In Old English the verb that became leave was lǣfan, and it did not mean to go away. It meant to let something remain: to allow a thing to stay as it was, to have something left over, to bequeath. The sense of departing appears only around 1200, by way of the idea of leaving something behind. For some eight centuries, then, the word has pointed in two directions at once. A person goes. Something stays. The dictionaries list the going as the newer meaning and the staying as the older one, and the longer I think about it, the more that order seems right.
I grew up in Amritsar and qualified in medicine there, at Sri Guru Ram Das Institute of Medical Sciences and Research, in 2002. In 2007 I began my first postgraduate year at the University of Arkansas for Medical Sciences in Little Rock. Those are the two fixed points the public record offers, and it does not join them. This essay will not join them either, and the reason, I have come to believe, is accuracy. Whatever a departure is, it is poorly described by the day on which it happened. An itinerary has a departure time. Attachment keeps no such schedule.
So I want to ask a narrower and, I think, more interesting question than the one an anecdote would answer. What does leaving actually end, and what does it leave in place? The single word binds together at least three different things. There are the logistics, which finish: a ticket is used, an address changes, an institution somewhere else expects a person to report for work. There is the ordinary competence of being a resident, which does not travel and has to be rebuilt. And there is attachment, which neither finishes nor travels in any simple sense, and which changes its character over the years in ways that nobody standing in a departure hall could predict. Most stories of migration fuse the three. I would like to pull them apart and see what each is made of.
Small Permissions #
Familiarity is made of small permissions. In the place where a person grows up, he knows without ever having been taught how to ask for something and how much preamble the asking requires; which part of a sentence can be left unsaid because the listener will finish it; when a shopkeeper’s silence is rudeness and when it is only arithmetic. He knows how close to stand in a queue, and whether there is a queue at all. He knows that in Punjabi the choice between ਤੁਸੀਂ, tusīṅ, and ਤੂੰ, tūṅ, the respectful and the intimate you, is a small social decision made dozens of times a day, and that a ਜੀ, jī, attached to a name or a reply can turn a bare fact into a courtesy. None of this feels like knowledge. It feels like the way things are. A dense old city such as Amritsar, where many lanes of the walled city are too narrow for a car and errands are run on foot among people who have seen you before, grants these permissions in great quantity and never mentions that it has done so.
This kind of knowing has an odd property: it is most complete where it is least articulate. Ask someone to explain how they know that a particular pause in a conversation means the matter is closed, and they will struggle. They know it the way a hand knows the weight of a familiar cup. The knowledge is real, it is used constantly, and it is almost entirely unavailable to inspection, which is why nobody thinks to list it among the things that will have to be replaced.
Leave, and the permissions stay behind. They have to be earned again, one at a time, in a place whose own permissions are just as unspoken. This is why departure is so often experienced as a strange loss of intelligence. A person who was competent last month finds that he cannot tell whether a remark was a joke, does not know which counter to approach, uses a word that is correct in the dictionary and slightly wrong in the room. Nothing in him has been damaged. The world has simply stopped finishing his sentences for him.
Medicine is an instructive case, because so much of it was designed to travel. A heart murmur is a heart murmur in any country. The anatomy of the hand does not change at a border, and the pharmacology of a drug is indifferent to the passport of the physician prescribing it. A medical education can be carried across the world with remarkably little loss, and that portability is one of the profession’s quiet achievements. But anyone who has practised in more than one place discovers that the clinical encounter is full of local knowledge which no textbook supplied. How much a patient will say before being asked. How disagreement is signalled when it is too polite to be spoken. Whether “I’m fine” is a report or a closing of the door. Which questions feel intrusive and which feel like care. The science travels; the permissions that let it be used gracefully have to be relearned in every new room.
I suspect that anyone who goes from a city of lanes to an American city laid out for cars discovers how much of his sense of belonging was made of being recognised by people who were not his friends. The shopkeeper, the man at the corner who knew which house was whose, the stranger who placed you by your surname. Such recognition is easy to dismiss as trivial because none of it is intimate. But a large share of a person’s daily dignity is supplied by it. The newer city is not unfriendly. It arranges its encounters differently, and a newcomer has to learn where, in that city, recognition now takes place: at work, in a congregation, among neighbours who wave from driveways, in the slow accumulation of being expected somewhere.
A Qissa Begins with Leaving #
Why do people go? Montaigne, asked why he travelled, gave an answer in his essay “Of Vanity” that has outlived most of his contemporaries’ books. He knew well, he said, what he was fleeing, but not what he was looking for. The sentence is usually admired for its candour. For a departure undertaken for training, I suspect it would often need to be turned around. A young physician who leaves to train elsewhere tends to know, or believes he knows, what he is looking for: a residency, a kind of medicine, a set of examinations passed and doors opened. What he does not know is what he is leaving, because the things he will miss are precisely the things he has never had to notice.
I am not going to give my own reasons here. Reasons offered years after a decision are always tidier than the reasons held at the time; memory edits motive with a confident hand, and the result reads like a plan. I would rather say what I believe about the category. Departures for training are rarely made for one reason. Opportunity is real, and so is curiosity, and so is the shape of what a given system offers at a given moment. There are obligations that pull toward going and others that pull toward staying, and a person can feel both without either being false. A story that reduces all of this to a single dream, or a single sacrifice, or a single pressure from outside, has chosen clarity over truth.
Punjabi literature’s most famous departure is instructive here, because it refuses that clarity from the start. In Waris Shah’s Heer, completed in 1766, the story proper does not open with Heer. It opens in Takht Hazara, on the Chenab, and its first great event is Ranjha’s leaving. Dhido Ranjha is the youngest son of a landholding family there, the favourite of his father. When the father dies, his brothers divide the land and leave him the worst of it, and their wives mock him, an idle young man with a flute, and grudge him even his food. He takes the flute and goes.
What I admire in the qissa is how mixed the departure is. It is an inheritance quarrel, a wounded pride, a meal refused, a vague direction toward a river and a name, and something that the poem will call love before it has any right to. Waris Shah does not make Takht Hazara a villain or a paradise. The brothers are grasping, the sisters-in-law are sharp, and the place is still home. Ranjha’s leaving is not presented as the correct decision, nor as a tragic one. It is presented as the event without which there would be no story, which is a different and more honest claim.
The poem is also funny about what happens next, and the comedy is the comedy of lost permissions. On his first night away from home Ranjha takes shelter in a village mosque, and its mullah, offended by this long-haired stranger with a flute, tries to turn him out; the two trade insults, and Waris Shah, who never misses a chance to puncture a cleric, gives the young man the better lines. It is a small episode and a precise one. The first institution the traveller meets in a new place does not know who he is and is not inclined to find out. At home he was the chief’s favourite son. Here he is a nuisance who has not learned the rules of the house.
Many departures are like that. Their meaning is not available on the day. It is assigned later, by what happened afterward, and it remains open to revision by what happens after that.
There is another detail of Ranjha’s leaving that I recognise from the medical version of the story. The son of a chief, the moment he crosses the river into someone else’s country, becomes a herdsman. In Jhang he takes work grazing the buffaloes of Heer’s father, and later, to reach her, he will have his ears pierced and become a jogi. Leaving resets his status, and the poem treats the reset neither as humiliation nor as triumph. It is simply the price of entry into another place’s order.
International medical graduates know a sober version of this. A physician who has qualified in one country commonly begins American training at the first postgraduate year, as an intern, whatever he has done before; my own record holds both a medical degree from Amritsar and an American intern year. I do not think that reset is a humiliation, though I understand why it is sometimes felt as one. It is a system declining to take another system’s word, and asking a newcomer to demonstrate, in its own idiom, what he already knows. That is frustrating, and it is also, in a profession where a stranger’s competence is a matter of public safety, not unreasonable. Ranjha with the buffaloes was learning the fields of a family he hoped to enter. An intern is doing something similar, with worse hours.
The Departed #
Language has a habit that I find revealing. In English, the departed are the dead. In Punjabi, as in Hindi and Urdu, a common and gentle way of saying that someone has died is to say that they have gone: ਤੁਰ ਗਏ, tur gae, they set off, they walked on. The vocabulary of leaving and the vocabulary of death share a border, and the traffic across it runs in both directions. A departure, in the oldest idiom of many languages, is a small death; a death is the last departure.
The shared vocabulary explains something about how emigration is felt, and also something about how it can go wrong. If leaving is a small death, then the one who leaves is a kind of ghost to the place he left, spoken of in the past tense, his room kept as it was. And the place becomes a ghost to him: preserved, finished, no longer capable of surprising him. Each side is tempted to mourn the other while both are alive. That is a sad arrangement, and it is a false one. Nobody died. Two sets of lives went on, at a distance, with telephones between them.
The most common leaving in Punjabi song is not an emigrant’s at all. It is a bride’s. The ਡੋਲੀ, ḍolī, the palanquin in which a bride was once carried from her parents’ house, and the ਵਿਦਾਈ, vidāī, the farewell, have produced some of the most tender songs in the language, songs in which a daughter takes leave of her father’s house and the house takes leave of her. Many of them are sad, and yet their sadness is not the sadness of a funeral. The daughter who leaves does not die. She goes elsewhere, and builds.
Punjabi kinship vocabulary also has a word for what such a departure leaves in place. A married woman’s parental home is her ਪੇਕੇ, peke. She no longer lives there, and the house is no longer arranged around her. She visits as something between a daughter and a guest, and the relationship has its own changed etiquette: certain things are now expected of her, certain things are no longer hers to decide. The peke does not stop being hers. It stops being hers in the old way.
I offer the comparison carefully, because in one respect it is uncomfortable. For most of history the bride’s departure was not chosen in any sense a modern reader would recognise, and the songs of the ḍolī carry that knowledge in their sorrow. A physician who leaves to train has a freedom that the girl in the palanquin did not. But the peke still seems to me a better model for the emigrant’s relationship with a first home than either of the models usually offered. It is not exile, a door shut. It is not a holiday, a door that swings both ways without consequence. It is a relationship that continues under new terms, in which the one who left must accept that the house has its own life and its own decisions, and in which belonging is real and no longer central.
There is a small joke buried in English that makes the same point from the other side. Blighty, the British soldier’s affectionate word for home, came into English from the Hindustani vilāyatī, foreign, from vilāyat, which in Punjabi as ਵਲੈਤ, valait, long meant abroad, and especially Britain. A word that meant the far country to one set of people became the word for the near one to another. Every pardes, every foreign land, is somebody’s des. The emigrant knows this in theory and forgets it in feeling. The place he went to is someone’s Takht Hazara. The place he left is still someone’s present tense.
The Aeroplane on the Roof #
Punjab knows a great deal about departure, and it has its own public ways of telling the story. In villages of the Doaba, the region between the Beas and the Sutlej, a little east of the Majha, rooftop water tanks have in recent decades been cast in concrete in the shapes of aeroplanes, ships and other emblems. The Tribune has tied the fashion to the region’s many emigrant families, and when the photographer Rajesh Vora published Everyday Monuments, the fruit of visits to some 150 villages, CNN’s report on the book described such sculptures as often commissioned by emigrants who come home for part of the year, or by the relatives who live there still. An aeroplane on a roof tells a success story. Someone went, and it worked.
I should be precise about my distance from it. My roots are in Khadur Sahib and I grew up in Amritsar, both in the Majha, the country between the Beas and the Ravi. The concrete aeroplanes belong to the Doaba’s story, not mine, and I have no standing to explain what they mean to the families who built them. What I can do is read them as a genre, the way one reads any public form.
I understand the impulse, and I respect it. A family’s pride is entitled to architecture. Money earned abroad, in a great many Punjabi households, has built rooms and paid for schooling and weddings, and there is no shame in saying so in concrete. The aeroplane is also, quite often, funny, and I think it knows it. It is hard to look at a jet parked on top of a farmhouse without smiling, and the smile is part of the message: we have done well enough to be playful about it.
But the story it tells has a small cast. It has room for the one who succeeded and for the people who are proud of him. It has less room for anyone whose departure did not work, whose years abroad were spent in kitchens and warehouses and the back seats of taxis without producing anything that could be set on a roof. It has no room at all for a feeling that complicates the plot, such as missing a place one does not regret having left. Public stories of success are not lies, but they are selections, and a selection repeated often enough begins to be mistaken for the whole. A young person looking up at the aeroplane learns that leaving is how one succeeds. He does not learn what it costs, or to whom, or that it sometimes does not work.
Statisticians have a name for the error, and by a coincidence I cannot resist, the story usually told to explain it is also about aeroplanes. During the Second World War the mathematician Abraham Wald, working with a statistical research group at Columbia University, was asked to think about where returning bombers should carry extra armour. The obvious answer was to reinforce the places where the returning aircraft were most often hit. Wald’s insight, as the story is generally told, was that the returning aircraft were the wrong evidence. They showed where a plane could be hit and still come home. The places where they bore no damage were the places where a hit was fatal, because those planes had not come back to be counted.
The concrete aeroplanes are the ones that came back. They record, faithfully, the departures that produced enough to build with. They cannot record the others, and nobody should blame them for that, any more than one blames a returning bomber for its holes. The error lies only in reading the visible sample as the whole. Medicine has to guard against the same mistake every day. The patients who return to a clinic are not a fair sample of the patients who were seen there; the ones who did badly elsewhere, or moved, or gave up, do not come back to report. A physician who judges his own practice by the people sitting in his waiting room is counting the aeroplanes on the roofs.
Punjabi has an older and sadder vocabulary for the other side of things: ਪਰਦੇਸ, pardes, the foreign land, and ਪਰਦੇਸੀ, pardesī, the one who lives in it, who in folk song is very often someone being missed. The rooftop and the song tell the same story from opposite ends, one as triumph and the other as absence. Neither is false. I distrust each of them on its own, because each has decided in advance what the departure meant.
Leaving Is Not Exile #
There are two ways to get the story of a chosen departure wrong, and they mirror each other. One glorifies it: the emigrant as hero, the destination as reward, the place left behind as a launch pad that has served its purpose. The other makes loss the price every migrant must confess, as though a departure were legitimate only if it were mourned, and gratitude for a new life were a kind of disloyalty. The first is the rooftop’s error and the second is the song’s. Both put a single feeling in charge.
The strongest reason for resisting the second error, in my own case, is that it borrows a grief that belongs to other people. Punjab has known departures that were not chosen at all. In 1947 the line drawn through the province turned millions of people into refugees within weeks, and the vocabulary of separation in Punjabi was deepened by that violence in ways that have lasted. Shiv Kumar Batalvi, who became the poet of birha, the ache of separation, was born in 1936 in a village that Partition placed on the other side of the border, and came as a child to the town whose name he carried. Such a departure is not a career decision. It is a wound inflicted on a person by history.
Faiz Ahmad Faiz, who spent years of his life in prison and in exile, wrote some of the finest poems in Urdu about being sent away. In one of them, which gave its title to his collection Mere Dil Mere Musafir, he addresses his own heart as his fellow traveller and tells it that the decree has been issued again: the two of them are to be watan-badar, put out of the homeland. The word is administrative and brutal, and he lets it sit in the poem like an official stamp on a page of verse. The exile does not choose the road. He is handed it.
A physician who leaves to train has no right to that word, and I think he does well to refuse it even in private. To call a chosen departure an exile is to take something from people who were actually exiled. It is also, in a quieter way, a failure of accuracy about oneself. The person who chose to go was not banished. He went toward something.
And yet the opposite simplification is just as false. A chosen departure is chosen within limits that were not chosen. Who can afford to sit examinations in another country, to travel for interviews, to spend years in training before earning a settled income, is shaped by money and family circumstance and luck as much as by merit. Opportunities to leave are distributed unequally, and so are the consequences of leaving. The physician’s freedom is real, and it rests on conditions that many people who would have liked the same freedom did not have. A truthful account holds both facts at once: this was a choice, and the choice was not equally available.
Salman Rushdie, in his essay “Imaginary Homelands,” first published in 1982, offered a different kind of correction, and it has stayed with me because it refuses to let loss have the last word. The word translation, he points out, comes from the Latin for bearing across. “Having been borne across the world, we are translated men.” It is usually assumed, he goes on, that something is always lost in translation; he clings, he says, to the notion that something can also be gained. I find that sentence more useful than any lament, not because it denies loss but because it insists on keeping the account open in both columns. A translated man is not a lesser copy of an original. He is a new text, with its own obligations to the old one.
Missing Without Regretting #
What I find most convincing is a departure that holds more than one feeling without demanding that they be reconciled. Going toward an opportunity need not diminish attachment to what is familiar, and missing a place need not invalidate the decision to leave it. Medicine gives some practice in this. A physician learns early that people can feel relief and grief about the same event, often in the same sentence, and that neither feeling is the true one hiding behind a false one. The daughter who has nursed a parent through a long illness may be relieved and devastated at once, and it would be a cruelty, and a clinical error, to treat her relief as evidence that her grief is insincere. Both are information.
A story in which ambition defeats sentiment, and the future arrives with every loose end tied, is tidier than most of the lives I have been privileged to hear about, my own included. So is the opposite story, in which every success abroad is shadowed by a secret regret that the emigrant must eventually confess. Some people regret leaving. Some do not. Many feel something more complicated than either, and they are entitled to have it recognised as complicated rather than translated into the nearest available cliché.
Attachment does change its shape over time. At first, I think, what a person misses from home is mostly ease: the permissions, the shortcuts, the language that needs no translating, the city that finishes his sentences. That kind of missing is practical, and it is cured, slowly, by competence. As ease is rebuilt somewhere else, a different attachment becomes visible, one that was there all along but hidden under the practical need. The place is no longer needed for getting through a day. It is no longer the ground of ordinary competence. What remains is something closer to fidelity: a wish to keep faith with a place one no longer depends on.
That later attachment is quieter and in some respects more demanding than the first. Practical homesickness asks for nothing except relief. Fidelity asks for work. It asks to know the city as it is now and not only as it was. It asks the emigrant to resist the particular temptation distance offers, which is to edit the place into an image that real life could never sustain, and then to love the image instead.
A Doctor in Norfolk #
W. G. Sebald’s The Emigrants, published in German in 1992 and in English four years later, is a book of four long portraits of people who left one country for another, and the first of them is a doctor. Henry Selwyn, retired, living on a large and neglected property in Norfolk, is an eccentric and courteous Englishman until, late in his acquaintance with the narrator, he reveals that he came to England as a child from a village in Lithuania, that his family had meant to go to America, and that for much of his life he had kept that origin out of sight. He was a successful emigrant by any administrative measure. He became a doctor; he became English. And in his old age, he confides, homesickness had come over him more and more.
The portrait ends with an image I have never been able to shake. Years after Selwyn’s death, the narrator reads in a newspaper that the remains of a Swiss mountain guide to whom Selwyn had been deeply attached as a young man, missing since the summer of 1914, have been released by a glacier more than seventy years later. Near the close of the section Sebald writes a sentence of quiet terror: “And so they are ever returning to us, the dead.”
I do not take from Sebald the lesson that the past lies in wait to ambush the emigrant, though it can be read that way. Selwyn’s story is darker than anything I would want to generalise, and its darkness belongs to its own history, to the century that made it. What I take is narrower. Selwyn’s departure was finished on paper decades before it was finished anywhere else, and the part of it that was never attended to did not go away. It went into the ice. A relationship with a first place that is not maintained does not dissolve. It freezes, and at some point it is likely to come down the mountain in a form one did not choose.
The alternative to the ice is to keep the relationship current: to let the place be a living place, about which one can be informed and corrected, rather than a buried one, which can only return as a ghost.
Leaving, it turns out, is also something a person learns to do more than once. In 2008 I left Little Rock for Fresno, where I completed residency, and Fresno has been home for many years now. Each move teaches the same lesson in a smaller size. A place does not stop mattering when the next one appears, and an address gradually acquires associations that no map could have supplied in advance. The newer place does not stay abstract for long once ordinary life begins in it. Its streets become routes, its seasons become expectations, its people become the ones by whom one is recognised. Training, language and habits of attention travel, but they do not arrive untouched, and they are used in a place that slowly begins to finish one’s sentences again.
Adaptation of that kind does not erase earlier belonging. It changes its job. The second place takes over the work of supplying daily ease, and the first is released from that work. Released, it can be seen more clearly. It can be valued for what it is rather than for what it does for me, which is perhaps the beginning of a more adult kind of love.
The Work of Remaining Connected #
A departure can be completed administratively while remaining unfinished in every other way. The ticket is used, the address changes, the new institution receives its new employee. None of those events decides how much the previous place will continue to matter, or on what terms. That is decided later, over years, by what the one who left chooses to do.
If affection depends entirely on a preserved picture, every change becomes a small betrayal. New buildings, unfamiliar habits, different ambitions among the people who stayed: each can appear to have damaged something the emigrant believed was being kept for him. But no agreement to keep it ever existed. The residents were living their own years, making their own decisions, quite properly indifferent to whether those decisions matched a picture carried somewhere in California. A city that changed in the emigrant’s absence did not break a promise. It never made one.
A more durable attachment allows the account to be corrected. It asks what has changed, what was misunderstood before leaving, and what matters now to those who remain. It reads, listens and asks questions instead of reciting memories. It accepts the role of the one in the peke: still a member, no longer the centre, welcome on terms that the household sets. This need not diminish gratitude for the place as it was experienced. It makes gratitude less possessive. A person can be grateful for a city without owning the version of it that formed him, in the same way that a patient can be grateful to a physician without requiring that physician never to change.
There is a clinical analogy that I find helpful here, though like most such analogies it should not be pushed too far. A good physician does not treat a returning patient from the notes of a visit five years ago. He reads the old notes, because they contain history that matters, and then he examines the person in front of him, who has lived five years since. An emigrant’s memory of his first city is an old note: indispensable, and out of date. The work of remaining connected is the work of taking a fresh history.
Leaving, then, becomes neither a final rejection nor a permanent claim on an earlier version of home. It becomes a change in the work required to remain connected. The logistics were finished long ago. The competence has been rebuilt, slowly, elsewhere. The attachment remains, and has turned out to be less a feeling than a practice, something one does rather than something one has.
A future can be chosen without making the past into a mistake, and a place can be loved without being required to stand still. Somewhere in the Doaba, on a flat roof under a white summer sky, a concrete aeroplane is standing still all the same. Whatever it announces to the street, its daily work is to hold water for whoever is still in the house. It has gone nowhere, and it was never meant to. It keeps the older meaning of the word.
Evidence and Editorial Note #
Documented findings. Public biography: family roots in Khadur Sahib; upbringing in Amritsar; MBBS at Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, 2002; PGY-1 at the University of Arkansas for Medical Sciences, Little Rock, 2007–2008; PGY-2 and PGY-3 with UCSF Fresno, 2008–2010; Fresno as home. The Old English origin of the verb leave (lǣfan, “to let remain”) and the emergence of the sense “depart” around 1200: Online Etymology Dictionary, “leave (v.)”. Concrete rooftop water tanks in the shapes of aeroplanes, ships and other figures in villages of Punjab’s Doaba region, and their association with emigrant families: The Tribune, “Doaba’s outlandish water tank art” (linked); Rajesh Vora’s Everyday Monuments and its documentation across some 150 villages, and the description of such sculptures as often commissioned by returning emigrants or their families, as reported by CNN in 2024. The Doaba (between the Beas and the Sutlej) and the Majha (between the Beas and the Ravi): standard geographic reference. Montaigne’s remark that he knew what he fled but not what he sought: “Of Vanity” (Essays, III.9), paraphrased. Waris Shah’s Heer (1766): Ranjha as the youngest son at Takht Hazara on the Chenab, the division of land after his father’s death, the taunts of his brothers’ wives, his departure with his flute, the quarrel with the mullah of the mosque where he spends his first night away, his work herding the buffaloes of Heer’s father and his later turn to the jogis: the poem as summarised in standard literary reference; no line is quoted. That international medical graduates commonly begin U.S. graduate medical training at the first postgraduate year: general knowledge of graduate medical education, stated as usual rather than universal. Abraham Wald’s wartime analysis of damage on returning bombers for the Statistical Research Group at Columbia University, the standard illustration of survivorship bias: standard history-of-statistics reference, presented as the story “as generally told.” Tur gae as a Punjabi idiom for death, the ḍolī and vidāī and their farewell songs (described in general terms, not quoted), and the kinship term peke: standard Punjabi usage and folk tradition. Blighty from Hindustani vilāyatī: standard English etymological reference. Shiv Kumar Batalvi’s birth in 1936 in a village that became part of Pakistan and his family’s move to Batala: standard biographical reference. Faiz Ahmad Faiz’s imprisonment and exile, his collection Mere Dil Mere Musafir and its title poem’s address to the heart and use of watan-badar: standard literary reference; described, not quoted. Rushdie’s “Imaginary Homelands” (London Review of Books, 1982), the quoted sentence and the paraphrased remark on gain in translation: the essay as collected in Imaginary Homelands (1991). W. G. Sebald, The Emigrants (German 1992; English 1996, tr. Michael Hulse), the portrait of Dr Henry Selwyn and its closing sentence: the book. facts not linked above rest on standard reference knowledge and were confined to well-established points. Vendor representations. None.
Recollection and tradition. The author’s places and dates of education and training are his published biography. No departure date, route, airport, companion, document, reason for leaving, family reaction or remembered scene is described or implied. The descriptions of Amritsar’s lanes, of Punjabi forms of address and of American cities laid out for cars are general description, not recollections of particular streets or people. The ḍolī songs and the peke are described as features of Punjabi tradition, not as universal practice or as the author’s family history. The daughter caring for a parent is a general illustration of mixed feelings, not a patient.
Analysis and forecast. The separation of departure into logistics, competence and attachment, the idea of familiarity as small permissions, the readings of Waris Shah, Faiz, Rushdie and Sebald, the application of survivorship bias to rooftop success stories and to clinic populations, the comparison of the emigrant’s first home with the peke, the view that a chosen departure should not borrow the language of exile, and the account of attachment as a practice that requires correction are the author’s present-day interpretation as of November 6, 2026. Independence. This essay is not sponsored by any institution, company, health system or technology developer.
About the Author #
Kanwar Partap Singh Gill, MD, traces his family roots to Khadur Sahib in Punjab’s Majha region and grew up in Amritsar. He attended Spring Dale School and completed pre-medical studies at Khalsa College in 1994–1996. He earned his MBBS from Sri Guru Ram Das Institute of Medical Sciences and Research in Amritsar in 2002.
He completed PGY-1 at the University of Arkansas for Medical Sciences in Little Rock in 2007–2008, and PGY-2 and PGY-3 with UCSF Fresno at Community Regional Medical Center from 2008 through 2010. He has practiced medicine in California since 2010.
His career has crossed four distinct information eras: predominantly paper-based medicine, early and fragmented electronic records, the integrated-EHR era, and the emerging age of generative and agentic artificial intelligence.