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A weekly newsletter on high-stakes communication — drawn from 27 years in operating theatres, military medicine, and hospital leadership. One story. One pattern. One thing you'll use.
Each piece below began as a newsletter issue — and earned a permanent home here.
"I'm Scared of Being Left Behind"
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Thirty years ago I was the medical officer accompanying a high altitude patrol to the passes of Tibet.
Twenty men. Two months of mountaineering and rock climbing training before we left. Peak fitness — every one of them. Strong, motivated, and carrying the particular kind of quiet pride that soldiers carry when they've been selected for something difficult.
In previous years, patrols on this route had lost lives. Bad weather. Bad terrain. Bad luck. We knew that. It didn't stop us. If anything, it sharpened us.
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The night before we launched, I examined every man. One by one. Vitals, fitness, clearance. It was routine — the kind of medical that feels like a formality when everyone is visibly strong and ready.
Then I came to Sukhi Singh.
Everything was fine — except his blood pressure. Not alarming. Not disqualifying. 130 over 89. Slightly elevated, possibly stress, possibly nothing. I told him to relax that evening, sleep well, and we'd check again in the morning.
It was a reasonable clinical decision.
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What I didn't notice — what I failed to register entirely — was that his teammates were standing right there in the room.
I hadn't declared him unfit. But in that space, in front of his team, on the eve of a mission he had trained months for, something else had been heard.
You might not make it.
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Sukhi said nothing.
Not that evening. Not the next morning. Not at any point during what followed.
What he did instead — quietly, alone, without telling anyone — was find antihypertensive tablets and take them. Wrong dose. No medical supervision. His calculation was simple: bring the numbers down before the next check, get cleared, get on the patrol.
He wanted to go up with his team. No matter what.
Next morning his BP read 100 over 60. I was pleased. I told him he was fit. We moved out early and climbed to the first acclimatisation stage at around 9000 feet. We were scheduled to spend six days there — adjusting to the altitude, letting our bodies catch up with the terrain — before moving to the next stage.
The six days passed. The team was ready. The morning we were due to move higher — the nursing assistant came to find me.
Sukhi was unconscious.
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I rushed to him. Nothing I tried woke him. My mind ran through the possibilities — high altitude cerebral oedema was high on the list, but something didn't fit. The picture was wrong.
We didn't wait to work it out. The whole team turned around. Instead of going up — we went down. Urgently, through the same terrain we had spent months training to climb. We got him to the nearest ambulance post and he was evacuated to hospital.
We continued the patrol. Twenty days. Safe return.
But I carried Sukhi with me the entire way up and back.
When I got down I asked about him. The answer, when it came, reframed everything.
He had self-medicated with antihypertensives. The tablets had worked — too well. His blood pressure had dropped dangerously low. What I had read as fitness at 100 over 60 was actually the consequence of a drug he had taken in secret, in the dark, because he was terrified of being left behind.
His medication hadn't failed him.
The conversation had.
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Sukhi Singh was not reckless. He was not careless. He was a proud, motivated soldier who loved his country and his team and could not bear the thought of watching them leave without him.
The environment we were in — the mission, the hierarchy, the teammates standing in the room — made six honest words impossible to say.
I'm scared of being left behind.
Spoken to me, privately, the night before we launched — and everything that followed might have been different. I could have examined him away from his teammates. I could have given him the space to tell me what he was actually feeling. I could have built a moment where those six words were safe to say.
I didn't know to do that then.
I know now.
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I have spent twenty-seven years in operating theatres, military medicine, and hospital leadership thinking about the gap between what people know and what they say out loud.
Sukhi's story is not unusual. The setting was extreme — Tibet, high altitude, a military patrol. But the silence at the centre of it happens everywhere.
It happens in hospitals when a junior nurse sees something concerning and stays quiet because the consultant seems certain.
It happens in operating theatres when a resident makes a decision based on incomplete information because nobody updated him on where the surgery was.
It happens in team meetings when someone has a doubt and swallows it because the room feels too senior, too busy, too decided.
The silence that nearly killed Sukhi Singh is the same silence that causes medication errors, missed diagnoses, and preventable harm in healthcare settings every day.
Not because people don't care.
Because the environment made honesty too costly.
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Creating the space for the honest word — that is the work I am now committed to.
Not through grand policy or systemic reform, though those matter too. But through the small, deliberate acts of communication that signal to every person in a room: what you know matters here. Say it.
If this story resonates with you — if you have ever been Sukhi, or worked alongside someone who was — I write about this every week in my newsletter, Communication Under Pressure.
One clinical story. One communication pattern. One thing you can use.
It is free. It arrives every Wednesday.
YOU CAN SUBSCRIBE @
lastvoiceyouhear.com.
Sukhi made it home. And thirty-five years later, he is still teaching me.
If Sukhi's story made you think of your own team — take the 2-minute Communication Audit. Eight questions. Eight dimensions. You'll know exactly where the silence lives.
Check your Communication Profile →lastvoiceyouhear.com/audit/
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