And then there were none.

“Hurry up.. bed number 22 is losing it. Oxygen saturation at 85%” , announced Sheila, our head nurse who had been doing eighteen hour shifts straight. As a brand new doctor, I was given the task of keeping an account of the ventilators, ensuring the right people were being prioritized to get them. I was also often permitted to do things that without Covid19 would have been impossible for a newbie to take on. This included diagnosing high risk patients, helping with intubation, double checking and signing prescriptions so that the senior doctors could keep the focus on tough decisions.

Typically oxygen saturation below 85% was enough to immediately get the mechanical ventilators to help the patient breathe. But considering we had only twelve ventilators and limited oxygen supply, I had to be prudent. In our remote town of Jamalpur there was no outlook for how many ventilators or oxygen supply we would be receiving and when. I had a detailed sheet listing several factors of every patient admitted such as age, pre-existing conditions, risk factor.

“Patients who have a higher chance of survival get prioritized.”, Dr.Yadav, the head of the hospital had told us during the staff meeting. “This means a fifteen year old, otherwise healthy patient, will be prioritized over a sixty year old diabetic patient“.

“This is crossing the moral boundary? What if there are two patients with the same age and health conditions?”, I had asked.

“Mamta, we are in a crisis. There are no federal guidelines.The discretion of the allocation of scarce medical resources is something that is practiced routinely in our country. We have to make judgement calls and move on. Let’s go , save lives”

It had been nine grueling weeks of trying to save fleeting lives. With face shields digging into my skin, dressed head to toe in protective clothing in the unbearable heat, lack of sleep, limited meals and stressful decisions, I felt like giving up. We had started with five Covid19 patients a day. Now they were up to thirty five. Eleven patients were intubated. There was only one ventilator remaining and barely enough oxygen. A shipment was on its way and would be here anytime.

I took a five minute break to call home and assure Ma that I was fine. Right when I was hanging up, I heard the sirens of the ambulance. A new patient, a woman in her early thirties, was being admitted with severe breathing issues. I quickly rushed to get all her details noted. On my way I felt slightly light-headed. “The fatigue is getting to me”, I told myself thinking I will ask for an hours’ break after I get the last ventilator signed off.

While I was doing the paperwork, I started feeling shortness of breath. I coughed to clear my throat. “Are you ok, Doctor?”, Sheila asked, rushing in with the vitals of the new patient. Before I could sign I felt the pen slip off my hand and fall with a clink on the ground. I felt my body melt down like a heap on the floor. I collapsed.

“Dr. Mamta Mishra — twenty five, no pre-existing conditions.”, I could hear faint discussions in the blurry background. “Mrs. Kaveri Sharma — thirty one. She has a husband and two small children. She was slightly obese but no notable health issues. We have to make a call quickly Dr. Yadav. One is a mom and one is a doctor”

“I have an opinion. Please save the mother”, I tried hard to speak those words aloud. No one could hear me. Or could they? I could make out the silhouette of Dr.Yadav. He was scribbling the name to assign the last ventilator.