The Scan That Reveals a History
In our day-to-day practice, we frequently see MRI scans of the brain in patients with hypertension or diabetes. Many of them come to us after an acute event—a stroke, sudden weakness, or a neurological deficit that finally brings them into the system.
But when you look at the MRI carefully, the story is rarely acute.
Scattered across the brain are white matter hyperintensities—small, quiet changes that don't happen overnight. They have been developing over years. Sometimes decades. The brain has been adapting, compensating, adjusting… until it no longer can.
The stroke feels sudden to the patient.
But to the scan, it is anything but sudden.
The body whispers for years, and then one day, it is forced to speak loudly.
In a way, the MRI is not just showing the event. It is revealing a history—one that was always there, just not listened to.
Over the years, I've realised that this pattern is not limited to medicine. We see the same thing play out in the professional lives of high achievers.
Some Lessons Don't Come from Scans
A few years ago, I was working on an AI project in medical imaging with a professor from an engineering college. We met regularly over four to five years, discussing ideas, possibilities, and the future of technology in healthcare. We had even travelled together to the RSNA meeting in Chicago, and had spoken about doing many more such trips.
In the last few meetings, I noticed something had changed. He looked tired. Not the usual kind of tiredness that comes from work, but a deeper fatigue. A certain dullness that didn't quite fit the person I had known.
When I asked, he brushed it aside—as most high-performing professionals do. Busy schedule. Travel. Nothing serious.
It took some persuasion to get him to agree to a few tests.
What we found was not subtle.
There was a large tumour in the liver, already spread across the body. From the time of diagnosis, he had barely four months.
What stays with me is not just the diagnosis, but the time before it—the months, perhaps longer, when the body must have been signaling. Quietly. Persistently.
We noticed something was off.
He felt it too, I'm sure.
But like many of us, he had reasons to explain it away.
We often think of serious illness as something that arrives suddenly.
But more often, it is something that was present—just not acknowledged.
Awareness Is Not Enough
There are also times when the signals are not subtle. They are known. Documented. Even treated. And yet, they are quietly set aside.
I remember a Diwali day many years ago. I was about to leave for my hometown after finishing the morning work and pooja at the diagnostic centre, when I got a call from my chartered accountant.
"Doctor, are you at the centre? I'm feeling a bit uneasy."
There was something in his voice that made me pause. I decided to wait.
It was just the two of us, along with one staff member, when he arrived. He complained of breathlessness. We did a chest X-ray.
His entire lung was white.
A large pleural effusion.
Further evaluation revealed that this was related to a malignancy he had been treated for in the past—something he had, over time, stopped following up.
What struck me was not just the diagnosis, but the contrast.
Here was a brilliant professional—sharp, widely respected, constantly engaged. He wrote, taught, advised. He was someone who introduced me to the world of business—taught me how to read balance sheets, explained concepts with clarity and patience.
And yet, somewhere along the way, he had chosen to set aside his own health.
Not out of ignorance.
But perhaps out of prioritisation.
We often assume that awareness is enough.
But awareness without action can be just another form of neglect.
The Assumption That Everything Can Be Deferred
Not all missed signals come from neglect. Sometimes, they come from a quiet reordering of priorities.
I increasingly see this in young, high-achieving couples—intelligent, driven, deeply invested in building their careers. They plan well, work hard, and assume that with enough resources, most things in life can be managed when the time is right.
Including health. Including family.
And for a while, this seems to work.
Until it doesn't.
What follows are multiple consultations, repeated visits, and a growing realisation that biology does not always align with timelines we set for ourselves.
This is not about right or wrong choices.
It is about something more subtle.
The assumption that everything can be deferred… and then optimised later.
In medicine, we learn early that some processes are time-bound. They don't respond indefinitely to intervention—no matter how advanced the treatment.
Professional life, however, often teaches us the opposite—that with enough effort, intelligence, or money, most problems can eventually be solved.
The body does not always agree.
Reading Your Own Signals
I have gone through phases where I was handling multiple roles at the same time—clinical practice, teaching, building a diagnostics business, and working on research. Long working hours were never the problem. I could work 15–16 hours a day, and in many ways, I still do.
Physical fatigue was not the signal for me.
What I began to notice instead were smaller shifts—irritability, a certain lack of focus, moments where the mind felt more scattered than it should. Nothing dramatic. Nothing that would qualify as a "problem." But enough to tell me that something was not in balance.
Fortunately, I did not ignore those signals.
Over time, I made small corrections. I turned more consciously towards practices like meditation, which helped bring a certain steadiness back. Physical exercise has been a constant for me for over a decade—it is something I consider non-negotiable.
But if there is one thing I have come to understand, it is this: we often take care of our physical health more seriously than our emotional well-being.
The body is easier to discipline.
The mind is easier to ignore.
On Carrying Weight
The phase of building something from scratch brings a different kind of stress. Not physical—but cognitive.
In the early years, the uncertainty of business does take a toll. Outcomes are not always in your control, and decisions carry weight.
Over time, I learnt to look at it differently.
There is rarely a "perfect" decision. You take a decision, and then you work to make it right. And if it still doesn't work, you accept that you were wrong and move on.
I have also learnt not to carry problems forward unnecessarily. No problem is important enough to occupy mental space indefinitely. At most, I allow it a sleepless night—after that, it has to find a resolution or be set aside.
In my experience, decision fatigue does not come from taking decisions. It comes from postponing them.
And just as knowledge can be shared, so can stress. A good team—including your family—becomes your support system. Delegating responsibility is not just operational—it keeps the mind lighter.
Work can be demanding.
But it should not be carried home.
A Different Kind of Reset
There are also experiences outside of work that quietly bring you back to centre. For me, participating in the annual wari procession has been one such experience. It is a family tradition—something I initially saw as a waste of time.
But that changed once I began to participate in it myself.
Over time, I realised it is not really about religion or ritual. It is about something more internal—a kind of spiritual reset. Walking with thousands of people, stripped of roles and titles, brings a certain humility and clarity that is difficult to find in structured professional life.
Sometimes, that perspective is what allows you to return to work with more clarity—and less noise.
The Invisible Strain
For many high-achieving professionals, the idea of work-life balance is often more theoretical than real.
Work is not separate from life. In many ways, it is life.
And because of that, the physical demands of work are usually managed. The body adapts. The schedule adjusts.
What is less visible is the other side of this equation.
The emotional and the spiritual strain.
These do not show up as clearly. There is no scan that highlights them. And yet, they influence how we think, how we decide, and how we experience the outcomes we work so hard to achieve.
A Diagnostic for the Self
If there is a diagnostic protocol for this, it is not complex—but it does require honesty.
It begins with simple questions.
Where did I start from?
What was the original sense of purpose?
What, genuinely, makes me feel at ease—not just accomplished?
Because over time, it is easy to replace purpose with momentum.
To keep moving, without asking why.
What Remains
Over time, my understanding of ambition has also changed.
For me, it is not just about achieving more. It is about maintaining santulan—a sense of natural balance.
The consequences of success are as important as the process of achieving it. And sometimes, that means letting go of opportunities that do not align with that balance.
What has remained most satisfying for me is teaching.
Seeing people who once worked with you go on to build something of their own—and hearing them say they carry forward something they learnt along the way—brings a different kind of fulfilment. One that is not easily measurable.
In the long run, consistency matters more than intensity.
In that sense, professional life is not very different from medicine.
We spend years learning to read images, to detect what is not obvious, to recognise patterns before they become problems.
Perhaps the same attention is needed inward.
Because the body continues to signal—quietly, consistently.
The question is not whether the signals are there.
It is whether we are willing to look.
Authored by
Dr. Abhijit Pawar,
MBBS,DNB,DMRE(Rad), IIM-A Alumnus,
Director, Nucleus Diagnostics (P.P Diagnostics Pvt Ltd)
Director, Medimap Healthcare Pvt Ltd.
