As Medical Superintendent, much of my time went to the macro of the pandemic — oxygen logistics, district guidelines, drug protocols. But the true story of Sevagram’s survival was written in the micro of the wards, visible only through the fogged goggles of a nurse or a junior resident.

The Human Friction of the Red Zone

One of the earliest difficulties was unexpectedly simple: patients stayed on. Even recovered and asymptomatic, many were terrified to return to villages where they might be shunned, and the resulting “bed-blocking” exhausted a staff already stretched thin. Our own protocols added friction — any surgical patient who tested positive, however stable, was transferred to the Covid ward at midnight, disrupting care for no clinical gain. Dr Jwalant Waghmare, who stepped out of the Anatomy dissection hall to become nodal officer for nearly six months, made a pragmatic call: we stopped the midnight transfers and asked each surgical unit to earmark six beds for stable Covid-positive patients within their own wards.

Tension surfaced too, between nurses and newly inducted residents overwhelmed by workload and mortality. Waghmare’s counsel to the nursing staff was simple: remember, they are still learning to function under the weight of death. That empathy defused more conflict than any memo could.

Ms Bharti Kamble, who managed the Covid wards from April 2020 to August 2022, watched them grow from a ten-bed unit to two hundred and fifty beds. Her team trained everyone in the exact choreography of donning and doffing PPE, where one slip could mean carrying the virus home. She remembers young nurses crying quietly while taping their gloves before a shift. In Wardha’s heat, the non-breathable suits became saunas; nurses collapsed from dehydration, their goggles fogged, and even setting up an infusion pump became a monumental task.

Fear produced its own errors. Many faculty from preclinical departments, who hadn’t touched a ventilator in years, were suddenly managing ICUs. Benhur Premendran, our Professor of Anaesthesiology, had to demonstrate to terrified staff that a gown and mask, used correctly, were enough — that it was safe to touch the patient. And exhaustion produced its own mistakes: a resident, sleep-deprived past reason, once prescribed Dulcolax instead of Paracetamol for a staff nurse’s husband, a small error that said everything about how thin the margin had become.

We corrected course as we learned. We stopped repeat RT-PCRs before discharge once we saw they were unnecessary, freeing beds faster. We relaxed the one-relative rule, realising the psychological comfort of family was as important as any drug. What sustained the wards was not flawless protocol but patience, trust, and an unspoken understanding that while perfection was impossible, abandonment was not an option.

The Night of April 6

That understanding was tested most severely on 6 April 2021. Within twenty-four hours, at the peak of the second wave, we lost twenty-six patients. In normal times, a single ICU death stops the clock; that night the clock seemed to shatter. ICU doctors filled out death certificates until their hands cramped; nurses worked through the formalities that follow every death; each one set off its own chain — nurse to supervisor, supervisor to family, nodal officer to the district for a hearse.

The government’s March 2020 protocol for handling bodies was sterile and uncompromising: body bags, hypochlorite decontamination, families permitted to view only from a distance, the body never handed over, rites performed by hospital attendants at the crematorium. That evening, in 45°C heat, our attendants worked six-hour stretches in full PPE without a drop of water, carrying as many as six bodies at a time.

In that atmosphere of exhaustion, the error we most feared arrived. Word reached our nodal officer that a patient — call him Gajanan — had died, and, following protocol, we informed his son. “I spoke to my father just a minute ago,” the son shouted. “He is alive. Let me speak to him again.” He called his father’s mobile. It rang. The old man answered.

It emerged that a different patient, Ganpat, had died, and in the noise of monitor alarms and muffled speech through N95 masks, a supervisor had misheard the name. By the time we caught it, relatives had already travelled five kilometres to the cremation ground to find a body that was not their father’s. That same day, attendants unpacked four bodies from a hearse to find that none matched the families waiting there.

I instituted a new rule that night, tired as I was: no body would leave a ward until two independent supervisors had verified the patient’s identity, thumbprint, and destination — only then would the nodal officer be told. We apologised repeatedly; it took hours of listening for the anger to subside. We learned, at the cost of real families’ grief, that when compassion is stretched to its limit it must be anchored in stricter discipline still. There was no victory in fixing the process that night — only a fragile order restored, and the knowledge that dignity, in a plague, has to be defended mistake by mistake.