“Did we require a more contemporary approach towards training that took on board the importance of self-critique and reflection?”

I got to know that my musings will be published on a blog, just after I joined my current position. However, there was also the question of the prolonged waiting time, which was spent understanding this position, the challenges associated with it and waiting for the manmade problem related to my medical council registration to be resolved. More about that later. At present, it might be important to talk about a paragraph that is missing from my blog, one about my experiences navigating the system in a foreign country and its version of specialist Palliative care.

I was the first physician to be anointed a specialist in a kingdom in the Middle East. However, my enthusiasm was tempered by the termination of my services against contractual stipulations. Suffice it to say that this was done without informing me that there had been an issue with the quality of my work. I was called for brief discussions with the Consultant in Anaesthesia who was leading the services, without the presence of any administrative staff, but there was never a straightforward conversation by way of discussing things. The fact that he had invited me to work there was difficult to deny; however, the experience involved him addressing my observations and explaining egregious decisions (like the fact that tramadol was not available because of strained relations with the country from which opioids were to be imported), me never being able to fully comprehend what he had been saying, and an internal construct calibrating what the conversation meant vis-à-vis my position. These interactions involved talking about the feedback that I had given pertaining to the deficits within the system (or their interpretation or lack thereof of palliative medicine principles – the distress due to collusion was to be translated into unresolved pain by the much-needed intervention of the consultant and transcribed into intravenous fentanyl infusion by the power of subjective interpretation) and the nature of my agreement (and the consultant’s disagreement) with the idea of palliative medicine registrars evaluating Medical Oncology patients in the Emergency department. Each one-sided, and perfectly didactic. Perhaps the conditioning that I had been subjected to, from my previous experiences that I wasn’t welcome in the hospital and its affiliates where I had trained (the rejection of my candidature at various interviews had taught me a resounding lesson on standing up for a lack of beds and pointing deficits in postgraduate training) because of my interests in interpreting the practice of palliation as being more nuanced and less farcical than the majority view, had some role to play.

However, the internal voice that was not yet fully formed was already warning me about what was to come. How did it take form? Perhaps emboldened by the mutterings of colleagues from Pakistan, Egypt and India and Nurses from the UK, it was warning me against termination (We Palliate had morphed into terminate me). Were they created by the echoes of their opinions? I had been dismissive of these concerns by creating a construct that rationalised my decision-making. So the particular decision (to terminate), which was preceded by a training session involving senior Consultants in that setting, was most prophetic. These consultants had found within themselves the impetus to train me, but their assessment consisted of incipient observations like “But you do not listen to your consultant”, implying that I was asking too many questions about the orders that were being given to me and that they were concerning.

Why was I asking questions of them?

Was it because a concoction of strong opioids was being prescribed in combination?

Was it because laxatives were not being prescribed adequately?

Was it because anti-emetics were suboptimal?

Was it because those on a combination of these strong opioids and CNS depressant medications seemed to suffer from hypoactive delirium and no investigation was being sought?

Or was it because I doubted the credentials of someone with a background in Anaesthesiology as being anointed the head of the Pain and Palliative care service.

To me, it seemed as if my training had involved allegiance to an imaginary consultant whose manifestation I should have to be enamoured with; however, I could not find it within myself to do so.

The day of the termination is etched in my memory forever, coming back from work and finding an email on the first official email ID, which was in my name, announcing my termination. In the room that was to represent my online presence, the arrival of this email was heralded by the thoughts of the medicine faculty from a public sector hospital that I had trained in. Sucking me into a vortex, from where there was to be no perceptible return.

This was followed by my outpouring of the injustice that had been done to me, which was duly acknowledged by the same consultant (from pain) as a single curt statement – thus: “but we are here to work for them” (with arched eyebrows and the usual paraphernalia associated with administrative acting). It was said clearly and in no uncertain terms that the administration of a reputed hospital in the Middle East considered individuals from the south – east asian region as “labourers”. This raised many red flags, and I could not bring myself to return to that department.

In fact, after the termination, I was suddenly made aware that interventional pain procedures were being done and that I was expected to prepare patients scheduled to undergo them. This was one last nail in the coffin of my self-respect as a specialist, and the fact that the consultant had waited six months before informing me that preparing patients for a procedure was part of my responsibilities as a Registrar was also new knowledge (somewhat).

I did visit the Ministry of Labour, where a learned senior lawyer asked me to lodge a case against the hospital, but I refused to do so. I believed that there had been a negation of a certain trust that had been placed in their offices, and an administration that had proceeded to jeopardise my career did not deserve legitimacy. Looking back at those events acts as a reminder of a certain kind of exaggerated hierarchy that is expected to accompany such positions. These settings might be decked with the best infrastructure and a show of enforced linearity, but their decision to violate employees who raise concerns about patient safety provides a certain insight into their way of life.

The following months and years were spent trying to understand what had transpired and digging up news items about their culture and history. That Human rights violations in the Middle East were commoner than one might expect became clear. Having not received my outstanding monetary dues and employment certificate (that my work deserved), I came across numerous instances of citizens being jailed and persecuted at the whims and fancies of an undemocratic construct, which resonated with my situation. Particular memory is reserved for the poor conditions that manual labourers who had been hired from third-world countries for the construction of a stadium in the vicinity were made to work round the clock. Their inhuman situation resonated with what the Consultant had said – that the administration treats all individuals from the so-called third world countries like their hired drivers or labourers.

I came across motley groups of resistance against the authoritarian regime which had cropped up online and volunteered this information about the unlawful termination of services at most of the events that I attended (and continue to intend to do so).

The realisation about the extent of violation was suppressed till I started attending interviews for positions in the public sector in my own country, at which time these issues (about a dictatorial, unyielding construct were brought to the fore once again. I have devoted a post on mindful critique (MC11) which is to be discussed at Wordcamp, Bangalore in the coming future. That this attitude towards an independent way of functioning exists across countries and systems and does not necessarily relate to the question of religion or nationality speaks volumes about the times that we all live in. About how human interactions in the formative stages of one’s employment continue to be judged by the familiarity of interactions and language.

This brings me to another important question: how do ideology and geopolitical alignment affect your choice of place to work and practice? When is it that your opinion about a political ideology, say religious intolerance or fascist thinking or an undemocratic manner of decision-making, becomes more important than your career?

How much of a role has the US government’s support of the Russian Putinesque invasion of the sovereign municipality (oops, nation) of Ukraine or the deplorable condition of non-resident Indians during the COVID-19 pandemic played in my decision not to pursue USMLE or travel to their country at this time?

Is the UK government’s support of the Saudis in their war against the guerrilla armies of the Houthi militia going to influence my decision to work with them in the future? How does the realisation that the Royal College has close association with Middle Eastern Islamic monarchies, and that many of its initiatives might be funded by the same money that I have refused, augur for my future?

Only time will tell.

Epilogue – No, the first line was not what was missing from the blog.

The missing paragraph, which was edited out (due perhaps to the rigorous requirements and the concrete nature of the editorial process), implied that time spent working in the Middle East had taught me valuable life lessons and made the resolve to fight what was wrong and perhaps unlawful stronger.

And, it had to be said.

P.S. I know that I haven’t mentioned my experiences in Brunei, but that’s material ripe for another editorial.

References

Arora, R. D. (2026, October 20). Palliative medicine: The speciality that chose me. EAPC Blog. https://eapcnet.wordpress.com/2026/10/20/palliative-medicine-the-specialty-that-chose-me/

Disclaimer

Artificial intelligence tools have been employed for language refinement and understand legal repercussions of putting out the truth. They do not replace critical scholarship, clinical experience, or editorial judgment. Final responsibility for all interpretations, factual accuracy, originality of synthesis, and the quality of the published material rests entirely with the Founder and Editor.