The room should have been respectful, focused, and intentional. Instead, there were cheers. Two operating tables stood side by side. Two women lay open on them—awake under spinal anesthesia or hovering at the edge of it—while the people entrusted with their lives turned towards a camera, flashing victory signs. Someone laughed. Someone “won.” This was not a simulation. Not a rehearsal. Not a grotesque parody. This was a government hospital in Lahore.
And for a few seconds of viral footage, the illusion cracked. Because what the public saw in that moment was not just a lapse in judgment. It was the anatomy of a system so overstretched, so desensitized, that even the operating theater — the last ‘sacred space’ of medicine — had begun to resemble a stage. There is no ambiguity here. Turning a life-altering surgical procedure into a competition is a direct violation of the Hippocratic Oath and of basic patient dignity.
A woman on that table is not a benchmark, not a lap time, and not a spectacle. The decision to suspend those involved addresses this ethical collapse. It affirms what must remain non-negotiable: professionalism, empathy, and respect for the patient. But it answers only one question — who is to blame? It avoids the far more uncomfortable one — why was this even possible? The question we didn’t ask. Why were there two operating tables in the same room? Why were two major surgeries happening simultaneously, inches apart, in what should be one of the most controlled and sterile environments in medicine?
This is not an anomaly. It is routine. Lady Willingdon Hospital, one of the largest maternity facilities, reportedly serves a catchment population of nearly 15 million people. According to the World Bank, Pakistan has approximately 0.6 physicians per 1,000 people, whereas the WHO recommends a minimum of one per 1,000 just for primary care—let alone specialized surgical unit. In a facility like Lady Willingdon, surgeons may perform 80–100 C-sections in a single 24-hour cycle.
When the Lancet Commission on Global Surgery suggests that a ‘surgical volume’ should be balanced to ensure a perioperative mortality rate of less than one percent, these high-velocity ‘twin-table’ environments push that threshold to its breaking point.” Against this overwhelming demand stands a stark reality: limited functional operating theateres and an unrelenting influx of emergency Caesarean section. In such conditions, ‘twin-table’ surgeries are not innovation. They are desperation.
TWIN-TABLE TRAP
Even without the theatrics of “racing,” performing two surgeries in one room is a compromise. It compromises sterility, as movement between adjacent surgical fields increases the risk of contamination. It compromises privacy, reducing a deeply personal medical experience into a shared space. And most critically, it compromises attention—the single most important currency in surgery. The operating theater is designed for precision, for silence, for focus. Not for noise, distraction, or divided vigilance. Yet when the system is overwhelmed, these compromises become normalized. And when the abnormal becomes routine, it stops being questioned.
EFFICIENCY VS HASTE
There is a clinical argument for speed. Shorter surgeries reduce anesthesia-related complications, lower infection risk, and often improve recovery outcomes. Efficiency, when born of expertise and coordination, is beneficial. But what unfolded in that video was not efficiency. It was haste. And haste, unlike efficiency, is dangerous. When speed becomes the objective rather than the byproduct, critical safeguards begin to erode: Meticulous hemostasis may be overlooked, increasing the risk of postoperative hemorrhage. Tissue handling becomes rougher, leading to unnecessary trauma and delayed healing. Surgical counts—the final check ensuring no instruments or sponges are left behind—are more prone to error.
In surgery, a moment saved can sometimes cost a complication later. Studies in tertiary care hospitals (like those published in the Journal of the Pakistan Medical Association) often show SSI (surgical site infection) rates as high as 10% to 15%, compared to less than 2-3% in well-resourced global theaters. To understand how such behavior emerges, one must confront an uncomfortable truth: high-volume, under-resourced healthcare systems do not just strain infrastructure—they reshape human behavior. Doctors working 30+ hour shifts, facing relentless patient inflow and limited resources, often develop what is known as compassion fatigue. Patients begin to blur into numbers, and procedures become tasks to clear.
Survival—both the patient’s and the doctor’s—becomes transactional. In such an environment, what begins as coping can evolve into detachment. There is a concept in sociology: backstage versus frontstage behavior. In private spaces, ‘humor’ can serve as a psychological shield. But the operating theater is not backstage. It is the most vulnerable frontstage imaginable. When the patient becomes the punchline, the system has already failed. The victory signs in that viral video were not merely a lapse in etiquette; they were the clinical symptoms of a burgeoning depersonalization epidemic.
When surveys of residents in major teaching hospitals reveal that over 60% of postgraduate trainees suffer from severe burnout—a psychological state where patients are no longer seen as human beings but as inanimate objects or tasks to be cleared—the operating room ceases to be a sanctuary of healing. It becomes, instead, a high-velocity pressure cooker where empathy is the first resource to evaporate, leaving behind a system where the backstage ‘humor’ of exhausted doctors bleeds into the ‘frontstage’ of patient care with devastating consequences.
Just weeks later, another video surfaced—this time from Services Hospital in Lahore. An ENT surgeon was forced to halt a procedure mid-operation as the operating theater plunged into darkness. The generator had run out of fuel. In the same building, the VIP wing remained fully powered. This was not a shortage, but a localized decision. At Lady Willingdon, the patients were placed side by side because there was no space. At Services Hospital, a patient was left in the dark because resources were reserved elsewhere. Although Pakistan spends less than 1.2% of its GDP on health instead of recommended 6%, there exists a deeper, unsettling truth: the issue is not just scarcity. It is prioritization.
Dr Arshad Taqi, a former president of the PMC, noted that professionalism cannot survive in a vacuum. “When you create an environment of chaos and resource scarcity, ethical boundaries are the first things to erode.” The Services Hospital blackout exposes a system capable of functioning—just selectively so. There was fuel, there was power, and there was capacity. But it was allocated based on status. This creates a dangerous precedent. When administrations signal—implicitly or explicitly—that some lives are more “worth protecting” than others, that message trickles down.
Is it any surprise, then, that overworked trainees begin to mirror that hierarchy in their own behavior? If the system treats patients as expendable, the individuals within it may eventually do the same. As noted by Dr Sania Nishtar, former special assistant on health, that the elite capture of health system was the greatest barrier to universal health coverage. “We have a system that is designed to serve the few at the expense of the many.” The doctors in the Lady Willingdon video were held accountable. That is vertical accountability—punishing individuals. But where is the horizontal accountability?
Who answers for: The shortage of operating theaters? The normalization of ‘twin-table’ surgeries? The allocation of resources that prioritizes VIP comfort over operational safety? Punishing individuals without reforming systems does not solve a crisis. It simply resets the stage for the next incident. This is not a story about a viral video. It is about the architecture of apathy—a healthcare system stretched beyond capacity, structured around inequality, and sustained through silent compromises. It is about a system where: Surgeons are forced into assembly-line medicine. Patients are reduced to throughput. And dignity becomes collateral damage.
The solution cannot be singular. Yes, there must be disciplinary action for breaches of professionalism. Standards matter. But discipline without reform is cosmetic. What is needed is: Investment in infrastructure to eliminate the need for ‘twin-table’ surgeries. Resource transparency to ensure equitable allocation within hospitals. Workforce support to address burnout and compassion fatigue. Policy accountability that looks beyond optics and addresses operational realities. Because no amount of professionalism can compensate for a system designed to fail.
In 2023, the Global Health Security Index ranked Pakistan 130th out of 195 countries in terms of healthcare robustness. We are a country that can build luxury high-rises; a land that has won itself the place as a moderator for potentially the greatest escalations of the century, yet we ‘fail’ to keep the lights on for a child’s tonsillectomy. The ‘architecture of apathy’ is built on a foundation of 1.1% GDP spending—and until that number moves, the victory signs will keep flashing, even in the dark.
We suspended the doctors for their victory signs. But we have yet to suspend the system that keeps VIP lights on while a common patient’s surgery is left to the mercy of a mobile phone flashlight—and a crowded room with two operating tables. It’s trying to remodel a structure built on sand foundations; no matter how hard we try to reinforce the walls with concrete, collapse is fated… almost like a self-fulfilling prophecy. Until that changes, the next video is not a possibility. It is an inevitability.
