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Dr Rohan Aggarwal is 26 years old. He doesn't even complete his medical training until next year. And yet, at one of the best hospitals in India, he is the doctor who must decide who will live and who will die when patients come to him gasping for breath, their family members begging for mercy.
As India's healthcare system teeters on the verge of collapse during a brutal second wave of Covid-19 raging through the country, Dr Aggarwal makes those decisions during a 27-hour workday that includes a grim overnight shift in charge of the emergency room at his New Delhi hospital.
Everyone at Holy Family Hospital - patients, relatives and staff - knows there aren't enough beds, not enough oxygen or ventilators to keep everyone who arrives at the hospital's front gates alive.
"Who to be saved, who not to be saved should be decided by God," Dr Aggarwal said. "We are not made for that - we are just humans. But at this point in time, we are being made to do this."
India has reported a global record of more than 300,000 daily cases for the past two weeks - figures experts say are almost certainly conservative.
In New Delhi, fewer than 20 of more than 5,000 Covid-19 intensive care unit beds are free at any one time. Patients rush from hospital to hospital, dying on the street or at home, while oxygen trucks move under armed guard to facilities with perilously low stocks.
Dr Aggarwal has no problem doing his marathon shift, but fears he might get infected too. He also knows that his own hospital will be unlikely to find him a bed. He has not been vaccinated: He was sick in January when shots for medical professionals were being rolled out and then by February he began to relax. "We were all under the misconception the virus had gone," he said.
The young man works in an environment where patients and relatives crowd every available space, many wearing no protection except for a simple cloth mask. Doctors and nurses have stopped wearing full protective equipment too - it is simply too difficult to work in.
In normal circumstances, Holy Family is one of the best hospitals in the country, attracting patients from across the world. But it is in a desperate position now: It has a capacity for 275 adults, but is caring for 385.
Usually, the emergency room is manned by junior doctors, while senior consultants and specialists work in the ICU. But that system has long broken down.
The on-duty doctor in the emergency room is now one of the most critical in the hospital.
Dr Aggarwal, who is deputed to the emergency room, is responsible for 65 patients. That gives him a maximum of four minutes to see each one before any emergencies, which frequently occur.
He also has to manage thousands of patients and relatives who want access to intensive care. He sits behind a desk as relatives crowd around him, pleading for admission. He makes the decision-making process sound simple. "If a patient has a fever, and I know he's sick but he's not requiring oxygen, I can't admit him," he said. "That's the criteria.
"People are dying on the streets without oxygen. So, people who don't require oxygen, even if they are sick, we don't admit them usually."
That's one choice. "Another choice is I have an old male and I have a young guy. Both are requiring high-flow oxygen; I have only one bed in the ICU. And I can't be emotional at that time, that he is a father to someone. The young have to be saved."
By the time his morning rounds end after about three hours, Dr Aggarwal's eyes are already burning from tiredness. After his long shift, he has to drag himself home.
Dr Aggarwal, who was brought up in Delhi, wanted to be a doctor since he was six years old - a job that carries huge prestige in India.
He passed his first set of exams when he was 19 and began training at a medical college attached to a government hospital in the east of the capital.
But this wasn't what he expected when he moved to the missionary-founded Holy Family Hospital.
Reuters
"If a patient has a fever, and I know he's sick but he's not requiring oxygen, I can't admit him. That's the criteria." - Dr Rohan Aggarwal (above)
