I wake before the alarm goes off to a glorious dawn chorus in London. Usually drowned out by the cacophony of humans, cars, and sirens, now a symphony of birdsong bursts through the window. My morning coffee has no smell or taste, the heat from the mug providing the only stimulus. I walk to the station through the park, where cherry trees are in bud, teasing that they will soon erupt in pink blossoms. A rusty flash in my peripheral vision leads to a stare-off with a fox, each of us surprised to see the other. Scenes from films of a postapocalyptic world come to mind as my footsteps echo through the deserted station. The gentle hum of the escalator transports me underground, and in the eeriness of an empty Tube carriage at rush hour, there is comfort in the familiar voice of the station announcements.

Through the main entrance of the hospital, the usual bustle of visitors and patients attending appointments is absent. I can hear none of the accustomed small talk between porters and patients being transported to scans. On the ward, I struggle to squeeze my hair under a surgical cap. Donning personal protective equipment (PPE) is like learning dance steps — gown, mask, face shield, gloves, more gloves. I feel like an astronaut as I step through the doors of the respiratory high-dependency unit, each step weighed down by the PPE and the anticipation of the day.

The resident presents the histories as we round. “The first patient is a 45-year-old man, no previous medical history. Lives with wife and three children. Fevers, dry cough, shortness of breath. Day 10 of Covid-19 symptoms.” Blood results show lymphopenia, chest radiograph shows bilateral infiltrates. He has been continuing his work as a taxi driver despite the lockdown. “No work, no money,” he explains through gasps. The patient is Somali and 6 feet 5 inches tall. His long legs stretch out, almost comically uncontained by the length of the bed. He clasps his mobile phone and I catch a glimpse of the home screen, a photograph of his young children smiling broadly. Respiratory rate, 60 breaths per minute. The alarm from the pulse oximeter bleeps continuously, signaling his extreme hypoxemia. As the anesthetic team rushes to intubate him, there is no breath left for him to ask the difficult questions to which we have no answers. “When will I wake up?” “Will I wake up?”

“The next patient is 68 years old, female, type 2 diabetes, on metformin. Lives with son, daughter-in-law, and grandchildren. Independent in activities of daily living and does the household cooking. Fevers, dry cough, shortness of breath. Day 8 of Covid-19 illness.” The patient has not changed into a hospital gown and wears a pink salwar kameez, the traditional long tunic and loose trouser suit of South Asia. The warm tones of the peach detailing of the salwar catch the light of the gold bangles that adorn her delicate wrists. She smiles despite her fever of 40°C and the tight face mask strapped to her head. We make adjustments to the pressures of the CPAP machine and the oxygen.

“52-year-old female, hypertension on ramipril. Works as a nurse in the dialysis unit. Day 11 of Covid-19 symptoms.” The chest x-ray is the worst I have seen, both lungs almost completely obliterated by infiltrates. I am surprised to see the patient sitting with calm composure in a chair and to hear a polite, muffled inquiry, “How are you, doc?” through her face mask. I place the probe on her finger, and 74% starkly appears. She puts her family on speakerphone, and I inform them that she is being transferred to intensive care. She speaks in Tagalog to her family, trying to reassure them, and interspersed I hear her teenage daughter speaking in English through tears, “I love you, Mama.” Her sister begs me, “Please doctor, please, please save her. Please promise me, doctor.”

“78-year-old man. History of myocardial infarction in 2012 and chronic kidney disease. Walks with a stick. Day 14 of Covid illness. Day 4 of CPAP. Worsening.” The patient’s turban is neatly tied. He has a long, white flowing beard and wears a kara — an iron bracelet, a symbol representing his faith. He is exhausted. His thin facial skin is bruised from the tight-fitting mask, and a pressure ulcer is slowly forming on his cheek, despite the regular adjustments made diligently by his nurse. After discussion with him and his family, we remove the CPAP mask and switch to a simple face mask. He asks for milky tea with two teaspoons of sugar. Later that afternoon, he closes his eyes and dies. A life filled with family and friendships, and at the end he is alone. The empty tea-stained polystyrene cup sits on the bedside table, its solace drained.

“55-year-old female. Diet-controlled type 2 diabetes. Works as a nurse in acute medicine. Day 8 of anosmia, fevers, and cough.” She looks so youthful, her eyes bright, her walnut-colored skin smooth. Her son lives in Ghana, her daughter is in the United States. “I am alone here,” she says, and tears overflow from her eyes. We try to fill the air with kind words, but they hang heavily, a meager attempt at consolation for the absence of family.

“47-year-old man with type 2 diabetes. Day 5 of cough and fevers. Admitted this morning. Oxygen saturations 95% on 4 liters of oxygen, and respiratory rate is 24.” The observations on the chart are the best I have seen today. My relief is displaced by the panic in his eyes. He has not been able to move his right arm for the past 30 minutes. His words tumble out like he is drunk. Imaging reveals the filling defect in the left internal carotid artery and the resulting infarct, the virus making his blood sticky and his endothelium inflamed. This virus is wicked and keeps taking.

The ward fills with gold warmth as the sun starts to set. The cardiac arrest alarm blares. The nurse has started chest compressions, and we go through the orchestrated ballet of resuscitation. Scissors quickly cut through the pink salwar, and the paddles are applied. Pulseless electrical activity due to hypoxemia. After we stop, the team stands dazed, stifled by PPE, stifled by not being able to console each other by a squeeze of the hand or a pat on the shoulder, stifled by watching this virus choke the breath from our patients.

I doff my PPE carefully and wash my hands. My face hurts, the tight mask that protects me marking my cheeks. The granddaughter is listed as the next of kin. I slowly dial the number and wait for an answer. I hear the background noise of family life, the volume on a television hastily turned down, the clang of a pot as dinner is prepared. I explain who I am and that I’m calling from the hospital. “Why are you calling? What’s happened? She’s OK, right?” I give the granddaughter the news and wait as this family’s world crumbles. The sounds of raw grief come through the receiver — crying, howling, guttural sobs. I am silent.

Morning news bulletins scream and shout the fears of the second wave. I inhale the steam from the cup and take a sip of tea, savoring the intricacy of cardamom and ginger. Autumn has erupted, and the leaves are changing to feuille morte and turmeric colors. A dark winter brings a tsunami of patients, countless individual desperate experiences accumulating in our collective grief. I dream of scissors cutting through the pink salwar.

I walk to the station through the park. Yellow heralds a hopeful reawakening with the drama of forsythia and daffodils trumpeting the arrival of spring. There has been a light rain in the early hours, and the earthy aroma of petrichor lies teasingly just below the surface. I can’t breathe deeply enough to fill my lungs with the scent.