On June 12, 2025, Air India flight crashed minutes after takeoff from Ahmedabad in India. Among the 242 people on board, only one survived: a man seated in 11A.

That image has stayed with me—not just because of the miraculous survival, but because of what it reveals about systems. Seat 11A was located near the plane’s wing box, the structurally strongest part of the aircraft, and beside an emergency exit. Experts say this rare combination gave him a chance. Everyone else perished.

In that story, I saw not just an aviation tragedy, but a brutal metaphor for the health care system I live and work in every day.

Because sometimes, it feels like medicine is also mid-crash—and we’re all still inside.

We trust complex systems to carry people from danger to safety. Whether it’s an airplane or a hospital, we rely on structure, design, and coordination. But when those systems falter, when one part fails or pressure overwhelms capacity, the crash isn’t just possible—it’s inevitable.

In medicine, system crashes don’t make headlines. They happen quietly, in exam rooms, in emergency departments, in insurance denials, in missed diagnoses. They happen when a patient’s pain is dismissed, when care is delayed because someone lives too far or earns too little, or when a provider is too burned out to listen closely enough.

And like in the flight, only a few get out.

Seat 11A has become a haunting symbol for me. It represents the person who survives not just because of resilience or determination, but because they happened to be seated near the exit, in the structurally strongest place. In health care, who gets that seat? It’s often the patient with the best insurance, the one who lives near an academic medical center, or the one who knows how to navigate the system. It’s not luck—but it’s not fairness either.

Others, just as worthy, sit in the metaphorical back of the plane. They’re the ones who don’t get seen until it’s too late. The ones with barriers that never show up on the chart. And far too often, they don’t survive—not because we failed as individual providers, but because the system failed them long before we ever met them.

Even we as clinicians are passengers in this aircraft. We imagine ourselves as pilots, in control, but most of the time, we’re just strapped into the same structure, trying to keep others safe while turbulence shakes us from the inside. We are trained to absorb suffering, to function without rest, to care through exhaustion. But the truth is: Some of us are barely holding on. And still, we tell others it’s going to be OK.

I have written before about personal loss and professional burnout—about the weight of witnessing pain that never ends and about moments of meaning that barely hold us together. The flight brought those memories back. Because it made me wonder: Why are we still relying on miracles? Why should survival—whether from disease or despair—depend on being in the right seat?

We need to build a different kind of plane. One where every seat is reinforced. One where no one has to rely on being near the exit. One where the system is designed not just for outcomes, but for equity, for dignity, and for humanity.

The man in 11A survived. But the question that medicine must ask itself is this: Why didn’t everyone?

And what will it take to make sure next time, they do?

Vivek Podder is a physician in Bangladesh.