Permission to Grow, Sir?

    You could grow a beard on civvy street. No one would care. In the army, a clean-shaven face isn’t just expected—it’s enforced. The day begins not with the sun, but with the sound of running water and the scrape of a razor. It doesn’t matter if you’ve had three hours of sleep, stood night duty in freezing rain, or are recovering from viral fever—if you can lift a hand, you shave. It’s not vanity. It’s muscle memory. A ritual that prepares you for the uniform, the salute, the responsibility. The moment the razor touches your skin, the civilian is gone. The soldier stands ready.

    And then there are our brothers from the Navy. God bless them. They can keep beards. Real ones. Groomed, shaped, elegant. I once told a naval officer, “You’ve cheated the system, sir. Beard and uniform—too much style in one man.” He smiled, tugged at his magnificent salt-and-pepper beard, and said, “Sea air demands insulation, my friend. And dignity.” I looked at him with real affection. And deep, helpless envy.

But the moment I go on leave, I stop.

    Not dramatically—just gently. I take off the stars, slide my boots under the bed, and drop the razor into a drawer like a prisoner slipping out of handcuffs. A day passes. Then two. A faint stubble emerges, hesitant at first, like it’s unsure of its welcome. I look in the mirror and nod. There you are. 

    My wife notices around day three. “You’re growing a beard again?” she asks, like she’s watching a rerun. “I’m letting it grow,” I reply. “Small difference. Big meaning. She shrugs. She’s seen this many times. She knows it’s not about the beard.

    The next day, my daughter reaches out and runs a finger across my chin. “Papa, your face is scratchy.” I grin. “I know. It’s freedom.” She looks at me, puzzled. Freedom, to her, is no homework on Sunday. One day, she’ll understand that there’s something deeply symbolic about freedom (of not shaving). It’s not laziness—it’s liberty. The kind that doesn’t need a speech or a salute. It’s a small, silent protest against routine. A man reclaiming his face, one prickly inch at a time. And this joy of not shaving becomes so precious that even on a Sunday, if it’s a day off, and if we know we won’t run into the Commandant—we sometimes risk it. We sit in the house, sipping tea, sporting our one-day stubble like a medal. In case we meet someone from the unit, the leave (मैं छुट्टी पर हूं.....) is automatically implied. No one asks us, but everyone notices.

    Still, when leave ends, or Monday arrives, I shave. No grand farewell. Just the razor meeting skin, sweeping away the freedom. The soldier returns. But inside, a part of me still carries that Sunday feeling. The warm defiance. The soft rebellion :)

    And I promise myself, as I rinse the blade and dry my face, that when the next Sunday comes—if the stars align and no duties call—I will let it grow again. Just for a day. Just for me. Because it’s not about the stubble. It’s about a choice. In the army, our days are ruled by structure: wake-up calls, drills, uniforms, salutes, orders. We don’t choose what to wear, when to eat, or even how to walk. And that’s okay—it’s the price we pay for being part of something larger than ourselves, something which makes us better than the rest. Discipline is the spine of the Army. It builds trust, cohesion, and efficiency. It shapes men into teams and transforms intent into action. Without rules, there is chaos—and we soldiers know that better than anyone. And in that rigid world, choice becomes sacred. A choice made not by command but by instinct. Something small. Something silly, perhaps. Like not shaving.

    So when you wake up on leave, or on a quiet Sunday, and your hand reaches for the razor—and then stops—that’s not laziness. That’s liberty. That’s your mind whispering, “Today, I decide.” The beard, the stubble—it’s not beautiful in itself. But it carries the sweetness of stolen freedom. Of breaking a small, invisible fence. It’s a rebellion that harms no one but heals something deep inside you. Like kids hiding chocolates under pillows, we guard that single day of unshaven bliss—not because we need it, but because it’s ours.

    That one-day stubble doesn’t disrespect the Army—it reaffirms our humanity within. It reminds us that beneath the uniform, there’s still a thinking, feeling man. A man who serves with conviction, but also breathes with longing, rests with gratitude, and occasionally looks in the mirror and says, “Today, just for a while, I’ll be me.” These moments don’t weaken discipline—they strengthen resilience. They renew the soldier's mind. They soften the hard edges of service, allowing us to return to our duties not resentfully, but willingly.

    So even if it lasts only a Sunday, even if it vanishes by Monday morning’s inspection, that fleeting taste of freedom matters. Not because it challenges the system—but because it restores the self. And then, razor in hand, we return to the rhythm of the Army. A little lighter. A little more whole. In a world of orders, disobedience (even tiny, harmless ones) reminds you that you’re still human. Still capable of choice. Still your own.

And that, perhaps, is why it feels so nice.