Akshay Raundhal, a 25-year-old queer man, completed his MBBS in 2019. Less than six months later, he was at the frontlines of India's coronavirus capital, Mumbai, battling the biggest pandemic of our times.
Before the pandemic hit, Raundhal worked at a small clinic for HIV positive patients in The Humsafar Trust. However, the work at the HIV clinic had slowed down during the lockdown as people couldn't get to the clinic, and instead of just waiting out the lockdown at home, he decided to be part of the battle. He volunteered as part of the doctors who responded to Maharasthra Chief Minister Uddhav Thackeray's call for 'Covid-Yudha' doctors. In the first week of April, Raundhal joined Jogeshwari Hospital in Jogeshwari West, Mumbai.
The first thing that Raundhal realized on his first day, was the sheer numbers he was up against. The patients kept coming in, the doctors were not enough.
According to NCBI data in India as of 2017, there are 1.34 doctors per 1,000 Indian citizens.
Raundhal saw this statistic unfolding when on some days during his three-month-long tenure, he was the only doctor assigned to a ward of 80 Covid-19 patients.
Added to his woes of being the only person in charge was the PPE. "Working in emergency wards isn't that hard," Raundhal tells News18 in an interview. "But working for 7 hours at a stretch in the same PPE, where not an inch of your skin is exposed, plus the Mumbai heat, the discomfort alone is a tough problem," he says.
It wasn't just 7 hours in the suffocating heat of Bombay in a PPE suit that took a toll physically -- it was also the constantly changing shifts.
"One day I'd be on the early morning shift, the next day I'd be on the mid-day, the third day, evening, the fourth day, at night. Every single day I had to wake up and go to sleep at a different time, my entire sleeping pattern, and whatever regularity came with it, was gone for a toss," says Raundhal.
Other than the fact that the process was physically draining, there was the mental exhaustion that too came with working in a ward where the balance between life and death was hanging by a minute thread.
"People think doctors only have to look after a patient's physical health. You also have to look after their mental health. They're alone in an isolation ward, away from their families, afraid, anxious, with nobody to talk to. You have to calm them down and tell them everything will be okay," he says.
So far, the Covid-19 virus still doesn't have a cure, and with Mumbai's mortality rate of 5.66%, doctors are prepared to see many deaths.
Raundhal was assigned to both the ward and in the ICU, and shared with News18 how the ICU part was the hardest.
"In the ICU, people would die alone. They would beg us, 'Bachalo mujhe, please,' and we'd feel helpless, because there's no cure, there's no one correct procedure to follow - we're doing whatever we can to our utmost ability, and it's still not enough," says Raundhal.
The entire process was mentally draining, something Raundhal says a lot of other young doctors are facing right now. "When you sign up for this profession, you know you will not be able to save all your patients, but the sheer scale of death is a lot more than in non-pandemic times. And for young doctors, who are just starting their jobs, to feel that feeling of helplessness is the most demotivating thing, ever," says Raundhal.
In the wards, the risk of dying is significantly low. In the ICU, it's the exact opposite. Patients already come in gasping for air, and the only thing doctors have are some specific medications which may or may not work, and oxygen. And sometimes, even oxygen doesn't cut it.
At present, India's hospitals are being run by young doctors, with older ones with higher risk factors assisting sometimes from a distance, or if in emergencies, directly.
He adds that the scariest thing for him initially was seeing healthy people who walked in succumb to the disease. "I would understand if someone who had co-morbidities and was old fighting a losing battle, but I would see people very close to my age, at 23, 27, with no other ailments pass away. That really shook me to my core," he said.
Raundhal has been with many patients who passed away from Covid-19 in their last moments. "There comes a time when there isn't enough oxygen supply in your brain, and patients go into delirium, where they would say violent things, lash out, make their last confessions, beg us to save them. I saw people in their final moments reaching out to hold someone's hand - and nobody was there. There were times when I held onto the outstretched hands, as someone who was there for them."
Raundhal left the hospital a week ago. His three-month contract was up and since he was pursuing a Master's degree, he couldn't sign another three-month extension. He went for a Covid-19 swab test and tested negative for the disease, following which he returned home.
While the physical exhaustion will slowly wear off, the mental pressure may take a while.
"It's still bad. I still get anxiety attacks. For three months I stayed in isolation, not knowing if I had the disease, only trying to save others, but I couldn't save everyone."
For Raundhal, who was often assigned to the wards alone, he got to take the call on who would be sent to the ICU. "I had to make the choice between three people who all looked like they desperately needed the single, available bed. Whoever I chose, it meant taking the risk that the other two may not survive."
In the three-month-long period, he understood there was only so much he could do. "Resources are limited. The scale of the virus is overwhelming. I had to keep convincing myself that I did the best I could with the facilities available, that I didn't have scope for things to be different," he says. "Doctors are not meant to play God, but in a crisis with limited facilities, sometimes who lives and who dies does depend on you," he adds.
In Raundhal's hospital, 5 doctors have so far tested positive for the virus.
"On my first day, I was very scared. I was terrified, but by the first month, I knew I could do this. I couldn't back out because this was a profession I chose." he says.
The battle at the forefront of the pandemic taught Raundhal a lot more in terms of medical experience than he would have ever learnt. "Every moment was like an emergency. But I learnt that I could manage an entire ward of 80 patients on my own, with just a nurse and a staff with me, something I never thought I'd ever be able to do before."
Raundhal's experience at the pandemic wasn't all dark, there were moments that made him see hope.
He recounts how there was a particular patient who would talk to him every day, and crack jokes and would generally try to keep the morale up. One day, he says, the patient crashed. He went into delirium and started attacking Raundhal, and then broke down and kept begging to see his kids. Raundhal's shift was over, and he was leaving, and he realized the state the patient was in, he may never see him again.
Three days later when Raundhal came back, the patient was gone. Raundhal's first thought was that the patient was dead. Sometime later, he saw the patient walk back in from dialysis. The patient smiled when he saw Raundhal, and that was enough motivation for him to go about the day.
"The entire day I went around with a smile plastered on my face thinking, 'He's still alive. He made it'," says Raundhal. The patient eventually recovered and was discharged.
This was just many of the small instances which made Raundhal realize that there was hope even in the seemingly dark war against an invisible virus.
Before the shadows of the Coronavirus pandemic crept in, Raundhal's job at the Humsafar Trust was that of a 'medical officer,' where he would screen and consult HIV-positive patients and help facilitate them for the next step of their treatment. Raundhal saw the job more than it was- as a way of helping the queer community with medical issues which often get side-lined.
This, he says, was his way of giving back to the LGBTQ+ community. The trust works with advocating the rights and health of LGBTQ people in India since 1994.
Fighting this pandemic, Raundhal says, isn't easy, but there's a mantra he's adapted to dealing with the circumstances. "Don't go thinking 'I can save everyone'. Just do your best, do your very best."