Freshly graduated doctors are the lesser-known workhorses of the rural healthcare system in India. These rural clinicians confront numerous ethical dilemmas in their day-to-day life, which are quite different from the ethical issues they may have encountered during their medical training and internship at a tertiary care hospital. These include taking end of life decisions, breaking bad news, conflicts in the doctor-patient relationship, declaration of death, and counselling of patients or family attendants of terminally ill patients. Yet, the decisions they make during such challenging situations are often influenced by their undergraduate training and limited clinical exposure. This is a personal reflection on the ethical dilemmas that I faced as a young medical graduate, appointed as the resident medical officer of a rural hospital in Kerala, and how they influenced me in my early stages of clinical practice.