In early March 2020, Dr Ravi Dosi saw a baffling surge in patients with respiratory problems in his busy one-room clinic on the ground floor of his house in the city of Indore.

The forty-year-old chest specialist wondered what was going on.

“There was an almost 50 per cent rise in patients coming to me with upper respiratory infections and complaints of sore throat. Testing for the coronavirus was still low, and we still didn’t realise what was going on,” Dr Dosi, who works at the Sri Aurobindo Institute of Medical Sciences, a 2,000-bed private medical college and hospital in the city, told me in April.

On 30 January 2020, a student who had returned to Kerala on vacation from Wuhan in China had been the first confirmed case of the coronavirus in India. In early March, there were some forty-odd reported infections across India, and life was, by and large, normal.

By the end of March, however, the patients had begun streaming into Dr Dosi’s hospital. They complained of dry cough, fever, body ache and difficulty in breathing. Their blood oxygen levels were low. Many were reporting loss of taste and smell. Some were coming in from the city, and some from far-flung districts of the central Indian state of Madhya Pradesh, some even from more than 150 kilometres away.

Unbeknownst to most people, the novel coronavirus had begun its carnage of disease and death through India. In time, it would become a patchwork pandemic, waxing and waning in different states at different points in time.

In Delhi, the central government’s officials were denying that the infection was spreading in the community. It was a position they held for months on end, even as infections and deaths from the virus spiralled across the country.

In early March, Health Minister Harsh Vardhan told the people not to panic. “As a doctor, I would suggest to follow personal hygiene but I don’t think that people need to panic here and wear a mask all the time at every nook and corner, out of fear,” he told journalists. “It is completely up to them if they want to wear a mask or not.”

In a mere span of a fortnight – that felt much longer than an actual fortnight – life had changed drastically for the doctors and health workers at the hospital and around the world. Dr Dosi lived in a single room with an attached bathroom in the hospital for more than three weeks, away from his wife, two children and his ageing parents. He toiled for twenty hours a day, and slept for four hours at night.

At the family home, 18 kilometres away, his father, a retired pathologist, fretted and worried about his son’s unending hours in the Covid ward. They communicated via video calls, between frantic trips to the isolation wards and intensive care. His mother would send him home-cooked food and call every day, imploring her son to come home and get some rest. “She would ask: ‘Why are you always working when there are other doctors to look after the patients? Why don’t you come back and take a break?’”

As the pandemic engulfed the hospital, Covid was resulting in completely unpredictable outcomes for patients, and health workers were being driven to the breaking point of physical exhaustion and mental frustration. Doctors and nurses worked in scrubs for hours together: “Wearing protective gear feels like getting into a coffin every day,” a doctor told me. They shared mobile phone pictures of themselves slumped over tables like zombies during nightshifts.

It was not entirely surprising: after all, India’s creaky health system had been battling with shortages forever, thanks to chronic public underinvestment – India had one doctor for more than 1,500 people; and a nurse for 670 people. “Fatigue and resilience are endemic to India’s public health system, rather than the result of a new pandemic,” Dwaipayan Banerjee, a medical anthropologist at the Massachusetts Institute of Technology told me.

Any patient arriving in the emergency room with shortness of breath was immediately a “Covid suspect” when she could be actually suffering from heart disease, dengue, scrub typhus or even acid reflux. But since everyone was a suspect, doctors and nurses took precautions, swabbed every patient, triaged carefully, and moved suspected patients into a separate ward until their results arrived.

Forging trust with severely ill patients in critical care became difficult because of the lack of communication with the doctor or the nurse, leave alone the cloud of misinformation, fears and anxieties associated with the virus and the alienating experience of India’s healthcare system.

For over a year, Dr Dosi and I talked on the mobile phone at all hours. He spoke to me between shifts, while in quarantine, and almost always from the hospital. At the peak of the pandemic in summer, he would hardly catch a few hours of sleep when he was lucky. It hurt, he said, to see young patients struggling for breath and teetering on the edge.

“I have never seen a challenge and crisis like this in my career. I have heard stories about an outbreak of plague in Surat [in 1994]. But this seems to be much bigger. The biggest challenge is to keep hopes alive and be positive,” he told me one day. “It’s been unrelenting.”

One weekend, I sent him a text to find out what was going on. “Please. Have an emergency in ICU,” he replied.

Excerpted with permission from the essay “The Doctor Who Saw 23,000 Covid-19 Patients”, by Soutik Biswas, from the anthology The Dark Hour: India Under Lockdowns, Roli Books.