I changed my gown and gloves, checked my mask and goggles, and moved on to my next patient: a student who had been coughing and feeling fatigued for multiple days. They had been with a friend before getting sick, and that friend had since fallen ill with symptoms of COVID-19, including a fever. The patient was having trouble catching their breath, but their symptoms were not severe or acute—as confirmed by a chest X-ray and a test of their oxygen levels—so I recommended discharge and quarantine, and they understood.

My next patient was a young professional. For the past week they’d had a dry cough and chest pain. They had no underlying health conditions, and they’d tried to follow the current guidelines by staying at home (the right thing to do, given the overwhelmed state of hospitals like mine) but that evening their breathing had become so labored that they called an ambulance. When I saw them, however, they were breathing comfortably, their chest X-ray was clear, and their oxygen levels were safe. They were visibly upset when I told them they would not be admitted. They wanted to be tested. I explained why we couldn’t do that, and completed their discharge paperwork.

I collected myself and approached my next patient: a young person who’d been suffering with a fever, cough, and extreme fatigue for the past three days. Their boss didn’t believe they were sick, so they’d continued to complete long shifts working with customers at a local business. After examining the young patient, I determined that they were in the same category as the previous three I’d seen—sick, but not sick enough to be given a precious hospital bed or COVID-19 test—so I gave them fluids, Tylenol, and a note for their employer confirming that they were indeed ill, and needed to stay home.

Late in the night, another young patient came in with a high fever and no underlying health conditions. They’d had a dry cough for the past four days. They’d come to the hospital after finding they were unable to walk a few feet without getting severely short of breath. On their chest X-ray, I saw lungs that were almost completely whited out, indicating a significant amount of inflammation. It was clear how uncomfortable they were, and how desperately they were trying to catch their breath. They were in a different category from the previous patients I’d seen that night. They needed to be admitted. They needed testing. They needed close monitoring.

I called the Intensive Care Unit team, and they admitted the young patient to the hospital. I finished my shift not long after, walked home, and got in bed, feeling unsteady. When I woke up a few hours later, I logged into our electronic medical record system and learned that in the time I’d been asleep, my patient’s oxygen levels had dropped severely. A breathing tube had been placed down their throat. A ventilator was now keeping them alive.