If you have watched Stranger Things, you know the premise: A quiet town appears functional on the surface while a darker, parallel world creeps into everyday life, or the Upside Down. The true danger is not just the monsters but also the refusal of adults in power to believe what is directly in front of them. Modern health care is living in its own Upside Down.

The metric trap

In my practice, I became deeply focused on one of the most celebrated metrics in stroke care, the door-to-needle time. We tracked every minute. We benchmarked constantly. We celebrated as the times fell, from 50 minutes to well below 30 minutes. By every traditional measure and metric, the system was working. But one day, after yet another record-setting stroke case in the emergency department, my emergency physician colleague turned to me and said, “We’re faster, but it feels way harder than ever.”

She was not questioning clinical excellence. She was naming something the metric could not capture: The emotional toll of constant urgency, the stress of delivering life-altering news, calming terrified families, and immediately resetting for the next emergency. Our door-to-needle times told us how fast we treated strokes. They told us nothing about how the system was treating the people delivering the care. That was the exact moment I understood the gap between what we measure and what people live.

Systemic monsters

In Stranger Things, the Upside Down is not some distant universe; rather, it is connected to the real one. What happens there eventually breaks through. The same is true in health care. Beneath scorecards and policies exists a reality clinicians and patients live every day: burnout, moral injury, communication breakdowns, health inequities, and fragmentation. This is not a failure of caring; instead, it is a failure of recognition.

Health care’s monsters are not people. They are systemic forces. The Demogorgons of health care are the emergencies that arise: staffing shortages, supply chain breakdowns, and public health emergencies. But the real threat is the Mind Flayer, chronic dysfunction that grows when fear goes unchecked and pressure is never questioned. This includes misaligned incentives, compliance masquerading as quality, and even bureaucracy confused with safety. In these environments, good people are not corrupted; they are conditioned. Speaking up feels risky. Hanging on feels easier than fixing.

Moral courage

In the Upside Down, even good people act in ways they never intended. In health care, clinicians and leaders can cause harm, but not out of malice, instead through systems that prioritize speed over space, documentation over dialogue, and optics over outcomes. And like the children in Stranger Things, frontline clinicians often see the danger first. They speak plainly. They lean on trust and teamwork, not hierarchy. In some circumstances, they are labeled resistant or emotional, until the consequences become impossible to ignore.

Every system needs its own Eleven. In health care, that is moral courage, the willingness to name uncomfortable truths, challenge norms, and keep human experience in the conversation. But this courage comes with a cost. Those who show it are often exhausted or sidelined. Without it, no amount of operational excellence will hold the system together.

Leadership lessons

The lesson from Stranger Things is not about monsters but about leadership. Hawkins does not survive through denial or more rules. It perseveres when people listen to inconvenient voices, face uncomfortable truths, and step into the dark with those already living there. Health care does not need more scorecards or more slogans about wellness. It needs people willing to ask a harder question: What are we optimizing for, and what are we ignoring? Because in the end, the greatest threat is not the monster. It is the fear and pain we refuse to face.

Ganesh Asaithambi is a neurologist.